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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. Source


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. Source


Spinks J.,Oxford Radcliffe Hospitals NHS Trust
BMJ Case Reports | Year: 2010

A case of a 4-month-old girl with a subglottic haemangioma successfully treated with propranolol is reported. Source


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. Source


Grant
Agency: Cordis | 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.

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