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  1. Article ; Online: Specialist healthcare services for concussion/mild traumatic brain injury in England

    Antonio Belli / Vanessa Raymont / Damian Holliman / Catherine McMahon / Peter Whitfield / Mark Wilson / Angelos G Kolias / Ben Jones / Richard Sylvester / Mario Ganau / Michael Parker / Shrouk Messahel / Peter John Hutchinson / Clint Gomes / Michael Grey / Michael Griffiths / Adel Helmy / Kanchan Sharma / Rupert Noad /
    Peter Jenkins / Emma Woodberry / Elika Karvandi / Timothy Griffiths / Philippa Griffiths / Tim Lawrence / Terence McLoughlin / Joanne Newton / Daniel Tadmor

    BMJ Open, Vol 13, Iss

    a consensus statement using modified Delphi methodology

    2023  Volume 12

    Abstract: Objective To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome.Design This consensus study followed the modified Delphi ... ...

    Abstract Objective To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome.Design This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%.Setting Specialist outpatient services.Participants Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England.Primary outcome measure A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England.Results 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics.Conclusions This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Risk of Aneurysm Rupture (ROAR) study

    Hiren Patel / James Galea / Giles Critchley / Nitin Mukerji / Nicholas Ross / Peter Whitfield / Jay Park / Harsh Bhatt / Megan Burns / Zoe Stone / Paul M Brennan / Jacqueline Birks / John Norris / Diederik Oliver Bulters / David Bennett / Stefan Mitrasinovic / Benjamin Fisher / Dominic Townsend / Kristin Veighey /
    Jonathan Downer / Rosa Sun / Andrew Bacon / Christos Michael Tolias / Justyna Ekert / Milo Hollingworth / Nikolaos Tzerakis / Ian Anderson / Edward White / Adel Helmy / Samir Matloob / Matthew Myers / Armin Nazari / Christopher Uff / Patrick Grover / Nathan McSorley / Alex Fung / Shuja Yaqub / Neeraj Kalra / James Ulrich / Rebecca Hodnett / Graham Dow / Steven Tominey / Mario Teo / Kristy Kehoe / Jeremy Cheong / Devika Rajashekar / Debayan Dasgupta / James Loan / Samuel Hall / Ajitesh Anand

    BMJ Open, Vol 13, Iss

    protocol for a long-term, longitudinal, UK multicentre study of unruptured intracranial aneurysms

    2023  Volume 3

    Abstract: Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand ...

    Abstract Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates.Methods and analysis The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims.Ethics and dissemination Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals.Trial registration number ISRCTN17658526.
    Keywords Medicine ; R
    Subject code 170
    Language English
    Publishing date 2023-03-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Imaging timing after glioblastoma surgery (INTERVAL-GB)

    Oliver Burton / Julie Woodfield / Daniel Richardson / Giles Critchley / Angelos Kolias / Thomas Santarius / Lewis Thorne / Peter Whitfield / Ola Rominiyi / Bharti Kewlani / Harsh Bhatt / Ahmed Ahmed / Michael O’Sullivan / Rasheed Zakaria / Michael D Jenkinson / Gerard Thompson / Paul M Brennan / Rory Piper / Seong Hoon Lee /
    Neil Barua / Engelbert Mthunzi / Sara Venturini / Daniel M Fountain / Najma Ahmed / Stephen J Price / Colin Watts / Michael T C Poon / Stuart Smith / Anand Pandit / Ryan K Mathew / Soham Bandyopadhyay / Rosa Sun / Setthasorn Zhi Yang Ooi / Victoria Wykes / William Bolton / Abdullah Egiz / Samantha J Mills / Babar Vaqas / Natalie Simon / Puneet Plaha / Georgios Solomou / Aswin Chari / Grainne McKenna / Melissa Gough / Simon Lammy / Sophie T Williams / Isabelle Williams / Andrew J Martin / Sam Hodgson / Robert Spencer

    BMJ Open, Vol 12, Iss

    protocol for a UK and Ireland, multicentre retrospective cohort study

    2022  Volume 9

    Abstract: Introduction Glioblastoma is the most common malignant primary brain tumour with a median overall survival of 12–15 months (range 6–17 months), even with maximal treatment involving debulking neurosurgery and adjuvant concomitant chemoradiotherapy. The ... ...

