Survey of the Use of Diffusion-Weighted Imaging for Cholesteatoma in the United Kingdom

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Sunil Dutt Sharma ◽  
Ahmad Hariri ◽  
Ravi Kumar Lingam ◽  
Arvind Singh
Keyword(s):  
United Kingdom ◽  
British Society ◽  
Petrous Apex ◽  
The United Kingdom ◽  
Diffusion Weighted ◽  
Clinical Scenarios ◽  
Head And Neck Imaging ◽  
The Mean ◽  
The Uk

<b><i>Background:</i></b> Non-echoplanar diffusion-weighted MRI (DWMRI) has a role in the surgical planning for cholesteatoma. <b><i>Aims/Objectives:</i></b> The aim of the study was to assess the use of DWMRI in the management of cholesteatoma across the UK, and measure clinicians’ confidence in the use of DWMRI. <b><i>Materials and Methods:</i></b> Telephone survey in 139 Otolaryngology Departments in the United Kingdom between March 2017 and July 2017, and asking radiology delegates at the British Society of Head and Neck Imaging 2017 meeting. <b><i>Results:</i></b> The response rate was 101 out of 139 Trusts (73%). Of those respondents who did have DWMRI available, 68/88 respondents (77%) use it for cholesteatoma. The mean confidence (±standard deviation) of the respondents with DWMRI in identifying cholesteatoma presence was 7.3 ± 2.1, in identifying volume of cholesteatoma was 6.8 ± 1.8, and in identifying subsites of cholesteatoma was 4.6 ± 2.1. <b><i>Conclusions and Significance:</i></b> DWMRI has a well-defined role in the follow-up of patients after cholesteatoma surgery, and those primary cases of cholesteatoma where the diagnosis is in question. The use of DWMRI for cholesteatoma is variable across the UK, but there are certain clinical scenarios where there is not enough awareness regarding the benefits of imaging (such as petrous apex cases of cholesteatoma).

scholarly journals The impact of symptoms on quality of life before and after diagnosis of coeliac disease: the results from a Polish population survey and comparison with the results from the United Kingdom

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emilia Majsiak ◽  
Magdalena Choina ◽  
Dominik Golicki ◽  
Alastair M. Gray ◽  
Bożena Cukrowska
Keyword(s):  
Quality Of Life ◽  
United Kingdom ◽  
Coeliac Disease ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
The United Kingdom ◽  
Before And After ◽  
The Mean ◽  
The Uk

Abstract Background Coeliac disease (CD) is characterised by diverse clinical symptoms, which may cause diagnostic problems and reduce the patients’ quality of life. A study conducted in the United Kingdom (UK) revealed that the mean time between the onset of coeliac symptoms and being diagnosed was above 13 years. This study aimed to analyse the diagnostic process of CD in Poland and evaluate the quality of life of patients before and after CD diagnosis. In addition, results were compared to the results of the original study conducted in the UK. Methods The study included 2500 members of the Polish Coeliac Society. The patients were asked to complete a questionnaire containing questions on socio-demographic factors, clinical aspects and quality of life, using the EQ-5D questionnaire. Questionnaires received from 796 respondents were included in the final analysis. Results The most common symptoms reported by respondents were bloating (75%), abdominal pain (72%), chronic fatigue (63%) and anaemia (58%). Anaemia was the most persistent symptom, with mean duration prior to CD diagnosis of 9.2 years, whereas diarrhoea was observed for the shortest period (4.7 years). The mean duration of any symptom before CD diagnosis was 7.3 years, compared to 13.2 years in the UK. CD diagnosis and the introduction of a gluten-free diet substantially improved the quality of life in each of the five EQ-5D-5L health dimensions: pain and discomfort, anxiety and depression, usual activities, self-care and mobility (p < 0.001), the EQ-Index by 0.149 (SD 0.23) and the EQ-VAS by 30.4 (SD 28.3) points. Conclusions Duration of symptoms prior to the diagnosis of CD in Poland, although shorter than in the UK, was long with an average of 7.3 years from first CD symptoms. Faster CD diagnosis after the onset of symptoms in Polish respondents may be related to a higher percentage of children in the Polish sample. Introduction of a gluten-free diet improves coeliac patients’ quality of life. These results suggest that doctors should be made more aware of CD and its symptoms across all age groups.

