Publications by authors named "G Jones"

6,421 Publications

Novel Radiobiology is an Essential Pillar for the Future of Radiation Oncology.

Clin Oncol (R Coll Radiol) 2021 Sep 17. Epub 2021 Sep 17.

Leicester Cancer Research Centre, University of Leicester, Leicester, UK.

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http://dx.doi.org/10.1016/j.clon.2021.09.005DOI Listing
September 2021

CPAP delivered outside critical care during the second wave of COVID-19: outcomes from a UK respiratory surge unit.

BMJ Open Respir Res 2021 09;8(1)

Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

Background: NHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling of care. However, data assessing this strategy are sparse, especially for the use of CPAP as a ceiling of care, and particularly when delivered outside of a traditional critical care environment. We describe a cohort of patients from Liverpool, UK, who received CPAP on a dedicated respiratory surge unit at the start of the second wave of the COVID-19 pandemic in UK.

Methods: Retrospective cohort analysis of consecutive patients receiving CPAP for the treatment of respiratory failure secondary to COVID-19 on the respiratory surge unit at the Royal Liverpool Hospital, Liverpool, UK from 21 September until 30 November 2020.

Results: 88 patients were included in the analysis. 56/88 (64%) were deemed suitable for escalation to invasive mechanical ventilation (IMV) and received CPAP as a trial; 32/88 (36%) received CPAP as a ceiling of care. Median age was 63 years (IQR: 56-74) and 58/88 (66%) were men. Median SpO/FiO immediately prior to CPAP initiation was 95 (92-152). Among patients for escalation to IMV, the median time on CPAP was 6 days (IQR 4-7) and survival at day 30 was 84% (47/56) with 14/56 (25%) escalated to IMV. Of those patients for whom CPAP was ceiling of care, the median duration of CPAP was 9 days (IQR 7-11) and 18/32 (56%) survived to day 30. Pulmonary barotrauma occurred in 9% of the cohort. There were no associations found on multivariant analysis that were associated with all-cause 30-day mortality.

Conclusions: With adequate planning and resource redistribution, CPAP may be delivered effectively outside of a traditional critical care setting for the treatment of respiratory failure due to COVID-19. Clinicians delivering CPAP to patients with COVID-19 pneumonitis should be alert to the dangers of pulmonary barotrauma. Among patients who are for escalation of care, the use of CPAP may avoid the need for IMV in some patients. Our data support the NHS England recommendation to consider CPAP as a ceiling of care.
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http://dx.doi.org/10.1136/bmjresp-2021-000907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441225PMC
September 2021

Variability in insulin pharmacokinetics following high-dose insulin therapy.

Clin Toxicol (Phila) 2021 Sep 15:1-3. Epub 2021 Sep 15.

St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia.

Introduction: High dose insulin (HDI) therapy for cardiogenic shock from acute poisoning can be complicated by treatable hypoglycemia which persists following poisoning recovery. Glucose requirements post-HDI reflect supraphysiological insulin plasma concentration. A publication reported a patient treated with HDI with plasma insulin concentrations >1000 µU/mL and elimination half-life 10-18 h requiring intravenous glucose replacement for >5 days. We report two cases treated with HDI (Actrapid; soluble or regular insulin) with shorter elimination half-lives.

Case Reports: A man ingesting diltiazem received HDI for approximately 60 h (maximum dose 10 U/kg/h) and supplemental intravenous dextrose for 44 h post-HDI. Post-HDI the maximum measured plasma insulin concentration was 6345 µU/mL and elimination half-life 5.5 h. A man ingesting propranolol received HDI for approximately 12 h (maximum dose 1.5 U/kg/h) and supplemental intravenous dextrose for 4 h post-HDI. Post-HDI the maximum measured plasma insulin concentration was 368 µU/mL and elimination half-life 2.2 h.

Discussion: Markedly different insulin pharmacokinetics post-HDI is observed in two cases and a previously published report, and factors contributing to the interpatient differences are poorly defined. This pharmacokinetic variability impacts on the severity and duration of treatable hypoglycemia post-HDI. Analytical factors impacting on the measured plasma insulin concentrations include appropriate sample dilution and differing analytical specificity for the type of insulin.
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http://dx.doi.org/10.1080/15563650.2021.1967372DOI Listing
September 2021

Prehospital Pericardiocentesis Using a Pneumothorax Needle.

Prehosp Emerg Care 2021 Sep 10:1-6. Epub 2021 Sep 10.

Hennepin Emergency Medical Services, Hennepin Healthcare, Minneapolis, MN, 55404.

Penetrating chest trauma carries significant morbidity and mortality. In traumatic cardiac arrest due to a penetrating mechanism, it is paramount that the patient be transported to a trauma center as quickly as possible and there are only limited options for resuscitation in the field. In this case, we discuss a patient with a penetrating knife wound to the chest who lost pulses from cardiac tamponade. Prehospital ultrasound was able to quickly identify the tamponade and a pericardiocentesis was performed using a Simplified Pneumothorax Emergency Air Release (SPEAR) Needle (North American Rescue, LLC, USA) with subsequent return of spontaneous circulation.
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http://dx.doi.org/10.1080/10903127.2021.1977441DOI Listing
September 2021

A Baby at All Costs? Exploring the Use and Provision of Unproven Adjuvant Treatments in the Context of IVF.

Semin Reprod Med 2021 Sep 9. Epub 2021 Sep 9.

Centre for Reproduction Research, De Montfort University, Leicester, United Kingdom.

The year 2018 marked 40 years since the birth of Louise Brown, the first baby born as a result of pioneering in vitro fertilization (IVF) treatment. Since then, advances have seen a wide range of reproductive technologies emerge into clinical practice, including adjuvant treatments often referred to as IVF "add-ons." However, these "optional extras" have faced growing criticism, especially when they have often come at additional financial cost to the patient and have little evidence supporting their efficacy to improve pregnancy or birth rates. Despite this, according to the latest national patient survey by the Human Fertilisation and Embryology Authority, three quarters of patients who had fertility treatment in the United Kingdom in the past two years had at least one type of treatment add-on highlighting the growing demand for these interventions. This article uses a psychosocial perspective to consider the motivations behind patient and clinician behavior along with the wider societal and economic factors that may be impacting upon the increase in the use of adjuvant treatments in fertility clinics more widely. It suggests the reasons fertility patients use unproven "optional extras" are complex, with interpersonal, psychological, and social factors intertwining to generate an increase in the use of IVF add-ons.
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http://dx.doi.org/10.1055/s-0041-1731789DOI Listing
September 2021
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