University of Manchester and Salford Royal Nhs Foundation Trust | Date: 2016-09-23
A method of selecting data, the method comprising, receiving data indicating a first requirement and identifying first records stored in a first database. The first records relate to first data subjects and the identification is based upon the first requirement. The first data subjects cannot be identified from the records of the first database. Second records are identified, the second records being stored in a second database and relating to the first data subjects. The first data subjects can be identified from the identified records of the second database. Each of the second records corresponds to a respective one of the first records, and the identification of the second records is based upon the first requirement.
News Article | April 20, 2017
Having a stroke damages immune cells as well as affecting the brain, research has found. The findings help explain why patients have a greater risk of catching life-threatening infections, such as pneumonia, after having a stroke. Therapies that boost survival of the affected immune cells or compensate for their damage could help improve the recovery of stroke patients, the researchers say. The study found that patients have reduced levels of protective antibodies in their blood after having a stroke, which might explain why they are more susceptible to infections. Tests with mice revealed those which experienced a stroke had fewer numbers of specialised immune cells called marginal zone B cells, which produce antibodies. Affected mice were more susceptible to bacterial lung infections, the researchers found. Loss of the B cells was caused by a chemical called noradrenaline produced by nerves activated during stroke. Researchers, led by the University of Edinburgh's Roslin Institute, found they could protect the mice from infections using a therapy to block the effects of noradrenaline. Noradrenaline is part of the body's fight or flight response. It helps to prepare the body for action and has a range of effects, such as raising heart rate, boosting blood supply and triggering the release of energy from stores. Blocking noradrenaline would probably be too dangerous in stroke patients, the researchers caution. They say development of other therapies that block or bypass the damage to the immune system could offer new approaches to help cut the risk of infection after stroke. The study could also lead to new tests to identify which stroke patients have the highest chances of developing an infection, so that they can be monitored more closely. Around one-third of stroke patients are stricken by infections, which can lessen their chances of making a good recovery. Treatment with antibiotics does not protect patients from developing infections and new therapies are urgently needed. The research is published in the journal Nature Communications and was funded by the Biotechnology and Biological Sciences Research Council and the Medical Research Council. The Roslin Institute receives strategic funding from the BBSRC. Experts from The University of Manchester and Salford Royal NHS Foundation Trust also contributed to the research. Dr Barry McColl, of The Roslin Institute at the University of Edinburgh, said: "Our work shows that stroke has damaging effects on the normal ability of the immune system to protect us from infections such as pneumonia, which are particularly life-threatening in stroke patients. This could partly explain why people who have strokes are so prone to getting infections. "We now plan to build on our findings by developing and testing new treatments that can block or bypass these immune deficits with B cells a particular target" Professor Craig Smith, on behalf of the stroke research group at Salford Royal NHS Foundation Trust, said: "Infections are a major complication of stroke and lead to a worse outcome for patients. This is an important study which provides new insights about how stroke affects the immune system, which we hope will lead to new approaches to preventing infections after stroke."
