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1.
BMC Med ; 22(1): 222, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831293

RESUMO

BACKGROUND: It is a requirement that medical students are educated in emergencies and feel well prepared for practice as a doctor, yet national surveys show that many students feel underprepared. Virtual reality (VR), combined with 360-degree filming, provides an immersive, realistic, and interactive simulation experience. Unlike conventional in-person simulation, it is scalable with reduced workforce demands. We sought to compare students' engagement and enjoyment of VR simulation to desktop computer-based simulation. METHODS: We conducted a prospective, interventional, evaluation study. The study was carried out on final year medical students undertaking their Pre-Foundation Assistantship (n = 116) at Imperial College School of Medicine (ICSM) in London. We compared objective engagement, subjective engagement, and subjective enjoyment of VR simulation to desktop computer-based simulation using cardiac arrest and life-threatening asthma scenarios. Engagement was measured objectively using students' physiological parameters, including heart rate and eye tracking, and facilitator observations using the validated 'Behavioural Engagement Related to Instruction' (BERI) protocol. Students' subjective engagement and enjoyment levels were measured using a post-session survey. RESULTS: Students' maximum heart rates were significantly higher during VR simulation with a mean difference of 4.2 beats per minute (3.2 to 5.2, p < 0.001), and eye tracking showed they spent a significantly greater mean percentage of time of 6.4% (5.1 to 7.7, p < 0.001) focusing on the scenarios in VR compared to standard desktop. Qualitative data showed students enjoyed and felt engaged with the sessions, which provided a safe space for learning. CONCLUSIONS: Our study shows that students found VR simulations enjoyable and were more engaged compared to standard desktop simulation. This suggests that 360-degree VR simulation experiences provide students with immersive, realistic training, which is scalable, giving them the unique opportunity to manage emergencies and work within emergency teams, which would not typically occur during traditional training.


Assuntos
Educação de Graduação em Medicina , Treinamento por Simulação , Estudantes de Medicina , Realidade Virtual , Humanos , Estudos Prospectivos , Masculino , Feminino , Educação de Graduação em Medicina/métodos , Treinamento por Simulação/métodos , Adulto Jovem , Adulto , Londres , Medicina de Emergência/educação
2.
Br Dent J ; 236(11): 917, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38877265
4.
Br J Oral Maxillofac Surg ; 62(5): 426-432, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38749799

RESUMO

Penetrating neck trauma is becoming a more frequently encountered presentation in UK emergency departments. Although largely attributable to violent crime, other aetiologies are on the rise. This study aimed to review changes in the pattern of penetrating neck injury (PNI) over a five-year period at our level 1 major trauma centre. Data were retrospectively collected on all patients presenting to the emergency department with PNIs between 2016 and 2021. The number of these injuries doubled between 2016 and 2021, accounting for 11% of all penetrating trauma in 2021. The majority of patients were male (87%). Violence remained the predominant aetiology but numbers of self-harm-related PNIs trebled between 2018 and 2021. PNIs are on the rise. These injuries remain complex to manage and require a multidisciplinary approach. Tackling violent crime remains essential in combating PNIs, but focus must also be placed on identifying and supporting individuals most at risk of deliberate self-harm from a deterioration in mental health.


Assuntos
Lesões do Pescoço , Centros de Traumatologia , Ferimentos Penetrantes , Humanos , Lesões do Pescoço/epidemiologia , Masculino , Ferimentos Penetrantes/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Estudos Retrospectivos , Feminino , Londres/epidemiologia , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Comportamento Autodestrutivo/epidemiologia , Violência/estatística & dados numéricos , Idoso
5.
Environ Sci Technol ; 58(20): 8771-8782, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38728551

