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Lama IY, Cheung LK, James A, Saghir M, Herd F, Greenhowe J. Ecthyma gangrenosum: A case report in a child with acute lymphoblastic leukaemia. JPRAS Open 2024; 40:215-221. [PMID: 38681531 PMCID: PMC11047190 DOI: 10.1016/j.jpra.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/18/2024] [Indexed: 05/01/2024] Open
Abstract
Aim We present a case of Ecthyma gangrenosum (EG) affecting left thigh in a child with acute lymphoblastic leukaemia (ALL) with an aim to raise awareness about this condition. Case presentation A 7-year-old female child who presented with lethargy, pallor and lumps to inner lip was diagnosed with B-cell precursor ALL. She was started on treatment as per UKALL 2011 guidelines Regime B. On day 28, she developed neutropenic sepsis along with a new lesion in her left thigh. She was started on intravenous Meropenum, Gentamicin and Caspofungin. The clinical diagnosis of EG was made based on lesion progression, positive blood and wound swab & tissue cultures for Pseudomonas aeruginosa and patient's immunocompromised status. The wound healed with secondary intention following debridement. We present a series of photographs to demonstrate her remarkable improvement. Discussion EG occurs in 1-30% of cases of Pseudomonas sepsis; other bacteria and fungi can be associated with this condition. It is identified more in oncology patients as seen in our patient. A multidisciplinary team approach should be provided in 3 stages with empirical antibiotics, followed by targeted antibiotics or antifungals & surgical debridement. Our patient was treated in similar fashion and made a good recovery. Conclusion It is a rare skin condition associated with a high mortality. We suggest all clinicians to be vigilant about this condition to be able to provide accurate diagnosis and prompt treatment to improve the overall prognosis.
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Affiliation(s)
- I Yonjan Lama
- Royal Aberdeen Children's Hospital, Department of Plastic Surgery, Aberdeen, Scotland, UK
| | - LK Cheung
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - A James
- Aberdeen Royal Infirmary, Department of Plastic surgery, Aberdeen, Scotland, UK
| | - M Saghir
- Aberdeen Royal Infirmary, Department of Plastic surgery, Aberdeen, Scotland, UK
| | - F Herd
- Royal Aberdeen Children's Hospital, Department of Oncology, Aberdeen, Scotland, UK
| | - J Greenhowe
- Royal Aberdeen Children's Hospital, Department of Plastic Surgery, Aberdeen, Scotland, UK
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Thapa A, Cowell A, Peters A, Noble DJ, James A, Lamb C, Grose D, Vohra S, Schipani S, Mactier K, Mackenzie J, Srinivasan D, Laws K, Moleron R, Niblock P, Soh FY, Paterson C, Wilson C. The UK Divide: Does Having a Pembrolizumab-Chemotherapy Option in Head and Neck Cancer Matter? Real-world Experience of First-line Palliative Pembrolizumab Monotherapy and Pembrolizumab-Chemotherapy Combination in Scotland. Clin Oncol (R Coll Radiol) 2024; 36:287-299. [PMID: 38395634 DOI: 10.1016/j.clon.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
AIMS The Scottish Medical Consortium recently approved first-line pembrolizumab monotherapy or in combination with chemotherapy for head and neck squamous cell carcinoma in the palliative setting, contrasting with the decision made by the National Institute for Health and Care Excellence, who approved monotherapy alone in England and Wales. The aim of this study was to provide real-world performance data for first-line pembrolizumab-containing treatments for head and neck squamous cell carcinoma in the palliative setting in Scotland. MATERIALS AND METHODS We analysed the electronic records of patients who started pembrolizumab-containing treatment between 1 March 2020 and 30 September 2021. Outcomes included overall survival, progression-free survival (PFS), the duration of response and the disease control rate. Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival. RESULTS Our cohort included 91 patients (median follow-up 10.8 months). Patient characteristics were similar to those in the KEYNOTE-048 study, although our cohort had a higher proportion of patients with newly diagnosed, non-metastatic disease. For patients receiving monotherapy (n = 76), 12- and 24-month overall survival were 45% and 27%, respectively. For patients receiving pembrolizumab-chemotherapy (n = 15), 12-month overall survival was 60% (24-month overall survival had not yet been reached). Experiencing one or more immune-related adverse event (irAE; versus no irAEs), of any grade, was associated with favourable overall survival and PFS for patients receiving monotherapy in both univariable Log-rank analysis (median overall survival 17.4 months versus 8.6 months, respectively, P = 0.0033; median PFS 10.9 months versus 3.0 months, respectively, P < 0.0001) and multivariable analysis (Cox proportional hazards regression: overall survival hazard ratio 0.31, P = 0.0009; PFS hazard ratio 0.17, P < 0.0001). CONCLUSION Our real-world data support the KEYNOTE-048 study findings and the value of combination treatment options. Additionally, our data show that irAEs of any grade, as reported in routine clinical records, are associated with better outcomes in this patient group, adding to the growing body of evidence showing that irAEs are generally a positive marker of programmed death-ligand 1 (PD-L1) inhibitor response.
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Affiliation(s)
- A Thapa
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - A Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Peters
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D J Noble
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK; Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - A James
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Vohra
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - K Mactier
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - J Mackenzie
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - D Srinivasan
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - K Laws
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Moleron
- Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - F-Y Soh
- Raigmore Hospital, Inverness, UK
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - C Wilson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Casetta C, Santosh P, Bayley R, Bisson J, Byford S, Dixon C, Drake RJ, Elvins R, Emsley R, Fung N, Hayes D, Howes O, James A, James K, Jones R, Killaspy H, Lennox B, Marchant L, McGuire P, Oloyede E, Rogdaki M, Upthegrove R, Walters J, Egerton A, MacCabe JH. CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings. BMC Psychiatry 2024; 24:122. [PMID: 38355533 PMCID: PMC10865566 DOI: 10.1186/s12888-023-05397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.
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Affiliation(s)
- C Casetta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - P Santosh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Bayley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Dixon
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - R J Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Fung
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | - O Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - K James
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Jones
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Killaspy
- Division of Psychiatry, University College London, London, UK
| | - B Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L Marchant
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Rogdaki
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - J Walters
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - A Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Dalal J, Mitra S, James A, Rivas Velarde M. Links across disabilities: unveiling associations between functional domains. BMC Public Health 2024; 24:41. [PMID: 38166865 PMCID: PMC10763216 DOI: 10.1186/s12889-023-17523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Persons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries. METHODS National census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups ('18-44' years and '45+' years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted. FINDINGS For all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - '18-44' years and '45+' years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains. CONCLUSIONS There are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.
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Affiliation(s)
- J Dalal
- Geneva School of Health Science, University of Applied Sciences Geneva HES-SO, Geneva, Switzerland.
| | - S Mitra
- Department of Economics, Fordham University, Bronx, USA
| | - A James
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Rivas Velarde
- Geneva School of Health Science, University of Applied Sciences Geneva HES-SO, Geneva, Switzerland
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Conway-Jones R, James A, Goldacre MJ, Seminog OO. Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021. Int J Eat Disord 2024; 57:162-172. [PMID: 37949682 DOI: 10.1002/eat.24091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population. METHOD A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. RESULTS We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH. DISCUSSION Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. PUBLIC SIGNIFICANCE This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.
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Affiliation(s)
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - M J Goldacre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - O O Seminog
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Zhou S, Chan C, Lau YC, Rulach R, Dyab H, Hendry F, Wilson C, Schipani S, Lamb C, Grose D, James A, Maxfield C, Dempsey MF, Paterson C. The Effects of Human Papillomavirus Status and Treatment on the Positive Predictive Value of Post-radiotherapy 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Advanced Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2023; 35:e699-e707. [PMID: 37798198 DOI: 10.1016/j.clon.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/03/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
AIMS The high negative predictive value of post-chemoradiation (CRT) positron emission tomography-computed tomography (PET-CT) is well established in head and neck squamous cell cancers (HNSCC). The positive predictive value (PPV) remains under scrutiny, with increasing evidence that it is affected by several factors. The aim of this study was to assess the PPV of post-treatment PET-CT for residual nodal disease when stratified by treatment modality and tumour human papillomavirus (HPV) status. MATERIALS AND METHODS This was a retrospective cohort study in a tertiary oncology centre carried out between January 2013 and December 2019. Patients were radically treated with radiotherapy only/CRT for node-positive HNSCC. PET-CT nodal responses were categorised as complete, equivocal (EQR) or incomplete (ICR), and outcomes extracted from electronic records. RESULTS In total, 480 patients were evaluated, all had a minimum potential follow-up of 2 years, with a median of 39.2 months. The PPV of 12-week PET-CT was significantly different between HPV-positive (22.5%) and HPV-unrelated (52.7%) disease, P < 0.001. It was also significantly different between the CRT (24.8%) and radiotherapy-only (51.1%) groups, P = 0.001. The PPV of an EQR was significantly less than an ICR, irrespective of HPV status and primary treatment modality. In HPV-positive disease, the PPV of an EQR was 9.0% for the CRT group compared with 21.4% for radiotherapy only, P = 0.278. The PPV in those who achieved an ICR was 34.2% in the CRT group, significantly lower than 70.0% in the radiotherapy-only group, P = 0.03. CONCLUSION The PPV of 12-week PET-CT is significantly lower for HPV-positive compared with HPV-unrelated HNSCC. It is poorer in patients with HPV-positive disease treated with CRT compared with radiotherapy alone.
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Affiliation(s)
- S Zhou
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Chan
- University Hospital Ayr, Ayr, UK
| | - Y C Lau
- Royal Alexandra Hospital, Glasgow, UK
| | - R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Dyab
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - F Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Grose
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Maxfield
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - M-F Dempsey
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - C Paterson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Foley P, Gebauer K, Sullivan J, McMeniman E, Shumack S, Ng J, James A, Rawlin M, Sidhu S, Tilakaratne D, Turner M, Radulski B, Nash P, Baker C. Australian consensus: Treatment goals for moderate to severe psoriasis in the era of targeted therapies - Adult patients. Australas J Dermatol 2023; 64:476-487. [PMID: 37501636 DOI: 10.1111/ajd.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis. METHODS A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree). RESULTS Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy. CONCLUSION The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care.