News Article | May 5, 2017
LONDON--(BUSINESS WIRE)--GlaxoSmithKline plc (LSE/NYSE: GSK) and Innoviva Inc (NASDAQ: INVA) today announced positive results from the innovative Salford Lung Study (SLS) in asthma, carried out amongst 4,233 patients treated by their own General Practitioner in everyday clinical practice. This open-label, randomised study showed that significantly more asthma patients initiated on treatment with Relvar Ellipta 100/25mcg or 200/25mcg (fluticasone furoate ‘FF’/vilanterol ‘VI’ or ‘FF/VI’) achieved an improvement in their asthma control compared with patients who continued to take their usual care medicines. Usual care treatment included inhaled corticosteroids (ICS) administered as monotherapy or as ICS/LABA (Long Acting Beta Agonist) combinations. For the primary effectiveness analysis, at 24 weeks a significantly higher percentage of patients with uncontrolled asthma and initiated on treatment with FF/VI achieved better control of their asthma (71%) measured by the Asthma Control Test (ACT), compared with patients continuing usual care treatment (56%), (Odds ratio 2.00, 95% CI 1.70, 2.34; p<0.001). Improvement was defined as an ACT total score ≥20 or an increase from baseline of ≥3. Statistically significant findings were also seen at 12, 40 and 52 weeks. Lead Investigator, Ashley Woodcock, Professor of Respiratory Medicine and Clinical Director for Respiratory Medicine, University Hospital of South Manchester and University of Manchester said: “I am really excited to see the results from SLS asthma. Asthma control continues to be a real challenge for patients and the healthcare community. Poor control can have a major impact on the lives of asthma patients. The effectiveness of different treatments on asthma control is difficult to investigate in a traditional double-blind randomised control trial, where the study design and intrusive monitoring can influence the behaviour of patients. In SLS, patient relevant outcomes are the major endpoints. GSK should be congratulated for running this unique study, designed to understand how asthma medicines work in everyday clinical practice.” In the study for the intent-to-treat (ITT) population, the incidence of serious adverse events (SAE) was the same in both arms (FF/VI 13% and usual care 13%). Pneumonia was a safety endpoint of special interest and a regulatory post-authorisation requirement of the European Medicines Agency (EMA). A novel aspect of the study design was that it allowed patient’s treatment to be modified throughout the study. Therefore two assessments relating to pneumonia have been performed, one based on the arm to which patients were randomised, the second based upon the treatment to which patients were exposed at the time of the event. Serious adverse events of pneumonia by randomised group were reported by 39 patients (FF/VI arm 23, 1%; usual care arm 16, <1%). These patients had 42 events and based on a pre-planned analysis non-inferiority of FF/VI to usual care was not confirmed. When these events were summarised according to the actual treatment patients were taking at the time of the event, 21 events were recorded for FF/VI and 21 events for usual care. Eric Dube, Senior Vice President and Head, Global Respiratory Franchise GSK, said: “Despite medical advances, more than half of patients with asthma continue to experience poor control and significant symptoms. The primary endpoint of this study showed that patients initiated with Relvar Ellipta treatment had twice the odds of achieving an improvement in asthma control compared with patients continuing usual care in this study in everyday clinical practice. This study has been a tremendous partnership effort between healthcare professionals, patients, academics and GSK and we would like to thank everyone who has helped to make this unique study possible.” Michael W. Aguiar, President and Chief Executive Officer of Innoviva said: “We are delighted to see the positive results from a second SLS study with Relvar Ellipta, the first being in chronic obstructive pulmonary disease. Asthma control remains a significant unmet medical need in the daily lives for many patients. We believe that this positive real world data successfully builds upon the previous clinical data to provide strong evidence of the benefits of Relvar Ellipta for the treatment of asthma.” These data will be presented in future publications and will be made available on clinicaltrials.gov. The Salford Lung Study is a Phase III multi-centre, open label randomised controlled trial (RCT). The objective of this study was to compare the effectiveness and safety profile of initiating treatment with FF/VI with usual asthma maintenance therapy over a 52 week period. All suitable patients with