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Cousins D, Sanders J, Muller D, Ward K, Asare E, Libby B, Showalter T, Romano K. Disease Characteristics and Patterns of Failure by Histologic Type for Patients Treated With Definitive Radiation for Cervical Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Clough A, Hales R, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, Choudhury A, Eccles C. PD-0938 impact of an atlas on radiographer inter-observer contour variation in prostate radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bueser T, Clayton T, Dodd M, Beaumont E, Owens G, Murray S, Sepehripour A, Oo A, Sanders J. The impact of COVID-19 on recovery after heart surgery: preliminary findings from the CardiacCovid Study. Eur J Cardiovasc Nurs 2021. [PMCID: PMC8344890 DOI: 10.1093/eurjcn/zvab060.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background/Introduction The COVID-19 pandemic has had far-reaching effects on everyday life leading to stress and anxiety, which may be heightened in those undergoing cardiac surgery. Health impacts following a traumatic event may be apparent at one month but can also present after many months. Purpose The aim of the CardiacCovid study was to explore the effect of the pandemic on recovery from cardiac surgery. We report the preliminary results from a single centre study in the UK during the early phase of the COVID-19 pandemic. Methods Patients >18 years old undergoing any form of cardiac surgery between 23rd March 2020 (UK lockdown) to 4th July 2020 (lifting of most restrictions) were recruited to this prospective observational study. Those too unwell or unable to give consent/complete study questionnaires were excluded. Participants completed a Quality of Life (QoL) (EQ-5D), impact of event (IES-R), depression (CES-D) and health service use questionnaire at baseline, 1 week after hospital discharge, and 6 weeks after surgery. Questionnaires were completed electronically on the Amplitude platform or via post. Ethics approval (20/YH/0132) was obtained and the study was registered (Clinicaltrials.gov:NCT04366167). Results A total of 395 patients had surgery of which 298 (91.7%) were screened and 203 (68.1%) were enrolled to the study. Participants were mostly male (74.6%), with a mean age of 63 years, undergoing urgent/emergency (57.9%) CABG +/-valve (70.1%). Mean inpatient stay was 8.6 days and in-hospital mortality was 0.5%. No patients had Covid-19. The initial findings suggest a deterioration of QoL at 1 week post discharge with near restoration to baseline level at 6 weeks post-surgery. Mean scores for CES-D and IES-R remained within subclinical levels at all available time points. However, at 6 weeks, a proportion of patients reached levels for depression on the CES-D and had high IES-R scores indicating possible post-traumatic stress. Conclusion We believe that this is the largest/only study exploring the impact of the pandemic on cardiac surgery recovery, including QoL, spanning the immediate recovery phase but will continue until 1 year. The findings so far show that recovery from cardiac surgery during the Covid-19 pandemic is similar to that reported prior to the pandemic (Cromhout et al 2018) and reinforces the need for psychosocial assessments to identify patients who may require additional support during the immediate recovery phase.
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Thomas A, Griffiths M, Kalakoutas A, Yates M, Sanders J. Recovery from aortic valve surgery: the trajectory of muscle mass, strength, and quality, and health-related quality of life (HRQoL). Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity
OnBehalf
Queen Mary University of London (QMUL) and Barts Health NHS Trust
Background/Introduction:
The impact of intensive care unit-acquired weakness (ICUAW) is considerable and is associated with reduced physical function and impaired health-related quality of life (HRQoL). Patients’ undergoing elective cardiac surgery are known to lose significant muscle mass and strength in the first seven days after surgery, but little is known beyond that time.
Purpose
We sought to investigate the effect of cardiac surgery on ICUAW (including muscle mass, strength, muscle quality) and HRQoL (including anxiety and depression and reintegration into society) until out-patient follow-up.
Methods
Eligible patients included adults undergoing a surgical elective aortic valve replacement without any pre-existing causes of severe muscle weakness or wasting. Muscle mass was measured using ultrasound of the rectus femoris cross-sectional area (RFcsa). Muscle quality was calculated using histogram analysis, specifically pixel intensity (PI), whereby a lower value is indicative of healthier muscle tissue. Muscle strength was measured using hand-held dynamometry specifically grip strength. HRQoL (EQ5D), anxiety and depression (hospital anxiety and depression scale (HADS)) and reintegration to normal living (RNLI index) were also collected. Measurements were assessed preoperatively, at day 7 and at out-patient follow-up.