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Affiliation(s)
- Peter Foley
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kurt Gebauer
- Fremantle Dermatology, Fremantle, Western Australia, Australia
- The University of Western Australia, Nedlands, Western Australia, Australia
| | - John Sullivan
- Kareena Private Hospital, Ramsay Surgical Centre, Miranda, New South Wales, Australia
- Kingsway Dermatology & Aesthetics, Miranda, New South Wales, Australia
| | - Erin McMeniman
- Dermatology Research Centre, Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan Ng
- Hobart Medical Specialists, Hobart, Tasmania, Australia
| | - Amelia James
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Morton Rawlin
- General Practitioner, Lower Templestowe, Victoria, Australia
| | - Shireen Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dev Tilakaratne
- Department of Dermatology, Royal Darwin Hospital, Tiwi, Northwest Territories, Australia
- Darwin Dermatology, Tiwi, Northwest Territories, Australia
| | | | - Barbara Radulski
- CNC Dermatology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter Nash
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Rheumatology Research Unit, Sunshine Coast, Queensland, Australia
| | - Christopher Baker
- Skin Health Institute, Carlton, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Zhu K, Hunter M, James A, Lim EM, Walsh JP. Relationships between longitudinal changes in body composition and bone mineral density in middle-to-older aged Australians. Osteoporos Int 2023; 34:1601-1611. [PMID: 37233793 PMCID: PMC10427547 DOI: 10.1007/s00198-023-06773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023]
Abstract
There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD). In 3671 participants aged 46-70 years at baseline, ∆lean mass was a stronger determinant than ∆fat mass of ∆BMD over 6 years. Maintained or increased lean mass may slow down age-related bone loss. PURPOSE There are limited longitudinal data regarding relationships between changes in body composition and bone mineral density (BMD) with ageing. We examined these in the Busselton Healthy Ageing Study. METHODS We studied 3671 participants (2019 females) aged 46-70 years at baseline with body composition and BMD assessments by dual-energy x-ray absorptiometry at baseline and after ~6 years. Relationships between changes in total body mass (∆TM), lean mass (∆LM) and fat mass (∆FM) with ∆BMD at total hip, femoral neck and lumbar spine were evaluated using restricted cubic spline modelling (accounting for baseline covariates) and mid-quartile least square means were compared. RESULTS ∆TM was positively associated with ∆BMD of total hip and femoral neck in both sexes, and spine in females; in females but not males, associations plateaued at ∆TM above ~5kg for all sites. In females, ∆LM was positively associated with ∆BMD of all three sites with plateauing of the relationship at ∆LM above ~1kg. Women in the highest quartile of ∆LM (Q4, mid-quartile value +1.6 kg) had 0.019-0.028 g/cm2 less reduction in BMD than those in the lowest quartile (Q1, -2.1 kg). In males, ∆LM was positively associated with ∆BMD of total hip and femoral neck; men in Q4 (+1.6 kg) had 0.015 and 0.011 g/cm2 less bone loss, respectively, compared with Q1 (-2.7 kg). ∆FM was positively associated with ∆BMD of total hip only in both sexes. CONCLUSION ∆LM is a stronger determinant than ∆FM of ∆BMD. Maintained or increased LM is associated with less age-related bone loss.
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Affiliation(s)
- K Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia.
- Medical School, University of Western Australia, Crawley, WA, Australia.
| | - M Hunter
- Busselton Population Medical Research Institute, Busselton, WA, Australia
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - A James
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - E M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - J P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
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James A, Kroll A, Minier C. Towards a better consideration of endocrine disruption within the technical guidance for deriving environmental quality standards. Regul Toxicol Pharmacol 2023; 143:105457. [PMID: 37451331 DOI: 10.1016/j.yrtph.2023.105457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Endocrine-disrupting chemicals (EDCs) are a reason for growing concern because of their substantial and long-lasting deleterious effects on human health and wildlife populations. These include direct effects on aquatic organisms and may be a concern to species feeding on the aquatic food chains and water, including humans. In the European Community, the dedicated legislative tools to protect the aquatic environment and human health from contaminants released to surface waters is the Water Framework Directive (WFD). The achievement of protection goals is assessed through the comparison of concentrations measured in the media and thresholds of no effect called Environmental Quality Standards (EQSs). As EDCs are explicitly mentioned in the WFD, an analysis of the state of the art was undertaken on how far and how consistently ED properties were considered in the derivation of EQS values. Our results reveal substantial heterogeneity according to substance and that among substances with ED evidences, EQSs have been derived without considering ED properties for 70% of them. A methodology to better consider endocrine disrupting properties is proposed and includes a logical and systematic approach to derive EQSs with a proposal to specify additional assessment factors based on the specific hazard and potential uncertainty.
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Affiliation(s)
- A James
- INERIS, Parc ALATA, BP2, 60550, Verneuil-en-Halatte, France.
| | - A Kroll
- Oekotoxzentrum, c/o Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - C Minier
- UMR-I 02 INERIS-URCA-ULHN SEBIO, Normandie University, FR CNRS 3730 Scale, 76063, Le Havre Cedex, France
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Ryan A, Stone RG, Gavin PJ, James A, Walsh M, McMahon CJ. Rheumatic Fever and Rheumatic Heart Disease. Ir Med J 2023; 116:777. [PMID: 37555534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Edland G, Awan S, James A, Keswani A. PERSISTENT ANGIOEDEMA AFTER COVID-19 VACCINATION: IS BRADYKININ TO BLAME? Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Williams R, Donald R, James A, Schiavone E, Hughes D, Wong A. Evaluation of a prescribing pharmacist-led heart failure (HF) up-titration clinic. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Pharmacotherapy is considered the cornerstone of treatment for patients with heart failure with reduced ejection fraction (HFrEF). Modulation of the renin-angiotensin-aldosterone (RAAS) and sympathetic nervous system have been shown to improve survival, reduce the risk of heart failure (HF) hospitalisations and improve quality of life. Unless contraindicated or not tolerated, these patients should be prescribed angiotensin-converting enzyme inhibitor (ACEi)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium-glucose co-transporter 2 (SGLT2) inhibitor and up-titrated to guideline directed dosages.1 Despite the availability of effective treatments, patients are often sub-optimally dosed and experience a prolonged optimisation process. Pharmacist-led clinics can complement existing services and increase uptake of guideline directed medical therapies (GDMT).
Purpose
To evaluate the effectiveness of pharmacist-led heart failure clinics in the Princess of Wales Hospital, supported by the Heart Failure team, in optimisation of patients with HFrEF.
Methods
Patients who attended HF pharmacist led clinic between November 2020 and November 2021 were included in the analysis. Baseline demographics, left ventricular ejection fraction (LVEF), biomarkers, vital signs and medications were documented at baseline and after optimisation of GDMT. Number of clinics appointments and rate of hospitalisation and mortality were captured during the study period.
Results
76 patients were reviewed over a total of 318 consultations (34% virtual), averaging 4 consultations per patient. The mean age was 71 years, 36% of patients were female, mean LVEF was 32% and NT-proBNP 3078ng/L with 15% of patients on “quadruple therapy” at baseline. 93% of patients were referred by cardiologists and the average time from referral to first appointment was 42 days. Post-optimisation, 67% of patients were receiving “quadruple therapy”, with increased uptake of ACEi/ARB/ARNI, beta-blocker, MRA and SGLT2i from baseline (100%, 77%, 93% and 90% respectively). Mean LVEF increased to 42% and mean NT-proBNP reduced to 1695ng/L. No significant changes in creatinine clearance, blood pressure, heart rate or serum potassium (sK+) were recorded. The hospitalisation rate was 11% for heart failure, 6% for other cardiovascular causes and the mortality rate was 7%.
Conclusions
The pharmacist-led HF clinic demonstrated a high uptake of optimally dosed GDMT and improvements in NT-proBNP and LVEF. Pharmacist-led clinics can enhance the provision of existing heart failure services to improve patient outcomes and heart failure care.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Williams
- Princess of Wales Hospital , Bridgend , United Kingdom
| | - R Donald
- Princess of Wales Hospital , Bridgend , United Kingdom
| | - A James
- Princess of Wales Hospital , Bridgend , United Kingdom
| | - E Schiavone
- Princess of Wales Hospital , Bridgend , United Kingdom
| | - D Hughes
- Princess of Wales Hospital , Bridgend , United Kingdom
| | - A Wong
- Princess of Wales Hospital , Bridgend , United Kingdom
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Khanna D, Volkmann E, Highland K, Allanore Y, Jouneau S, Seibold J, James A, Alves M, Distler O. AB0657 Severity and impact of gastrointestinal symptoms in patients with SSc-ILD treated with nintedanib: data from SENSCIS-ON. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGastrointestinal (GI) involvement is a common manifestation of systemic sclerosis (SSc) and a frequent side-effect of drugs used to treat SSc. In the SENSCIS trial, nintedanib reduced the rate of decline in forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (SSc-ILD), with an adverse event profile characterised predominantly by GI events.ObjectivesTo assess the severity and impact of GI symptoms on quality of life in patients treated with nintedanib in the open-label extension trial, SENSCIS-ON.MethodsPatients with SSc-ILD who completed the SENSCIS trial or a drug–drug interaction (DDI) study of nintedanib and oral contraceptive were eligible to enter SENSCIS-ON. Patients who received nintedanib in SENSCIS (up to 100 weeks) and continued nintedanib in SENSCIS-ON comprised the “continued nintedanib” group. Patients who received placebo in SENSCIS and initiated nintedanib in SENSCIS-ON, or who received nintedanib for a short time in the DDI study, comprised the “initiated nintedanib” group. We assessed changes in scores on the UCLA Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA SCTC GIT) questionnaire v2.0 from baseline to week 52. This questionnaire comprises 7 scales measuring the severity and impact of GI symptoms: reflux, distension or bloating, faecal soilage, diarrhoea, constipation, emotional well-being, social functioning. Each scale is scored from 0 to 3 except for the diarrhoea scale (0 to 2) and constipation scale (0 to 2.5). The total score, the mean of the scores for the scales except constipation, ranges from 0 to 2.83, with higher scores indicating worse symptoms.ResultsThe “continued nintedanib” group comprised 197 patients and the “initiated nintedanib” group comprised 247 patients (231 from SENSCIS). Of these, 178 and 218 patients, respectively, provided a total UCLA SCTC GIT score at baseline. At baseline, mean (SD) total scores were 0.33 (0.33) and 0.33 (0.34) in the continued nintedanib and initiated nintedanib groups, respectively. Mean (SD) scores on the 7 scales ranged from 0.16 (0.52) to 0.70 (0.73) in the continued nintedanib group and from 0.13 (0.43) to 0.64 (0.68) in the initiated nintedanib group. Increases (worsening) in scores were observed