Publications by authors named "William Gray"

Background: Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear.

Methods: This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models.

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  • The study aimed to assess how a community diabetes specialist nurse (cDSN) collaborating with district nurses (DNs) could improve insulin therapy management and optimize patient care.
  • The research involved monitoring 148 patients before and after implementing the intervention, focusing on hypoglycaemic and hyperglycaemic events and overall DN workload.
  • Results showed a significant decrease in both types of events, reduced DN visits, and substantial cost savings of £1.9 million, suggesting the intervention's effectiveness and the potential for broader application in other areas.
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  • Percutaneous transluminal angioplasty (PTA) for peripheral artery disease often results in vascular dissections, increasing the need for additional interventions (target lesion revascularization or TLR).
  • A study using a decision-analytic model analyzed the clinical outcomes, costs, and quality of life impacts of using the Tack Endovascular System versus the standard PTA approach, showing lower TLR rates with the Tack-supported strategy.
  • The results suggest that focal stenting (using Tack) is cost-effective for non-severe dissections and may even save costs for severe cases while improving patient quality of life, highlighting potential economic benefits in managing dissections post-PTA.
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  • * In this randomized controlled trial involving 446 patients, the SurVeil PCB showed a primary safety rate of 91.8% and a primary efficacy rate of 82.2%, while the IN.PACT Admiral had rates of 89.8% and 85.9%, respectively.
  • * The results indicate that the SurVeil PCB is a safe and effective treatment option, demonstrating non-inferiority to the IN.PACT Admiral PCB over a 24-month period.
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To compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and preserved ejection fraction (pEF) according to flow-gradient status.This retrospective study focused on patients with severe AS and pEF (≥ 50%) undergoing TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) between 2018 and 2022 (n = 781). Patients were divided into 3 groups: normal-flow high-gradient (NF-HG, stroke volume index ≥ 35 mL/m and mean pressure gradient ≥ 40 mmHg or peak velocity ≥ 4 m/second), low-flow high-gradient (LF-HG), and paradoxical low-flow low-gradient (pLF-LG) groups.

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Introduction: Postponement of surgery at preoperative assessment in the days or weeks before the patient is admitted for surgery, as distinct from cancellation on the planned day of surgery, can be devastating for patients and an inefficient use of finite resources. However, postponements are often poorly recorded. The primary aim of this pilot study was to investigate elective surgical postponement rates during or after preoperative assessment across England, and the reasons for postponement for patients on an elective surgical pathway.

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Objectives: To compare recorded patient management between a clinical audit and administrative dataset for patients presenting with ureteric stones in England and to assess the feasibility of using administrative data for routine audit.

Patients And Methods: The British Association of Urological Surgeons conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31st March 2021 and in-patient and out-patient management received recorded.

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Purpose: Intravascular lithotripsy (IVL) has shown promising safety and effectiveness in calcified peripheral artery disease (PAD) in large trials and small real-world experiences. Real-world evidence from a larger cohort is lacking, so we aimed to evaluate the real-world acute performance of IVL in the treatment of calcified PAD.

Materials And Methods: The Disrupt PAD III Observational Study (OS) is a prospective, multicenter, single-arm study.

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  • The NHS in England aims for net zero carbon emissions by 2045, focusing on reducing the carbon footprint of elective total hip arthroplasty (THA) procedures.
  • A study analyzed data from over 537,000 THA surgeries between 2014 and 2022, finding that the carbon footprint per patient decreased by about 25% during this period.
  • Key improvements, particularly in reducing hospital stay lengths, significantly contributed to this decline, suggesting that enhancing surgical efficiency can help meet sustainability goals while benefiting patient care and reducing costs.
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Background: The association of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This study aimed to evaluate the impact of elevated BMI on the outcome of transcatheter aortic valve replacement (TAVR) for aortic stenosis.

Methods: This retrospective study included 1019 patients with a BMI of ≥18.

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  • The study looked at how a heart procedure called TEER affects patients with different types of heart failure (HF) who also have a condition called mitral regurgitation (MR).
  • Over 162 patients were analyzed, and they found that people with mixed HF had worse health outcomes after the procedure compared to those with just systolic or diastolic HF.
  • The total hospital costs were similar for all groups, meaning no one type of heart failure cost significantly more than the others during their hospital stay.
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  • There is an urgent need for societal transformation to reduce humanity's environmental impact, as environmental health directly influences human health; health care contributes approximately 5% of global greenhouse gas emissions.
  • Health-care professionals must lead efforts to enhance environmental performance in health systems, utilizing Life-cycle assessment (LCA) to evaluate the environmental impacts of healthcare products and processes from creation to disposal.
  • Urological conditions often require intensive resource management and have considerable environmental impacts, prompting the need for improved methodologies in LCA to identify environmentally harmful practices and accelerate sustainable innovations within healthcare.
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Background: The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate the estimated difference between the carbon footprint of the Getting It Right First Time (GIRFT) High Volume Low Complexity (HVLC) pathway for cataract surgery and current practice.