RESUMO

This randomized crossover study investigated the metabolic and mRNA alterations associated with exposure to high and low traffic-related air pollution (TRAP) in 50 participants who were either healthy or were diagnosed with chronic pulmonary obstructive disease (COPD) or ischemic heart disease (IHD). For the first time, this study combined transcriptomics and serum metabolomics measured in the same participants over multiple time points (2 h before, and 2 and 24 h after exposure) and over two contrasted exposure regimes to identify potential multiomic modifications linked to TRAP exposure. With a multivariate normal model, we identified 78 metabolic features and 53 mRNA features associated with at least one TRAP exposure. Nitrogen dioxide (NO2) emerged as the dominant pollutant, with 67 unique associated metabolomic features. Pathway analysis and annotation of metabolic features consistently indicated perturbations in the tryptophan metabolism associated with NO2 exposure, particularly in the gut-microbiome-associated indole pathway. Conditional multiomics networks revealed complex and intricate mechanisms associated with TRAP exposure, with some effects persisting 24 h after exposure. Our findings indicate that exposure to TRAP can alter important physiological mechanisms even after a short-term exposure of a 2 h walk. We describe for the first time a potential link between NO2 exposure and perturbation of the microbiome-related pathways.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Microbioma Gastrointestinal , Humanos , Masculino , Londres , Feminino , Pessoa de Meia-Idade , Estudos Cross-Over , Poluição Relacionada com o Tráfego , Dióxido de Nitrogênio
6.
BMJ Paediatr Open ; 8(1)2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38782482

RESUMO

The aim of this study was to characterise paediatric emergency department presentations during the 2023 thunderstorm asthma (TA) epidemic, characterised by a sudden surge in wheeze presentations, with analysis of environmental factors.Wheeze presentations totalled 50 (28%) on 12 June and 18 (19%) 13 June. There was no prior asthma in 39 (57%) and no atopic disorders in 30 (44%). There was neither asthma nor atopic disorders in 8 (12%). 44 (65%) were severe or life-threatening. There were no endotracheal intubations and no deaths. High pollen and air pollution warnings were issued.TA poses a significant, sudden health threat, often in children without asthma. A surge strategy is required.


Assuntos
Asma , Serviço Hospitalar de Emergência , Humanos , Asma/epidemiologia , Asma/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Criança , Londres/epidemiologia , Masculino , Feminino , Pré-Escolar , Adolescente , Sons Respiratórios/etiologia , Tempo (Meteorologia) , Lactente , Poluição do Ar/efeitos adversos , Pólen/efeitos adversos
7.
BMJ Open Qual ; 13(2)2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38782489

RESUMO

INTRODUCTION: In healthcare teams, psychological safety is associated with improved performance, communication, collaboration and patient safety. Extracorporeal membrane oxygenation (ECMO) retrieval teams are multidisciplinary teams that initiate ECMO therapy for patients with severe acute respiratory failure in referring hospitals and transfer patients to regional specialised centres for ongoing care. The present study aimed to explore an ECMO team's experience of psychological safety and generate recommendations to strengthen psychological safety. METHODS: The study was conducted in the Royal Brompton Hospital (RBH), part of Guy's and St Thomas' NHS Foundation Trust in London. RBH is one of six centres commissioned to provide ECMO therapy in the UK. 10 participants were recruited: 2 consultants, 5 nurses and 3 perfusionists. Semistructured interviews were used to explore the team members' views on teamwork, their perceived ability to discuss concerns within the team and the interaction between speaking up, teamwork and hierarchy. A Reflexive Thematic Analysis approach was used to explore the interview data. RESULTS: The analysis of the interview dataset identified structural and team factors shaping psychological safety in the specific context of the ECMO team. The high-risk environment in which the team operates, the clearly defined process and functions and the structured opportunities that provide legitimate moments to reflect together influence how psychological safety is experienced. Furthermore, speaking up is shaped by the familiarity among team members, the interdependent work, which requires boundary spanning across different roles, and leadership behaviour. A hierarchy of expertise is privileged over traditional institutional ranking. CONCLUSION: This study surfaced the structural and team factors that influence speaking up in the specific context of an ECMO retrieval team. Such information is used to suggest interventions to improve and strengthen psychological safety.


