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Renshaw C.,Kings College London | Ketley N.,Queen Elizabeth Hospital NHS Trust | Moller H.,Kings College London | Davies E.A.,Kings College London
BMC Cancer | Year: 2010

Background: Multiple myeloma is an uncommon cancer with a poor prognosis. Its incidence is expected to increase due to ageing populations and better diagnosis, and new treatments have been developed to improve survival. Our objective was to investigate trends in the epidemiology and survival of multiple myeloma for South East England.Methods: Data on 15,010 patients diagnosed with multiple myeloma between 1985 and 2004 was extracted from the Thames Cancer Registry database. We calculated the yearly age-standardised incidence rates for males and females and age-specific incidence rates in 10-year age groups for both sexes combined. We also explored geographical variation in incidence across primary care trusts. We then used period analysis to calculate trends in 1- and 5-year relative survival over the 15 years 1990-2004, comparing survival by sex and by age group 59 years and below versus 60 years and above. Finally, we investigated 5-year relative survival for the period 2000-2004 by socio-economic deprivation, assigning patients to quintiles of deprivation using the Income Domain of the Index of Multiple Deprivation 2004 based on postcode of residence.Results: The incidence of multiple myeloma was higher in males than in females and in patients over 70, throughout the period 1985-2004. No obvious geographical pattern of incidence by primary care trust emerged. The 1- and 5-year relative survival of male and female patients increased in both age groups and was statistically significant in males aged over 60. There was a tendency for better survival in patients resident in the most affluent areas, but this did not reach statistical significance.Conclusions: The trends in incidence of multiple myeloma in males and females are similar to that reported from other western populations. Relative survival was higher for younger patients although we found significant improvements in 1-year relative survival for male patients over 60 years old. The improved survival demonstrated for patients of all ages is likely to reflect increased detection, earlier diagnosis and the introduction of new treatments. Future studies should investigate the influence of ethnicity on incidence and survival, and the effect of specific treatments on survival and quality of life. © 2010 Renshaw et al; licensee BioMed Central Ltd. Source

Hodd J.,Queen Elizabeth Hospital NHS Trust
Nursing in critical care | Year: 2010

To estimate the ability of simulated tracheal suction, adjusting the positive end expiratory pressure (PEEP) settings on the ventilator or compressing a self-inflating bag to minimize aspiration during cuff deflation and extubation in a bench-top model. During intubation, colonized secretions accumulate in the subglottic space above the endotracheal tube (ETT) cuff. Consequently, during cuff deflation and extubation, there is a risk of aspiration of the secretions. This may result in pneumonitis or pneumonia. There are a number of techniques used during cuff deflation and extubation to prevent secretion aspiration. A model trachea was intubated and the proximal end of the ETT was attached to a mechanical ventilator. Ten millilitres of water was placed above the inflated cuff and then nine test protocols were implemented in a random order to simulate tracheal suction, adjusting the PEEP settings on the ventilator or compressing a self-inflating bag. The volume of water 'aspirated' by the model was determined by weighing the apparatus pre- and post-extubation. Statistical analysis was performed using regression analysis and heteroscedastic t tests with a Bonferroni correction. The level of PEEP was negatively correlated with the volume of fluid aspirated [co-efficient -0.24 (99% confidence interval -0.31 to -0.17), R(2) = 0.75]. Significantly less fluid was aspirated when a PEEP of 35 cmH(2)O was applied when compared with competing techniques. This study suggests that applying PEEP during cuff deflation and extubation is protective against aspiration. We conclude that unless there is a contraindication, the application of PEEP should be considered when extubating patients. Source

Mahendru A.A.,Foundation University | Al-Taher H.,Queen Elizabeth Hospital NHS Trust
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2010

Introduction and hypothesis: Cystodistension is not a standardised procedure; however, it is being used for various indications. Methods: Four hundred eighty-six questionnaires were posted to consultant gynaecologists, urologists and urogynaecologists in the UK to evaluate the current practice with regards to the indications, technique, benefits and complications of cystodistension. Results: The response rate was 39%. The analysis of each question was done separately. 58.8% of respondents were urogynaecologists or gynaecologists. The most common indication to perform cystodistension was interstitial cystitis both for diagnosis and treatment followed by reduced bladder capacity (40.7%) and overactive bladder (35.4%). Most of the respondents (96%) performed short-duration distension for <20 minutes. Conclusions: It appears that cystodistension has a role in practice; however, its indications and benefits are still controversial and there is a wide variation in the technique of cystodistension due to lack of standardisation. Further research is needed before any conclusions about its benefits and safety can be made. © 2009 The International Urogynecological Association. Source

