Research Registrar Research Articles

The Life and Works of Solomon Epstein, MD, FRCP (1940–2020)

The Life and Works of Solomon Epstein, MD, FRCP (1940–2020)

Nicholas David Carr

It is with great sadness that we mark the passing of Nicholas David Carr (“Nick”), a former president of the Association of Coloproctology of Great Britain and Ireland (ACPGBI). Nick...

How to write a textbook: our experience and advice to budding authors

Several years ago, we were approached by a medical publisher to write a textbook of cardiology as part of a new undergraduate series. We were friends, colleagues and both research...

Michael Harrison: clinical neurologist and stroke researcher

Neurologist Michael Harrison is best known for his research into stroke and the neurological complications of HIV/AIDS. He is a former director of the Reta Lila Weston Institute for Neurological...

Abstract 91: Physicians’ Attitudes Toward Elevated Blood Pressure and Recurrent Events After Acute Ischemic Stroke

Background: Strict blood pressure (BP) control among acute ischemic stroke (AIS) survivors would improve prognosis and decrease recurrent vascular events, which, however, has not been investigated in detail. Methods: AIS survivors at discharge who was admitted between 2010 and 2011 were included in the analysis dataset. Baseline characteristics were gathered through a multicenter prospective stroke registry (CRCS-K). BP measurements, clinic visit and prescription of BP-lowering medications after discharge were collected through medical records until 1 year (± 2 months of grace period). Recurrent vascular events until 1 year after stroke including stroke, myocardial infarction and death were gathered through a structured telephone interview by trained research registrars or medical records review. Individual treatment intensification (TI) scores were calculated by the following equation; (observed medication change - predicted medication change by a standard guideline) / number of clinic visit. TI scores were categorized into quintile groups and their associations with recurrent events were assessed by Cox proportional hazard models. Results: Of the 3482 AIS survivors, 2675 (77%) were diagnosed of hypertension and 1977 (57%) had BP-lowering medication prescription at discharge. Median NIHSS score at admission was 3 [1 - 6] points and 1573 (45.3%) had mRS score 0f 0 - 1 at discharge. TI score over 1-year after discharge was mean - 0.24 ± 0.30 and median - 0.15 [- 0.42, 0]. Compared to Q3 (third quintile; group TI score, - 0.15 ± 0.05), Q5 (group TI score, 0.04 ± 0.08) had higher proportion of cardioembolic stroke (32% vs 20%) and higher median NIHSS score (4 vs 3). Extreme groups of TI scores, Q1 or Q5, showed increased hazard for having mortality or composite events (see Table). Conclusions: Physicians’ attitudes toward elevated BP, represented by the TI score, was significantly associated with long-term vascular outcomes.

Olivia Marie-Virginie Mine Schofield

Olivia Marie-Virginie Mine Schofield was a dedicated and well respected consultant dermatologist who enhanced dermatology services in Scotland, particularly in paediatric dermatology. She was appointed as a consultant dermatologist to...

Cliff Roberton: devoted his working life to improving the care of babies

Clifford Roberton (“Cliff”) was a distinguished member of the first generation of neonatal paediatricians who developed and promoted the science and practice of the medical care of ill newborn babies....

21 Concussion, chronic trauma encephalopathy and dementia – what the newspapers say and what we really (don’t) know

My interest in neuropsychiatry began during a spell working in Kenya as a Wellcome Research Registrar conducting a study on the psychiatric and cognitive effects of HIV infection. I then completed my higher training in Edinburgh, under the guidance of Professors Michael Sharpe and Charles Warlow, where I developed an interest in functional neurological symptoms. I currently work as a Consultant Neuropsychiatrist in Edinburgh split between the brain injury units at the Astley Ainslie Hospital and the Regional Neurosciences Unit at the Western General Hospital. My collaboration with Michael and Charles has continued and I hold a post as part time Senior Lecturer at Edinburgh University where, along with Dr Jon Stone, we are engaged in the Scottish Neurological Symptoms Study a multi-centre, prospective cohort study of 4000 new neurology outpatients examining the outcome of functional neurological symptoms. There has been a large media interest over recent years in the long term health effects of concussive injuries sustained by sportsman, culminating in a Hollywood movie ‘Concussion’ starring Will Smith. Hardly a week goes by without further studies being announced in the media and creating considerable interest in social media. The message is that concussion is a dangerous condition that causes a complex neuropsychiatric disorder, chronic traumatic encephalopathy (CTE), with a neuropsychiatric phenotype of mood change, irritability and suicidal behaviour which develops over time into a neurodegenerative disorder and death. Increasing alarm has followed and it has been suggested that this is not just a disorder of elite sportsman but a problem for youth sport and that even heading a football (soccer) may cause dementia; a terrifying prospect for those parents trying to decide whether to allow their children to participate in sports. But, in my clinical work as a neuropsychiatrist specialising in brain injury rehabilitation and functional neurological disorders I have personally reviewed over 2000 cases of mild brain injury and I simply never see anything that resembles these description. By contrast what i see is entirely in keeping with what Lishman so eloquently described as “what has initially been based in physiogenic disturbance readily thereafter becomes prolonged, and nonetheless disabling, by virtue of a complicated interplay of psychogenic factors.” And i am left wondering if these catastrophic claims of CTE are really true. To tackle this question more objectively than twitter allows we might examine what evidence is available on the concept of CTE, its relationship to concussion, and its neuropsychiatric phenotype; what the evidence on outcome of mild traumatic brain injury in general is; and what cohort studies on the risk factors for Alzheimer’s disease (AD) can tell us? Reference . Concussion, dementia and CTE: are we getting it very wrong? Carson A JNNP 2017 in press.

