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Storey R.F.,University of Sheffield | Angiolillo D.J.,University of Florida | Bonaca M.P.,Brigham and Womens Hospital | Thomas M.R.,University of Sheffield | And 11 more authors.
Journal of the American College of Cardiology

Background The PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial studied 2 doses of ticagrelor, 90 mg twice a day (bid) and 60 mg bid, for long-term prevention of ischemic events in patients with prior myocardial infarction. Both doses similarly reduced the rate of ischemic events versus placebo. The pharmacokinetics and pharmacodynamics of ticagrelor 60 mg bid have not been studied. Objectives In this study, the authors sought to study the pharmacokinetics and pharmacodynamics for ticagrelor 60 mg compared with 90 mg bid. Methods A total of 180 patients who received >4 weeks of study medication had blood sampling in the morning pre-maintenance dose and again 2 h post-dose. All patients received aspirin. Plasma levels of ticagrelor and its active metabolite AR-C124910XX were determined. P2Y12 inhibition was assessed by the VerifyNow P2Y12 assay (Accumetrics, Inc., San Diego, California) (P2Y12 reaction units [PRU]), light transmittance aggregometry (adenosine diphosphate 5 and 20 μmol/l and arachidonic acid), and vasodilator-stimulated phosphoprotein phosphorylation assays. VerifyNow Aspirin assays and serum thromboxane B2 measurements were performed. Results Mean pre- A nd post-dose plasma levels of ticagrelor were 35% and 38% lower, respectively, with 60 mg versus 90 mg. Both doses achieved high levels of platelet inhibition pre- A nd post-dose, with numerically slightly more variability with 60 mg: Mean (SD) pre-dose PRU values were 59 ± 63 and 47 ± 43 for ticagrelor 60 and 90 mg, respectively (p = 0.34). High platelet reactivity, determined as PRU >208, was rare with the 60-mg pre-dose and was absent post-dose. Platelet reactivity pre- A nd post-dose, as measured by light transmittance aggregometry or vasodilator-stimulated phosphoprotein assays, was numerically but not significantly lower with 90 mg than with 60 mg. Aspirin response was not affected by either dose. Conclusions Ticagrelor 60 mg bid achieved high levels of peak and trough platelet inhibition in nearly all patients, similar to that with 90 mg bid, helping to explain the efficacy of the lower ticagrelor dose in PEGASUS-TIMI 54. © 2016 American College of Cardiology Foundation. Source

Smith M.J.,Rotherham NHS Foundation Trust | Perkins A.C.,University of Nottingham
Nuclear Medicine Communications

BACKGROUND: The radiopharmaceutical 23-(Se)selena-25-homotaurocholic acid (SeHCAT), introduced 30 years ago, serves as a convenient and reliable diagnostic test for bile acid malabsorption. Recent advances in understanding the pathophysiology of bile acid diarrhoea have led to increased use of SeHCAT; however, some questions on its applicability remain unanswered. To obtain a better understanding of the application of this diagnostic test, a national survey was carried out within the UK. METHODS: A web-based semistructured questionnaire was used. Invitations to participate were sent to the lead contacts of the 227 Nuclear Medicine Departments in the UK known to the British Nuclear Medicine Society. Information was sought on workload, trends in referrals, acquisition protocols, patient preparation, results, normal ranges and interpretation. For those not using SeHCAT, questions on reasons for not using the test and intentions to commence its use in the future were asked. RESULTS: Responses from 129 UK centres were included in analysis. Seventy-three of these (57%) used SeHCAT in diagnosis, and most of them reported an increase in referrals over the last 3 years. Several departments have started using SeHCAT recently in response to demand from clinicians. There was considerable variability in the practical implementation of the technique and the 'normal' range used for reporting. CONCLUSION: The findings from the survey have provided a better understanding of how diagnosis using SeHCAT is carried out in the UK. An important finding was the wide variation in the normal reference values used for diagnostic reporting. Establishing greater consistency in the interpretation and reporting of the results of this test would be of considerable clinical value. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins. Source

Mangnall J.,Rotherham NHS Foundation Trust
British Journal of Community Nursing

Intermittent catheterisation provides a safe and effective alternative to indwelling catheterisation for many patients who require bladder drainage. It can be undertaken by health professionals in a variety of clinical settings for a range of clinical indications and, more commonly, by patients themselves. This article will consider intermittent catheterisation, its indications as a bladder drainage technique and considerations for community nurses when teaching the technique. © 2015 MA Healthcare Ltd. Source

Garner J.,Rotherham NHS Foundation Trust
Journal of the Royal Army Medical Corps

Getting academic research published can be a daunting undertaking at first, and before the advent of academic junior doctor posts, was a hidden art for most. Publications remain an important milestone in academic progress in many disciplines and in some medical specialties are a prerequisite for selection to higher training grades. This article provides a brief overview of some of the issues facing those wishing to publish and how they may be overcome. Source

Cuff A.,Rotherham NHS Foundation Trust
International Journal of Therapy and Rehabilitation

Background/Aims: Arthroscopic subacromial decompression (ASAD) surgery poses a risk of developing post-operative shoulder stiffness. This has proven to be a significant concern to the patient, surgeon and therapist, despite early mobilisation rehabilitation. The post-operative stiff shoulder is often recalcitrant to conservative treatment. This case report aims to describe a novel conservative treatment option for post-operative shoulder stiffness in a patient following ASAD for subacromial pain. Methods: A 39-year-old male with a stiff shoulder following ASAD for subacromial pain engaged in a self-stretching exercise programme using a novel treatment device, the Rotater, which allows passive stretching of the shoulder into internal and external rotation. Results: The patient demonstrated marked improvement in active range of motion (ROM) in all directions post-intervention, with a concomitant clinically significant improvement demonstrated on the Oxford Shoulder Score (34/48 at baseline; 44/48 post-intervention). Conclusions: The introduction of the Rotater into the patient’s rehabilitation resulted in improved rotational ROM, a clinically significant improvement in function of the affected shoulder and the prevention of further operative treatment. © 2015, MA Healthcare Ltd. Source

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