10957 research outputs found
Sort by
Changes in practice of less-invasive surfactant administration (LISA) in United Kingdom neonatal units.
Get PDFAIM: To determine whether the use of less-invasive surfactant administration (LISA) had changed between 2018 and 2024. METHODS: An online questionnaire was sent to all 191 neonatal units between June 2023 and May 2024. One consultant from each neonatal unit was randomly selected. Follow-up was done by telephone (middle-grade doctor grade and above or alternatively to Advanced Neonatal Nurse Practitioners) for the non-responders. RESULTS: Response rate was 100%from 191 units neonatal units. LISA was used in 134 (70%) neonatal units in 2024 compared to 35 (18.7%) units in 2018 (p < 0.001). The reason why LISA was not performed was lack of experience/training (51%) or not having a standardised practice/guideline (49%). LISA in the delivery suite (DS) had increased from 2% in 2018 to 16% in 2024, and the use of video laryngoscope for LISA is becoming standard of practice. The oxygen requirement criteria for the use of LISA in both the DS and on neonatal unit had reduced to FiO2 of 0.3 or more. CONCLUSION: The uptake of LISA had increased in the United Kingdom. There is greater use of LISA in the DS. Lack of training and expertise were the major limiting factors for LISA not being performed
Current management of chronic kidney disease in type-2 diabetes-A tiered approach: An overview of the joint Association of British Clinical Diabetologists and UK Kidney association (ABCD-UKKA) guidelines.
Get PDFA growing and significant number of people with diabetes develop chronic kidney disease (CKD). Diabetes-related CKD is a leading cause of end-stage kidney disease (ESKD) and people with diabetes and CKD have high morbidity and mortality, predominantly related to cardiovascular disease (CVD). Despite advances in care over the recent decades, most people with CKD and type 2 diabetes are likely to die of CVD before developing ESKD. Hyperglycaemia and hypertension are modifiable risk factors to prevent onset and progression of CKD and related CVD. People with type 2 diabetes often have dyslipidaemia and CKD per se is an independent risk factor for CVD, therefore people with CKD and type 2 diabetes require intensive lipid lowering to reduce burden of CVD. Recent clinical trials of people with type 2 diabetes and CKD have demonstrated a reduction in composite kidney end point events (significant decline in kidney function, need for kidney replacement therapy and kidney death) with sodium-glucose co-transporter-2 (SGLT-2) inhibitors, non-steroidal mineralocorticoid receptor antagonist finerenone and glucagon-like peptide 1 receptor agonists. The Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) Diabetic Kidney Disease Clinical Speciality Group have previously undertaken a narrative review and critical appraisal of the available evidence to inform clinical practice guidelines for the management of hyperglycaemia, hyperlipidaemia and hypertension in adults with type 2 diabetes and CKD. This 2024 abbreviated updated guidance summarises the recommendations and the implications for clinical practice for healthcare professionals who treat people with diabetes and CKD in primary, community and secondary care settings
To predict the prognosis of adolescents with anorexia nervosa leaving inpatient treatment: the development and initial evaluation of a novel tool to be used by a multi-disciplinary team
Get PDFPurpose
This study aimed to develop and evaluate the Newbridge Prognosis Score (NPS), a prognostic questionnaire designed for use by a multidisciplinary team (MDT) when an anorexia nervosa (AN) patient is discharged from an inpatient treatment facility for eating disorders. The tool integrates the collective judgment of MDT members to predict short-term outcomes in adolescents with AN, focusing on physical, psychological, and behavioural factors and systematically assessing psychopathology, weight, and continued treatment needs. This information is intended to guide individualized community support, enhance post-discharge recovery, and aid in the allocation of limited community-based resources.
Methods
A group of adolescent girls and boys undergoing inpatient treatment for AN participated in the study. In addition, a matched control sub-sample was created. Upon discharge, the multidisciplinary team scored the Newbridge Prognosis Score (NPS), and follow-up data were collected 6 months later from the young person and/or their parents or carers.
Results
The NPS significantly correlates with key recovery items, such as weight maintenance, lower eating disorder psychopathology, subsequent need for readmission and engagement in follow-up. Higher NPS scores predict poorer outcomes, such as more severe psychopathology, lower weight or weight loss and higher readmission risk at follow-up. Psychological factors are strong predictors of post-discharge prognosis, with the suggestion that those sufferers may require enhanced psychological support. The NPS is more effective at predicting long-term readmission risk than short-term outcomes. However, the NPS explained only a proportion of the variance in these outcomes and sensitivity in predicting readmission within the matched control sample was mixed.
Conclusions
The NPS shows promise as a potential tool for predicting short-term outcomes following AN treatment. While promising, further refinement of the tool is needed, prior to being validated for use in clinical practice.
Level of evidence
Level III. Evidence obtained from a well-designed cohort or case-controlled analytic studies
Role of Mirikizumab in the Treatment of Inflammatory Bowel Disease-From Bench to Bedside
Get PDFMirikizumab is a monoclonal antibody directed against the p19 subunit of interleukin (IL)-23 to inhibit its interaction with the IL-23 receptor. IL-23 is a key cytokine involved in initiating and perpetuating the inflammatory cascade in inflammatory bowel disease (IBD). Mirikizumab is the first agent from the novel anti-IL-23p19 drug class to be licensed for ulcerative colitis and the first to present long-term endoscopic, histologic, symptomatic, and quality-of-life outcomes. More recently, the VIVID trial programme has led to the approval of mirikizumab in moderate to severe Crohn’s disease. This review explores the history of its development, discusses key immunopharmacological properties unique to the drug, and details the available clinical trials and real-world evidence supporting its use in IBD
Longitudinal associations of retinal vessel morphology with intraocular pressure and blood pressure at follow-up visit-Findings from a Danish eye and vision cohort, Project FOREVER.
