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Morris G, Evans S, Stevenson J, Kotecha A, Parry M, Jeys L, Grimer R. Bone metastases of the hand. Ann R Coll Surg Engl 2017; 99:563-567. [PMID: 28853594 DOI: 10.1308/rcsann.2017.0096] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction The aim of this study was to identify patients with malignant hand lesions, establish the proportions of those that were metastases and review their clinical course. Methods A retrospective search of a prospective tumour database was carried out to identify all patients treated at our unit with hand metastases. Patient demographics were recorded including site of primary malignancy, region of the hand involved, management of their metastasis and clinical outcome. Results Overall, 149 patients were identified with a malignant tumour of the hand. Ten had a metastatic lesion. There were 3 women and 7 men with a median age of 68 years (range: 28-91 years) at presentation. All presented with non-mechanical hand pain while four had pain and swelling. The median interval from symptom onset to diagnosis was eight weeks. The minimum follow-up duration was four months. Three patients had no history of malignancy. Of the remaining seven patients, three had other known metastases. Six patients underwent solely palliative radiotherapy. Three patients had amputation. One was treated with surgical excision and radiotherapy. One had an amputation and axillary node clearance. All but one patient had died by the time of the latest follow-up appointment. The median time to death following identification of acrometastases was 18 months. Sites of primary disease were skin (n=4), lung (n=3), kidney (n=2) and neuroendocrine system (n=1). The thumb was the most commonly affected location. Conclusions This study demonstrates that patients presenting with non-mechanical hand pain should be considered to have a malignant process until proved otherwise, particularly in patients with thumb symptoms and a history of prior malignancy.
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Yang P, Evans S, Bali N, Ramasamy A, Evans R, Stevenson J, Jeys L, Grimer R. Malignant bone tumours of the foot. Ann R Coll Surg Engl 2017; 99:568-572. [PMID: 28853588 DOI: 10.1308/rcsann.2017.0114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Malignant osseous foot tumours are uncommon. Their oncological outcomes have been poorly documented in the literature so far. The aim of this study was to establish the incidence and to evaluate the oncological outcomes of such patients. Methods Our large orthopaedic oncology database was used to review 70 malignant osseous foot tumour patients. Results The age at diagnosis of malignant osseous foot tumours demonstrated a bimodal distribution peaking in the second and eighth decades of life. Overall, 55 primary malignant bone tumours of the foot (79%) were identified. The median duration from onset of symptoms to diagnosis was 52 weeks (interquartile range [IQR]: 17-104). Eight primary tumours (15%) underwent an accidental excision (ie intralesional excision of a malignant bone tumour where some of the tumour has been left behind, also known as a 'whoops procedure') prior to referral to our unit. Forty-six patients (84%) underwent surgery overall and thirteen of these developed recurrence or metastases. Seven of eight patients with a previous accidental excision underwent amputation. Fifteen osseous metastatic foot lesions were identified. The median length of foot symptoms to diagnosis was 24 weeks (IQR: 20-36 weeks). The median time to death following diagnosis of osseous foot metastases was 20.1 months (IQR: 11.3-27.8 months). Conclusions A high index of suspicion and awareness of clinical features of malignant osseous foot tumours are both essential to avoid diagnostic delays. Amputation is associated with a respectable outcome for patients who have undergone previous accidental excisions.