asthma at 74 primary care sites in and around Salford and South Manchester, UK, were identified from practice databases and invited to participate in the study by their own GP. The primary endpoint of the study was measured at week 24 in the primary effectiveness analysis population. In total, 4,233 patients with asthma who were taking an inhaled corticosteroid (ICS) with or without a long acting beta -agonist (LABA) were randomised to receive either FF/VI or to continue on their existing asthma maintenance therapy (usual care). Usual care was prescribed by the patients GP and included ICS either alone or in a combination with a LABA. In the usual care arm 36% of patients were on an ICS alone and 64% were on an ICS/LABA combination at the time of commencing study medication. The Salford Lung Study had minimal exclusion criteria and involved a broad demographic of patients. At baseline patients had a mean age of 49.8 (min 18 years) and were split by gender (males vs. female 41/59%). To enrol in the study, patients were required to have a GP diagnosis of asthma as their primary respiratory disease and be receiving maintenance therapy with an ICS with or without LABA for at least 4 weeks prior to visit 2. At baseline 72% of patients had uncontrolled asthma with an ACT total score of 5 to 19. Patients were followed for a period of 52 weeks in a normal clinical practice setting using their electronic medical record (EMR), linking primary care, secondary care and pharmacy data to collect study data. Throughout the duration of the study physicians were allowed to modify or switch treatment at any point as this would happen in normal clinical practice, the only exception being a switch from usual care to FF/VI. At weeks 12, 24, and 40 patients were telephoned to enquire about whether they had experienced any serious adverse events or non-serious adverse drug reactions. On these telephone calls patients were asked to provide responses to the ACT. At month 12 a face to face visit was carried out. The Standardised Asthma Quality of Life Questionnaire (AQLQ[S]) was also conducted at week 24 and week 52 by telephone. The study team was able to monitor all hospital admissions, outpatient and emergency department visits, as well as data from primary care (including all healthcare contacts, out-of-hours activity and prescriptions of antibiotics or oral steroids) via the electronic health records. The Intent-to-Treat (ITT) population is defined as all patients who have been randomised and received at least one prescription of study medication (e.g., FF/VI or usual asthma maintenance therapy). The primary effectiveness analysis (PEA) population is defined as all ITT patients who have an ACT total score of < 20 at baseline (Randomisation Visit). The odds ratio expressed in the results is calculated as the ratio of the odds of achieving better asthma control as a patient initiated with Relvar Ellipta and the odds of achieving better asthma control as a patient continuing on usual care. This value is adjusted for any imbalances between the treatment arms in certain key characteristics. The study design protocol paper can be found on clintrials.gov. The ACT is a well recognised instrument that is used globally in asthma treatment guidelines to assess asthma control. It is self-administered utilising 5 questions to assess asthma control during the past 4 weeks on a 5-point categorical scale (1 to 5). By answering all five questions, a patient with asthma can obtain a score that may range between 5 and 25, with higher scores indicating better control. An ACT total score of 5 to 19 suggests that a patient’s asthma is poorly or not well controlled. A score of 20 to 25 suggests that a patient’s asthma is likely to be well controlled. The total score is calculated as the sum of the scores from all 5 questions, provided all scores are non-missing; if any individual scores are missing then the overall score will be set to missing. A change of 3 points is clinically meaningful for the patient. The Salford Lung Study is intended to enable healthcare professionals and decision makers to more fully assess the potential value of FF/VI by providing data collected in a normal clinical practice setting which is representative of how healthcare professionals and patients may use the medicine in everyday life. It will add to the existing data set from double blind randomised clinical trials (RCTs) for the medicine which, while critical to establishing the safety and efficacy of a medicine, are conducted in a highly controlled environment and enrol a more highly selected patient population than would be expected in everyday clinical care. The study is made possible through a unique collaboration between GSK, North West e-Health (NWEH), The University of Manchester, Salford Royal NHS Foundation Trust, University Hospital of South Manchester (UHSM), NHS Salford and GPs and community pharmacists in Salford, Trafford and South Manchester. The Salford Lung Study in COPD reported findings in May 2016. This is the second of the two Salford Lung Studies to report. Asthma is a chronic lung disease that inflames and narrows the airways. Asthma affects 358 million people worldwide. The causes of asthma are not completely understood but likely involve an interaction between a person’s genetic make-up and the environment. Relvar Ellipta is a once-daily dual combination treatment comprising fluticasone furoate, an inhaled corticosteroid and vilanterol, a long-acting beta -agonist, in a single inhaler, the Ellipta. Relvar Ellipta is indicated in Europe in the regular treatment of patients aged 12 and over with asthma, where use of a combination product (long-acting ß2–agonist, LABA, and inhaled corticosteroid, ICS) is appropriate: Patients not adequately controlled on both ICS and 'as-needed' short-acting ß -agonist (SABA). Full EU prescribing information is available at: EU Prescribing Information for Relvar Ellipta. FF/VI is contraindicated in patients with hypersensitivity to either fluticasone furoate, vilanterol, or any of the excipients. FF/VI should not be used to treat acute asthma symptoms or an acute exacerbation in COPD, for which a short-acting bronchodilator is required. Increasing use of short-acting bronchodilators to relieve symptoms indicates deterioration of control and patients should be reviewed by a physician. Patients should not stop therapy with FF/VI in asthma or COPD, without physician supervision since symptoms may recur after discontinuation. Asthma-related adverse events and exacerbations may occur during treatment with FF/VI. Patients should be asked to continue treatment but to seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation of treatment with FF/VI. Paradoxical bronchospasm may occur with an immediate increase in wheezing after dosing. This should be treated immediately with a short-acting inhaled bronchodilator. FF/VI should be discontinued immediately, the patient assessed and alternative therapy instituted if necessary. Cardiovascular effects, such as cardiac arrhythmias e.g. supraventricular tachycardia and extrasystoles may be seen with sympathomimetic medicinal products including FF/VI. Therefore fluticasone furoate/vilanterol should be used with caution in patients with severe cardiovascular disease. For patients with moderate to severe hepatic impairment, the 92/22 mcg dose should be used and patients should be monitored for systemic corticosteroid-related adverse reactions. FF/VI 184/22 mcg is not indicated for patients with COPD. There is no additional benefit of the 184/22 mcg dose compared to the 92/22 mcg dose and there is a potential increased risk of pneumonia and systemic corticosteroid-related adverse reactions. An increase in the incidence of pneumonia has been observed in patients with COPD receiving FF/VI. There was also an increased incidence of pneumonias resulting in hospitalisation. In some instances these pneumonia events were fatal. The incidence of pneumonia in patients with asthma was common at the higher dose. In a previous study of FF/VI in asthma the incidence of pneumonia in patients with asthma taking FF/VI 184/22 mcg was numerically higher compared with those receiving FF/VI 92/22 mcg or placebo. Hyperglycaemia: There have been reports of increases in blood glucose levels in diabetic patients and this should be considered when prescribing to patients with a history of diabetes mellitus. Systemic effects may occur with any inhaled corticosteroid, particularly at high doses prescribed for long periods. These effects are much less likely to occur than with oral corticosteroids. Possible systemic effects include Cushing’s syndrome, Cushingoid features, adrenal suppression, decrease in bone mineral density, growth retardation in children and adolescents, cataract and glaucoma and more rarely, a range of psychological or behavioural effects including psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children). FF/VI should be administered with caution in patients with pulmonary tuberculosis or in patients with chronic or untreated infections. Data from large asthma and COPD clinical trials were used to determine the frequency of adverse reactions associated with FF/VI. Very common adverse reactions (occurring in >1/10 patients) with FF/VI were headache and nasopharyngitis. Common adverse reactions (occurring in >1/100 to <1/10 patients) were pneumonia, upper respiratory tract infection, bronchitis, influenza, candidiasis of mouth and throat, oropharyngeal