1
|
Stephen L, Dunn JA, Balmer C, Gasson SJ, Elbeltagi NI, Copson ER, Palmieri C. Abstract P4-07-37: A UK study exploring the attitudes and experience of patients living with metastatic breast cancer with regard to clinical research: A patient advocate-academic collaborative study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-07-37] [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: 03/06/2023]
Abstract
Abstract
Background: Clinical trials are key to improving outcomes in metastatic breast cancer (MBC). However, participation is low. Little data exists regarding the attitudes and experiences of patients in relation to clinical research. This study co-developed by a patient living with MBC and researchers aims to explore the experiences and issues related to accessing and participating in clinical research. Material and Method: A mixed methods study consisting of an online survey and qualitative interviews. Participants responded to an online questionnaire which contained closed and open questions, this was live between 17th May 2021 and 30th November 2021. Qualitative interviews from a sample of patients who gave their consent were carried out between 15th August 2021 and 22nd November 2021. Descriptive statistical analysis of the quantitative results from the closed questions and thematic analysis of the qualitative data generated by the open-ended questions and interviews were utilised. Data were extracted on 1st December 2021. Results: 768 eligible responses were received (765 female, 2 male, 1 unknown gender). The greatest proportion of responders were aged 51-60 years (37%), 92% were white (n=708) and 45% employed (n=345). 31% (n=235) were diagnosed with MBC within the last year with 14% (n=107) >5 years ago. 86% (n=660) knew what a clinical trial was. With 23% (n=173) reported an oncologist raising trial participation while 32% (n=243) of patients raising participation with their oncologist. Responses to such inquiries varied from positive and supportive to ‘vague and dismissive’. Accessing new treatments (96%, n=737) and playing a more active role in own health (81%, n=619) would encourage trial participation while being unsure of potential benefits (43%, n=333) was the commonest reason for possible non-participation. Preferred sources of information on trials were a consultant (80%, n=612), nurse (61%, n=467) or trial database (29%, n=220). 36% (n=276) were willing to travel for a study increasing to 56% (n=430) if travel costs were covered, and 43% (n=306) would travel worldwide for a study. £0 to over £100 per month for travel was reported to be affordable. Of the 14% (107 of 768) who had taken part in clinical trials; 72% (n=77) found it a positive experience. Free text responses indicated this was related to additional/longer monitoring. The lack of information relating to trials was a recurring theme. 21 participants were interviewed for the qualitative sub study, with three complementary themes emerging from these namely (1) information about clinical trials/research, (2) barriers to participation and (3) research priorities. Conclusion: This large UK study provides insights into the experiences and attitudes of patients with MBC in relation to clinical research. It demonstrates that patients are keen to be involved in research but face barriers to inclusions. Key messages include the need to develop patient facing trial databases, the importance of clinical staff in the provision of study information and a willingness to travel for a trial but the need for financial support. Addressing the issues identified in this survey are key to ensuring MBC patients not only have opportunities to participate in clinical research but also the ability to take these opportunities up.
Citation Format: Lesley Stephen, Janet A. Dunn, Claire Balmer, Sophie J. Gasson, Nada I. Elbeltagi, Ellen R. Copson, Carlo Palmieri. A UK study exploring the attitudes and experience of patients living with metastatic breast cancer with regard to clinical research: A patient advocate-academic collaborative study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-37.
Collapse
Affiliation(s)
| | - Janet A. Dunn
- 2University of Warwick, Coventry, England, United Kingdom
| | | | | | - Nada I. Elbeltagi
- 5Warwick clinical Trials Unit, University of Warwick, United Kingdom
| | - Ellen R. Copson
- 6University of Southampton, Southampton, England, United Kingdom
| | | |
Collapse
|
2
|
Ulrich S, Balmer C, Becker K, Bruhs J, Danne F, Debus V, Dewein L, Doll U, Fleck T, Grafmann M, Greil S, Grosser U, Saur P, Skrzypek S, Steinmetz M. COVID-19 Infection after Pediatric Heart Transplantation in Germany, Austria, and Switzerland. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742987] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Chairwoman of the Working Group Thoracic Organ Transplantation DGPK, LMU, München, Deutschland
| | - C. Balmer
- Children's Hospital Zurich, Zürich, Switzerland
| | - K. Becker
- Department of Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Deutschland
| | - J. Bruhs
- Center of Congential Heart Disease, HDZ-NRW, Ruhr-University, Bad Oeynhausen, Bad Oeynhausen, Deutschland
| | - F. Danne
- Department of Pediatric Cardiology, DHZ Berlin, Berlin, Deutschland
| | - V. Debus
- Department of Pediatric Cardiology, University Hospital Münster, Münster, Deutschland
| | - L. Dewein
- Department of Pediatrics, University Hospital Ulm, Ulm, Deutschland
| | - U. Doll
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Deutschland
| | - T. Fleck
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg, Deutschland
| | - M. Grafmann
- Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Deutschland
| | - S. Greil
- Department of Pediatric Cardiology, University Hospital Wien, Vienna, Austria
| | - U. Grosser
- Department of Pediatric Cardiology, University Hospital Hannover, Hanover, Deutschland
| | - P. Saur
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Deutschland
| | - S. Skrzypek
- Kinderherzzentrum Giessen, Gießen, Deutschland
| | | | | |
Collapse
|
3
|
Stephen L, Dunn J, Palmieri C, Balmer C. A NATIONAL STUDY OF THE EXPERIENCES, INFORMATION NEEDS AND ATTITUDES TO CLINICAL RESEARCH OF PATIENTS LIVING WITH SECONDARY BREAST CANCER IN THE UK. Breast 2021. [DOI: 10.1016/s0960-9776(21)00533-6] [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: 10/20/2022] Open
|
4
|