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Evans S, Loring D, Goldstein F, John S. A-11Initial Visit Predictors of Subjective Memory Complaints in Caucasian and African American Older Adults. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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John S, Evans S, Hanfelt J, Loring D, Goldstein F. Diversity-1Subjective Memory Complaints Among Cognitively Normal Caucasian and African American Older Adults Predict Future Diagnostic Conversion: An Examination of Racial Differences in Clinical Presentation at Initial Visit. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx075.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fang X, Bogomolovas J, Zhang W, Wu T, Liu C, Lowe J, Ouyang K, Zhang Z, Ma X, Mu Y, Stroud M, Lao DH, Dalton N, Gu Y, Wang C, Wang M, Liang Y, Lange S, Peterson K, Evans S, Chen J. Abstract 88: A Crucial Role of BAG3 in Preventing Dilated Cardiomyopathy. Circ Res 2017. [DOI: 10.1161/res.121.suppl_1.88] [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: 11/16/2022]
Abstract
Defective protein quality control (PQC) systems are implicated in multiple diseases, with molecular chaperones/co-chaperones being critical to PQC. Cardiomyocytes are constantly challenged by mechanical and metabolic stress, placing great demand on the PQC system. Mutations and downregulation of the co-chaperone protein
B
cl-2-
a
ssociated athano
g
ene 3 (BAG3) are associated with cardiac myopathy and heart failure, and a BAG3 E455K mutation leads to Dilated cardiomyopathy (DCM). However, the role of BAG3 in the heart and mechanisms by which the E455K mutation lead to DCM remained obscure. Here, we found that cardiac-specific BAG3 knockout (CKO) and cardiac-specific E455K BAG3 knockin mice developed DCM. Comparable phenotypes in the two mutants demonstrated that the E455K mutation resulted in loss-of-function, and experiments revealed that the E455K mutation disrupted interaction between BAG3 and HSP70. In both mutants, decreased levels of small heat shock proteins (sHSPs) were observed, and a specific subset of proteins required for metabolic and contractile function of cardiomyocytes was enriched in the insoluble fraction. Together, these observations suggested that interaction between BAG3 and HSP70 was essential for BAG3 to stabilize sHSPs and maintain cardiomyocyte protein homeostasis. Our results provide new insight into the pathogenesis of heart failure caused by defects in BAG3 pathways, suggesting that increasing protein levels of BAG3 may be of therapeutic benefit in heart failure.
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Kudlicka A, Evans S, Pool J, Oyebode J, Woods B, Clare L. GREAT TRIAL: PERSONALISED COGNITIVE REHABILITATION GOALS OF PEOPLE WITH EARLY-STAGE DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3137] [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] Open
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Zhang Q, Huang R, Guo X, Ye Y, Lu J, Zhuang S, Zhang Q, Zhu F, Gong X, Yan J, Geng P, Luo L, Lin L, Chen Y, Zhao X, Evans S, Jiang C, Liang X, Sun Y. The temporal requirements for Isl1 in sympathetic neuron proliferation, differentiation and diversification. Mech Dev 2017. [DOI: 10.1016/j.mod.2017.04.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Darton R, Atkinson T, Bäumker T, Evans S, Netten A. QUALITY OF LIFE OUTCOMES OF HOUSING WITH CARE FOR OLDER PEOPLE IN ENGLAND. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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O’Leary B, Denomme J, Kitchen-Clark T, Contreras J, Li-Wong F, Evans S, Sahota T, Abji T. IDENTIFYING PATIENT DELIRIUM: RELYING ON SCREENING IS NOT ENOUGH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evans S, Brooker D, Droes R, Meiland F, Rymaszewska J, Szczesniak D, Chattat R, Farina E. EVALUATION OF THE MEETING CENTER SUPPORT PROGRAMME FOR PEOPLE WITH DEMENTIA AND THEIR FAMILY CARERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1257] [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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Yang P, Evans S, Khan Z, Abudu A, Jeys L, Grimer R. Reconstruction of the distal tibia following resection of aggressive bone tumours using a custom-made megaprosthesis. J Orthop 2017; 14:406-409. [PMID: 28725124 DOI: 10.1016/j.jor.2017.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/15/2017] [Accepted: 06/21/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Largest, single-centre study of clinical and functional outcomes of patients who underwent endoprosthetic replacement (EPR) for aggressive distal tibial bone tumours. METHOD Retrospective observational study of eight patients was undertaken. RESULTS Median follow-up was 77 months (range 13-276). Cumulative five and ten year survival was 63% and 42% respectively. Three patients developed either disease recurrence or metastases post-surgery. One patient developed deep infection requiring washout and suppressive antibiotics. No patients required revision surgery. The median MSTS score at last follow up was 66%. CONCLUSIONS EPR of the distal tibia is a viable option and provides good function outcomes.
