The energy needed to drive airflow through the trachea normally constitutes a minor component of the work of breathing. However, with progressive tracheal compression, patient subjective symptoms can ...include severe breathing difficulties. Many patients suffer multiple respiratory co-morbidities and so it is important to assess compression effects when evaluating the need for surgery. This work describes the use of computational prediction to determine airflow resistance in compressed tracheal geometries reconstructed from a series of CT scans. Using energy flux analysis, the regions that contribute the most to airway resistance during inhalation are identified. The principal such region is where flow emerging from the zone of maximum constriction undergoes breakup and turbulent mixing. Secondary regions are also found below the tongue base and around the glottis, with overall airway resistance scaling nearly quadratically with flow rate. Since the anatomical extent of the imaged airway varied between scans—as commonly occurs with clinical data and when assessing reported differences between research studies—the effect of sub-glottic inflow truncation is considered. Analysis shows truncation alters the location of jet breakup and weakly influences the pattern of pressure recovery. Tests also show that placing a simple artificial glottis in the inflow to a truncated model can replicate patterns of energy loss in more extensive models, suggesting a means to assess sensitivity to domain truncation in tracheal airflow simulations.
Quality of life in differentiated thyroid cancer McIntyre, Charlotte; Jacques, Thomas; Palazzo, Fausto ...
International journal of surgery (London, England),
02/2018, Letnik:
50
Journal Article
Recenzirano
The incidence of thyroid cancer has increased significantly over the last ten years and conversely the mortality has decreased. With 85% of patients with thyroid cancer surviving for ten years or ...longer it is increasingly important to study the quality of life in these patients and identify which aspects of the patients' health and wellbeing could be improved.
During the first UK patient-doctor thyroid cancer forum, patient attendees filled in an anonymized questionnaire. Patients with a diagnosis of differentiated thyroid cancer were studied, and patients less than 6 months from diagnosis were excluded. The questionnaire included demographic data, the EQ-5D-3L validated tool, information on post-operative outcomes; scar satisfaction, use of calcium supplements >6months post-operatively, vocal cord palsy, anti-depressant use and psychological counselling.
82 completed questionnaires were used for the study. The median age at diagnosis was 42 years (range 18–72), and there was a female:male ratio of 6:1. EQ-5D utility health scores: the mean weighted health outcome of the average population in the UK is 0.86 (SD 0.23). Our group had a significantly lower quality of life compared to the average UK population, with a mean weighted health outcome of 0.776 (SD 0.26, p value < .0004).
This study assesses quality of life in a group of self-selected patients who attended the patient-doctor thyroid cancer forum and, although accepting there is a sampling bias, the conference provided an opportunity to assess the quality of life of patients with differentiated thyroid cancer. The study has found that the average quality of life in this group of patients is lower than that of the UK population, and lower than that of patients with breast, colorectal and prostate cancer. A large number of these patients suffer with fatigue, and depression requiring anti-depressants and/or counselling.
•A study of the quality of life in patients with differentiated thyroid cancer.•The study cohort had a significantly lower quality of life when compared to that of the UK population average.•Large numbers of patients suffer fatigue and depression requiring anti-depressants or counselling.
Objective
To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy.
Study ...Design
Prospective observational study.
Setting
Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic.
Methods
Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays.
Results
Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80.
Conclusion
In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.
Background
The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2–5%. The poorly understood characteristic of parathyroid tissue to manifest ...autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery.
Methods
Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition.
Results
Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially ‘visualisable’ glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF.
Conclusion
Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
We determine the efficacy for three known structurally related, membrane active detergents against multidrug resistant and wild type strains of
. Accessible solution state NMR experiments are used to ...quantify phospholipid headgroup composition of the microbial membranes and to gain molecular level insight into antimicrobial mode of action.
Despite 49.1% of registered pharmacists in the UK being from a Black, Asian and Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males. People from ...BAME communities may experience minority stress which contributes to a professional attainment gap compared with non-BAME colleagues. Minority stress describes additional stressors, such as unconscious bias, micro-aggression and racial minority stress, experienced by minoritized people to adhere to the social norms of the majority. There is little evidence describing experiences of minority stress in pharmacy practice and education. The aim was to explore experiences of racial minority stress in pharmacy education and practice.
A convenience sample of pharmacy students and pharmacists were recruited via email and social media posts to volunteer to take part in interviews and focus groups. A topic guide was used to explore experiences of unconscious bias, microaggressions and racial minority stress in education and practice. Interviews and focus groups were transcribed verbatim and inductively analysed using thematic analysis underpinned by a phenomenological approach. Ethical approval was granted from Newcastle University (5340/2020, 2430/2593).
Forty-five participants were recruited. Six focus groups and sixteen one-to-one semi-structured interviews were conducted. The sample was varied, with 56% (n = 25) students and 33% (n = 15) registered pharmacists from community, hospital, primary care, academia and an additional 11% (n = 5) still in foundation training in these sectors. The sample include diversity of racial identities, including 40% (n = 18) South Asian, 27% (n = 12) White, 15% (n = 7) Black, 7% (n = 3) Chinese and Arab mixed, 2% (n = 1) and 2% (n = 1) Not disclosed. Three themes were identified – Theme 1) Experiences of racial minority stress, Theme 2) Making sense of racial minority stress, and Theme 3) Responding to racial minority stress. Participants characteristics (for example skin colour, dialect, religious dress) made them feel susceptible to judgement, racist comments and microaggressions in education and practice. Participants required time to interpret, understand and make sense of incidents of racial minority stress. Responses to stressors included ‘ignoring ignorance’ and using a ‘professional identity’ to mask feelings. However, malicious comments and actions from other pharmacy staff were responded to differently to experiences from patients. Participants reported poor self-confidence to challenge racist behaviours in the workplace.
The aim of this study was to explore experiences of racial minority stress in pharmacy education and practice. This study shows dealing with microaggression, racial minority stress and judgement in pharmacy education and practice is a burden experienced by people from BAME backgrounds. These experiences could contribute to the professional attainment gap in pharmacy, as making sense of these experiences is an additional burden pharmacists and trainees must bear in comparison to people from non-BAME backgrounds. Further work is needed to explore interventions to reduce minority stress in pharmacy practice and education to reduce the attainment gap across the sector.
•Little was known about experiences of racial minority stress in pharmacy education and practice.•Micro-aggressions, unconcious bias and racism in pharmacy practice and education contributed to racial minority stress.•Patients and professional colleagues contributed to racial minority stress in different ways.•Interventions could be developed to support people experiencing racial minority stress.•Experiences of racial minority stressors appeared to influence beliefs about professional attainment.
BJS Paper 12 Thyroidectomy consent – A UK study McIntyre, Charlotte; Di Marco, Aimee; Palazzo, Fausto ...
European journal of surgical oncology,
December 2017, 2017-12-00, Letnik:
43, Številka:
12
Journal Article
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