Results
Thirty-one patients were recruited, with 22 (70.9%) patients attending follow-up. Patients lost 6.5% RFcsa (p= <0.0001) in the first seven days post-surgery and 10.1% (p = 0.0014) between preoperative assessment and follow-up. Hand-held grip strength decreased significantly (10.6%, p= <0.0001) in the first seven days post-surgery, however, differing to RFcsa, recovered considerably between day 7 and follow-up (7.7%, p = 0.018). Decreased muscle quality was observed solely in the first seven days after surgery (8.3%, p = 0.0094). The EQ5D visual analogue scale and crosswalk index increased significantly from preoperative assessment to follow-up (10%, p = 0.0250; 17.6%, p = 0.022 respectively) and day 7 to follow-up (11.7%, p = 0.0311; 27.9%, p = 0.011 respectively). While depression scores significantly decreased between the same time points as the EQ5D, changes in anxiety and RNLI scores, were non-significant.
Conclusion
Patients undergoing surgical aortic valve replacements lose considerable muscle mass in hospital, failing to recover even at out-patient follow-up. Furthermore, muscle quality decreases in the first seven days after surgery in line with the acute muscle loss. However, the impact on strength is less extensive as patients appear to recover the loss by follow-up. Patients’ health scores, function index and depression scores also improve, suggesting that muscle mass is the only outcome to not recover at follow-up. Therefore, patients appear to recover well from AVR surgery even surpassing some of their preoperative results, with the exception of the RFcsa.
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Burton S, Hayes J, Scott-Morell N, Jones I, Sanders J, Walthall H, Wright J. Should I stay or should I go? An exploration of the decision-making behaviour of acute cardiac patients during the Covid-19 pandemic. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Liverpool John Moores University
Background
The Covid-19 pandemic has resulted in excess mortality. With efforts to reduce population movement and the spread of the disease, non-emergency patients are deterred from seeking help. Reduction in the number of patients presenting with acute cardiac conditions has dropped significantly, impacting initial and follow-up treatment. In a national survey, 71% reported they were afraid to visit hospital due to fear of being exposed to the virus, and 46% worried about putting pressure on the health service. Internet searches for chest pain symptoms increased following the announcement of lockdown and public health messages, suggesting an influence of government messaging on patient behaviour. Current work suggests that patients are turning to informal support networks to facilitate decision making, while more formalised networks are blocked.
Purpose
To qualitatively explore decision making of patients and their family members’ when faced with an acute cardiac event. This methodology provides insight into why patients made said decisions, and what factors influenced their decision making, during the Covid-19 pandemic.
Methods
A qualitative methodology was employed using purposive sampling of cardiac patients, who had attended hospital during a Covid-19 lockdown. Data was collected using semi-structured, digitally recorded, telephone or video call interviews. Interviews were transcribed verbatim and subjected to thematic analysis.
Results
Twenty-four participants were recruited, from three sites throughout England.
Three themes were generated from the study
Reliance on informal support network, including disclosing their symptoms to family and friends, in turn leading to displaced or co-decision making. Secondly, a lack of awareness of cardiac symptoms leading to delayed help-seeking. Finally, an indirect Covid-19 effect, in which patients suggest that Covid-19 did not influence their decisions, yet a perception that their condition was non-urgent combined with a belief that GP services were limited resulted in delayed help-seeking
Conclusions
Patients have turned to informal health support networks, especially when the cause of symptoms are unknown. While the presence of Covid-19 is not explicitly noted as being influential, indirect effects are noted. Findings highlight the need for informed public health messages, that allow those in need of treatment to access care as and when they need.
