Oxford Radcliffe Hospitals NHS Trust

Oxford, United Kingdom

Oxford Radcliffe Hospitals NHS Trust

Oxford, United Kingdom
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Grant
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2010.1.2-3 | Award Amount: 2.25M | Year: 2011

EuroGentest is an FP6 European network for the harmonization of genetic testing and for the further improvement of quality in genetic services across Europe. This proposal is to support EuroGentest2, a Coordination Action that will cover the different aspects of quality assurance of genetic practice and has all the ingredients to fulfil the needs. EuroGentest2 will be concerned with setting the targets for laboratory and health professional accreditation, by contributing to guidelines and standards, and actively interacting with the professional organizations and the policy makers. EuroGentest2 will also assist the diagnostic and clinical community and the individual laboratories and counselling units in reaching those aims by providing tools for quality management and by coordinating training activities. EuroGentest2 will extend its activities from postnatal diagnostic and predictive testing to prenatal testing, thereby building on the achievements of the FP6 SAFE network, and to direct to consumer testing. A major aim of the Coordination Action will be the creation of a European association of genetic diagnostic centres that will guarantee the future of the network. The Coordination Action will lead to the further harmonization and quality assurance of genetic practice. The patients will benefit by the improvement of the analytical and clinical quality and validity of the testing, and from improved trans-border services and information. The European diagnostics industry will benefit through a faster access of innovations to the market through the validation for diagnostic use. It will enable countries and regions with less developed health care infrastructure to develop standards for best practice of provision of clinical genetic service. The Coordination Action will also identify research needs and have the capacity to set a research agenda that corresponds to the needs of the human genetics community


Ali I.,Imperial College London | Wojnarowska F.,Oxford Radcliffe Hospitals NHS Trust
British Journal of Dermatology | Year: 2011

Background Significant changes in scalp, facial and body hair occur after the menopause. These can have a significant negative impact on self-esteem and are also potential markers of endocrine or metabolic diseases. Knowledge of postmenopausal hair changes is important for clinicians to distinguish between normal physiological change and those that require further medical investigation. Objectives To assess the subjective experience of scalp, facial and body hair change in a large cohort of normal postmenopausal females. Methods Postmenopausal females aged 45 years or over of northern European origin completed a questionnaire detailing scalp, facial and body hair changes following the menopause. Women with a history of thyroid disease, oophorectomy or premature menopause were excluded from the study. The Mann-Whitney U-test and the π 2 test were used to assess the correlation between scalp, facial and body hair changes with age. Results Diffuse generalized hair loss was the most common form of scalp hair loss, reported by 26% of women. Frontal hair loss was reported by 9% of women. Facial hair gain was cited by 39% of females with the chin being the most frequent site for new growth (32% of women). Body hair loss was significantly correlated with older age (P < 0·001) and was most frequent at androgen-sensitive sites. We noted two patterns: (i) diffuse hair loss in which diffuse generalized scalp hair loss was significantly correlated with body hair loss and increasing age (P < 0·05); and (ii) frontal hair loss which was associated with higher facial hair scores and relatively younger age (P < 0·05) compared with women with diffuse hair loss. Conclusions This is the first comprehensive study of the subjective hair changes in postmenopausal women. This study demonstrates two distinct patterns of hair change relating to age, which may reflect different underlying pathophysiological mechanisms and are of relevance to the medical management of these women as well as being possible predictors of health outcomes. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.


Eley K.A.,University of Oxford | Watt-Smith S.R.,Oxford Radcliffe Hospitals NHS Trust
British Journal of Oral and Maxillofacial Surgery | Year: 2012

First described by Weber and later modified by Fergusson, the Weber-Fergusson incision has undergone numerous modifications, but the fundamental approach to maxillectomy has largely remained the same. We report the potential benefit of a nasolabial incision for partial maxillectomy. The incision is hidden within the nasolabial fold and obviates the need for division of the upper lip, which may undergo atrophy and shortening after radiotherapy. © 2011 The British Association of Oral and Maxillofacial Surgeons.


