ORCID Profile
0000-0001-6581-2788
Current Organisations
Royal Brisbane and Women's Hospital
,
University Hospital Lewisham
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Publisher: SAGE Publications
Date: 18-07-2019
Abstract: This article reviews the principles of unsupervised learning, a novel technique which has increasingly been reported as a tool for the investigation of chronic rhinosinusitis (CRS). It represents a paradigm shift from the traditional approach to investigating CRS based upon the clinically recognized phenotypes of “with polyps” and “without polyps” and instead relies upon the application of complex mathematical models to derive subgroups which can then be further examined. This review article reports on the principles which underlie this investigative technique and some of the published ex les in CRS. This review summarizes the different types of unsupervised learning techniques which have been described and briefly expounds upon their useful applications. A literature review of studies which have unsupervised learning is then presented to provide a practical guide to its uses and some of the new directions of investigations suggested by their findings. The commonest unsupervised learning technique applied to rhinology research is cluster analysis, which can be further sub ided into hierarchical and non-hierarchical approaches. The mathematical principles which underpin these approaches are explained within this article. Studies which have used these techniques can be broadly ided into those which have used clinical data only and that which includes biomarkers. Studies which include biomarkers adhere closely to the established canon of CRS disease phenotypes, while those that use clinical data may erge from the typical “polyp versus non-polyp” phenotypes and reflect subgroups of patients who share common symptom modifiers. Artificial intelligence is increasingly influential in health care research and machine learning techniques have been reported in the investigation of CRS, promising several interesting new avenues for research. However, when critically appraising studies which use this technique, the reader needs to be au fait with the limitations and appropriate uses of its application.
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJMED-2022-000382
Abstract: The emergence of SARS-CoV-2 has brought olfactory dysfunction to the forefront of public awareness, because up to half of infected in iduals could develop olfactory dysfunction. Loss of smell—which can be partial or total—in itself is debilitating, but the distortion of sense of smell (parosmia) that can occur as a consequence of a viral upper respiratory tract infection (either alongside a reduction in sense of smell or as a solo symptom) can be very distressing for patients. Incidence of olfactory loss after SARS-CoV-2 infection has been estimated by meta-analysis to be around 50%, with more than one in three who will subsequently report parosmia. While early loss of sense of smell is thought to be due to infection of the supporting cells of the olfactory epithelium, the underlying mechanisms of persistant loss and parosmia remain less clear. Depletion of olfactory sensory neurones, chronic inflammatory infiltrates, and downregulation of receptor expression are thought to contribute. There are few effective therapeutic options, so support and olfactory training are essential. Further research is required before strong recommendations can be made to support treatment with steroids, supplements, or interventions applied topically or injected into the olfactory epithelium in terms of improving recovery of quantitative olfactory function. It is not yet known whether these treatments will also achieve comparable improvements in parosmia. This article aims to contextualise parosmia in the setting of post-viral olfactory dysfunction, explore some of the putative molecular mechanisms, and review some of the treatment options available.
Publisher: Oxford University Press (OUP)
Date: 10-07-2019
DOI: 10.1136/POSTGRADMEDJ-2019-136519
Abstract: Chronic rhinosinusitis (CRS) is a common, treatable disease that affects approximately 11% of British adults. It places an enormous burden on patients, with significant detriment to their quality of life, and the health service as it consumes vast numbers of both primary and secondary care resources. However, there is considerable variability in treatment strategies and prescribing practices. This review summarises the key recommendations from landmark guidelines in the treatment of CRS and critically appraises the evidence for treatment.
Publisher: Wiley
Date: 26-04-2020
DOI: 10.1111/COA.13549
Publisher: Wiley
Date: 22-04-2021
DOI: 10.1111/COA.13779
Abstract: We set out to create Consensus Guidelines, based on current evidence and relative risks of adverse effects and the costs of different treatments, which reflect the views of the British Rhinological Society (BRS) Council on where the use of biologics should be positioned within treatment pathways for CRSwNP, specifically in the setting of the National Health Service (NHS). An expert panel of 16 members was assembled. A review of the literature and evidence synthesis was undertaken and circulated to the panel. We used the RAND/UCLA methodology with a multi‐step process to make recommendations on the use of biologics. N/A. N/A. Recommendations were made, based on underlying disease severity, prior treatments and co‐morbidities. A group of patients for whom biologics were considered an appropriate treatment option for CRSwNP was defined. Although biologics are not currently available for the treatment of CRSwNP, the BRS Council have defined a group of patients who have higher rates of “failure” with current treatment pathways, higher resource use and are more likely to suffer with uncontrolled symptoms. We would urge NICE to consider approval of biologics for such indications without applying further restrictions on use.
