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Article ; Online: Diagnostic intervals in oropharyngeal cancers from a primary care perspective: a ten-year case note review.

Wilcock, Jane / Grafton-Clarke, Ciaran

2021

Abstract: Background Rates of oropharyngeal (OP) cancer are increasing and mortality is related to stage at diagnosis. Early diagnosis is vital to improving patient outcomes.Aim To describe current general practice pathways and time intervals in OP cancer and: a) ... ...

Abstract	Background Rates of oropharyngeal (OP) cancer are increasing and mortality is related to stage at diagnosis. Early diagnosis is vital to improving patient outcomes.Aim To describe current general practice pathways and time intervals in OP cancer and: a) compare to current National Institute for Health and Care Excellence guidance to refer from general practitioners (GPs) to general medical dentists (dentists); and b) referral pathways for pharyngeal cancers.Design and setting A ten-year retrospective study of patients diagnosed with OP cancer in one suburban general practice in England using GP notes, including secondary care correspondence.Results There were 12 cases of OP cancer; six oral and six pharyngeal. There were marked differences in referral pathways and time intervals for people with visible, or palpable, oral cancers and those with non-visible, or impalpable, pharyngeal cancers. No one had GP to dentist referral. General practice 'safety-netting' or follow-up was not commonly recorded.Conclusion GPs are pivotal in diagnosing symptomatic OP cancers. General practice and dental teams encountering symptoms of uncertain aetiology (for example, pharyngitis) should offer safety-netting to shorten patient intervals to re-attendance. Pathways for oral cancer referral were usually clear and linear. Pathways for pharyngeal cancer were usually complex, with much longer time intervals in primary and secondary care, and would benefit from a single national referral pathway to ENT.
Language	English
Publishing date	2021-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	218090-x
ISSN	1476-5373 ; 0007-0610
ISSN (online)	1476-5373
ISSN	0007-0610
DOI	10.1038/s41415-021-2947-6
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Article ; Online: Interdental and GP relationships in oral cancer.

Wilcock, Jane / Grafton-Clarke, Ciaran

The British journal of general practice : the journal of the Royal College of General Practitioners

2020 Volume 70, Issue 700, Page(s) 534

MeSH term(s)	Dentists ; Humans ; Mouth Neoplasms/diagnosis ; Oral Hygiene
Language	English
Publishing date	2020-10-29
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/bjgp20X713201
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Article ; Online: Antibiotics for the induction and maintenance of remission in ulcerative colitis.

Gordon, Morris / Sinopoulou, Vassiliki / Grafton-Clarke, Ciaran / Akobeng, Anthony K

The Cochrane database of systematic reviews

2022 Volume 5, Page(s) CD013743

Abstract: Background: Antibiotics have been considered to treat ulcerative colitis (UC) due to their antimicrobial properties against intestinal bacteria linked to inflammation. However, there are concerns about their efficacy and safety.: Objectives: To ... ...

