PubMed | Bournemouth University, Belfast City Hospital, Royal Bournemouth Hospital NHS Foundation Trust, Cancer Research UK Research Institute and 4 more.
Type: Journal Article | Journal: Leukemia & lymphoma | Year: 2016
Chronic lymphocytic leukemia (CLL) is characterized by heterogeneous clinical behavior and there is a need for improved biomarkers. The current study evaluated the prognostic significance of serum free light chains (sFLC, kappa, and lambda) and other serum markers (bar, serum thymidine kinase (sTK), soluble CD23, and LDH) together with established biomarkers in 289 patients enrolled into the LRF CLL4 trial. In a multivariable analysis of serum markers alone, higher big and kappa light chains were statistically significant in predicting disease progression and higher blg, and sTK in predicting mortality. In multivariable analysis for overall survival the following were independently significant: 2M levels, immunoglobulin gene (IGHV) mutational status (>98% homology), age, 17p13 deletions (>10%), and CD38 expression. 2M is the only serum marker that retained clear independent value as a biomarker in the LRF CLL4 trial and remains powerfully prognostic requiring evaluation in any future method of risk stratifying patients.
Kerr D.,Royal Bournemouth Hospital NHS Foundation Trust |
Wizemann E.,Diabetes Schwerpunktpraxis |
Senstius J.,Novo Nordisk AS |
Zacho M.,Novo Nordisk AS |
Ampudia-Blasco F.J.,University of Valencia
Journal of Diabetes Science and Technology | Year: 2013
Aim: We review and summarize the literature on the safety and stability of rapid-acting insulin analogs used for continuous subcutaneous insulin infusion (CSII) in patients with diabetes. Methods: Two predefined search strategies were systematically implemented to search Medline and the Cochrane Register of Clinical Trials for publications between 1996 and 2012. Results: Twenty studies were included in the review: 13 in vitro studies and 7 clinical studies. In vitro studies investigated the effects of extreme CSII conditions (high temperature and mechanical agitation) on the risk of catheter occlusions and insulin stability factors, such as potency, purity, high molecular weight protein content, pH stability, and preservative content (m-cresol, phenol). Under these conditions, the overall stability of rapid-acting insulin analogs was similar for insulin lispro, insulin aspart, and insulin glulisine, although insulin glulisine showed greater susceptibility to insulin precipitation and catheter occlusions. A limited number of clinical trials were identified; this evidence-based information suggests that the rate of catheter occlusions in patients with type 1 diabetes using CSII treatment may vary depending on the rapid-acting analog used. Conclusions: Based on a limited amount of available data, the safety, stability, and performance of the three available rapidacting insulin analogs available for use with CSII were similar. However, there is limited evidence suggesting that the risk of occlusion may vary with the insulin preparation under certain circumstances. © Diabetes Technology Society.
Olateju T.,Queen Alexandra Hospital |
Begley J.,Royal Bournemouth Hospital NHS Foundation Trust |
Flanagan D.,Derriford Hospital |
Kerr D.,Royal Bournemouth Hospital |
Kerr D.,Bournemouth University
Journal of Diabetes Science and Technology | Year: 2012
Background: Most manufacturers of blood glucose monitoring equipment do not give advice regarding the use of their meters and strips onboard aircraft, and some airlines have blood glucose testing equipment in the aircraft cabin medical bag. Previous studies using older blood glucose meters (BGMs) have shown conflicting results on the performance of both glucose oxidase (GOX)- and glucose dehydrogenase (GDH)-based meters at high altitude. The aim of our study was to evaluate the performance of four new-generation BGMs at sea level and at a simulated altitude equivalent to that used in the cabin of commercial aircrafts. Methodology/Principal Findings: Blood glucose measurements obtained by two GDH and two GOX BGMs at sea level and simulated altitude of 8000 feet in a hypobaric chamber were compared with measurements obtained using a YSI 2300 blood glucose analyzer as a reference method. Spiked venous blood samples of three diferent glucose levels were used. The accuracy of each meter was determined by calculating percentage error of each meter compared with the YSI reference and was also assessed against standard International Organization for Standardization (ISO) criteria. Clinical accuracy was evaluated using the consensus error grid method. The percentage (standard deviation) error for GDH meters at sea level and altitude was 13.36% (8.83%; for meter 1) and 12.97% (8.03%; for meter 2) with p = .784, and for GOX meters was 5.88% (7.35%; for meter 3) and 7.38% (6.20%; for meter 4) with p = .187. There was variation in the number of time individual meters met the standard ISO criteria ranging from 72-100%. Results from all four meters at both sea level and simulated altitude fell within zones A and B of the consensus error grid, using YSI as the reference. Conclusions: Overall, at simulated altitude, no diferences were observed between the performance of GDH and GOX meters. Overestimation of blood glucose concentration was seen among individual meters evaluated, but none of the results obtained would have resulted in dangerous failure to detect and treat blood glucose errors or in giving treatment that was actually contradictory to that required. © Diabetes Technology Society.
