One year efficacy, safety and tolerability outcomes of endoscopic proximal intestinal exclusion therapy using the Endobarrier device: institution of the UK's first National Health Service Endobarrier service for type 2 diabetes and obesity

2017 ◽  
Author(s):  
Piya Sen Gupta ◽  
Mahender Yadagiri ◽  
Susan Irwin ◽  
Wyn Burbridge ◽  
Hardeep Gandhi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
One Year ◽  
Diabetes And Obesity

scholarly journals Could social prescribing contribute to type 2 diabetes prevention in people at high risk? Protocol for a realist, multilevel, mixed methods review and evaluation

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042303
Author(s):  
Sara Calderón Larrañaga ◽  
Megan Clinch ◽  
Trisha Greenhalgh ◽  
Sarah Finer
Keyword(s):  
Type 2 Diabetes ◽  
National Health Service ◽  
High Risk ◽  
Health Service ◽  
National Health ◽  
Stakeholder Group ◽  
Long Term Conditions ◽  
Social Prescribing

IntroductionSocial prescribing is an innovation being widely adopted within the UK National Health Service policy as a way of improving the management of people with long-term conditions, such as type 2 diabetes (T2D). It generally involves linking patients in primary care with non-medical community-based interventions. Despite widespread national support, evidence for the effectiveness of social prescribing is both insufficient and contested. In this study, we will investigate whether social prescribing can contribute to T2D prevention and, if so, when, how and in what circumstances it might best be introduced.Methods and analysisWe will draw on realist evaluation to investigate the complex interpersonal, organisational, social and policy contexts in which social prescribing relevant to T2D prevention is implemented. We will set up a stakeholder group to advise us throughout the study, which will be conducted over three interconnected stages. In stage 1, we will undertake a realist review to synthesise the current evidence base for social prescribing. In stage 2, we will investigate how social prescribing relevant to people at high risk of T2D ‘works’ in a multiethnic, socioeconomically diverse community and any interactions with existing T2D prevention services using qualitative, quantitative and realist methods. In stage 3 and building on previous stages, we will synthesise a ‘transferable framework’ that will guide implementation and evaluation of social prescribing relevant to T2D prevention at scale.Ethics and disseminationNational Health Service ethics approval has been granted (reference 20/LO/0713). This project will potentially inform the adaptation of social prescribing services to better meet the needs of people at high risk of T2D in socioeconomically deprived areas. Findings may also be transferable to other long-term conditions. Dissemination will be undertaken as a continuous process, supported by the stakeholder group. Tailored outputs will target the following audiences: (1) service providers and commissioners; (2) people at high risk of T2D and community stakeholders; and (3) policy and strategic decision makers.PROSPERO registration numberCRD42020196259.

scholarly journals The United Kingdom’s first NHS EndoBarrier service for long-standing poorly controlled type 2 diabetes and obesity: outcomes one year after EndoBarrier removal

2021 ◽  
Author(s):  
Robert E J Ryder ◽  
Mahi Yadagiri ◽  
Wyn Burbridge ◽  
Susan P Irwin ◽  
Hardeep Gandhi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Dose ◽  
Severe Depression ◽  
Sustained Improvement ◽  
White Ethnicity ◽  
Daily Insulin Dose ◽  
One Year ◽  
Diabetes And Obesity

Aims: EndoBarrier is a 60 cm duodenal–jejunal bypass liner endoscopically implanted for up to one year. It mimics the bypass part of Roux-en-Y bariatric surgery and reduces weight and HbA1c while it is in situ. We aimed to assess the extent to which these improvements are sustained in people with diabetes in the year following removal.Methods: Between October 2014 and November 2017 we implanted 62 EndoBarriers in an NHS service with all removed by November 2018. Outcomes were monitored in a registry.Results: By November 2019, 46/62 (72%) (mean±SD age 51.5±7.7 years, 52% male, 54.3% white ethnicity, median (IQR) diabetes duration 14.5 (8–20) years, 67.4% insulin-treated and mean±SD body mass index (BMI) 41.6±7.1 kg/m2) had attended and 16/62 (28%) did not attend their one-year post-EndoBarrier follow-up appointment. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 21.1±19.6 mmol/mol from 77.1±20.0 to 56.0±11.2 mmol/mol (p<0.001) (by 1.9±1.8% from 9.2±1.8% to 7.3±1.0% (p<0.001)), weight fell by 17.2±8.8 kg from 121.9±29.4 kg to 104.7±30.1 kg (p<0.001), BMI fell from 41.6±7.5 to 35.5±7.5 kg/m2 (p<0.001), systolic blood pressure from 139.0±14.0 to 126.0±14.6 mmHg (p<0.001) and serum alanine aminotransferase from 30.0±16.9 to 18.8±11.0 U/L (p<0.001). Median (IQR) total daily insulin dose reduced from 104 (54–162) to 30 (0–62) units (n=31, p<0.001); 10/31 (32%) insulin-treated people with diabetes were able to discontinue insulin. One year post-EndoBarrier, 18/46 (39%) demonstrated fully sustained improvement, 18/46 (39%) partially sustained improvement and 10/46 (22%) reverted to baseline. Of those deteriorating, 9/10 (90%) had depression and/or bereavement; they also had less fall in weight and HbA1c during EndoBarrier treatment. In the 16/62 (28%) who did not attend follow-up, reasons for non-attendance were too far to travel (25%), need to take time off work (6.3%), severe depression (6.3%) and death (6.3%). In 56.3% of cases no reason was given.Conclusion: Our data demonstrate that EndoBarrier is highly effective in people with long-standing poorly controlled type 2 diabetes and obesity, with maintenance of significant improvement one year after removal in 78% of cases for whom data were available. As an endoscopic procedure it is relatively simple and non-invasive and it deserves further investigation.