Does level of motivation for change impact post-treatment outcomes in the eating disorders? Protocol for a systematic review with quantitative analysis

BackgroundEating Disorders are highly prevalent and widespread mental health problems, with marked risk of chronicity and refractoriness to treatment. Affected individuals are hesitant to change their behaviours and therefore struggle to maintain motivation for therapy. This review aims to produce the first high-quality meta-analysis of the literature on the impact of level of motivation for change on post-treatment outcomes in anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder (OSFED).MethodsA systematic review will be conducted using Cochrane library, Embase, MEDLINE, and PsychINFO. Research registrars and bibliographies of included articles will be screened, and experts will be contacted. The search strategy consists of terms related to eating disorders, motivation, and outcome. Randomized controlled trials, clinical controlled trials, time series, and before-after studies will be included. Participants will be adolescents and adults who are diagnosed with anorexia nervosa, bulimia nervosa, binge-eating disorder or OSFED and who are entering psychotherapy treatment. The predictor studied is defined as motivation for change at the beginning of treatment. The primary outcome will be an overall change in eating-disorder symptomatology at the end of treatment and at less than, and over 6-month follow-up. Other outcomes of interest include change in restricting, binging, and compensatory behaviours, change in shape, weight and eating concerns, change in psychiatric comorbidities, weight restoration, and dropout rates. Articles will be selected, data will be extracted, and the risk of bias will be assessed by independent reviewers using forms pre-created on Eppi-Reviewer 4 software. Results will be combined using a random-effects model. Studies of all sizes and qualities will be included in the analyses. Heterogeneity will be examined by funnel plot, Cochran’s Q, and I2 statistic. Sensitivity analyses will be performed to account for clinical and methodological differences across studies.DiscussionThis systematic review will help determine the predictive value of motivation for change on treatment outcomes in eating disorders.Trial registrationOur systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016035285). All modifications will be available on the PROSPERO website, along with the dates, a description, and a justification.

AB1187-HPR Rheumatologist and Rheumatology Health Care Professionals' Current Practice and Beliefs around Physical Activity Promotion in Rheumatoid Arthritis

BackgroundRegular physical activity (PA) in rheumatoid arthritis (RA) is beneficial for people with RA (Van Den Ende et al 2000). However, people with RA are less physically active than their...

MP 7 Conversion disorder

My interest in neuropsychiatry began during a spell working in Kenya as a Wellcome Research Registrar conducting a study on the psychiatric and cognitive effects of HIV infection. I then completed my higher training in Edinburgh, under the guidance of Professors Michael Sharpe and Charles Warlow, where I developed an interest in functional neurological symptoms. I currently work as a Consultant Neuropsychiatrist in Edinburgh split between the brain injury units at the Astley Ainslie Hospital and the Regional Neurosciences Unit at the Western General Hospital. My collaboration with Michael and Charles has continued and I hold a post as part time Senior Lecturer at Edinburgh University where, along with Dr Jon Stone, we are engaged in the Scottish Neurological Symptoms Study a multi-centre, prospective cohort study of 4000 new neurology outpatients examining the outcome of functional neurological symptoms. This brief review of recent scientific papers on conversion disorders aims to describe some key contributions to the literature over the last 5 years across a range of disparate investigatory techniques. I hope to provide an account of the most recent findings of relevance to diagnosis, underpinning mechanisms, risks factors and treatment. A reference list of papers described will be posted on the BNPA website.

