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Article: IBD barriers across the continents: a continent-specific analysis - Australasia.

Elford, Alexander T / Leong, Rupert W / Halmos, Emma P / Morgan, Manal / Kilpatrick, Kate / Lewindon, Peter J / Gearry, Richard B / Christensen, Britt

Therapeutic advances in gastroenterology

2023 Volume 16, Page(s) 17562848231197509

Abstract: Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous ...

Abstract	Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs.
Language	English
Publishing date	2023-09-08
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2440710-0
ISSN	1756-2848 ; 1756-283X
ISSN (online)	1756-2848
ISSN	1756-283X
DOI	10.1177/17562848231197509
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Article ; Online: Accelerated implementation of remote reporting during the COVID-19 pandemic.

Callaway, M / Greenhalgh, R / Harden, S / Elford, J / Drinkwater, K / Vanburen, T / Ramsden, W

Clinical radiology

2021 Volume 76, Issue 6, Page(s) 443–446

Abstract: Aim: To assess, via a survey of UK radiological departments, if the COVID-19 pandemic led to a change in radiological reporting undertaken in a home environment with appropriate IT support.: Materials and methods: All imaging departments in the UK ... ...

Abstract	Aim: To assess, via a survey of UK radiological departments, if the COVID-19 pandemic led to a change in radiological reporting undertaken in a home environment with appropriate IT support. Materials and methods: All imaging departments in the UK were contacted and asked about the provision of home reporting and IT support before and after the first wave of the pandemic. Results: One hundred and thirty-seven of the 217 departments contacted replied, producing a response rate of 61%. There was a 147% increase in the provision of remote access viewing and reporting platforms during the pandemic. Although 578 consultants had access to a viewing platform pre-pandemic, this had increased to 1,431 during the course of the first wave. Conclusion: This survey represents work undertaken by UK NHS Trusts in co-ordinating and providing increased home-reporting facilities to UK radiologists during the first wave of this global pandemic. The impact of these facilities has been shown to allow more than just the provision of reporting of both elective and emergency imaging and provides additional flexibility in how UK radiologists can help support and provide services. This is a good start, but there are potential problems that now need to be overcome.
MeSH term(s)	COVID-19/epidemiology ; Health Care Surveys ; Humans ; Pandemics ; Radiology Department, Hospital/organization & administration ; SARS-CoV-2 ; Teleworking ; United Kingdom/epidemiology
Language	English
Publishing date	2021-01-29
Publishing country	England
Document type	Journal Article
ZDB-ID	391227-9
ISSN	1365-229X ; 0009-9260
ISSN (online)	1365-229X
ISSN	0009-9260
DOI	10.1016/j.crad.2021.01.004
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Article ; Online: Service evaluation suggests variation in clinical care provision in adults with congenital adrenal hyperplasia in the UK and Ireland.

Doyle, Lauren Madden / Ahmed, S Faisal / Davis, Jessica / Elford, Sue / Elhassan, Yasir S / James, Lynette / Lawrence, Neil / Llahana, Sofia / Okoro, Grace / Rees, D Aled / Tomlinson, Jeremy W / O'Reilly, Michael W / Krone, Nils P

Clinical endocrinology

2024

Abstract: Background: Congenital adrenal hyperplasia (CAH) encompasses a rare group of autosomal recessive disorders, characterised by enzymatic defects in steroidogenesis. Heterogeneity in management practices has been observed internationally. The International ...

Abstract	Background: Congenital adrenal hyperplasia (CAH) encompasses a rare group of autosomal recessive disorders, characterised by enzymatic defects in steroidogenesis. Heterogeneity in management practices has been observed internationally. The International Congenital Adrenal Hyperplasia registry (I-CAH, https://sdmregistries.org/) was established to enable insights into CAH management and outcomes, yet its global adoption by endocrine centres remains unclear. Design: We sought (1) to assess current practices amongst clinicians managing patients with CAH in the United Kingdom and Ireland, with a focus on choice of glucocorticoid, monitoring practices and screening for associated co-morbidities, and (2) to assess use of the I-CAH registry. Measurements: We designed and distributed an anonymised online survey disseminated to members of the Society for Endocrinology and Irish Endocrine Society to capture management practices in the care of patients with CAH. Results: Marked variability was found in CAH management, with differences between general endocrinology and subspecialist settings, particularly in glucocorticoid use, biochemical monitoring and comorbidity screening, with significant disparities in reproductive health monitoring, notably in testicular adrenal rest tumours (TARTs) screening (p = .002), sperm banking (p = .0004) and partner testing for CAH (p < .0001). Adoption of the I-CAH registry was universally low. Conclusions: Differences in current management of CAH continue to exist. It appears crucial to objectify if different approaches result in different long-term outcomes. New studies such as CaHASE2, incorporating standardised minimum datasets including replacement therapies and monitoring strategies as well as longitudinal data collection, are now needed to define best-practice and standardise care.
Language	English
Publishing date	2024-03-17
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.15043
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Article ; Online: Hypoxia-inducible factor 1 alpha limits dendritic cell stimulation of CD8 T cell immunity.