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Marsh H, Evans S. The molecular constituents of the liquid phase which occurs during the carbonization of graphitizing materials. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/196966s1042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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O'Callaghan ME, Raymond E, Campbell J, Vincent AD, Beckmann K, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti K. Tools for predicting patient-reported outcomes in prostate cancer patients undergoing radical prostatectomy: a systematic review of prognostic accuracy and validity. Prostate Cancer Prostatic Dis 2017; 20:378-388. [DOI: 10.1038/pcan.2017.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/20/2017] [Accepted: 03/30/2017] [Indexed: 11/09/2022]
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Hassan N, Speight L, Wilby A, Sayers A, Evans S, Byrne A, Smith A, Ketchell R, Lau D, Duckers J. 406 A survey of nausea and vomiting (N&V) at clinical stability and during IV antibiotics in adult cystic fibrosis patients attending the All Wales Adult CF Centre (AWACFC). J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Evans S, Bae H, Sayers A, Crighton P, Lau D, Ketchell R, Speight L, Duckers J. 375 Staff knowledge at the All Wales Adult CF CENTRE (AWACFC) – do we know what our patients know? J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
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Evans S, Moore L, Jeyarajan H, Cole D, Calhoun D, Withrow K. 0579 HYPOGLOSSAL NERVE STIMULATION: A HIGHLY EFFECTIVE, LOW MORBIDITY ALTERNATIVE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA IN SELECT CPAP-INTOLERANT PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Thiel M, Evans S, Sawdy R. Women's healthcare consultations on operations: a multidisciplinary provider questionnaire. J ROY ARMY MED CORPS 2017; 163:394-396. [PMID: 28400524 DOI: 10.1136/jramc-2016-000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/22/2017] [Accepted: 03/26/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND 30% of UK primary care consultations relate to gynaecology. Servicewomen access healthcare in general more frequently than their NHS counterparts, so military medical professionals are thus more likely to be managing significant numbers of gynaecological conditions on deployed military operations. Little is known about their confidence and preparedness in managing female-specific complaints. This study aimed to assess clinicians' views as to their training and confidence in managing gynaecological conditions; to gauge the need for developing treatment guidelines and specific training opportunities and to establish the frequency and scope of female-specific presentations on a military deployment. METHOD A retrospective questionnaire-based service evaluation of clinical practice was undertaken via an anonymised questionnaire, which was distributed to 44 randomly selected Afghanistan-based UK military medical professionals in May 2014. All clinicians with sick parade duties were eligible for inclusion. RESULTS 23 (57.5%) military medical professionals reported managing one or more gynaecological conditions per month while deployed and 4 (25%) doctors treated more than 5 per month. Of those questioned, 21 (52.5%) felt underprepared to manage gynaecological conditions confidently. Two-thirds would attend a short course on the subject, 13 (32.5%) thought gynaecology should be included in medical predeployment training (PDT) and 26 (65%) wanted management guidelines included within Clinical Guidelines for Operations (CGOs). CONCLUSIONS Military medical professionals treat servicewomen with gynaecological problems on deployment. Half of the medical professionals questioned felt they had insufficient training and experience to do so confidently. Training packages, as part of PDT or stand alone, were reported as acceptable methods of improving confidence and knowledge. The common gynaecological acute presentations were suggested as topics to be included in CGOs.