in both groups from baseline to week 52, except for on the constipation scale (Figure 1). Based on the total score, between baseline and week 52, the proportion of patients with moderate or severe or very severe GI symptoms increased, but 45.7% and 39.7% of patients in the continued nintedanib and initiated nintedanib groups, respectively, had no or mild GI symptoms at week 52 (Table 1).Table 1.Changes in severity and impact of gastrointestinal symptoms based on UCLA SCTC GIT total score between baseline and week 52 of SENSCIS-ONBaselineWeek 52None or mildModerateSevere or very severeMissingTotalContinued nintedanibNone or mild81 (41.1)5 (2.5)04 (2.0)90 (45.7)Moderate38 (19.3)10 (5.1)01 (0.5)49 (24.9)Severe or very severe13 (6.6)14 (7.1)7 (3.6)1 (0.5)35 (17.8)Missing6 (3.0)3 (1.5)1 (0.5)13 (6.6)23 (11.7)Total138 (70.1)32 (16.2)8 (4.1)19 (9.6)197 (100)Initiated nintedanibNone or mild87 (35.2)6 (2.4)1 (0.4)4 (1.6)98 (39.7)Moderate35 (14.2)12 (4.9)2 (0.8)3 (1.2)52 (21.1)Severe or very severe8 (3.2)7 (2.8)4 (1.6)1 (0.4)20 (8.1)Missing37 (15.0)15 (6.1)4 (1.6)21 (8.5)77 (31.2)Total167 (67.6)40 (16.2)11 (4.5)29 (11.7)247 (100)Data are n (%) of patients. None or mild=scores of 0 to 0.49; moderate=scores of 0.5 to 1; severe or very severe=scores of 1.01 to 3.Figure 1.Changes in UCLA SCTC GIT scores from baseline to week 52 of SENSCIS-ONConclusionIn the SENSCIS-ON trial, the majority of patients with SSc-ILD treated with nintedanib had no or mild GI symptoms at baseline. A small worsening in GI symptoms was observed over 52 weeks. Diarrhoea had the greatest impact, reflecting the adverse event profile of nintedanib. Recommendations for the management of diarrhoea in patients treated with nintedanib should be implemented in clinical practice.AcknowledgementsThe SENSCIS-ON trial was funded by Boehringer Ingelheim.Disclosure of InterestsDinesh Khanna Shareholder of: Eicos Sciences, Inc - stocks, Consultant of: AbbVie, Acceleron, Actelion, Amgen, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos NV, Genentech/Roche, Gilead, GlaxoSmithKline, Horizon Therapeutics, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Sanofi-Aventis, United Therapeutics, Prometheus, Theraly, AstraZeneca, Grant/research support from: Bayer, Bristol-Myers Squibb, Horizon Therapeutics, Immune Tolerance Network, National Institutes of Health, Pfizer, Employee of: CiviBioPharma/Eicos Sciences, Inc - Leadership/Equity position – Chief Medical Officer, Elizabeth Volkmann Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, Corbus, Forbius, Horizon, Kadmon, Kristin Highland Speakers bureau: Actelion Pharmaceuticals (Jansen), Bayer Healthcare, Boehringer Ingelheim, United Therapeutics, Paid instructor for: Acceleron Pharmaceuticals, Actelion Pharmaceuticals, Bayer Healthcare, Boehringer Ingelheim, Gilead Sciences, United Therapeutics, Consultant of: Boehringer Ingelheim, United Therapeutics, Genentech, Forsee Pharmaceuticals, Grant/research support from: Acceleron Pharmaceuticals, Actelion Pharmaceuticals, Bayer Healthcare, Boehringer Ingelheim, Genentech, Gossamer Bio, Eiger Pharmaceuticlas, Lilly Pharmaceuticals, Reata Pharmaceuticals, United Therapeutics, Viela Bio (Horizon Pharmaceuticals), Yannick Allanore Consultant of: Abbvie, AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Medsenic, Mylan, Prometheus, Roche, Sanofi, Grant/research support from: Alpine Immunosciences, Medsenic, OSE Immunotherapeutics, Stéphane Jouneau Paid instructor for: Cours, formations - Actelion, AIRB, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, LVL, Mundipharma, Novartis, Pfizer, Roche, Consultant of: Advisory Boards, consultancy - AIRB, Boehringer Ingelheim, Roche, Grant/research support from: Recherche Clinique - AIRB, Biogen, Bristol-Myers Squibb, Boehringer Ingelheim, Galactic, Gilead, LVL, Roche, SavaraAides pour des recherches - AIRB, Boehringer Ingelheim, LVL, Novartis, Roche, James Seibold Shareholder of: Prometheus Biosciences, Speakers bureau: Boehringer Ingelheim, Consultant of: Alexion, Blade, Camurus AB, GlaxoSmithKline, Prometheus Biosciences, Sironax, Sojournix, Xenikos, Employee of: Prometheus Biosciences, Alexandra James Employee of: Alexandra James is an employee of Elderbrook solutions GmbH that is contracted by Boehringer Ingelheim, Margarida Alves Employee of: Margarida Alves is an employee of Boehringer Ingelheim, Oliver Distler Speakers bureau: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Speaker fee: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Consultancy fee: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and TopadurOD has/had relationships with the following companies in the area of potential treatments for arthritides in the last three calendar years:Consultancy fee: Abbvie, Grant/research support from: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Research Grants: Boehringer Ingelheim, Kymera, Mitsubishi Tanabe
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Baker C, James A, Supranowicz M, Spelman L, Shumack S, Cole J, Weightman W, Sinclair R, Foley P. Method of Assessing Skin Cancerization and Keratoses TM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization. Clin Exp Dermatol 2022; 47:1144-1153. [PMID: 35150158 PMCID: PMC9313559 DOI: 10.1111/ced.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A range of 'field-directed' treatments is available for the management of extensive skin field cancerization (ESFC), but to date, the only validated objective quantitative tools are limited to assessment of actinic keratoses (AKs) affecting the head. AIMS To develop a versatile quantitative instrument for objective clinical assessment of ESFC and perform initial internal validation across multiple anatomical zones. METHODS The study comprised instrument development, pilot testing and instrument refinement and two rounds of reliability and inter-rater validation testing. The study was noninterventional and used a convenience sample of de-identified patient photographs selected based on preset criteria. An expert panel developed the instrument and scoring system via a modified Delphi voting process. A sample of 16 healthcare professionals from multiple specialties undertook the pilot testing, and a panel of seven dermatologists were involved in validation testing. Validation was determined by assessment of overall inter-rater agreement using Gwet chance-corrected agreement coefficients (ACs). RESULTS The instrument produced, called the Method for Assessing Skin Cancer and Keratoses™ (MASCK™), comprises the Skin Field Cancerization Index (SFCIndex), derived from area of skin involvement and AKs (number and thickness), a global assessment score and a cancer-in-zone score, and uses Likert scales for quantitative scoring. The SFCIndex is a composite score comprising the number and thickness of AKs multiplied by area of skin involvement. ACs for the SFCIndex components, the overall SFCIndex score and the global assessment score were > 0.80 (rated 'almost perfect') while the AC for the cancer-in-zone metric was lower (0.33, rated 'fair'). Internal consistency was demonstrated via positive correlation between the overall SFCIndex score and the global assessment score. CONCLUSIONS Our study found near-perfect agreement in inter-rater reliability when using MASCK to assess the severity of ESFC in multiple anatomical sites. Further validation of this novel instrument is planned to specifically assess its reliability, utility and feasibility in clinical practice.
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Affiliation(s)
- Christopher Baker
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia
| | - Amelia James
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia
| | | | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNSWAustralia
| | - Judith Cole
- Department of DermatologySt John of God HospitalSubiacoWAAustralia
| | - Warren Weightman
- Department of Dermatology Queen Elizabeth HospitalWoodvilleSAAustralia
| | | | - Peter Foley
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia,Probity Medical ResearchSkin Health InstituteMelbourneVic.Australia
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Allanore Y, Khanna D, Smith V, Aringer M, Hoffmann-Vold AM, Kuwana M, Merkel PA, James A, Sambevski S, Alves M, Denton CP. POS0070 CONTINUED TREATMENT WITH NINTEDANIB IN PATIENTS WITH LIMITED CUTANEOUS SYSTEMIC SCLEROSIS (lcSSc) AND INTERSTITIAL LUNG DISEASE (ILD). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFew data are available on the progression and management of ILD, or the management of adverse events associated with drug treatment, in patients with lcSSc. SENSCIS-ON is an open-label extension trial that is collecting data on decline in forced vital capacity (FVC) and adverse events in patients treated with nintedanib over the long term.ObjectivesTo assess decline in FVC and adverse events in patients with lcSSc and ILD treated with nintedanib in SENSCIS-ON.MethodsPatients with SSc-ILD were eligible to enter SENSCIS-ON if they completed the randomized placebo-controlled SENSCIS trial (in which patients received trial drug until the last patient reached week 52 but for ≤100 weeks) or a drug–drug interaction (DDI) study of nintedanib and oral contraceptive (in which female patients received nintedanib for ≤28 days). Among patients with lcSSc, we analysed changes from baseline in FVC and adverse events over 52 weeks of SENSCIS-ON in patients who received nintedanib in SENSCIS and continued it in SENSCIS-ON (“continued nintedanib” group) and in patients who received placebo in SENSCIS and initiated nintedanib in SENSCIS-ON or who received nintedanib for a short time in the DDI study (“initiated nintedanib” group). Analyses were descriptive.ResultsThere were 98 patients with lcSSc in the continued nintedanib group and 127 patients with lcSSc (114 from SENSCIS, 13 from the DDI study) in the initiated nintedanib group. In these groups, respectively, mean (SD) FVC values at inclusion in SENSCIS-ON were 2449 (662) mL and 72.7(16.7) % predicted and 2508 (771) mL and 74.1 (17.4) % predicted. Mean (SE) changes in FVC from baseline to week 52 of SENSCIS-ON were −45.1 (19.1) mL in the continued nintedanib group, −41.5 (24.0) mL in the initiated nintedanib group, and −43.3 (15.3) mL in all patients with lcSSc, similar to the change in FVC in patients with lcSSc at week 52 of the SENSCIS trial (−39.1 [22.2] mL). The adverse event profile of nintedanib in SENSCIS-ON was consistent with that reported over 52 weeks of the SENSCIS trial (Table 1). Over 52 weeks, adverse events led to discontinuation of nintedanib in 3.1% of patients with lcSSc who continued nintedanib in SENSCIS-ON and 16.5% who initiated nintedanib in SENSCIS-ON.Table 1.Adverse events (irrespective of causality) reported over 52 weeks in patients with lcSSc and ILD in SENSCIS and SENSCIS-ON.SENSCISSENSCIS-ONNintedanib(n=135)Placebo(n=142)Continued nintedanib(n=98)Initiated nintedanib(n=127)Most frequent adverse events*Diarrhoea104 (77.0)43 (30.3)70 (71.4)89 (70.1)Nausea45 (33.3)20 (14.1)19 (19.4)32 (25.2)Vomiting33 (24.4)16 (11.3)15 (15.3)31 (24.4)Nasopharyngitis21 (15.6)29 (20.4)18 (18.4)23 (18.1)Upper respiratory tract infection18 (13.3)19 (13.4)13 (13.3)18 (14.2)Skin ulcer11 (8.1)18 (12.7)11 (11.2)14 (11.0)Cough17 (12.6)25 (17.6)13 (13.3)8 (6.3)Adverse event(s) leading to permanent treatment discontinuation25 (18.5)12 (8.5)3 (3.1)21 (16.5)Adverse event(s) leading to dose reduction47 (34.8)5 (3.5)17 (17.3)62 (48.8)Serious adverse event(s)30 (22.2)26 (18.3)22 (22.4)31 (24.4)n (%) of patients with lcSSc with ≥1 such event reported over 52 weeks (or until 28 days after last drug intake if earlier in SENSCIS or until 7 days after last trial drug intake if earlier in SENSCIS-ON). *Adverse events reported in >10% of patients with lcSSc in either group in SENSCIS-ON. Adverse events were coded according to preferred terms in the Medical Dictionary for Regulatory Activities.ConclusionThe change in FVC in patients with lcSSc and ILD who received nintedanib over 52 weeks, and the safety profile of nintedanib, in SENSCIS-ON were similar to that observed in patients with lcSSc and ILD who received nintedanib in SENSCIS. These analyses support a continued effect of nintedanib on slowing decline in FVC and the ability