Earl H, Hiller L, Vallier AL, Loi S, McAdam K, Hughes-Davies L, Rea D, Howe D, Raynes K, Higgins HB, Wilcox M, Plummer C, Mahler-Araujo B, Provenzano E, Chhabra A, Gasson S, Balmer C, Abraham JE, Caldas C, Hall P, Shinkins B, McCabe C, Hulme C, Miles D, Wardley AM, Cameron DA, Dunn JA. Six versus 12 months' adjuvant trastuzumab in patients with HER2-positive early breast cancer: the PERSEPHONE non-inferiority RCT. Health Technol Assess 2020; 24:1-190. [PMID: 32880572 PMCID: PMC7505360 DOI: 10.3310/hta24400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The addition of adjuvant trastuzumab to chemotherapy has significantly improved outcomes for people with human epidermal growth factor receptor 2 (HER2)-positive, early, potentially curable breast cancer. Twelve months' trastuzumab, tested in registration trials, was adopted as standard adjuvant treatment in 2006. Subsequently, similar outcomes were demonstrated using 9 weeks of trastuzumab. Shorter durations were therefore tested for non-inferiority. OBJECTIVES To establish whether or not 6 months' adjuvant trastuzumab is non-inferior to 12 months' in the treatment of HER2-positive early breast cancer using a primary end point of 4-year disease-free survival. DESIGN This was a Phase III randomised controlled non-inferiority trial. SETTING The setting was 152 NHS hospitals. PARTICIPANTS A total of 4088 patients with HER2-positive early breast cancer who it was planned would receive both chemotherapy and trastuzumab took part. INTERVENTION Randomisation (1 : 1) to 6 months' or 12 months' trastuzumab treatment. MAIN OUTCOMES The primary end point was disease-free survival. The secondary end points were overall survival, cost-effectiveness and cardiac function during treatment with trastuzumab. Assuming a 4-year disease-free survival rate of 80% with 12 months' trastuzumab, 4000 patients were required to demonstrate non-inferiority of 6 months' trastuzumab (5% one-sided significance, 85% power), defining the non-inferiority limit as no worse than 3% below the standard arm. Costs and quality-adjusted life-years were estimated using a within-trial analysis and a lifetime decision-analytic model. RESULTS Between 4 October 2007 and 31 July 2015, 2045 patients were randomised to 12 months' trastuzumab and 2043 were randomised to 6 months' trastuzumab. Sixty-nine per cent of patients had ER-positive disease; 90% received anthracyclines (49% with taxanes; 41% without taxanes); 10% received taxanes without anthracyclines; 54% received trastuzumab sequentially after chemotherapy; and 85% received adjuvant chemotherapy (58% were node negative). At 6.1 years' median follow-up, with 389 (10%) deaths and 566 (14%) disease-free survival events, the 4-year disease-free survival rates for the 4088 patients were 89.5% (95% confidence interval 88.1% to 90.8%) in the 6-month group and 90.3% (95% confidence interval 88.9% to 91.5%) in the 12-month group (hazard ratio 1.10, 90% confidence interval 0.96 to 1.26; non-inferiority p = 0.01), demonstrating non-inferiority of 6 months' trastuzumab. Congruent results were found for overall survival (non-inferiority p = 0.0003) and landmark analyses 6 months from starting trastuzumab [non-inferiority p = 0.03 (disease-free-survival) and p = 0.006 (overall survival)]. Six months' trastuzumab resulted in fewer patients reporting adverse events of severe grade [365/1929 (19%) vs. 460/1935 (24%) for 12-month patients; p = 0.0003] or stopping early because of cardiotoxicity [61/1977 (3%) vs. 146/1941 (8%) for 12-month patients; p < 0.0001]. Health economic analysis showed that 6 months' trastuzumab resulted in significantly lower lifetime costs than and similar lifetime quality-adjusted life-years to 12 months' trastuzumab, and thus there is a high probability that 6 months' trastuzumab is cost-effective compared with 12 months' trastuzumab. Patient-reported experiences in the trial highlighted fatigue and aches and pains most frequently. LIMITATIONS The type of chemotherapy and timing of trastuzumab changed during the recruitment phase of the study as standard practice altered. CONCLUSIONS PERSEPHONE demonstrated that, in the treatment of HER2-positive early breast cancer, 6 months' adjuvant trastuzumab is non-inferior to 12 months'. Six months' treatment resulted in significantly less cardiac toxicity and fewer severe adverse events. FUTURE WORK Ongoing translational work investigates patient and tumour genetic determinants of toxicity, and trastuzumab efficacy. An individual patient data meta-analysis with PHARE and other trastuzumab duration trials is planned. TRIAL REGISTRATION Current Controlled Trials ISRCTN52968807, EudraCT 2006-007018-39 and ClinicalTrials.gov NCT00712140. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 40. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Helena Earl
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Anne-Laure Vallier
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Shrushma Loi
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Karen McAdam
- Department of Oncology, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luke Hughes-Davies
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Donna Howe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kerry Raynes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helen B Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Chris Plummer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Betania Mahler-Araujo
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Metabolic Research Laboratories, University of Cambridge, Cambridge, UK
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anita Chhabra
- Pharmacy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Sophie Gasson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Claire Balmer
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Jean E Abraham
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Carlos Caldas
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Peter Hall
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
- Health Economics Group, University of Exeter Medical School, Exeter, UK
| | - David Miles
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Andrew M Wardley
- NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David A Cameron
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| |
Collapse
|
5
|
Akdis D, Saguner AM, Medeiros-Domingo A, Schaller A, Balmer C, Steffel J, Brunckhorst C, Duru F. Multiple clinical profiles of families with the short QT syndrome. Europace 2019; 20:f113-f121. [PMID: 29016797 DOI: 10.1093/europace/eux186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/03/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Short QT syndrome (SQTS) is a rare cardiac channelopathy characterized by a shortened corrected QT (QTc)-interval that can lead to ventricular arrhythmias and sudden cardiac death. The aim of this study was to investigate the clinical phenotypes and long-term outcomes of three families harbouring genetic mutations associated with the SQTS. Methods and results Clinical data included medical history, physical examination, 12-lead ECG, 24-h Holter-ECG, and transthoracic echocardiography from three index patients and their first-degree relatives. Next generation clinical exome sequencing and genetic cascade screening were performed in index patients and their relatives, respectively. Two index patients experienced malignant ventricular arrhythmias and one patient suffered from arrhythmogenic syncope during a median follow-up period of 8 years. They all had genetic mutations associated with the SQTS. Two mutations were found in the KCNH2 gene, and one in the CACNA2D gene. One patient had an additional SCN10A variant. Alive and mutation-positive family members had short QTc-intervals, but no further phenotypic manifestations. None of the mutation-negative family members had an abnormal ECG or any symptoms. In all patients with shortened QTc-intervals, the QTc-interval had a low long-term variability and QTc shortening always remained detectable by 12-lead ECG. Conclusion This study shows the variety of phenotypic manifestations in different families with SQTS. It further emphasizes the importance of a 12-lead ECG for early diagnosis, and the utility of next generation sequencing for the identification of mutations associated with the SQTS.