scholarly journals Further Aspects of the UK Engine Technology Demonstrator Programme

1988 ◽  
Author(s):  
D. W. Hughes ◽  
W. J. Chrispin
Keyword(s):  
United Kingdom ◽  
Scale Development ◽  
Gas Turbine ◽  
Full Scale ◽  
Cost Overrun ◽  
The United Kingdom ◽  
Technology Demonstration ◽  
The Uk ◽  
Technology Demonstrator

In 1987, a paper entitled ‘The United Kingdom Engine Technology Demonstrator Programme’ (ASME 87-GT-203) was presented at the Gas Turbine Conference in Anaheim. That paper postulated that a programme of engine technology demonstration ahead of commitment to full-scale development was essential if past problems of cost overrun and inadequate performance at service entry were to be avoided. The paper concluded that the UK had established a balanced programme of technology demonstration, emphasising that Industry and Government must invest this activity with the same commitment traditionally given to projects if the full benefits were to be realised. This follow-up paper presents an expanded view of future programme objectives and how the programme elements formulated for their achievement are to be managed.

Report of the UK Oral and Dental Health Research Summit

2010 ◽  
Vol os17 (3) ◽  
pp. 123-126 ◽  
Author(s):  
Kenneth A Eaton ◽  
Ario Santini
Keyword(s):  
United Kingdom ◽  
Health Research ◽  
Dental Health ◽  
Faculty Members ◽  
British Society ◽  
Dental Practice ◽  
Summit Meeting ◽  
Dental Research ◽  
The United Kingdom ◽  
The Uk

On 14th April 2010, a national research summit meeting for oral and dental researchers was held at Sheffield University. The event was organised by Professor Paul Speight, President of the British Society for Oral and Dental Research (BSODR) and Dean of the School of Clinical Dentistry, University of Sheffield. The summit was jointly sponsored by the BSODR, the National Institute for Health Research (NIHR) Oral and Dental Specialty Group and the Health and Science Committee of the British Dental Association (BDA). Sixty invited participants took part. They included the Faculty of General Dental Practice (UK) Chair of Research and its two National Research Facilitators, along with Faculty members who attended as representatives of other organisations. The purpose of the meeting was to bring together the leaders of oral and dental research in the United Kingdom (UK) to consider the achievements of research in this field in the UK and how it could develop in the future.

scholarly journals Prevalence and Mortality of Individuals With X-Linked Hypophosphatemia: A United Kingdom Real-World Data Analysis

2019 ◽  
Vol 105 (3) ◽  
pp. e871-e878 ◽  
Author(s):  
Samuel Hawley ◽  
Nick J Shaw ◽  
Antonella Delmestri ◽  
Daniel Prieto-Alhambra ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
United Kingdom ◽  
Fibroblast Growth Factor 23 ◽  
Later Life ◽  
Population Based ◽  
Real World Data ◽  
The United Kingdom ◽  
Multisystemic Disease ◽  
The Uk ◽  
The Life Course

Abstract Background X-linked hypophosphatemia (XLH) is a rare multisystemic disease with a prominent musculoskeletal phenotype. We aim here to improve understanding of the prevalence of XLH across the life course and of overall survival among people with XLH. Methods This was a population-based cohort study using a large primary care database in the United Kingdom (UK) from 1995 to 2016. XLH cases were matched by age, gender, and practice to up to 4 controls. Trends in prevalence over the study period were estimated (stratified by age) and survival among cases was compared with that of controls. Findings From 522 potential cases, 122 (23.4%) were scored as at least possible XLH, while 62 (11.9%) were classified as highly likely or likely (conservative definition). In main analyses, prevalence (95% CI) increased from 3.1 (1.5–6.7) per million in 1995–1999 to 14.0 (10.8–18.1) per million in 2012–2016. Corresponding estimates using the conservative definition were 3.0 (1.4–6.5) to 8.1 (5.8–11.4). Nine (7.4%) of the possible cases died during follow-up, at median age of 64 years. Fourteen (2.9%) of the controls died at median age of 72.5 years. Mortality was significantly increased in those with possible XLH compared with controls (hazard ratio [HR] 2.93; 95% CI, 1.24–6.91). Likewise, among those with likely or highly likely XLH (HR 6.65; 1.44–30.72). Conclusions We provide conservative estimates of the prevalence of XLH in children and adults within the UK. There was an unexpected increase in mortality in later life, which may have implications for other fibroblast growth factor 23–related disorders.

