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Article: A virtuous framework for professional reflection.

George, Andrew Jt / Urch, Catherine E / Cribb, Alan

2023 Volume 10, Issue 1, Page(s) 78–81

Abstract: Reflection on professional practice (either individually or in dialogue with peers or seniors) will often focus on doctors' skills. This approach emphasises compliance and competence. This paper suggests that an alternative and useful lens for ... ...

Abstract	Reflection on professional practice (either individually or in dialogue with peers or seniors) will often focus on doctors' skills. This approach emphasises compliance and competence. This paper suggests that an alternative and useful lens for professional reflection and development can be drawn from the framework of virtue ethics to encourage consideration of the ultimate purpose of medicine, and the character or virtues needed to be a good doctor. This alternative approach supports doctors to reflect on and develop their virtues, including practical wisdom, which orchestrates the doctor's skills and virtues. This emphasis on purpose and character within professional reflection promotes excellence, rather than just competency, and engages with what motivated most doctors to enter medicine.
Language	English
Publishing date	2023-10-02
Publishing country	England
Document type	Journal Article
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.7861/fhj.2022-0121
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Let's stop talking about covid-safe and covid-secure-it's covid-mitigated.

Urch, Catherine E / George, Andrew J T

BMJ (Clinical research ed.)

2020 Volume 370, Page(s) m3616

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Humans ; Occupational Exposure/prevention & control ; Occupational Health ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Risk Assessment ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-09-18
Publishing country	England
Document type	Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.m3616
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Article ; Online: Feasibility of Implementation and the Impact of a Digital Prehabilitation Service in Patients Undergoing Treatment for Oesophago-Gastric Cancer.

Moorthy, Krishna / Halliday, Laura J / Noor, Nigel / Peters, Christopher J / Wynter-Blyth, Venetia / Urch, Catherine E

Current oncology (Toronto, Ont.)

2023 Volume 30, Issue 2, Page(s) 1673–1682

Abstract: Background: Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital ... ...

Abstract	Background: Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital prehabilitation service. Methods: Patients undergoing treatment for OG cancer with curative intent were recruited into the study. During the COVID-19 pandemic, patients were offered a digital prehabilitation service. Following the lifting of COVID-19 restrictions, patients were also offered both a hybrid clinic-based in-person service and a digital service. Implementation and clinical metrics from the two prehabilitation models were compared. Results: 31 of 41 patients accepted the digital service (75%). Of the people who started the digital programme, 3 dropped out (10%). Compliance with the weekly touchpoints was 86%, and the median length of programme was 12 weeks. Twenty-six patients enrolled in the in-person service. Two patients dropped out (10%). Average compliance to weekly touchpoints was 71%, and the median length of programme was 10 weeks. In the digital group, sit to stand (STS) increased from 14.5 (IQR 10.5-15.5) to 16 (IQR 16-22); Discussion: This study has shown that digital prehabilitation can be delivered effectively to patients with OG cancer, with high engagement and retention rates. We observed improvements in some physical and psychological parameters with the digital service, with comparable clinical outcomes to the in-person service.
MeSH term(s)	Humans ; Preoperative Exercise ; Stomach Neoplasms ; Feasibility Studies ; Pandemics ; Preoperative Care ; COVID-19
Language	English
Publishing date	2023-01-30
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol30020128
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Article: Let's stop talking about covid-safe and covid-secure-it's covid-mitigated

Urch, Catherine E / George, Andrew J T

BMJ

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #781162
Database	COVID19

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Article ; Online: Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain.

Chumbley, Gillian M / Thompson, Lindsey / Swatman, Joanna E / Urch, Catherine

European journal of pain (London, England)

2019 Volume 23, Issue 5, Page(s) 985–993

Abstract: Introduction: Pain which persists after thoracotomy is well recognized, and activation of the N-methyl-d-aspartate (NMDA) receptor could be a contributing factor. This study sought to establish whether ketamine given peri-operatively could reduce ... ...

