Leicester General Hospital

About: Leicester General Hospital is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Transplantation. The organization has 2481 authors who have published 3034 publications receiving 107437 citations.

Doctor in the process. The engagement of clinical directors in hospital management.

Abstract: Aims to examine medical involvement in hospital management processes, and to consider the implications of current experience for the next generation of clinical directors. Doctors who move into a formal management role often find themselves unprepared for their new responsibilities. Research has thus concentrated on identifying the management competences which doctors lack, and with designing ways to remedy the deficit. Seeks to move beyond this deficit model by adopting a perspective which focuses on the engagement of doctors in the management process. Draws data from in‐depth interviews with six clinical directors and 19 other members of the hospital management team at Leicester General Hospital NHS Trust (LGH). Content analysis of interviews suggests that the engagement of clinical directors in the hospital management process at this site can be described as reluctant, transient, service‐driven, power‐pulled and pressured. This negative portrayal of the role, however, must be set in the context of the “management expectation” held of clinical directors by other hospital managers and staff ‐ an expectation that is not currently fulfilled.

Diurnal Blood Pressure Change Varies With Stroke Subtype in the Acute Phase

Abstract: Background and Purpose —It is unclear whether acute stroke is associated with a loss of the normal diurnal blood pressure (BP) change and whether stroke type influences this. Some of this confusion results from the use of fixed time definitions of day and night, which can be overcome by the use of cumulative sums analysis (cusums). Methods —Ninety-eight stroke patients had 24-hour BP monitoring (Spacelabs 90207) performed within 48 hours of ictus. Three subgroups were identified: cortical infarct, n=50; subcortical infarct, n=29; and primary intracerebral hemorrhage [PICH], n=19. An age-matched control group of 74 subjects was also studied. Diurnal change was assessed by both day-night differences (absolute and percentage) and cusums (cusums plot height [CPH] and circadian alteration magnitude [CDCAM]); ANCOVA was used to compare groups. Results —Compared with control subjects, cortical infarct and PICH subgroups had significantly reduced mean diurnal systolic changes using day-night differences (absolute, –12 and –17 mm Hg; percentage, –10 and –12, respectively; P <0.0001) and cusums (CDCAM, –6.96 and –8.6 mm Hg; CPH, –32.05 and –46.04 mm Hg, respectively; P <0.005), only the subcortical infarct subgroup demonstrated reduced percentage differences (–4.4%, P <0.02). Mean diastolic differences were significantly reduced in all stroke subgroups(CPH, –24.84, –17.31, and –36.92 mm Hg; absolute, –8.26, –4.04, and –11.44 mm Hg; percentage, –10.65, –5.81, and –15.23%, for cortical infarct, subcortical infarct, and PICH subgroups, respectively; P <0.05), except for CDCAM, which was not reduced in subcortical infarcts (–4.78 and –7.70 mm Hg for cortical infarct and PICH subgroups, respectively; P <0.001). Conclusions —Diurnal BP change was reduced in the 3 stroke subgroups studied, especially in patients with cortical infarcts and PICH. This may reflect damage to the central modulation of autonomic BP control. The implications in terms of prognosis and therapy in the acute period require further study.

Dose of intravenous immunoglobulins in chronic inflammatory demyelinating polyneuropathy

Abstract: The usual initiating dose of intravenous immunoglobulins (IVIg) in the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) is 2 g/kg/course. Although not evidence based, subsequent reductions are advised to the lowest possible level for maintenance. In practice, the achievable levels of such reductions and their impact on treatment frequency have not been studied. Factors determining maximal dosage reduction are unknown. We retrospectively reviewed data concerning IVIg therapy for 15 patients with CIDP, from their medical records between 1997 and 2005. Lowest effective dose and treatment frequency were determined. The following correlations were ascertained: dose to frequency, dose to weight, dose to disease duration, amplitude of dose reduction to disease duration, and dose to pre-therapeutic disease severity. Dose reductions were possible in all (mean: 63.3%, range: 42.4-88%). The lowest effective dose of IVIg per course and treatment frequency were both very variable (18-108 g and 2-17 weeks, respectively). Lowest dose per course did not correlate to weight, frequency of administration, disease duration, or pre-therapeutic degree of disability. Amplitude of dose reduction achieved was independent of disease duration. Treatment frequency could not be lowered in any patient. Our findings show that IVIg target doses should be titrated individually but suggest that infusion frequencies are fixed in each case in relapsing CIDP. Importantly, lower dose treatment is not associated with shorter intervals between courses, and lowest effective dose is independent of weight and disease duration. Initial level of disability does not appear to influence dose required. These results suggest considerably lower, standardized, initiating, and maintenance doses might be effective and highlight the need for prospective dose comparative trials.