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Dröes RM, Meiland FJM, Evans S, Brooker D, Farina E, Szcześniak D, Van Mierlo LD, Orrell M, Rymaszewska J, Chattat R. Comparison of the adaptive implementation and evaluation of the Meeting Centers Support Program for people with dementia and their family carers in Europe; study protocol of the MEETINGDEM project. BMC Geriatr 2017; 17:79. [PMID: 28376895 PMCID: PMC5381019 DOI: 10.1186/s12877-017-0472-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 11/17/2022] Open
Abstract
Background The MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations. Methods The project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19‑36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process. Discussion An overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond. Trial registration The trial was retrospectively registered in May 2016: trial number: NTR5936.
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Daly A, Evans S, Ashmore C, Chahal S, Santra S, MacDonald A. The challenge of nutritional profiling of a protein-free feed module for children on low protein tube feeds with organic acidaemias. J Hum Nutr Diet 2017; 30:292-301. [PMID: 28294445 DOI: 10.1111/jhn.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enteral tube feeding for children with organic acidaemias (OA) is recommended. Protein restriction, providing minimum safe levels of protein intake, is advocated. Standard paediatric tube feeding formulae provide more than the minimum safe protein requirements and are unsuitable in OA without modification. Modified paediatric enteral feeds consist of several modular ingredients. The aim of this prospective longitudinal interventional study was to assess the efficacy of a premeasured novel protein-free module developed for children aged over 12 months compared to conventional practice. METHODS In total, 15 children with OA (11.6-31 kg) needing enteral feeding were recruited. The protein-free module, from either a protein-free infant feed or modular ingredients, was replaced by the study feed. To ensure metabolic stability, energy and protein intake were unchanged. Dietary intake, anthropometry and nutritional biochemistry were recorded at baseline and week 26. RESULTS Dietary intakes of magnesium (P = 0.02), sodium (P = 0.005), vitamin D (P = 0.04), docosahexaenoic acid (P = 0.01) and arachidonic acid (P = 0.001) significantly improved; plasma selenium (P = 0.002) and whole blood glutathione peroxidase (P = 0.02) significantly increased. Feed preparation accuracy as measured by composition analysis showed consistent errors both in pre- and study feeds. CONCLUSIONS A protein-free module improved nutritional intake and biochemistry, although feed preparation errors remained a common finding.
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Pinto A, Daly A, Evans S, Almeida MF, Assoun M, Belanger-Quintana A, Bernabei S, Bollhalder S, Cassiman D, Champion H, Chan H, Dalmau J, de Boer F, de Laet C, de Meyer A, Desloovere A, Dianin A, Dixon M, Dokoupil K, Dubois S, Eyskens F, Faria A, Fasan I, Favre E, Feillet F, Fekete A, Gallo G, Gingell C, Gribben J, Kaalund-Hansen K, Horst N, Jankowski C, Janssen-Regelink R, Jones I, Jouault C, Kahrs GE, Kok IL, Kowalik A, Laguerre C, Le Verge S, Lilje R, Maddalon C, Mayr D, Meyer U, Micciche A, Robert M, Rocha JC, Rogozinski H, Rohde C, Ross K, Saruggia I, Schlune A, Singleton K, Sjoqvist E, Stolen LH, Terry A, Timmer C, Tomlinson L, Tooke A, Vande Kerckhove K, van Dam E, van den Hurk T, van der Ploeg L, van Driessche M, van Rijn M, van Teeffelen-Heithoff A, van Wegberg A, Vasconcelos C, Vestergaard H, Vitoria I, Webster D, White FJ, White L, Zweers H, MacDonald A. Dietary practices in isovaleric acidemia: A European survey. Mol Genet Metab Rep 2017; 12:16-22. [PMID: 28275552 PMCID: PMC5328917 DOI: 10.1016/j.ymgmr.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background In Europe, dietary management of isovaleric acidemia (IVA) may vary widely. There is limited collective information about dietetic management. Aim To describe European practice regarding the dietary management of IVA, prior to the availability of the E-IMD IVA guidelines (E-IMD 2014). Methods A cross-sectional questionnaire was sent to all European dietitians who were either members of the Society for the Study of Inborn Errors of Metabolism Dietitians Group (SSIEM-DG) or whom had responded to previous questionnaires on dietetic practice (n = 53). The questionnaire comprised 27 questions about the dietary management of IVA. Results Information on 140 patients with IVA from 39 centres was reported. 133 patients (38 centres) were given a protein restricted diet. Leucine-free amino acid supplements (LFAA) were routinely used to supplement protein intake in 58% of centres. The median total protein intake prescribed achieved the WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Centres that prescribed LFAA had lower natural protein intakes in most age groups except 1 to 10 y. In contrast, when centres were not using LFAA, the median natural protein intake met WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Enteral tube feeding was rarely prescribed. Conclusions This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.
