Heart of England: HEFT Repository
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Causes and consequences of diagnostic delay in Guillain-Barré syndrome in a U.K. tertiary centre.
No full textINTRODUCTION/AIMS
Understanding the potential causes and consequences of diagnostic delay in Guillain-Barré syndrome (GBS) could improve quality of care and outcomes. We aimed to determine these.
METHODS
We retrospectively reviewed records of subjects with GBS, admitted to our centre at University Hospitals Birmingham, U.K., between January 2005 and December 2020. We evaluated time to diagnosis from presentation, factors associated with diagnostic delay and its potential consequences.
RESULTS
We included 119 consecutive subjects. Diagnostic delay >5 days from first presentation occurred in 27/119 (22.7%) of patients. Diagnostic delay was associated with age >60 years (OR: 3.58; 95% CI: 1.44-8.85), pre-existing cardiac/respiratory disease (OR: 4.10; 95% CI: 1.46-11.54), pre-existing diabetes (OR: 10.38; 95% CI: 2.47-43.69), documented normal initial neurological examination (OR: 2.49; 95% CI: 1.03-6.02), initial assessment by primary care (OR: 3.33; 95% CI: 1.22-9.10) and >1 visit for medical attention (OR: 10.29; 95% CI: 3.81-27.77). Diagnostic delay was not associated with length of in-patient stay, ICU admission, ventilation, ability to walk at discharge, or in-patient mortality. Independent associations with diagnostic delay were observed for >1 visit for medical attention (OR: 10.15; 95% CI: 3.64-28.32) and pre-existing cardiac/respiratory disease (OR: 3.98; 95% CI: 1.19-13.28). An association of diagnostic delay with in-patient mortality was ascertained specifically in subjects with classic GBS (OR: 5.33; 95% CI: 1.1-25.87).
DISCUSSION
Diagnostic delay in GBS results from patient-specific factors and patient pathways. A high index of suspicion is appropriate for certain patient groups. Prospective studies are needed to further investigate this topic. This article is protected by copyright. All rights reserved
Porphyromonas pasteri and Prevotella nanceiensis in the sputum microbiota are associated with increased decline in lung function in individuals with cystic fibrosis.
No full textAlthough anaerobic bacteria exist in abundance in cystic fibrosis (CF) airways, their role in disease progression is poorly understood. We hypothesized that the presence and relative abundance of the most prevalent, live, anaerobic bacteria in sputum of adults with CF were associated with adverse clinical outcomes. This is the first study to prospectively investigate viable anaerobic bacteria present in the sputum microbiota and their relationship with long-term outcomes in adults with CF. We performed 16S rRNA analysis using a viability quantitative PCR technique on sputum samples obtained from a prospective cohort of 70 adults with CF and collected clinical data over an 8 year follow-up period. We examined the associations of the ten most abundant obligate anaerobic bacteria present in the sputum with annual rate of FEV change. The presence of and were associated with a greater annual rate of FEV change; -52.3 ml yr (95 % CI-87.7;-16.9), -67.9 ml yr (95 % CI-115.6;-20.1), respectively. Similarly, the relative abundance of these live organisms were associated with a greater annual rate of FEV decline of -3.7 ml yr (95 % CI: -6.1 to -1.3, =0.003) and -5.3 ml yr (95 % CI: -8.7 to -1.9, =0.002) for each log increment of abundance, respectively. The presence and relative abundance of certain anaerobes in the sputum of adults with CF are associated with a greater rate of long-term lung function decline. The pathogenicity of anaerobic bacteria in the CF airways should be confirmed with further longitudinal prospective studies with a larger cohort of participants
EULAR points to consider for minimal reporting requirements in synovial tissue research in rheumatology.
No full textBACKGROUND
Synovial tissue research has become widely developed in several rheumatology centres, however, large discrepancies exist in the way synovial tissue is handled and, more specifically, how data pertaining to biopsy procedure, quality check and experimental results are reported in the literature. This heterogeneity hampers the progress of research in this rapidly expanding field. In that context, under the umbrella of European Alliance of Associations for Rheumatology, we aimed at proposing points to consider (PtC) for minimal reporting requirements in synovial tissue research.
METHODS
Twenty-five members from 10 countries across Europe and USA met virtually to define the key areas needing evaluation and formulating the research questions to inform a systematic literature review (SLR). The results were presented during a second virtual meeting where PtC were formulated and agreed.
RESULTS
Study design, biopsy procedures, tissue handling, tissue quality control and tissue outcomes (imaging, DNA/RNA analysis and disaggregation) were identified as important aspects for the quality of synovial tissue research. The SLR interrogated four databases, retrieved 7654 abstracts and included 26 manuscripts. Three OPs and nine PtC were formulated covering the following areas: description of biopsy procedure, overarching clinical design, patient characteristics, tissue handling and processing, quality control, histopathology, transcriptomic analyses and single-cell technologies.
CONCLUSIONS
These PtC provide guidance on how research involving synovial tissue should be reported to ensure a better evaluation of results by readers, reviewers and the broader scientific community. We anticipate that these PtC will enable the field to progress in a robust and transparent manner over the coming years
Exploring the lived experience of women with rosacea: visible difference and psychological impact.
No full textAdvanced Life Support Update.
No full textThis article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901
SARS-CoV-2-Specific T Cell Responses Are Not Associated with Protection against Reinfection in Hemodialysis Patients.
No full text
Covariate analysis query: Hospital surgical volume-outcome relationship in caesarean hysterectomy for placenta accreta spectrum.
No full textCompassionate End-of-Life Care in the Intensive Care Unit Involves Early Establishment of Treatment Goals.
No full textThe medical algorithmic audit.
No full textArtificial intelligence systems for health care, like any other medical device, have the potential to fail. However, specific qualities of artificial intelligence systems, such as the tendency to learn spurious correlates in training data, poor generalisability to new deployment settings, and a paucity of reliable explainability mechanisms, mean they can yield unpredictable errors that might be entirely missed without proactive investigation. We propose a medical algorithmic audit framework that guides the auditor through a process of considering potential algorithmic errors in the context of a clinical task, mapping the components that might contribute to the occurrence of errors, and anticipating their potential consequences. We suggest several approaches for testing algorithmic errors, including exploratory error analysis, subgroup testing, and adversarial testing, and provide examples from our own work and previous studies. The medical algorithmic audit is a tool that can be used to better understand the weaknesses of an artificial intelligence system and put in place mechanisms to mitigate their impact. We propose that safety monitoring and medical algorithmic auditing should be a joint responsibility between users and developers, and encourage the use of feedback mechanisms between these groups to promote learning and maintain safe deployment of artificial intelligence systems