to manage adverse events of nintedanib in patients with lcSSc and ILD over the longer term.AcknowledgementsThe SENSCIS-ON trial was funded by Boehringer Ingelheim.Disclosure of InterestsYannick Allanore Consultant of: Abbvie, AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Medsenic, Mylan, Prometheus, Roche, Sanofi, Grant/research support from: Alpine Immunosciences, Medsenic, OSE immunotherapeutics, Dinesh Khanna Shareholder of: Stocks - Eicos Sciences, Inc., Consultant of: AbbVie, Acceleron, Actelion, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos NV, Genentech/Roche, Gilead, GlaxoSmithKline, Horizon Therapeutics, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Prometheus, Sanofi-Aventis, Theraly, United Therapeutics, Grant/research support from: Bayer, Bristol-Myers Squibb, Horizon Therapeutics, Immune Tolerance Network, National Institutes of Health, Pfizer, Employee of: Leadership/Equity position – Chief Medical Officer - CiviBioPharma/Eicos Sciences, Inc, Vanessa Smith Speakers bureau: Actelion Pharmaceuticals, Boehringer-Ingelheim Pharma GmbH&Co, Janssen-Cilag NV, UCB Biopharma Sprl, Consultant of: Boehringer-Ingelheim Pharma GmbH&Co, Janssen-Cilag NV, Grant/research support from: Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer-Ingelheim Pharma GmbH&Co, Janssen-Cilag NV, Research Foundation - Flanders (FWO), Martin Aringer Speakers bureau: AbbVie, AstraZeneca, Boehringer Ingelheim, BristolMyersSquibb, Chugai, Galapagos, GlaxoSmithKline, Lilly, MSD, Novartis, Otsuka, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Galapagos, GlaxoSmithKline, Lilly, Pfizer, Roche, Sanofi, Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme, Roche, Paid instructor for: Boehringer Ingelheim, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Masataka Kuwana Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, Consultant of: AstraZeneca, Boehringer Ingelheim, Corbus, MochidaKissei, Grant/research support from: Boehringer Ingelheim, MBL, Ono Pharmaceuticals, Peter A Merkel Consultant of: AbbVie, AstraZeneca, Boeringher Ingelheim, Bristol-Myers Squibb, ChemoCentryx, CSL Behring, Dynacure, EMDSerono, Forbius, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, Immagene, InflaRx, Jannsen, Kiniksa, Kyverna, Magenta, MiroBio, Neutrolis, Novartis, Pfizer, Regeneron, Sparrow, Takeda, Talaris, Grant/research support from: AbbVie, AstraZeneca, Boeringher Ingelheim, Bristol-Myers Squibb, ChemoCentryx, Eicos, Forbius, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, InflaRx, Sanofi, Takeda, Alexandra James Employee of: Alexandra James is an employee of Elderbrook solutions GmbH that is contracted by Boehringer Ingelheim, Steven Sambevski Employee of: Steven Sambevski is an employee of Boehringer Ingelheim, Margarida Alves Employee of: Margarida Alves is an employee of Boehringer Ingelheim, Christopher P Denton Speakers bureau: Boehringer Ingelheim, Janssen, Consultant of: Abbvie, Acceleron, Boehringer Ingelheim, Corbus, CSL Behring, GlaxoSmithKline, Roche, Grant/research support from: ARXX Therapeutics, GlaxoSmithKline, Horizon Therapeutics, Servier
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Irwin PGJ, Teanby NA, Fletcher LN, Toledo D, Orton GS, Wong MH, Roman MT, Pérez‐Hoyos S, James A, Dobinson J. Hazy Blue Worlds: A Holistic Aerosol Model for Uranus and Neptune, Including Dark Spots. J Geophys Res Planets 2022; 127:e2022JE007189. [PMID: 35865671 PMCID: PMC9286428 DOI: 10.1029/2022je007189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
We present a reanalysis (using the Minnaert limb-darkening approximation) of visible/near-infrared (0.3-2.5 μm) observations of Uranus and Neptune made by several instruments. We find a common model of the vertical aerosol distribution i.e., consistent with the observed reflectivity spectra of both planets, consisting of: (a) a deep aerosol layer with a base pressure >5-7 bar, assumed to be composed of a mixture of H2S ice and photochemical haze; (b) a layer of photochemical haze/ice, coincident with a layer of high static stability at the methane condensation level at 1-2 bar; and (c) an extended layer of photochemical haze, likely mostly of the same composition as the 1-2-bar layer, extending from this level up through to the stratosphere, where the photochemical haze particles are thought to be produced. For Neptune, we find that we also need to add a thin layer of micron-sized methane ice particles at ∼0.2 bar to explain the enhanced reflection at longer methane-absorbing wavelengths. We suggest that methane condensing onto the haze particles at the base of the 1-2-bar aerosol layer forms ice/haze particles that grow very quickly to large size and immediately "snow out" (as predicted by Carlson et al. (1988), https://doi.org/10.1175/1520-0469(1988)045<2066:CMOTGP>2.0.CO;2), re-evaporating at deeper levels to release their core haze particles to act as condensation nuclei for H2S ice formation. In addition, we find that the spectral characteristics of "dark spots", such as the Voyager-2/ISS Great Dark Spot and the HST/WFC3 NDS-2018, are well modelled by a darkening or possibly clearing of the deep aerosol layer only.
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Affiliation(s)
| | - N. A. Teanby
- School of Earth SciencesUniversity of BristolBristolUK
| | - L. N. Fletcher
- School of Physics & AstronomyUniversity of LeicesterLeicesterUK
| | - D. Toledo
- Instituto Nacional de Técnica Aeroespacial (INTA)MadridSpain
| | - G. S. Orton
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - M. H. Wong
- Center for Integrative Planetary ScienceUniversity of CaliforniaBerkeleyCAUSA
| | - M. T. Roman
- School of Physics & AstronomyUniversity of LeicesterLeicesterUK
| | | | - A. James
- Department of PhysicsUniversity of OxfordOxfordUK
| | - J. Dobinson
- Department of PhysicsUniversity of OxfordOxfordUK
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Hoffmann-Vold AM, Hachulla E, Herrick A, Moua T, Riemekasten G, Vonk M, James A, Alves M, Distler O. POS0854 BASELINE CHARACTERISTICS OF PATIENTS WITH IMPROVEMENT OR PROGRESSION OF SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE (SSc-ILD) DURING THE SENSCIS TRIAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe course of SSc-ILD is variable, and may include periods of stability or even improvement in forced vital capacity (FVC) as well as periods of decline.ObjectivesTo investigate the baseline characteristics of patients with SSc-ILD in the placebo group of the SENSCIS trial whose ILD improved or progressed over 52 weeks.MethodsThe SENSCIS trial enrolled patients with SSc with first non-Raynaud symptom in the prior ≤7 years, extent of fibrotic ILD on high-resolution computed tomography (HRCT) ≥10% and FVC ≥40% predicted. Patients who had been taking a stable dose of mycophenolate for ≥6 months were allowed to participate. We investigated the baseline characteristics of patients in the placebo group whose ILD showed improvement (absolute increase in FVC ≥5% predicted), stability (absolute decline or increase in FVC <5% predicted), progression (absolute decline in FVC ≥5% predicted), or significant progression (absolute decline in FVC ≥10% predicted) over 52 weeks. P-values based on ANOVA or Chi-squared tests were used to compare the baseline characteristics of the patients who showed improvement, stability and progression.ResultsOf 288 patients, 21 (7.3%) showed improvement, 166 (57.6%) stability, and 101 (35.1%) ILD progression, of whom 37 (12.8% of all patients) had significant ILD progression over 52 weeks. Most baseline characteristics were similar across the groups based on progression, but there were differences in DLCO % predicted (p=0.02) and in the proportion of patients taking mycophenolate (p=0.09) among patients who showed improvement, stability and progression (Table 1).Table 1.Baseline characteristics of patients in the placebo group of the SENSCIS trial in subgroups based on course of SSc-ILD over 52 weeks.Improvement (n=21)Stability (n=166)Progression (n=101)Significant progression (n=37) (subset of Progression)P-value for comparison of Improvement, Stability, ProgressionAge, years55.9 ± 12.053.2 ± 12.653.1 ± 12.855.3 ± 11.80.64Female71.475.970.373.00.59Years since first non-Raynaud symptom3.7 ± 1.73.5 ± 1.73.5 ± 1.93.6 ± 1.90.81Diffuse cutaneous SSc47.649.453.556.80.78Anti-topoisomerase I antibody positive61.958.466.356.80.44High sensitivity C-reactive protein, mg/L5.1 ± 8.97.8 ± 23.05.6 ± 9.94.2 ± 4.40.62Modified Rodnan skin score9.3 ± 7.310.5 ± 8.411.9 ± 9.712.7 ± 11.30.29History of gastroesophageal reflux disease (GERD)76.272.978.278.40.62Extent (%) of fibrotic ILD on HRCT*26.4 ± 16.235.5 ± 20.436.6 ± 21.840.8 ± 23.50.12Presence of honeycombing on HRCT14.316.815.526.50.94Presence of ground glass opacities on HRCT81.086.689.784.80.51FVC % predicted77.1 ± 18.071.7 ± 17.273.3 ± 15.274.2 ± 14.80.33DLco % predicted61.5 ± 14.953.4 ± 14.851.1 ± 15.147.3 ± 14.50.02Taking mycophenolate71.448.245.535.10.09Data are mean ± SD or % at baseline. Missing data were excluded. *Assessed visually in whole lung to nearest 5%. The assessment did not include pure (non-fibrotic) ground glass opacities.ConclusionThese findings suggest that in the SENSCIS trial, patients who had higher DLCO % predicted or who were taking mycophenolate at baseline were less likely to show progression of SSc-ILD over 52 weeks.AcknowledgementsThe SENSCIS trial was funded by Boehringer Ingelheim. Oliver Distler was a member of the SENSCIS trial Steering Committee.Disclosure of InterestsAnna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme, Roche, Paid instructor for: Boehringer Ingelheim, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Eric Hachulla Speakers bureau: Johnson & Johnson, GlaxoSmithKline, Roche-Chugai; and research funding from CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Consultant of: Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Grant/research support from: GlaxoSmithKline, Roche-Chugai, Sanofi-Genzyme, Ariane Herrick Speakers bureau: Janssen, Consultant of: Arena, Boehringer Ingelheim, Camurus, CSL Behring, Gesynta, Grant/research support from: Gesynta, Teng Moua: None declared, Gabriela Riemekasten Speakers bureau: Boehringer Ingelheim, Janssen, Consultant of: Boehringer Ingelheim, Janssen, Madelon Vonk Speakers bureau: Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, MSD, Novartis, Roche, Consultant of: Boehringer Ingelheim, Corbus, Janssen, Grant/research support from: Boehringer Ingelheim, Ferrer, Galapagos, Janssen, Alexandra James Employee of: Alexandra James is an employee of Elderbrook solutions GmbH that is contracted by Boehringer Ingelheim, Margarida Alves Employee of: Margarida Alves is employee of Boehringer Ingelheim, Oliver Distler Speakers bureau: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Speaker fee: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Consultancy fee: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and TopadurOD has/had relationships with the following companies in the area of potential treatments for arthritides in the last three calendar years:Consultancy fee: Abbvie, Grant/research support from: OD has/had relationships with the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years:Research Grants: Boehringer Ingelheim, Kymera, Mitsubishi Tanabe
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Zhou S, Chan C, Dyab H, Rulach R, Hendry F, Maxfield C, Hendry M, James A, Lamb C, Grose D, Wilson C, Schipani S, Lau Y, Paterson C. OC-0433 Positive predictive value of post radiotherapy FDG PET-CT is affected by treatment and HPV-status. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alaterre C, Fazilleau C, Constantin JM, James A. Monitoring Delirium in the Intensive Care Unit Practices, perceptions and attitudes of critical care nurses and physicians. A French National Survey. Intensive Crit Care Nurs 2021; 69:103178. [PMID: 34920933 DOI: 10.1016/j.iccn.2021.103178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- C Alaterre
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne-Université, France
| | - C Fazilleau
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne-Université, France
| | - J M Constantin
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne-Université, France.