Collapse
Affiliation(s)
- D Akdis
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - A M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - A Medeiros-Domingo
- Department of Cardiology, Inselspital Bern, University Hospital Bern, Freiburgstrasse 8, CH-3010 Bern, Switzerland
| | - A Schaller
- Division of Human Genetics, Department of Pediatrics, Inselspital Bern, University Hospital Bern, Freiburgstrasse 8, CH-3010 Bern, Switzerland
| | - C Balmer
- Department of Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland
| | - J Steffel
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - C Brunckhorst
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - F Duru
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| |
Collapse
|
6
|
Abdelrahim A, Balmer C, Jones J, Mehanna H, Dunn J. Considerations for a head and neck smoking cessation support programme; A qualitative study of the challenges in quitting smoking after treatment for head and neck cancer. Eur J Oncol Nurs 2018; 35:54-61. [PMID: 30057084 DOI: 10.1016/j.ejon.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/13/2017] [Revised: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Smoking is a major cause of head and neck squamous cell carcinoma (HNSCC), yet many patients who receive a diagnosis continue to smoke. This has an adverse effect on treatment and recovery, and leads to increased risks of recurrence and second cancers. There is evidence that stopping smoking after diagnosis can lead to better outcomes and reversal of risks. However, there is limited evidence for effective smoking cessation interventions in this population, and little about patient opinions regarding quitting smoking and support provided by healthcare professionals. METHODS This qualitative study was conducted as part of a larger project with the objective of developing a smoking cessation support programme. Eleven patients who had completed head and neck cancer (HNC) treatment were interviewed about smoking and quitting attempts. Interviews were semi-structured and took place face-to-face or over the phone. RESULTS Participants gave detailed accounts of their smoking journey. Thematic analysis of the data led to the identification of 2 overarching themes and four interlinking themes. Themes describe the 'guilty habit' of smoking, perceived 'barriers to quit', the 'teachable moment' of a diagnosis and the contrary 'social motivation' to both smoke and quit. CONCLUSIONS The results of this study highlight some missed needs for this group and major gaps in the support that is available. It is intended that the results will be used to develop a support programme for quitting smoking long term in a way that is useful and relevant to this complex population.
Collapse
Affiliation(s)
- Ameera Abdelrahim
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK; Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK.
| | - Claire Balmer
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - June Jones
- Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Hisham Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| |
Collapse
|
7
|
Dunn J, Hiller L, Balmer C, Wilcox M, Vallier AL, Gasson S, Hulme C, Miles D, Wardley AM, Cameron DA, Earl HM. Patient’s perspective of living with and beyond the treatment of trastuzumab: Results from the PERSEPHONE early breast cancer trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22101] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Janet Dunn
- Warwick Clinical Trials Unit, Coventry, United Kingdom
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | - Maggie Wilcox
- Independent Cancer Patients Voice, London, United Kingdom
| | - Anne-Laure Vallier
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sophie Gasson
- Warwick Clinical Trials Unit, Coventry, United Kingdom
| | - Claire Hulme
- University of Leeds, Academic Unit of Health Economics, Leeds, United Kingdom
| | - David Miles
- Mount Vernon Cancer Center, Medical Oncology, London, United Kingdom
| | - Andrew M. Wardley
- The NIHR Manchester Clinical Research Facility at The Christie NHS Foundation Trust & University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - David A. Cameron
- University of Edinburgh, Cancer Research UK Edinburgh Centre, Edinburgh, United Kingdom
| | - Helena Margaret Earl
- University of Cambridge, Department of Oncology & NIHR Cambridge Biomedical Research Centre & Cambridge University Hospitals NHS Foundation Trust, Cambridge Breast Cancer Research Unit, Cambridge, United Kingdom
| | | |
Collapse
|
8
|
Telishevska M, Hebe J, Nürnberg JH, Paul T, Krause U, Gebauer R, Gass M, Balmer C, Berger F, Molatta S, Emmel M, Lawrenz W, Kriebel T, Hessling G. Catheter Ablation in Asymptomatic Pediatric WPW Patients: Results from a Large Multicenter Study. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - J. Hebe
- Center f. Electrophysiology, Bremen, Germany
| | | | - T. Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany
| | - U. Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany
| | - R. Gebauer
- Department of Pediatric Cardiology, Heart Center, University Hospital, Leipzig, Germany
| | - M. Gass
- Department of Electrophysiology, Lake Heart Center, Constance, Germany
| | - C. Balmer
- Department of Pediatric Cardiology, University Children`s Hospital, Zurich, Switzerland
| | - F. Berger
- Department of Pediatric Cardiology, University Children`s Hospital, Zurich, Switzerland
| | - S. Molatta
- Clinic for Cardiology Heart and Diabetes Center, NRW Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - M. Emmel
- Department of Pediatric Cardiology, Heart Center, University Hospital, Cologne, Germany
| | - W. Lawrenz
- Department of Pediatric Cardiology, Congenital Heart Disease, Heart Center, Duisburg, Germany
| | - T. Kriebel
- Department of Pediatric Cardiology, Westpfalz-Klinikum, Kaiserslautern, Germany
| | | |
Collapse
|
9
|
Abdelrahim A, Balmer C, Mehanna H, Jones J, Dunn J. Smoking after cancer: A qualitative study of the challenges in quitting smoking after a diagnosis of, and treatment for, head and neck cancer. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.07.135] [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: 10/20/2022] Open
|
10
|
Balmer C, Griffiths F, Dunn J. A review of the issues and challenges involved in using participant-produced photographs in nursing research. J Adv Nurs 2015; 71:1726-37. [DOI: 10.1111/jan.12627] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Balmer