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Aktuerk D, Ali J, Badran A, Balmforth D, Bleetman D, Brown C, Suelo-Calanao R, Cartwright J, Casey L, Chiwera L, Fudulu D, Garner M, Gradinariu G, Harky A, Hussain A, Hutton S, Kew E, Loubani M, Mani K, Martin J, Rochon M, Moawad N, Mohamed S, Muretti M, Murphy G, Olivieri G, Paglinawan I, Quijano-Campos J, Rizzo V, Robertson S, Rogers L, Roman M, Salmon K, Sanders J, Talukder S, Tanner J, Vaja R, Zientara A, Green S, Miles R, Lamagni T, Harrington P. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020; 106:812-819. [DOI: 10.1016/j.jhin.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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Dalwadi S, Thames H, Tang C, Crook J, Sanders J, Blanchard P, Ciezki J, Keyes M, Merrick G, Catton C, Razlee H, Stock R, Sullivan F, Millar J, Frank S. Is The Phoenix Criterion Of Biochemical Failure (BF) In Men Treated With Low-Dose Rate Prostate Brachytherapy Appropriate? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sanders J, Venkatesan A, Davis J, Kudchadker R, Tang C, Bruno T, Ma J, Frank S. OC-1040: Computer aided brachytherapy: assisting the practice of prostate brachytherapy with machine learning. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanders J, Frank S, Venkatesan A, Bathala T, Tang C, Kudchadker R, Bruno T, Pagel M, Ma J. OC-1034: Parallel imaging compressed sensing for prostate MRI without an endorectal coil: a prospective study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Turok D, Gero A, Simmons R, Kaiser J, Stoddard G, Sexsmith C, Gawron L, Sanders J. O4 The levonorgestrel vs. copper intrauterine device for emergency contraception: A non-inferiority randomized controlled trial. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Self JE, Dunn MJ, Erichsen JT, Gottlob I, Griffiths HJ, Harris C, Lee H, Owen J, Sanders J, Shawkat F, Theodorou M, Whittle JP. Management of nystagmus in children: a review of the literature and current practice in UK specialist services. Eye (Lond) 2020; 34:1515-1534. [PMID: 31919431 PMCID: PMC7608566 DOI: 10.1038/s41433-019-0741-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
Abstract
Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.
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Williams A, Shigrekar A, Galbreth G, Sanders J. Application and testing of a triple bubbler sensor in molten salts. NUCLEAR ENGINEERING AND TECHNOLOGY 2020. [DOI: 10.1016/j.net.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Furmaniak J, Sanders J, Sanders P, Miller-Gallacher J, Ryder MM, Rees Smith B. Practical applications of studies on the TSH receptor and TSH receptor autoantibodies. Endocrine 2020; 68:261-264. [PMID: 32472423 PMCID: PMC7266850 DOI: 10.1007/s12020-019-02180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/26/2019] [Indexed: 10/28/2022]
Abstract
Studies on the TSH receptor (TSHR) have numerous practical applications in vitro and in vivo. For example human monoclonal autoantibodies (MAbs) to the TSHR are useful reagents for in vitro diagnostics. Measurement of TSHR autoantibodies (TRAbs) is helpful in diagnosis and management of autoimmune thyroid disease. Currently available highly sensitive and specific assays to measure TRAbs use the human TSHR MAb M22 instead of the TSH. Furthermore, preparations of the human TSHR MAb M22 are useful as the World Health Organisation International Standard for thyroid stimulating antibody and for calibration of the assays for measuring TRAbs. Preparations of thermostabilised TSHR extracellular domain have recently become available and this is likely to have an impact on improvements in specificity testing for TRAb assays. In addition the stable TSHR preparations have practical application for specific immunoadsorption of patient serum TRAbs. Human TSHR MAbs also have promising prospects as new therapeutics. Autoantibodies with TSHR antagonistic activities are "natural" inhibitors of TSHR stimulation and are expected to be helpful in controlling TSHR activity in patients with Graves' disease, Graves' ophthalmopathy and thyroid cancer.