| | - A James
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne-Université, France
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Sowman M, Sunde J, Pereira T, Snow B, Mbatha P, James A. Unmasking governance failures: The impact of COVID-19 on small-scale fishing communities in South Africa. Mar Policy 2021; 133:104713. [PMID: 34608349 PMCID: PMC8479870 DOI: 10.1016/j.marpol.2021.104713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/08/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has highlighted the pre-existing vulnerability of the small-scale fisheries sector in South Africa and exposed the structural inequalities and ongoing injustices facing this sector. The failures within the fisheries governance and management system linked to the slow pace of implementing the Small-scale Fisheries Policy of 2012, have further exacerbated their vulnerability. This paper explores the immediate impacts of the COVID-19 pandemic on the small-scale fisheries sector and exposes how governance failures within the fisheries sector have increased their vulnerability. Restrictions on fishing activities and mobility, closure of conservation areas, unfair fines and arrests, loss of markets and barriers to sale of fish products as well as lack of access to water, have had significant impacts on small-scale fishers and coastal communities. The lack of social protection and the limited emergency relief provided by government further exacerbated their precarious position. Despite their vulnerability, fishers have demonstrated a measure of resilience, supporting those in need with food, lobbying government to amend restrictions and recognise their rights, and challenging efforts to fast-track development and exclude their voices. The crisis has highlighted an urgent need for broad, national level transformation to deal with the poverty and injustices facing poor coastal communities, as well as fisheries-specific policy reform.
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Affiliation(s)
- M Sowman
- University of Cape Town, South Africa
| | - J Sunde
- University of Cape Town, South Africa
| | | | - B Snow
- Strathclyde University, Scotland
| | - P Mbatha
- University of Cape Town, South Africa
| | - A James
- Rhodes University, South Africa
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James A, Plank MJ, Binny RN, Lustig A, Hannah K, Hendy SC, Steyn N. A structured model for COVID-19 spread: modelling age and healthcare inequities. Math Med Biol 2021; 38:299-313. [PMID: 34002201 PMCID: PMC8194522 DOI: 10.1093/imammb/dqab006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
We use a stochastic branching process model, structured by age and level of healthcare access, to look at the heterogeneous spread of COVID-19 within a population. We examine the effect of control scenarios targeted at particular groups, such as school closures or social distancing by older people. Although we currently lack detailed empirical data about contact and infection rates between age groups and groups with different levels of healthcare access within New Zealand, these scenarios illustrate how such evidence could be used to inform specific interventions. We find that an increase in the transmission rates among children from reopening schools is unlikely to significantly increase the number of cases, unless this is accompanied by a change in adult behaviour. We also find that there is a risk of undetected outbreaks occurring in communities that have low access to healthcare and that are socially isolated from more privileged communities. The greater the degree of inequity and extent of social segregation, the longer it will take before any outbreaks are detected. A well-established evidence for health inequities, particularly in accessing primary healthcare and testing, indicates that Māori and Pacific peoples are at a higher risk of undetected outbreaks in Aotearoa New Zealand. This highlights the importance of ensuring that community needs for access to healthcare, including early proactive testing, rapid contact tracing and the ability to isolate, are being met equitably. Finally, these scenarios illustrate how information concerning contact and infection rates across different demographic groups may be useful in informing specific policy interventions.
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Affiliation(s)
- A James
- School of Mathematics and Statistics, University of Canterbury, Science Road Christchurch 8140, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - M J Plank
- School of Mathematics and Statistics, University of Canterbury, Science Road Christchurch 8140, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - R N Binny
- Manaaki Whenua, 54 Gerald Street, Lincoln 7608, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - A Lustig
- Manaaki Whenua, 54 Gerald Street, Lincoln 7608, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - K Hannah
- Department of Physics, University of Auckland, 38 Princes Street Auckland 1010, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - S C Hendy
- Department of Physics, University of Auckland, 38 Princes Street Auckland 1010, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
| | - N Steyn
- Department of Physics, University of Auckland, 38 Princes Street Auckland 1010, New Zealand and Te Pūnaha Matatini, University of Auckland, 38 Princes Street Auckland 1010, New Zealand
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Plank MJ, James A, Steyn N. Comment: weekly COVID-19 testing with household quarantine and contact tracing is feasible and would probably end the epidemic. R Soc Open Sci 2021; 8:201546. [PMID: 34168885 PMCID: PMC8220265 DOI: 10.1098/rsos.201546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/11/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M. J. Plank
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Te Pūnaha Matatini, Centre of Research Excellence in Complex Systems, New Zealand
| | - A. James
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Te Pūnaha Matatini, Centre of Research Excellence in Complex Systems, New Zealand
| | - N. Steyn
- Te Pūnaha Matatini, Centre of Research Excellence in Complex Systems, New Zealand
- Department of Physics, University of Auckland, New Zealand
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James A, Plank MJ, Hendy S, Binny R, Lustig A, Steyn N, Nesdale A, Verrall A. Successful contact tracing systems for COVID-19 rely on effective quarantine and isolation. PLoS One 2021; 16:e0252499. [PMID: 34081709 PMCID: PMC8174731 DOI: 10.1371/journal.pone.0252499] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/18/2021] [Indexed: 12/31/2022] Open
Abstract
Models of contact tracing often over-simplify the effects of quarantine and isolation on disease transmission. We develop a model that allows us to investigate the importance of these factors in reducing the effective reproduction number. We show that the reduction in onward transmission during quarantine and isolation has a bigger effect than tracing coverage on the reproduction number. We also show that intuitively reasonable contact tracing performance indicators, such as the proportion of contacts quarantined before symptom onset, are often not well correlated with the reproduction number. We conclude that provision of support systems to enable people to quarantine and isolate effectively is crucial to the success of contact tracing.
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Affiliation(s)
- A. James
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Te Pūnaha Matatini, Auckland, New Zealand
| | - M. J. Plank
- School of Mathematics and Statistics, University of Canterbury, Christchurch, New Zealand
- Te Pūnaha Matatini, Auckland, New Zealand
| | - S. Hendy
- Te Pūnaha Matatini, Auckland, New Zealand
- Department of Physics, University of Auckland, Auckland, New Zealand
| | - R. Binny
- Te Pūnaha Matatini, Auckland, New Zealand
- Manaaki Whenua, Lincoln, New Zealand
| | - A. Lustig
- Te Pūnaha Matatini, Auckland, New Zealand
- Manaaki Whenua, Lincoln, New Zealand
| | - N. Steyn
- Te Pūnaha Matatini, Auckland, New Zealand
- Department of Physics, University of Auckland, Auckland, New Zealand
| | - A. Nesdale
- Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - A. Verrall
- Department of Pathology and Molecular Medicine, University of Otago, Dunedin, New Zealand
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Joachim S, Beaudouin R, Daniele G, Geffard A, Bado-Nilles A, Tebby C, Palluel O, Dedourge-Geffard O, Fieu M, Bonnard M, Palos-Ladeiro M, Turiès C, Vulliet E, David V, Baudoin P, James A, Andres S, Porcher JM. Effects of diclofenac on sentinel species and aquatic communities in semi-natural conditions. Ecotoxicol Environ Saf 2021; 211:111812. [PMID: 33472112 DOI: 10.1016/j.ecoenv.2020.111812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 05/14/2023]
Abstract
Due to the potential hazard of diclofenac on aquatic organisms and the lack of higher-tier ecotoxicological studies, a long-term freshwater mesocosm experiment was set up to study the effects of this substance on primary producers and consumers at environmentally realistic nominal concentrations 0.1, 1 and 10 µg/L (average effective concentrations 0.041, 0.44 and 3.82 µg/L). During the six-month exposure period, the biovolume of two macrophyte species (Nasturtium officinale and Callitriche platycarpa) significantly decreased at the highest treatment level. Subsequently, a decrease in dissolved oxygen levels was observed. High mortality rates, effects on immunity, and high genotoxicity were found for encaged zebra mussels (Dreissena polymorpha) in all treatments. In the highest treatment level, one month after the beginning of the exposure, mortality of adult fish (Gasterosteus aculeatus) caused effects on the final population structure. Total abundance of fish and the percentage of juveniles decreased whereas the percentage of adults increased. This led to an overall shift in the length frequency distribution of the F1 generation compared to the control. Consequently, indirect effects on the community structure of zooplankton and macroinvertebrates were observed in the highest treatment level. The No Observed Effect Concentration (NOEC) value at the individual level was < 0.1 µg/L and 1 µg/L at the population and community levels. Our study showed that in more natural conditions, diclofenac could cause more severe effects compared to those observed in laboratory conditions. The use of our results for regulatory matters is also discussed.
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Affiliation(s)
- S Joachim
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France.