Burton M.J.,Oxford Radcliffe Hospitals NHS Trust
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome) is a rare clinical syndrome of unknown cause usually identified in children. OBJECTIVES: To assess the efficacy of tonsillectomy (with or without adenoidectomy) in children with PFAPA. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 1); MEDLINE (PubMed); EMBASE; CINAHL; mRCT (metaRegister of clinical trials, including ClinicalTrials.gov); NRR (National Research Register); LILACS; KoreaMed; IndMed; PakMediNet; China Knowledge Network; CAB Abstracts; Web of Science; BIOSIS Previews; ICTRP (International Clinical Trials Registry Platform) and Google. The date of the last search was 21 January 2010. SELECTION CRITERIA: Randomised studies comparing adeno-/tonsillectomy with non-surgical treatment. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: Two trials involving 67 children were included. One high quality study demonstrated a dramatic benefit of adenotonsillectomy in children with PFAPA diagnosed according to rigid, standard criteria with a relative 'risk' (RR) of symptom resolution after 18 months of 12.63 (95% CI 1.81 to 87.98) and a lower rate of episodes per patient-month (rate ratio 0.07; 95% CI 0.04 to 0.13). A less methodologically rigorous study enrolled some children with PFAPA, but probably included others with alternative types of recurrent pharyngitis, and performed tonsillectomy alone. This also demonstrated a significant benefit for surgery at six months: RR 1.93 (95% CI 1.11 to 3.36); rate ratio episodes per patient-month 0.10 (95% CI 0.04 to 0.28). The pooled relative risk of symptom resolution was 3.25 (95% CI 1.78 to 5.92) and the resulting number needed to treat (NNT) 2 (95% CI 1 to 3). AUTHORS' CONCLUSIONS: The trials included in this review reported follow up at 18 and six months respectively but it is well-established that children with PFAPA recover spontaneously and treatment can be administered to try and reduce the severity of individual episodes. Therefore, the parents and carers of children with PFAPA must weigh the risks and consequences of surgery (hospitalisation, a predictable period of time postoperatively away from school/nursery, the risks of surgery) against the alternative of a finite period of recurrent episodes of disease at predictable intervals, potentially requiring time off school and the regular use of medication. It is uncertain whether adenoidectomy combined with tonsillectomy adds any additional benefit to tonsillectomy alone.


Johnson D.,Oxford Radcliffe Hospitals NHS Trust | Wilkie A.O.M.,Oxford Radcliffe Hospitals NHS Trust | Wilkie A.O.M.,Weatherall Institute of Molecular Medicine
European Journal of Human Genetics | Year: 2011

Craniosynostosis, defined as the premature fusion of the cranial sutures, presents many challenges in classification and treatment. At least 20% of cases are caused by specific single gene mutations or chromosome abnormalities. This article maps out approaches to clinical assessment of a child presenting with an unusual head shape, and illustrates how genetic analysis can contribute to diagnosis and management. © 2011 Macmillan Publishers Limited All rights reserved.


Mackillop L.,Oxford Radcliffe Hospitals NHS Trust | Williamson C.,Imperial College London
Postgraduate Medical Journal | Year: 2010

Pregnancy is a time of great maternal physiological and metabolic changes. This affects the biochemical and haematological parameters used in the assessment of liver disease, and it is important to appreciate the different reference ranges in pregnancy to facilitate recognition of liver disorders in pregnancy. Due to the increased physiological and metabolic stress of pregnancy, liver disorders that have previously been subclinical may become symptomatic - for example, primary biliary cirrhosis. Gallstone disease is a common problem in women of childbearing age, and pregnancy promotes their formation. The viral hepatidides constitute a huge disease burden worldwide and the pregnant state confers particular concerns for the mother and her baby. In particular, hepatitis E has a predilection for the pregnant population and confers a particularly poor prognosis. In addition certain pregnancy specific disorders - for example, haemolysis, elevated liver enzymes, low platelets syndrome, acute fatty liver of pregnancy, and obstetric cholestasis - affect primarily the liver. It is important to know how to diagnose and manage these conditions and distinguish them from nonpregnancy specific conditions as this will change the timing and management of affected women and their babies, some of whom can be seriously ill. We propose an approach to the investigation and management of the pregnant patient with abnormal liver function tests.


Su E.L.,Royal Melbourne Hospital | Su E.L.,University of Oxford | Snape M.D.,University of Oxford | Snape M.D.,Oxford Radcliffe Hospitals NHS Trust
Expert Review of Vaccines | Year: 2011

Although meningococcal disease caused by serogroup B remains an important public health concern, a licensed vaccine providing broad protection against this pathogen is not yet available. Advances in genomics have paved the way for the discovery of new vaccine candidates for inclusion into a multicomponent serogroup B vaccine. In this article, we will review recent advances in the development of these vaccines, focussing particularly on one of the 'next generation' MenB vaccines, 4CMenB. © 2011 Expert Reviews Ltd.