Safety results from the treatment of 109 cerebral aneurysms using the Woven EndoBridge technique: preliminary results in the United Kingdom

2018 ◽  
Vol 128 (1) ◽  
pp. 144-153 ◽  
Author(s):  
Aimee Lawson ◽  
Andy Molyneux ◽  
Robin Sellar ◽  
Saleh Lamin ◽  
Allan Thomas ◽  
...  
Keyword(s):  
United Kingdom ◽  
Clinical Outcome ◽  
Cerebral Aneurysms ◽  
Clinical Use ◽  
The United Kingdom ◽  
The Uk ◽  
Woven Endobridge ◽  
Web Device ◽  
The Web

OBJECTIVEThe Woven Endobridge (WEB) device has been in clinical use for the treatment of brain aneurysms for the past 4 years. Observational studies to assess clinical outcome and related complications have been published. Clear evidence is required to better understand the safety profile of the WEB device. The authors here present a multicenter series that provides a detailed safety analysis focused on patient selection, procedural events, and technical issues of treated patients throughout the United Kingdom (UK).METHODSA nationwide password-protected database was set up to collect anonymous information across the UK (14 centers). Complications and clinical outcome were analyzed for the initial 109 patients (112 procedures). An independent root cause analysis classified the complications into groups (procedural, disease, device, ancillary device, and other). The modified Rankin Scale (mRS) was used as a marker of clinical outcome.RESULTSEach of the 109 patients had 1 aneurysm suitable for WEB treatment (109 aneurysms). Three patients had 2 procedures, making a total of 112 procedures performed. Eight procedures were abandoned because of access issues; 2 patients went on to have a successful procedure. All 109 patients had a preprocedure and discharge mRS scores recorded. One hundred patients had a recorded mRS score from a > 3-month follow-up.Deployment of the WEB device was successful in 103 (94.5%) of 109 patients and 104 (92.9%) of 112 procedures. One patient had 2 successful WEB procedures on separate occasions. Patients without a successfully implanted WEB device were included in the analysis. Selection analysis showed that the average patient age was 56.5 years among 34 men and 75 women. The percentage of incidental aneurysms was 58.7%, acute 16.5%, symptomatic 18.3%, and recurrent 6.4%. Further results analysis showed that 40 (36.7%) of 109 patients had recorded adverse events, including those unrelated to the WEB device. Events that could be related to the WEB device numbered 17 (15.6%) among the 109 patients. Two patients with device-related complications were symptomatic. Overall, 11 patients (10.1%) had persistent clinical sequelae. Thromboembolism was the most prevalent event, affecting 15.6% of the patients (17 of 109), and 6.4% of the patients (7 of 109) with a thromboembolism were symptomatic.Overall mortality before discharge was 0% and at the > 3-month follow-up was 5% (5 of 100 patients). Morbidity was defined as an mRS score increase to > 2. Overall morbidity at discharge was 1.8% (2 of 109) and at the > 3-month follow-up was 6% (6 of 100). No device-related morbidity or mortality was associated with this group.CONCLUSIONSThe UK data show that the WEB device is safe for clinical use. Thromboembolic complication adds a risk that should be minimized with appropriate anticoagulation and correct sizing of the device. There is scope for further evaluation and standardization of an anticoagulation regimen for the WEB device.

scholarly journals Laboratory Performance of Serum B12 Assay in the United Kingdom (UK) As Assessed By the UK National External Quality Assessment Scheme for Haematinics: Implications for Clinical Interpretation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2230-2230 ◽  
Author(s):  
Finlay Mackenzie ◽  
Vinod Devalia
Keyword(s):  
United Kingdom ◽  
Quality Assessment ◽  
Serum Sample ◽  
External Quality Assessment ◽  
British Society ◽  
External Quality ◽  
Clinical Interpretation ◽  
Target Value ◽  
The United Kingdom ◽  
The Uk

