Leicester Royal Infirmary

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.

Long‐term efficacy and safety of cyclosporin in severe adult atopic dermatitis

Abstract: Summary A prospective, open, multicentre study was performed to investigate the efficacy and safety of longterm treatment with cyclosporin in adults with severe atopic dermatitis. Subjects were treated for a maximum of 48 weeks. For the first 8 weeks, cyclosporin was administered at 2.5 mg/kg per day. The dose was then adjusted according to response. Disease activity was monitored using the six-area. six-sign score and the proportion of skin involved. Pruritus and sleep disturbance were assessed using four-point scales. Response was further evaluated on a five-point scale. Adverse events. blood pressure and serum biochemistry were monitored. Tolerability was assessed on a five-point scale. One hundred subjects were enrolled and 65 completed 48 weeks of treatment. Withdrawals occurred due to remission (three), inadequate response (seven), protocol violations (11) and adverse events (14, of which seven were probably treatment related). Cyclosporin produced rapid and highly significant improvements in all indices of disease activity. Sixty-five subjects considered that they had shown a considerable improvement or complete clearance of disease. Most patients relapsed after cessation of treatment. but neither signs nor symptoms had returned to baseline severity 8 weeks later. Blood pressure and serum creatinine levels increased slightly. and in one subject renal impairment was a major factor contributing to withdrawal of the drug. Overall, 85 subjects rated the tolerability of cyclosporin as good or very good. The results indicate that cyclosporin has a place in the long-term treatment of severe atopic dermatitis provided that appropriate patients are selected and careful monitoring is performed.

Pharmacoeconomics: NICE's approach to decision-making.

Abstract: The National Institute for Health and Clinical Excellence (NICE) is a decision-maker Where NICE reaches a positive conclusion about the use of a particular health technology (such as a pharmaceutical product) in the National Health Service (NHS), there is a legal requirement for the service to make it available if a patient's physician considers it clinically appropriate [1] Although this legal obligation does not apply to technologies recommended in NICE's clinical guidelines, there is still a reasonable expectation by the Care Quality Commission for NHS healthcare professionals to use NICE's clinical guidelines as the basis, where appropriate, for their clinical practice NICE's independent advisory bodies (the Appraisal Committees, the Public Health Advisory Committee and Guideline Development Groups) are required to take account of both clinical and cost-effectiveness in reaching their conclusions about the use of health technologies generally and of pharmaceuticals in particular [2–4] These advisory bodies must fully assess the available evidence on benefits and costs in order to come to a decision as to whether the use of a technology is considered a cost-effective use of resources However, the scientific evidence underpinning any decision about the use of a particular health technology is never perfect Nor is it all-embracing Advisory bodies therefore need to use their experience to make judgements beyond the existing evidence These judgements are of two types [5]: Scientific value judgements are ones about what can be inferred from the available evidence base; and the extent to which imperfections in the evidence base should influence decisions Social value judgements are concerned with what is appropriate and acceptable for society in delivering healthcare across the NHS

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’

Abstract: Background: the ageing demographic means that increasing numbers of older people will be attending emergency departments (EDs). Little previous research has focused on the needs of older people in ED and there have been no evaluations of comprehensive geriatric assessment (CGA) embedded within the ED setting. Methods: a pre-post cohort study of the impact of embedding CGA within a large ED in the East Midlands, UK. The primary outcome was admission avoidance from the ED, with readmissions, length of stay and bed-day use as secondary outcomes. Results: attendances to ED increased in older people over the study period, whereas the ED conversion rate fell from 69.6 to 61.2% in people aged 85+, and readmission rates in this group fell from 26.0% at 90 days to 19.9%. In-patient bed-day use increased slightly, as did the mean length of stay. Discussion: it is possible to embed CGA within EDs, which is associated with improvements in operational outcomes.

The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline.

Abstract: Nicola S. Curry, Ross Davenport, Sue Pavord, Susan V. Mallett, Dianne Kitchen, Andrew A. Klein, Helena Maybury, Peter W. Collins and Mike Laffan Department of Haematology, Oxford University Hospitals NHS Foundation Trust, NIHR BRC, Blood Theme, Oxford University, Oxford, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK NEQAS for Blood Coagulation, Sheffield, Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, Department of Obstetrics, Leicester Royal Infirmary, Leicester, Department of Haematology, School of Medicine, Cardiff University, Cardiff, and Department of Haematology, Imperial College and Hammersmith Hospital, London, UK