Assuntos
Oxigenação por Membrana Extracorpórea , Equipe de Assistência ao Paciente , Segurança do Paciente , Pesquisa Qualitativa , Humanos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/normas , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Londres , Entrevistas como Assunto/métodos , Melhoria de Qualidade , Feminino , Masculino , Segurança Psicológica
8.
BMJ Open ; 14(5): e082253, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38803264

RESUMO

OBJECTIVES: This study identifies the most common recorded reason for attendance to primary care for children under 5 years old, including a breakdown via age, ethnicity, deprivation quintile and sex. DESIGN: Cross-sectional. SETTING: 39 of 40 general practices in Lambeth, London, UK. PARTICIPANTS: 22 189 children under 5 years who had attended primary care between the 1 April 2017 and 31 March 2020 and had not opted out of anonymous data sharing within Lambeth DataNet. OUTCOME MEASURE: The primary objective was to identify the most frequently recorded complaint in general practice for children under 5 years old. The secondary objective was to understand how presenting complaint differs by age, ethnicity, sex and deprivation level. The third objective was to create a multivariate logistic regression with frequent attendance as the outcome variable. RESULTS: Nine conditions formed over 50% of all patient interactions: the most common reason was upper respiratory tract infections (14%), followed by eczema (8%) and cough (7%). While there was some variation by ethnicity and age, these nine conditions remained dominant. Children living in the most deprived area are more likely to be frequent attenders than children living in the least deprived area (adjusted OR (AOR) 1.27 (95% CI 1.14 to 1.41)). Children of Indian (AOR 1.47 (1.04 to 2.08)), Bangladeshi (AOR 2.70 (1.95 to 3.74)) and other white (AOR 1.18 (1.04 to 1.34)) ethnicities were more likely to be frequent attenders, compared with those of white British ethnicity. CONCLUSIONS: Most reasons for attendance for children under 5 years to primary care are for acute, self-limiting conditions. Some of these could potentially be managed by increasing access to community care services, such as pharmacies. By focusing on the influence of the broader determinants of health as to why particular groups are more likely to attend, health promotion efforts have the opportunity to reduce barriers to healthcare and improve outcomes.


Assuntos
Atenção Primária à Saúde , Humanos , Estudos Transversais , Masculino , Feminino , Lactente , Pré-Escolar , Londres/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Recém-Nascido , Infecções Respiratórias/epidemiologia , Modelos Logísticos
9.
Artigo em Inglês | MEDLINE | ID: mdl-38791850

RESUMO

This study explores how young people's mental health was affected by the COVID-19 pandemic using artwork and semi-structured interviews. The mental health impacts of the pandemic are important to understand so that policy and practice professionals can support those affected, prepare and respond to future crises, and support young people who are isolated and restricted in other contexts. Co-designed participatory art workshops and interviews were conducted with 16-18-year-olds (n = 21, 62% female) from the London-based Longitudinal cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP). Artworks and interview transcripts were qualitatively co-and analysed with young people. From interviews, six themes were identified: adaptation, restriction, change, challenges, overcoming adversity, and lockdown life. From the artwork, four themes were identified: trapped, negative mental wellbeing, positive emotions, and technology. Everyday factors such as home environment, social support, hobbies, habits, and online education were key determinants of how challenged and restricted participants felt, and their capacity to overcome this. This demonstrates the importance of wider (social and environmental) determinants and supports a systems-level public health approach to young people's mental health. For example, young people's mental health services should collaborate with other sectors to address such determinants in a holistic way. Clearer guidance and support with occupation, relationships, environment, routine and activities could mitigate the negative mental health impacts of major environmental changes on young people.


Assuntos
Adaptação Psicológica , COVID-19 , Saúde Mental , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Adolescente , Feminino , Masculino , Londres , Estudos Longitudinais , SARS-CoV-2 , Arte , Entrevistas como Assunto , Pandemias , Apoio Social
10.
Support Care Cancer ; 32(5): 321, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38691178

RESUMO

BACKGROUND: The COVID-19 pandemic has had an enormous impact on the experiences of patients across all health disciplines, especially those of cancer patients. The study aimed to understand the experiences of cancer patients who underwent surgery during the first two waves of the pandemic at Guy's Cancer Centre, which is a large tertiary cancer centre in London. METHODS: A mixed-methods approach was adopted for this study. Firstly, a survey was co-designed by the research team and a patient study group. Patients who underwent surgery during the COVID-19 pandemic were invited to take part in this survey. Results were analysed descriptively. Three discussion groups were then conducted to focus on the main themes from the survey findings: communication, COVID-19 risk management and overall experience. These discussion groups were transcribed verbatim and underwent a thematic analysis using the NVivo software package. RESULTS: Out of 1657 patients invited, a total of 250 (15%) participants took part in the survey with a mean age of 66 (SD 12.8) and 52% females. The sample was representative of a wide range of tumour sites and was reflective of those invited to take part. Overall, the experience of the cancer patients was positive. They felt that the safety protocols implemented at the hospital were effective. Communication was considered key, and patients were receptive to a change in the mode of communication from in-person to virtual. CONCLUSIONS: Despite the immense challenges faced by our Cancer Centre, patients undergoing surgery during the first two waves of the COVID-19 pandemic had a generally positive experience with minimal disruptions to their planned surgery and ongoing care. Together with the COVID-19 safety precautions, effective communication between the clinical teams and the patients helped the overall patient experience during their surgical treatment.