Abstract	Introduction: Pain which persists after thoracotomy is well recognized, and activation of the N-methyl-d-aspartate (NMDA) receptor could be a contributing factor. This study sought to establish whether ketamine given peri-operatively could reduce persistent post-surgical pain. Trial design: Double-blind, randomized, placebo-controlled trial comparing low-dose intravenous ketamine and saline placebo. Methods: Seventy patients undergoing thoracotomy were randomized to receive either intravenous ketamine (0.1 mg kg Results: There were no significant differences in post-operative pain, except the ketamine group reported less pain at rest 48 hr after surgery (p = 0.03). The ketamine group requested significantly less morphine via PCA in the first 24 hr (p = 0.03). There were no differences in pain measures or opioid consumption at 6 weeks, 3, 6 or 12 months. Patients in the ketamine group were more lightheaded (p = 0.02) and experienced more vivid dreams (p = 0.001). Conclusions: Ketamine reduced opioid consumption compared to placebo after surgery, but we were unable to detect any differences in persistent post-surgical pain between the groups. Significance: This study adds to the growing body of evidence advocating the use of ketamine to reduce opioid consumption. No previous studies of peri-operative ketamine have followed patients for a year after thoracotomy. This study found no reduction in persistent post-surgical pain.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Analgesia, Patient-Controlled ; Analgesics/therapeutic use ; Analgesics, Opioid/therapeutic use ; Anesthetics, Local/therapeutic use ; Double-Blind Method ; Female ; Humans ; Ketamine/therapeutic use ; Male ; Middle Aged ; Morphine/therapeutic use ; Pain Measurement ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Thoracotomy/adverse effects ; Treatment Outcome
Chemical Substances	Analgesics ; Analgesics, Opioid ; Anesthetics, Local ; Ketamine (690G0D6V8H) ; Morphine (76I7G6D29C)
Language	English
Publishing date	2019-02-04
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1390424-3
ISSN	1532-2149 ; 1090-3801
ISSN (online)	1532-2149
ISSN	1090-3801
DOI	10.1002/ejp.1366
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Article ; Online: Views of advance care planning in older hospitalized patients following an emergency admission

Anna-Maria Bielinska / Gehan Soosaipillai / Julia Riley / Ara Darzi / Catherine Urch / Stephanie Archer

PLoS ONE, Vol 17, Iss 9, p e

A qualitative study.

2022 Volume 0273894

Abstract: Background There is increasing evidence of the need to consider advance care planning (ACP) for older adults who have been recently admitted to hospital as an emergency. However, there is a gap in knowledge regarding how to facilitate ACP following acute ...

Abstract	Background There is increasing evidence of the need to consider advance care planning (ACP) for older adults who have been recently admitted to hospital as an emergency. However, there is a gap in knowledge regarding how to facilitate ACP following acute illness in later life. Aim/objectives To explore the perceived impact of ACP on the lives of older persons aged 70+ who have been acutely admitted to hospital. Method Semi-structured qualitative interviews were conducted with older adults aged 70+ who were admitted to hospital as an emergency. Thematic analysis was enhanced by dual coding and exploration of divergent views within an interdisciplinary team. Results Twenty participants were interviewed. Thematic analysis generated the following themes: (1) Bespoke planning to holistically support a sense of self, (2) ACP as a socio-cultural phenomenon advocating for older persons rights, (3) The role of personal relationships, (4) Navigating unfamiliar territory and (5) Harnessing resources. Conclusion These findings indicate that maintaining a sense of personal identity and protecting individuals' wishes and rights during ACP is important to older adults who have been acutely unwell. Following emergency hospitalization, older persons believe that ACP must be supported by a network of relationships and resources, improving the likelihood of adequate preparation to navigate the uncertainties of future care in later life. Therefore, emergency hospitalization in later life, and the uncertainty that may follow, may provide a catalyst for patients, carers and healthcare professionals to leverage existing or create new relationships and target resources to enable ACP, in order to uphold older persons' identity, rights and wishes following acute illness.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Evidence of a role for descending serotonergic facilitation in a rat model of cancer-induced bone pain.

Donovan-Rodriguez, Tansy / Urch, Catherine E / Dickenson, Anthony H

Neuroscience letters

2006 Volume 393, Issue 2-3, Page(s) 237–242

Abstract: Descending modulation of spinal processing plays an important role in chronic pain states. Monoamine pathways comprise a major component of descending controls from the brainstem to the spinal cord. Recent emphasis has been on facilitatory actions ... ...