Tran, Charles W / Gold, Matthew J / Garcia-Batres, Carlos / Tai, Kelly / Elford, Alisha R / Himmel, Megan E / Elia, Andrew J / Ohashi, Pamela S

PloS one

2020 Volume 15, Issue 12, Page(s) e0244366

Abstract: Dendritic cells are sentinels of the immune system and represent a key cell in the activation of the adaptive immune response. Hypoxia-inducible factor 1 alpha (HIF-1α)-a crucial oxygen sensor stabilized during hypoxic conditions-has been shown to have ... ...

Abstract	Dendritic cells are sentinels of the immune system and represent a key cell in the activation of the adaptive immune response. Hypoxia-inducible factor 1 alpha (HIF-1α)-a crucial oxygen sensor stabilized during hypoxic conditions-has been shown to have both activating and inhibitory effects in immune cells in a context- and cell-dependent manner. Previous studies have demonstrated that in some immune cell types, HIF-1α serves a pro-inflammatory role. Genetic deletion of HIF-1α in macrophages has been reported to reduce their pro-inflammatory function. In contrast, loss of HIF-1α enhanced the pro-inflammatory activity of dendritic cells in a bacterial infection model. In this study, we aimed to further clarify the effects of HIF-1α in dendritic cells. Constitutive expression of HIF-1α resulted in diminished immunostimulatory capacity of dendritic cells in vivo, while conditional deletion of HIF-1α in dendritic cells enhanced their ability to induce a cytotoxic T cell response. HIF-1α-expressing dendritic cells demonstrated increased production of inhibitory mediators including IL-10, iNOS and VEGF, which correlated with their reduced capacity to drive effector CD8+ T cell function. Altogether, these data reveal that HIF-1α can promote the anti-inflammatory functions of dendritic cells and provides insight into dysfunctional immune responses in the context of HIF-1α activation.
MeSH term(s)	Animals ; Biomarkers/metabolism ; CD8-Positive T-Lymphocytes/immunology ; Cells, Cultured ; Dendritic Cells/cytology ; Dendritic Cells/metabolism ; Gene Knockout Techniques ; Hypoxia-Inducible Factor 1, alpha Subunit/genetics ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism ; Interleukin-10/metabolism ; Mice ; Nitric Oxide Synthase Type II/metabolism ; Vascular Endothelial Growth Factor A/metabolism
Chemical Substances	Biomarkers ; Hif1a protein, mouse ; Hypoxia-Inducible Factor 1, alpha Subunit ; IL10 protein, mouse ; Vascular Endothelial Growth Factor A ; vascular endothelial growth factor A, mouse ; Interleukin-10 (130068-27-8) ; Nitric Oxide Synthase Type II (EC 1.14.13.39) ; Nos2 protein, mouse (EC 1.14.13.39)
Language	English
Publishing date	2020-12-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0244366
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Article: The Size of the Virus of Rabies ("Fixed" Strain) by Ultrafiltration Analysis.

Galloway, I A / Elford, W J

The Journal of hygiene

2010 Volume 36, Issue 4, Page(s) 532–535

Language	English
Publishing date	2010-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	218215-4
ISSN	0022-1724
ISSN	0022-1724
DOI	10.1017/s0022172400043874
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Article: The Size of the Virus of Aujeszky's Disease ("Pseudo-rabies", "Infectious Bulbar Paralysis", "Mad-itch") by Ultrafiltration Analysis.

Elford, W J / Galloway, I A

The Journal of hygiene

2010 Volume 36, Issue 4, Page(s) 536–539

Language	English
Publishing date	2010-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	218215-4
ISSN	0022-1724
ISSN	0022-1724
DOI	10.1017/s0022172400043886
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Article: An investigation of the merits of ozone as an aerial disinfectant.

Elford, W J / van den Ende, J

The Journal of hygiene

2010 Volume 42, Issue 3, Page(s) 240–265

Language	English
Publishing date	2010-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	218215-4
ISSN	0022-1724
ISSN	0022-1724
DOI	10.1017/s0022172400035464
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Article: Studies on the disinfecting action of hypochlorous acid gas and sprayed solution of hypochlorite against bacterial aerosols.

Elford, W J / van den Ende, J

The Journal of hygiene

2010 Volume 44, Issue 1, Page(s) 1–14

Language	English
Publishing date	2010-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	218215-4
ISSN	0022-1724
ISSN	0022-1724
DOI	10.1017/s0022172400013255
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Article: Reducing the Risk of Coronary Artery Disease: Helping patients change.