High Volume Acupuncture Clinic (Hvac) for Chronic Knee Pain – Audit of a Possible Model for Delivery of Acupuncture in the National Health Service

2008 ◽  
Vol 26 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Saul Berkovitz ◽  
Mike Cummings ◽  
Chris Perrin ◽  
Rieko Ito
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Knee Pain ◽  
National Health ◽  
Large Scale ◽  
High Volume ◽  
Clinical Results ◽  
Group Setting ◽  
Chronic Knee Pain ◽  
One Year

Recent research has established the efficacy, effectiveness and cost effectiveness of acupuncture for some forms of chronic musculoskeletal pain. However, there are practical problems with delivery which currently prevent its large scale implementation in the National Health Service. We have developed a delivery model at our hospital, a ‘high volume’ acupuncture clinic (HVAC) in which patients are treated in a group setting for single conditions using standardised or semi-standardised electroacupuncture protocols by practitioners with basic training. We discuss our experiences using this model for chronic knee pain and present an outcome audit for the first 77 patients, demonstrating satisfactory initial (eight week) clinical results. Longer term (one year) data are currently being collected and the model should next be tested in primary care to confirm its feasibility.

scholarly journals Spectacle and Secrecy: Press Coverage of Conjoined Twins in 1950s Britain

2005 ◽  
Vol 49 (2) ◽  
pp. 197-212 ◽  
Author(s):  
Kelly Loughlin
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Conjoined Twins ◽  
Press Coverage ◽  
College Hospital ◽  
News Reports ◽  
Hammersmith Hospital ◽  
One Year ◽  
Surgical Separation

In the early 1950s, when the National Health Service (NHS) was still in its infancy, the British public was gripped by news reports of two attempts at the surgical separation of conjoined twins. The first operation involved one-year-old twin girls from Kano, Nigeria. The twins were xiphopagus (joined at the lower sternum) and shared a liver, separation was attempted at London's Hammersmith Hospital in December 1953. One child survived. In February 1955 news broke of the birth of craniophagus twins (joined at the head) in Keighley, West Yorkshire. Separation of the month-old girls was attempted at London's University College Hospital, but neither child survived.

2047-P: UK First National Health Service (NHS) Endobarrier (EB) Service: Maintenance of Improvement One Year after Device Removal

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2047-P
Author(s):  
ROBERT E.J. RYDER ◽  
PIYA SEN GUPTA ◽  
MAHENDER YADAGIRI ◽  
SUSAN P. IRWIN ◽  
WYN BURBRIDGE ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Device Removal ◽  
One Year

scholarly journals Consultant psychiatrists' views on the supervision register

1998 ◽  
Vol 22 (7) ◽  
pp. 409-411 ◽  
Author(s):  
Francesco L. Lowe-Ponsford ◽  
Paul Wolfson ◽  
James Lindesay
Keyword(s):  
Mental Health ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Response Rate ◽  
Mentally Disordered ◽  
The Public ◽  
Mental Health Act ◽  
One Year ◽  
Do So

A questionnaire on attitudes to the supervision register, about one year after its introduction, was sent to all consultant psychiatrists identified as working in the National Health Service South Thames Region. A response rate of 72.3% was obtained. Half of the respondents felt that the supervision register was not likely to reduce the risk of violence to the public by mentally disordered people and a quarter was unsure. Just over half felt confident in predicting violence, and over half felt that they had been reasonably trained to do so. Most had not changed their practice in admitting or discharging patients, or in the use of the Mental Health Act. There were criticisms of the register, for example: lack of resources needed to implement it, increased paperwork, stigmatisation of patients and the lack of a formal appeal mechanism. Fifty per cent felt the register should be abolished, only 25.5% felt it should not be.

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