Abstract	Background: Antibiotics have been considered to treat ulcerative colitis (UC) due to their antimicrobial properties against intestinal bacteria linked to inflammation. However, there are concerns about their efficacy and safety. Objectives: To determine whether antibiotic therapy is safe and effective for the induction and maintenance of remission in people with UC. Search methods: We searched five electronic databases on 10 December 2021 for randomised controlled trials (RCTs) comparing antibiotic therapy to placebo or an active comparator. Selection criteria: We considered people with UC of all ages, treated with antibiotics of any type, dose, and route of administration for inclusion. Induction studies required a minimum duration of two weeks for inclusion. Maintenance studies required a minimum duration of three months to be considered for inclusion. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Our primary outcome for induction studies was failure to achieve remission and for maintenance studies was relapse, as defined by the primary studies. Main results: We included 12 RCTs (847 participants). One maintenance of remission study used sole antibiotic therapy compared with 5-aminosalicylic acid (5-ASA). All other trials used concurrent medications or standard care regimens and antibiotics as an adjunct therapy or compared antibiotics with other adjunct therapies to examine the effect on induction of remission. There is high certainty evidence that antibiotics (154/304 participants) compared to placebo (175/304 participants) result in no difference in failure to achieve clinical remission (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.74 to 1.06). A subgroup analysis found no differences when steroids, steroids plus 5-ASA, or steroids plus 5-ASA plus probiotics were used as additional therapies to antibiotics and placebo. There is low certainty evidence that antibiotics (102/168 participants) compared to placebo (121/175 participants) may result in no difference in failure to achieve clinical response (RR 0.75, 95% CI 0.47 to 1.22). A subgroup analysis found no differences when steroids or steroids plus 5-ASA were used as additional therapies to antibiotics and placebo. There is low certainty evidence that antibiotics (6/342 participants) compared to placebo (5/349 participants) may result in no difference in serious adverse events (RR 1.19, 95% CI 0.38 to 3.71). A subgroup analysis found no differences when steroids were additional therapies to antibiotics and placebo. There is low certainty evidence that antibiotics (3/342 participants) compared to placebo (1/349 participants) may result in no difference in withdrawals due to adverse events (RR 2.06, 95% CI 0.27 to 15.72). A subgroup analysis found no differences when steroids or steroids plus 5-ASA were additional therapies to antibiotics and placebo. It is unclear if there is any difference between antibiotics in combination with probiotics compared to no treatment or placebo for failure to achieve clinical remission (RR 0.68, 95% CI 0.39 to 1.19), serious adverse events (RR 1.00, 95% CI 0.07 to 15.08), or withdrawals due to adverse events (RR 1.00, 95% CI 0.07 to 15.08). The certainty of the evidence is very low. It is unclear if there is any difference between antibiotics compared to 5-ASA for failure to achieve clinical remission (RR 2.20, 95% CI 1.17 to 4.14). The certainty of the evidence is very low. It is unclear if there is any difference between antibiotics compared to probiotics for failure to achieve clinical remission (RR 0.47, 95% CI 0.23 to 0.94). The certainty of the evidence is very low. It is unclear if there is any difference between antibiotics compared to 5-ASA for failure to maintain clinical remission (RR 0.71, 95% CI 0.47 to 1.06). The certainty of the evidence is very low. It is unclear if there is any difference between antibiotics compared to no treatment for failure to achieve clinical remission in a mixed population of people with active and inactive disease (RR 0.56, 95% CI 0.29 to 1.07). The certainty of the evidence is very low. For all other outcomes, no effects could be estimated due to a lack of data. Authors' conclusions: There is high certainty evidence that there is no difference between antibiotics and placebo in the proportion of people who achieve clinical remission at the end of the intervention period. However, there is evidence that there may be a greater proportion of people who achieve clinical remission and probably a greater proportion who achieve clinical response with antibiotics when compared with placebo at 12 months. There may be no difference in serious adverse events or withdrawals due to adverse events between antibiotics and placebo. No clear conclusions can be drawn for any other comparisons. A clear direction for future research appears to be comparisons of antibiotics and placebo (in addition to standard therapies) with longer-term measurement of outcomes. Additionally. As there were single studies of other head-to-head comparisons, there may be scope for future studies in this area.
MeSH term(s)	Anti-Bacterial Agents/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Colitis, Ulcerative/drug therapy ; Humans ; Mesalamine/adverse effects ; Mesalamine/therapeutic use ; Remission Induction
Chemical Substances	Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Mesalamine (4Q81I59GXC)
Language	English
Publishing date	2022-05-18
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD013743.pub2
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Article ; Online: The Role of High-Fidelity Simulation in the Acquisition of Endovascular Surgical Skills: A Systematic Review.

Gomaa, Abdul-Rahman / Grafton-Clarke, Ciaran / Saratzis, Athanasios / Davies, Robert S M

Annals of vascular surgery

2023 Volume 93, Page(s) 405–427

Abstract: Background: The widespread introduction of minimally invasive endovascular techniques in cardiovascular surgery has necessitated a transition in the psychomotor skillset of trainees and surgeons. Simulation has previously been used in surgical training; ...

