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.

Are one or two simple questions sufficient to detect depression in cancer and palliative care? A Bayesian meta-analysis

Abstract: The purpose of this study is to examine the value of one or two simple verbal questions in the detection of depression in cancer settings. This study is a systematic literature search of abstract and full text databases to January 2008. Key authors were contacted for unpublished studies. Seventeen analyses were found. Of these, 13 were conducted in late stage palliative settings. (1) Single depression question: across nine studies, the prevalence of depression was 16%. A single 'depression' question enabled the detection of depression in 160 out of 223 true cases, a sensitivity of 72%, and correctly reassured 964 out of 1166 non-depressed cancer sufferers, a specificity of 83%. The positive predictive value (PPV) was 44% and the negative predictive value (NPV) 94%. (2) Single interest question: there were only three studies examining the 'loss-of-interest' question, with a combined prevalence of 14%. This question allowed the detection of 60 out of 72 cases (sensitivity 83%) and excluded 394 from 459 non-depressed cases (specificity of 86%). The PPV was 48% and the NPV 97%. (3) Two questions (low mood and low interest): five studies examined two questions with a combined prevalence of 17%. The two-question combination facilitated a diagnosis of depression in 138 of 151 true cases (sensitivity 91%) and gave correct reassurance to 645 of 749 non-cases (specificity 86%). The PPV was 57% and the NPV 98%. Simple verbal methods perform well at excluding depression in the non-depressed but perform poorly at confirming depression. The 'two question' method is significantly more accurate than either single question but clinicians should not rely on these simple questions alone and should be prepared to assess the patient more thoroughly.

Phase I Evaluation of Intranasal Trivalent Inactivated Influenza Vaccine with Nontoxigenic Escherichia coli Enterotoxin and Novel Biovector as Mucosal Adjuvants, Using Adult Volunteers

Abstract: Trivalent influenza virus A/Duck/Singapore (H5N3), A/Panama (H3N2), and B/Guandong vaccine preparations were used in a randomized, controlled, dose-ranging phase I study. The vaccines were prepared from highly purified hemagglutinin and neuraminidase from influenza viruses propagated in embryonated chicken eggs and inactivated with formaldehyde. We assigned 100 participants to six vaccine groups, as follows. Three intranasally vaccinated groups received 7.5-μg doses of hemagglutinin from each virus strain with either 3, 10, or 30 μg of heat-labile Escherichia coli enterotoxin (LTK63) and 990 μg of a supramolecular biovector; one intranasally vaccinated group was given 7.5-μg doses of hemagglutinin with 30 μg of LTK63 without the biovector; and another intranasally vaccinated group received saline solution as a placebo. The final group received an intramuscular vaccine containing 15 μg hemagglutinin from each strain with MF59 adjuvant. The immunogenicity of two intranasal doses, delivered by syringe as drops into both nostrils with an interval of 1 week between, was compared with that of two inoculations by intramuscular delivery 3 weeks apart. The intramuscular and intranasal vaccine formulations were both immunogenic but stimulated different limbs of the immune system. The largest increase in circulating antibodies occurred in response to intramuscular vaccination; the largest mucosal immunoglobulin A (IgA) response occurred in response to mucosal vaccination. Current licensing criteria for influenza vaccines in the European Union were satisfied by serum hemagglutination inhibition responses to A/Panama and B/Guandong hemagglutinins given with MF59 adjuvant by injection and to B/Guandong hemagglutinin given intranasally with the highest dose of LTK63 and the biovector. Geometric mean serum antibody titers by hemagglutination inhibition and microneutralization were significantly higher for each virus strain at 3 and 6 weeks in recipients of the intramuscular vaccine than in recipients of the intranasal vaccine. The immunogenicity of the intranasally delivered experimental vaccine varied by influenza virus strain. Mucosal IgA responses to A/Duck/Singapore (H5N3), A/Panama (H3N2), and B/Guandong were highest in participants given 30 μg LTK63 with the biovector, occurring in 7/15 (47%; P = 0.0103), 8/15 (53%; P = 0.0362), and 14/15 (93%; P = 0.0033) participants, respectively, compared to the placebo group. The addition of the biovector to the vaccine given with 30 μg LTK63 enhanced mucosal IgA responses to A/Duck/Singapore (H5N3) (P = 0.0491) and B/Guandong (P = 0.0028) but not to A/Panama (H3N2). All vaccines were well tolerated.

ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents.

Abstract: Karin Langea, Peter Swiftb, Ewa Pańkowskac and Thomas Danned aDepartment of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany; bChildrens Hospital, Leicester Royal Infirmary, Leicester, LE1 5WW, UK; cThe Institute of Diabetology, ul. Żegańska 46a, 04-736, Warszawa, Poland; and dDiabetes Centre for Children and Adolescents at the Kinderund Jugendkrankenhaus, Auf der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Germany

The reluctance to seek treatment for neurotic disorders.

Abstract: In previous papers from the National Survey of Psychiatric Morbidity in Great Britain, we have demonstrated that people with neurotic disorders rarely present their symptoms to primary care physicians and when they do, are quite likely not to be given treatment. In this paper, we examined survey respondents' reports of specific instances of reluctance to seek help in relation to sociodemographic, socio-economic and clinical attributes of our subjects. All people in the National Household Survey assessed as having a neurotic disorder were asked if at any time in the previous year they had avoided seeking appropriate treatment. Clinical measures included diagnosis, symptom severity, and deficits in carrying out tasks of daily living. Of nearly 1400 respondents, a quarter said they had not been to see a doctor at some time in the past year when they or their family felt they should have. The major determinant of this reluctance was symptom severity: more severe cases were more likely to report an episode of ...

Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes

Abstract: BACKGROUND: The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers These differences cannot be accounted for by differences in demographic, medical, or treatment variables Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers METHODS: An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory All individuals with diabetes aged 11-18 yr (494% female), with duration of diabetes of at least 1 yr, were invited to participate Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL-SF]), with well-being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project RESULTS: Older participants (p < 0001) and females (p < 0001) reported less physical activity Physical activity was associated with positive health perception (p < 0001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis The more time spent on the computer (r = 006; p < 005) and less time spent doing school homework (r = -009; p < 0001) were associated with higher HbA1c Between centers, there were significant differences in reported physical activity (p < 0001) and sedentary behavior (p < 0001), but these differences did not account for center differences in metabolic control CONCLUSIONS: Physical activity is strongly associated with psychological well-being but has weak associations with metabolic control Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences