scholarly journals Areas of agreement in the management of childhood non-infectious chronic anterior uveitis in the UK

2019 ◽  
Vol 104 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Ameenat Lola Solebo ◽  
Jugnoo S Rahi ◽  
Andrew D Dick ◽  
Athimalaipet V Ramanan ◽  
Jane Ashworth ◽  
...  
Keyword(s):  
Anterior Uveitis ◽  
Severe Disease ◽  
Evidence Base ◽  
Future Research ◽  
Multiple Sources ◽  
Delphi Consensus ◽  
Modified Delphi ◽  
The Uk ◽  
High Level

Background/aimsThere is a paucity of high-level evidence to support the management of childhood uveitis, particularly for those children without juvenile idiopathic arthritis uveitis (JIA). We undertook a modified Delphi consensus exercise to identify agreement in the management of chronic anterior uveitis (CAU), the most common manifestation of childhood disease.MethodsA four-round, two-panel process was undertaken between June and December 2017. Paediatric uveitis specialists identified through multiple sources, including a multicentre network (the Paediatric Ocular Inflammation Group), were invited to participate. They were asked whether they agreed with items derived from existing guidelines on the management of JIA-U when extrapolated to the population of all children with CAU. Consensus was defined as agreement greater than or equal to 75% of respondents.Results26 of the 38 (68%) invited specialists participated with the exercise, and response rates were 100% for rounds one to three, and 92% for round four. Consensus was reached on 23 of the 44 items. Items for which consensus was not reached included management at presentation, use of systemic and periocular steroids for children with severe disease and the role of conventional steroid sparing immunosuppressants beyond methotrexate.ConclusionThe areas of management uncertainty at the level of the group, as indicated by absence of consensus, reflect the areas where the evidence base is particularly poor. Our findings identify the key areas for the future research needed to ensure better outcomes for this blinding childhood ocular inflammatory disorders.

scholarly journals The newly created Publicly Available Specification (PAS 141) for reusable electrical/electronic products

2014 ◽  
Vol 25 (8) ◽  
pp. 1135-1147 ◽  
Author(s):  
Joao Quariguasi-Frota-Neto ◽  
Andrew Reade ◽  
Azadeh Dindarian ◽  
Andrew Gibson
Keyword(s):  
Necessary Conditions ◽  
Future Research ◽  
Electronic Products ◽  
Content Type ◽  
Business Innovation ◽  
Scant Attention ◽  
The Uk ◽  
Comprehensive Framework ◽  
Future Work

Purpose – In 2011, a governmental initiative driven by the Department for Business Innovation and Skills invited the British Standards Institute (BSI) to write and publish a publicly available specification (PAS) for the reuse of waste electrical and electronic equipment entitled PAS 141. The specification's ambitious goals, chief among them to reduce the amount of e-waste generated in the UK, has prompted debate as to whether they are realistic and the extent to which they can be influenced by the certification. The purpose of this paper is to propose a comprehensive framework that can be used in future research to enhance understanding of the mechanisms by which the introduction of PAS 141 certification could lead to the fulfillment of its goals, that is, successful uptake. The authors believe this framework can serve as a roadmap for those interested in the investigation of this novel certification and its effect on the market for reusable electrical and electronic products. Design/methodology/approach – This paper is based on interviews with reuse organizations and first hand experience as a participant in the steering group that elaborated the certification being investigated, i.e. PAS 141. Findings – It is uncertain whether PAS 141 will fulfill its promises, which are, in the view of the authors, rather ambitious, e.g. reduce e-waste. Furthermore, more research is needed to examine the effect that the introduction of the certification has on the materialization of its goals, and on the complex inter-relationship that exist between the goals and what the authors define as intermediary necessary conditions. Research limitations/implications – This is the first attempt the outline the research needs that arise from the introduction of PAS-141, and the authors believe that there are other equally important questions that are yet to be presented and examined. Practical implications – This paper proposes 28 hypotheses which will help future work to empirically establish: the possibility of PAS-141 attaining its goals and the main necessary conditions for that to happen. This information is pivotal to determine whether the certification is working and to pinpoint opportunities for improvement. Social implications – This works contributes to the understanding of the role of certification on the market of reused products, which employs a large number of people, and in particular, whose coming from disadvantaged backgrounds. Originality/value – Although certification in general has been widely investigated in prior research, scant attention has been paid to certification in the context of electronic products. To the best of the knowledge, this is the first paper of its kind, as it is the first to examine certification in that context.

scholarly journals Healthcare utilization and costs in adults with SLE in the United Kingdom: a real-world observational retrospective cohort analysis

2021 ◽  
Author(s):  
Mihail Samnaliev ◽  
Volkan Barut ◽  
Sharada Weir ◽  
Julia Langham ◽  
Sue Langham ◽  
...  
Keyword(s):  
Disease Severity ◽  
Healthcare Costs ◽  
Severe Disease ◽  
Cohort Analysis ◽  
Practice Research ◽  
Future Research ◽  
First Year ◽  
Clinical Practice Research Datalink ◽  
Comorbid Conditions ◽  
The Uk

Abstract Objectives To describe direct healthcare costs for adults with systemic lupus erythematosus (SLE) in the UK over time and by disease severity and encounter type. Methods Patients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink—Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm based on prescriptions and comorbid conditions. We estimated all-cause healthcare costs and incremental costs associated with each year of follow-up compared with a baseline year adjusting for age, sex, disease severity, and comorbid conditions (2017 UK pounds). Results We identified 802 patients; 369 (46.0%) with mild, 345 (43.0%) moderate, and 88 (11.0%) severe disease. The mean all-cause cost increased in the 3 years before diagnosis, peaked in the first year after diagnosis and remained high. Adjusted total mean annual increase in costs per patient was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (p < 0.0001). The increase in costs per year were 4.7-fold and 1.6-fold higher among patients with severe SLE compared with those with mild and moderate SLE respectively. Primary care utilisation was the leading component of costs during the first year of diagnosis. Conclusion The healthcare costs for patients with SLE in the UK are substantial, remain high after diagnosis and increase with increasing severity. Future research should assess whether earlier diagnosis and treatment may reduce disease severity and associated high healthcare costs.

scholarly journals Algorithm for the Diagnosis and Treatment of Acute Biliary Pancreatitis

2005 ◽  
Vol 94 (2) ◽  
pp. 124-129 ◽  
Author(s):  
N. Alexakis ◽  
J. P. Neoptolemos
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Severe Disease ◽  
Developed Countries ◽  
Needle Aspiration ◽  
Evidence Base ◽  
Infected Necrosis ◽  
Mild Disease ◽  
Long Term Follow Up ◽  
Clinically Significant ◽  
High Level

Gallstones are the commonest cause of acute pancreatitis in developed countries. There is now a considerable evidence base consolidated by a series of systematic reviews, metaanalyses and guidelines that has established a clear algorithm for diagnosis and management. In the majority of patients the combination of ultrasonography and serum alanine transaminase <60 iu/l >48 hours of symptoms will identify gallstones as the cause. The simplest method of severity assessment is a high level of serum C-reactive protein (> 150 mg/l up to 72 hours after symptoms). In mild disease, all fit patients must undergo laparoscopic cholecystectomy with intraoperative cholangiography or if not fit for surgery then endoscopic sphincterotomy during the same admission to prevent further attacks. All patients with severe disease should undergo endoscopic sphincterotomy in less than 72 hours. Patients with >30% necrosis should undergo fine needle aspiration for bacteriology. Necrosectomy is indicated for infected necrosis or sterile necrosis if there are persisting clinically significant symptoms. There is increasing evidence for the use of minimally invasive pancreatic necrosectomy. Enteral nutrition should be instituted whenever possible but antibiotics should be reserved for patients with proven sepsis. The presence of fungal infection requires active anti-fungal therapy. Patients with severe disease should undergo cholecystectomy at a later stage. Patients who have undergone necrosectomy require long-term follow-up because of delayed complications.

Couple Interventions for Same-Sex Couples

2019 ◽  
pp. 97-114
Author(s):  
Christopher A. Pepping ◽  
W. Kim Halford ◽  
Anthony Lyons
Keyword(s):  
Minority Stress ◽  
Couple Therapy ◽  
Evidence Base ◽  
Future Research ◽  
Relationship Education ◽  
Heterosexual Couples ◽  
Same Sex ◽  
Same Sex Couples ◽  
Future Research Directions

This chapter reviews the emerging field of couple interventions for same-sex couples. It outlines the evidence base for couple relationship education and couple therapy based on research with heterosexual couples. It reviews data pertaining to relationship stability and relationship satisfaction of same-sex couples and also the similarities and differences in the predictors of relationship outcomes between heterosexual and same-sex couples. The differences suggest modifications are required, including addressing the role of external influences on couple functioning, the role of dyadic coping to buffer effects of minority stress, non-monogamous relationships, and managing disclosure of one’s relationship. Currently, there is modest uptake of couple services among same-sex couples, and this chapter offers suggestions to enhance the relevance and inclusivity of couple interventions. It concludes by proposing a number of future research directions, including examining the efficacy of couple interventions for same-sex couples and evaluating innovations to increase same-sex couples’ access to services.

scholarly journals Situating Continuing Professional Development in Life Long Learning in Qatar

2016 ◽  
Vol 11 (11) ◽  
pp. 81 ◽  
Author(s):  
Vishanth Weerakkody ◽  
Mohamad Osmani ◽  
Paul Waller ◽  
Nitham Hindi ◽  
Rajab Al-Esmail
Keyword(s):  
Professional Development ◽  
Continuing Professional Development ◽  
Developed Countries ◽  
The Past ◽  
Life Long Learning ◽  
The Us ◽  
Local Contexts ◽  
The Uk ◽  
High Level

<p>Continued professional development (CPD) has been at the centre of capacity building in most successful organisations in western countries over the past few decades. Specialised professions in fields such as Accounting, Finance and ICT, to name but a few, are continuously evolving, which is necessitating certain standards to be followed through registration and certification by a designated authority (e.g. ACCA). Whilst most developed countries such as the UK and the US have well established frameworks for CPD for these professions, several developing nations, including Qatar (the chosen context for this article) are only just beginning to adopt these frameworks into their local contexts. However, the unique socio-cultural settings in such countries require these frameworks to be appropriately modified before they are adopted within the respective national context. The purpose of this paper is to examine the role of CPD in Qatar through comparing the UK as a benchmark and drawing corresponding and contrasting observations to formulate a roadmap towards developing a high level framework.</p>

scholarly journals Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

2020 ◽  
Vol 29 (155) ◽  
pp. 190147 ◽  
Author(s):  
Franck F. Rahaghi ◽  
Nadera J. Sweiss ◽  
Lesley Ann Saketkoo ◽  
Mary Beth Scholand ◽  
Joseph B. Barney ◽  
...  
Keyword(s):  
Adverse Events ◽  
Delphi Study ◽  
Severe Disease ◽  
Pulmonary Sarcoidosis ◽  
Event Management ◽  
Delphi Consensus ◽  
Consensus Recommendations ◽  
Modified Delphi ◽  
Immunosuppressive Medications ◽  
Starting Dose

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines.We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale.Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe.In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis.

Chronic obstructive pulmonary disease

2017 ◽  
Author(s):  
Amina Jaffer ◽  
Anant Patel ◽  
John Hurst
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Phenotypic Variability ◽  
Evidence Base ◽  
Future Research ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Potential Benefits ◽  
Learning Points

This chapter discusses the case of a 70-year-old man with his first presentation of chronic obstructive pulmonary disease. This case is used as a basis to explore and describe the diagnosis, investigation, and management of this condition. The chapter includes the evidence base and relative guidelines that support current practice, as well as highlighting useful learning points and providing expert opinion. The role of lung volume reduction surgery is discussed, and its potential benefits in selected patients highlighted. Phenotypic variability within chronic obstructive pulmonary disease is increasingly recognized, and this is discussed, including the implications on current management and future research.

Folate bioavailability: UK Food Standards Agency workshop report

2003 ◽  
Vol 90 (2) ◽  
pp. 473-479 ◽  
Author(s):  
Peter Sanderson ◽  
Helene McNulty ◽  
Pierpaolo Mastroiacovo ◽  
Ian F. W. McDowell ◽  
Alida Melse-Boonstra ◽  
...  
Keyword(s):  
Folic Acid ◽  
Weighted Average ◽  
Relative Bioavailability ◽  
Evidence Base ◽  
Future Research ◽  
Workshop Report ◽  
Food Standards ◽  
Folate Bioavailability ◽  
The Uk ◽  
Review Current

The UK Food Standards Agency convened a group of expert scientists to review current research investigating folate bioavailability. The workshop aimed to overview current research and establish priorities for future research. Discrepancies were observed in the evidence base for folate bioavailability, especially with regard to the relative bioavailability of natural folates compared with folic acid. A substantial body of evidence shows folic acid to have superior bioavailability relative to food folates; however, the exact relative bioavailability still needs to be determined, and in particular with regard to mixed diets. The bioavailability of folate in a mixed diet is probably not a weighted average of that in the various foods consumed; thus the workshop considered that assessment of folate bioavailability of whole diets should be a high priority for future research.

“Take home” naloxone: what does the evidence base tell us?

2015 ◽  
Vol 15 (2) ◽  
pp. 67-75 ◽  
Author(s):  
Josefien J. F. Breedvelt ◽  
Derek K. Tracy ◽  
Emily C. Dickenson ◽  
Lucy V. Dean
Keyword(s):  
Evidence Base ◽  
Future Research ◽  
Opioid Overdose ◽  
Pilot Studies ◽  
Content Type ◽  
Practical Concern ◽  
Drug Overdoses ◽  
Associated Risk Factors ◽  
The Uk

Purpose – Opiod users are at high risk of suffering from drug overdoses. Naloxone has been used for decades in emergency treatment settings to reverse the symptoms of opioid overdose. Pilot studies and regional programmes have been rolled out to make naloxone more widely available. This review of user/carer administration of naloxone – so-called “take home naloxone” – aims to provide health professionals and interested readers with an up-to-date evidence base, clinical implications and practical concern considerations for such community management. The paper aims to discuss these issues. Design/methodology/approach – A review and analysis of the recent literature on naloxone. Findings – The evidence base suggests training and education is effective in preparing users for wider naloxone distribution. Furthermore, studies of varying quality indicate that naloxone may prove useful in reducing overdose-related deaths. However, even after implementation ineffective response techniques continued to be used at times and there remained a heistance to call medical services post overdose. Intranasal naloxone may reduce some of the risks associated with intramuscular naloxone. Ethical considerations, including provision of a needle and syringe kit to the community, should be considered. Studies suffered from a lack of follow-up data and methodological difficulties are associated with establishing opioid-related deaths post implementation. Two running trials in the UK might mitigate these concerns. Research limitations/implications – Future research is needed to address wider context of an overdose and targeting associated risk factors. Originality/value – Clinicians and other professionals will be informed on the most up-to-date evidence base and which areas are improtant to consider when take-home naloxone is introduced in their services.

Market Change, Distribution, and New Firm Formation and Growth: The Case of Real-Ale Breweries in the United Kingdom

1997 ◽  
Vol 29 (3) ◽  
pp. 405-417 ◽  
Author(s):  
C M Mason ◽  
K N McNally
Keyword(s):  
Small Business ◽  
Small Businesses ◽  
Future Research ◽  
Business Sector ◽  
Brewing Industry ◽  
Firm Formation ◽  
New Firm Formation ◽  
New Firm ◽  
The Uk

Many of the most influential accounts of the growth in the numbers of new businesses being started and the general increase in the economic significance of the small-business sector draw upon flexible specialisation theory, which explains such trends in terms of the breakup of the mass market for standardised goods and services and the consequent emergence of a variety of smaller niche markets capable of exploitation by new or small businesses. In this paper our purpose is to suggest that the opportunities for new firm formation and growth arising from such changes may be more circumscribed than have hitherto been acknowledged. Drawing upon evidence from the UK brewing industry, which has seen the creation of many hundreds of new breweries during the past twenty years, we highlight the role of distribution channels as a significant barrier to the growth of the small-business sector. Changes to the regulatory environment (the Beer Orders) in an attempt by government to improve the competitiveness of the UK brewing industry have, paradoxically, had the opposite effect to that intended, and so have failed to increase market opportunities for microbrewers. Future research must give greater attention to the role of distribution in order to achieve a better understanding of the changing structure and spatial organisation of production.

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