1,720,980 research outputs found
P75 comparison between 4% formalin instillation and purastat application for radiation proctopathy
No full textIntroduction: Formalin therapy is an established method for the treatment of radiation proctopathy (RP). Emerging data suggests a potential role for Purastat application in the treatment of RP; however, no comparison to conventional treatment has been made to date. The aim of this study was to assess the safety and efficacy of Purastat for the treatment of RP compared to conventional treatment. Methods: consecutive patients with RP referred between January 2018 and December 2019 were treated with either conventional formalin or Purastat, based on endoscopist preference. Patients symptoms were scored with the subjective, objective management analysis (SOMA) scale, and the endoscopic severity of RP was graded by Zincola score. These measures were taken pre-treatment and prior to any subsequently planned treatments if clinically warranted, typically at 6-week intervals up to a maximum of 4 sessions. Results: of 17 patients (all male) referred for treatment, 11 patients underwent conventional Formalin instillation and 6 patients Purastat. Table 1 shows demographic and treatment outcomes. There was no statistical difference between the 2 groups in patient demographics, baseline symptom severity and Zincola score. Post-treatment protocol SOMA score reduction was significantly greater in the formalin group v Purastat group (8 to 1 v 8.2 to 4, p=0.01 respectively), and Zincola score reduction ( 4–2 v 4–3, p= 0.04 respectively). There was 1 case of mild anaphylaxis with facial flushing with Formalin, which settled with observation. [P75 Table 1 Demographic and treatment outcomes not included]. Conclusions: formalin instillation is still a cheap and effective treatment of RP. Although Purastat has a beneficial adverse event profile, its limited effect in this small cohort does not yet warrant widespread usage
A randomised controlled trial of structured nurse-led outpatient clinic follow-up for dyspeptic patients after direct access gastroscopy
No full textBackground: dyspepsia is a common disorder in the community, with many patients referred for diagnostic gastroscopy by their General Practitioner (GP). The National Institute of Clinical Excellence (NICE) recommends follow-up after investigation for cost effective management, including lifestyle advice and drug use. An alternative strategy may be the use of a gastro-intestinalnurse practitioner (GNP) instead of the GP. The objective of this study is to compare the effectiveness and costs of systematic GNP led follow-up to usual care by GPs in dyspeptic patientsfollowing gastroscopy.Results: direct access adult dyspeptic patients referred for gastroscopy; without serious pathology, were followed-up in a structured nurse-led outpatient clinic. Outcome measurementused to compare the two study cohorts (GNP versus GP) included Glasgow dyspepsia severity (Gladys) score, Health Status Short Form 12 (SF12), ulcer healing drug (UHD) use and costs. One hundred and seventy five patients were eligible after gastroscopy, 89 were randomised to GNP follow-up and 86 to GP follow-up. Follow-up at 6 months was 81/89 (91%) in the GNP arm and 79/86 (92%) in the GP arm. On an intention to treat analysis, adjusted mean differences (95%CI) at follow-up between Nurse and GP follow-up were: Gladys score 2.30 (1.4–3.2) p < 0.001, SF12140.6 (96.5–184.8) p =< 0.001 and UHD costs £39.60 (£24.20–£55.10) p =< 0.001, all in favour ofnurse follow-up.Conclusion: a standardised and structured follow-up by one gastrointestinal nurse practitioner was effective and may save drug costs in patients after gastroscopy. These findings need replicationin other centres
Optimising the performance of magnetic assisted capsule endoscopy (MACE) of the upper GI tract using multiplanar CT modelling
No full textActivity of the leukotriene pathway in Barrett’s metaplasia and oesophageal adenocarcinoma
No full textOBJECTIVE: Leukotriene (LT) B(4) is a lipid inflammatory mediator implicated in tumorigenesis in animal models of Barrett's oesophagitis, but little is known about the cysteinyl-leukotrienes (LTC(4), LTD(4), LTE(4)), which have distinct inflammatory and tumorigenic actions in other tissues. We recently showed that the terminal enzymes for the synthesis of both LT families are highly expressed in human oesophageal adenocarcinoma (OA) tissues. This study therefore examined the capacity of Barrett's metaplasia (BM) and OA tissues to synthesise LTs in vitro.SUBJECTS AND METHODS: Oesophageal biopsies from patients with BM (n = 14), high-grade dysplasia (n = 2), OA (n = 11), and squamous control tissues (n = 11) were cultured with calcium ionophore A32187 (2 ?M) for 60 min. LTB(4) and cysteinyl-leukotrienes were extracted and measured by specific enzyme immunoassays.RESULTS: Levels of LTB(4) and cysteinyl-leukotrienes were 8.6-fold (P < 0.01) and 2.4-fold (P < 0.02) higher, respectively, in OA tissues than in squamous control tissues, but levels in BM tissues (n = 14) were not altered. Production of the two LT families correlated across all tissue types (r = 0.62, p < 0.00005).CONCLUSIONS: Increased synthesis of LTB(4) and cysteinyl-leukotrienes has not previously been shown in human OA tissue and our results may indicate a role of these lipids in Barrett's disease progression
Optimising the performance of magnetic assisted capsule endoscopy (MACE) of the upper GI tract using multiplanar CT modelling
No full textA simulation to evaluate screening for Helicobacter pylori infection in the prevention of peptic ulcers and gastric cancers
No full textA discrete event simulation model has evaluated a screening programme for Helicobacter pylori infection (H. pylori) in which individuals under the age of 50 years would be screened once. Eradication of H. pylori would reduce the peptic ulcer risk immediately and the gastric cancer risk after a fixed delay. The data were derived from published databases and peer reviewed papers. The simulation model, using variance reduction techniques, predicted that a screening programme would reduce morbidity and deaths but could cost around £19 million for England and Wales in the first year of screening. A factorial design analysis showed the sensitivity of key variables. An increase in the opportunistic testing was found significantly to reduce the impact of screening
Improving outpatient services: the Southampton IBD virtual clinic
No full textThe follow-up of inflammatory bowel disease (IBD) patients is challenging due to the relapsing remitting nature of the diseases, the wide spectrum of severity and complexity as well as the need for monitoring of long-term complications and drug treatments. Conventional outpatient follow-up lacks flexibility for patients and there are competing pressures for clinic time. Alternative follow-up pathways include telephone clinics, self-management programmes or discharging patients. The IBD virtual clinic (VC) is a further option. Patients with an established diagnosis for >2 years, who have been stable for >1 year, do not have primary sclerosing cholangitis and who give their consent, are entered into the VC system. Two months before their annual follow-up is due patients are sent blood test forms and a simple questionnaire with an information sheet. If they meet any of the criteria on the questionnaire, they are asked to contact the IBD specialist nursing team to discuss their situation. The blood test results and the patient's database entry are reviewed to ensure that they are not due surveillance investigations. The patients and their GPs then receive a letter informing them of their management plan. We currently follow-up 20% of the Southampton IBD cohort using the VC. The VC system is an innovative, efficient and patient-responsive method for following up mild to moderate IBD. It is well liked by patients but is dependent on a well-maintained database with good integration of IT systems and requires both clerical and IBD nurse specialist suppor
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
- …