Abstract Serum B12 assay is the most commonly used routine test for assessing cobalamin status in the body. In the United Kingdom, there are around 350 laboratories performing the assay using seven different platforms. External quality assessment of the assays is organised by UK NEQAS for Haematinics by sending a serum sample every 3 months. An 'all participants' consensus mean is calculated and used as the target value and the results analysed with respect to intra- and inter- group variation. The percentage bias from the target value is used to assess performance. We present data on one such assessment to demonstrate the problems of the serum B12 assay (Survey number 248, April 2018) and also how it is interpreted by the laboratory for clinical use. Method A serum sample with a B12 target value of approximately 173 ng/L was sent to participating laboratories for analysis. Laboratories were also asked for an interpretation of their result which would be reported to the requesting clinician, namely from low to high. Results Fig 1 shows an individual laboratory's result (indicated by the arrow) in relation to all laboratories using the same technology (shaded histogram) or all methods (open histogram). There is a significant variation ranging from 86 to 258 ng/L depending on the assay used, with an overall standard deviation of 28 and co-efficient of variation of 16%. Fig 2 shows the distribution of results in the different methodologies used and how each laboratory interpreted its result. It demonstrates the bias of results obtained by the different methods. The assays using Beckman Coulter Access/Dxl (SF5 and SF6) gave much lower results than other methods. In the group SF5, three laboratories interpreted the result as 'normal' and one as 'indeterminate'. In the groups Abbot Architect (AB13) and Roche Cobas/Modular (BO5), although having higher results than other groups, there is a significant number of laboratories interpreting the result as 'low' and also 'normal' or 'indeterminate'. Fig 3 shows a graphical representation of an individual laboratory's performance bias and the consistency of its individual and group bias over a period of 6 months. The Bias score (B score on y axis) is how far the result obtained deviated from the target value. The C score (on x axis) informs on consistency of the bias over the past 6 months. Hence, ideally both B score and C score should be as low as possible, and therefore all methodologies would harmonise towards similar results. Discussion These data demonstrate the limitations of the serum B12 assay in assessing body B12 status. The numerical value obtained of any sample can vary considerably between the different methodologies used. In addition, the interpretation provided by the laboratory can also be highly variable. This may have profound implications for clinical assessment and management. In addition, this is compounded by the fact that it is not quite clear what would be regarded as the normal or reference range. Laboratories in the United Kingdom use the manufacturers ranges and clinicians may consult the British Society for Haematology Guidelines (Devalia V et al (2014) BCSH Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British Journal of Haematology, 166, 496-513) for help in clinical interpretation. Our data shows that the different reference ranges quoted by the kit manufacturers do not correspond to their assay bias, ie there is no simple direct correlation between the ranges provided against the bias of their particular assay. Conclusion The UK NEQAS Haematinics Programme demonstrates problems associated with the serum B12 assay with data on variation of results obtained, bias and interpretation of results in a style that is unique across currently available Proficiency Testing/ External Quality Assessment schemes. Laboratories need to be aware of their performance in assessing serum B12 level in order to provide appropriate clinical advice. This needs collection of feedback and audit of data of the clinical situation for which the request was made. Clinicians need to be aware of the performance of their laboratories in order that they can interpret the result provided in a meaningful way in relation to the clinical picture. Disclosures No relevant conflicts of interest to declare.

scholarly journals FIREWORKS, FLAGS AND SIGNS: VOICES FROM THE STREETS OF POST-BREXIT BRITAIN

2020 ◽  
Vol 59 (1) ◽  
pp. 491-506
Author(s):  
Sara Roberts
Keyword(s):  
United Kingdom ◽  
Civil Society ◽  
Empirical Evidence ◽  
Symbolic Violence ◽  
British Society ◽  
Popular Discourse ◽  
The United Kingdom ◽  
Global Trend ◽  
The Uk ◽  
The Eu

ABSTRACT In this article, Sara Roberts, a former BBC researcher and journalist - currently teacher and writer, offers her personal impressions of the recent rise of populism in Britain, based on her experiences in Oxford, where she lives. This essay offers empirical evidence that Brexit has had a profoundly divisive effect on British society from the micro to the macro level, and threatens the very union of nations that makes up the United Kingdom. The campaign for the UK to leave the EU (‘Brexit’) in the 2016 referendum exploited xenophobic and racist sentiment, thereby creating linguistic and symbolic violence which has managed to pervade popular discourse and consciousness, and which may foreshadow an increase in actual violence. It is suggested here that violence and fear lie at the heart of populism and that all populist movements rely on them, as well as ignorance, to first gain and then maintain support. Acting against the global trend towards populism, the current younger generation; education; civil society and Art are offered as avenues of hope for the future.