Assuntos
COVID-19 , Neoplasias , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Masculino , Londres , Neoplasias/cirurgia , Idoso , Pessoa de Meia-Idade , Inquéritos e Questionários , Institutos de Câncer/organização & administração , Comunicação , Idoso de 80 Anos ou mais , Adulto
11.
Front Public Health ; 12: 1358250, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38699416

RESUMO

Introduction: This article explores how systemic injustices and social inequalities affect refugee and asylum seeker integration, thriving, and mental health in London. This is pertinent as the United Kingdom currently operates a 'broken' asylum system with unfair policies and a 'tough' immigration rhetoric which makes it extraordinarily difficult for asylum seekers and refugees to achieve community integration, have a good quality of life, be able to thrive, and have good health including mental health. Paradoxically, the United Kingdom Home Office also features an Indicators for Integration Framework to provide practical ways to design more effective strategies, monitor services and evaluated integration interventions. Methods: This study employed a qualitative research design including semi-structured interviews with 19 mental health and psychosocial support service providers working in third-sector organizations in London. Results: The study results show that the current asylum system severely undermines efforts to support asylum seekers and refugees with their integration. All participants highlighted that asylum seekers and refugees lacked experienced poor quality of life and faced structural challenges to build meaningful social connections; to have access education, fair employment and good work; to achieve good mental health and wellbeing; and to be able to thrive. Discussion: To improve community integration, quality of life, thriving, and mental health for asylum seekers and refugees in London and, beyond, the United Kingdom, four recommendations are made on structural and service-levels: (1) reform of the current asylum system by centering human rights; (2) implement and carry out needs assessments among asylum seekers and refugees focussing on key social determinants; (3) ensure asylum seekers and refugees benefit from the NHS Inclusion Health framework; and (4) extend the NHS Patient and Carer Race Equality framework beyond England. To be effective, all four initiatives need to be grounded in a participatory approach that meaningfully involves diverse groups of stakeholders including asylum seekers and refugees.


Assuntos
Integração Comunitária , Saúde Mental , Pesquisa Qualitativa , Qualidade de Vida , Refugiados , Humanos , Refugiados/psicologia , Londres , Feminino , Masculino , Entrevistas como Assunto , Adulto , Serviços de Saúde Mental
12.
Int J Geriatr Psychiatry ; 39(5): e6097, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38782606

RESUMO

BACKGROUND: While some people with mild cognitive impairment (MCI) progress to dementia, many others show no progression. The aim of this study was to identify factors associated with risk of dementia development in this population. METHOD: A large naturalistic retrospective cohort study was assembled from mental healthcare records in a south London catchment. Patients were selected at first recorded diagnosis of MCI and subsequent dementia diagnosis was ascertained from case notes or death certificate, excluding those with dementia diagnoses and deaths within 6 months of MCI diagnosis. A range of demographic and clinical characteristics were ascertained around MCI diagnosis and Cox proportional hazards models were used to investigate independent predictors of dementia, focussing on neuropsychiatric symptoms, contextual factors, and antidepressant treatment. RESULTS: Of 2250 patients with MCI, 236 (10.5%) developed dementia at least 6 months after MCI diagnosis. Aside from older age, lower cognitive function, and activities of daily living impairment, impaired social relationships and recorded loneliness were associated with a higher risk of developing dementia. Patients of Black (compared to White) ethnicity were at a lower risk. For depression and antidepressant receipt, only tricyclic use compared to no antidepressant use was associated with an increased dementia risk. CONCLUSIONS: No evidence was found for co-morbid affective disorders or different antidepressant classes as risk factors for dementia development following MCI diagnosis, but loneliness and social impairment were independent predictors and would be worth evaluating as targets for interventions to delay progression.