    Abstract Introduction Glioblastoma is the most common malignant primary brain tumour with a median overall survival of 12–15 months (range 6–17 months), even with maximal treatment involving debulking neurosurgery and adjuvant concomitant chemoradiotherapy. The use of postoperative imaging to detect progression is of high importance to clinicians and patients, but currently, the optimal follow-up schedule is yet to be defined. It is also unclear how adhering to National Institute for Health and Care Excellence (NICE) guidelines—which are based on general consensus rather than evidence—affects patient outcomes such as progression-free and overall survival. The primary aim of this study is to assess MRI monitoring practice after surgery for glioblastoma, and to evaluate its association with patient outcomes.Methods and analysis ImagiNg Timing aftER surgery for glioblastoma: an eVALuation of practice in Great Britain and Ireland is a retrospective multicentre study that will include 450 patients with an operated glioblastoma, treated with any adjuvant therapy regimen in the UK and Ireland. Adult patients ≥18 years diagnosed with glioblastoma and undergoing surgery between 1 August 2018 and 1 February 2019 will be included. Clinical and radiological scanning data will be collected until the date of death or date of last known follow-up. Anonymised data will be uploaded to an online Castor database. Adherence to NICE guidelines and the effect of being concordant with NICE guidelines will be identified using descriptive statistics and Kaplan-Meier survival analysis.Ethics and dissemination Each participating centre is required to gain local institutional approval for data collection and sharing. Formal ethical approval is not required since this is a service evaluation. Results of the study will be reported through peer-reviewed presentations and articles, and will be disseminated to participating centres, patients and the public.
    Keywords Medicine ; R
    Subject code 616
    Language English
    Publishing date 2022-09-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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  4. Article ; Online: Correction to

    Angelos G. Kolias / Ellie Edlmann / Eric P. Thelin / Diederik Bulters / Patrick Holton / Nigel Suttner / Kevin Owusu-Agyemang / Yahia Z. Al-Tamimi / Daniel Gatt / Simon Thomson / Ian A. Anderson / Oliver Richards / Peter Whitfield / Monica Gherle / Karen Caldwell / Carol Davis-Wilkie / Silvia Tarantino / Garry Barton / Hani J. Marcus /
    Aswin Chari / Paul Brennan / Antonio Belli / Simon Bond / Carole Turner / Lynne Whitehead / Ian Wilkinson / Peter J. Hutchinson / British Neurosurgical Trainee Research Collaborative (BNTRC) and Dex-CSDH Trial Collaborators

    Trials, Vol 20, Iss 1, Pp 1-

    Dexamethasone for adult patients with a symptomatic chronic subdural haematoma (Dex-CSDH) trial: study protocol for a randomised controlled trial

    2019  Volume 1

    Abstract: After publication of the original article [1], the authors notified that that one of the BNTRC institutional collaborator names was misspelled. ...

    Abstract After publication of the original article [1], the authors notified that that one of the BNTRC institutional collaborator names was misspelled.
    Keywords Medicine (General) ; R5-920
    Language English
    Publishing date 2019-03-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Dexamethasone for adult patients with a symptomatic chronic subdural haematoma (Dex-CSDH) trial

    Angelos G. Kolias / Ellie Edlmann / Eric P. Thelin / Diederik Bulters / Patrick Holton / Nigel Suttner / Kevin Owusu-Agyemang / Yahia Z. Al-Tamimi / Daniel Gatt / Simon Thomson / Ian A. Anderson / Oliver Richards / Peter Whitfield / Monica Gherle / Karen Caldwell / Carol Davis-Wilkie / Silvia Tarantino / Garry Barton / Hani J. Marcus /
    Aswin Chari / Paul Brennan / Antonio Belli / Simon Bond / Carole Turner / Lynne Whitehead / Ian Wilkinson / Peter J. Hutchinson / British Neurosurgical Trainee Research Collaborative (BNTRC) and Dex-CSDH Trial Collaborators

    Trials, Vol 19, Iss 1, Pp 1-

    study protocol for a randomised controlled trial

    2018  Volume 14

    Abstract: Abstract Background Chronic subdural haematoma (CSDH) is a common neurosurgical condition, typically treated with surgical drainage of the haematoma. However, surgery is associated with mortality and morbidity, including up to 20% recurrence of the CSDH. ...

