4 results
Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes
- Part of
- Aimee-Louise Chambault, Kathryn Olsen, Louise J. Brown, Sophie L. Mellor, Nilofer Sorathia, Arthur E. Thomas, Neel Kothari, Amer Harky
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 25 November 2021, pp. 1-9
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- Article
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Background:
Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects.
Methods:A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay.
Results:A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference −4.05 (−4.78, −3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference −4.78 (−5.97, −3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39).
Conclusion:Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.
Compliance with nice guidelines for management of depression in a community mental health team
- Sophie Mellor, Shay-Anne Pantall, Lisa Brownell
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S333-S334
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- Article
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- Open access
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Aims
To evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.
BackgroundReducing the prevalence of depression continues to be a major public health challenge.
Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.
MethodA retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.
ResultKey results include:
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The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).
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Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.
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Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).
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Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.
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A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.
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Risk assessments were out of date for 71% of patients.
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100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.
Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.
ConclusionCMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.
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Cardiac output monitoring in paediatric cardiac surgery: a review
- Part of
- Hannah M. Woodman, Corlyn Lee, Ayesha N. Ahmed, Bassit A. Malik, Sophie Mellor, Louise J. Brown, Leanne Gentle, Amer Harky
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- Journal:
- Cardiology in the Young / Volume 31 / Issue 1 / January 2021
- Published online by Cambridge University Press:
- 05 January 2021, pp. 23-30
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- Article
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The aim of this review is to present the current options for cardiac output (CO) monitoring in children undergoing cardiac surgery. Current technologies for monitoring identified were a range of invasive, minimally invasive, and non-invasive technologies. These include pulmonary artery catheter, transoesophageal echocardiography, pulse contour analysis, electrical cardiography, and thoracic bioreactance. A literature search was conducted using evidence databases which identified two current guidelines; the NHS Greater Glasgow and Clyde guideline and Royal College of Anaesthetics Guideline. These were appraised using the AGREE II tool and the evidence identified was used to create an overview summary of each technological option for CO monitoring. There is limited evidence regarding the accuracy of modalities available for CO monitoring in paediatric patients during cardiac surgery. Each technology has advantages and disadvantages; however, none could be championed as the most beneficial. Furthermore, a gold standard for CO monitoring has not yet been identified for paediatric populations, nor is it apparent whether one modality is preferable based on the available evidence. Additional evidence using a standardised method for comparing CO measurements should be conducted in order to determine the best option for CO monitoring in paediatrics. Furthermore, cost-effectiveness assessment of each modality should be conducted. Only then will it be possible for clear, evidence-based guidance to be written.
6 - Life Chances: Thinking with art to Generate new Understandings of Low-Income Situations
- Edited by Morag McDermont, University of Bristol, Tim Cole, University of Bristol, Janet Newman, Angela Piccini, University of Bristol
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- Book:
- Imagining Regulation Differently
- Published by:
- Bristol University Press
- Published online:
- 03 March 2021
- Print publication:
- 29 January 2020, pp 105-126
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- Chapter
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Summary
Introduction
In what ways do regulatory regimes enact, delimit and inhibit the progress of families on low incomes across England and Wales? Although they may not explicitly interact, diverse regimes are affectively experienced, including immigration status (including from European Union [EU] countries), employment assessments and activation, mental health, child protection, structural and overt racism, and the nonportability of professional qualifications across national systems. In this chapter, we explore how contemporary social practice art materialises these intersections and enables disruptions of regulatory regimes in ways not possible using traditional social science approaches. We focus on a research team that included artists Close and Remote, and explain how the team co-produced, with community members and academics, a socially engaged artwork – Life Chances – that aimed to generate new knowledges about the regulatory regimes that low-income families with children experience. Aiming towards what sociologist Yasmin Gunaratnam (2012) describes as a form of improvisational empathy, Life Chances worked with Thomas More's (1516) Utopia and Ruth Levitas's (2013) Utopia as Method as ‘a form of speculative sociology of the future’ (Levitas, 2013: 85). By staging and troubling contradictory notions of ‘life chances’ through art, we specifically ask how the regulatory services that families encounter in two urban settings – the Easton area of Bristol and Butetown, Riverside and Grangetown in Cardiff – shape, constrain and enable the life chances of individual families and communities, or what Pierre Bourdieu (1977) refers to as doxa, and how these services might be ‘otherwise’.
Life Chances was co-designed by academics from Bristol and Cardiff Universities, artists Close and Remote, and two community organisations: the Single Parent Action Network (SPAN) in Bristol and South Riverside Community Development Centre (SRCDC) in Cardiff. From the outset, there was an intention to work with social practice art. In addition to its emphasis on collaborative working closely reflecting the principles of co-production, we wanted to work with the everyday materials that families on low incomes encounter. Moreover, we were interested in working with a creative practice that would manifest the distributed, entangled and durational relationships across diverse regulatory regimes.