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Lugg-Widger F, Robling M, Lau M, Paranjothy S, Pell J, Sanders J, White J, Cannings-John R. Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment. Int J Popul Data Sci 2020; 5:1154. [PMID: 32935057 PMCID: PMC7473263 DOI: 10.23889/ijpds.v5i1.1154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Individual, social and economic circumstances faced by young mothers (19 years or under) can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which aims to improve prenatal health behaviours, birth outcomes, child development and health outcomes, and maternal life course. Establishing evidence of effectiveness beyond the original US setting is important to understand where further adaptation is required within a country specific context. Objective This study will form one strand of the Scottish Government’s plan to evaluate the effectiveness of FNP as compared to usual care for mothers and their children in Scotland and will focus only on outcomes that can be identified using routine administrative data systems. Methods This study is a natural experiment with a case-cohort design using linked anonymised routine health, educational and social care data. Cases will be women enrolled as FNP Clients in ten NHS Health Boards in Scotland and Controls will be women who met FNP eligibility criteria but were pregnant at a time when the programme was not recruiting. Outcomes are mapped to the Scottish FNP logic model. All comparative analyses will be pre-specified, conducted on an intention to treat basis and will use multilevel regression models to compare outcomes between groups. Discussion The study protocol is based upon the specification of FNP commissioned by the Scottish Government. This study design is novel for the evaluation of the FNP/NFP programmes which are primarily evaluated with an RCT. Outcomes included within the study have been selected on the basis that they are outcomes FNP aims to influence and where there is routine data available to assess the outcome
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Baltussen EJM, Brouwer de Koning SG, Sanders J, Aalbers AGJ, Kok NFM, Beets GL, Hendriks BHW, Sterenborg HJCM, Kuhlmann KFD, Ruers TJM. Tissue diagnosis during colorectal cancer surgery using optical sensing: an in vivo study. J Transl Med 2019; 17:333. [PMID: 31578153 PMCID: PMC6775650 DOI: 10.1186/s12967-019-2083-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background In colorectal cancer surgery there is a delicate balance between complete removal of the tumor and sparing as much healthy tissue as possible. Especially in rectal cancer, intraoperative tissue recognition could be of great benefit in preventing positive resection margins and sparing as much healthy tissue as possible. To better guide the surgeon, we evaluated the accuracy of diffuse reflectance spectroscopy (DRS) for tissue characterization during colorectal cancer surgery and determined the added value of DRS when compared to clinical judgement. Methods DRS spectra were obtained from fat, healthy colorectal wall and tumor tissue during colorectal cancer surgery and results were compared to histopathology examination of the measurement locations. All spectra were first normalized at 800 nm, thereafter two support vector machines (SVM) were trained using a tenfold cross-validation. With the first SVM fat was separated from healthy colorectal wall and tumor tissue, the second SVM distinguished healthy colorectal wall from tumor tissue. Results Patients were included based on preoperative imaging, indicating advanced local stage colorectal cancer. Based on the measurement results of 32 patients, the classification resulted in a mean accuracy for fat, healthy colorectal wall and tumor of 0.92, 0.89 and 0.95 respectively. If the classification threshold was adjusted such that no false negatives were allowed, the percentage of false positive measurement locations by DRS was 25% compared to 69% by clinical judgement. Conclusion This study shows the potential of DRS for the use of tissue classification during colorectal cancer surgery. Especially the low false positive rate obtained for a false negative rate of zero shows the added value for the surgeons. Trail registration This trail was performed under approval from the internal review board committee (Dutch Trail Register NTR5315), registered on 04/13/2015, https://www.trialregister.nl/trial/5175.
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De Boo L, Cimino-Mathews A, Lubeck Y, Daletzakis A, Opdam M, Sanders J, Hooijberg E, van Rossum A, Loncova Z, Rieder D, Trajanoski Z, Vollebergh M, Sobral-Leite M, Van de Vijver K, Broeks A, van der Wiel R, van Tinteren H, Linn S, Horlings H, Kok M. Tumour-infiltrating lymphocytes and BRCA-like status in stage III breast cancer patients treated with intensified carboplatin-based chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhou Z, Sanders J, Johnson J, Guha-Thakurta N, Chen M, Briere T, Wang Y, Son J, Li J, Ma J. Machine Learning Based Detection of Brain Cancer Metastases in MR Images for Stereotactic Radiosurgery Using Single-Shot Detectors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Crook J, Tang C, Thames H, Blanchard P, Sanders J, Ciezki J, Keyes M, Merrick G, Catton C, Raziee H, Sullivan F, Stock R, Anscher M, Frank S. A Biochemical Definition of Cure Following Brachytherapy for Prostate Cancer: A Multi-Institution International Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wastlund D, Moraitis AA, Thornton JG, Sanders J, White IR, Brocklehurst P, Smith G, Wilson E. The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis. BJOG 2019; 126:1243-1250. [PMID: 31066982 PMCID: PMC6771727 DOI: 10.1111/1471-0528.15809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
Objective To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy. Design Health economic simulation model. Setting All English NHS antenatal services. Population Nulliparous women in the third trimester treated within the UK NHS. Methods A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature. Main outcome measures Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy. Results Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected. Conclusions The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective. Tweetable abstract Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted. Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted.
