Rosemary J Greenwood | University of York (original) (raw)

Papers by Rosemary J Greenwood

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2019

BackgroundEarly diagnosis of necrotising enterocolitis (NEC) may improve prognosis but there are ... more BackgroundEarly diagnosis of necrotising enterocolitis (NEC) may improve prognosis but there are no proven biomarkers.ObjectiveTo investigate changes in faecal volatile organic compounds (VOCs) as potential biomarkers for NEC.DesignMulticentre prospective study.Settings8 UK neonatal units.PatientsPreterm infants <34 weeks gestation.MethodsDaily faecal samples were collected prospectively from 1326 babies of whom 49 subsequently developed definite NEC. Faecal samples from 32 NEC cases were compared with samples from frequency-matched controls without NEC. Headspace, solid phase microextraction gas chromatography/mass spectrometry was performed and VOCs identified from reference libraries. VOC samples from cases and controls were compared using both discriminant and factor analysis methods.ResultsVOCs were found to cluster into nine groups (factors), three were associated with NEC and indicated the possibility of disease up to 3–4 days before the clinical diagnosis was established....

BMJ open, Jan 18, 2018

Immune thrombocytopenia (ITP) is an autoimmune condition that may cause thrombocytopenia-related ... more Immune thrombocytopenia (ITP) is an autoimmune condition that may cause thrombocytopenia-related bleeding. Current first-line ITP treatment is with high-dose corticosteroids but frequent side effects, heterogeneous responses and high relapse rates are significant problems with only 20% remaining in sustained remission with this approach. Mycophenolate mofetil (MMF) is often used as the next treatment with efficacy in 50%-80% of patients and good tolerability but can take up to 2 months to work. To test the hypothesis that MMF combined with corticosteroid is a more effective first-line treatment for immune thrombocytopenia (ITP) than current standard of corticosteroid alone. DesignMulticentre, UK-based, open-label, randomised controlled trial. Haematology departments in secondary care. We plan to recruit 120 patients >16 years old with a diagnosis of ITP and a platelet count <30x10/L who require first-line treatment. Patients will be followed up for a minimum of 12 months follo...

BMJ open, Jan 14, 2018

To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, ... more To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Proof of concept before and after study with feasibility of delivering the intervention. Three burns services within two UK hospital trusts. Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Introduction of LF sheets and pillowcases during a 15-month period. For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the pri...

European Journal of Cancer Supplements, 2008

Rheumatology, 2017

Objective. To evaluate the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (B... more Objective. To evaluate the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), the revised Bristol Rheumatoid Arthritis Numerical Rating Scales (BRAF-NRS V2) and the Rheumatoid Arthritis Impact of Disease (RAID) scale in six countries. Methods. We surveyed RA patients in France, Germany, The Netherlands, Spain, Sweden and the UK, including the HAQ, 36-item Short Form Health Survey (SF-36) and potential revisions of the BRAF-NRS coping and Spanish RAID coping items. Factor structure and internal consistency were examined by factor analysis and Cronbach's a and construct validity by Spearman's correlation. Results. A total of 1276 patients participated (76% female, 25% with a disease duration <5 years, median HAQ 1.0). The original BRAF-MDQ four-factor structure and RAID single-factor structure were confirmed in every country with 566% of variation in items explained by each factor and all item factor loadings of 0.710.98. Internal consistency for the BRAF-MDQ total and subscales was a Cronbach's a of 0.750.96 and for RAID, 0.930.96. Fatigue construct validity was shown for the BRAF-MDQ and BRAF-NRS severity and effect scales, correlated internally with SF-36 vitality and with RAID fatigue (r = 0.630.93). Broader construct validity for the BRAFs and RAID was shown by correlation with each other, HAQ and SF-36 domains (r = 0.460.82), with similar patterns in individual countries. The revised BRAF-NRS V2 Coping item had stronger validity than the original in all analyses. The revised Spanish RAID coping item performed as well as the original. Conclusion. Across six European countries, the BRAF-MDQ identifies the same four aspects of fatigue, and along with the RAID, shows strong factor structure and internal consistency and moderategood construct validity. The revised BRAF-NRS V2 shows improved construct validity and replaces the original.

Alcohol and Alcoholism, 2014

Journal of Public Health, 2015

Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID... more Opioid substitution treatment (OST) reduces the harm of injecting and opioid dependence. The SCID feasibility trial explored the processes of conducting a randomised control trial (RCT) with people who inject drugs (PWID) in a low threshold agency. Feasibility of the intervention investigated whether offering PWID immediate access to OST via specialist primary care increased numbers in OST at 3 months, compared to offering advice and case management. Methods Un-blinded RCT was conducted at Bristol Drugs Project needle exchange. A total of 311 individuals were eligible and 100 consented to participate. Trial process outcomes involved exploring OST status at 3 months; secondary outcomes were substance use and health related quality of life measures. Results Follow-up was 86%. At 3 months, 51% intervention and 47% of control participants were in OST (OR of success of intervention 1.17 (0.54-2.57). Opioid use reduced by 79% and 73% respectively (OR of intervention success 1.38 (0.5-3.7). Physical and mental health improved but there was little differences between groups. Conclusions The feasibility of conducting the trial was a success, but there was insufficient evidence of an effect compared to intensive case management. Further development and evaluation of case management approaches in low-threshold agencies is warranted.

