12,134 research outputs found
Beyond passive immunity: is there priming of the fetal immune system following vaccination in pregnancy and what are the potential clinical implications?
No full textInfection is responsible for over half a million neonatal deaths worldwide every year, and vaccination in pregnancy is becoming increasingly recognized as an important strategy for the protection of young infants. Increasing evidence suggests that exposure to maternal infection in utero may “prime” the developing immune system, even in the absence of infant infection. It is also possible that in utero priming may occur following maternal vaccination, with antigen-specific cellular immune responses detectable in utero and at birth. However, this remains a topic of some controversy. This review focuses on the evidence for in utero priming and the clinical implications for vaccination in pregnancy, considering whether in utero priming following vaccination could provide protection independent of antibody-mediated passive immunity, the possible effects of vaccination on subsequent infant vaccinations, their potential “non-specific” effects, and how the design and timing of vaccination might affect prenatal priming. Looking forward, we describe other possible options for quantifying antigen-specific cellular responses, including MHC tetramers, novel proliferation and cytokine-based assays, and animal models. Together, these may help us address future research questions and establish more robust evidence of fetal immune system priming
Interview with Nicholas Christopher, author of Somewhere in the Night: Film Noir and the American City
No full textInterview with Nicholas Christopher, author of Somewhere in the Night: Film Noir and the American Cit
Systematic review: the management of chronic diarrhoea due to bile acid malabsorption
No full textBackground: Bile acid malabsorption (BAM) is a common, yet under-recognised, cause of chronic diarrhoea, with limited guidance available on the appropriate management of patients with BAM.
Aim: To summarise the evidence supporting different treatments available for patients with bile acid malabsorption, noting their impact on clinical outcomes, tolerability and associated side effects.
Methods: A literature search was conducted through PubMed, the Cochrane Database of Systematic Reviews and Scopus. Relevant articles studied patients who had been diagnosed with BAM and were clinically assessed before and after therapy.
Results: A total of 30 relevant publications (1241 adult patients) were identified, which investigated the clinical response to drugs, including colestyramine, colestipol, colesevelam, aluminium hydroxide and obeticholic acid. The most commonly used diagnostic test of bile acid malabsorption was the SeHCAT test (24 studies). Colestyramine treatment was by far the most studied of these agents, and was successful in 70% of 801 patients (range: 63–100%).
Conclusions: Colestyramine and colestipol are generally effective treatments of gastrointestinal symptoms from BAM, but may be poorly tolerated and reduce the bioavailability of co-administered agents. Alternative therapies (including colesevelam and aluminium hydroxide) as well as dietary intervention may also have a role, and the promising results of the first proof-of-concept study of obeticholic acid suggest that its novel approach may have an exciting future in the treatment of this condition. Future trials should employ accurate diagnostic testing and be conducted over longer periods so that the long-term benefits and tolerability of these different approaches can be evaluated
Bilateral thoracoscopic splanchnotomy: A simple tool to alleviate pain in chronic pancreatic disease
No full textHow to do it:Chronic intractable pain is a common problem in severe pancreatic disease. Bilateral thoracoscopic splanchnotomy, a thoracoscopic neurotomy of the splanchnic nerves, is rarely performed but may provide significant pain relief in these patients. We present a safe strategy that uses prone positioning and two thoracoscopic ports for either hemithorax, permitting easy exposure and simple dissection of the greater and lesser splanchnic nerves. In our experience, this technique provides excellent pain relief with a minimal postoperative stay and few postoperative adverse events. This intervention has the potential to reduce dependency on opioid agents and improve quality of life in carefully selected patients
How Do We Know If Course Changes Are Effective? Student Survey Data Used to Inform Course Design
No full textBrooks, D. Christopher; Clarkson, C.E.; Marsh, Lauren; Wilcox, Kimerly. (2011). How Do We Know If Course Changes Are Effective? Student Survey Data Used to Inform Course Design. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/161433
Association between influenza vaccination and hospitalisation or all-cause mortality in people with COVID-19: a retrospective cohort study
No full textIntroduction Recent evidence suggests that influenza vaccination may offer protection against COVID-19 severity. Our aim was to quantify the association between influenza vaccination status and risk of hospitalisation or all-cause mortality in people diagnosed with COVID-19.
Methods A retrospective cohort study using routinely collected health records from patients registered to a General Practitioner (GP) practice in South West England within the Electronic Care and Health Information Analytics database. The cohort included 6921 people with COVID-19 during the first wave of the pandemic (1 January–31 July 2020). Data on influenza vaccination, hospitalisation and all-cause mortality were ascertained through linked clinical and demographic records. We applied propensity score methods (stabilised inverse probability of treatment weight) to quantify the association between influenza vaccination status and COVID-19 outcomes (hospitalisation or all-cause mortality).