| | - R Beaudouin
- Unit of Models for Ecotoxicology and Toxicology (METO), INERIS, 60550 Verneuil-en-Halatte, France
| | - G Daniele
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 rue de la Doua, F-69100 Villeurbanne, France
| | - A Geffard
- Université de Reims Champagne Ardenne, UMR-I 02 SEBIO, Moulin de la Housse BP 1039, 51687 Reims
| | - A Bado-Nilles
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France
| | - C Tebby
- Unit of Models for Ecotoxicology and Toxicology (METO), INERIS, 60550 Verneuil-en-Halatte, France
| | - O Palluel
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France
| | - O Dedourge-Geffard
- Université de Reims Champagne Ardenne, UMR-I 02 SEBIO, Moulin de la Housse BP 1039, 51687 Reims
| | - M Fieu
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 rue de la Doua, F-69100 Villeurbanne, France
| | - M Bonnard
- Université de Reims Champagne Ardenne, UMR-I 02 SEBIO, Moulin de la Housse BP 1039, 51687 Reims
| | - M Palos-Ladeiro
- Université de Reims Champagne Ardenne, UMR-I 02 SEBIO, Moulin de la Housse BP 1039, 51687 Reims
| | - C Turiès
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France
| | - E Vulliet
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 rue de la Doua, F-69100 Villeurbanne, France
| | - V David
- Unit of Models for Ecotoxicology and Toxicology (METO), INERIS, 60550 Verneuil-en-Halatte, France
| | - P Baudoin
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France
| | - A James
- Expertise entoxicologie/écotoxicologie des substances chimiques (ETES), INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte, France
| | - S Andres
- Expertise entoxicologie/écotoxicologie des substances chimiques (ETES), INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte, France
| | - J M Porcher
- Unité d'écotoxicologie in vitro et in vivo(ECOT)/UMR-I 02 SEBIO, INERIS, Parc ALATA, BP2, 60550 Verneuil-en-Halatte,France
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Balachandran V, Dittmer J, Bayly M, Armarego S, Zhou X, Mejia R, Singh T, James A, Seah P. P46 Renal Effects of Procaine vs. Lignocaine Containing Modified Melbourne Formula Cardioplegia. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhu K, Hunter M, James A, Lim EM, Cooke BR, Walsh JP. Relationship between visceral adipose tissue and bone mineral density in Australian baby boomers. Osteoporos Int 2020; 31:2439-2448. [PMID: 32719992 DOI: 10.1007/s00198-020-05556-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/21/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED Adiposity has a complex relationship with bone health. In 4865 Australian baby boomers (2642 females) aged 45-70 years, we found that higher visceral adipose tissue mass is associated with reduced bone density adjusting for body mass and lifestyle factors, suggesting that excess visceral fat may be deleterious to bone. INTRODUCTION Increased body mass is associated with higher bone mineral density (BMD), but higher visceral adipose tissue (VAT) may have a negative impact on bone health. In the Busselton Healthy Ageing Study, we examined associations between VAT mass and BMD in 4865 participants (2642 females) aged 45-70 years. METHODS VAT mass and BMD of whole body, total hip, femoral neck and lumbar spine were measured using DXA. VAT mass was examined as a continuous variable and in quartiles using sex-specific cut-offs. RESULTS The mean age was 58.0 ± 5.8 years. Males had significantly higher BMI (28.3 ± 3.7 vs 27.5 ± 4.9 kg/m2) and VAT mass (1675 ± 878 vs 882 ± 600 g) than females (both P < 0.001). In males, after adjustment for age, body mass, height and lifestyle factors, VAT mass negatively associated with total body, total hip and femoral neck BMD (β = - 0.153 to - 0.293, all P < 0.001). Males in the highest quartile of VAT mass (> 2200 g) had significantly lower BMD at all three sites than those in lower quartiles, with estimated BMD differences of 2.3-5.7% (all P < 0.05). In females, VAT mass negatively associated with total body, femoral neck and lumbar spine BMD (β = - 0.067 to - 0.178, all P < 0.05) and those in the highest quartile (> 1250 g) had significantly lower total body BMD than other quartiles (by 1.7-3.7%, all P < 0.05). CONCLUSION In middle-aged Australians, after covariate adjustment, higher DXA-derived VAT mass is associated with reduced bone density, suggesting that excess visceral fat may be deleterious to bone, especially in males.
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Affiliation(s)
- K Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia.
- Medical School, University of Western Australia, Crawley, Western Australia, Australia.
| | - M Hunter
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - A James
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - E M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
| | - B R Cooke
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - J P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
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Williamson A, Nowicki S, James A, Chalmers A, Carruthers R, Duffton A. OC-0588: The role of the Consultant Neuro-Oncology Radiographer in the peer review session for brain tumours. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Byrne HL, Le Duc G, Lux F, Tillement O, Holmes NM, James A, Jelen U, Dong B, Liney G, Roberts TL, Kuncic Z. Enhanced MRI-guided radiotherapy with gadolinium-based nanoparticles: preclinical evaluation with an MRI-linac. Cancer Nanotechnol 2020. [DOI: 10.1186/s12645-020-00065-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The AGuIX® (NH TherAguix) nanoparticle has been developed to enhance radiotherapy treatment and provide strong MR contrast. These two properties have previously been investigated separately and progressed to clinical trial following a clinical workflow of separate MR imaging followed some time later by radiotherapy treatment. The recent development of MRI-linacs (combined Magnetic Resonance Imaging–linear accelerator systems enabling MRI-guided radiotherapy) opens up a new workflow where MR confirmation of nanoparticle uptake can be carried out at the time of treatment. A preclinical study was carried out to assess the suitability of a gadolinium-containing nanoparticle AGuIX® (NH TherAguix) for nano-enhanced image-guided radiotherapy on an MRI-linac.
Methods
Treatments were carried out on F344 Fischer rats bearing a 9L glioma brain tumour. Animals received either: (A) no treatment; (B) injection of nanoparticles followed by MRI; (C) radiotherapy with MRI; or (D) injection of nanoparticles followed by radiotherapy with MRI. Pre-clinical irradiations were carried out on the 1.0 T, 6 MV in-line Australian MRI-linac. Imaging used a custom head coil specially designed to minimise interference from the radiotherapy beam. Anaesthetised rats were not restrained during treatment but were monitored with a cine-MRI sequence. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis was used to quantify residual gadolinium in the brain in normal and tumour tissue.
Results
A preclinical evaluation of nano-enhanced radiation treatment has been carried out on a 1.0 T MRI-linac, establishing a workflow on these novel systems. Extension of life when combining radiotherapy with nanoparticles was not statistically different from that for rats receiving radiotherapy only. However, there was no detrimental effect for animals receiving nanoparticles and radiation treatment in the magnetic field compared with control branches. Cine-MR imaging was sufficient to carry out monitoring of anaesthetised animals during treatment. AGuIX nanoparticles demonstrated good positive contrast on the MRI-linac system allowing confirmation of tumour extent and nanoparticle uptake at the time of treatment.
Conclusions
Novel nano-enhanced radiotherapy with gadolinium-containing nanoparticles is ideally suited for implementation on an MRI-linac, allowing a workflow with time-of-treatment imaging. Live irradiations using this treatment workflow, carried out for the first time at the Australian MRI-linac, confirm the safety and feasibility of performing MRI-guided radiotherapy with AGuIX® nanoparticles. Follow-up studies are needed to demonstrate on an MRI-linac the radiation enhancement effects previously shown with conventional radiotherapy.
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Zhou S, Rulach R, Hendry F, Stobo D, James A, Dempsey MF, Grose D, Lamb C, Schipani S, Rizwanullah M, Wilson C, Lau YC, Paterson C. Positron Emission Tomography-Computed Tomography Surveillance after (Chemo)Radiotherapy in Advanced Head and Neck Squamous Cell Cancer: Beyond the PET-NECK Protocol. Clin Oncol (R Coll Radiol) 2020; 32:665-673. [PMID: 32561027 DOI: 10.1016/j.clon.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the implementation of 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) surveillance after (chemo)radiotherapy, to compare outcomes for those who achieved a complete (CR), equivocal (EQR) and incomplete (ICR) nodal response on 12-week PET-CT according to their human papillomavirus (HPV) status, and to assess the safety of ongoing surveillance beyond 12 weeks in the HPV-positive EQR group. MATERIALS AND METHODS All patients with node-positive head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy between January 2013 and September 2017 were identified. PET-CT responses were classified as CR, ICR or EQR. Patient outcomes were obtained from electronic records. RESULTS In total, 236 patients with a minimum of 2 years of follow-up were identified. The mean age was 59 years; 79.3% had N2 disease; 77.1% of patients had oropharyngeal cancer and 10.1% had squamous cell carcinoma of unknown primary, of whom 82.0% (169) were HPV positive; 78.0% received chemoradiotherapy. The median time from the end of radiotherapy to PET-CT was 91 days. Of the HPV-related HNSCC, 60.4% achieved CR, 29.0% EQR and 10.6% ICR. With a median follow-up of 41.7 months, there was no difference in survival between patients with HPV-related HNSCC achieving CR and EQR (median overall survival not reached for both, P = 0.67) despite the omission of immediate neck dissection in 98.0% of the EQR group. CONCLUSION Patients with HPV-positive HNSCC who have achieved EQR have comparable survival outcomes to those who achieved a CR despite the omission of immediate neck dissections; this shows the safety of ongoing surveillance beyond 12 weeks in this group of patients.
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Affiliation(s)
- S Zhou
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - F Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - D Stobo
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - A James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M-F Dempsey
- Greater Glasgow and Clyde NHS Trust, Glasgow, UK
| | - D Grose
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Rizwanullah
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Y C Lau
- Greater Glasgow and Clyde NHS Trust, Glasgow, UK
| | - C Paterson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Keating S, James A, Griffey R, Ablordeppey E. 265 Barriers and Facilitators of De-Implementing Chest X-Rays after Central Venous Catheter Insertion. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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James A. Addressing oral health-related quality of life of the elderly – A Oral health promotion approach. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Older people are representative of the vulnerable population. According to census 2011, the proportion of elderly in India is 8.6%. Owing to social transformation and evolving lifestyles, the number of old age homes is increasing rapidly with institutionalized elderly having poorer oral health status. This study was conducted to assess the situation among the sample of institutions meant for the elderly and to plan relevant intervention, policy development aligning with principles of health promotion to improve the oral health quality of life.
Methods
A mixed-method study was adopted after approval from the institutional ethical board. To plan an appropriate intervention, situation analysis was done by conducting in-depth interviews, administrating questionnaires and direct observation. The intervention was planned based on the data obtained by building healthy public policy by a memorandum of understanding (MoU) between institutions, distribution of oral hygiene aids, oral health education, and demonstration of oral hygiene techniques. Institutionalized elderly selected for intervention in an old age home were 82. At baseline, oral health quality of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI). After 3 months follow-up, Paired t-tests were used to compare baseline and follow-up data.
Results
Qualitative data on thematic analysis revealed that administrators highlighted on fiscal, economic, administrative, personnel, ethical aspects of policy instrument and type of oral health care services to be provided. Quantitative results showed that mean and SD for the pre and post GOHAI score was 1.6 ± 0.41 and 3.06 ± 0.80 (P < 0.001)
Conclusions
Oral health promotion approach to address challenges and issues at the community level appears a more promising approach as it facilitates a systematic process and more comprehensive. Policy initiatives with stakeholders brought a sustainable improvement of oral health quality of life.
Key messages
Ottawa charter model oral health promotion based intervention with the coordination of stakeholders helps in improving functional ability and intrinsic capacity of institutionalized elderly. To improve the quality of life among institutionalized elderly there is a need for transformation of health systems away from disease based curative models to comprehensive health care models.
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Affiliation(s)
- A James
- Public Health Dentistry, Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
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Oikonomidi T, Ravaud P, James A, Cosson E, Montori V, Tran VT. What makes digital health intrusive? Qualitative findings from an international study on diabetes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why.
Methods
We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]).
Results
We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests.
Conclusions
Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden.
Key messages
Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.
