Mahomed K.,Ipswich Hospital
Cochrane database of systematic reviews (Online) | Year: 2011
Vitamin D deficiency can occur in people whose diet is relatively low in the vitamin and those who are not exposed to much sunlight. The objective of this review was to assess the effects of vitamin D supplementation on pregnancy outcome. We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001). Acceptably controlled trials of vitamin D supplementation during pregnancy. One reviewer assessed trial quality and extracted data. Two trials involving 232 women were included. In one trial the mothers had higher mean daily weight gain and lower number of low birthweight infants. In the other trial the supplemented group had lower birthweights. There is not enough evidence to evaluate the effects of vitamin D supplementation during pregnancy.
Ahmad Z.,Norwich University |
Siddiqui N.,Brisbane Hand and Upper Limb Unit |
Malik S.S.,Ipswich Hospital |
Abdus-Samee M.,University of London |
And 2 more authors.
Bone and Joint Journal | Year: 2013
Lateral epicondylitis, or 'tennis elbow', is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment. This review discusses the mechanism of disease, symptoms and signs, investigations, current management protocols and potential new treatments. © 2013 The British Editorial Society of Bone & Joint Surgery.
Phillips J.S.,Norwich University |
Yung M.W.,Ipswich Hospital
Clinical Otolaryngology | Year: 2014
Objective: To determine the COMQ-12 score in an adult population without active COM. Design: Analysis of COMQ-12 scores in participants without active COM. Setting: East Anglia, United Kingdom. Participants: 70 healthy volunteers recruited from two local hospitals. Main outcome measures: COMQ-12. Results: The median COMQ-12 score overall was two and the modal score was 0 with 27 (39%) participants achieving this score. Conclusion: We recommend that the 'normal' values defined in this study be seriously considered before contemplating intervention, especially when patients with low scores are considered for surgery. © 2014 John Wiley & Sons Ltd.
Schoenwald A.V.,Ipswich Hospital
Australian Health Review | Year: 2011
Purpose. This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management. Healthcare setting. The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice. Method of data collection. Data were conveniently collected by the NP on prescription and service provision over 200 working days. Main findings. Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics. Principal conclusions. These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required. What is known about the topic? There is little published information on the development of the Nurse Practitioner (NP) role in acute pain services in Australia or overseas. The acute pain role is a new development in Australia and so previous descriptions of NP practice have focussed on other specialty areas such as Emergency or Mental Health. What does this paper add? This report demonstrates positive and safe client outcomes as a result of a NP role in acute pain management. More importantly, it may contribute to accumulating evidence that NPs are safe prescribers of opioids and other analgesics in acute settings. What are the implications for practitioners? Novice NPs and Candidates practising in this specialty need to use this information as support for their own role development and implementation in other acute pain services in Australia. © 2011 AHHA.
Dearnaley D.P.,Institute of Cancer Research |
Jovic G.,University College London |
Syndikus I.,Clatterbridge Center for Oncology |
Khoo V.,Royal Marsden NHS Foundation Trust |
And 13 more authors.
The Lancet Oncology | Year: 2014
Background: The aim of this trial was to compare dose-escalated conformal radiotherapy with control-dose conformal radiotherapy in patients with localised prostate cancer. Preliminary findings reported after 5 years of follow-up showed that escalated-dose conformal radiotherapy improved biochemical progression-free survival. Based on the sample size calculation, we planned to analyse overall survival when 190 deaths occurred; this target has now been reached, after a median 10 years of follow-up. Methods: RT01 was a phase 3, open-label, international, randomised controlled trial enrolling men with histologically confirmed T1b-T3a, N0, M0 prostate cancer with prostate specific antigen of less than 50 ng/mL. Patients were randomly assigned centrally in a 1:1 ratio, using a computer-based minimisation algorithm stratifying by risk of seminal vesicle invasion and centre to either the control group (64 Gy in 32 fractions, the standard dose at the time the trial was designed) or the escalated-dose group (74 Gy in 37 fractions). Neither patients nor investigators were masked to assignment. All patients received neoadjuvant androgen deprivation therapy for 3-6 months before the start of conformal radiotherapy, which continued until the end of conformal radiotherapy. The coprimary outcome measures were biochemical progression-free survival and overall survival. All analyses were done on an intention-to-treat basis. Treatment-related side-effects have been reported previously. This trial is registered, number ISRCTN47772397. Findings: Between Jan 7, 1998, and Dec 20, 2001, 862 men were registered and 843 subsequently randomly assigned: 422 to the escalated-dose group and 421 to the control group. As of Aug 2, 2011, 236 deaths had occurred: 118 in each group. Median follow-up was 10·0 years (IQR 9·1-10·8). Overall survival at 10 years was 71% (95% CI 66-75) in each group (hazard ratio [HR] 0·99, 95% CI 0·77-1·28; p=0·96). Biochemical progression or progressive disease occurred in 391 patients (221 [57%] in the control group and 170 [43%] in the escalated-dose group). At 10 years, biochemical progression-free survival was 43% (95% CI 38-48) in the control group and 55% (50-61) in the escalated-dose group (HR 0·69, 95% CI 0·56-0·84; p=0·0003). Interpretation: At a median follow-up of 10 years, escalated-dose conformal radiotherapy with neoadjuvant androgen deprivation therapy showed an advantage in biochemical progression-free survival, but this advantage did not translate into an improvement in overall survival. These efficacy data for escalated-dose treatment must be weighed against the increase in acute and late toxicities associated with the escalated dose and emphasise the importance of use of appropriate modern radiotherapy methods to reduce side-effects. Funding: UK Medical Research Council. © 2014 Dearnaley et al. Open Access article distributed under the terms of CC BY.