Albumin as an outcome measure in haemodialysis in patients: the effect of variation in assay method

Abstract: Introduction Background. Serum/plasma albumin is an important predictor of future mortality/morbidity in haemo- Serum/plasma albumin is an important predictor of dialysis (HD) patients and has been proposed as an future mortality/morbidity in patients with renal failure important audit measure. Different methods of albu- [1,2]. This predictive power is a reflection of the effect min assay give different results and the bias between of inflammation (albumin is a negative acute phase methods may be greater in renal failure patients. reactant) and malnutrition on albumin concentration Methods. Albumin concentration in plasma was meas- [3]. Hypoalbuminaemia is a marker for patients who ured by three methods, two dye-binding methods (bro- are unwell for other reasons (e.g. malignancy, infection, mocresol green (BCG) and bromocresol purple (BCP)) severe vascular disease), who are malnourished or both. There are no data to prove that interventions and an immuno-turbidimetric (ITM ) method, in 143 directed to raising serum albumin could improve the HD patients (group I ) and 49 non-renal patients outcome in these patients. A number of authorities (group II ). Comparisons were made between means, have recommended the audit of albumin concentravariation in differences across a range of albumin tions as an outcome measure of dialysis treatment. The concentrations and on the percentage of patients within Renal Association standards document [4] recomthe normal range. mends that serum albumin should be ‘within the Results. In HD patients (group I ), BCG over- normal range quoted by the local pathology laboratestimated plasma albumin compared with the other ory’ and this has been used as an important outcome two methods. The difference could be as much as 10 g/l measure in the first report of the UK Renal Registry and was more marked in hypoalbuminaemic patients. [5]. The use of the local range recognizes that a number The BCP method gave results closer to the ITM of different assay methods are used for measuring method, particularly in HD patients. These differences albumin and that these methods give different results were less marked in group II patients but both meth- [6 ]. We have noted that there are often major difods overestimated albumin compared with the ITM ferences in albumin measurements between two labmethod. Using the BCG local laboratory normal range, oratories routinely analysing samples from our haemo84% of HD patients had plasma albumin concentra- dialysis ( HD) patients. These laboratories use different tions within the normal range but this fell to 57% if assay methods but have similar normal ranges. the BCP results were used. However, we have found consistently that albumin Conclusions. The method for determining albumin concentrations, determined by the bromocresol purple concentration has a marked effect on the results par- (BCP) dye-binding method, are lower than the bromticularly in HD patients. BCG, the most commonly ocresol green (BCG) dye-binding method. These used method, gives higher results than other methods differences have been reported in renal failure patients and correlates poorly with an immunological method. before [7–10]. In this study, we sought to characterize These differences make comparative audit between the magnitude of the difference in a larger population, nephrology units difficult and have implications for compared with a ‘gold standard’ method for albumin other biochemical variables and other specialties. assay based on an immunological method. We also assessed the effect of different assay methods on the

Retinal Layer Abnormalities as Biomarkers of Schizophrenia

Abstract: Objective Schizophrenia is associated with several brain deficits, as well as visual processing deficits, but clinically useful biomarkers are elusive. We hypothesized that retinal layer changes, noninvasively visualized using spectral-domain optical coherence tomography (SD-OCT), may represent a possible "window" to these abnormalities. Methods A Leica EnvisuTM SD-OCT device was used to obtain high-resolution central foveal B-scans in both eyes of 35 patients with schizophrenia and 50 demographically matched controls. Manual retinal layer segmentation was performed to acquire individual and combined layer thickness measurements in 3 macular regions. Contrast sensitivity was measured at 3 spatial frequencies in a subgroup of each cohort. Differences were compared using adjusted linear models and significantly different layer measures in patients underwent Spearman Rank correlations with contrast sensitivity, quantified symptoms severity, disease duration, and antipsychotic medication dose. Results Total retinal and photoreceptor complex thickness was reduced in all regions in patients (P < .0001). Segmentation revealed consistent thinning of the outer nuclear layer (P < .001) and inner segment layer (P < .05), as well as a pattern of parafoveal ganglion cell changes. Low spatial frequency contrast sensitivity was reduced in patients (P = .002) and correlated with temporal parafoveal ganglion cell complex thinning (R = .48, P = .01). Negative symptom severity was inversely correlated with foveal photoreceptor complex thickness (R = -.54, P = .001) and outer nuclear layer thickness (R = -.47, P = .005). Conclusions Our novel findings demonstrate considerable retinal layer abnormalities in schizophrenia that are related to clinical features and visual function. With time, SD-OCT could provide easily-measurable biomarkers to facilitate clinical assessment and further our understanding of the disease.