    Abstract Abstract Background Chronic subdural haematoma (CSDH) is a common neurosurgical condition, typically treated with surgical drainage of the haematoma. However, surgery is associated with mortality and morbidity, including up to 20% recurrence of the CSDH. Steroids, such as dexamethasone, have been identified as a potential therapy for reducing recurrence risk in surgically treated CSDHs. They have also been used as a conservative treatment option, thereby avoiding surgery altogether. The hypothesis of the Dex-CSDH trial is that a two-week course of dexamethasone in symptomatic patients with CSDH will lead to better functional outcome at six months. This is anticipated to occur through reduced number of hospital admissions and surgical interventions. Methods Dex-CSDH is a UK multi-centre, double-blind randomised controlled trial of dexamethasone versus placebo for symptomatic adult patients diagnosed with CSDH. A sample size of 750 patients has been determined, including an initial internal pilot phase of 100 patients to confirm recruitment feasibility. Patients must be recruited within 72 h of admission to a neurosurgical unit and exclusions include patients already on steroids or with steroid contraindications, patients who have a cerebrospinal fluid shunt and those with a history of psychosis. The decision regarding surgical intervention will be made by the clinical team and patients can be included in the trial regardless of whether operative treatment is planned or has been performed. The primary outcome measure is the modified Rankin Scale (mRS) at six months. Secondary outcomes include the number of CSDH-related surgical interventions during follow-up, length of hospital stay, mRS at three months, EQ-5D at three and six months, adverse events, mortality and a health-economic analysis. Discussion This multi-centre trial will provide high-quality evidence as to the effectiveness of dexamethasone in the treatment of CSDH. This has implications for patient morbidity and mortality as well as a potential economic impact on the overall health service burden from this condition. Trial registration ISRCTN, ISRCTN80782810. Registered on 7 November 2014. EudraCT, 2014-004948-35. Registered on 20 March 2015. Dex-CSDH trial protocol version 3, 27 Apr 2017. This protocol was developed in accordance with the SPIRIT checklist. Available as a separate document on request.
    Keywords Chronic subdural haematoma ; Dexamethasone ; Neurosurgery ; Neurology ; Randomised control trial ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2018-12-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Dex-CSDH randomised, placebo-controlled trial of dexamethasone for chronic subdural haematoma

    Ellie Edlmann / Eric P. Thelin / Karen Caldwell / Carole Turner / Peter Whitfield / Diederik Bulters / Patrick Holton / Nigel Suttner / Kevin Owusu-Agyemang / Yahia Z. Al-Tamimi / Daniel Gatt / Simon Thomson / Ian A. Anderson / Oliver Richards / Monica Gherle / Emma Toman / Dipankar Nandi / Phillip Kane / Beatrice Pantaleo /
    Carol Davis-Wilkie / Silvia Tarantino / Garry Barton / Hani J. Marcus / Aswin Chari / Antonio Belli / Simon Bond / Rafael Gafoor / Sarah Dawson / Lynne Whitehead / Paul Brennan / Ian Wilkinson / Angelos G Kolias / Peter J. A. Hutchinson / Dex-CSDH trial collaborative and BNTRC collaborative.

    Scientific Reports, Vol 9, Iss 1, Pp 1-

    report of the internal pilot phase

    2019  Volume 13

    Abstract: Abstract The Dex-CSDH trial is a randomised, double-blind, placebo-controlled trial of dexamethasone for patients with a symptomatic chronic subdural haematoma. The trial commenced with an internal pilot, whose primary objective was to assess the ... ...

    Abstract Abstract The Dex-CSDH trial is a randomised, double-blind, placebo-controlled trial of dexamethasone for patients with a symptomatic chronic subdural haematoma. The trial commenced with an internal pilot, whose primary objective was to assess the feasibility of multi-centre recruitment. Primary outcome data collection and safety were also assessed, whilst maintaining blinding. We aimed to recruit 100 patients from United Kingdom Neurosurgical Units within 12 months. Trial participants were randomised to a 2-week course of dexamethasone or placebo in addition to receiving standard care (which could include surgery). The primary outcome measure of the trial is the modified Rankin Scale at 6 months. This pilot recruited ahead of target; 100 patients were recruited within nine months of commencement. 47% of screened patients consented to recruitment. The primary outcome measure was collected in 98% of patients. No safety concerns were raised by the independent data monitoring and ethics committee and only five patients were withdrawn from drug treatment. Pilot trial data can inform on the design and resource provision for substantive trials. This internal pilot was successful in determining recruitment feasibility. Excellent follow-up rates were achieved and exploratory outcome measures were added to increase the scientific value of the trial.
    Keywords Medicine ; R ; Science ; Q
    Subject code 610
    Language English
    Publishing date 2019-04-01T00:00:00Z
    Publisher Nature Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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