Results 2613 (38%) participants received an influenza vaccination between 1 January 2019 and COVID-19 diagnosis. Receipt of influenza vaccination was associated with a significantly lower odds of hospitalisation or all-cause mortality (adjusted OR: 0.85, 95% CI 0.75 to 0.97, p=0.02), and 24% reduced odds of all-cause mortality (adjusted OR: 0.76, 95% CI 0.64 to 0.90).
Discussion Influenza vaccination was associated with a 15%–24% lower odds of severe COVID-19 outcomes. The current UK influenza vaccination programme needs urgent expansion as an integral component of the ongoing response plans to the COVID-19 pandemic
Current practice and attitudes towards vaccination during pregnancy: a survey of GPs across England
No full textBackground Antenatal vaccines are commonly delivered in primary care, yet the views of GPs regarding these programmes have been neglected in research to date.
Aim To establish the attitudes and current practice of GPs towards antenatal vaccination and their views on the optimal location for delivery of this service.
Design and setting A multicentre online survey questionnaire.
Method A questionnaire was sent to GPs across England between December 2018 and January 2019.
Results The majority of 1586 responders considered antenatal vaccination safe (96% for influenza, 89% pertussis). GPs were significantly less confident in their knowledge of pertussis compared with influenza vaccination (64% versus 80% were confident, P<0.001), and many desired further education (59% versus 48%, P<0.001). Few (37%) discussed vaccination with pregnant women regularly, but most (80%) felt their recommendation would influence decision making. Those with greater confidence in their knowledge of pertussis and influenza vaccination, and who were >2 years since qualifying, discussed vaccination significantly more often (odds ratio [OR] 3.52, P<0.001; OR 2.34, P = 0.001; OR 1.76, P = 0.003, respectively), regardless of whether they routinely saw pregnant women. Most (83%) reported that antenatal vaccination was GP led in their region, yet only 26% thought it should be primarily GP based. GPs expressed disconnect from antenatal care, and many suggested that midwives and/or secondary care should take greater responsibility for the delivery of antenatal vaccination.
Conclusion There is support among GPs to embed vaccination programmes within routine antenatal care. Further educational resources, specifically designed for the needs of GPs, are needed to facilitate opportunistic discussion with pregnant women about vaccination
Oral spironolactone for acne vulgaris in adult females: an update of the literature
No full textDear Editor,In 2016, the article Oral Spironolactone for Acne Vulgaris inAdult Females: A Hybrid Systematic Review, was publishedin your journal [1]. This article considered all available dataon spironolactone for acne in adult females, and concludedthat the quality of research was not of a high enough standard to guide prescribing recommendations. Spironolactonetherefore continues to be prescribed of license in the treatment of acne, based on case reports and expert opinionrather than robust evidence.An updated search of the literature, using the same searchstrategy as the original review, was performed on 5 February, 2020 to identify any new published data in the feld.Electronic searches were conducted on EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials,Cochrane Skin, Science Citation Index and LILACS databases. Trial databases searched included the meta Registerof Controlled Trials, US National Institutes of Health ongoing trials register, ANZCTR, World Health Organizationand the European Union’s clinical trials register. Finally, aGoogle hand search was performed using the search termsacne and spironolacton
Use of antibiotics for acute sore throat and tonsillitis in primary care
No full textAntibiotics are commonly prescribed for sore throat in primary care, yet are often of limited benefit.1 They are commonly associated with adverse effects, and contribute towards healthcare costs and antibiotic resistance at both the global and individual level.1 Prescribing antibiotics also reinforces patients’ belief in the need for antibiotics, and increases the chance of re-attendance in the future.2With a view to helping clinicians optimise antibiotic use, this article summarises evidence concerning the aetiology and natural history of sore throat, incidence of complications, and the use of clinical prediction tools, and compares the outcomes of different antibiotic prescription strategies (no, immediate, and delayed antibiotics), as well as patients’ views on these approaches
Matt Christopher Papers - Accession 1309
No full textThe collection includes letters written by the children’s book author, Matt Christopher, to his son, Marty Christopher. Many of the letters also contain newspaper articles of interest to Matt Christopher, which deal with local sports teams, his writing career, his participation in an exhibition baseball game against the New York Giants in 1938, and other of general interest. Most of the letters are personal in nature, however, a majority of the letters delve into Matt Christopher’s writing career, personal interests, the author’s health, as well as his family life.https://digitalcommons.winthrop.edu/manuscriptcollection_findingaids/2649/thumbnail.jp
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