Sawa, R J / Jennett, P / Elford, R W

Canadian family physician Medecin de famille canadien

2011 Volume 37, Page(s) 651–654

Abstract: Lifestyle and prevention are increasingly emphasized as ways to promote cardiovascular health. Family physicians will play a central role in detecting risk and encouraging lifestyle changes. This article outlines an effective preventive approach to ... ...

Abstract	Lifestyle and prevention are increasingly emphasized as ways to promote cardiovascular health. Family physicians will play a central role in detecting risk and encouraging lifestyle changes. This article outlines an effective preventive approach to coronary artery disease. The steps and skills involved are discussed as well as aspects of practice cultures that influence family physicians' activities.
Language	English
Publishing date	2011-01-03
Publishing country	Canada
Document type	Journal Article
ZDB-ID	603565-6
ISSN	0008-350X
ISSN	0008-350X
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Article ; Online: A home-based, multidisciplinary liver optimisation programme for the first 28 days after an admission for acute-on-chronic liver failure (LivR well): a study protocol for a randomised controlled trial.

Ngu, Natalie Ly / Saxby, Edward / Worland, Thomas / Anderson, Patricia / Stothers, Lisa / Figredo, Anita / Hunter, Jo / Elford, Alexander / Ha, Phil / Hartley, Imogen / Roberts, Andrew / Seah, Dean / Tambakis, George / Liew, Danny / Rogers, Benjamin / Sievert, William / Bell, Sally / Le, Suong

Trials

2022 Volume 23, Issue 1, Page(s) 744

Abstract: Background: Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease ... ...

Abstract	Background: Acute-on-chronic liver failure (ACLF) represents a rising global healthcare burden, characterised by increasing prevalence among patients with decompensated cirrhosis who have a 28-day transplantation-free mortality of 33.9%. Due to disease complexity and a high prevalence of socio-economic disadvantage, there are deficits in quality of care and adherence to guideline-based treatment in this cohort. Compared to other chronic conditions such as heart failure, those with liver disease have reduced access to integrated ambulatory care services. The LivR Well programme is a multidisciplinary intervention aimed at improving 28-day mortality and reducing 30-day readmission through a home-based, liver optimisation programme implemented in the first 28 days after an admission with either ACLF or hepatic decompensation. Outcomes from our feasibility study suggest that the intervention is safe and acceptable to patients and carers. Methods: We will recruit adult patients with chronic liver disease from the emergency departments, in-patient admissions, and an ambulatory liver clinic of a multi-site quaternary health service in Melbourne, Australia. A total of 120 patients meeting EF-Clif criteria will be recruited to the ACLF arm, and 320 patients to the hepatic decompensation arm. Participants in each cohort will be randomised to the intervention arm, a 28-day multidisciplinary programme or to standard ambulatory care in a 1:1 ratio. The intervention arm includes access to nursing, pharmacy, physiotherapy, dietetics, social work, and neuropsychiatry clinicians. For the ACLF cohort, the primary outcome is 28-day mortality. For the hepatic decompensation cohort, the primary outcome is 30-day re-admission. Secondary outcomes assess changes in liver disease severity and quality of life. An interim analysis will be performed at 50% recruitment to consider early cessation of the trial if the intervention is superior to the control, as suggested in our feasibility study. A cost-effectiveness analysis will be performed. Patients will be followed up for 12 weeks from randomisation. Three exploratory subgroup analyses will be conducted by (a) source of referral, (b) unplanned hospitalisation, and (c) concurrent COVID-19. The trial has been registered with the Australian New Zealand Clinical Trials Registry. Discussion: This study implements a multidisciplinary intervention for ACLF patients with proven benefits in other chronic diseases with the addition of novel digital health tools to enable remote patient monitoring during the COVID-19 pandemic. Our feasibility study demonstrates safety and acceptability and suggests clinical improvement in a small sample size. An RCT is required to generate robust outcomes in this frail, high healthcare resource utilisation cohort with high readmission and mortality risk. Interventions such as LivR Well are urgently required but also need to be evaluated to ensure feasibility, replicability, and scalability across different healthcare systems. The implications of this trial include the generalisability of the programme for implementation across regional and urban centres. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001703897 . Registered on 13 December 2021. WHO Trial Registration Data Set. See Appendix 1.
MeSH term(s)	Acute-On-Chronic Liver Failure/diagnosis ; Acute-On-Chronic Liver Failure/therapy ; Adult ; Australia ; COVID-19 ; Hospitalization ; Humans ; Pandemics ; Quality of Life ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2022-09-05
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-022-06679-x
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