- Warwick Medical School Clinical Trials Unit; Coventry UK
| | | | - Janet Dunn
- Warwick Medical School Clinical Trials Unit; Coventry UK
| |
Collapse
|
11
|
Balmer C, Griffiths F, Dunn J. A 'new normal': Exploring the disruption of a poor prognostic cancer diagnosis using interviews and participant-produced photographs. Health (London) 2014; 19:451-72. [PMID: 25323052 DOI: 10.1177/1363459314554319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer survival is increasing, and many people are living years after cancer treatment. For example, it is predicted that 46 per cent of men and 56 per cent of women diagnosed in 2007 in England and Wales will survive their cancer for 5 years or more. However, 'survivors' may be living with significant physical, psychological and social disruption caused by their illness. Furthermore, huge disparities exist in the outcomes for different cancer 'types', and there has been little investigation of those living with 'poor prognostic' cancers. Our aim was to explore the experience of living after the diagnosis of a poor prognostic cancer. Data were gathered from 30 people via interviews and participants' own photographs. Our findings suggest that a full 'recovery' may be impossible after a cancer diagnosis. Such diagnoses will continue to threaten biographical trajectory and self-identity forever. 'Returning to normal' was considered highly important for participants, but a changed normality had to be accepted in which lives were managed carefully and a constant fear of recurrence created liminality and made 'survivorship' ambiguous. Experience was often complicated by the social response associated with cancer that hindered communication and increased isolation. Participant-produced photographs, used here for the first time specifically by a sample of people with poor prognosis cancer, proved to be an acceptable data collection method and have added a poignancy and 'completeness' to the data that have arguably led to a more comprehensive understanding.
Collapse
|
12
|
Dunn J, Donnelly P, Marshall A, Wilcox M, Watson E, Young A, Balmer C, Ramirez M, Hartup S, Maxwell A, Evans A. Follow-up in Early Breast Cancer — A Surgical and Radiological Perceptive. Clin Oncol (R Coll Radiol) 2014; 26:625-9. [DOI: 10.1016/j.clon.2014.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 01/29/2023]
|
13
|
Ehrlinspiel D, Balmer C, Kühlkamp V, Gass M. Transseptal Puncture for Radiofrequency Ablations in a Pediatric Population. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394068] [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: 10/24/2022]
|
14
|
Abstract
This case report is of a significant chemical burn to the face resulting from the use of an external garlic poultice for toothache. The patient used internet search engines to seek a toothache remedy and did not identify any reports of this complication. This report aims to inform all dentists of the risks of raw garlic application to the skin and also to ensure that in the future any patient using the internet for a toothache remedy will be made aware of the potential risk and how to avoid it.
Collapse
Affiliation(s)
- D Sisson
- Liverpool University Dental Hospital, USA
| | | |
Collapse
|
15
|
Balmer C, Griffiths F, Dunn J. A qualitative systematic review exploring lay understanding of cancer by adults without a cancer diagnosis. J Adv Nurs 2013; 70:1688-701. [DOI: 10.1111/jan.12342] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Claire Balmer
- Warwick Clinical Trials Unit; University of Warwick Medical School; Coventry UK
| | | | - Janet Dunn
- Health Sciences; University of Warwick Medical School; Coventry UK
| |
Collapse
|
16
|
Niemitz M, Seitz DCM, Oebels M, Schranz D, Hövels-Gürich H, Hofbeck M, Kaulitz R, Galm C, Berger F, Nagdymann N, Stiller B, Borth-Bruhns T, Konzag I, Balmer C, Goldbeck L. The development and validation of a health-related quality of life questionnaire for pre-school children with a chronic heart disease. Qual Life Res 2013; 22:2877-88. [DOI: 10.1007/s11136-013-0414-9] [Citation(s) in RCA: 11] [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] [Accepted: 04/10/2013] [Indexed: 11/28/2022]
|
17
|
Mueller P, Attenhofer Jost C, Rohrbach M, Valsangiacomo Buechel E, Seifert B, Balmer C, Kretschmar O, Baumgartner M, Weber R. Cardiac disease in children and young adults with various lysosomal storage diseases: Comparison of echocardiographic and ECG changes among clinical groups. Int J Cardiol Heart Vessel 2013; 2:1-7. [PMID: 29450157 PMCID: PMC5801096 DOI: 10.1016/j.ijchv.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/20/2013] [Indexed: 06/08/2023]
Abstract
BACKGROUND Lysosomal storage disease (LSD) is a rare inherited disease group. Consecutively there are few data on cardiac changes in mucopolysaccharidosis (MPS), Anderson Fabry disease (AFD), and other LSD (oLSD) including Pompe disease (PD) and Danon disease (DD), I-cell disease ICD and mucolipidosis III (ML III). METHODS Between 1994 and 2011, we identified 39 patients with LSD: 25 with MPS, 8 with AFD, and 6 with oLSD including PD (1), ML III (2), DD (1), and ICD (2) at our institution fulfilling the inclusion criteria of at least one echocardiogram and ECG. RESULTS Median age was 11.4 years (range: 2-27), 22 were females (56%). Normal echocardiograms were present in 12 patients (31%): 4 with MPS (16%), 7 AFD (88%), and 1 oLSD (17%). Valvular heart disease was present in 23 patients (59%) occurring more often in MPS (76%) and oLSD (67%) than in AFD (0%) (p < 0.001). The most common ECG abnormality was a short PR interval in 10 of 35 patients (29%) occurring in all LSD groups. Median follow-up was 5.8 (0.2-22.2) years showing diminished 5-year survival compared to an age-matched group. However, no patient died due to a cardiac cause and no cardiovascular intervention was necessary. CONCLUSION Echocardiographically detectable cardiovascular involvement in children with LSD is mostly confined to MPS and oLSD. Valve thickening in echo and a short PR interval in the ECG are the most frequent abnormalities. Routine repeat assessment is recommended in LSD. However, significant cardiac disease necessitating cardiac intervention is rare during a short follow-up.
