Institution
Leicester Royal Infirmary
Healthcare•Leicester, United Kingdom•
About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.
Papers published on a yearly basis
Papers
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TL;DR: Stapled haemorrhoidectomy is an effective treatment for third degree haemOrrhoids with significant advantages for patients compared with conventional haem orrhoids, and controlled symptoms of prolapse, discharge and bleeding in all patients.
421 citations
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University Hospital Southampton NHS Foundation Trust1, University of Padua2, University of Southampton3, University of Bern4, University Hospital of Bern5, University of Western Australia6, Erasmus University Rotterdam7, University of Toronto8, Medical University of Graz9, University of Paris10, Leicester Royal Infirmary11, Imperial College London12, Katholieke Universiteit Leuven13, University of North Carolina at Chapel Hill14, Sapienza University of Rome15, Copenhagen University Hospital16, University of Paris-Sud17, Charles University in Prague18, Cochrane Collaboration19
TL;DR: This guideline focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence, and proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia.
Abstract: The diagnosis of primary ciliary dyskinesia is often confirmed with standard, albeit complex and expensive, tests. In many cases, however, the diagnosis remains difficult despite the array of sophisticated diagnostic tests. There is no "gold standard" reference test. Hence, a Task Force supported by the European Respiratory Society has developed this guideline to provide evidence-based recommendations on diagnostic testing, especially in light of new developments in such tests, and the need for robust diagnoses of patients who might enter randomised controlled trials of treatments. The guideline is based on pre-defined questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. It focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence. It then used a modified Delphi survey to develop an algorithm for the use of diagnostic tests to definitively confirm and exclude the diagnosis of primary ciliary dyskinesia; and to provide advice when the diagnosis was not conclusive. Finally, this guideline proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia.
417 citations
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414 citations
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TL;DR: The pathophysiology, clinical manifestations of reperfusion injury to the heart and the possible therapeutic approaches to avoiding any adverse effects are reviewed.
414 citations
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TL;DR: Rectal misoprostol in a dose of 800 micrograms could be a useful 'first line' drug for the treatment of primary postpartum haemorrhage.
Abstract: Background
Primary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries.
Objectives
To assess the effectiveness and safety of any intervention used for the treatment of primary PPH.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2013).
Selection criteria
Randomised controlled trials comparing any interventions for the treatment of primary PPH.
Data collection and analysis
We assessed studies for eligibility and quality and extracted data independently. We contacted authors of the included studies to request more information.
Main results
Ten randomised clinical trials (RCTs) with a total of 4052 participants fulfilled our inclusion criteria and were included in this review.
Four RCTs (1881 participants) compared misoprostol with placebo given in addition to conventional uterotonics. Adjunctive use of misoprostol (in the dose of 600 to 1000 mcg) with simultaneous administration of additional uterotonics did not provide additional benefit for our primary outcomes including maternal mortality (risk ratio (RR) 6.16, 95% confidence interval (CI) 0.75 to 50.85), serious maternal morbidity (RR 0.34, 95% CI 0.01 to 8.31), admission to intensive care (RR 0.79, 95% CI 0.30 to 2.11) or hysterectomy (RR 0.93, 95% CI 0.16 to 5.41).
Two RCTs (1787 participants) compared 800 mcg sublingual misoprostol versus oxytocin infusion as primary PPH treatment; one trial included women who had received prophylactic uterotonics, and the other did not. Primary outcomes did not differ between the two groups, although women given sublingual misoprostol were more likely to have additional blood loss of at least 1000 mL (RR 2.65, 95% CI 1.04 to 6.75). Misoprostol was associated with a significant increase in vomiting and shivering.
Two trials attempted to test the effectiveness of estrogen and tranexamic acid, respectively, but were too small for any meaningful comparisons of pre-specified outcomes.
One study compared lower segment compression but was too small to assess impact on primary outcomes.
We did not identify any trials evaluating surgical techniques or radiological interventions for women with primary PPH unresponsive to uterotonics and/or haemostatics.
Authors' conclusions
Clinical trials included in the current review were not adequately powered to assess impact on the primary outcome measures. Compared with misoprostol, oxytocin infusion is more effective and causes fewer side effects when used as first-line therapy for the treatment of primary PPH. When used after prophylactic uterotonics, misoprostol and oxytocin infusion worked similarly. The review suggests that among women who received oxytocin for the treatment of primary PPH, adjunctive use of misoprostol confers no added benefit.
The role of tranexamic acid and compression methods requires further evaluation. Furthermore, future studies should focus on the best way to treat women who fail to respond to uterotonic therapy.
407 citations
Authors
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Name | H-index | Papers | Citations |
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George Davey Smith | 224 | 2540 | 248373 |
Nilesh J. Samani | 149 | 779 | 113545 |
Peter M. Rothwell | 134 | 779 | 67382 |
John F. Thompson | 132 | 1420 | 95894 |
James A. Russell | 124 | 1024 | 87929 |
Paul Bebbington | 119 | 583 | 46341 |
John P. Neoptolemos | 112 | 648 | 52928 |
Richard C. Trembath | 107 | 368 | 41128 |
Andrew J. Wardlaw | 92 | 311 | 33721 |
Melanie J. Davies | 89 | 814 | 36939 |
Philip Quirke | 89 | 378 | 34071 |
Kenneth J. O'Byrne | 87 | 629 | 39193 |
David R. Jones | 87 | 707 | 40501 |
Keith R. Abrams | 86 | 355 | 30980 |
Martin J. S. Dyer | 85 | 373 | 24909 |