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Daly A, Evans S, Chahal S, Santra S, MacDonald A. Glycomacropeptide in children with phenylketonuria: does its phenylalanine content affect blood phenylalanine control? J Hum Nutr Diet 2017; 30:515-523. [PMID: 28111827 DOI: 10.1111/jhn.12438] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In phenylketonuria (PKU), there are no data available for children with respect to evaluating casein glycomacropeptide (CGMP) as an alternative to phenylalanine-free protein substitutes [Phe-free L-amino acid (AA)]. CGMP contains a residual amount of phenylalanine, which may alter blood phenylalanine control. METHODS In a prospective 6-month pilot study, we investigated the effect on blood phenylalanine control of CGMP-amino acid (CGMP-AA) protein substitute in 22 PKU subjects (13 boys, nine girls), median age (range) 11 years (6-16 years). Twelve received CGMP-AA and nine received Phe-free L-AA, (1 CGMP-AA withdrawal). Subjects partially or wholly replaced Phe-free L-AA with CGMP-AA. If blood phenylalanine exceeded the target range, the CGMP-AA dose was reduced and replaced with Phe-free L-amino acids. The control group remained on Phe-free L-AAs. Phenylalanine, tyrosine and Phe : Tyr ratio concentrations were compared with the results for the previous year. RESULTS In the CGMP-AA group, there was a significant increase in blood phenylalanine concentrations (pre-study, 275 μmol L-1 ; CGMP-AA, 317 μmol L-1 ; P = 0.02), a decrease in tyrosine concentrations (pre-study, 50 μmol L-1 ; CGMP-AA, 40 μmol L-1 ; P = 0.03) and an increase in Phe : Tyr ratios (pre-study, Phe : Tyr 4.9:1; CGMP-AA, Phe : Tyr 8:1; P = 0.02). In the control group there was a non-significant fall in phenylalanine concentrations (pre-study 325μmol/L: study 280μmol/L [p = 0.9], and no significant changes for tyrosine or phe/tyr ratios [p = 0.9]. Children taking the CGMP-AA found it more acceptable to L-AA. CONCLUSIONS Blood phenylalanine control declined with CGMP-AA but, by titrating the dose of CGMP-AA, blood phenylalanine control remained within target range. The additional intake of phenylalanine may have contributed to the change in blood phenylalanine concentration. CGMP-AA use requires careful monitoring in children.
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Corless D, Ellis M, Dawson E, Fraser F, Evans S, Perry JD, Silver CP, Reisner C, Beer M, Boucher BJ, Cohen RD. Using Activities of Daily Living Assessments to Measure the Effectiveness of Vitamin D Supplements in Elderly Long-Stay Patients. Br J Occup Ther 2016. [DOI: 10.1177/030802268705000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selected activities of daily living were used to measure improvement in independence of long-stay elderly patients known to have low concentrations of plasma 25-hydroxyvitamin D. This was a double-blind random controlled trial lasting between 8 and 40 weeks. No significant changes were found in either group.
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Narayan A, Evans S, Sheeder J, Guiahi M. Does the expectation of pain with intrauterine device (IUD) insertion differ between those who initiate IUD and those who do not? A survey of adolescents and young adult women. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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