Assuntos
Antidepressivos , Disfunção Cognitiva , Demência , Modelos de Riscos Proporcionais , Humanos , Disfunção Cognitiva/epidemiologia , Feminino , Masculino , Demência/epidemiologia , Demência/tratamento farmacológico , Idoso , Fatores de Risco , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Londres/epidemiologia , Atividades Cotidianas , Pessoa de Meia-Idade , Depressão/epidemiologia , Depressão/tratamento farmacológico , Solidão/psicologia
15.
BMC Health Serv Res ; 24(1): 554, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38693519

RESUMO

BACKGROUND: There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study's objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. METHODS: Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. RESULTS: Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers - communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. CONCLUSION: This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement.


Assuntos
Agendamento de Consultas , Acessibilidade aos Serviços de Saúde , Medicina Estatal , Humanos , Londres , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Pesquisa Qualitativa , Entrevistas como Assunto , Idoso , Disparidades em Assistência à Saúde/etnologia , Grupos Minoritários/estatística & dados numéricos , Grupos Minoritários/psicologia , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Comunicação
16.
Dev Sci ; 27(4): e13503, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38576154

RESUMO

Adolescence is marked by the onset of puberty, which is associated with an increase in mental health difficulties, particularly in girls. Social and self-referential processes also develop during this period: adolescents become more aware of others' perspectives, and judgements about themselves become less favourable. In the current study, data from 119 girls (from London, UK) aged 9-16 years were collected at two-time points (between 2019 and 2021) to investigate the relationship between puberty and difficulties in mental health and emotion regulation, as well as the role of self-referential and social processing in this relationship. Structural equation modelling showed that advanced pubertal status predicted greater mental health and emotion regulation difficulties, including depression and anxiety, rumination and overall difficulties in emotion regulation, and in mental health and behaviour. Advanced pubertal status also predicted greater perspective-taking abilities and negative self-schemas. Exploratory analyses showed that negative self-schemas mediated the relationships between puberty and rumination, overall emotion regulation difficulties, and depression (although these effects were small and would not survive correction for multiple comparisons). The results suggest that advanced pubertal status is associated with higher mental health and emotion regulation problems during adolescence and that negative self-schemas may play a role in this association. RESEARCH HIGHLIGHTS: This study investigates the relationship between puberty, mental health, emotion regulation difficulties, and social and self-referential processing in girls aged 9-16 years. Advanced pubertal status was associated with worse mental health and greater emotion regulation difficulties, better perspective-taking abilities and negative self-schemas. Negative self-schemas may play a role in the relationships between advanced pubertal status and depression, and advanced pubertal status and emotion regulation difficulties, including rumination.


Assuntos
Depressão , Regulação Emocional , Saúde Mental , Puberdade , Autoimagem , Humanos , Adolescente , Feminino , Criança , Puberdade/psicologia , Puberdade/fisiologia , Regulação Emocional/fisiologia , Depressão/fisiopatologia , Reino Unido , Ansiedade , Emoções/fisiologia , Londres
17.
Curr Probl Cardiol ; 49(7): 102577, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38653441

RESUMO

BACKGROUND: There is a paucity of evidence on impact of a delay in Cardiac Sarcoidosis (CS) diagnosis after high-grade atrioventricular-block (AVB) and this study aims to fill this void. METHODS: Consecutive CS patients (n = 77) with high grade AVB referred to one specialist hospital in London between February 2007 to February 2023 were retrospectively reviewed. The median time from AVB to diagnosing CS (112 days) was used to define the Early (n = 38) and Late (n = 39) cohorts. The primary endpoint was a composite of all-cause mortality, cardiac transplantation, ventricular arrhythmic events or heart failure hospitalisation. Secondary endpoints included difference in maintenance prednisolone dose, need for cardiac device upgrade and device complications. RESULTS: The mean age of the cohort was 54.4 (±10.6) years of whom 64 % were male and 81 % Caucasian. After a mean follow up of 54.9 (±45.3) months, the primary endpoint was reached by more patients from the Late cohort (16/39 vs. 6/38, p = 0.02; multivariable HR 6.9; 95 %CI 1.5-32.2, p = 0.01). Early Group were more likely to have received an Implantable Cardioverter Defibrillator or Cardiac Resynchronisation Therapy-defibrillator as index device after AVB (19/38 vs. 6/39; p < 0.01) and had fewer device upgrades (19/38 vs. 30/39, p = 0.01) and a trend towards fewer device complications (1 vs. 5, p = 0.20). The maintenance dose of prednisolone was significantly higher in Late Group [20.7(±9.7) mg vs. 15.3(±7.9) mg, p = 0.02]. CONCLUSION: A late diagnosis of CS was associated with more adverse events, a greater probability of needing a device upgrade and required higher maintenance steroid dose.


