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Belo Horizonte, Brazil

Williams E.J.,Bh Tec Inc. | Ogollah R.,Bournemouth University | Thomas P.,Bournemouth University | F. Logan R.,Queens Medical Center | And 3 more authors.
Endoscopy | Year: 2012

Study background and aims: Predicting outcome at endoscopic retrograde cholangiopancreatography (ERCP) remains difficult. Our aimwas to identify the risk factors for failed ERCP. Patients and methods: A prospective multicenter study of ERCP was performed in 66 hospitals across England. Data on 4561 patients were collected using a structured questionnaire completed at the time of ERCP. Results: In total 3209 patients had not had an ERCP prior to the study period. Considering their first ever ERCP, 2683 (84 %) were successfully cannulated, 2241(70%) had all intended therapy completed, 360 (11 %) had some intended therapy completed, and 608 (19 %) were considered to have had a failed procedure. For first ever ERCP, factors associated with incomplete procedure (odds ratio and 95% confidence interval) were: Billroth surgery (9.2, 3.2-26.7), precutting (2.0, 1.6-2.7), common bile duct (CBD) stone size and number (3.2, 2.1-4.8 for multiple, large stones), interventions in the pancreatic duct (3.4, 1.6- 7.0), and CBD stenting (2.8, 2.2-3.5). Analysis of the 1352 patients who had undergone an ERCP prior to the study period indicated previous failed ERCP was also predictive of incomplete therapy (1.5, 1.1-2.1). The modified Schutz score correlated with ERCP completion, as did the Morriston score, even when modified to include only variables measurable before the procedure. Conclusion: This study confirms that patient- and procedure-based variables are key predictors of technical success and validates current methods of rating ERCP difficulty. Of note, a correlation between outcome and institutional factors, such as unit and endoscopist caseload, was not demonstrated. © Georg Thieme Verlag KG, Stuttgart New York. Source

MacGregor K.,Bh Tec Inc.
Journal of perioperative practice | Year: 2013

Anaesthesia awareness is a terrifying prospect for any patient undergoing a surgical procedure and can cause considerable physical and psychological distress. Recommendations to reduce the risk of anaesthesia awareness include: undertaking a thorough preoperative assessment, ensuring that equipment has been checked, reducing drug error, consistent monitoring, and investment in safer technology. By implementing these recommendations it is hoped that patient safety and care can be improved during clinical anaesthesia. Source

Radley J.D.,University of Birmingham | Coram R.A.,Bh Tec Inc.
Geology Today | Year: 2014

Quartzite pebbles and cobbles, commonly known as Bunter quartzites, are widely dispersed throughout southern Britain. They can be traced back to Early Triassic pebble beds outcropping in the Wessex Basin and the English Midlands. Derived fossils within the quartzites confirm that most, if not all, were derived from Ordovician and Devonian terrains, over what is now the general region of the Armorican peninsula of north-west France. In Early Triassic times that area of ancient rocks formed part of a chain of young Variscan mountains which were subject to a monsoonal climate, and shed vast quantities of eroded quartzite. Ultimately, this debris was transported northwards into what is now southern Britain, by the Budleighensis river system. © 2014 John Wiley & Sons Ltd, The Geologists' Association & The Geological Society of London. Source

Komisarovas L.,Poole Hospital NHS Foundation Trust | Jayasinghe C.,Bh Tec Inc. | Seah T.E.,National Dental Center | Ilankovan V.,Poole Hospital NHS Foundation Trust
British Journal of Oral and Maxillofacial Surgery | Year: 2011

Trends in the incidence and the sites of primary malignant melanoma on the skin of head and neck in Dorset as well as the outcome of treated cases were overviewed for the first time. Increase in incidence rate of cutaneous head and neck melanoma from 1.3 per 100,000 in 2004 to 3.1 per 100,000 in 2007 was recorded. The most prevalent histogenetic type of cutaneous malignant melanoma on head and neck in our study was melanoma of superficial spreading type 35.1% (n = 20) of all registered cases. Superficial spreading melanoma apart from being the most common type of malignant melanoma of the head and neck in Dorset also showed increase in the number of diagnosed cases of the reviewed years. It increased from 2 (22.2%) of all head and neck melanoma cases in 2004 to 7 (30.4%) in 2007. The average age at the time of diagnosis the cutaneous malignant melanoma of head and neck for both men and women was 73.5 years. Breslow thickness, Clark's level of invasion, tumour ulceration and anatomical site remained the most important prognostic factors. Correlation between Breslow thickness and Clark's level of invasion found to be stronger in men. © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Source

Rossetti A.O.,Bh Tec Inc. | Rossetti A.O.,University of Lausanne | Alvarez V.,University of Lausanne | Januel J.-M.,University of Lausanne | Burnand B.,University of Lausanne
Journal of Neurology | Year: 2013

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (±30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ≥3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ≥3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches. © 2012 Springer-Verlag. Source

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