$Research paper thumbnail of A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial$

The Journal of bone and joint surgery. American volume, 2010

Controversy exists with regard to whether to treat AO/OTA 31-A2 fractures of the proximal part of... more Controversy exists with regard to whether to treat AO/OTA 31-A2 fractures of the proximal part of the femur with an intramedullary device or an extramedullary device. A prospective, randomized, controlled trial was performed to compare the outcome of treatment of these unstable fractures of the proximal part of the femur with either a sliding hip screw or a long gamma nail. Two hundred and ten patients presenting with an AO/OTA 31-A2 fracture of the proximal part of the femur were randomized, at the time of admission, to fixation with use of either a long gamma nail or a sliding hip screw. The primary outcome measure was reoperation within the first postoperative year. Secondary measures included mortality, length of hospital stay, transfusion rate, change in mobility and residence, and quality of life as measured with the EuroQol 5D outcome score. There was no significant difference between the reoperation rates for the two groups. In total, five patients (three from the long-gamma...

$Research paper thumbnail of The administration of intermittent parathyroid hormone affects functional recovery from pertrochanteric fractured neck of femur: a protocol for a prospective mixed method pilot study with randomisation of treatment allocation and blinded assessment (FRACTT)$

BMJ open, Jan 29, 2014

Pertrochanteric hip fractures occur in an elderly population and cause considerable morbidity and... more Pertrochanteric hip fractures occur in an elderly population and cause considerable morbidity and loss of functional ability as the fracture heals. Recently, parathyroid hormone (PTH), which is licensed for the treatment of osteoporosis, has been shown to potentially accelerate bone healing in animal and human studies. If its administration could allow a faster functional recovery after pertrochanteric hip fracture, then a patient's hospital stay may be reduced and rehabilitation could be potentially accelerated. PTH can currently only be administered by subcutaneous injection. The acceptability of this intervention is unknown in this elderly population. The aim of this pilot study is to inform the design of a future powered study comparing the functional recovery after pertrochanteric hip fracture in patients undergoing standard care versus those who undergo administration of subcutaneous injection of PTH. The study is an open label, prospective, randomised, comparative pilot s...

$Research paper thumbnail of Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall? Protocol for a randomised controlled feasibility study$

JAMA Internal Medicine, 2014

Midwifery, 2002

Objectives: to determine whether a specif|c 'hands-o¡' breastfeeding technique, based on the phys... more Objectives: to determine whether a specif|c 'hands-o¡' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems.To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis. Design: a non-randomised prospective cohort phased intervention study.

Journal of Reproductive and Infant Psychology, 2003

Postnatal depression occurs in 10-15% of postpartum women. Studies have shown associations with e... more Postnatal depression occurs in 10-15% of postpartum women. Studies have shown associations with endogenous hormone levels (oestrogen, progesterone, cortisol and thyroxin) and with autoimmune thyroid dysfunction. Breastfeeding has not been shown to increase the risk of developing postpartum depression. A prospective study involving 54 breastfeeding mothers of mixed parity and similar socio-economic status and education used bivariate analysis to look

Journal of Clinical Microbiology, 2005

The modifications to the vaginal habitat accompanying a change to vaginal flora in bacterial vagi... more The modifications to the vaginal habitat accompanying a change to vaginal flora in bacterial vaginosis (BV) are poorly understood. In this study enzymes involved in mucin degradation were measured, including a novel glycosulfatase assay. Women attending an emergency walk-in sexually transmitted disease clinic were studied. One high vaginal swab (HVS) was used to prepare a gram-stained smear to determine BV status, using Ison and Hay's criteria, and a separate swab was used for the purposes of the assays. The median glycosulfatase activity was 8.5 (range, −1.2 to 31.9) nmol h −1 1.5 ml −1 of HVS suspension in patients with BV compared to 0.5 (range, −0.7 to 9.4) nmol h −1 1.5 ml −1 of HVS suspension in patients without BV ( P = <0.001). The median glycoprotein sialidase activity was 29.2 (range, −17 to 190) nmol h −1 1.5 ml −1 of HVS suspension in patients with BV compared to −1.1 (range, −41 to 48) nmol h −1 1.5 ml −1 of HVS suspension in patients without BV ( P < 0.001). ...

