Royal Surrey County Hospital

About: Royal Surrey County Hospital is a healthcare organization based out in Guildford, United Kingdom. It is known for research contribution in the topics: Cancer & Population. The organization has 2222 authors who have published 3064 publications receiving 86753 citations.

Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: A meta-analysis of seven clinical trials

Abstract: Background and aims Basal insulin analogues have a reduced risk of hypoglycaemia compared with NPH insulin, but hypoglycaemia still remains a major impediment to achieving recommended fasting plasma glucose (FPG) targets in patients with diabetes. Insulin degludec (IDeg) is a new basal insulin that forms soluble multihexamers after subcutaneous injection resulting in an ultra-long duration of action and stable glucose-lowering effect. The aim of this analysis was to compare the effect of IDeg on FPG and nocturnal confirmed hypoglycaemia as compared to insulin glargine (IGlar). Methods and results Data were included from seven phase 3a, randomised, open-label, treat-to-target clinical trials in which once-daily IDeg was compared with once-daily IGlar. Two trials included a total of 957 patients with type 1 diabetes (T1D) and five trials included a total of 3360 patients with type 2 diabetes (T2D); all trials were 26 or 52 weeks in duration. Confirmed hypoglycaemia was defined as plasma glucose Conclusion This analysis shows that the lower rate of nocturnal confirmed hypoglycaemia seen with IDeg relative to IGlar is accompanied by a reduced mean FPG, in particular in patients with T2D.

The impact of macular edema on visual function in intermediate, posterior, and panuveitis.

Abstract: Purpose: To evaluate the impact of macular edema on visual acuity and visual field sensitivity in uveitis.Design: This study utilized baseline data from the Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized, parallel treatment clinical trial comparing alternative treatments for intermediate, posterior and panuveitis.Patients & Methods: 255 patients (481 eyes with uveitis) recruited at 23 subspecialty centers. Visual acuity, optical coherence tomography and Humphrey 24-2 visual field testing.Results: Macular edema was associated with impaired visual acuity (p < 0.01). Different phenotypes of macular edema were associated with different degrees of visual impairment: cystoid changes without retinal thickening were associated with moderately impaired visual acuity (–5 ETDRS letters), but visual acuity was worse in eyes with retinal thickening (–13 letters) and with both cysts and thickening (–19 letters). Uveitis sufficient to satisfy the study’s inclusion criteria was associated with impaired ...

Influence of number of views and mammographic film density on the detection of invasive cancers: results from the NHS Breast Screening Programme.

Abstract: The National Health Service Breast Screening Programme (NHSBSP) has recommended the adoption of two view mammography at the prevalent screen, and the use of a target film density in the range 1.4-1.8. The aim of this study was to review the impact of number of views and optical density on the detection of invasive cancers. The last four annual returns for screening centres in the NHSBSP have been analysed retrospectively for 2827342 women aged 50-64 years attending their first (prevalent) screening examination. The detection of invasive cancers was assessed in relation to the number of views and film density using the age adjusted, Standardized Detection Ratio measure of screening performance. Typical film densities were reported for each screening year by local physicists, and the average value for all mammography sets at each programme calculated, and found to vary from 0.85 to 1.85. The mean film density across the NHSBSP rose progressively from 1.30 (SD = 0.21) in 1991/2 to 1.57 (SD = 0.12) in 1994/5....

Psychological effects of withdrawal of growth hormone therapy from adults with growth hormone deficiency.

Abstract: Summary objective Growth hormone (GH) is known to be required for physical well-being. Although it is also widely believed to be important for quality of life (QoL) and psychological health, there is less supportive evidence. The objective of this study was to investigate the psychological effects of discontinuation of GH replacement from adults with severe GH deficiency (GHD). design A double-blind, placebo-controlled trial in which GH replacement therapy was discontinued for 3 months from 12 of 21 GH-deficient adults, where nine continued with GH replacement. patients GH-treated adults (10 men, 11 women), all with severe GHD (peak GH < 7·7 mU/l on provocative testing), mean age 44·9 years (range 25–68 years). measurements Semi-structured interviews were given at baseline and end-point plus questionnaires that included a new hormone-deficiency specific, individualized, QoL questionnaire (HDQoL), the General Well-being Index (GWBI), the Well-being Questionnaire (W-BQ12), the Short-Form 36 health status questionnaire (SF-36), the Nottingham Health Profile (NHP) and the General Health Questionnaire (GHQ). results Three months after baseline the serum total IGF-I of placebo-treated patients fell from normal, age-related levels (mean 26·6 ± 13·2 nmol/l) to levels indicative of severe GHD (11·6 ± 6·6 nmol/l) (P < 0·001). Psychological symptoms of GH withdrawal, reported in interviews at end-point by placebo-treated patients, included decreased energy, and increased tiredness, pain, irritability and depression. Patients who believed they knew which treatment they had received correctly identified the treatment (GH or placebo) at end-point (χ2 = 11·25, P < 0·01). Significant between-treatment-group differences in change scores were found for SF-36 General Health (P < 0·01), W-BQ12 Energy (P < 0·01) and HDQoL do physically (P < 0·05), indicating reduced general health, reduced energy and greater perceived impact of hormone deficiency on physical capabilities in the placebo-treated group at end-point relative to GH-treated patients. conclusion Withdrawal of GH treatment from adults with severe GH deficiency has detrimental psychological effects.

Can CT scan protocols used for radiotherapy treatment planning be adjusted to optimize image quality and patient dose? A systematic review.

Abstract: This article reviews publications related to the use of CT scans for radiotherapy treatment planning, specifically the impact of scan protocol changes on CT number and treatment planning dosimetry and on CT image quality. A search on PubMed and EMBASE and a subsequent review of references yielded 53 relevant articles. CT scan parameters significantly affect image quality. Some will also affect Hounsfield unit (HU) values, though this is not comprehensively reported on. Changes in tube kilovoltage and, on some scanners, field of view and reconstruction algorithms have been found to produce notable HU changes. The degree of HU change which can be tolerated without changing planning dose by >1% depends on the body region and size, planning algorithms, treatment beam energy and type of plan. A change in soft-tissue HU value has a greater impact than changes in HU for bone and air. The use of anthropomorphic phantoms is recommended when assessing HU changes. There is limited published work on CT scan protocol optimization in radiotherapy. Publications suggest that HU tolerances of ±20 HU for soft tissue and of ±50 HU for the lung and bone would restrict dose changes in the treatment plan to <1%. Literature related to the use of CT images in radiotherapy planning has been reviewed to establish the acceptable level of HU change and the impact on image quality of scan protocol adjustment. Conclusions have been presented and further work identified.