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Sanders J, Channon S, Gobat N, Bennert K, Addison K, Robling M. Implementation of the Family Nurse Partnership programme in England: experiences of key health professionals explored through trial parallel process evaluation. BMC Nurs 2019; 18:13. [PMID: 30976196 PMCID: PMC6444391 DOI: 10.1186/s12912-019-0338-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/19/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Family Nurse Partnership (FNP) programme was introduced to support young first-time mothers. A randomised trial found FNP added little short-term benefit compared to usual care. The study included a comprehensive parallel process evaluation, including focus groups, conducted to aid understanding of the introduction of the programme into a new service and social context. The aim of the focus groups was to investigate views of key health professionals towards the integration and delivery of FNP programme in England. METHODS Focus groups were conducted separately with Family Nurses, Health Visitors and Midwives at trial sites during 2011-2012. Transcripts from audio-recordings were analysed thematically. RESULTS A total of 122 professionals participated in one of 19 focus groups. Family Nurses were confident in the effectiveness of FNP, although they experienced practical difficulties meeting programme fidelity targets and considered that programme goals did not sufficiently reflect client or community priorities. Health Visitors and Midwives regarded FNP as well-resourced and beneficial to clients, describing their own services as undervalued and struggling. They wished to work closely with Family Nurses, but felt excluded from doing so by practical barriers and programme protection. CONCLUSION FNP was described as well-resourced and delivered by highly motivated and well supported Family Nurses. FNP eligibility, content and outcomes conflicted with individual client and community priorities. These factors may have restricted the potential effectiveness of a programme developed and previously tested in a different social milieu. Building Blocks ISRCTN23019866 Registered 20/04/2009.
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Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen KJ, ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Horlings HM, Sanders J, Levin MD, Sonke GS. Abstract P6-17-19: What to do with trastuzumab therapy after achieving radiological complete remission (rCR) in HER2+ metastatic breast cancer (MBC)? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Intro MBC is generally considered incurable, but patients with HER2+ disease treated with trastuzumab do relatively well and some have an exceptional durable response and survive over 10 years. We analyzed the clinical-pathological characteristics associated with long-term survival in patients with HER2+ MBC treated with trastuzumab. In addition, we studied the effect of stopping trastuzumab in case of rCR.
Methods We included all patients with HER2+ MBC treated with first- or second-line trastuzumab-based palliative therapy between January 2000 and December 2014 in 8 Dutch hospitals (Netherlands Cancer Institute, Erasmus Medical Center, Albert Schweitzer Hospital, Reinier de Graaf Hospital, Amphia Hospital, St. Antonius Hospital, Ikazia Hospital, Haga Hospital). Patients were identified through the Netherlands Cancer Registry and linkage with the institutes' tumor registries. Data was collected from medical records using case record forms. Primary endpoint was overall survival (OS), defined as first-date of MBC until death due to any cause. Kaplan-Meier survival estimates were calculated and multivariable Cox-regression models used to identify prognostic factors for improved survival. Time to progression (TTP) after achieving rCR for patients who continued and stopped trastuzumab and breast cancer specific survival were secondary outcomes.
Results We included 744 patients (median age 53, range 24-87). Median follow-up (FU) was 109 months (range 0-178). Clinical factors associated with improved survival in multivariable analyses were single-organ metastases, ER-positivity, no skin or liver metastases, no prior trastuzumab, local therapy of metastatic disease and achievement of rCR. In line with our first single center analyses1, achievement of rCR was the strongest predictor of improved survival (multivariable HR 0.30, 95%CI 0.20-0.46). RCR was observed in 71 patients (10%), of whom 60 had been treated with trastuzumab and chemotherapy, 9 with trastuzumab and hormonal therapy, and 2 with hormonal therapy. In patients with rCR the estimated 10-year OS was 53% versus 7% in patients who did not achieve rCR (p<0.001).