Publisher: Wiley
Date: 04-02-2021
DOI: 10.1111/COA.13716
Abstract: To report changes in practice brought about by COVID‐19 and the implementation of new guidelines, and to explore factors relating to unscheduled re‐presentations for patients discharged from the emergency department (ED). Prospective multicentre national audit over 12 weeks from 6th April 2020. UK secondary care ENT departments. Adult patients with acute epistaxis. Re‐presentation within 10 days for patients discharged from the ED. Eighty three centres from all four UK nations submitted 2631 valid cases. The majority of cases were ED referrals (89.7%, n = 2358/2631). 54.6% were discharged from the ED following ENT review (n = 1267/2322), of whom 19.5% re‐presented within 10 days (n = 245/1259) and 6.8% were ultimately admitted (n = 86/1259). 46.7% of patients had a non‐dissolvable pack inserted by ED prior to referral to ENT (n = 1099/2355). The discharge rates for ED patients and their subsequent re‐presentation rates were as follows: non‐dissolvable packs, 29.5% discharged (n = 332/1125), 18.2% re‐presented (n = 60/330) dissolvable products, 71.1% discharged (n = 488/686), 21.8% re‐presented (n = 106/486) cautery only, 89.2% discharged (n = 247/277), 20.0% re‐presented (n = 49/245) and no intranasal intervention, 85.5% discharged (n = 200/234), 15.2% re‐presented (n = 30/198). Univariable logistic regression showed that not being packed by ED, antiplatelet medications, failed cautery and recent epistaxis treatment were significant predictors of re‐presentation within 10 days. Management of acute epistaxis was notably affected during the initial peak of the pandemic, with a shift towards reduced admissions. This national audit highlights that many patients who may previously have been admitted to hospital may be safely discharged from the ED following acute epistaxis.
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.JSURG.2016.01.012
Abstract: "Grit" can be defined as the passion and perseverance for long-term goals, and it can be measured by a validated scale. It has been associated with success in erse fields such as basic military training and spelling tests. Surgical training is arduous with large number of trainees reporting burnout, and it could be expected that grit is a fundamental requirement to complete training. This study aimed to examine the relationship of grit in surgical training, whether grit varies by grade of surgeon, and the association of grit with burnout. This was a prospective survey-based study, using the validated tools Short Grit Scale and Oldenburg Burnout Inventory. UK-based ear, nose, and throat doctors based in secondary care were invited to participate. Ear, nose, and throat surgeons were used as the s le population, with subgroups of core trainees (core surgical trainees), specialist registrars (higher surgical training), and consultants. A total of 102 participants completed the study (33 core surgical trainees, 49 mid-career trainees in higher surgical training, and 22 consultants). Consultants were significantly grittier than trainees (p < 0.05). Grit had a significant inverse relationship with burnout (r = -0.54, p < 0.05). There was a nonsignificant trend of reduced burnout in consultants. Age and sex were not associated with grit or burnout. These findings reinforce the concept that grit is fundamentally important to completion of surgical training. In addition, grittier in iduals are more likely to resist burnout than their less gritty counterparts. These findings carry implications for retention and recruitment of trainee surgeons, and further study is required to investigate whether surgical training influences grit levels or selects out the grittiest trainees to survive to completion.
Publisher: Wiley
Date: 06-08-2020
DOI: 10.1111/COA.13609
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/8098426
Abstract: Background . Prevalence of rhinitis in athletes has frequently been studied and varies widely from 27% to 74%. The aim of this systematic review was to examine the prevalence of rhinitis in athletes, to specifically compare the evidence of rhinitis in land-based and aquatic athletes. Methods . Systematic search of MEDLINE, EMBASE, and the non-MEDLINE subset of PubMed was performed from inception to March 8, 2016, to identify studies on rhinitis in athletes. Results . Of the 373 identified unique articles, a total of 13 studies satisfied the criteria for this review. The final group contained 9 cohort and 4 case-control studies. We found 10 studies that reported the prevalence of allergic rhinitis (21%–56.5%). In contrast, nonallergic rhinitis was identified by only 1 author (6%). We have also evaluated the prevalence of rhinitis in the separate subgroups (land, water, and cold air) where swimmers seem to be the most affected (40%–74%), followed by cross-country skiers (46%) and track and field athletes (21 to 49%). Conclusion . We did not reveal any convincing trend of a higher prevalence in land-based athletes compared to general population. By contrast, aquatic and cold air athletes demonstrate increased prevalence reflecting the irritant effects of their environment on the nasal mucosa.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Abigail walker.