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1. Students' participation in collaborative research should be recognised

Author

Aditya Borakati, Kenneth McLean, Thomas M. Drake, Ewen M. Harrison, Sivesh K. Kamarajah, Chetan Khatri, Dmitri Nepogodiev, Minaam Abbas, Muhammad Abdalkoddus, Areej Abdel-Fattah, Reem Abdelgalil, Haweya Abdikadir, Ryan Adams, Sarah Adams, Inioluwa Adelaja, Abiola Adeogun, Helena Adjei, Amirul Adlan, Hussamuddin Adwan, Sara Aeyad, Raiyyan Aftab, Amir Afzul, Vani Agarwal, Hosam Aglan, Medha Agrawal, Rishi Agrawal, Fiza Ahmed, Sobia Akhtar, Onyinye Akpenyi, Maithem Al-Attar, Muhammed Al-Ausi, Waleed Al-Khyatt, Alia Al-Mousawi, Zainab Al-Nasser, Anand Alagappan, Justin Alberts, Maryam Alfa-Wali, Abdulmajid Ali, Adnan Ali, Tamara Ali, Bilal Alkhaffaf, Rachael Allen, Kassem Alubaidi, Edemanwan Andah, Richard Anderson, Kirstine Andrew, Andrew Ang, Eshen Ang, Theophilus Anyomih, James Archer, Matt Archer, Steven Arnell, Matthew Arnold, Esha Arora, Nadeem Ashraf, Raees Ashraf, Jordan Ashwood, Usama Asif, Andrew Atayi, Sameera Auckburally, Ralph Austin, Sultana Azam, Aishah Azri Yahaya, Fiyin Babatunde, Simon Bach, Roudi Bachar, Abdul Badran, Caroline Baillie, Edward Balai, Alexander Baldwin, Vartan Balian, Danielle Banfield, Jonathan Bannard-Smith, Connor Barker, Behrad Barmayehvar, Jane Barnfield, David Bartlett, Richard Bartlett, Kwaku Baryeh, Siddharth Basetti, Kellie Bateman, Michael Bath, Andrew Beamish, William Beasley, Simon Beecroft, Ardit Begaj, Gurpreet Beghal, Jessica Belchos, Katarzyna Bera, Tara Bergara, Anna Betts, Aneel Bhangu, Gayathri Bhaskaran, Amina Bhatti, Mihai Bica, Caitlin Billyard, Emily Birkin, Jane Blazeby, Harry Blege, Natalie Blencowe, Christopher Blore, Alex Boddy, Matthew Boissaud-Cooke, Anita Bolina, William Bolton, David Bosanquet, Doug Bowley, Kathryn Boyce, Graham Branagan, Jessica Brayley, Joanna Brecher, Kristina Bresges, Emily Briggs, Ryan Broll, Damien Brown, Elliot Brown, Leo Brown, Robin Brown, Rory Brown, Connor Bruce, Pepa Bruce, Rory Buckle, Emily Budd, Richard Buka, Dermot Burke, Joshua Burke, Alisha Burman, Laura Burney, Amy Burrows, Mohammed Bux, Ronan Cahill, Clementina Calabria, Julian Camilleri-Brennan, Amy Campbell, Bill Campbell, Matthew Cant, Yun Cao, Sophie Carlson, Grace Carr, Luke Carr, Rebecca Carr, Richard Carr, Eleanor Cartwright, Alice Castle, Kirsty Cattle, Daniel Cave, Stephen Chapman, Alexandros Charalabopoulos, Sanjay Chaudhri, Ahmad Chaudhry, Paresh Chauhan, Priyesh Chauhan, Ryad Chebbout, Yunzi Chen, Louisa Chenciner, Jingjie Cheng, Natalie Cheng, Lin Chew, Zenab China, Abhishek Chitnis, Praminthra Chitsabesan, Paul Choi, Sarah Choi, Mariam Choudhry, Chern Choy, Claudia Ciurleo, Henry Claireaux, Peter Coe, Simon Cole, Katy Concannon, Edward Cope, Olivia Corbridge, Jessica Court, Louise Cox, Anna Craig-Mcquaide, Ben Cresswell, Lauren Crozier, Neil Cruickshank, Lucy Cuckow, Helen Cui, Elspeth Cumber, Sarah Cumming, Olivia Cundy, Melissa Cunha, Pedro Cunha, Laura Cunliffe, Jazleen Dada, Prita Daliya, Jeffrey Dalli, Ian Daniels, James Daniels, Ahmed Daoub, Sabeera Dar, Emma Das, Kaustuv Das, Emily Davies, Gareth Davies, Kirsty Davies, Kristen Davies, Rachel Davies, Victoria Dawe, Joshua Lucas de Carvalho, Katie De Jong, Katherine Deasy, Praveena Deekonda, Sahil Deepak, Henal Desai, Karishma Desai, Ryan Devlin, Nishat Dewan, Akashdeep Dhillon, Priya Dhillon, Tanya Dhir, Salomone Di Saverio, Julia Diamond, Peter Dib, Panagiotis A. Dimitriadis, Shiva Dindyal, Matthew Doe, Ciaran Doehrty, Tara