pain, sinusitis, pharyngitis, rhinitis, cough, dysphonia, abdominal pain, arthralgia, back pain, fractures, and pyrexia and muscle spasms..Extrasystoles were observed as an uncommon adverse reaction (occurring in >1/1,000 to <1/100 patients). Rare adverse reactions (occurring in >1/10,000 to < 1/1,000) were hypersensitivity reactions (including anaphylaxis, angioedema, rash and urticaria), anxiety, tremor, palpitations, tachycardia and paradoxical bronchospasm. With the exception of pneumonia and fractures, the safety profile was similar in patients with asthma and COPD. During clinical studies, pneumonia and fractures were more frequently observed in patients with COPD. Relvar Ellipta is known as Breo Ellipta in the United States. Breo Ellipta is licensed in the US for: Full US prescribing information, including BOXED WARNING and Medication Guide is available at us.gsk.com or US Prescribing Information for Breo Ellipta. Innoviva – Innoviva is focused on bringing compelling new medicines to patients in areas of unmet need by leveraging its significant expertise in the development, commercialization and financial management of bio-pharmaceuticals. Innoviva's portfolio is anchored by the respiratory assets partnered with Glaxo Group Limited (GSK), including RELVAR®/BREO® ELLIPTA® and ANORO® ELLIPTA®, which were jointly developed by Innoviva and GSK. Under the agreement with GSK, Innoviva is eligible to receive associated royalty revenues from RELVAR®/BREO® ELLIPTA®, ANORO® ELLIPTA®. In addition, Innoviva retains a 15 percent economic interest in future payments made by GSK for earlier-stage programs partnered with Theravance Biopharma, Inc., including the closed triple combination therapy for COPD. For more information, please visit Innoviva's website at www.inva.com. GSK – one of the world’s leading research-based pharmaceutical and healthcare companies – is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For further information please visit www.gsk.com. ANORO, BREO, RELVAR and ELLIPTA are trademarks of the GlaxoSmithKline group of companies. GSK cautions investors that any forward-looking statements or projections made by GSK, including those made in this announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Such factors include, but are not limited to, those described under Item 3.D Principal risks and uncertainties in the company's Annual Report on Form 20-F for 2016. This press release contains certain "forward-looking" statements as that term is defined in the Private Securities Litigation Reform Act of 1995 regarding, among other things, statements relating to goals, plans, objectives and future events. Innoviva intends such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 21E of the Securities Exchange Act of 1934 and the Private Securities Litigation Reform Act of 1995. Such forward-looking statements involve substantial risks, uncertainties and assumptions. These statements are based on the current estimates and assumptions of the management of Innoviva as of the date of this press release and are subject to risks, uncertainties, changes in circumstances, assumptions and other factors that may cause the actual results of Innoviva to be materially different from those reflected in the forward-looking statements. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are described under the headings "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" contained in Innoviva's Annual Report on Form 10-K for the year ended December 31, 2016, which is on file with the U.S. Securities and Exchange Commission (SEC) and available on the SEC's website at www.sec.gov. Additional factors may be described in those sections of Innoviva's Quarterly Report on Form 10-Q for the quarter ended March 31, 2017, to be filed with the SEC in the second quarter of 2017. In addition to the risks described above and in Innoviva's other filings with the SEC, other unknown or unpredictable factors also could affect Innoviva's results. No forward-looking statements can be guaranteed and actual results may differ materially from such statements. Given these uncertainties, you should not place undue reliance on these forward-looking statements. The information in this press release is provided only as of the date hereof, and Innoviva assumes no obligation to update its forward-looking statements on account of new information, future events or otherwise, except as required by law. (INVA-G).
News Article | March 1, 2017
DURHAM, N.C., March 1, 2017 /PRNewswire/ -- The Salford Royal NHS Foundation Trust of the National Health Service (NHS), one of the most innovative and digitally-advanced Trusts in the United Kingdom (UK), has announced a partnership with Validic, the industry's leading data connectivity...
