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"Clayton, Lucy"
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Portrait of the artist
The first exhibition to focus on images of artists from within the Royal Collection, 'Portrait of the Artist' not only show-cases self-portraits by world-renowned artists including Rembrandt, Rubens, Artemisia Gentileschi, Lucian Freud and David Hockney but also features images of artists by their friends, relatives and pupils, including the most reliable surviving likeness of Leonardo da Vinci by his student, Francesco Melzi. Well-known self-portraits intended to advertise the artist's talents will be shown alongside more intimate and personal works. The exhibition will examine a range of themes played out within these objects, from the 'cult' of the artist to the symbolism evoked through images of the artist's studio. The changing status of the artist over the centuries is another theme and the way in this is conveyed, both in the physical works and in the relationships between artist and patron will be highlighted. The role of monarchs in commissioning, collecting and displaying portraits of artists will also be discussed.
Book
Age of Transfused Blood in Critically Ill Adults
In a trial involving more than 2400 critically ill patients, 90-day mortality was similar among patients receiving blood donated on average 6 days earlier and those receiving blood donated 22 days earlier. The age of the transfused blood did not influence outcomes.
Blood transfusions are administered frequently and may have unintended consequences in critically ill patients.
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4
Current regulations permit the storage of red cells for up to 42 days, but prolonged storage has been associated with changes that may render red cells ineffective as oxygen carriers and that lead to the accumulation of substances that have untoward biologic effects.
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A systematic review of 18 observational studies involving a total of 409,840 patients and three randomized, controlled trials involving a total of 126 patients suggested that the transfusion of older red cells, as compared with newer red cells, was associated with . . .
Journal Article
Novel 1 L polyethylene glycol-based bowel preparation (NER1006): proof of concept assessment versus standard 2 L polyethylene glycol with ascorbate – a randomized, parallel group, phase 2, colonoscopist-blinded trial
Background
Colonoscopy requires colon cleansing. For this, many polyethylene glycol (PEG)-based preparations still require a high preparation-volume intake. Using an increased osmotic load with ascorbate (Asc), five new low-volume PEG-based bowel preparations (LVPEG) were tested for clinical proof of concept.
Methods
This two-part, open-label study examined preparation-volumes of 1–1.25 L and total required fluid volumes of 2–3 L. Part 1, in healthy volunteers, used mean cumulative 24-h stool weight (target > 2750 g) to identify a lead candidate. Part 2 was endoscopist-blinded: patients undergoing screening colonoscopy were randomized before treatment with the selected lead, one of two variants of it, or the control 2 L PEG + Asc. Two primary endpoints were used for proof of concept demonstration: mean 24-h stool weight and bowel cleansing success (Harefield Cleansing Scale).
Results
A total of 120 subjects (30 per group) were enrolled/randomized 1:1:1:1 (max 40:60 gender ratio) per completed Part. In Part 1, LVPEG-3 achieved the largest mean stool weight (3399 g:
P
< 0.0001 vs target) and was selected for Part 2. In Part 2, stool weights exceeded the target, notably for LVPEG-4 (3215 g:
P
< 0.001), which achieved 100% cleansing success after a total required fluid intake of 2 L. The control achieved 90% cleansing success. Adverse events were few, gastrointestinal in nature and similar between groups.
Conclusions
LVPEG-4 achieved a clinically useful combination of cleansing, safety/tolerability and low consumption volume: 1 L preparation + 1 L required additional fluid. Named NER1006, LVPEG-4 demonstrated clinical proof of concept and warrants further investigation.
Trial registration
October 2012.
Identifier:
NCT01714466
. EudraCT:
2012–003052-37
The trial was prospectively registered.