Dogra, Arpan Doshi, Alison Downey, Joseph Doyle, Ashleigh Draper, Sarah Duff, Joseph Duncumb, Sophie Dupre, Justine Durno, Michal Dzieweczynski, Nicola Eardley, Sarah Easby, Sam Easdon, Hamdi Ebdewi, Lydon Eccles, Jacob Edwards, Padma Eedarapalli, Mohamed Elbuzidi, Patrick Elder, Lucy Elliott, Malaz Elsaddig, Ysabelle Embury-Young, Sophie Emesih, Alec Engledow, William English, Christos Episkopos, Jonathan Epstein, Rahim Esmail, Taher Fatayer, Nicolò Favero, Nicola Fearnhead, Maxine Feldman, Evelyn Fennelly, Stephen Fenwick, Lucie Ferguson, Stuart Fergusson, Petros Fessas, Isabel FitzGerald, J. Edward Fitzgerald, Harry Fitzpatrick, Daniel Fletcher, Tonia Forjoe, Beniamino Forte, Alex Fowler, Benjamin France, Abraham Francis, Niroshan Francis, Sunil Francis, Sam Freeman, Vicky Fretwell, Teresa Fung, Hugh Furness, Michael Gallagher, Stuart Gallagher, Chuanyu Gao, Lothaire Garard, Shona Gardner, Andrew Gaukroger, Daniel George, Simi George, Jamal Ghaddar, Ali Ghaffar, Shamira Ghouse, Amanda Gilbert, Ashveen Gill, Francesco Giovinazzo, Carey Girling, Lolade Giwa, James Glasbey, Paul Glen, Mary Goble, Jenna Godfrey, Shreya Goel, Wenn Goh, Kajal Gohil, Shyam Gokani, David Gold, David Golding, Andrea Gonzalez-Ciscar, Ross Goodson, Melissa Gough, Shubhangi Govil, Thomas Gower, Christopher Graham, Sam Gray, Patrick Green, Samuel Greenhalgh, Kyriacos Gregoriou, Rhiannon Gribbell, Mary Catherine Gribbon, Charlotte Grieco, Emma Griffiths, Ewen Griffiths, Nathan Griffiths, Sara Griffiths, Cathleen Grossart, Daniel Guerero, Christianne Guillotte, Rishi Gupta, Claire Guy, Adam Gwozdz, James Haddow, Shazia Hafiz, Constantine Halkias, Elisabeth Hall, Hasseb Hamid, Emma Hamilton, Gurvinder Singh Harbhajan Singh, John Hardman, Rhiannon Harries, Rhydian Harris, Suzanne Harrogate, Megan Harty, Jessica Harvey, Rahima Hashemi, Ahmed Hassane, Helen Hawkins, Thomas Hawthorne, John Hayes, Phoebe Hazenberg, Harry Heath, Madhusoodhana Hebbar, R. Heer, Roisin Hegarty O'Dowd, David Henshall, Philip Herrod, Elizabeth Hester, Emily Heywood, Nick Heywood, Frances Hill, James Hill, Kirsty Hill, May Ho, Marianne Hollyman, David Holroyd, Joseph Home, Steve Hornby, Laura Horne, Charlotte Horseman, Huma Hosamuddin, Amy Hough, George Hourston, Nathan Hudson-Peacock, Belinda Hughes, Katie Hughes, Isabel Huppatz, Penelope Hurst, Mahrukh Hussain, Shoaib Fahad Hussain, Syeda Hussain, Imogen Hutchings, Bilal Ibrahim, Lema Imam, Rory Ingham, Rose Ingleton, Rizwan Iqbal, Jenny Isherwood, Abdurrahman Islim, Omar Ismail, Shashank Iyer, Toby Jackman, Prashant Jain, Nadeem Jamal, Sabine Jamal, Ellen James, Nirmitha Jayaratne, Nathan Jeffreys, Hiral Jhala, Courtney Johnson, Zoe Johnston, Conor Jones, Emma-Jane Jones, Keaton Jones, Victor Jones, Roshan Joseph, Dilan Joshi, Holly Joyce, Claire Joyner, Aditya Kale, Sagar Kanabar, Lina Kanapeckaite, Hadyn Kankam, Sarantos Kaptanis, Edward Karam, Dimitrios Karponis, Anne Karunatilleke, Veeru Kasivisvanathan, Geeta Kaur, Samina Kauser, Nigel Keelty, Denise Kelly, Jessica Kennett, Molly Kerr, Ahmed Kerwan, Apoorva Khajuria, Mostafa Khalil, Mehnoor Khaliq, Ayushah Khan, Hamzah Khan, Haroon Khan, Maaz Khan, Maria Khan, Shahab Khan, Kaywaan Khan, Rachel Khaw, Ashni Kheterpal, Parisa Khonsari, Miraen Kiandee, Samuel Kim, Suji Kim, Sung-Hee Kim, Harry King, Anna Kinsella, Ajit Kishore, Stefan Klimach, Angelos G. Kolias, Anna Kolodziejczyk, Chia Yew Kong, Tseun Han James Kong, Omar Kouli, Sebi Kukran, Sevi Kukran, Geev Kumaran, Vladislav Kutuzov, Chris Laing, Georgina Laing, Kulvinder