Abstract	Descending modulation of spinal processing plays an important role in chronic pain states. Monoamine pathways comprise a major component of descending controls from the brainstem to the spinal cord. Recent emphasis has been on facilitatory actions mediated by the 5-HT3 receptor. We investigated the effects of spinally administered ondansetron, a selective 5-HT3 receptor antagonist, on electrical- and natural-evoked dorsal horn (DH) neuronal responses in a rat model of cancer-induced bone pain (CIBP). Injection of MRMT-1 cells into the tibiae of Sprague-Dawley rats was used to model CIBP, whilst sham-operated rats were injected with the cell medium alone. Behavioural testing at regular intervals monitored the development of mechanical allodynia, cold allodynia, and ambulatory-evoked pain. In vivo electrophysiology experiments were carried out 15-17 days after surgery, when there were significant behavioural and neuronal alterations in the cancer animals. Spinally administered ondansetron (10, 50, and 100 microg) had no effect on electrical-evoked neuronal responses, but significantly reduced mechanical- and thermal-evoked responses in both the groups of animals. Furthermore, the effects of ondansetron were significantly greater in cancer animals compared to shams. These results therefore suggest a role for descending serotonergic facilitation in CIBP.
MeSH term(s)	Animals ; Behavior, Animal ; Bone Diseases/physiopathology ; Cell Line, Tumor ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Evoked Potentials/drug effects ; Evoked Potentials/physiology ; Evoked Potentials/radiation effects ; Functional Laterality ; Male ; Motor Activity/physiology ; Neoplasms/complications ; Neoplasms/etiology ; Neoplasms/physiopathology ; Ondansetron/administration & dosage ; Pain/etiology ; Pain/physiopathology ; Pain Measurement/methods ; Physical Stimulation/methods ; Posterior Horn Cells/drug effects ; Posterior Horn Cells/physiopathology ; Posterior Horn Cells/radiation effects ; Rats ; Rats, Sprague-Dawley ; Reaction Time/physiology ; Rotarod Performance Test/methods ; Serotonin/metabolism ; Serotonin Antagonists/administration & dosage ; Temperature ; Time Factors
Chemical Substances	Serotonin Antagonists ; Serotonin (333DO1RDJY) ; Ondansetron (4AF302ESOS)
Language	English
Publishing date	2006-01-30
Publishing country	Ireland
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	194929-9
ISSN	1872-7972 ; 0304-3940
ISSN (online)	1872-7972
ISSN	0304-3940
DOI	10.1016/j.neulet.2005.09.073
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Article ; Online: Advance care planning in older hospitalised patients following an emergency admission

Anna-Maria Bielinska / Stephanie Archer / Adetokunbo Obanobi / Gehan Soosipillai / Lord Ara Darzi / Julia Riley / Catherine Urch

PLoS ONE, Vol 16, Iss 3, p e

A mixed methods study.

2021 Volume 0247874

Abstract: Introduction Although advance care planning may be beneficial for older adults in the last year of life, its relevance following an emergency hospitalisation requires further investigation. This study quantifies the one-year mortality outcomes of all ... ...

Abstract	Introduction Although advance care planning may be beneficial for older adults in the last year of life, its relevance following an emergency hospitalisation requires further investigation. This study quantifies the one-year mortality outcomes of all emergency admissions for patients aged 70+ years and explores patient views on the value of advance care planning following acute hospitalisation. Method This mixed methods study used a two-stage approach: firstly, a quantitative longitudinal cohort study exploring the one-year mortality of patients aged 70+ admitted as an emergency to a large multi-centre hospital cohort; secondly, a qualitative semi-structured interview study gathering information on patient views of advance care planning. Results There were 14,260 emergency admissions for 70+-year olds over a 12-month period. One-year mortality for admissions across all conditions was 22.6%. The majority of these deaths (59.3%) were within 3 months of admission. Binary logistic regression analysis indicated higher one-year mortality with increasing age and male sex. Interviews with 20 patients resulted in one superordinate theme, "Planning for health and wellbeing in the spectrum of illness". Sub-themes entitled (1) Advance care planning benefitting healthcare for physical and psycho-social health, (2) Contemplation of physical deterioration death and dying and 3) Collaborating with healthcare professionals to undertake advance care planning, suggest that views of advance care planning are shaped by experiences of acute hospitalisation. Conclusion Since approximately 1 in 5 patients aged 70+ admitted to hospital as an emergency are in the last year of life, acute hospitalisation can act as a trigger for tailored ACP. Older hospitalised patients believe that advance care planning can benefit physical and psychosocial health and that discussions should consider a spectrum of possibilities, from future health to the potential of chronic illness, disability and death. In this context, patients may look for expertise from healthcare professionals for planning their future care.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Gabapentin normalizes spinal neuronal responses that correlate with behavior in a rat model of cancer-induced bone pain.