Methods: Retrospective analysis of administrative data.

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Data on the long-term outcomes of prosthesis patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. This study aimed to investigate the incidence and clinical outcomes of measured PPM (PPM) and predicted PPM (PPM) in patients who underwent TAVI. This is a retrospective analysis of 3,016 patients who underwent TAVI at a large health care system between 2012 and 2021.

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  • Risk scores like MitraScore and COAPT help identify patients with mitral regurgitation (MR) who are at risk of adverse events but may still benefit from transcatheter edge-to-edge repair (TEER).
  • The study validated MitraScore in the COAPT trial with 614 patients and the COAPT risk score in the MIVNUT registry with 1007 patients, both focusing on predicting all-cause mortality over approximately 2 years.
  • Results indicated that both scores had fair to good predictive accuracy for mortality, with higher effectiveness seen in TEER patients, confirming the benefits of combining TEER with guideline-directed medical therapy (GDMT) across different risk levels.
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Transcatheter atrial shunt therapies, designed to dynamically lower left atrial (LA) pressure by shunting blood into the larger reservoir of the right atrium and central veins, have been developed as a novel treatment for heart failure (HF) over the past 10+ years. Several atrial shunt devices and procedures are currently in development with several pivotal randomized clinical trials (RCT) underway; however, only 2 sham-controlled RCT (both with the Atrial Shunt Device [Corvia Medical] in HF with EF ≥ 40%) have been reported thus far; a mechanistic RCT (n = 44) that demonstrated a reduction in exercise LA pressure at 1 month and a pivotal RCT (n = 626) that was neutral with no difference in outcomes or health status between shunt and sham groups. Subsequent analyses of the single completed pivotal RCT found that peak exercise pulmonary vascular resistance <1.

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Objectives: To evaluate the carbon footprint of the perioperative transurethral resection of bladder tumour (TURBT) pathway from decision to treat to postoperative discharge, and model potential greenhouse gas (GHG) emissions reduction strategies.

Materials And Methods: This process-based attributional cradle-to-grave life-cycle assessment (LCA) of GHG emissions modelled the perioperative TURBT pathway at a hospital in Southwest England. We included travel, energy and water use, all reusable and consumable items, and laundry and equipment sterilisation.

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Unlabelled: We report a hybrid procedure of robotic-assisted coronary artery bypass grafting and transcatheter aortic valve-in-valve implantation for left main disease and prosthetic aortic valve stenosis. Robotic-assisted coronary artery bypass grafting using a left internal mammary artery graft was preferred to percutaneous coronary intervention because of the complex anatomy of the coronary lesion and concerns about dual antiplatelet therapy tolerance. This was followed by a valve-in-valve procedure five days later, allowing the patient to be discharged the next day.

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HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania.

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: This study aimed to understand the care needs, care arrangements and burden of care for people with dementia in Northern Tanzania. : This was a cross-sectional, observational study. People with dementia and their carers ( = 53) were recruited from an outpatient clinic, and data on carer burden and independence in activities of daily living were collected.

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Objective: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting.

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Objective: To investigate the impact of prior coronary artery bypass grafting (CABG) and coronary lesion complexity on transcatheter aortic valve replacement (TAVR) outcomes for aortic stenosis.

Methods: Clinical outcomes of TAVR were retrospectively compared between patients with and without prior CABG, and between patients with prior CABG and without coronary artery disease (CAD). The impact of the CABG SYNTAX score was also evaluated in patients with prior CABG.

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Background/purpose: To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis.

Methods/materials: This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). Propensity score matching was used to compare the two groups.

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Comments are provided on the recent paper by Ebadi et al. [3], which demonstrates that the formulated model that was solved contains misconceptions or errors that render the work unsuitable for describing the evolution of interfacial areas in two-fluid porous medium systems. The need for kinematic equations is described and components of a theoretically consistent approach are summarized.

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Xyloglucan is believed to play a significant role in cell wall mechanics of dicot plants. Surprisingly, Arabidopsis plants defective in xyloglucan biosynthesis exhibit nearly normal growth and development. We investigated a mutant line, cslc-Δ5, lacking activity in all five Arabidopsis cellulose synthase like-C (CSLC) genes responsible for xyloglucan backbone biosynthesis.

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