White R.,Oxford Radcliffe Hospitals NHS Trust
Proceedings of the Nutrition Society | Year: 2011

Professor Pennington was an advocate for quality in all aspects of nutrition support and its delivery, ensuring that the patient remained at the centre of all decisions, and that specialist artificial nutrition support was best managed by the multidisciplinary nutrition team and the education of the wider healthcare community. Within the conference theme of Quality, this commentary aims to outline drivers for and risks to aspects of quality in parenteral nutrition (PN) services. Quality is defined as a particular property or attribute associated with excellence; in the context of the provision of PN this can be translated to quality processes and standards in the assessment, prescription, preparation, administration and monitoring of PN. Quality products and services are delivered through the timely application of knowledge, competence, procedures and standards. Quality can be so easily compromised; inattention, ignorance and arrogance all play their part. PN is a high-risk therapy; the quality of its delivery should not be entirely dependent on the skills, knowledge and competence of those delivering this care but on accepted standards, procedures, communication, resource and infrastructure. Identification of key steps in the provision of PN and a review of the relevant patient safety data reveal points where safeguards can be put in place to ensure quality is not compromised. Full evaluation of standardisation, computerisation and competency-based training as risk-reduction strategies is required. © 2011 The Authors.


Grant
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2012.4.1-4 | Award Amount: 970.62K | Year: 2012

The ECRAN (European Communication on Research Awareness Needs) project is designed to develop a portfolio of open educational resources, including a film, for the general population about the challenges raised by independent clinical research. The European Commission (FP7 Health Priority) decided to allocate substantial funding to independent (investigator-driven) clinical trials. Together with member states, the FP7 infrastructure unit supports the preparation and operation of a pan-European infrastructure for clinical trials (ECRIN). Through these instruments, Europe has the capacity to design and conduct independent, multinational clinical trials. The objective of the ECRAN project is to develop tools to communicate key messages to citizens, patients, healthcare professionals, researchers, policymakers and society about independent, multinational clinical research. These messages will focus on: i) the importance of public understanding of the need for and basic principles of clinical trials, fostering active involvement of patients in trials and of their representatives in trial design; ii) the need for independent clinical trials driven by healthcare issues, to optimise treatment strategies through comparison of benefits and harms of multiple therapeutic options, supporting evidence-based clinical practice and reduction in healthcare inequalities; iii) the need for transparency and optimal use of data, to promote the cost-effectiveness of treatments and to reduce the economic burden of diseases; iv) the need for multinational cooperation, taking advantage of Europes population size and diversity, and of its medical expertise. These objectives will be addressed using communication tools, including: a website, with an online database of open educational resources in different European languages; a film on clinical trials, dubbed in many languages, which is envisaged as a keystone of this initiative; an international event on multinational clinical trials.


Scott R.B.,Oxford Radcliffe Hospitals NHS Trust | Eccles F.,Oxford Radcliffe Hospitals NHS Trust | Molyneux A.J.,University of Oxford | Kerr R.S.C.,University of Oxford | And 2 more authors.
Stroke | Year: 2010

Background and Purpose-: The International Subarachnoid Aneurysm Trial (ISAT) reported lower rates of death and disability with endovascular versus neurosurgical treatment of ruptured intracranial aneurysms. However, assessment of functional outcome was limited to the modified Rankin Scale, which is known to be insensitive to cognitive function. A neuropsychological substudy (N-ISAT) was therefore done in all recruits from 8 ISAT centers in the United Kingdom. Methods-: Detailed neuropsychological assessment was performed at a 12-month follow-up visit. Impairment was defined as performance below the 5th percentile of the study population on at least 2 tests in ≥2 major cognitive domains. Analysis was restricted to patients who were not known to be otherwise disabled according to the modified Rankin Scale (ie, modified Rankin Scale 0 to 2). Results-: Of 836 patients randomized in ISAT in the 8 UK centers (411 allocated endovascular treatment versus 425 neurosurgery), 224 were dead or disabled before 12-month follow-up (78 allocated endovascular treatment versus 135 neurosurgery). Of the remaining 612 patients eligible for neuropsychological assessment, 137 (65 allocated endovascular treatment versus 72 neurosurgery) did not attend. Of the 474 nondisabled patients who were assessed, 152 (32.1%) had cognitive impairment. Patients with cognitive impairment had reduced self-reported health-related quality of life (P<0.001) in both treatment groups, but cognitive impairment was less common in those allocated endovascular treatment (70 of 262 versus 82 of 212 allocated neurosurgery, OR=0.58, 95% CI 0.38 to 0.87, P=0.0055). The incidence of epilepsy was also lower in the N-ISAT endovascular group (7 versus 18, OR=0.30, 0.11 to 0.77, P=0.005) but was independent of the effect on cognitive function. Conclusions-: Cognitive impairment occurred in approximately one third of patients who were not otherwise disabled according to the modified Rankin Scale in N-ISAT and was more frequent in the neurosurgery group. These results have implications for management of ruptured intracranial aneurysms and more generally for interpretation of the outcomes of clinical trials that use the modified Rankin Scale. © 2010 American Heart Association, Inc.

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