SUMMARYAn increase in the number of human isolates of Salmonella virchow phage type (PT) 26 in England and Wales during 1994 was investigated. A national case control study was conducted which included 88 cases and 182 controls. The cases were mostly young adults (median age 26) and 13 (15 %) were admitted to hospital. Acquisition of S. virchow PT 26 was associated with the consumption of any chicken (OR 2-5, CI 1 1-5'8), of chicken curry from restaurants and take aways (OR 2-9, CI 1-4-6 1), and of some other diverse types of pre-prepared chicken (OR 3 8, CI 19-7 6). Halal chicken was associated (P = 0 006) with illness in a subset. There were negative associations with contact with animals (OR 0 47, CI 0-23-0 95) and with the consumption of chicken cooked whole (OR 0 37, CI 0-21-0-66). The increase in S. virchow PT 26 may be due to changing epizoology and may be an indicator of what will become the dominant salmonella strain in poultry in future years. The increasing incidence of S. virchow PT 26 is of particular concern because of its association with more invasive disease in humans.
Objectives To estimate the number of patients with recurrent respiratory papillomatosis currently managed in secondary and tertiary health care in the UK and the frequency of its treatment with radiofrequency cold ablation (Coblation™). Design Cross‐sectional survey of ENT consultants in the UK with validation using Hospital Episode Statistics (HES) inpatient data. Setting Online survey. Participants ENT consultants in the UK. Main outcome measures Number of recurrent respiratory papillomatosis patients currently managed in acute care in the UK and frequency of use of Coblation. Results A total of 283 ENT consultants from 128 UK NHS healthcare trusts and health boards completed the online survey. Responses were received from 86% of surveyed organisations, and an estimated 45% of all ENT consultants in UK. The estimated number of recurrent respiratory papillomatosis patients from the cross‐sectional survey was 918 (at August 2015) which included 730 patients in England. The number of recurrent respiratory papillomatosis patients in England estimated from Hospital Episode Statistics (2014/15 financial year) was up to 741. A total of 42 Coblation procedures conducted in the UK were identified from the cross‐sectional survey; 36 were conducted in England compared with 34 identified from Hospital Episode Statistics. Conclusions The numbers of recurrent respiratory papillomatosis patients and Coblation procedures identified in England from a cross‐sectional survey and Hospital Episode Statistics were in broad agreement. Our study estimated 1.42 recurrent respiratory papillomatosis patients per 100 000 in the general UK population. We also estimated that Coblation procedures accounted for 3% of interventional treatments conducted in the UK recurrent respiratory papillomatosis population.
Introduction and objectivesNICE Guidance encourages further research on the efficacy of bronchial thermoplasty (BT). This study uses data from the British Thoracic Society (BTS) UK Difficult Asthma Registry (DAR) and the Hospital Episodes Statistics (HES) database to assess aspects of efficacy and compares these with previous trials.MethodsLung function (FEV1), quality of life (AQLQ), rescue steroid use, healthcare visits and days lost from work/school were compared at BT baseline and 12 month follow-up in patients for whom DAR data were available. In calculating annualised figures, baseline data were assumed to represent 12 months pre-BT, and 12 month follow-up data were scaled according to the time period that the follow-up represented.Significance testing for differences in FEV1 and AQLQ used a paired t-test. Differences in event counts were tested using non-parametric bootstrap hypothesis tests.HES was searched for BT episodes from 1st April 2011 to 31st January 2015. An anonymised matching technique was used to link patients in HES and DAR, and for those whom sufficient time had elapsed since BT, HES A&E attendances were compared in the 12 months pre-BT and the 12 months starting from 30 days post-BT (to exclude any transient increases).Results31 patients had 12 month follow-ups in DAR, enabling comparison with BT baseline where data were available. All outcomes from DAR showed improvement at 12 month follow-up compared to BT baseline (Table 1). The mean improvement in AQLQ score (0.92) was smaller than that reported in AIR2 (1.35; n = 190), AIR (1.3; n = 52) and RISA (1.53; n = 15) trials.Abstract S12 Table 1Summary of efficacy outcomesBT baseline12 month follow-upnSignificanceFEV1 (DAR)71.62 ± 19.9579.14 ± 23.1821p = 0.051AQLQ (DAR)3.88 ± 1.154.80 ± 1.2413p = 0.002Rescue steroid courses (annualised, DAR)3.0 [0.0–10.0]1.99 [0.0–14.04]22p = 0.236Unscheduled healthcare visits (annualised, DAR)4.0 [0.0–15.0]2.65 [0.0–8.94]20p = 0.039Hospital admissions (annualised, DAR)2.0 [0.0–6.0]0.0 [0.0–11.23]23p = 0.277Days lost from work/school (annualised, DAR)0.0 [0.0–35.0]0.0 [0.0–0.0]11p = 0.013A&E (all cause) attendances (annualised, HES)2 [1–10]2.5 [1–4]12p = 0.159Values reported as mean ± SD or median [min-max]; p < 0.05 for statistical significanceFrom HES, there were 24 A&E attendances (in 5/12 patients) in the 12 months pre-treatment and 15 A&E attendances (in 6/12 patients) in the 12 months post-treatment.ConclusionTo date, efficacy outcomes appear consistent with those observed in previous clinical trials, with a smaller, but statistically significant, improvement in AQLQ score. The reduction in unscheduled healthcare visits and days lost from work/school also reached statistical significance. Although the median number of A&E attendances increased in the 12 patients studied, the annual rate of A&E attendances per patient reduced from 2 to 1.25.
Based on the individual costs of screening tests for Hepatitis B (£6.30) and C (£5.13), for the 1115 current TB patients, our trust wide hepatitis screening costs were estimated at £12,744. The approximate cost of a liver transplant operation at Kings College Hospital in 2012 was £125,000, not including the additional after care costs and accounting for possible complications. We feel the cost of hepatitis screening is outweighed by the benefits of identifying patients with positive serology in a timely fashion; permitting closer monitoring of their liver function and initiating an early gastroenterology referral.It is vital we attempt to reduce the morbidity and possible mortality of hepatotoxicity in hepatitis positive TB patients; the financial, emotional and psychological implications for a patient undergoing a liver transplant are enormous. We propose that hepatitis screening is incorporated into current TB guidelines.
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