News Article | March 1, 2017
DURHAM, North Carolina, March 1, 2017 /PRNewswire/ -- The Salford Royal NHS Foundation Trust of the National Health Service (NHS), one of the most innovative and digitally-advanced Trusts in the United Kingdom (UK), has announced a partnership with Validic, the industry's leading data connectivity platform to develop a new model of integrated care for the United Kingdom. The partnership will enable the integration of patient-generated health data from in-home medical devices, wearables and consumer health apps into the Electronic Health Record (EHR). The goal of this initiative is to identify how the integration of this data yields a measurable difference in patient care, outcomes and engagement. Salford Royal, a collection of health systems representing the western part of Manchester, has received £10M to pioneer innovative and re-vamped approaches to digital services, with a heavy emphasis on remote services. Through this partnership with Validic, Salford Royal will start integrating fitness and sleep data to pilot its use and value within the EHR. Long term, this partnership will enable the Trust to bring in the full spectrum of clinical, fitness, biometric, lab, and lifestyle data available via Validic's 400 device and application connections. Salford Royal is one of the first healthcare organizations to pilot the use of real-time PGHD for care and research in the United Kingdom. This initiative could have broad impact. A recently released study said one of NHS' remote services could save 25 million clinic visits by people who are on stroke management. That frees not only patient time, but also care team resources. "Salford Royal is making personal health data actionable and valuable to both providers and patients by enabling access to the needed insights and context," Validic CEO Drew Schiller said. "By placing a focus on preventative and personalized care, Salford Royal is pioneering how data are used to improve the affordability and accessibility of healthcare." Data will also be aggregated into a database, in which clinicians and researchers can use to identify trends, correlations, and causations. For example, researchers will be able to correlate sleep and heart rate data to identify new care methods for weight and diabetes management – enabling patients greater control to self-manage their condition and offering physicians insight into how a patient's lifestyle impacts their health and disease state. This dynamic in which patients receive their data back contextualized and physicians have an opportunity to treat patients holistically creates an accountable care model. Validic provides the industry's leading data connectivity platform enabling access to personal health data from hundreds of in-home clinical devices, wearables and consumer health applications. Validic was awarded Frost & Sullivan's "Best Value in Healthcare Information Interoperability," "Top 10 Healthcare Innovating Disruptor," and "Visionary Innovation Leadership" awards. To learn more about Validic, follow Validic on Twitter or visit www.validic.com.
New J.P.,Salford Royal NHS Foundation Trust |
Bakerly N.D.,Salford Royal NHS Foundation Trust |
Leather D.,Glaxosmithkline |
Woodcock A.,University of Manchester
Thorax | Year: 2014
We need to assess clinical treatments in real-life settings outside of randomised controlled trials (RCTs). Pragmatic RCT (pRCT) data can supplement RCTs by providing effectiveness information to support healthcare decisions. Electronic health records can facilitate concurrent safety monitoring and data collection without direct patient contact for large randomised study populations in pRCTs. The Salford Lung Study is the world's first phase III pRCT in asthma and chronic obstructive pulmonary disease (COPD), which aims to randomise over 7000 patients. This paper describes the hurdles overcome and the enormous effort and resource required to establish this comparative effectiveness study of a prelicence intervention. GlaxoSmithKline protocol HZC115151 Asthma study clinicaltrials.gov registration NCT01706198 COPD study clinicaltrials.gov registration NCT01551758. © 2014, BMJ Publishing Group. All rights reserved.
