ORCID Profile
0000-0003-2332-5839
Current Organisation
University of Leeds
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Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JHEP.2016.04.030
Abstract: Spontaneous clearance of chronic hepatitis C virus (HCV) infection (CHC) is rare. We conducted a retrospective case-control study to identify rates and factors associated with spontaneous clearance of CHC. We defined cases as in iduals who spontaneously resolved CHC, and controls as in iduals who remained chronically infected. We used data obtained on HCV testing between 1994 and 2013 in the West of Scotland to infer case/control status. Specifically, untreated patients with ⩾2 sequential s les positive for HCV RNA ⩾6months apart followed by ⩾1 negative test, and those with ⩾2 positive s les ⩾6months apart with no subsequent negative s les were identified. Control patients were randomly selected from the second group (4 atient of interest). Case notes were reviewed and patient characteristics obtained. 25,113 s les were positive for HCV RNA, relating to 10,318 patients. 50 cases of late spontaneous clearance were identified, contributing 241 person-years follow-up. 2,518 untreated, chronically infected controls were identified, contributing 13,766 person-years follow-up, from whom 200 controls were randomly selected. The incidence rate of spontaneous clearance was 0.36/100 person-years follow-up, occurring after a median 50months' infection. Spontaneous clearance was positively associated with female gender, younger age at infection, lower HCV RNA load and co-infection with hepatitis B virus. It was negatively associated with current intravenous drug use. Spontaneous clearance of CHC occurs infrequently but is associated with identifiable host and viral factors. More frequent HCV RNA monitoring may be appropriate in selected patient groups. Clearance of hepatitis C virus infection without treatment occurs rarely once chronic infection has been established. We interrogated a large Scottish patient cohort and found that it was more common in females, patients infected at a younger age or with lower levels of HCV in the blood, and patients co-infected with hepatitis B virus. Patients who injected drugs were less likely to spontaneously clear chronic infection.
Publisher: Wiley
Date: 04-2022
DOI: 10.1111/IMJ.15126
Abstract: Medical inpatients can develop acute general surgical conditions. However, this is rare. The presence of multiple acute pathologies delays diagnosis and these patients have poorer prognoses. To determine the incidence, risk factors and prognosis of medical inpatients developing acute general surgical conditions. A single‐centre retrospective case–control study was conducted over 1 year in the United Kingdom. Medical patients developing acute surgical pathology were identified using the local referral system. For each case, two controls were selected from a pool of medical inpatients receiving no general surgical input during their admission. Patient records were used to collect hospital admission details, demographic and laboratory data. Univariate analysis and multivariable analysis were performed. The study included 42 cases and 84 controls. The incidence of general surgical pathology in medical inpatients was 2.3/1000 admissions/year. In multivariate analysis, risk factors associated with developing general surgical pathology were previous abdominal surgery (odds ratio (OR) =3.68 95% confidence interval (CI): 1.43 to 9.48 P = 0.007) and doubling from baseline creatinine (OR = 18.9 95% CI: 2.57 to 139 P = 0.004). Patients with surgical pathology had longer inpatient stays (22.8 vs 9.4 days P 0.001) and a higher inpatient mortality (23.8% vs 7.1% P = 0.011). Development of surgical pathology was strongly associated with mortality (OR = 4.06 95% CI: 1.36 to 12.1). The development of acute surgical pathology in medical inpatients is rare but associated with longer inpatient stays and higher mortality. We have identified risk‐factors associated with the development of surgical pathology, which can be used to identify patients at risk of surgical pathology.
Publisher: Routledge
Date: 14-06-2012
Publisher: SAGE Publications
Date: 15-06-2022
DOI: 10.1177/26320843221106950
Abstract: To test the feasibility of undertaking a simultaneous Study Within A Trial (SWAT) to train staff who recruit participants into surgical randomised controlled trials (RCTs), by assessing key uncertainties around recruitment, randomisation, intervention delivery and data collection. Twelve surgical RCTs were eligible. Interested sites (clusters) were randomised 1:1, with recruiting staff (surgeons and nurses) offered training or no training. The primary outcome was the feasibility of recruiting sites across multiple surgical trials simultaneously. Secondary outcomes included numbers/types of staff enrolled, attendance at training, training acceptability, confidence in recruiting and participant recruitment rates six months later. Four RCTs (33%) comprising 91 sites participated. Of these, 29 sites agreed to participate (32%) and were randomised to intervention (15 sites, 29 staff) or control (14 sites, 29 staff). Research nurses attended and found the training to be acceptable no surgeons attended. In the intervention group, there was evidence of increased confidence when pre- and post- training scores were compared (mean difference in change 1.42 95% CI 0.56, 2.27 p = 0.002). There was no effect on recruitment rate. It was feasible to randomise sites across four surgical RCTs in a simultaneous SWAT design. However, as small numbers of trials and sites participated, and no surgeons attended training, strategies to improve these aspects are needed for future evaluations.
Publisher: Oxford University Press (OUP)
Date: 05-02-2020
DOI: 10.1002/BJS.11453
Abstract: This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21 P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41 P = 0·498). There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Bethan Davies.