Hodd J.,Queen Elizabeth Hospital NHS Trust
Nursing in critical care | Year: 2010

To determine the current practice among critical care nurses in the UK with regard to airway management during cuff deflation and extubation. There are a number of techniques used by clinicians to prevent aspiration during cuff deflation and extubation of patients. There are no published clinical studies comparing the different manoeuvres available to clinicians at the time of extubation nor any data to suggest which technique is most commonly used. All members of the British Association of Critical Care Nurses with an email address were invited to participate in an online survey. A total of 533 (29%) nurses from 184 (84%) intensive care unit (ICUs) in the UK completed the survey. Just under half of the sample (n = 258, 48.4%) had more than 10 years of critical care experience and the vast majority (n = 427, 80.1%) worked in general ICUs. The majority of respondents (n = 461, 86.5%) suction the trachea during cuff deflation and extubation. A further 304 (57%) respondents ask patients to cough as part of extubation. Respondents increase the positive end expiratory pressure setting on the ventilator infrequently as part of routine procedure for extubation (n = 7, 1.3%). The majority of UK critical care nurses either suction the trachea during cuff deflation and extubation of patients and/or simply ask the patient to cough. Further clinical trials are required to identify the most appropriate and safe technique for critically ill patients. © 2010 The Authors. Nursing in Critical Care © 2010 British Association of Critical Care Nurses. Source

Cockburn J.,University of Sussex | Hildick-Smith D.,University of Sussex | Cotton J.,Royal Wolverhampton Hospitals NHS Trust | Doshi S.,Queen Elizabeth Hospital NHS Trust | And 6 more authors.
International Journal of Cardiology | Year: 2014

Introduction Rotational atherectomy (RA) is widely used for treating calcified coronary lesions. Clinical data however remain limited. Methods We assessed outcome and survival among patients undergoing percutaneous coronary intervention (PCI) with or without RA in the UK between September 2007 and March 2011. Results Data from 221,669 percutaneous coronary intervention (PCI) procedures were analysed; 2152 patients (0.97%) underwent RA (RA +); the remainder underwent conventional PCI (RA -). RA + patients were older (71.7 ± 9.6 vs. 64.1 ± 12.8 year; p < 0.001), and had a higher incidence of diabetes (26.4% vs. 18.0%; p < 0.001), hypertension, (61.9% vs. 49.4%; p < 0.001), peripheral vascular disease (9.9% vs. 4.2%, p < 0.001), cerebrovascular disease (5.5% vs. 3.4%, p < 0.001), renal impairment (3.4% vs. 1.5%, p < 0.001) and poor left ventricular function (11.4% vs. 4.3%,p < 0.001). Procedural success was lower among RA + patients (90.3% vs 94.6%; p < 0.001) and procedural complications were more frequent (9.7% vs 5.4%; p < 0.001). After 2.4 ± 1.2 years follow-up, unadjusted Cox proportional hazard modeling demonstrated poorer survival for RA + patients (HR 2.21, 95%CI 1.97-2.49; p < 0.0001). This disadvantage remained after adjustment for adverse variables (HR 1.26, 95%CI 1.11-1.44; p = 0.0004) and following propensity analysis. There was evidence however of improved survival for RA + patients with left main stem disease (HR 0.52, 95%CI 0.35-0.75, p < 0.0001), and peripheral vascular disease (HR 0.65, 95%CI 0.43-0.98, p < 0.0005). Conclusions Rotational atherectomy was undertaken in patients with higher pre-procedural risk. Medium term survival was worse among patients undergoing rotational atherectomy, and this survival disadvantage remained after correction for available adverse factors. Rotational atherectomy however remains clinically useful for patients with calcified coronary lesions. © 2013 Elsevier Ireland Ltd. Source

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