Lal, Peter Lalor, Joel Lambert, Sai Geethan Lambotharan, Eve Lancaster, Jasmine Latter, Michelle Latter, Kenny Lau, Alexa Lazarou, Madeline Leadon, Gabriel Lee, Jeyoung Lee, Kathryn Lee, Matthew Lee, Samuel Lee, Zong Lee, Edward Leung, Thomas Lewis, Hansen Li, Mimi Li, Wan Jane Liew, Yao Ren Liew, Alexander Light, Lydia Lilis, Diana Lim, Hui Lim, Joseph Lim, Zhi Lim, Siyin Liu, James Lloyd, Andrew Logan, Priya Loganathan, M. Long, Lydia Longstaff, Luisa Lopez Rojas, Richard Lovegrove, Jack Lowe-Zinola, Byron Lu Morrell, Joshua Luck, Andreas Luhmann, Surabhika Lunawat, Jon Lund, Cong Luo, Lorna Luo, Iona Lyell, Panagis Lykoudis, Jonathan Macdonald, Aliya Mackenzie, Conor Magee, Pooja Mahankali-Rao, Kamal Mahawar, Mehreen Mahfooz, Faisal Mahmood, Samir Makwana, Tom Malik, Sohaib Mallick, Jyothis Manalayil, Tinaye Mandishona, Sudhakar Mangam, Maniragav Manimaran, Natarajan Manimaran, Chris Manson, Sufyan Mansoor, Fatima Mansour, Alejandro Marcos Rodrigo, Nicholas Markham, Maria Marks, Paul Marriott, Hannah Marsden, Laura Martin, Tiago Martins, John Mason, Luke Mason, Mariam Masood, Nikhil Math, Ginimol Mathew, Jacob Matthews, Jonathan Mayes, Ursula Mc Gee, Ross Mcallister, Sandra Mcallister, Scott Mccain, Conor Mccann, Emmet Mccann, Cathal McCarthy, Gillian Mccoll, Greg Mcconaghie, Ace Mcdermott, Frank McDermott, Rachel Mcdougall, Mark McDowell, Gordon McFarlane, Richard McGregor, Doug McKechnie, Jillian McKenna, Scott McKinstry, Georgia Mclachlan, E. Mclean, Elizabeth McLennan, Angus McNair, Kenneth Mealy, Lauren Mecia, Alexander Mehta, Aidan Mellan, Arathi Menon, Donald Menzies, Zhubene Mesbah, David Messenger, George Miller, Aseem Mishra, Sona Mistry, Tahira Mohamed, Nisha Mohamed Mushaini, Midhun Mohan, Ameerah Mohd Azmilssss, Ajay Mohite, Krishna Moorthy, Jalal Moradzadeh, Richard Morgan, Gabriella Morley, Alice Mortimer, Hannah Mownah, Paul Moxey, Gagira Mudalige, Umarah Muhammad, Samuel Munday, Ben Murphy, Ciaran Murphy, Caoimhe Murray, Hannah Murray, Michael Murray, Mohammed Ibrar Murtaza, Jameel Mushtaq, Ameer Mustafa, Shams Mustafa, Laura Myers, Sam Myers, Adeeb Naasan, Kiran Nadeem, Hanzla Naeem, Prashant Naik, Arun Nair, Keshav K. Nambiar, Muhammad Naqi, Zehra Naqvi, Yan Ning Neo, Georgia Irene Neophytou, Jonathan Neville, Tom Newman, Benjamin Ng, Guat Ng, Jing Qi Ng, Vincent Ng, Zhan Herr Ng, Maire Ni Bhoirne, James Nicholas, Gary Nicholson, George Ninkovic-Hall, Gemma Nixon, Mike Norwood, Toby Noton, Romman Nourzaie, Richard Novell, Donald Nyanhongo, James O'Brien, Rory O'Kane, Stephen O'Neill, Hugh O'Sullivan, Thomas Oakley, Chinomso Ogbuokiri, Oluwafunto Ogunleye, Su Oh, Emezie Okorocha, James Olivier, Rele Ologunde, Sharif Omara, Alice Ormrod, Caroline Osborne, Joanna Osmanska, Raisah Owasil, Sebastian Owczarek, Ezgi Ozcan, Sri Palaniappan, Francesco Palazzo, Abbas Palkhi, Gargi Pandey, James Park, Jennifer Parker, Anna Parry, James Parsonage, Lauren Passby, Bhavi Patel, Bhavik Patel, Chantal Patel, Dinisha Patel, Kirtan Patel, Panna Patel, Pratiksha Patel, Trupesh Patel, Mariasoosai Pathmarajah, Amogh Patil, Pradeep Patil, Yusuf Patrick, Jessica Pearce, Lyndsay Pearce, Colin Peirce, Bryony Peiris, Amy Pendrill, Sreelata Periketi, Michael Perry, George Petrov, Charlotte Phillips, Grace Pike, Ana Catarina Pinho-Gomes, Parhana Polly, Arachchige Ponweera, Yanish Poolovadoo, Raunak Poonawala, Petya Popova, Dimitri Pournaras, Brooke Powell, Praveena Prabakaran, Esha Prakash, Tapani Pratumsuwan, Anusha Prem Kumar, Helen Puddy, Michael Pullinger, Nikita Punjabi, Oliver