Collapse
Affiliation(s)
- P. Mueller
- Department of Cardiology, University Children's Hospital, Switzerland
| | | | - M. Rohrbach
- Division of Metabolism, Children's Research Center, University Children's Hospital Zurich, Switzerland
| | | | - B. Seifert
- Division of Biostatistics, ISPM, University of Zurich, Switzerland
| | - C. Balmer
- Department of Cardiology, University Children's Hospital, Switzerland
| | - O. Kretschmar
- Department of Cardiology, University Children's Hospital, Switzerland
| | - M.R. Baumgartner
- Division of Metabolism, Children's Research Center, University Children's Hospital Zurich, Switzerland
| | - R. Weber
- Department of Cardiology, University Children's Hospital, Switzerland
| |
Collapse
|
18
|
Larenza MP, Althaus H, Conrot A, Balmer C, Schatzmann U, Bettschart-Wolfensberger R. Anaesthesia recovery quality after racemic ketamine or S-ketamine administration to male cats undergoing neutering surgery. SCHWEIZ ARCH TIERH 2012; 150:599-607. [DOI: 10.1024/0036-7281.150.12.599] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
19
|
Balmer C, Griffiths F, Dunn J. Using photovoice to study the experience of living with and beyond the diagnosis of a poor prognostic cancer. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000196.82] [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: 11/04/2022]
|
20
|
Macluskey M, Durham J, Balmer C, Bell A, Cowpe J, Dawson L, Freeman C, Hanson C, McDonagh A, Jones J, Millsopp L, Oliver R. Dental student suturing skills: a multicentre trial of a checklist-based assessment. Eur J Dent Educ 2011; 15:244-9. [PMID: 21985209 DOI: 10.1111/j.1600-0579.2010.00665.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND The assessment of clinical skills is essential to determine whether an undergraduate is competent to perform the tasks outlined in the curriculum. Such assessments in dentistry have historically not been subjected to large scale validity and reliability testing due the relatively small student numbers at each institute. The aims of this study were to test the validity and reliability of a standardised, checklist-based, suturing objective structured clinical examination (OSCE) and then to perform a multicentre trial to determine its performance over a large cohort of students. MATERIALS AND METHODS A total of seven UK schools agreed to take part in the trial. To test the validity and reliability of the checklist, the examiner at each institution reviewed and scored video footage of 10 students performing the assessment. Each institution then carried out the assessment providing a checklist score and a global score for each of their own students. RESULTS The assessment was well received by the staff, with acceptable inter-examiner variability. In total, 496 students completed the suturing OSCE with a success rate of 81% with a variation between schools of between 66% and 96%. A significant correlation was found between the checklist score and the global score (r = 0.361, P = 0.000). No one item on the checklist was found to be a determinant factor in the outcome of the OSCE. CONCLUSIONS This checklist-based assessment of suturing skills was found to have face and content validity. Its reliability was promising, but merits further investigation. There may be an argument for the standardisation of the assessment of this core surgical skill throughout several UK-based dental schools.
Collapse
Affiliation(s)
- M Macluskey
- Unit of Oral Surgery and Medicine, University of Dundee Dental School, Dundee, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Durham J, Balmer C, Bell A, Cowan G, Cowpe J, Crean SJ, Dawson L, Evans A, Freeman C, Jones J, Macluskey M, McDonagh A, McHanwell S, Millsopp L, Myrddin L, Oliver R, Renton T, Sivarajasingam V, Still D, Taylor K, Thomson P. A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom. Eur J Dent Educ 2010; 14:210-214. [PMID: 20946248 DOI: 10.1111/j.1600-0579.2009.00612.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post-graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. MATERIALS AND METHODS A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. RESULTS Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. CONCLUSION Using this generic checklist, it may now be possible to pool data inter-institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.
Collapse
Affiliation(s)
- J Durham
- Association of British Academic Oral and Maxillofacial Surgeons' National Education Group, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Mauch J, Kutter A, Madjdpour C, Spielmann N, Balmer C, Frotzler A, Bettschart-Wolfensberger R, Weiss M. Electrocardiographic changes during continuous intravenous application of bupivacaine in neonatal pigs. Br J Anaesth 2010; 105:437-41. [DOI: 10.1093/bja/aeq197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
23
|
Gimenez-Lopez MDC, Gardener JA, Shaw AQ, Iwasiewicz-Wabnig A, Porfyrakis K, Balmer C, Dantelle G, Hadjipanayi M, Crossley A, Champness NR, Castell MR, Briggs GAD, Khlobystov AN. Endohedral metallofullerenes in self-assembled monolayers. Phys Chem Chem Phys 2010; 12:123-31. [DOI: 10.1039/b915170b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Baldwin VE, Jarad FD, Balmer C, Mair LH. Inadvertent Injection of Sodium Hypochlorite into the Periradicular Tissues during Root Canal Treatment. ACTA ACUST UNITED AC 2009; 36:14-6, 19. [DOI: 10.12968/denu.2009.36.1.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- VE Baldwin
- General Dental Practitioner, Carrickfergus, UK
| | - FD Jarad
- Lecturer/Honorary SpR in Restorative Dentistry, UK
| | - C Balmer
- Consultant in Oral Surgery and Honorary Lecturer, Associate Dean of Postgraduate Dental Education, Liverpool University Dental Hospital, UK
| | - LH Mair
- Head of School of Dentistry, University of Central Lancashire, Preston, Lancs PR1 2HE, UK
| |
Collapse
|
25
|
Knirsch W, Stutz K, Kretschmar O, Tomaske M, Balmer C, Schmitz A, Berger F, Bauersfeld U, Weiss M. Regional cerebral oxygenation by NIRS does not correlate with central or jugular venous oxygen saturation during interventional catheterisation in children. Acta Anaesthesiol Scand 2008; 52:1370-4. [PMID: 19025530 DOI: 10.1111/j.1399-6576.2008.01703.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether regional cerebral oxygenation (rSO(2)) by near-infrared spectroscopy correlates with central venous (SvO(2)) or internal jugular (SjO(2)) oxygen saturation, and whether changes over time (Delta) in rSO(2) (DeltarSO(2)) predict changes in SvO(2) (DeltaSvO(2)) and SjO(2) (DeltaSjO(2)). METHODS The rSO(2) values were measured using the INVOS 5100 cerebral oximeter in children undergoing interventional cardiac catheterization and were compared with the oxygen saturation of analysed central venous and internal jugular blood samples. Changes over time (Delta) were calculated as the difference between the values before and after catheter intervention for rSO(2).(DeltarSO(2)), SvO(2).(DeltaSvO(2)) and SjO(2).(DeltaSjO(2)). Simple regression and Bland-Altman analysis were performed. Data are presented as median (range). RESULTS Sixty patients aged 4.3 (0.2-16.0) years were investigated. A closer correlation was found between rSO(2) and SvO(2) (r=0.728, P<0.0001) than between rSO(2) and SjO(2) (r=0.665, P<0.0001). The bias between rSO(2) and SvO(2).(SjO(2)) was 0.17% (-0.60%), with limits of agreement from -15.5% to 15. 9% (-18.6-17.4%). The sensitivity/specificity for DeltarSO(2) to indicate a fall in SvO(2) or in SjO(2) was 70.3%/65.2% and 68.6%/60.0%, respectively. CONCLUSION Neither absolute values nor changes in rSO(2) using the INVOS 5100 allowed reliable estimation of SvO(2) or SjO(2) and their trends.
