1,548 results match your criteria: "Royal Centre for Defence Medicine Research & Academia[Affiliation]"

Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol.

BMJ Open

February 2024

NHS Blood & Transplant and Barts Health NHS Trust, London, UK.

Introduction: Uncontrolled bleeding is a major cause of death for patients with major trauma. Current transfusion practices vary, and there is uncertainty about the optimal strategy. Whole blood (WB) transfusion, which contains all components in one bag, is considered potentially advantageous, particularly for resuscitating patients with major bleeding in the prehospital setting.

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IgG glycosylation associates with risk of progression from latent to active tuberculosis.

J Infect

March 2024

Department of Infection, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK. Electronic address:

Objectives: Glycosylation motifs shape antibody structure, stability and antigen affinity and play an important role in antibody localization and function. Serum IgG glycosylation profiles are significantly altered in infectious diseases, including tuberculosis (TB), but have not been studied in the context of progression from latent to active TB.

Methods: We performed a longitudinal study of paired bulk IgG glycosylation and transcriptomic profiling in blood from individuals with active TB (ATB) or latent TB infection (LTBI) before and after treatment.

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Agreement between arterial and end-tidal carbon dioxide in adult patients admitted with serious traumatic brain injury.

PLoS One

February 2024

Emergency and Urgent Care Research in Cambridge (EUReCa), PACE Section, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.

Background: Low-normal levels of arterial carbon dioxide (PaCO2) are recommended in the acute phase of traumatic brain injury (TBI) to optimize oxygen and CO2 tension, and to maintain cerebral perfusion. End-tidal CO2 (ETCO2) may be used as a surrogate for PaCO2 when arterial sampling is less readily available. ETCO2 may not be an adequate proxy to guide ventilation and the effects on concomitant injury, time, and the impact of ventilatory strategies on the PaCO2-ETCO2 gradient are not well understood.

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Introduction: The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011 Patient blood management guidelines: module 1 - critical bleeding/massive transfusion were updated and published. Systematic reviews were conducted for pre-specified research questions, and recommendations were based on meta-analyses of included studies.

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Article Synopsis
  • A household survey conducted in Karonga, Malawi, revealed a significant injury incidence rate of 6900 per 100,000, with 29.2% of households reporting an injury, mostly non-fatal.
  • Among those injured, 76.1% sought medical care, primarily at first-level health facilities, but only 32.0% received care within an hour, and only 29.7% went to a second facility for treatment.
  • Reasons for not seeking care included the perception that injuries were not serious (52.1%), along with transportation issues (13.4%) and costs (5.6%), highlighting barriers to accessing timely medical treatment.
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Objective: To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance.

Background: Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability.

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Article Synopsis
  • Injuries in low- and middle-income countries, like Malawi, are a significant yet overlooked health issue, with many systems failing to provide adequate care for injured patients.
  • Researchers used nine different methods to assess trauma care barriers in Karonga, focusing on three delays: seeking, reaching, and receiving care, providing a comprehensive view of the health system's challenges.
  • A total of 26 barriers to timely and quality injury care were identified, ranging from costs and transport issues to systemic weaknesses in healthcare facilities.
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Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention.

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Mild traumatic brain injury (mTBI) is common with many patients suffering disabling long-term sequelae, with visual symptoms frequently reported. There are no objective biomarkers of mTBI that are routinely used in clinical practice. Optical coherence tomography (OCT) has been used in mTBI research, as it enables visualisation of the neuroretina, allowing measurement of the retinal nerve fibre layer and ganglion cell layer.

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Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study.

Crit Care Resusc

December 2023

Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Objective: To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions.

Design Setting And Participants: Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021.

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Background: Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction.

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Measuring moral distress and moral injury: A systematic review and content analysis of existing scales.

Clin Psychol Rev

March 2024

MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Canada; Department of Psychiatry, Western University, London, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada. Electronic address:

Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use.

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Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents.

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Hepatoblastoma is characterized by driver mutations in , making it an attractive biomarker for a liquid biopsy approach utilizing circulating tumor DNA (ctDNA). This prospective observational study sought to ascertain the feasibility of ctDNA detection in patients with hepatoblastoma and explore its associations with established clinical indicators and biomarkers, including serum Alpha-fetoprotein (AFP). We obtained 38 plasma samples and 17 tumor samples from 20 patients with hepatoblastoma.

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Article Synopsis
  • - Recent shifts in clinical research recognize patients as valuable contributors beyond just participants, highlighting their importance in every phase of the research process.
  • - Engaging patients from the outset leads to research that is more relevant and practical for those affected by specific conditions, with increased support from research funders and regulatory bodies.
  • - A meeting organized by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials sought to create guidelines for better patient engagement in clinical pain research, focusing on aspects like representation, timing, and effective communication.
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Background: The interaction between iron deficiency and malaria is incompletely understood. We evaluated longitudinal changes in iron homeostasis in volunteers enrolled in malaria volunteer infection studies (VIS) and in Malaysian patients with falciparum and vivax malaria.

Methods: We retrieved samples and associated data from 55 participants enrolled in malaria VIS, and 171 malaria patients and 30 healthy controls enrolled in clinical studies in Malaysia.

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Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20 % of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis.

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Monkeypox virus (MPXV) is a reemerging virus of global concern. An outbreak of clade I MPXV affected 20 captive chimpanzees in Cameroon in 2016. We describe the epidemiology, virology, phylogenetics, and clinical progression of this outbreak.

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Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs.

J Affect Disord

March 2024

Univ. Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale (INSERM) U 1300, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University, Grenoble, France.

Objective: Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA.

Methods: Administrative claims data were linked to objective PAP therapy usage.

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Are military fitness tests safe for members with a total hip arthroplasty?

BMJ Mil Health

February 2024

Royal Canadian Medical Service, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada.

Introduction: Canadian Armed Forces (CAF) members must complete an annual fitness evaluation. Members with a total hip arthroplasty (THA) may be at risk of injury during these strenuous tests. To inform CAF policy, we sought expert consensus on the safety of fitness testing for members with a THA.

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Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study.

Scand J Trauma Resusc Emerg Med

December 2023

Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, UK.

Background: Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury.

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Article Synopsis
  • Combat trauma can lead to serious pain issues for military personnel, including phantom limb pain (PLP) and residual limb pain (RLP), with a high prevalence found in a systematic review of 31 studies involving 14,738 participants.
  • Meta-analysis showed that the pooled prevalence of PLP was 57%, RLP was 61%, and chronic neuropathic pain was 26%, with significant variability between studies.
  • The review highlighted the need for standardized definitions and measurement tools for pain in future research, as factors like psychological issues and the presence of RLP were reported to influence PLP.
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The science of micronutrients in clinical practice - Report on the ESPEN symposium.

Clin Nutr

January 2024

Gelderse Vallei Hospital, Ede and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands. Electronic address:

Background & Aims: The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium.

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