Charles Putt, Omar Qadir, Mubasher Qamar, Patrick Quinn, Arham Qureshi, Mohamed Rabie, Angus Radford, Anand Radhakrishnan, Ansh Radotra, Nasir Rafiq, Aria Rahem, Nahim Rahman, Syed Rahman, Ramesh Rajagopal, Nick Rajan, Nikitha Rajaraman, Sumetha Rajendran, Liandra Ramachenderam, Divya Ramakrishnan, Denisha Ramjas, James Rammell, Ritika Rampal, George Ramsay, Ratan Randhawa, Ellis Rea, Stephanie Rees, Saad Rehman, Salwah Rehman, Nabila Rehnnuma, Melina Rejayee, Zakaria Rob, Charlotte Roberts, Grace Roberts, Ben Roberts, Harry Robinson, Stephen Robinson, Ailin Rogers, Alex Rogers, William Rook, Talisa Ross, Chloe Roy, Azelea Rushd, Duncan Rutherford, Michael Saat, Kaushik Sadanand, Rebecca Sagar, Harkiran Sagoo, Arin Saha, Kapil Sahnan, Mohammed Salik Sait, Saif Sait, Damien Salekin, Mostafa Salem, Nadia Salloum, Emma Sanders, Jasmesh Sandhu, N. Sandhu, Lorna Sandison, Laura Sandland-Taylor, Ron Sangal, Chandan Sanghera, Josephine Saramunda, Lauren Satterthwaite, Moritz Schramm, Rupert Scott, Chloe Searle, Harkiran Seehra, Juan Jose Segura-Sampedro, Harpreet Kaur Sekhon Inderjit Singh, Shaikh Sanjid Seraj, Ishani Seth, Rajiv Sethi, Apar Shah, Mario Shaid, Shafaque Shaikh, Awad Shamali, Elizabeth Sharkey, Abhi Sharma, Neil Sharma, Sachin Sharma, Aniruddh Shenoy, Maleasha Shergill, Shahram Shirazi, Imran Siddiqui, Raykal Sim, Lucy Simmonds, Andrew Simon, William Simpson, Bharpoor Singh, J. Singh, Prashant Singh, Anant Sinha, Sidhartha Sinha, Robert Sinnerton, Chaamanti Sivakumar, Brendan Skelly, Richard Slater, Samuel Small, Neil Smart, Yat Wing Smart, Alexander Smith, Charlotte Smith, Jason Smith, Rebecca Smith, Scott Smith, Peter Sodde, Zhi Min Soh, Aniket Sonsale, Ahmed Soualhi, John Spearman, Robert Spencer, Harry Spiers, Philip Stather, Michael Stoddart, Bradley Storey, Howard Stringer, Thomas Stringfellow, Ben Stubbs, Niv Sukir, Nivian Sukirthan, Yasir Suleman, Aparnah Sureshkumar, Ashwin Suri, Timen Swartbol, Hyder Tahir, E. Tian Tan, Huai Ling Tan, Laura Tan, Alethea Tang, Priyal Taribagil, Yao Zong Tay, Beth Taylor, Zara Taylor, Alexandra Thatcher, Rachel Thavayogan, Michael Thomaa, Daniah Thomas, Jenny Thomas, Paul Thomas, Thomas Pinkney, Chris Thompson, Mag Ting, Ethan Toner, Godwin Tong, Jared Torkington, Molly Traish, Miles Triniman, John Trotter, Kwong Tsang, Sanchit Turaga, Hannah Turley, James Turner, Tomas Urbonas, Alexandra Urquhart, Nimai Vadgama, Aashay Vaidya, Gijs van Boxel, Swati Vara, Massimo Varcada, Rebecca Varley, Dee Varma, Martinique Vella-Baldacchino, Sara Venturini, Naina Verma, Saurabh Verma, Gabrielle Vernet, Mark Vipond, Alex von Roon, Qasim Wadood, Kathryn Waite, Lewis Walker, Nathan Walker, Jonathan C.M. Wan, Liyang Wang, Xue Wang, Alex Ward, Thomas Ward, Nienke Warnaar, Lloyd Warren, Oliver Warren, Sam Waters, Angus Watson, Laura Jayne Watson, Dominic Waugh, Daniel Weinberg, Malcolm West, Carla White, Tim White, Katharine Whitehurst, Robert Whitham, Tharindri Wijekoon, Manuk Wijeyaratne, Richard Wilkin, Alex Wilkins, Adam Williams, Gethin Williams, Luke Williams, Robert Williams, Andrew Williamson, Jacinthe Willson, Andrew Wilson, Holly Wilson, James Wilson, Lizzie Wilson, Megan Wilson, Michael Wilson, Rebekah Wilson, Tim Wilson, Evelina Woin, Esther Wright, Jenny Wright, Nicholas Wroe, Joanne Wylie, Yiwang Xu, Satheesh Yalamarthi, Angela Yan, Narisu Yang, Eda Yardimci, Ibrahim Yasin, Ismael Yasin, Noor Yasin, Joseph Yates, Jih Dar Yau, Tricia Yeoh, Joshua Yip, Cissy Yong, Vasudev Zaver, Tatiana Zhelezniakova, and Adreana Zulkifli