Collapse
Affiliation(s)
- W Knirsch
- Division of Paediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Knirsch W, Kretschmar O, Tomaske M, Stutz K, Nagdyman N, Balmer C, Schmitz A, Berger F, Bauersfeld U, Weiss M. Comparison of cardiac output measurement using the CardioQPTMoesophageal Doppler with cardiac output measurement using thermodilution technique in children during heart catheterisation. Anaesthesia 2008; 63:851-5. [DOI: 10.1111/j.1365-2044.2008.05495.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Tomaske M, Knirsch W, Kretschmar O, Woitzek K, Balmer C, Schmitz A, Bauersfeld U, Weiss M. Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution. Br J Anaesth 2008; 100:517-20. [PMID: 18305081 DOI: 10.1093/bja/aen024] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon) monitor with the pulmonary artery catheter (PAC) thermodilution method in children. METHODS CO values using the Aesculon monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland-Altman analysis. Data were presented as mean (sd). A mean percentage of <30% was defined to indicate clinical useful reliability of the Aesculon monitor. RESULTS A total of 50 patients with a median (range) age of 7.5 (0.5-16.5) yr were enrolled in the study. Mean CO values were 3.7 (1.5) litre min(-1) (PAC thermodilution) and 3.1 (1.7) litre min(-1) (Aesculon) monitor). Analysis for CO measurement showed a good correlation between the two methods (r=0.894; P<0.0001). The bias between the two methods was 0.66 litre min(-1) with a precision of 1.49 litre min(-1). The mean percentage error for CO measurements was 48.9% for the Aesculon monitor when compared with PAC thermodilution. CONCLUSIONS Electrical velocimetry using the Aesculon monitor did not provide reliable CO values when compared with PAC thermodilution. Whether the Aesculon monitor can be used as a CO trend monitor has to be assessed by further investigations in patients with changing haemodynamics.
Collapse
Affiliation(s)
- M Tomaske
- Division of Paediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Dodge-Khatami A, Weber R, Balmer C, Fasnacht M, Prêtre R, Bauersfeld U. Neonatal surgical systemic-pulmonary artery shunts in complex congenital heart defects: The impact of shunt type on outcome. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967297] [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: 10/21/2022]
|
29
|
Weiss M, Knirsch W, Kretschmar O, Dullenkopf A, Tomaske M, Balmer C, Stutz K, Gerber AC, Berger F. Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment †. Br J Anaesth 2006; 96:486-91. [PMID: 16464981 DOI: 10.1093/bja/ael014] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Aims of this study were to assess the maximum displacement of tracheal tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the Microcuff Paediatric Endotracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation. METHODS We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients' tracheas were orally intubated and the tracheal tubes positioned with the intubation depth mark at the level of the vocal cords. The tracheal tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30 degrees flexion, 0 degrees neutral position and 30 degrees extension. RESULTS One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum tracheal tube-tip displacement after head-neck 30 degrees extension and 30 degrees flexion demonstrated a linear relationship to age [maximal upward tube movement (mm)=0 0.71 x age (yr)+9.9 (R(2)=0.893); maximal downward tube movement (mm)=0.83 x age (yr)+9.3 (R(2)=0.949)]. Maximal tracheal tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension. CONCLUSIONS The intubation depth marks were appropriate to avoid inadvertent tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the tracheal tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer time.
Collapse
Affiliation(s)
- M Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Barclay J, Vestey J, Lambert A, Balmer C. Reducing the symptoms of lymphoedema: is there a role for aromatherapy? Eur J Oncol Nurs 2006; 10:140-9. [PMID: 16563861 DOI: 10.1016/j.ejon.2005.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 10/14/2005] [Accepted: 10/19/2005] [Indexed: 11/18/2022]
Abstract
Lymphoedema is a chronic and debilitating condition caused by lymphatic insufficiency, which may have serious physical, social and psychological implications for the patient. It is usually managed by a combination of strategies aimed at protecting and decongesting the oedematous limb(s) and stimulating the development of supplementary lymphatic pathways to control swelling in the long-term. However, it is not known which therapies are the most effective. Anecdotally, the addition of aromatherapy oils to massage cream may have a positive effect on symptom relief in people with cancer, although evidence is again lacking. This paper describes a randomized trial of self-massage and skin care using a cream containing aromatherapy oils versus self-massage and skin care using a cream without aromatherapy oils on objective limb volume measurements and symptom relief as measured by the Measure Yourself Medical Outcome Profile 2 (MYMOP2) in a sample of people with lymphoedema. Results indicate that self-massage and skin care significantly improved patient-identified symptom relief and wellbeing for this sample. It also slightly, but not significantly reduced limb volume. However, aromatherapy oils, carefully chosen on the basis that they should benefit this group, did not appear to influence any improvement in these measures.