scholarly journals Follow up after Primary Treatment of Soft Tissue Sarcoma: A Survey of Current Practice in the United Kingdom

Sarcoma ◽  
2007 ◽  
Vol 2007 ◽  
pp. 1-6 ◽  
Author(s):  
C. H. Gerrand ◽  
L. J. Billingham ◽  
P. J. Woll ◽  
R. J. Grimer
Keyword(s):  
United Kingdom ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Current Practice ◽  
Primary Treatment ◽  
X Rays ◽  
The United Kingdom ◽  
Clinical Scenarios ◽  
Risk Of Relapse

Despite the clinical and financial implications, there is little evidence about how patients who have been treated for soft tissue sarcoma should be followed up. The purpose of this study was to determine current practice in the United Kingdom. 192 clinicians treating patients with soft tissue sarcoma were surveyed with a postal questionnaire enquiring about frequency and method of follow up and how patients would be followed up in each of 3 clinical scenarios: a patient with a trunk or extremity tumour at low risk of relapse; a patient with a trunk or extremity tumour at high risk of relapse; and a patient with a retroperitoneal or abdominal tumour. 155 (81%) clinicians responded. Clinic visits and X-rays were the most frequently used methods of follow up. Chest CT scans, local site imaging, and blood tests were used infrequently. The intensity and methods of follow up varied with each of the clinical scenarios. There was a seven-to-twenty fold variation in cost between the least and the most expensive regimes. Respondents were generally supportive of the development of the clinical trial in this area.

scholarly journals Clinical outcomes and safety of Diphoterine® irrigation for chemical eye injury: A single-centre experience in the United Kingdom

2021 ◽  
Vol 13 ◽  
pp. 251584142110304
Author(s):  
Muzammil Ahmad Nahaboo Solim ◽  
Teresa Maria Lupion-Duran ◽  
Romeela Rana-Rahman ◽  
Trushar Patel ◽  
Desiree Ah-Kine ◽  
...  
Keyword(s):  
United Kingdom ◽  
Stem Cell ◽  
Normal Saline ◽  
Saline Water ◽  
Case Series ◽  
Eye Injury ◽  
The United Kingdom ◽  
The Mean ◽  
Limbal Stem Cell

Purpose: Diphoterine® is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre. Methods: This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020. Results: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3–70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR ( p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up. Conclusion: This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics.

scholarly journals Evaluating the Residual Nitrite Concentrations of Bacon in the United Kingdom

Foods ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. 916
Author(s):  
William Crowe ◽  
Christopher T Elliott ◽  
Brian D Green
Keyword(s):  
United Kingdom ◽  
World Health Organisation ◽  
World Health ◽  
Processed Meat ◽  
The European Union ◽  
The United Kingdom ◽  
Regulatory Limits ◽  
Residual Nitrite ◽  
The Mean ◽  
The Uk

The preservative sodium nitrite is added to processed meat with the intention of preventing the growth of Clostridium botulinum, but this also influences product flavour and colour. The World Health Organisation has declared nitrites to be ‘probably carcinogenic’. Use is permitted by the European Union but its addition is limited to 100 mg/kg in all processed meat, except bacon, which is limited to 175 mg/kg. At present, there is no independent peer-reviewed literature assessing the residual nitrite levels in bacon in the United Kingdom. Furthermore, this is the largest study of residual nitrite concentrations in bacon that has ever been conducted. A total of 89 different commercially available bacon samples were collected, and analysed using flow injection analysis to determine their residual nitrite content. The mean residual nitrite concentration for all bacon samples was 10.80 mg/kg. Residual nitrite levels did not differ between smoked and unsmoked bacon. Middle cut bacon (26.00 mg/kg) had significantly higher residual nitrite concentrations than back bacon (8.87 mg/kg; p = 0.027), and medallion bacon (4.47 mg/kg; p = 0.008). This study shows that there is large variation in the mean residual nitrite levels of bacon sold in the UK and all the reported values are within current regulatory limits. Despite this, it appears that many manufacturers could decrease the amount that they are currently using in their products.

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