Subjects
Medical education, Manchester Cancer Research Centre, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, MEDLINE, General Medicine, 030230 surgery, Collaborative research, 03 medical and health sciences, 0302 clinical medicine, Foundation Programme, Medicine, Surgery, 030212 general & internal medicine, business
Published
2017
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2. What's that abdominal mass?

Author

Emily Davies, Suman Bandhu, Aarti Mistry, and Nicola Medd

Subjects
medicine.medical_specialty, Umbilicus (mollusc), 030232 urology & nephrology, Ultrasonography, Prenatal, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Medicine, Humans, Neonatology, business.industry, Crying, Infant, Newborn, Hydrocolpos, Anus, Abdominal mass, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Vagina, Gestation, Abdomen, Female, medicine.symptom, business
Abstract

A woman was admitted for planned induction at 39+5 weeks gestation. This was her third pregnancy. She had two previous children who were fit and well. Antenatal scans showed a fetal intra-abdominal mass measuring 6.2×5.5×7 cm in the lower abdomen, which was compressing the bladder. The mass was thought to be originating from the ovary or the bowel. On postnatal examination, the baby girl had a distended and full abdomen. There was a right-sided abdominal mass palpable above the umbilicus and 3 cm in size. It was firm, smooth and mobile in consistency. She had a normal anus and external female genitalia, with evidence of a prolapsed vagina on crying. She had passed urine and opened her bowels. The baby was kept nil by mouth and on intravenous fluids until the abdominal radiography was performed. The image is shown in figure 1. Figure 1 Neonatal abdominal radiograph. Describe the findings noted on the abdominal radiograph? She was …

Published
2017

3. The integration of BRCA testing into oncology clinics

Author

Emily Davies, Nazneen Rahman, Andreia Fernandes, Angela George, Natalie Percival, Jennifer Gyertson, Monica Hamill, and Susana Banerjee

Subjects
Oncology, medicine.medical_specialty, endocrine system diseases, Genes, BRCA2, Genes, BRCA1, Cancer Care Facilities, Poly(ADP-ribose) Polymerase Inhibitors, Clinical nurse specialist, Nurse's Role, Piperazines, Article, Olaparib, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Informed consent, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Genetic Testing, Precision Medicine, skin and connective tissue diseases, General Nursing, Genetic testing, Ovarian Neoplasms, Informed Consent, medicine.diagnostic_test, business.industry, Oncology Nursing, Precision medicine, humanities, female genital diseases and pregnancy complications, Oncology nursing, chemistry, Patient Satisfaction, 030220 oncology & carcinogenesis, PARP inhibitor, Mutation, Hereditary Breast and Ovarian Cancer Syndrome, Phthalazines, Female, business, Nurse Clinicians
Abstract

Purpose: The PARP inhibitor, Olaparib, is approved for women with BRCA-mutated ovarian cancer. Therefore there is an urgent need to test patients and obtain results in time to influence treatment. Models of BRCA testing, such as the mainstreaming oncogenetic pathway, involving oncology health professionals are being used. The authors report on the establishment of the extended role of the clinical nurse specialist in consenting women for BRCA testing in routine gynaecology-oncology clinics using the mainstreaming model. Methods: Nurses undertook generic consent training and specific counselling training for BRCA testing in the form of a series of online videos, written materials and checklists before obtaining approval to consent patients for germline BRCA1 and BRCA2 mutations. Results: Between July 2013 and December 2015, 108 women with ovarian cancer were counselled and consented by nurses in the medical oncology clinics at a single centre (The Royal Marsden, UK). This represented 36% of all ovarian cancer patients offered BRCA testing in the oncology clinics at the centre. Feedback from patients and nurses was encouraging with no significant issues raised in the counselling and consenting process. Conclusion: The mainstreaming model allows for greater access to BRCA testing for ovarian cancer patients, many of whom may benefit from personalised therapy (PARP inhibitors). This is the first report of oncology nurses in the BRCA testing pathway. Specialist oncology nurses trained in BRCA testing have an important role within a multidisciplinary team counselling and consenting patients to undergo BRCA testing.

Published
2016

4. Does ad hoc quality-of-life discussion in inflammatory skin disease consultations reflect standardized patient-reported outcomes?

Author

Mir-saeed Salek, Chirag Bipinbhai Patel, Emily Davies, and Andrew Yule Finlay

Subjects
medicine.medical_specialty, Pediatrics, business.industry, Inflammatory skin disease, Dermatology, Dermatology Life Quality Index, medicine.disease, Positive correlation, humanities, Checklist, Secondary care, Patient satisfaction, Psoriasis, Internal medicine, medicine, business, Acne
Abstract

Background. There is little information concerning how much health-related quality-of-life (HRQoL) information is elicited in dermatology outpatient consultations. Objectives. To observe and record ad hoc HRQoL discussion in inflammatory skin disease consultations, to systematically measure the patient’s HRQoL and to measure patient satisfaction with dermatology care. Methods. Clinic consultations of patients with inflammatory skin conditions attending a secondary care clinic were observed by a single researcher (CP). Data were collected on the 10 subject areas of the Dermatology Life Quality Index (DLQI) and on sleep, burden, frustration and depression. Patients were sent the DLQI and Medical Interview Satisfaction Scale (MISS)-21 questionnaires after the consultation. Results. In total, 100 consultations were observed (psoriasis n ¼ 50, eczema n ¼ 17, acne n ¼ 13 and others n ¼ 20). In 26% (n ¼ 26), there was no mention of HRQoL issues. In 59% (n ¼ 44), HRQoL discussions were initiated by the clinician. In only 26% (n ¼ 19) of consultations were ‡ 3 items on the observer’s checklist raised. In all, 57 evaluable DLQI and MISS-21 questionnaires were returned. The mean ± SD DLQI score was 7.2 ± 7.0 (n ¼ 18) for patients with whom there was no HRQoL discussion and 10.8 ± 6.7 (n ¼ 39, P ¼ 0.038) for those with whom HRQoL was discussed. The mean ± SD MISS-21 score was 108.8 ± 16.5 (n ¼ 18) for the patients with whom there was no HRQoL discussion and 111.3 ± 13.6 (n ¼ 39, P ¼ 0.42) for those with whom HRQoL was discussed. The mean ± SD patient expectation score was 5.5 ± 1.0 (median 5, range 3–7). There was a positive correlation between the patient expectation and MISS-21 scores (rs ¼ 0.815, P < 0.0001). Conclusions. Despite little extent or depth to HRQoL discussion, HRQoL issues were raised in the majority of inflammatory skin disease consultations. The consultations usually met the patients’ expectations and most patients were satisfied.