News Article | November 18, 2016
Elsevier, a world-leading provider of scientific, technical and medical information products and services, is proud to recognise organisations for outstanding achievements in the implementation and usage of health information and technology that truly improves patient care and safety, via the HIMSS-Elsevier Digital Healthcare Award for Outstanding ICT Innovation. This award, announced at the HIMSS Europe Conference on 20th November, recognises projects from across Europe that either harness the application of information within a healthcare setting, thus setting a new standard for patient management and care. Four organisations have been shortlisted for this award, including: Centro Hospitalar de São João, Portugal - the advanced analytics system, HVITAL (Health SurVeillance, MonIToring and ALert) monitors and assesses clinical data from across hospital systems to automatically identify (and more importantly alert health professionals) patients at risk with regard to clinical deterioration and infection management. This allows health professionals to prioritise patient care and speed up the rate of intervention. Up to 30% of intensive care admissions are now predicted at least seven days in advance - allowing better management of valuable resources. Devon Partnership NHS Trust, UK - development of MyWard, a visual electronic whiteboard, the first in a mental health care setting on the UK. The aim of MyWard is to streamline patient management process, in order to reduce the administrative burden on staff as well as ensure clinical care is delivered in a timely manner and all information relating to patients is viewable, in real time, via one source. Gobierno Del Principado de Asturias, Spain - the establishment of a tele-ophthalmology service, including full integration with electronic medical records (a first in Spain). This new service ensures that all patients (even in this largely rural setting) with diabetes receive appropriate screening for diabetic retinopathy promptly, with a multi-disciplinary team of nurses, primary care physicians and ophthalmologists analysing images. Salford Royal NHS Foundation Trust, UK - the implementation of a pathology recognition alert (comprising recognition and treatment guidance) within the Electronic Patient Record system aims to reduce the high mortality rate from acute kidney injury through earlier recognition and treatment. Audits show that, from a pre-implementation rate of less than 30%, this new protocol achieves 100% identification of patients with acute kidney injury. "Technology is critical to allowing health systems to adapt to changes in demand and demographics," said Dr. Peter Edelstein, Chief Medical Officer at Elsevier and chair of the judging panel. "The shortlisted projects not only streamlined services but, crucially, delivered real improvements to patients. That is the outcome we are looking to achieve and the real value of innovation." 2016 marks the first year Elsevier has expanded its support of the award to Europe, having previously supported the Asia Pacific region for four years and the Middle East region twice since 2015. It reflects Elsevier's on-going commitment to supporting healthcare providers to continually evolve to meet the needs of a changing population. All the shortlisted projects use robust data and insight to streamline systems, and make better use of healthcare practitioner skills in order to better manage patients and improve clinical outcomes. The winner will be announced on 20th November during an exclusive award ceremony at HIMSS WoHIT in Barcelona, Spain. Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions - among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey - and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. http://www.elsevier.com
Thomas A.N.,Salford Royal NHS Foundation Trust |
Taylor R.J.,Salford Royal NHS Foundation Trust
Anaesthesia | Year: 2012
We categorised and established the rates of patient safety incidents reported during 2009 and 2010 from critical care units in 12 hospital trusts in North-West England. We identified a total of 4219 incidents reported during 127 467 calendar days of critical care with a median (IQR [range]) of 31 (26-45 [20-57]) incidents per 1000 days per trust. A median (IQR [range]) of 10 (7-13 [3.5-27]) incidents per 1000 days were associated with harm. Pressure sores were the most common cause of harm, with a median (IQR [range]) of 3.9 (1.0-6.6 [0-20.4]) incidents per 1000 days. Only 89 (2.1%) incidents described more than temporary harm, of which 12 were airway related incidents. Five incidents described the use of inappropriate arterial flush solutions. It is possible to compare rates of incident reporting in different trusts over time to determine if different methods of care are associated with different reporting rates. The wide range of reported pressure sore rates suggests that their incidence could be reduced. © 2012 The Association of Anaesthetists of Great Britain and Ireland.