Olateju T.,Royal Hampshire County Hospital |
Begley J.,Royal Bournemouth Hospital NHS Foundation Trust |
Green D.J.,Keele University |
Kerr D.,Bournemouth University
Canadian Journal of Diabetes | Year: 2015
Objective: To determine the physiologic and glycemic responses to energy drinks by people with type 1 diabetes. Methods: In a double-blind randomized comparison of Red Bull, Red Bull Light and a control drink, 16 adults (11 females; average age 31.5 years) with type 1 diabetes and an average glycated hemoglobin (A1C) of 68 mmol/mol were given 750 mL of Red Bull, Red Bull Light and Suso Orange in a random order. During 3 hours, comparisons were made of blood pressure and blood glucose and caffeine levels; 4-choice reaction time (4CRT) and a digit symbol substitution test were used to assess cognitive performance. Mood was measured using the University of Wales Institute of Science and Technology mood adjective checklist. Results: Consumption of Red Bull and Suso Orange were associated with an early sustained rise in blood glucose, which was augmented by Red Bull (p=0.02). A transient rise in systolic blood pressure (115.9mm Hg to 124.5 mm Hg and 115.8 mm Hg to 125.9 mm Hg, respectively, both p<0.01) followed consumption of Red Bull and Red Bull Light. There were less consistent changes in diastolic blood pressure and heart rate. Consumption of both energy drinks resulted in modest improvement in performance on the digit substitution test but had no effect on 4CRT. Energy arousal and hedonic tone were influenced transiently only, following the consumption of Suso Orange. Conclusions: Consumption of energy drinks can result in a significant carbohydrate load for people with diabetes, and patients must consider the need to adjust their insulin regimens appropriately. Caffeine-containing energy drinks can cause a rise in blood pressure, which may be an important consideration for individuals at risk for diabetes-related complications. © 2015 Canadian Diabetes Association.
Marden S.,Royal Bournemouth Hospital NHS Foundation Trust |
Thomas P.W.,Bournemouth University |
Sheppard Z.A.,Bournemouth University |
Knott J.,Royal Bournemouth Hospital NHS Foundation Trust |
And 2 more authors.
Diabetic Medicine | Year: 2012
Aims To assess the numeracy and literacy skills of individuals with Type1 diabetes and determine if there is a relationship with achieved glycaemic control independent of their duration of diabetes, diabetes education, demographic and socio-economic factors. Methods One hundred and twelve patients completed the study (mean current age 43.8±12.5years, 47% male, mean duration of diabetes 22.0±13.2years) out of 650 randomly selected patients from the Bournemouth Diabetes and Endocrine Centre's diabetes register. The Skills for Life Initial Assessments were used to measure numeracy and literacy. These indicate skills levels up to level2, equivalent to the national General Certificate of Secondary Education grades A*-C. HbA 1c was also measured. Pearson's correlation was used to measure the correlation of numeracy and literacy scores with HbA 1c. To compare mean HbA 1c between those with or without level2 skills, t-tests were used, and multiple linear regression was used to investigate whether any differences were independent of duration of diabetes, diabetes education, demographic and socio-economic factors. Results Literacy was not associated with achieved HbA 1c. In contrast, participants with numeracy skills at level2 or above achieved an HbA 1c lower than those with numeracy skills below level2 (P=0.027). Although higher socio-economic status was associated with lower mean HbA 1c, the relationship between numeracy and HbA 1c appeared to be independent of socio-economic factors. Conclusions Low numeracy skills were adversely associated with diabetes control. Assessment of numeracy skills may be relevant to the structure of diabetes education programmes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
Vaughan N.,Bournemouth University |
Dubey V.N.,Bournemouth University |
Wainwright T.W.,Royal Bournemouth Hospital NHS Foundation Trust |
Middleton R.G.,Royal Bournemouth Hospital NHS Foundation Trust
Proceedings of the 2015 Science and Information Conference, SAI 2015 | Year: 2015
This paper summarises recent validation studies and evidence demonstrating whether training on virtual reality (VR) simulators directly relates to improved performance in-vivo for orthopaedic surgical procedures. This research provides a summary of transfer validity on virtual reality orthopaedic simulators. This covers studies which have shown validation of simulators and have shown the transfer of simulator-acquired skill to the operating room. The findings of this study are that there are 6 studies showing transfer of skill for VR to in-vivo However more studies assessing efficacy and transfer validity are required to conclusively quantify the transfer validity of VR orthopaedic simulators. However there is a popular positive opinion for the ability of VR training to convert into better in-vivo performance. © 2015 IEEE.