Published
2007
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5. Encephalopathy in children: an approach to assessment and management

Author

Santosh R. Mordekar, Emily Davies, and Daniel J. A. Connolly

Subjects
medicine.medical_specialty, Pediatrics, media_common.quotation_subject, Encephalopathy, MEDLINE, Hypoxia ischemia, Brain diagnosis, Autoimmune Diseases, Diagnosis, Differential, Presentation, Central Nervous System Infections, X ray computed, Medicine, Humans, Intensive care medicine, Child, media_common, Brain Diseases, business.industry, medicine.disease, Magnetic Resonance Imaging, Brain Injuries, Pediatrics, Perinatology and Child Health, Hypoxia-Ischemia, Brain, Differential diagnosis, business, Tomography, X-Ray Computed
Abstract

Childhood encephalopathy is an uncommon but significant paediatric presentation and is associated with significant mortality and long-term morbidity in survivors. By definition it is a somewhat non-specific presentation with a wide differential diagnosis and long list of possible investigations. Choice of investigation, including neuroimaging modality, can be a daunting prospect for the clinician faced with the encephalopathic child and it is important to select appropriately for a high diagnostic yield. Initial management centres on good emergency care irrespective of cause. More specific therapies however vary enormously, and appropriate treatment is important and influences outcome. Evidence exists for mana©gement of many of the individual conditions causing encephalopathy. This review aims to outline a clinical approach to selecting investigations to identify a specific cause and provides an overview of the treatment for the commoner causes of encephalopathy that a general paediatrician may reasonably expect to be faced with.

Published
2011

6. Safety of topical corticosteroids in pregnancy

Author

Gudula Kirtschig, Shu-Hui Wang, Cathy Bennett, Ching-Chi Chi, Emily Davies, and Fenella Wojnarowska

Subjects
medicine.medical_specialty, Pediatrics, Administration, Topical, Cleft Lip, Skin Pigmentation, Cohort Studies, Adrenal Cortex Hormones, Pregnancy, Internal medicine, medicine, Birth Weight, Humans, Pharmacology (medical), business.industry, Case-control study, Abnormalities, Drug-Induced, Infant, Low Birth Weight, medicine.disease, Cleft Palate, Pregnancy Complications, Observational Studies as Topic, Low birth weight, Meta-analysis, Relative risk, Case-Control Studies, Cohort, Premature Birth, Apgar score, Female, Dermatologic Agents, medicine.symptom, business, Cohort study
Abstract

Background Topical corticosteroids are the most frequently prescribed dermatological treatment and are often used by pregnant women with skin conditions. However, little is known about their safety in pregnancy. Objectives To assess the effects of topical corticosteroids on pregnancy outcomes in pregnant women. Search methods This is an update of a review previously published in 2009. We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, the Cochrane Pregnancy and Childbirth Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 6), MEDLINE, EMBASE, and LILACS. We also searched five trials registers and checked the reference lists of included studies, published reviews, articles that had cited the included studies, and one author's literature collection, for further references to relevant RCTs. Selection criteria Randomised controlled trials and cohort studies of topical corticosteroids in pregnant women, as well as case-control studies comparing maternal exposure to topical corticosteroids between cases and controls when studies reported pre-specified outcomes. The primary outcomes included mode of delivery, major congenital abnormality, birth weight, and preterm delivery (delivery before 37 completed weeks gestation); the secondary outcomes included foetal death, minor congenital abnormality, and low Apgar score (less than seven at 5 min). Data collection and analysis We used standard methodological procedures expected by Cochrane. Two authors independently applied selection criteria, extracted data, and assessed the quality of the included studies. A third author was available for resolving differences of opinion. A further author independently extracted data from included studies that were conducted by authors of this systematic review. Main results We included 7 new observational studies in this update, bringing the total number to 14, including 5 cohort and 9 case-control studies, with 1,601,515 study subjects. Most studies found no causal associations between maternal exposure to topical corticosteroids of any potency and pregnancy outcomes when compared with no exposure. These outcomes included: mode of delivery (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.95 to 1.15, 1 cohort study, n = 9904, low quality evidence); congenital abnormalities, including orofacial cleft or cleft palate and hypospadias (where the urethral opening is on the underside of the penis) (RR 0.82, 95% CI 0.34 to 1.96, 2 cohort studies, n = 9512, low quality evidence; and odds ratio (OR) 1.07, 95% CI 0.71 to 1.60, 1 case-control study, n = 56,557); low birth weight (RR 1.08, 95% CI 0.86 to 1.36; n = 59,419, 4 cohort studies; very low quality evidence); preterm delivery (RR 0.93, 95% CI 0.81 to 1.08, 4 cohort studies, n = 59,419, low quality evidence); foetal death (RR 1.02, 95% CI 0.60 to 1.73, 4 cohort studies, n = 63,885, very low quality evidence); and low Apgar score (RR 0.84, 95% CI 0.54 to 1.31, 1 cohort study, n = 9220, low quality evidence). We conducted stratified analyses of mild or moderate potency, and potent or very potent topical corticosteroids, but we found no causal associations between maternal exposure to topical corticosteroid of any potency and congenital abnormality, orofacial clefts, preterm delivery, or low Apgar score. For low birth weight, although the meta-analysis based on study-level data was not significant for either mild to moderate corticosteroids (pooled RR 0.90, 95% CI 0.74 to 1.09, 3 cohort studies, n > 55,713) or potent to very potent corticosteroids (pooled RR 1.58, 95% CI 0.96 to 2.58, 4 cohort studies, n > 47,651), there were significant differences between the two subgroups (P = 0.04). The results from three of the individual studies in the meta-analysis indicated an increased risk of low birth weight in women who received potent to very potent topical corticosteroids. Maternal use of mild to moderate potency topical steroids was associated with a decreased risk of foetal death (pooled RR 0.70, 95% CI 0.64 to 0.77, 2 studies, n = 48,749; low quality evidence), but we did not observe this effect when potent to very potent topical corticosteroids were given during pregnancy (pooled RR 1.14, 95% CI 0.69 to 1.88, 3 studies, n = 37,086, low quality evidence). We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group approach to rate the overall quality of the evidence. Data from observational studies started at low quality. We further downgraded the evidence because of imprecision in low birth weight and inconsistency in foetal death. Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. Authors' conclusions This update adds more evidence showing no causal associations between maternal exposure to topical corticosteroids of all potencies and pregnancy outcomes including mode of delivery, congenital abnormalities, preterm delivery, foetal death, and low Apgar score, which is consistent with the previous version of this review. This update provides stratified analyses based on steroid potency; we found no association between maternal use of topical corticosteroids of any potency and an increase in adverse pregnancy outcomes, including mode of delivery, congenital abnormality, preterm delivery, foetal death, and low Apgar score. Similar to the previous version of the review, this update identified a probable association between low birth weight and maternal use of potent to very potent topical corticosteroids, especially when the cumulative dosage of topical corticosteroids throughout the pregnancy is very large, which warrants further investigation. The finding of a possible protective effect of mild to moderate topical corticosteroids on foetal death could also be examined.