Assuntos
Bloqueio Atrioventricular , Cardiomiopatias , Sarcoidose , Humanos , Sarcoidose/diagnóstico , Sarcoidose/complicações , Masculino , Feminino , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/terapia , Bloqueio Atrioventricular/etiologia , Pessoa de Meia-Idade , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Estudos Retrospectivos , Fatores de Tempo , Diagnóstico Precoce , Londres/epidemiologia , Prednisolona/uso terapêutico , Prednisolona/administração & dosagem , Adulto , Seguimentos , Idoso
18.
Br J Community Nurs ; 29(Sup4): S37-S42, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38578923

RESUMO

The 11th annual National Lymphoedema Conference, organised by the British Journal of Community Nursing in association with the British Lymphology Society and Lipoedema UK, was hosted at the America Square Conference Centre, London, on 22 February 2024. The conference, which aims to provide new insights into the latests developments in lymphoedema care and management through talks by leading experts in the field, was attended by an impressive number of delegates and exhibitors. The sessions were Chaired by BLS Trustee Rebecca Elwell, and are summarised below.


Assuntos
Lipedema , Linfedema , Humanos , Linfedema/terapia , Londres
19.
BMJ Open Respir Res ; 11(1)2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38575338

RESUMO

BACKGROUND: We assessed the effectiveness of sotrovimab vs no early COVID-19 treatment in highest-risk COVID-19 patients during Omicron predominance. METHODS: Retrospective cohort study using the Discover dataset in North West London. Included patients were non-hospitalised, aged ≥12 years and met ≥1 National Health Service highest-risk criterion for sotrovimab treatment. We used Cox proportional hazards models to compare HRs of 28-day COVID-19-related hospitalisation/death between highest-risk sotrovimab-treated and untreated patients. Age, renal disease and Omicron subvariant subgroup analyses were performed. RESULTS: We included 599 sotrovimab-treated patients and 5191 untreated patients. Compared with untreated patients, the risk of COVID-19 hospitalisation/death (HR 0.50, 95% CI 0.24, 1.06; p=0.07) and the risk of COVID-19 hospitalisation (HR 0.43, 95% CI 0.18, 1.00; p=0.051) were both lower in the sotrovimab-treated group; however, statistical significance was not reached. In the ≥65 years and renal disease subgroups, sotrovimab was associated with a significantly reduced risk of COVID-19 hospitalisation, by 89% (HR 0.11, 95% CI 0.02, 0.82; p=0.03) and 82% (HR 0.18, 95% CI 0.05, 0.62; p=0.007), respectively. CONCLUSIONS: Risk of COVID-19 hospitalisation in sotrovimab-treated patients aged ≥65 years and with renal disease was significantly lower compared with untreated patients. Overall, risk of hospitalisation was also lower for sotrovimab-treated patients, but statistical significance was not reached.


Assuntos
Anticorpos Monoclonais Humanizados , Anticorpos Neutralizantes , Tratamento Farmacológico da COVID-19 , COVID-19 , Humanos , Londres/epidemiologia , Estudos Retrospectivos , Medicina Estatal
20.
BMJ Open ; 14(4): e082346, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38604624

RESUMO

INTRODUCTION: It is important to promote resilience in preadolescence; however, there is limited research on children's understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London's Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London. METHODS AND ANALYSIS: We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6-12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8-12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data. ETHICS AND DISSEMINATION: The Queen Mary Ethics of Research Committee at Queen Mary University of London has approved this study (approval date: 9 October 2023; ref: QME23.0042). The researchers plan to publish the results in peer-reviewed journals and present findings at academic conferences.


Assuntos
Resiliência Psicológica , Criança , Humanos , Povo Asiático , Islamismo , Londres , Pais
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