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1.  Recommendations for involving the family in developmental care of the NICU baby 
Journal of Perinatology  2015;35(Suppl 1):S5-S8.
Family involvement is a key to realize the potential for long-lasting positive effects on physical, cognitive and psychosocial development of all babies, including those in the neonatal intensive care unit (NICU). Family-centered developmental care (FCDC) recognizes the family as vital members of the NICU health-care team. As such, families are integrated into decision-making processes and are collaborators in their baby's care. Through standardized use of FCDC principles in the NICU, a foundation is constructed to enhance the family's lifelong relationship with their child and optimize development of the baby. Recommendations are made for supporting parental roles as caregivers of their babies in the NICU, supporting NICU staff participation in FCDC and creating NICU policies that support this type of care. These recommendations are designed to meet the basic human needs of all babies, the special needs of hospitalized babies and the needs of families who are coping with the crisis of having a baby in the NICU.
PMCID: PMC4660048  PMID: 26597804
2.  Retrospective analysis of the impact of HPV status and smoking on mucositis in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemotherapy and radiotherapy 
Oral oncology  2014;50(9):869-876.
The standard concurrent radiotherapy and chemotherapy regimens for patients with oropharyngeal cancer are highly toxic. Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has recently emerged as a distinct biological and clinical entity with improved response to treatment and prognosis. A tailored therapeutic approach is needed to optimize patient care. The aim of our study was to investigate the impact of HPV and smoking status on early toxicities (primarily mucositis) associated with concurrent chemotherapy and radiotherapy in patients with OPSCC.
Materials and methods
We retrospectively evaluated 72 consecutive patients with OPSCC and known HPV status treated with concurrent radiotherapy and chemotherapy at our institution. Treatment-related toxicities were stratified by smoking and HPV status and compared using univariate and multivariate logistic regression.
HPV-positive patients had a 6.86-fold increase in the risk of having severe, grade 3–4 mucositis. This effect was preserved after adjusting for patient smoking status, nodal stage, radiotherapy technique and radiotherapy maximum dose. Additionally, HPV status had significant effect on the objective weight loss during treatment and at three months after treatment. Consistently, non-smokers had a significant 2.70-fold increase in the risk of developing severe mucositis.
Risk factors for OPSCC modify the incidence of treatment-related early toxicities, with HPV-positive and non-smoking status correlating with increased risk of high grade mucositis and associated outcomes. Retrospective single-institution studies need to be interpreted cautiously. However, this finding is important to consider when designing therapeutic strategies for HPV-positive patients and merits further investigation in prospective clinical trials.
PMCID: PMC4148719  PMID: 24998139
Human papillomavirus; Smoking; Oral mucositis; Radiotherapy; Chemotherapy; Squamous cell of head and neck
3.  Can guidelines improve referral to elective surgical specialties for adults? A systematic review 
Quality & Safety in Health Care  2010;19(3):187-194.
To assess effectiveness of guidelines for referral for elective surgical assessment.
Systematic review with descriptive synthesis.
Data sources
Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites.
Selection of studies
Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults.
Outcome measures
Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs.
24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change.
Guidelines for elective surgical referral can improve appropriateness of care by improving pre-referral investigation and treatment, but there is no strong evidence in favour of other beneficial effects.
PMCID: PMC2989157  PMID: 20211956
Family practice (MeSH); primary healthcare (MeSH); referral and consultation (MeSH) surgical procedures; operative (MeSH); practice guidelines (MeSH); algorithms (MeSH]
4.  Dynamic Data-Driven Finite Element Models for Laser Treatment of Cancer 
Elevating the temperature of cancerous cells is known to increase their susceptibility to subsequent radiation or chemotherapy treatments, and in the case in which a tumor exists as a well-defined region, higher intensity heat sources may be used to ablate the tissue. These facts are the basis for hyperthermia based cancer treatments. Of the many available modalities for delivering the heat source, the application of a laser heat source under the guidance of real-time treatment data has the potential to provide unprecedented control over the outcome of the treatment process [7, 18]. The goals of this work are to provide a precise mathematical framework for the real-time finite element solution of the problems of calibration, optimal heat source control, and goal-oriented error estimation applied to the equations of bioheat transfer and demonstrate that current finite element technology, parallel computer architecture, data transfer infrastructure, and thermal imaging modalities are capable of inducing a precise computer controlled temperature field within the biological domain.