Published
2009

7. Correlation of pathologic features in spectral domain optical coherence tomography with conventional retinal studies

Author

Emily Davies, Bradley A. Bower, Cynthia A. Toth, Joseph A. Izatt, and Marcin Stopa

Subjects
genetic structures, Fundus image, Spectral domain, Pilot Projects, Retinal Drusen, Macular Edema, Retina, Domain (software engineering), Correlation, chemistry.chemical_compound, symbols.namesake, Macular Degeneration, Nuclear magnetic resonance, Imaging, Three-Dimensional, Optical coherence tomography, medicine, Humans, Fluorescein Angiography, Aged, medicine.diagnostic_test, Fourier Analysis, business.industry, Retinal, General Medicine, eye diseases, Choroidal Neovascularization, Ophthalmology, Fourier transform, chemistry, symbols, Female, sense organs, business, Tomography, Optical Coherence
Abstract

To delineate pathologic changes in retinal cross sections obtained with spectral (Fourier) domain optical coherence tomography (SDOCT), so that the findings are maintained when collapsed into a two-dimensional fundus image for comparison with conventional retinal studies.SDOCT of the posterior pole of 12 eyes (5 with neovascular age-related macular degeneration [AMD]; 7 with nonneovascular AMD) produced three-dimensional stacks of scans. Location of pathologic features was delineated with color markings in each scan before the stack was collapsed along the depth axis. This en face image contained retinal vessel shadowing and preserved color markings of delineated pathologic features relative to the vessel pattern and was superimposed onto conventional studies.For patients with neovascular AMD, location and extent of choroidal neovascularization, macular edema, and subretinal fluid were visible on the two-dimensional summed images and, in some cases, involved sites not suspected with conventional imaging. For patients with nonneovascular AMD, the location of drusen and geographic atrophy were correlated with autofluorescence images. For one eye with drusen and three eyes with neovascular AMD, presence or extent of subretinal fluid identified by SDOCT was not visible using other imaging methods.In this pilot AMD study, pathologic features within SDOCT scans were transferred into two-dimensional en face projections, enabling researchers to correlate lateral extent of pathologic features from SDOCT with conventional studies. This integration of SDOCT with other retinal studies is promising and will be useful to study the relationship between local OCT morphology and other parameters of retinal disease or function.

Published
2008

8. Development of quantitative diagnostic observables for age-related macular degeneration using Spectral Domain OCT

Author

Anjul M. Davis, David F. Wiley, Emily Davies, Bradley A. Bower, Stephanie J. Chiu, Joseph A. Izatt, Cynthia A. Toth, Robert J. Zawadzki, and Alfred R. Fuller

Subjects
genetic structures, medicine.diagnostic_test, Computer science, business.industry, Spectral domain, Retinal, Macular degeneration, Drusen, computer.software_genre, medicine.disease, eye diseases, Geographic atrophy, chemistry.chemical_compound, Optical coherence tomography, chemistry, Voxel, Age related, medicine, Segmentation, Computer vision, sense organs, Artificial intelligence, business, computer, Biomedical engineering
Abstract

We report on the development of quantitative, reproducible diagnostic observables for age-related macular degeneration (AMD) based on high speed spectral domain optical coherence tomography (SDOCT). 3D SDOCT volumetric data sets (512 x 1000 x 100 voxels) were collected (5.7 seconds acquisition time) in over 50 patients with age-related macular degeneration and geographic atrophy using a state-of-the-art SDOCT scanner. Commercial and custom software utilities were used for manual and semi-automated segmentation of photoreceptor layer thickness, total drusen volume, and geographic atrophy cross-sectional area. In a preliminary test of reproducibility in segmentation of total drusen volume and geographic atrophy surface area, inter-observer error was less than 5%. Extracted volume and surface area of AMD-related drusen and geographic atrophy, respectively, may serve as useful observables for tracking disease state that were not accessible without the rapid 3D volumetric imaging capability unique to retinal SDOCT.