Donovan-Rodriguez, Tansy / Dickenson, Anthony H / Urch, Catherine E

Anesthesiology

2004 Volume 102, Issue 1, Page(s) 132–140

Abstract: Background: Cancer-induced bone pain is a major clinical problem for which current treatments lack full efficacy. Gabapentin is licensed for use in neuropathic pain yet is also effective against inflammatory stimuli in animals.: Methods: A rat model ... ...

Abstract	Background: Cancer-induced bone pain is a major clinical problem for which current treatments lack full efficacy. Gabapentin is licensed for use in neuropathic pain yet is also effective against inflammatory stimuli in animals. Methods: A rat model of cancer-induced bone pain using the MRMT-1 cell line injected into the tibia was established to investigate the efficacy of acute (10, 30, 100 mg/kg) and chronic (30 mg/kg) systemic gabapentin on electrophysiological superficial dorsal horn neuronal responses to natural and noxious electrical stimuli, as well as on pain-related behavior. Results: In electrophysiological studies gabapentin worked both acutely (100 mg/kg) and chronically (30 mg/kg) to normalize the hyperexcitable superficial dorsal horn neuronal response, significantly reducing electrical-evoked and mechanical-evoked but not thermal-evoked responses. The behavioral study showed that chronic gabapentin (30 mg/kg) significantly attenuated pain behavior in MRMT-1 rats, restoring responses to preoperative baseline degrees, and that this attenuation was accompanied by a reversion to normal (non-MRMT-1) wide-dynamic-range: nociceptive specific superficial dorsal horn neuronal profiles. Conclusions: Pain-related behavior in this rat model of cancer-induced bone pain is strongly linked to hyperexcitability of a population of superficial dorsal horn neurones. Gabapentin normalizes the cancer-induced bone pain induced dorsal horn neuronal changes and attenuates pain behavior. It may therefore provide a novel clinical treatment for cancer-induced bone pain.
MeSH term(s)	Amines/pharmacology ; Analgesics/pharmacology ; Animals ; Behavior, Animal/drug effects ; Behavior, Animal/physiology ; Bone Neoplasms/complications ; Cell Line, Tumor ; Cyclohexanecarboxylic Acids/pharmacology ; Dose-Response Relationship, Drug ; Electric Stimulation ; Electrophysiology ; Evoked Potentials/drug effects ; Gabapentin ; Male ; Neoplasm Transplantation ; Neurons/drug effects ; Osteotomy ; Pain/etiology ; Pain/physiopathology ; Pain/psychology ; Pain Measurement/drug effects ; Physical Stimulation ; Rats ; Rats, Sprague-Dawley ; Spinal Cord/cytology ; Spinal Cord/drug effects ; Temperature ; gamma-Aminobutyric Acid/pharmacology
Chemical Substances	Amines ; Analgesics ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid (56-12-2) ; Gabapentin (6CW7F3G59X)
Language	English
Publishing date	2004-11-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	269-0
ISSN	0003-3022
ISSN	0003-3022
DOI	10.1097/00000542-200501000-00022
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Book: Diagnostic and therapeutic antibodies

George, Andrew J. T / Urch, Catherine E

(Methods in molecular medicine ; 40)

2000

Author's details	ed. by Andrew J. T. George
Series title	Methods in molecular medicine ; 40
Language	English
Size	XIV, 477 S, Ill., graph. Darst, 23 cm
Publisher	Humana Press
Publishing place	Totowa, NJ
Document type	Book
Note	Literaturangaben
ISBN	0896037983 ; 9780896037984
Database	Former special subject collection: coastal and deep sea fishing

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