PMCID: PMC2850081  PMID: 20376194
hyperthermia; real-time computing; medical imaging; cancer treatment; optimization; goal-oriented error estimation
5.  Factors associated with the health status of internally displaced persons in northern Uganda 
Globally, there are over 24 million internally displaced persons (IDPs) who have fled their homes due to violence and insecurity but who remain within their own country. There have been up to 2 million IDPs in northern Uganda alone. The objective of this study was to investigate factors associated with mental and physical health status of IDPs in northern Uganda.
A cross-sectional survey was conducted in November 2006 in IDP camps in the Gulu and Amuru districts of northern Uganda. The study outcome of physical and mental health was measured using the SF-8 instrument, which produces physical (PCS) and mental (MCS) component summary measures. Independent demographic, socio-economic, and trauma exposure (using the Harvard Trauma Questionnaire) variables were also measured. Multivariate regression linear regression analysis was conducted to investigate associations of the independent variables on the PCS and MCS outcomes.
1206 interviews were completed. The respective mean PCS and MCS scores were 42.2 (95% CI 41.32 to 43.10) and 39.3 (95% CI 38.42 to 40.13), well below the instrument norm of 50, indicating poor health. Variables with negative associations with physical or mental health included gender, age, marital status, income, distance of camp from home areas, food security, soap availability, and sense of safety in the camp. A number of individual trauma variables and the frequency of trauma exposure also had negative associations with physical and mental health.
This study provides evidence on the impact on health of deprivation of basic goods and services, traumatic events, and fear and uncertainty amongst displaced and crisis affected populations.
PMCID: PMC2635937  PMID: 19028730
6.  A meta-analysis of variables that predict significant intracranial injury in minor head trauma 
Archives of Disease in Childhood  2004;89(7):653-659.
Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury.
Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population.
Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH.
Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0).
Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.
PMCID: PMC1719991  PMID: 15210499
7.  High Quality Acute Care for the Severely Injured is not Consistently Available in England, Wales and Northern Ireland: Report of a Survey by the Trauma Committee, The Royal College of Surgeons of England 
A survey was undertaken to determine the extent to which acute hospitals in England, Wales and Northern Ireland were meeting the acute trauma management standards published in 2000 by The Royal College of Surgeons of England and the British Orthopaedic Association.
A questionnaire comprising 72 questions in 16 categories of management was distributed in July 2003 to all eligible hospitals via the link network of the British Orthopaedic Association. Data were collected over a 3-month period.
Of 213 eligible hospitals, 161 (76%) responded. In every category of acute care, failure to meet the standards was reported. Only 34 (21%) hospitals met all the 13 indicative standards that were considered pivotal to good trauma care, but all hospitals met at least 7 of these standards. Failures were usually in the organisation of services rather than a lack of resources, with the exception of the inadequate capacity for admission to specialist neurosurgery units. A minority of hospitals reported an inability to provide emergency airway control or insertion of chest tube. The data have not been verified and deficiencies in reporting cannot be excluded.
The findings of this survey suggest that high quality care for the severely injured is not available consistently across England, Wales and Northern Ireland, and appear to justify concerns about the ability of the NHS to deal effectively with the current trauma workload and the consequences of a major incident.