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Affiliation(s)
- T Oikonomidi
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ravaud
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, France
| | - A James
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - E Cosson
- U 1125, Sorbonne Paris Nord, INRA/CNAM, Bobigny, France
- Department of Endocrinology, Sorbonne Paris Nord, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, CRNH-IdF, CINFO, Bobigny, France
| | - V Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
- Department of Health and Human Services, Center for Evidence and Practice Improvement of the Agency for Healthcare Research and Quality, Rockville, USA
| | - V T Tran
- UMR 1153, Université de Paris, CRESS, INSERM, INRA, Paris, France
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Matteson E, Kelly C, Distler J, Hoffmann-Vold AM, Seibold J, Mittoo S, Distler O, Dellaripa PF, James A, Schlenker-Herceg R, Stowasser S, Quaresma M, Flaherty KR. OP0115 EFFECT OF NINTEDANIB ON PROGRESSION OF INTERSTITIAL LUNG DISEASE (ILD) IN PATIENTS WITH AUTOIMMUNE DISEASE-RELATED ILDS: FURTHER DATA FROM THE INBUILD TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In the INBUILD trial in patients with progressive fibrosing ILDs, nintedanib reduced the rate of decline in forced vital capacity (FVC) versus placebo over 52 weeks both in the overall population and in the subgroup with autoimmune disease-related ILDs. Patients continued blinded randomised treatment until the end of the trial.Objectives:Assess the effects of nintedanib on the risks of death, acute exacerbation of ILD or death, and disease progression or death over the whole INBUILD trial in patients with autoimmune disease-related ILDs and a progressive phenotype.Methods:Patients with progressive fibrosing ILDs other than idiopathic pulmonary fibrosis (IPF) were randomised to receive nintedanib 150 mg bid or placebo. Time to i) death, ii) first acute exacerbation of ILD or death, and iii) disease progression (absolute decline in FVC ≥10% predicted) or death, over the whole trial were analysed in patients with autoimmune disease-related ILDs. Incidence rates of adverse events per 100 patient–years were calculated based on events with onset between the first trial drug intake and the last intake plus 28 days. Analyses were descriptive.Results:Of 663 patients, 170 (82 nintedanib, 88 placebo) had autoimmune disease-related ILDs (89 RA-ILD, 39 SSc-ILD, 19 MCTD-ILD, 23 other autoimmune ILDs including Sjogren’s disease-related ILD [n=7], interstitial pneumonia with autoimmune features [n=5] and undifferentiated CTD-ILD [n=3]). Over the whole trial, in the nintedanib and placebo groups, respectively, mean (SD) exposure to drug was 15.4 (7.4) and 16.9 (6.1) months and maximum exposure was 26.0 and 25.2 months; 62 (75.6%) and 68 (77.3%) patients in these groups, respectively, completed the planned observation time. Over the whole trial, in the nintedanib and placebo groups, respectively, 9.8% and 12.5% of patients died, 12.2% and 20.5% of patients had ≥1 acute exacerbation of ILD or died, and 40.2% and 53.4% of patients had disease progression or died (Table). Diarrhoea was the most common adverse event, with incidence rates of 139.2 and 26.3 events per 100 patient–years in the nintedanib and placebo groups, respectively. Adverse events led to treatment discontinuation in 20.7% of patients in the nintedanib group and 13.6% of patients in the placebo group.Conclusion:Data from the INBUILD trial suggest that nintedanib has a clinically meaningful effect on slowing the progression of ILD in patients with progressive fibrosing autoimmune disease-related ILDs, with adverse events that can be tolerated by most patients.Table.Nintedanib (n=82)Placebo (n=88)HR (95% CI)*Death8 (9.8)11 (12.5)0.80 (0.32, 1.98)≥1 acute exacerbation of ILD or death10 (12.2)18 (20.5)0.58 (0.27, 1.27)Disease progression (absolute decline in FVC ≥10% predicted) or death33 (40.2)47 (53.4)0.72 (0.46, 1.13)n (%) with event over the whole trial (mean [SD] exposure: 15.4 [7.4] and 16.9 [6.1] months in nintedanib and placebo groups, respectively). *Based on time to first event.Disclosure of Interests:Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking, Clive Kelly Consultant of: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, James Seibold Shareholder of: BriaCell, Pacific Therapeutics, Consultant of: Atlantic, Blade Therapeutics, Eicos Sciences, Eiger Biopharmaceuticals, Indalo Therapeutics, Mitsubishi Tanabe Pharma, Bayer, Xenikos, Boehringer Ingelheim, Camurus, Corbus Pharmaceuticals, EMD Serono, Speakers bureau: Boehringer Ingelheim, Shikha Mittoo Grant/research support from: Pfizer, Consultant of: Novartis, Abbvie, Pfizer, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Paul F. Dellaripa Grant/research support from: Paul Dellaripa has received institutional grants from Genentech, Consultant of: Paul Dellaripa participated in advisory boards for Boehringer Ingelheim, Alexandra James Employee of: Employee of Boehringer Ingelheim, Rozsa Schlenker-Herceg Employee of: Employee of Boehringer Ingelheim, Susanne Stowasser Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Kevin R. Flaherty Grant/research support from: Kevin Flaherty has received grants from Boehringer Ingelheim, Consultant of: Kevin Flaherty has acted as a consultant for Boehringer Ingelheim, Bellerophon, Blade Therapeutics, Roche/Genentech, and VeracyteHe was a member of the INBUILD trial Steering Committee
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Volkmann E, Castellví I, Johnson S, Matteson E, Distler J, Seibold J, Costabel U, James A, Coeck C, Quaresma M, Cottin V. SAT0157 NINTEDANIB DOSE ADJUSTMENTS AND ADVERSE EVENTS IN PATIENTS WITH PROGRESSIVE AUTOIMMUNE DISEASE-RELATED INTERSTITIAL LUNG DISEASES IN THE INBUILD TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In the INBUILD trial in patients with progressive fibrosing ILDs, the adverse event (AE) profile of nintedanib was characterised predominantly by gastrointestinal AEs. Dose adjustments were used to manage AEs.Objectives:Assess AEs and dose adjustments in patients with autoimmune disease-related ILDs in the INBUILD trial.Methods:Patients with progressive fibrosing ILDs other than idiopathic pulmonary fibrosis were randomised to nintedanib 150 mg bid or placebo. Dose reductions to 100 mg bid and treatment interruptions were permitted to manage AEs. AEs over 52 weeks of treatment (or 28 days after last trial drug intake for patients who discontinued drug before week 52) were assessed in patients who received ≥1 dose of trial drug.Results:Of 663 patients in the INBUILD trial, 170 (82 nintedanib, 88 placebo) had autoimmune disease-related ILDs (89 RA-ILD, 39 SSc-ILD, 19 MCTD-ILD, 23 other autoimmune ILDs). In the nintedanib and placebo groups of patients with autoimmune disease-related ILDs, respectively, over 52 weeks, the proportions of patients with ≥1 dose reduction were 28.0% and 3.4%, with ≥1 treatment interruption were 31.7% and 10.2%, and with ≥1 dose reduction and/or treatment interruption were 40.2% and 12.5% (Table). Dose intensity (amount of drug administered divided by amount that would have been received had 150 mg bid been administered over 52 weeks or until permanent treatment discontinuation) was >90% in 80.5% of patients in the nintedanib group and 95.5% in the placebo group. AEs led to permanent treatment discontinuation in 17.1% and 10.2% of patients treated with nintedanib and placebo, respectively. Diarrhoea was the most common AE, reported in 63.4% and 27.3% of patients in the nintedanib and placebo groups, respectively. Diarrhoea AEs led to dose reduction, treatment interruption and permanent treatment discontinuation in 7.3%, 9.8% and 4.9% of patients in the nintedanib group, compared with 0%, 1.1% and 1.1% of patients in the placebo group, respectively. Of the nintedanib-treated patients who experienced ≥1 diarrhoea AE, 80.8% experienced 1 or 2 events and 76.9% experienced events that were mild at worst (Common Terminology Criteria for Adverse Events [CTCAE] grade 1).Conclusion:In the INBUILD trial, management of AEs via dose adjustments enabled most patients with autoimmune disease-related ILDs to remain on treatment for 52 weeks. Diarrhoea was the AE that most commonly led to dose adjustment.TableNintedanib(n=82)Placebo (n=88)Patients with ≥1 dose reduction or treatment interruption33 (40.2)11 (12.5)Patients with ≥1 dose reduction23 (28.0)3 (3.4)Total number of dose reductions253Patients with ≥1 dose re-escalation after dose reduction5 (6.1)2 (2.3)Patients with ≥1 treatment interruption26 (31.7)9 (10.2)Total number of treatment interruptions3211Total duration of treatment interruptions, days, mean (SD)20.1 (15.1)19.3 (20.7)Data are n (%) of patients unless otherwise indicated.Disclosure of Interests:Elizabeth Volkmann Grant/research support from: Forbius, Corbus Pharmaceuticals, Consultant of: Boehringer Ingelheim, Forbius, Speakers bureau: Boehringer Ingelheim, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Sindhu Johnson Grant/research support from: Boehringer Ingelheim, Corbus Pharmaceuticals, GlaxoSmithKline, Roche, Merck, Bayer, Consultant of: Boehringer Ingelheim, Ikaria, Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, James Seibold Shareholder of: BriaCell, Pacific Therapeutics, Consultant of: Atlantic, Blade Therapeutics, Eicos Sciences, Eiger Biopharmaceuticals, Indalo Therapeutics, Mitsubishi Tanabe Pharma, Bayer, Xenikos, Boehringer Ingelheim, Camurus, Corbus Pharmaceuticals, EMD Serono, Speakers bureau: Boehringer Ingelheim, Ulrich Costabel Consultant of: Boehringer Ingelheim, Roche, Fibrogen, Global Blood Therapeutics, Speakers bureau: Boehringer Ingelheim, Roche, AstraZeneca, Alexandra James Employee of: Employee of Boehringer Ingelheim, Carl Coeck Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Vincent Cottin Grant/research support from: Boehringer Ingelheim, Roche, Consultant of: Boehringer Ingelheim, Roche, Actelion, Bayer, Gilead Sciences, Novartis, Promedior, Celgene, Galapagos, Galecto. He was a member of the INBUILD trial Steering Committee., Speakers bureau: Actelion, Boehringer Ingelheim, Novartis, Roche, Sanofi
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Aringer M, Pope J, Kelly C, Hoffmann-Vold AM, Belperio J, James A, Coeck C, Quaresma M, Matteson E. THU0189 EFFICACY AND SAFETY OF NINTEDANIB IN PATIENTS WITH AUTOIMMUNE DISEASE-RELATED INTERSTITIAL LUNG DISEASE TREATED WITH DMARDS AND/OR GLUCOCORTICOIDS AT BASELINE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background:In the INBUILD trial in patients with progressive fibrosing ILDs, nintedanib reduced the rate of decline in forced vital capacity (FVC) vs placebo over 52 weeks in the overall population and in the subgroup with autoimmune disease-related ILDs. Patients taking stable doses of medications to treat RA or CTD were eligible, but the protocol excluded enrolment of patients treated with azathioprine, cyclosporine, mycophenolate, tacrolimus, rituximab, cyclophosphamide, or oral glucocorticoids >20 mg/day.Objectives:Assess the influence of DMARDs and/or glucocorticoids at baseline on the efficacy and safety of nintedanib in patients with progressive autoimmune disease-related ILDs.Methods:In patients with progressive autoimmune disease-related ILDs in the INBUILD trial, the rate of decline in FVC (mL/year) and adverse events (AEs) over 52 weeks of treatment (or until 28 days after last trial drug intake for patients who discontinued drug before week 52) were assessed in subgroups by use of DMARDs and/or glucocorticoids (any dose) at baseline (yes/no).Results:170 patients in the INBUILD trial (82 nintedanib, 88 placebo) had autoimmune disease-related ILDs (89 RA-ILD, 39 SSc-ILD, 19 MCTD-ILD, 23 other). The baseline characteristics of patients taking (n=131) and not taking (n=39) DMARDs and/or glucocorticoids are shown in the Table. All but 1 patient taking glucocorticoids at baseline was taking <20 mg/day. The mean (SE) annual rate of decline in FVC in the placebo group was numerically greater in patients taking vs not taking DMARDs and/or glucocorticoids at baseline (Figure). The effect of nintedanib vs placebo on reducing the rate of decline in FVC was numerically more pronounced in patients taking vs not taking DMARDs and/or glucocorticoids at baseline, but the treatment-by-subgroup-by-time interaction p-values did not indicate heterogeneity in the effect of nintedanib between subgroups (Figure). In patients taking vs not taking DMARDs and/or corticosteroids at baseline, respectively, diarrhoea was reported in 59.4% and 77.8% of patients treated with nintedanib and 28.4% and 23.8% of patients treated with placebo. Serious AEs were more frequent in patients taking vs not taking DMARDs and/or glucocorticoids at baseline in both the nintedanib (39.1% vs 16.7%) and placebo (35.8% vs 19.0%) groups.Conclusion:In the INBUILD trial, the rate of FVC decline was numerically greater in placebo-treated patients who were taking DMARDs and/or glucocorticoids at baseline than in those who were not. The rate of FVC decline was slower in patients treated with nintedanib than placebo both in patients who were and were not taking DMARDs and/or glucocorticoids at baseline. Nintedanib had an acceptable safety profile both in patients who were and were not using DMARDs and/or glucocorticoids at baseline.DMARDs and/or glucocorticoids at baselineYes (n=131)No (n=39)Male, %51.930.8FVC, mL, mean (SD)2372 (718)2188 (619)ILD diagnosis, %RA-ILD60.325.6SSc-ILD15.348.7MCTD-ILD10.712.8Other13.712.8Biologic DMARDs, %15.3–Non-biologic DMARDs, %46.6–Glucocorticoids, %87.8–Most common biologic DMARDs, non-biologic DMARDs and glucocorticoids were abatacept (4.6%), hydroxychloroquine/hydroxychloroquine sulphate (19.8%) and prednisone (37.4%), respectively.Disclosure of Interests:Martin Aringer Consultant of: Boehringer Ingelheim, Roche, Speakers bureau: Boehringer Ingelheim, Roche, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Clive Kelly Consultant of: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, John Belperio: None declared, Alexandra James Employee of: Employee of Boehringer Ingelheim, Carl Coeck Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Eric Matteson Grant/research support from: Pfizer, Consultant of: Boehringer Ingelheim, Gilead, TympoBio, Arena Pharmaceuticals, Speakers bureau: Simply Speaking
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White T, Langen C, Schmidt M, Hough M, James A. Comparative Neuropsychiatry: White Matter Abnormalities in Children and Adolescents with Schizophrenia, Bipolar Affective Disorder, and Obsessive-Compulsive Disorder. Eur Psychiatry 2020; 30:205-13. [DOI: 10.1016/j.eurpsy.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/08/2014] [Accepted: 10/12/2014] [Indexed: 12/14/2022] Open
Abstract
AbstractBackground:There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.Methods:A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.Results:Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.Conclusions:White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.