Published
2007
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9. Differences in Clinical Features and Comorbid Burden between HLA-C∗06:02 Carrier Groups in >9,000 People with Psoriasis

Author

Konstantinos Douroudis, Ravi Ramessur, Ines A. Barbosa, David Baudry, Michael Duckworth, Caroline Angit, Francesca Capon, Raymond Chung, Charles J. Curtis, Paola Di Meglio, Jonathan M.R. Goulding, Christopher E.M. Griffiths, Sang Hyuck Lee, Satveer K. Mahil, Richard Parslew, Nick J. Reynolds, Alexa R. Shipman, Richard B. Warren, Zenas Z.N. Yiu, Michael A. Simpson, Jonathan N. Barker, Nick Dand, Catherine H. Smith, Ian Evans, Ruth Murphy, Tess McPherson, Elise Kleyn, Philip Laws, Gabrielle Becher, Anthony Bewley, Amir Rashid, Oras Alabas, Simon Morrison, Shehnaz Ahmed, Eleanor Pearson, Josh Richards, Teena Mackenzie, Brian Kirby, David Burden, Linda Lawson, Kathleen McElhone, Anthony Ormerod, Caroline Owen, Nadia Aldoori, Mahmud Ali, Alex Anstey, Fiona Antony, Charles Archer, Suzanna August, Periasamy Balasubramaniam, Kay Baxter, Alexandra Bonsall, Victoria Brown, Katya Burova, Aamir Butt, Mel Caswell, Sandeep Cliff, Mihaela Costache, Sharmela Darne, Emily Davies, Claudia DeGiovanni, Trupti Desai, Bernadette DeSilva, Victoria Diba, Eva Domanne, Harvey Dymond, Caoimhe Fahy, Leila Ferguson, Maria-Angeliki Gkini, Alison Godwin, Fiona Hammonds, Sarah Johnson, Teresa Joseph, Manju Kalavala, Mohsen Khorshid, Liberta Labinoti, Nicole Lawson, Alison Layton, Tara Lees, Nick Levell, Helen Lewis, Calum Lyon, Sandy McBride, Sally McCormack, Kevin McKenna, Serap Mellor, Paul Norris, Urvi Popli, Gay Perera, Nabil Ponnambath, Helen Ramsay, Aruni Ranasinghe, Saskia Reeken, Rebecca Rose, Rada Rotarescu, Ingrid Salvary, Kathy Sands, Tapati Sinha, Simina Stefanescu, Kavitha Sundararaj, Kathy Taghipour, Michelle Taylor, Michelle Thomson, Joanne Topliffe, Roberto Verdolini, Rachel Wachsmuth, Martin Wade, Shyamal Wahie, Sarah Walsh, Shernaz Walton, Louise Wilcox, and Andrew Wright

Subjects
medicine.medical_specialty, Endotype, HLA-C Antigens, Dermatology, Disease, Biochemistry, Psoriatic arthritis, Internal medicine, Psoriasis, medicine, Humans, Genetic Predisposition to Disease, Clinical significance, Expressivity (genetics), Molecular Biology, Alleles, business.industry, Cell Biology, Odds ratio, medicine.disease, Biobank, Cross-Sectional Studies, Female, business, Biomarkers
Abstract

The identification of robust endotypes—disease subgroups of clinical relevance—is fundamental to stratified medicine. We hypothesized that HLA-C∗06:02 status, the major genetic determinant of psoriasis, defines a psoriasis endotype of clinical relevance. Using two United Kingdom–based cross-sectional datasets—an observational severe-psoriasis study (Biomarkers of Systemic Treatment Outcomes in Psoriasis; n = 3,767) and a large population-based bioresource (UK Biobank, including n = 5,519 individuals with psoriasis)—we compared demographic, environmental, and clinical variables of interest in HLA-C∗06:02–positive (one or two copies of the HLA-C∗06:02 allele) with those in HLA-C∗06:02‒negative (no copies) individuals of European ancestry. We used multivariable regression analyses to account for mediation effects established a priori. We confirm previous observations that HLA-C∗06:02–positive status is associated with earlier age of psoriasis onset and extend findings to reveal an association with disease expressivity in females (Biomarkers of Systemic Treatment Outcomes in Psoriasis: P = 2.7 × 10 –14, UK Biobank: P = 1.0 × 10 –8). We also show HLA-C∗06:02–negative status to be associated with characteristic clinical features (large plaque disease, OR for HLA-C∗06:02 = 0.73, P = 7.4 × 10 –4; nail involvement, OR = 0.70, P = 2.4 × 10 –6); higher central adiposity (Biomarkers of Systemic Treatment Outcomes in Psoriasis: waist circumference difference of 2.0 cm, P = 8.4 × 10 –4; UK Biobank: waist circumference difference of 1.4 cm, P = 1.5 × 10 –4), especially in women; and a higher prevalence of other cardiometabolic comorbidities. These findings extend the clinical phenotype delineated by HLA-C∗06:02 and highlight its potential as an important biomarker to consider in future multimarker stratified medicine approaches.

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