PMCID: PMC1964077  PMID: 16551394
Trauma; Severe injury; Acute care; Survey
8.  The experience and training of British general surgeons in trauma surgery for the abdomen, thorax and major vessels. 
BACKGROUND: The report Better Carefor the Severely Injured [London: The Royal College of Surgeons of England and the British Orthopaedic Association; 2000] states that an experienced general surgeon trained in the techniques required to perform life-saving emergency surgery is vital in the management of major trauma. The experience and training of general surgeons in the UK in the management of trauma to the abdomen, thorax and major vessels has never been assessed. METHOD: Postal questionnaire sent to UK general surgical consultants and Higher Surgical Trainees (HSTs). RESULTS: A total of 854 (48%) questionnaires were completed. Of respondents, 85% believe that major trauma should be directed to hospitals that provide a dedicated trauma service. Of non-vascular specialists, 43% felt their training was adequate to manage vascular trauma and only one-third of general surgical consultants felt adequately prepared to manage acute cardiothoracic injuries. The median number of trauma laparotomies undertaken annually was 2 for blunt injury and 1 for penetrating injury. Of HSTs, 21% had not performed a splenectomy for trauma and 44% had no experience of packing for liver injuries. CONCLUSIONS: There is limited experience and training in the surgical management of torso trauma in the UK. Implementation of the recommendations from Better Care for the Severely Injured will be hampered unless steps are taken to maximise experience and improve training.
PMCID: PMC2504212  PMID: 12484581
9.  Darbepoetin alfa is more potent in vivo and can be administered less frequently than rHuEPO 
British Journal of Cancer  2002;87(4):476-477.
© (2002) Cancer Research UK
PMCID: PMC2376125
10.  Lateral Orbital/Anterior Midfacial Degloving Approach for Nasopharyngeal Angiofibromas with Cavernous Sinus Extension 
Skull base surgery  1994;4(4):232-238.
A case of nasopharyngeal angiofibroma removed through a modified lateral approach for an infratemporal fossa resection is reported. This modification involved removing the bone of the lateral orbital apex and posterior middle fossa to expose the dura and periorbita and, when combined with a midfacial degloving approach, provided full access to the tumor abutting the cavernous sinus extradurally while preserving middle ear function.
PMCID: PMC1661816  PMID: 17171177
11.  Surgical Therapy of Glomus Vagale Tumors 
Skull base surgery  1993;3(4):182-192.
Lying between the carotid bifurcation and the jugular foramen, glomus vagale tumors share characteristics with paragangliomas of those two structures, such as invasion of the carotid artery, destruction of the skull base, and cranial neuropathies. This capability for local invasion provides a therapeutic challenge with regard to the proper assessment of tumor extent and the selection of appropriate treatment. In order to clarify an approach to the management of glomus vagale tumors, we reviewed a 10-year experience with 15 patients treated for this tumor at the University of Zürich Department of Otolaryngology, using a new system of classification. This system highlights the relative position of a vagal paraganglioma to the jugular foramen and is helpful in designing the proper therapy. Pitfalis in surgical technique, recommended preoperative evaluation, and the roles of balloon occlusion and irradiation in the treatment of these tumors, are discussed.
PMCID: PMC1656457  PMID: 17170910
12.  Spas and sensibilities: Darwin at Malvern. 
PMCID: PMC2557456  PMID: 11622586
13.  Vaginal Cytology 
British Medical Journal  1974;1(5904):391.
PMCID: PMC1633628
16.  Practicalities of nursing. 
British Medical Journal  1971;3(5776):702.
PMCID: PMC1798999  PMID: 5569555
18.  Operative Gynaecology 
British Medical Journal  1969;1(5636):103-104.
PMCID: PMC1981949
20.  Placental Insufficiency 
Postgraduate Medical Journal  1962;38(438):225-228.
PMCID: PMC2482454  PMID: 13873750
21.  Jargon 
British Medical Journal  1964;1(5383):632.
PMCID: PMC1813912
22.  Jargon 
British Medical Journal  1964;1(5377):245.
PMCID: PMC1813068
25.  Clinical Aspects of Prolonged Pregnancy 
British Medical Journal  1962;2(5312):1080-1081.
PMCID: PMC1926448  PMID: 14016070

Results 1-25 (69)