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McMahon JD, Pitts R, Isbister J, Aslam-Pervez B, James A, McLellan D, Wright S, Wales CJ, McCaul J, Thomson E, Ansell MJ, Hislop WS, MacIver C, Devine JC, Carson E. Postoperative risk stratification in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2020; 58:462-468. [PMID: 32222310 DOI: 10.1016/j.bjoms.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
Postoperative prognostic stratification using the Union for International Cancer Control (UICC) TNM 8th edition staging rules (UICC 8) may identify additional groups of patients who could benefit from adjuvant radiotherapy. Currently, selection for such treatment is not based on all known prognostic factors, and their relative importance may vary depending on the overall risk category. The objective of this study therefore was to evaluate these possibilities. We retrospectively studied 644 patients who had surgery with curative intent for oral squamous cell carcinoma (OSCC) between March 2006 and February 2017. The outcomes of interest were disease-specific survival (DSS) and locoregional recurrence (LRR). Patients were re-staged according to the UICC 8 staging rules. Putative clinical and pathological prognostic variables were evaluated and hazard ratios estimated. Regression analysis was done to identify independent prognostic factors, and iterative analyses identified clinically-relevant risk categories with a minimum of residual prognostic variables. The significance of recognised pathological prognostic factors differed according to the overall risk category. An intermediate risk group comprising patients with pN1 disease as well those with pT3 disease solely on the basis of a depth of invasion (DOI) of more than 10 mm, was identified. A trial to evaluate the benefit or otherwise of adjuvant radiotherapy in this group is now required. Individual prognostic risk factors should be considered within the context of the overall risk category in patients with OSCC.
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Affiliation(s)
- J D McMahon
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | - R Pitts
- Medical and Life Sciences Schools, University of Dundee.
| | | | | | - A James
- Beatson Oncology Centre, NHS Greater Glasgow and Clyde Health Board.
| | - D McLellan
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | - S Wright
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | - C J Wales
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | - J McCaul
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | | | - M J Ansell
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
| | - W S Hislop
- NHS Ayrshire and Arran Crosshouse Hospital.
| | - C MacIver
- Maxillofacial / Head and Neck Unit, Mafraq Hospital.
| | - J C Devine
- Maxillofacial / Head and Neck Unit, Mafraq Hospital.
| | - E Carson
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board.
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Paterson C, Thomson M, Caldwell B, Young R, McLean A, Porteous S, Clark S, Messow C, Kean S, Grose D, Lamb C, Rizwannullah M, James A, Schipani S, Wilson C, Rulach R, Jones R. Radiotherapy-induced xerostomia: a randomised, double-blind, controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2019; 57:1119-1125. [DOI: 10.1016/j.bjoms.2019.10.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
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Berry A, Pushpanathan M, Bruce D, James A, Hunter M, Bucks R. Attentional deficits in OSA are moderated both by older age and lower cognitive reserve. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gage MM, Mylander WC, Rosman M, Fujii T, Le Du F, Raghavendra A, Sinha AK, Espinosa Fernandez JR, James A, Ueno NT, Tafra L, Jackson RS. Combined pathologic-genomic algorithm for early-stage breast cancer improves cost-effective use of the 21-gene recurrence score assay. Ann Oncol 2019; 29:1280-1285. [PMID: 29788166 DOI: 10.1093/annonc/mdy074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The 21-gene recurrence score (RS) (Oncotype DX®; Genomic Health, Redwood City, CA) partitions hormone receptor positive, node negative breast cancers into three risk groups for recurrence. The Anne Arundel Medical Center (AAMC) model has previously been shown to accurately predict RS risk categories using standard pathology data. A pathologic-genomic (P-G) algorithm then is presented using the AAMC model and reserving the RS assay only for AAMC intermediate-risk patients. Patients and methods A survival analysis was done using a prospectively collected institutional database of newly diagnosed invasive breast cancers that underwent RS assay testing from February 2005 to May 2015. Patients were assigned to risk categories based on the AAMC model. Using Kaplan-Meier methods, 5-year distant recurrence rates (DRR) were evaluated within each risk group and compared between AAMC and RS-defined risk groups. Five-year DRR were calculated for the P-G algorithm and compared with DRR for RS risk groups and the AAMC model's risk groups. Results A total of 1268 cases were included. Five-year DRR were similar between the AAMC low-risk group (2.7%, n = 322) and the RS < 18 low-risk group (3.4%, n = 703), as well as between the AAMC high-risk group (22.8%, n = 230) and the RS > 30 high-risk group (23.0%, n = 141). Using the P-G algorithm, more patients were categorized as either low or high risk and the distant metastasis rate was 3.3% for the low-risk group (n = 739) and 24.2% for the high-risk group (n = 272). Using the P-G algorithm, 44% (552/1268) of patients would have avoided RS testing. Conclusions AAMC model is capable of predicting 5-year recurrences in high- and low-risk groups similar to RS. Further, using the P-G algorithm, reserving RS for AAMC intermediate cases, results in larger low- and high-risk groups with similar prognostic accuracy. Thus, the P-G algorithm reliably identifies a significant portion of patients unlikely to benefit from RS assay and with improved ability to categorize risk.
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Affiliation(s)
- M M Gage
- Department of Surgery, Johns Hopkins Hospital, Baltimore
| | - W C Mylander
- The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis
| | - M Rosman
- The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis
| | - T Fujii
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Le Du
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Raghavendra
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A K Sinha
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J R Espinosa Fernandez
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A James
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N T Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - L Tafra
- The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis
| | - R S Jackson
- The Rebecca Fortney Breast Center, Anne Arundel Medical Center, Annapolis.
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Connellan C, Kelleher S, Islam M, Kenny D, James A, Prendiville T, Walsh K. Commotio Cordis Caused During Hurling Game. Ir Med J 2019; 112:956. [PMID: 31538753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A teenage boy had a cardiac arrest following a blow to the chest from a hurling ball (sliotar). Prompt resuscitation and automated external defibrillation enabled a full recovery. This is the first reported case of commotio cordis caused by a sliotar although it is described in other sports. Primary prevention of commotio cordis (CC) and secondary prevention of cardiac death are discussed.
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Affiliation(s)
- C Connellan
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - S Kelleher
- Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
| | - M Islam
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - D Kenny
- Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
| | - A James
- Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
| | - T Prendiville
- Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
| | - K Walsh
- Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
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Gatta L, Rodriguez I, Strickland K, Gilner J, Grotegut C, Ronald J, Bashir M, James A, Lee P, Secord A. Novel management of morbidly adherent placenta: Preliminary outcomes assessment of 13-year experience with prospective multidisciplinary algorithm. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Williamson A, James A, Chalmers A, Carruthers R, Nowicki S, McLoone P. OC-0529 Evaluation of the potential treatment delivery benefits of Varian HyperArc for brain metastases. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paterson C, McCrea I, Hay L, Allwood-Speirs S, Devlin L, Sankaralingam M, McLoone P, Wilson C, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Nixon I, Thomson M, McJury M, Foster J, Duffton A. EP-1137 DW MRI as biomarker of response during RT for intermed/high risk SCC oropharynx: a feasibility study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kjartansdottir O, Williamson A, Patibandla A, Currie S, Carruthers R, Chalmers A, James A, Nowicki S. EP-1233 Stereotactic radiosurgery to brain metastases using Varian HyperArc in the Beatson Cancer Centre. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paterson C, Crosbie R, McLoone P, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Wilson C, Campbell F, Easton F, Thomson M. EP-1136 Management SCC unknown primary with contemporary diagnostic and radiotherapy techniques. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhou S, Rulach R, Hendry F, Stobo D, Dempsey M, Grose D, Lamb C, James A, Schipani S, Rizwannullah M, Wilson C, Paterson C. OC-023 Real life application of the PET-Neck protocol for post radiotherapy surveillance in advanced HNSCC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paterson C, Morton A, Lamb C, Wilson C, Grose D, Rizwanullah M, Schipani S, Easton F, Campbell F, James A, Philip M, Thomson M. PO-060 Outcomes from concomitant cetuximab with radiotherapy in HNSCC: A retrospective cohort study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rulach R, Zhou S, Hendry F, Stobo D, Dempsey M, Grose D, Lamb C, James A, Schipani S, Rizwanullah M, Wilson C, Paterson C. OC-024 12 week PET-CTs have a low PPV for nodal residual disease in HPV positive oropharygeal cancers. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Head J, Armes H, James A. Giving a face to remote management - the digital future of physiotherapy. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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