Thirty patients stopped trastuzumab after achieving rCR. Median time between onset of rCR and last gift of trastuzumab in these patients was 6 months (0-132). Twenty-one patients (70%) remain in complete remission after a median FU of 75 months (range 54-90) since onset of rCR. Nine patients experienced disease progression after a median time of 14 months (range 9-62) since last gift of trastuzumab. Of these, 8 patients died due to MBC and one again achieved an ongoing rCR. Out of 39 patients who continued trastuzumab after achieving rCR, 12 are in ongoing remission after a median FU of 71 months (range 51-91). In this group median TTP was 14 months (range 5-23).
Conclusion Achieving rCR is strongly associated with long-term survival in patients with HER2+ MBC. Seventy percent of patients who stopped trastuzumab after achieving rCR remained in remission, suggesting this can be an attractive approach in selected patients. External validation of these findings is required, however, as well as additional analyses to characterize the patients -and their tumors- who achieved rCR.
1 Steenbruggen, CancerRes 2017
Citation Format: Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen KJ, ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Horlings HM, Sanders J, Levin M-D, Sonke GS. What to do with trastuzumab therapy after achieving radiological complete remission (rCR) in HER2+ metastatic breast cancer (MBC)? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-19.
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Baltussen L, Kok E, Brouwer de Koning S, Sanders J, Aalbers A, Kok N, Beets G, Flohil C, Bruin S, Kuhlmann K, Sterenborg H, Ruers T. Hyperspectral imaging for real-time tissue classification during colorectal cancer surgery. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ubink I, van Eden WJ, Snaebjornsson P, Kok NFM, van Kuik J, van Grevenstein WMU, Laclé MM, Sanders J, Fijneman RJA, Elias SG, Borel Rinkes IHM, Aalbers AGJ, Kranenburg O. Histopathological and molecular classification of colorectal cancer and corresponding peritoneal metastases. Br J Surg 2018; 105:e204-e211. [PMID: 29341165 DOI: 10.1002/bjs.10788] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/19/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with colorectal peritoneal carcinomatosis have a very poor prognosis. The recently developed consensus molecular subtype (CMS) classification of primary colorectal cancer categorizes tumours into four robust subtypes, which could guide subtype-targeted therapy. CMS4, also known as the mesenchymal subtype, has the greatest propensity to form distant metastases. CMS4 status and histopathological features of colorectal peritoneal carcinomatosis were investigated in this study. METHODS Fresh-frozen tissue samples from primary colorectal cancer and paired peritoneal metastases from patients who underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy were collected. Histopathological features were analysed, and a reverse transcriptase-quantitative PCR test was used to assess CMS4 status of all collected lesions. RESULTS Colorectal peritoneal carcinomatosis was associated with adverse histopathological characteristics, including a high percentage of stroma in both primary tumours and metastases, and poor differentiation grade and high-grade tumour budding in primary tumours. Furthermore, CMS4 was significantly enriched in primary tumours with peritoneal metastases, compared with unselected stage I-IV tumours (60 per cent (12 of 20) versus 23 per cent; P = 0.002). The majority of peritoneal metastases (75 per cent, 21 of 28) were also classified as CMS4. Considerable intrapatient subtype heterogeneity was observed. Notably, 15 of 16 patients with paired tumours had at least one CMS4-positive tumour location. CONCLUSION Significant enrichment for CMS4 was observed in colorectal peritoneal carcinomatosis. Surgical relevance Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival of selected patients with colorectal peritoneal carcinomatosis, but recurrence is common. Histopathological and molecular analysis of colorectal peritoneal carcinomatosis could provide clues for development of novel therapies. In this study, colorectal peritoneal carcinomatosis was found to be enriched for tumours with high stromal content and CMS4-positive status. To further improve prognosis for patients with colorectal peritoneal carcinomatosis, therapies that target tumour-stroma interaction could be added to CRS-HIPEC.
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Geist C, Sanders J, Myers K, Simmons R, Everett B, Gawron L, Turok D. Changing lives, dynamic plans? 12-month shifts in pregnancy intentions. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kozlowski Z, Gawron L, Sanders J, Panushka K, Myers K, Turok D. “I’m poor so I’ll take what I can get”: contraceptive preferences and needs among women with housing insecurity or homelessness. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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