Children's participation in clinical research: factors influencing parental consent

Background An important obstacle when undertaking clinical research in children is the consent procedure. Understanding the factors influencing this process is vital in improving children9s involvement in clinical research. Objective To report the rates and causes for recruitment refusal into two studies of childhood pneumonia and empyema and investigate the underlying factors contributing to refusal. Methods Two paediatric respiratory studies investigating childhood pneumonia and empyema and requiring informed consent were carried out at the same site. During the period from April 2010 to March 2011, the number of eligible children who gave or refused consent for each study was documented. Each research team included a paediatric research nurse and paediatric research registrar (doctor). Information was collected prospectively on each consent refusal. Rates of refusal by role of person taking consent, severity of illness and reason for refusal were then analysed. Results A total of 116 children were eligible for enrolment into pneumonia study and 28 into empyema study, giving 144 consent procedures. Ten (7%) parents refused the consent. The rate of refusal did not differ between medical and nursing staff. Eighty percent of the children who were not enrolled had severe disease. Refusals were linked with not wanting the child to undergo further investigations, research delaying discharge, and anxiety regarding written consent and length of information sheets. Conclusion Consent refusal was not related to the role of the person seeking consent. Severity of child9s illness appears to determine parent9s decision regarding participation in clinical research.

A career in cardiology

The career in cardiology course is a one day symposium run by the British Cardiovascular Society. In 2011 it was held on 18 February at the Hilton Hotel in Coventry and was timed to precede the national specialty trainee 3 (ST3) recruitment process. The symposium covers the application process for higher specialty training in cardiology and offers an insight into the subspecialties of cardiology. It is an opportunity to obtain advice and opinions on cardiology ST3 recruitment from people who are highly experienced in the field and involved in the recruitment process. The symposium was developed by Aung Myat (clinical research fellow for the National Institute for Health Research and specialist registrar in cardiology at Guy’s and St Thomas’ NHS Foundation Trust), Simon Redwood (professor of interventional cardiology at Guy’s and St Thomas’), and Tony Gershlick (professor of interventional cardiology at University Hospitals of Leicester NHS Trust). The faculty included prominent cardiologists from …

Anthony David Perrett

Arriving in England, from New Zealand, Anthony David Perrett was Sidney Truelove’s research registrar at Oxford. Afterwards, as senior medical registrar at Mulago Hospital, Kampala, Uganda, and honorary lecturer at...

Conference

AbstractThe 16th Migraine Trust International Symposium, held in London, highlighted a broad range of topics emerging from extensive basic science work and clinical research in the field, carefully assembled by Professor PJ Goadsby, symposium chairman. Dr Juana Marin, Research Registrar at the Institute of Neurology in London, reports. Copyright © 2007 Wiley Interface Ltd

Can Optical Coherence Tomography Predict the Outcome of Laser Photocoagulation for Diabetic Macular Edema?

To assess the outcome of laser photocoagulation in patients with diabetic macular edema. Forty-seven patients (51 eyes) with clinically significant macular edema (CSME) undergoing grid laser photocoagulation were included. Clinical examination and optical coherence tomography (OCT) were performed at baseline and 3 to 4 months after treatment. The central foveal thickness, mean inner macular thickness (average retinal thickness in fovea and inner macular circle), and mean macular thickness were calculated. Based on the greatest OCT thickness at baseline, patients were grouped according to mild (< 300 microm; Group 1), moderate (300 to 399 microm; Group 2), and severe (> or = 400 microm; Group 3) macular edema. Group 2 showed significant reductions in central foveal thickness (23 microm, P = .02), mean inner macular thickness (18 microm, P = .02), and mean macular thickness (9 microm, P = .04) with slight improvement in visual acuity. Groups 1 and 3 did not show any significant change in macular thickness values and there was a statistically insignificant worsening of visual acuity in these groups. Patients with moderate macular thickening of 300 to 400 microm benefit most from laser treatment. OCT may help in choosing the appropriate treatment for CSME based on the degree of macular thickening. Long-term studies are warranted to confirm these findings.

Not just skin deep: Professor William Cunliffe

The leading acne researcher, recently retired from a 30 year post at the Department of Dermatology at Leeds General Infirmary, talks to Kay Brennan about his career “I was a spotty student,” Cunliffe confesses, explaining his interest in acne, which began when he was a medical student in Manchester. “I went to see a dermatologist and was given a diagnosis of acne, but no one could tell me what caused it. I wanted to find answers. Very little was known back then about acne: you were supposed to accept and get on with it.” His acne persisted as a junior doctor and, after passing Member of the Royal College of Physicians exams, he applied for a post as a dermatology research registrar in Newcastle. “I was recommended to work with Sam Shuster, in Newcastle, an up and coming chap who was probably the first true clinical scientist in dermatology in the United Kingdom. He had very revolutionary ideas on the mechanisms behind acne and was a very inspiring and dynamic man.” Shuster was a demanding boss: “I learnt never to promise to be home for Sunday lunch and usually didn't make it for Monday lunch either. We were pushed …