Collapse
Affiliation(s)
- Janet Barclay
- Dorset Cancer Centre, Poole Hospital, Longfleet Road, Poole BH15 2JB, UK
| | | | | | | |
Collapse
|
31
|
Abstract
Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.
Collapse
Affiliation(s)
- Claire Balmer
- Dorset Cancer Centre, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB, UK.
| |
Collapse
|
32
|
Chaudhari M, Balmer C, Heng JT, Wright J, Stümper O. Usefulness of Blalock-Taussig shunt Doppler flow velocity profiles in the assessment of pulmonary artery pressure and flow. Eur J Echocardiogr 2004; 5:111-7. [PMID: 15036022 DOI: 10.1016/s1525-2167(03)00052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Revised: 06/03/2003] [Accepted: 06/04/2003] [Indexed: 10/26/2022]
Abstract
AIM To assess the utility of continuous wave Doppler evaluation of velocity profiles across a Blalock-Taussig (BT) shunt in the evaluation of pulmonary artery pressure and pulmonary blood flow. METHODS AND RESULTS Eleven children with complex congenital heart disease with a BT shunt as the sole source of pulmonary blood supply were studied prospectively (median age 5 (0.3-21) months). Doppler evaluations of shunt flow velocity profile and cardiac catheterization were carried out simultaneously. Pulmonary artery pressure and flow were estimated using the modified Bernoulli equation and velocity time integral of shunt flow. There was a positive correlation between (1) the Doppler estimates for mean pulmonary artery pressure, using the diastolic flow velocity, and the mean pulmonary venous wedge pressure ( r = 0.93, SEE = 1.0 mmHG; P<0.001 ) and (2) the Doppler derived and calculated pulmonary blood flow ( r = 0.9, SEE = 0.19 l/min; P<0.001). In contrast, the Doppler estimates for mean pulmonary artery pressure using the peak or mean Doppler gradients were poor. CONCLUSION The diastolic BT shunt flow velocity can be used reliably to predict mean pulmonary artery pressure when a BT shunt is the sole source of pulmonary artery flow. There was agreement between Doppler predicted pulmonary blood flow and catheter based calculations. These findings may prove a useful tool for perioperative management.
Collapse
Affiliation(s)
- M Chaudhari
- The Heart Unit, Birmingham Children's Hospital--NHS Trust, Steelhouse Lane, Birmingham, UK
| | | | | | | | | |
Collapse
|
33
|
Balmer C, Beghetti M, Fasnacht M, Friedli B, Arbenz U. Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart 2004; 90:77-81. [PMID: 14676250 PMCID: PMC1768038 DOI: 10.1136/heart.90.1.77] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate immediate and midterm results after balloon valvoplasty in a paediatric population with congenital aortic stenosis, giving special consideration to aortic regurgitation. DESIGN Retrospective study. SETTING Two tertiary referral centres for paediatric cardiology. PATIENTS 70 consecutive patients, with an age range of 0-16.4 years. Group A infants < 3 months old (n = 21). Group B children > 3 months old (n = 49). Median follow up time was 19.8 months, range 0-158 months. INTERVENTION All patients underwent balloon aortic valvoplasty. The balloon to annulus ratio was selected at a mean of 0.90 (range 0.67-1.0). MAIN OUTCOME MEASURES Doppler gradients and degree of aortic regurgitation. RESULTS The pressure gradient dropped significantly with the intervention and increased mildly at follow up. Freedom from relevant aortic regurgitation (that is, moderate and severe) was initially lower in group A (75% v 90% after one month) but after two years the difference between the two groups was not significant (50% v 61%). Freedom from reintervention was significantly lower in group A (with 35% v 80%) after three years. CONCLUSION Aortic balloon valvoplasty is safe and effective but has a high rate of early reintervention in infants with critical aortic stenosis. The major long term problem is progressive aortic regurgitation, which does not seem to be prevented by the use of small balloons.
Collapse
Affiliation(s)
- C Balmer
- Paediatric Cardiology Units of the Children's University Hospital, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
34
|
Balmer C, Fasnacht M, Rahn M, Molinari L, Bauersfeld U. Long-term follow up of children with congenital complete atrioventricular block and the impact of pacemaker therapy. Europace 2002; 4:345-9. [PMID: 12408251 DOI: 10.1053/eupc.2002.0266] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS This study assessed survival, morbidity and impact of pacemaker (PM) therapy in children with Congenital Complete Atrioventricular Block (CCAVB). METHODS AND RESULTS Data of 32 children, diagnosed as showing CCAVB at a median age of 0.4 years (range foetal-10 years), were retrospectively analysed. For comparison of clinical data patients were separated into two groups: CCAVB without structural heart disease (group 1; n = 23) and with structural heart disease (group 2; n = 9). Median follow-up time was 10.2 years. Pacemakers (PM) were implanted in 17 group 1 and all group 2 children. Frequency of PM therapy, age and symptoms before PM implantation did not differ significantly between the groups. Indications for PM implantation were bradycardia in 15, decreased exercise tolerance in 6, syncope in 3 and heart failure in 2 children. PM system related complications occurred in 11/26 (42%) children. Although 1 child died due to PM exit block no further CCAVB related symptoms were recorded in children with PM. CONCLUSION PM therapy reduces mortality and morbidity in children with CCAVB when compared with natural history data. Although children with PM are free from CCAVB related symptoms limited morbidity remains due to PM system related complications.
Collapse
Affiliation(s)
- C Balmer
- Division of Paediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
35
|
|
36
|
Balmer C, Lunn D, Jansson J, Dawson T. An education programme for people with cancer. Prof Nurse 2000; 15:663-6. [PMID: 12026466] [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: 02/25/2023]
Abstract
Evidence suggests that cancer patients want support, information and to be involved in treatment decisions. A course designed in the USA aims to help cancer patients learn more about the disease and become an informed part of the therapeutic team. The introduction of a similar course at one UK centre suggested that it is an effective way of informing and supporting people.