Journal of Child Psychology and Psychiatry, 2003

Twins tend to lag behind singletons in their language development, but the causes were unknown. N... more Twins tend to lag behind singletons in their language development, but the causes were unknown. Ninety-six twin pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC), for whom birth was after at least 33 weeks of gestation, were compared with 98 pairs of singletons, no more than 30 months apart in age. Parental qualities and family interaction were assessed through standardised questionnaires and interviews and both structured and unstructured observations in the home at 20 months and 36 months. The possible causal role of postnatal family influences was assessed through five criteria: i) the feature had to differ between twins and singletons; ii) individual differences in that feature had to relate to individual differences in language level within the sample of singletons and of twins; iii) the feature as measured at 20 months had to predict language as assessed at 36 months; iv) that had to apply after controlling for language level at 20 months; and v) introduction of the predictive feature into an overall model had to obliterate the twin-singleton difference in language level. Patterns of parent-child interaction and communication met these five criteria. The maternal factors all concerned aspects of interaction that were broadly concerned with communication: encouraging the child to speak, providing elaborating comments, engaging in reading to the child and talking about the story and its illustrations. The HOME inventory findings provided similar findings with respect to responsiveness, involvement and level of experiences involved. Family features that might have been influential, but which were not, included parental depression, breast-feeding, family size, and style of sibling interaction. Patterns of parent-child interaction and communication within the normal range have environmentally mediated effects on language and account for twin-singleton differences in language developmently. The results indicate the value of a natural experiment in testing competing causal hypotheses, and show the role of environmental factors as influences on language variations within the normal range, for both twins and singletons.

International Journal of Language & Communication Disorders, 2001

The prevalence and developmental course of supposed 'secret language' was examine... more The prevalence and developmental course of supposed 'secret language' was examined in a cohort of twins and closely spaced singletons pairs, with systematic assessments at 20 months and again at 36 months. Two forms of apparent 'secret language' were examined: (1) shared understanding--speech directed generally but unintelligible to the parent, although apparently clearly understood within the child pair, and (2) private language directed exclusively to the other twin/sibling--not intelligible to the parent, but apparently clearly understood and used only within the child pair. Both occurred in singleton pairs, but the rate was much higher in twins. In most cases it seemed to be a developmental phenomenon occurring in the second year of life with the emergence of immature speech, and decreasing considerably over the next 16 months. A small group of children, primarily male twins, was reported to use a private language at 36 months. This group had poorer cognitive and language functioning, and was characterized by highly dependent relationships. Some aspects of the twins' home environment were less stimulating and less responsive, most probably reflecting the abilities and relationships of the children. A follow-up of these children when they were approximately 6 years of age showed that language outcome was poor for the subgroup (n = 4) who did not develop normal language alongside the use of a private language.

Focus on Alternative and Complementary Therapies, 2007

Family Practice, 2007

Objectives. To assess the effectiveness of professional herbal practice in the treatment of menop... more Objectives. To assess the effectiveness of professional herbal practice in the treatment of menopausal symptoms. To generate pilot data for future sample size calculations. Methods. A pilot prospective, randomized, waiting list controlled trial was conducted in primary care at one urban UK GP practice. Participants were 45 women aged 46-59, experiencing selfdefined menopausal symptoms and no menstrual bleeding for 3 months. Exclusion criteria included use of hormone replacement therapy. Participants were block randomized into a treatment group (n = 15) who received a course of individualized treatment from one of three herbal practitioners, and control group (n = 30) offered treatment after waiting 4 months. Treatment was six consultations over 5 months including discussion of nutrition, lifestyle and individualized herbal prescription. Change in menopausal symptoms was measured in both groups using the validated Greene Climacteric Scale. Measure Yourself Medical Outcome Profile recorded changes in self-defined most troublesome symptoms. Results. Forty-four participants completed the study. The treatment group demonstrated a statistically and clinically significant reduction in menopausal symptoms compared to the control group. Total scores for menopausal symptoms reduced for both groups. Reduction for the treated group was 9.05 points greater than that for the control group, CI 5.08-13.03, as were changes in vasomotor scores (mean 1.81, CI 1.00-2.62). Libido increased (mean 0.69, CI 0.38-0.99) in the group receiving herbal treatment. Conclusion. The treatment package from herbal practitioners improved menopausal symptoms, particularly hot flushes and low libido. This offers evidence to support herbal medicine as a treatment choice during the menopause.

European Journal of Surgical Oncology (EJSO), 2008

Introduction: Core biopsy is frequently used in the investigation of breast lumps. However it can... more Introduction: Core biopsy is frequently used in the investigation of breast lumps. However it can be difficult both to decide how many cores should be taken, and also how to assess adequacy of a specimen. A study was devised to compare benign and malignant breast core biopsy specimens, and whether they sank or floated in formalin. Methods: 79 consecutive patients with primary breast pathology underwent ultrasound-guided core biopsy. The cores were placed in specimen bottles containing formalin, and it was recorded whether they floated or sank. All specimens were sent for histological examination using routine staining with Haemotoxylin & Eosin and oestrogen-receptor antibodies. Results: Of the 79 biopsies assessed, 46 proved to be malignant, of which 39 (84.7%) sank. 33 biopsies were benign, with 22 (66.6%) floating. All but one of the false negative and false positive results could be explained by fat analysis of the specimens. Conclusions: This simple test, with a sensitivity of 78.0% and specificity of 75.9%, gives an early indication of the histological results. This can help by guiding the number of cores taken, as well as aiding the clinician by giving them more information at the initial consultation. From our results, it would seem reasonable that where there is a strong clinicoradiological suspicion of malignancy, a diagnostic biopsy should not be deemed adequate until a sinking specimen is obtained.