Abstract	Background: The widespread introduction of minimally invasive endovascular techniques in cardiovascular surgery has necessitated a transition in the psychomotor skillset of trainees and surgeons. Simulation has previously been used in surgical training; however, there is limited high-quality evidence regarding the role of simulation-based training on the acquisition of endovascular skills. This systematic review aimed to systematically appraise the currently available evidence regarding endovascular high-fidelity simulation interventions, to describe the overarching strategies used, the learning outcomes addressed, the choice of assessment methodology, and the impact of education on learner performance. Methods: A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using relevant keywords to identify studies evaluating simulation in the acquisition of endovascular surgical skills. References of review articles were screened for additional studies. Results: A total of 1,081 studies were identified (474 after removal of duplicates). There was marked heterogeneity in methodologies and reporting of outcomes. Quantitative analysis was deemed inappropriate due to the risk of serious confounding and bias. Instead, a descriptive synthesis was performed, summarizing key findings and quality components. Eighteen studies were included in the synthesis (15 observational, 2 case-control and 1 randomized control studies). Most studies measured procedure time, contrast usage, and fluoroscopy time. Other metrics were recorded to a lesser extent. Significant reductions were noted in both procedure and fluoroscopy times with the introduction of simulation-based endovascular training. Conclusions: The evidence regarding the use of high-fidelity simulation in endovascular training is very heterogeneous. The current literature suggests simulation-based training leads to improvements in performance, mostly in terms of procedure and fluoroscopy time. High-quality randomized control trials are needed to establish the clinical benefits of simulation training, sustainability of improvements, transferability of skills and its cost-effectiveness.
MeSH term(s)	Humans ; High Fidelity Simulation Training ; Treatment Outcome ; Learning ; Simulation Training/methods ; Computer Simulation ; Clinical Competence
Language	English
Publishing date	2023-03-09
Publishing country	Netherlands
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2023.02.025
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Article ; Online: Is it too difficult for disadvantaged applicants to get into medical school?

Grafton-Clarke, Ciaran

Medical teacher

2016 Volume 38, Issue 11, Page(s) 1184

MeSH term(s)	Humans ; Minority Groups ; School Admission Criteria ; Schools, Medical/organization & administration ; Schools, Medical/standards ; Socioeconomic Factors ; United Kingdom ; Vulnerable Populations
Language	English
Publishing date	2016-11
Publishing country	England
Document type	Letter
ZDB-ID	424426-6
ISSN	1466-187X ; 0142-159X
ISSN (online)	1466-187X
ISSN	0142-159X
DOI	10.1080/0142159X.2016.1237016
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Article ; Online: Live streaming to sustain clinical learning.

Grafton-Clarke, Ciaran / Uraiby, Hussein / Abraham, Shalin / Kirtley, Joanne / Xu, Gang / McCarthy, Mark

The clinical teacher

2022 Volume 19, Issue 4, Page(s) 282–288

Abstract: Background: The COVID-19 pandemic has necessitated the need to develop teaching innovations that provide safe, authentic clinical encounters which facilitate experiential learning. In tandem with the dissemination of teleconsultation and online teaching, ...