Get PDFPURPOSE: To characterise the retinal vasculometry of a Danish eye and vision cohort and examine associations with systolic blood pressure (BP), diastolic BP, mean arterial BP, and intraocular pressure (IOP). DESIGN: Longitudinal study. METHODS: The retinal vasculature of fundus images from the FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) cohort was analysed using a fully automated image analysis program. Longitudinal associations of retinal vessel morphology at follow-up visit with IOP (baseline and follow-up) and BP (follow-up) were examined using multilevel linear regression models adjusting for age, sex and retinal vasculometry at baseline as fixed effects and person as random effect. Width measurements were additionally adjusted for the spherical equivalent. RESULTS: A total of 2089 subjects (62% female) with a mean age of 61 (standard deviation 8) years and a mean follow-up period of 4.1 years (SD 0.6 years) were included. The mean arteriolar diameter was approximately 20% thinner than the mean venular diameter, and venules were about 21%-23% less tortuous than arterioles. BP at follow-up was associated with decreased arteriolar diameter from baseline to follow-up. After adjusting for baseline IOP, IOP at follow-up was associated with increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08-1.10, p-value 0.024). CONCLUSION: In a Danish eye and vision cohort, variations in BP and alterations in IOP over time were associated with changes in the width and tortuosity of retinal vessels. Our findings contribute novel insights into retinal vascular alterations over time
Creating a home with a critically ill child: A qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care
Get PDFBackground
Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings.
Objective
The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the NNU and the PICU. This paper reports on one of the themes (creating a home) identified inductively from the dataset.
Methods
We used a qualitative research design using semistructured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated in an NNU before being admitted to the PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach.
Results
A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. ‘We identified ‘creating a home’ as a key inductive theme with three subthemes: (i) developing parental roles; (ii) creating a physical home; and (iii) creating core memories.
Conclusions
There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home, and to create memories together
Associations of social engagement, and loneliness with the progression and reversal of frailty: longitudinal investigations of two prospective cohorts from the UK and the USA.
Get PDFBACKGROUND: Social connections may impact the dynamic trajectory of frailty. METHODS: Using data from the British Regional Heart Study (BRHS) in the UK (n = 715), and the US Health, Aging and Body Composition (Health ABC) Study (n = 1256), we conducted multinominal regression analyses to examine the association of baseline and change in social engagement and loneliness with progression to pre-frailty and frailty, as well as their association with reversal to pre-frailty and robust status among older adults. RESULTS: A higher level of social engagement at baseline (BRHS: relative risk ratio (RRR) 0.69 [95%CI 0.55-0.85]; Health ABC: 0.56 [0.45-0.70]), as well as increase in social engagement (BRHS: 0.73, [0.59-0.90]; Health ABC: 0.51 [0.41-0.63]), were associated with a lower risk of developing frailty. In BRHS, a higher level of loneliness at baseline (1.42 [1.10-1.83]) and an increase in loneliness (1.50 [1.18-1.90]), increased the risk of developing frailty. For reversal of frailty, higher social engagement at baseline (Health ABC: 1.63 [1.08-2.47]) and an increase in social engagement (BRHS:1.74[1.18-2.50]; Health ABC: 1.79[1.17-.274]) were beneficial. CONCLUSION: Social connections maybe potentially important and modifiable factors in both preventing and reversing progression of frailty in older adults
Non-employment over the working life: Implications for cognitive function and decline in later life
Get PDFObjectives
Disuse theory predicts that cognitive function is vulnerable to transitions that remove factors that support cognitive skills. We sought to investigate whether non-employment over the working life was associated with cognitive function and decline in later life (≥60 years old), and possible gender differences in the association.
Study design
Longitudinal study.
Method
We used data from the MRC National Survey of Health and Development (NSHD). Cognitive function was measured by verbal memory and processing speed. Linear regression was used to test associations between non-employment duration and cognitive function at age 60–64, and conditional change models were used to examine associations between non-employment and cognitive decline from age 60–64 to 69. Gender specific models were adjusted for childhood factors and educational attainment, adult occupational features, and adult health and lifestyle indicators. Missing data was accounted for using multiple imputation by chained equations.
Results
In fully adjusted models >15 years non-employment was associated with lower cognitive function at age 60–64 in men (verbal memory: −0.72, 95%CI −1.18, −0.26; processing speed: −0.61, 95%CI -1.00, −0.28), but not women. Fully adjusted models also indicated that long-term and intermediate lengths of non-employment were associated with faster decline in verbal memory (−0.38, 95%CI -0.75, −0.02) and processing speed (−0.28, 95%CI -0.52, −0.03) in men. There was no association between non-employment and cognitive decline among women.
Conclusion
Long-term non-employment in men, but not women, is associated with accelerated cognitive ageing
Finerenone in the management of diabetes kidney disease.
Get PDFPeople with type 2 diabetes are at risk of developing progressive diabetic kidney disease (DKD) and end stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Slowing progression of kidney disease and reducing cardiovascular events can be achieved by a number of means including the targeting of blood pressure and the use of specific classes of drugs The use of Renin Angiotensin Aldosterone System (RAAS) blockade is effective in preventing or slowing progression of DKD and reducing cardiovascular events in people with type 2 diabetes, albeit differently according to the stage of DKD. However, emerging therapy such as non-steroidal selective mineralocorticoid antagonists (finerenone) is proven to lower blood pressure and further reduce the risk of progression of DKD and cardiovascular disease in people with type 2 diabetes. This consensus reviews current evidence and make recommendations for the use of finerenone in the management of diabetes kidney disease in the UK
Access Repository Dashboard
Do you manage St George's Online Research Archive? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!