PubMed | University of Valladolid, Nottingham City Hospital and Royal Bournemouth Hospital NHS Foundation Trust
Type: Journal Article | Journal: Clinical Medicine Insights. Oncology | Year: 2016
Despite advances in the treatment of colorectal cancer (CRC), it remains the second most common cause of cancer-related death in the Western world. Angiogenesis is a complex process that involves the formation of new blood vessels from preexisting vessels. It is essential for promoting cancer survival, growth, and dissemination. The inhibition of angiogenesis has been shown to prevent tumor progression experimentally, and several chemotherapeutic targets of tumor angiogenesis have been identified. These include anti-vascular endothelial growth factor (VEGF) treatments, such as bevacizumab (a VEGF-specific binding antibody) and anti-VEGF receptor tyrosine kinase inhibitors, although antiangiogenic therapy has been shown to be effective in the treatment of several cancers, including CRC. However, it is also associated with its own side effects and financial costs. Therefore, the identification of biomarkers that are able to identify patients who are more likely to benefit from antiangiogenic treatment is very important. This article intends to be a concise summary of the potential biomarkers that can predict or prognosticate the benefit of antiangiogenic treatments in CRC, and also what we can expect in the near future.
Kerr D.,Royal Bournemouth Hospital NHS Foundation Trust |
Messing R.,Abbott Laboratories |
Resch A.,Abbott Laboratories
Journal of Diabetes Science and Technology | Year: 2011
Self-monitoring of blood glucose (SMBG) values is an accepted requirement for patients with diabetes using multiple daily injections of insulin. Nevertheless, for many patients, the full value of SMBG has yet to be realized due to a number of factors that contribute to patients not taking appropriate action based on the achieved result. The reasons for this are complex but are related to the burden imposed by performing the tests, the need for complex numerical calculations, and the demand for undertaking this activity multiple times each day. In the near future, SMBG devices are likely to include technological innovations that are aimed at overcoming these barriers, offering "actionable" SMBG for patients using insulin. These innovations should include technologies that will allow customization and individualization based upon specific therapy regimens. © Diabetes Technology Society.
Sims J.,Royal Bournemouth Hospital NHS Foundation Trust |
Richardson T.,Royal Bournemouth Hospital NHS Foundation Trust |
Kerr D.,Royal Bournemouth Hospital NHS Foundation Trust
Clinical Risk | Year: 2010
Despite having been first used in 1922, insulin prescription errors for hospitalized patients remain common. Improper use of insulin for people hospitalized with diabetes can lead to serious adverse clinical outcomes, prolonged length of stay with important health economic consequences, and a poor patient experience of their hospital treatment. Although the problem of insulin prescription errors is widely appreciated, the approach to reducing the risk of these occurring is variable and subject to local influences and interpretation of current guidance. In addition, risk management in this area appears to be based upon the actual consequences of the error at an individual level rather than the error itself and the potential for harm in others. It may be of more benefit to recognize the potential for harm from insulin errors as a driver to delivering change within NHS service delivery for people with diabetes admitted to hospital.
Cidon E.U.,Royal Bournemouth Hospital NHS Foundation Trust
Clinical Medicine Insights: Oncology | Year: 2016
Cholangiocarcinoma is a very heterogeneous and rare group of neoplasms originating from the perihilar, intra-, or extrahepatic bile duct epithelium. It represents only 3% of gastrointestinal cancers, although their incidence is increasing as its mortality increases. Surgical resection is the only potentially curative option, but unfortunately the resectability rate is low. Overall, these malignancies have got a very poor prognosis with a five-year survival rate of 5-10%. Although the five-year survival rate increases to 25-30% in the cases amenable to surgery, only 10-40% of patients present with resectable disease. Therefore, it is necessary to optimize the benefit of adjuvant strategies after surgery to increase the rate of curability. This study reviewed the role of adjuvant chemotherapy in resectable bile duct cancers. © the authors, publisher and licensee Libertas Academica Limited.