Collapse
Affiliation(s)
- C Balmer
- Dorset Cancer Centre, Poole Hospital NHS Trust
| | | | | | | |
Collapse
|
37
|
Walsh P, Gonzalez R, Dow S, Elmslie R, Potter T, Glode LM, Baron AE, Balmer C, Easterday K, Allen J, Rosse P. A phase I study using direct combination DNA injections for the immunotherapy of metastatic melanoma. University of Colorado Cancer Center Clinical Trial. Hum Gene Ther 2000; 11:1355-68. [PMID: 10890744 DOI: 10.1089/10430340050032447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Walsh
- Division of Dermatology, University of Colorado Health Sciences Center, Denver 80262, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
Temporal parameters of the gait cycle and foot roll over in 105 healthy adults (75 women and 30 men aged 16 to 63 years) were collected using foot switches. The subjects walked unobserved at their preferred pace and velocity in a hallway 19 m long and 2.8 m wide. After correction for height, a significant gender influence remained on stance parameters and stride duration. For these adults, age had an effect on the forward tilt of the foot and the double support time only. Differences due to side related only to foot patterning and not stride, stance and swing times. Asymmetry coefficient for temporal parameters of gait cycle and foot roll over revealed the greatest asymmetry in metatarsal head and great toe latency and support. These reference data are considered valid in a laboratory using sensors and signal processing comparable to ours.
Collapse
Affiliation(s)
- Y Blanc
- Laboratoire de Cinésiologie, Hôpitaux Universitaires, 24 Rue Micheli du Crest, 1211, Genève,
| | | | | | | |
Collapse
|
39
|
|
40
|
Balmer C, Stastny B, Hochreutener H, Kind C, Baerlocher K. Zweimaliges toxisches Schocksyndrom. Monatsschr Kinderheilkd 1998. [DOI: 10.1007/s001120050255] [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]
|
41
|
Crawford ED, Kozlowski JM, Debruyne FM, Fair WR, Logothetis CJ, Balmer C, Robinson RG, Porter AT, Kirk D. The use of strontium 89 for palliation of pain from bone metastases associated with hormone-refractory prostate cancer. Urology 1994; 44:481-5. [PMID: 7524233 DOI: 10.1016/s0090-4295(94)80043-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E D Crawford
- Division of Urology, University of Colorado Health Sciences Center, Denver
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kane MA, Johnson A, Nash AE, Boose D, Mathai G, Balmer C, Yohn JJ, Robinson WA. Serum melatonin levels in melanoma patients after repeated oral administration. Melanoma Res 1994; 4:59-65. [PMID: 8032220 DOI: 10.1097/00008390-199402000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The goal of this study was to determine the effect of oral melatonin in divided doses on plasma melatonin levels in patients with metastatic melanoma. Hourly blood samples were obtained from five patients for 24 h prior to melatonin administration and for 24 h during oral administration of melatonin, 50 mg every 4 h. In two of the five patients, the expected nocturnal plasma melatonin peak was observed. Oral melatonin was well absorbed. Plasma melatonin levels exhibited six peaks and troughs, were two to four-fold higher during peaks than troughs, and remained more than 25 times higher than peak pretreatment melatonin levels, even during troughs. Divided oral doses of melatonin were well tolerated and maintained plasma melatonin levels 25-80 times higher than endogenous peak values.
Collapse
Affiliation(s)
- M A Kane
- Division of Medical Oncology, University of Colorado Health Sciences Center, Denver 80262
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
We undertook a study to investigate the therapeutic potential of orally administered melatonin in patients with advanced melanoma. Forty-two patients received melatonin in doses ranging from 5 mg/m2/day to 700 mg/m2/day in four divided doses. Two were excluded from analysis. After a median follow-up of 5 weeks, six patients had partial responses, six additional patients had stable disease. Sites of response included the central nervous system, subcutaneous tissue and lung. The median response duration was 33 weeks for the partial responders. There was a suggestion of a dose-response relationship. The toxicity encountered was minimal and consisted primarily of fatigue in 17 of 40 patients. Melatonin also appeared to reduce basal levels of follicle-stimulating hormone (FSH). No significant changes were encountered in serum levels of luteinizing hormone (LH) or thyroid stimulating hormone (TSH). We conclude that further study of melatonin as a potentially useful agent in metastatic melanoma is warranted.
Collapse
Affiliation(s)
- R Gonzalez
- Division of Medical Oncology, University of Colorado Cancer Center, Denver 80262
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
A tissue-equivalent test material for MRI has been produced from a polysaccharide gel, agarose, containing gadolinium chloride chelated to EDTA. By varying the amounts of each constituent, the T1 and T2 of the material can be varied independently. As a result, the entire range of in vivo tissue relaxation times can be covered. Through the mathematical modelling of the 1H relaxation theories for both the gel and chelated paramagnetic ion, it has been possible to create a material with relaxation properties and behaviour predictable as functions of both the Larmor frequency and temperature. The similarity of the material to in vivo tissues, in terms of its biological and physical NMR characteristics, makes it an excellent tissue-equivalent substance, in addition to being an accurate calibration standard for routine MRI.
Collapse
Affiliation(s)
- P M Walker
- Department of Medical Physics, Hammersmith Hospital, London, UK
| | | | | | | |
Collapse
|
45
|
Scollo-Lavizzari G, Balmer C. Electroencephalography and computerized transaxial tomography in patients with temporal lobe epilepsy. Eur Neurol 1980; 19:33-8. [PMID: 7371651 DOI: 10.1159/000115125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Computerized transaxial tomography was carried out on 112 patients with partial seizures with complex symptomatology. Structural abnormalities were defined in 33% of their studies: tumors in 8 patients, diffuse cerebral atrophy in 2, focal cortical atrophy in 27 and vascular abnormality in 1 case.
Collapse
|