Abstract	Background: The COVID-19 pandemic has necessitated the need to develop teaching innovations that provide safe, authentic clinical encounters which facilitate experiential learning. In tandem with the dissemination of teleconsultation and online teaching, this pilot study describes, evaluates and justifies a multi-camera live-streaming teaching session to medical students from the clinical environment. Approach: Multiple audio and video inputs capturing an outpatient clinic setting were routed through Open Broadcast Software (OBS) to create a customised feed streamed to remote learners through a videoconferencing platform. Sessions were conducted between September 2020 and March 2021. Twelve students sequentially interacted with a patient who held an iPad. Higher quality Go-Pro cameras captured the scene, allowing students to view the consultation from the patient and doctor's perspective. A consultant then conducted a 'gold standard' patient consultation observed by students. A faculty member remotely facilitated the session, providing pre-clinic teaching and debriefing. The equipment required with costing for a standard and low-cost version is described, as well as a set-up schematic and overview of ideal conditions and barriers encountered during trials. Evaluation: All students completed a post-participation questionnaire, rating the overall quality of the sessions as 9.7/10. The quality of online facilitation, utility of observing peers' and consultant interaction with the patient, opportunity for peer-to-peer learning and availability of multiple camera angles were particularly valued by students. Implications: This innovation permits an authentic clinical interaction to be experienced by multiple students remotely, promoting equitable access to high-quality teaching, while maintaining the safety of students and patients.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Learning ; Pandemics ; Pilot Projects ; Students, Medical
Language	English
Publishing date	2022-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2151518-9
ISSN	1743-498X ; 1743-4971
ISSN (online)	1743-498X
ISSN	1743-4971
DOI	10.1111/tct.13488
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Article ; Online: Cardiac Magnetic Resonance Left Ventricular Filling Pressure Is Associated with NT-proBNP in Patients with New Onset Heart Failure.

Assadi, Hosamadin / Matthews, Gareth / Chambers, Bradley / Grafton-Clarke, Ciaran / Shabi, Mubien / Plein, Sven / Swoboda, Peter P / Garg, Pankaj

Medicina (Kaunas, Lithuania)

2023 Volume 59, Issue 11

Abstract: Background and ... ...

Abstract	Background and Objectives
MeSH term(s)	Humans ; Natriuretic Peptide, Brain ; Heart Failure ; Magnetic Resonance Imaging ; Stroke Volume/physiology ; Prognosis ; Magnetic Resonance Spectroscopy ; Biomarkers
Chemical Substances	pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0) ; Biomarkers
Language	English
Publishing date	2023-10-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina59111924
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Article ; Online: Is local anaesthesia superior to general anaesthesia in endovascular repair of abdominal aortic aneurysm?

Harky, Amer / Grafton-Clarke, Ciaran / Chan, Jeremy

Interactive cardiovascular and thoracic surgery

2019 Volume 29, Issue 4, Page(s) 599–603

Abstract: A best evidence topic in cardiovascular surgery was written in accordance to a structured protocol. The question addressed was: in patients undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is local anaesthetic (LA) superior to general ... ...

Abstract	A best evidence topic in cardiovascular surgery was written in accordance to a structured protocol. The question addressed was: in patients undergoing endovascular repair of abdominal aortic aneurysm (EVAR), is local anaesthetic (LA) superior to general anaesthetic in terms of perioperative outcomes? Altogether, 630 publications were found using the reported search protocol, of which 3 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and primary outcomes were tabulated. The 3 included studies are systematic reviews with meta-analyses, with no randomized trials identified. Within the studies, there is a degree of heterogeneity in terms of surgical case-mix (elective or emergency EVAR or both) and anaesthetic technique (LA, regional anaesthetic, local-regional anaesthetic and general anaesthetic). With 1 study not providing pooled estimates, the second study demonstrated statistical significance in favour of local-regional anaesthetic within the elective setting in terms of mortality [pooled odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52-0.95; P = 0.02], morbidity (pooled OR 0.73, 95% CI 0.55-0.96; P = 0.0006) and total length of hospital admission (pooled mean difference: -1.53, 95% CI -2.53 to -0.53; P = 0.00001). The third study failed to demonstrate a statistically significant mortality benefit with LA (pooled OR 0.54, 95% CI 0.21-1.41; P = 0.211). While the results of these studies fail to provide a clear answer to a complex surgical problem, it would be appropriate, in the light of current evidence, to recommend LA as non-inferior to general anaesthetic in both emergency and elective settings.
MeSH term(s)	Anesthesia, General ; Anesthesia, Local ; Anesthetics, Local ; Aortic Aneurysm, Abdominal/surgery ; Elective Surgical Procedures ; Endovascular Procedures ; Humans ; Odds Ratio ; Time Factors ; Treatment Outcome
Chemical Substances	Anesthetics, Local
Language	English
Publishing date	2019-06-07
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivz135
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Article ; Online: Teaching handover in undergraduate education: an evidence-based multi-disciplinary approach.