Early Childhood Nurse-Delivered Cognitive Behavioural Counselling for Post-Natal Depression

Objective: The aims were (1) to establish whether Early Childhood Nurses (ECNs) can be trained in a modified Cognitive Behavioural Therapy (CBT) for Post-natal Depression (PND), and (2) to compare the outcome of women treated with this therapy with ‘ideal standard care’ using non-specific counselling by ECNs with no additional training. Method: Five ECNs were trained in CBT and supervised weekly. Women were screened post-natally using the Edinburgh PND Scale (EPDS) and diagnostically assessed by a research registrar. Women with DSM-IV major or minor depression (n=37) were then randomized into either ‘ideal standard care’ (n=20) or CBT (n=17) for six weekly sessions. Two stages of follow-up were undertaken: research registrar interview immediately post-treatment and a postal follow-up at six months. Results: The training package was evaluated both by ECN completed questionnaires and analysis of taped therapy sessions. These evaluations indicated that ECNs could deliver modified CBT. There was a very high rate of recovery at initial follow-up with 70-80% recovered (EPDS &lt; 10) in both groups. Six month follow-up showed a trend towards CBT being more effective in the longer term. Conclusions: ECNs can effectively provide a modified CBT intervention in the treatment of PND. For the majority of this sample with mild-moderate depression, perceived support from their ECN (forming an integral part of both the baseline assessment interview and control condition) appeared to be as effective as modified CBT.

Care of minor injuries by emergency nurse practitioners or junior doctors: a randomised controlled trial

We aimed to assess the care and outcome of patients with minor injuries who were managed by a nurse practitioner or a junior doctor in our accident and emergency department. 1453 eligible patients, over age 16 years, who presented at our department with minor injuries were randomly assigned care by a nurse practitioner (n=704) or by a junior doctor (n=749). Each patient was first assessed by the nurse practitioner or junior doctor who did a clinical assessment; the assessments were transcribed afterwards to maintain masked conditions. Patients were then assessed by an experienced accident and emergency physician (research registrar) who completed a research assessment, but took no part in the clinical management of the patient. A standard form was used to compare the clinical assessment of the nurse practitioner or junior doctor with the assessment of the research registrar. The primary outcome measure was the adequacy of care (history taking, examination of patient, interpretation of radiographs, treatment decision, advice, and follow-up). Compared with the rigorous standard of the experienced accident and emergency research registrar, nurse practitioners and junior doctors made clinically important errors in 65 (9.2%) of 704 patients and in 80 (10.7%) of 749 patients, respectively. This difference was not significant. The nurse practitioners were better than junior doctors at recording medical history and fewer patients seen by a nurse practitioner had to seek unplanned follow-up advice about their injury. There were no significant differences between nurse practitioners and junior doctors in the accuracy of examination, adequacy of treatment, planned follow-up, or requests for radiography. Interpretation of radiographs was similar in the two groups. Properly trained accident and emergency nurse practitioners, who work within agreed guidelines can provide care for patients with minor injuries that is equal or in some ways better than that provided by junior doctors.

Conservation of inflatable penile prosthesis during radical retropubic prostatectomy.

British Journal of UrologyVolume 79, Issue 2 p. 283-284 Conservation of inflatable penile prosthesis during radical retropubic prostatectomy W.D. Dunsmuir FRCS, Research Registrar., W.D. Dunsmuir FRCS, Research Registrar. St George's Hospital, Tooting, London, UKSearch for more papers by this authorR.S. Kirby MS, FRCS, Consultant Urologist., R.S. Kirby MS, FRCS, Consultant Urologist. St George's Hospital, Tooting, London, UKSearch for more papers by this author W.D. Dunsmuir FRCS, Research Registrar., W.D. Dunsmuir FRCS, Research Registrar. St George's Hospital, Tooting, London, UKSearch for more papers by this authorR.S. Kirby MS, FRCS, Consultant Urologist., R.S. Kirby MS, FRCS, Consultant Urologist. St George's Hospital, Tooting, London, UKSearch for more papers by this author First published: 29 October 2003 https://doi.org/10.1046/j.1464-410X.1997.09025.xCitations: 10 Mr W.D. Dunsmuir Department of Urology, St George's Hospital, Blackshaw Road, Tooting, London SW17 ORE, UK. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume79, Issue2February 1997Pages 283-284 RelatedInformation