Winter-Roach B.A.,Salford Royal NHS Foundation Trust
Cochrane database of systematic reviews (Online) | Year: 2012
Epithelial ovarian cancer is diagnosed in 4500 women in the UK each year of whom 1700 will ultimately die of their disease.Of all cases 10% to 15% are diagnosed early when there is still a good possibility of cure. The treatment of early stage disease involves surgery to remove disease often followed by chemotherapy. The largest clinical trials of this adjuvant therapy show an overall survival (OS) advantage with adjuvant platinum-based chemotherapy but the precise role of this treatment in subgroups of women with differing prognoses needs to be defined. To systematically review the evidence for adjuvant chemotherapy in early stage epithelial ovarian cancer to determine firstly whether there is a survival advantage of this treatment over the policy of observation following surgery with chemotherapy reserved for treatment of disease recurrence, and secondly to determine if clinical subgroups of differing prognosis based on histological sub-type, or completeness of surgical staging, have more or less to gain from chemotherapy following initial surgery. We performed an electronic search using the Cochrane Gynaecological Cancer Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 3), MEDLINE (1948 to Aug week 5, 2011) and EMBASE (1980 to week 36, 2011). We developed the search strategy using free-text and medical subject headings (MESH). We selected randomised clinical trials that met the inclusion criteria set out based on the populations, interventions, comparisons and outcome measures. Two review authors independently extracted data and assessed trial quality. Disagreements were resolved by discussion with a third review author. We performed random-effects meta-analyses and subgroup analyses. Five randomised controlled trials (RCTs), enrolling 1277 women, with a median follow-up of 46 to 121 months, met the inclusion criteria. Four trials were included in the meta-analyses and we considered them to be at a low risk of bias. Meta-analysis of five-year data from three trials indicated that women who received adjuvant platinum-based chemotherapy had better overall survival (OS) than those who did not (1008 women; hazard ratio (HR) 0.71; 95% confidence interval (CI) 0.53 to 0.93). Likewise, meta-analysis of five-year data from four trials indicated that women who received adjuvant chemotherapy had better progression-free survival (PFS) than those who did not (1170 women; HR 0.67; 95% CI 0.53 to 0.84). The trials included in these meta-analyses gave consistent estimates of the effects of chemotherapy. In addition, these findings were robust over time (10-year PFS: two trials, 925 women; HR 0.67; 95% CI 0.54 to 0.84).Subgroup analysis suggested that women who had optimal surgical staging of their disease were unlikely to benefit from adjuvant chemotherapy (HR for OS 1.22; 95% CI 0.63 to 2.37; two trials, 234 women) whereas those who had sub-optimal staging did (HR for OS 0.63; 95% CI 0.46 to 0.85; two trials, 772 women). One trial showed a benefit from adjuvant chemotherapy among women at high risk (HR for OS 0.48; 95% CI 0.32 to 0.72) but not among those at low/medium risk (HR for OS 0.95; 95% CI 0.54 to 1.66). However, these subgroup findings could be due to chance and should be interpreted with caution. Adjuvant platinum-based chemotherapy is effective in prolonging the survival of the majority of patients who are assessed as having early (FIGO stage I/IIa) epithelial ovarian cancer. However, it may be withheld from women in whom there is well-differentiated encapsulated unilateral disease (stage 1a grade 1) or those with comprehensively staged Ib, well or moderately differentiated (grade 1/2) disease. Others with unstaged early disease or those with poorly differentiated tumours should be offered chemotherapy. A pragmatic approach may be necessary in clinical settings where optimal staging is not normally performed/achieved. In such settings, adjuvant chemotherapy may be withheld from those with encapsulated stage Ia grade 1 serous and endometrioid carcinoma and offered to all others with early stage disease.
Protheroe R.T.,Intensive Care Medicine and Anaesthesia |
Gwinnutt C.L.,Salford Royal NHS Foundation Trust
Anaesthesia | Year: 2011
Head injury is one of the major causes of trauma-related morbidity and mortality in all age groups in the United Kingdom, and anaesthetists encounter this problem in many areas of their work. Despite a better understanding of the pathophysiological processes following traumatic brain injury and a wealth of research, there is currently no specific treatment. Outcome remains dependant on basic clinical care: management of the patient's airway with particular attention to preventing hypoxia; avoidance of the extremes of lung ventilation; and the maintenance of adequate cerebral perfusion, in an attempt to avoid exacerbating any secondary injury. Hypertonic fluids show promise in the management of patients with raised intracranial pressure. Computed tomography scanning has had a major impact on the early identification of lesions amenable to surgery, and recent guidelines have rationalised its use in those with less severe injuries. Within critical care, the importance of controlling blood glucose is becoming clearer, along with the potential beneficial effects of hyperoxia. The major improvement in outcome reflects the use of protocols to guide resuscitation, investigation and treatment and the role of specialist neurosciences centres in caring for these patients. Finally, certain groups are now recognised as being at greater risk, in particular the elderly, anticoagulated patient. © 2011 The Authors.