Gordon, Morris / Grafton-Clarke, Ciaran / Hill, Elaine

MedEdPublish (2016)

2019 Volume 8, Page(s) 100

Abstract: This article was migrated. The article was marked as recommended. Poor standards of handover threaten patient safety and continuity of care, contributing significantly to morbidity and mortality. Handover practices has risen to the forefront of the ... ...

Abstract	This article was migrated. The article was marked as recommended. Poor standards of handover threaten patient safety and continuity of care, contributing significantly to morbidity and mortality. Handover practices has risen to the forefront of the patient safety agenda, with a call to develop and implement undergraduate handover modules into undergraduate healthcare education. Recent systematic reviews demonstrate a common failure of educational interventions to demonstrate a theoretical and pedagogical framework underpinning the delivery of education and method of assessment. The authors developed and piloted a multi-disciplinary evidence-based undergraduate handover training program to health care students studying at a UK university. The intervention was designed based on underpinning educational theories. It has been developed in a manner that supports dissemination and replication, with a model that is cost effective. The intervention was designed to assess learner reaction, attitudes and confidence, and knowledge and skills. This was achieved through a pre- and post-intervention attitude questionnaire, and an externally validated pre- and post-intervention knowledge assessment. 46 undergraduate students participated, with a statistically significant increase in self-reported attitudes (p < 0.001) and knowledge (p < 0.001) following the handover intervention. Students participated from the disciplines of medicine, adult nursing, pharmacy, mental health nursing, paramedic practice and operating department practioners. This intervention serves as a significant resource for those looking to develop local interventions and stands as a truly multi-disciplinary approach to handover education, mirroring the clinical reality. The introduction of this handover intervention immediately improves the attitudes, knowledge and skills of undergraduate healthcare students. Future work should sample beyond the selected 6 professions, investigating the transference of outcomes to the workplace, as well as the impact on patient safety.
Language	English
Publishing date	2019-05-02
Publishing country	Scotland
Document type	Journal Article
ISSN	2312-7996
ISSN (online)	2312-7996
DOI	10.15694/mep.2019.000100.1
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Article ; Online: Validation of Left Atrial Volume Correction for Single Plane Method on Four-Chamber Cine Cardiac MRI.

Assadi, Hosamadin / Sawh, Nicholas / Bailey, Ciara / Matthews, Gareth / Li, Rui / Grafton-Clarke, Ciaran / Mehmood, Zia / Kasmai, Bahman / Swoboda, Peter P / Swift, Andrew J / Geest, Rob J van der / Garg, Pankaj

Tomography (Ann Arbor, Mich.)

2024 Volume 10, Issue 4, Page(s) 459–470

Abstract: Background: Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane- ...

Abstract	Background: Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane-derived LA indices against the biplane method to simplify the post-processing of cine CMR. Methods: In this study, 100 patients from Leeds Teaching Hospitals were used as the derivation cohort. Bias correction for the single plane method was applied and subsequently validated in 79 subjects. Results: There were significant differences between the biplane and single plane mean LA maximum and minimum volumes and LA ejection fraction (EF) (all Conclusions: LA volumetric and functional assessment by the single plane method has a systematic bias compared to the biplane method. After bias correction, single plane LA volume and function are comparable to the biplane method.
MeSH term(s)	Humans ; Magnetic Resonance Imaging, Cine/methods ; Female ; Male ; Heart Atria/diagnostic imaging ; Middle Aged ; Aged ; Stroke Volume/physiology ; Reproducibility of Results ; Adult ; Image Interpretation, Computer-Assisted/methods
Language	English
Publishing date	2024-03-25
Publishing country	Switzerland
Document type	Journal Article ; Validation Study ; Research Support, Non-U.S. Gov't
ISSN	2379-139X
ISSN (online)	2379-139X
DOI	10.3390/tomography10040035
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