Journal Article
Existing Bowel Preparation Quality Scales Are Reliable in the Setting of Centralized Endoscopy Reading
BackgroundDevelopment of bowel preparation products has been based upon colon cleansing rating by a local endoscopist. It is unclear how bowel preparation scales perform when centrally evaluated.AimsTo evaluate the reliability of bowel preparation quality scales when assessed by central readers.MethodsFour central readers evaluated 52 videos in triplicate, 2 weeks apart, during the entire endoscopic procedure (insertion/withdrawal of the colonoscope) and exclusively on colonoscope withdrawal using the Boston Bowel Preparation Scale (BBPS), Chicago Bowel Preparation scale, Harefield Cleansing Scale, Ottawa Bowel Preparation Quality Scale (OBPQS), Aronchick score, a visual analogue scale, and additional items proposed in a modified Research and Development/University of California Los Angeles appropriateness process. Reliability was assessed with intraclass correlation coefficients.ResultsIntraclass correlation coefficients (95% confidence interval) for inter-rater reliability of the quality scales ranged from 0.51 to 0.65 (consistent with moderate to substantial inter-rater reliability) during the entire procedure. Corresponding intraclass correlation coefficients for intra-rater reliability ranged from 0.69 to 0.77 (consistent with substantial intra-rater reliability). Reliability was highest in the right colon and lowest in the left colon. No differences were observed in reliability when assessed for the procedure overall (insertion/withdrawal) relative to assessment on withdrawal alone.ConclusionAll five bowel preparation quality scales had moderate to substantial inter-rater reliability. Panelists considered the Aronchick score too simplistic for clinical trials and recognized that assessment of residual fluid in the Ottawa Bowel Preparation Quality Scale was not amenable to central assessment.
Journal Article
The age of blood in pediatric intensive care units (ABC PICU): study protocol for a randomized controlled trial
Background
The “Age of Blood in Children in Pediatric Intensive Care Unit” (ABC PICU) study is a randomized controlled trial (RCT) that aims to determine if red blood cell (RBC) unit storage age affects outcomes in critically ill children. While RBCs can be stored for up to 42 days in additive solutions, their efficacy and safety after long-term storage have been challenged. Preclinical and clinical observational evidence suggests loss of efficacy and lack of safety of older RBC units, especially in more vulnerable populations such as critically ill children. Because there is a belief that shorter storage will improve outcomes, some physicians and institutions systematically transfuse fresh RBCs to children. Conversely, the standard practice of blood banks is to deliver the oldest available RBC unit (first-in, first-out policy) in order to decrease wastage.
Methods/design
The ABC PICU study, is a double-blind superiority trial comparing the development of “New or Progressive Multiple Organ Dysfunction Syndrome” (NPMODS) in 1538 critically ill children randomized to either transfusion with RBCs stored for ≤ 7 days or to standard-issue RBCs (oldest in inventory). Patients are being recruited from 52 centers in the US, Canada, France, Italy, and Israel.
Discussion
The ABC PICU study should have significant implications for blood procurement services. A relative risk reduction of 33% is postulated in the short-storage arm. If a difference is found, this will indicate that fresher RBCs do improve outcomes in the pediatric intensive care unit population and would justify that use in critically ill children.
If no difference is found, this will reassure clinicians and transfusion medicine specialists regarding the safety of the current system of allocating the oldest RBC unit in inventory and will discourage clinicians from preferentially requesting fresher blood for critically ill children.
Trial registration
ClinicalTrials.gov, ID:
NCT01977547
. Registered on 6 November 2013.
Journal Article
Renal colic and childbirth pain: female experience versus male perception
Saiful Miah,1,2 Charlotte Gunner,3 Lucy Clayton,4 Suresh Venugopal,5 Nigel R Boucher,5 Bo Parys61Division of Surgery and Interventional Science, University College London, London, UK; 2Urology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; 3Urology Department, Raigmore Hospital, Inverness, UK; 4Psychiatry Department, Highbury Hospital, Nottingham, UK; 5Urology Department, Chesterfield Royal Infirmary, Chesterfield, UK; 6Urology Department, Rotherham General Hospital, Rotherham, UKRenal colic is often described by patients as the worst pain ever experienced.1 Pain during childbirth is also similarly described.2 To date, no study has comparatively evaluated the pain of renal colic to that of childbirth in female patients who have experienced both. Furthermore, no such study has evaluated the perception that men with renal colic have with respect to the pain experienced during childbirth. Here we present our cross-sectional observational study to address these questions. The primary objectives of our study were to answer these questions and highlight the severity of renal colic which is not always faced and treated aggressively.
Journal Article
