Publications by authors named "Helen E Davies"

Article Synopsis
  • Study focused on how long COVID symptoms fluctuate in response to various activities, measuring severity, timing, and recovery through Ecological Momentary Assessments.
  • 376 participants recorded data on 8 core symptoms and results showed increased symptom severity shortly after physical, social, and cognitive exertions, with notable rises in fatigue levels.
  • Findings suggest clear patterns of symptom variations can aid in self-management and highlight potential therapeutic targets for treatment.
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Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with OI symptoms and comorbidities. Participants with a diagnosis of long covid were recruited from eight UK long covid clinics, and healthy volunteers from general population.

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Background: Long COVID encompasses a heterogeneous set of ongoing symptoms that affect many individuals after recovery from infection with SARS-CoV-2. The underlying biological mechanisms nonetheless remain obscure, precluding accurate diagnosis and effective intervention. Complement dysregulation is a hallmark of acute COVID-19 but has not been investigated as a potential determinant of long COVID.

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Millions of people are suffering from Long COVID or post-acute sequelae of COVID-19 (PASC). Several biological factors have emerged as potential drivers of PASC pathology. Some individuals with PASC may not fully clear the coronavirus SARS-CoV-2 after acute infection.

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Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care.

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Deeper understanding of mold-induced cytokine signatures could promote advances in the diagnosis and treatment of invasive mycoses and mold-associated hypersensitivity syndromes. Currently, most T-cellular immunoassays in medical mycology require the isolation of mononuclear cells and have limited robustness and practicability, hampering their broader applicability in clinical practice. Therefore, we developed a simple, cost-efficient whole blood (WB) assay with dual α-CD28 and α-CD49d co-stimulation to quantify cytokine secretion in response to antigens.

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Article Synopsis
  • Pneumothorax and pneumomediastinum are complications that can occur in COVID-19 patients requiring hospitalization, with this study being the largest case series documented to date.
  • The research involved a retrospective collection of 71 cases from UK hospitals between March and June 2020, focusing on patients with either pneumothorax, pneumomediastinum, or both.
  • Findings indicate that while the survival rates at 28 days were similar for both conditions, older patients (≥70 years) had significantly lower survival rates compared to younger patients.
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Background: Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter.

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The hypoxic patient with a normal chest X-ray can be a diagnostic challenge. This case illustrates the rational diagnostic process and describes a relatively rare but important complication of cancer metastasis. Thrombotic microangiopathy, like lymphangitis carcinomatosa, may cause respiratory failure and is a poor prognostic finding.

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Article Synopsis
  • Malignant pleural effusion (MPE) is difficult to treat, and while talc pleurodesis is a popular method, there's no consensus on the best way to deliver the talc, leading to varying practices.
  • * This study aimed to determine if talc poudrage delivered during thoracoscopy with local anesthesia was more effective than talc slurry via chest tube for inducing pleurodesis.
  • * Conducted across 17 UK hospitals, the trial involved 330 participants who were followed for various outcomes, including pleurodesis failure, hospital stay duration, and quality of life indicators.
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Introduction: Clinician-rated performance status (C-PS) is used routinely to predict whether patients are fit enough to undergo treatment for lung cancer. However, a good proportion of those with seemingly good C-PS do not go on to receive, let alone complete treatment. The value of C-PS in accurately predicting this is unclear, as is the merit of evaluating patient-rated PS (P-PS).

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A 65-year-old man was referred to the respiratory unit for evaluation of a left lower-zone opacity noted on a chest radiograph. On review, he appeared well and denied any respiratory symptoms. Physical examination was normal.

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Article Synopsis
  • Patients with malignant pleural effusion feel breathless, and we want to see if a treatment called urokinase can help them breathe better and make a procedure called pleurodesis more successful.
  • A study was done with 71 patients; some got urokinase and some got a fake treatment (placebo).
  • The results showed that urokinase didn’t help with breathlessness or make pleurodesis better, but it did help patients stay in the hospital for a shorter time and live a bit longer.
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Introduction: The presence of muscle mass depletion is associated with poor outcomes and survival in cancer. Alongside muscle mass, assessment of muscle strength or physical performance is essential for the diagnosis of sarcopenia. Non-small cell lung cancer (NSCLC) is a prevalent form of cancer with high mortality, and Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) is commonly used to assess patients' suitability for treatment.

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Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination of some of these procedures. Areas covered: Recent advances for the expanding range of treatment options in malignant pleural effusions are summarized, according to the best available evidence. Expert commentary: Selection of a treatment approach in malignant pleural effusions should take into account patient preferences and performance status, tumor type, predicted prognosis, presence of a non-expandable lung, and local experience or availability.

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Article Synopsis
  • A study was conducted to compare the cost-effectiveness of indwelling pleural catheter (IPC) and talc pleurodesis for treating malignant pleural effusion, focusing on patient quality of life.
  • The analysis found that there were no significant differences in utility scores or quality-adjusted life-years (QALYs) between the two treatments, but IPC was associated with a favorable incremental cost-effectiveness ratio of $10,870 per QALY.
  • IPC showed better cost-effectiveness for patients with a limited survival of less than 14 weeks, while extensive nursing time for catheter care could lead to higher costs, making talc a more viable option in such cases.
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Importance: For treatment of malignant pleural effusion, nonsteroidal anti-inflammatory drugs (NSAIDs) are avoided because they may reduce pleurodesis efficacy. Smaller chest tubes may be less painful than larger tubes, but efficacy in pleurodesis has not been proven.

Objective: To assess the effect of chest tube size and analgesia (NSAIDs vs opiates) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion.

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Background: Non-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, or loss of muscle mass, is an integral part of cancer cachexia.

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Introduction: The management of recurrent malignant pleural effusions (MPE) can be challenging. Various options are available, with the most efficacious and widely used being talc pleurodesis. Talc can either be applied via a chest drain in the form of slurry, or at medical thoracoscopy using poudrage.

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The approach to management of malignant pleural effusions (MPE) has changed over the past few decades. The key goals of MPE management are to relieve patient symptoms using the least invasive means and in the most cost-effective manner. There is now a realization that patient-reported outcome measures should be the primary goal of MPE treatment, and this now is the focus in most clinical trials.

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Background: Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events.

Methods: Using data from the clinical trial, we compared costs associated with use of IPCs and with talc pleurodesis.

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Purpose Of Review: Malignant pleural effusion (MPE) is common. However, regardless of the differences between patients, their underlying cancer type, and pleural fluid characteristics, management options are often limited. These have not advanced significantly over the last 80 years since pleurodesis was first described.

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Context: Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy. Palliation is achieved by fluid drainage, but the most effective first-line method has not been determined.

Objective: To determine whether indwelling pleural catheters (IPCs) are more effective than chest tube and talc slurry pleurodesis (talc) at relieving dyspnea.

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