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Mentessidou A, Djendov F, Long AM, Jackson C. Systematic Review and Meta-analysis of Laparoscopic Versus Open Radical Nephrectomy for Paediatric Renal Tumors With Focus on Wilms' Tumor. Ann Surg 2024; 279:755-764. [PMID: 37990910 DOI: 10.1097/sla.0000000000006154] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To summarize and evaluate the outcomes of laparoscopic radical nephrectomy (LRN) and compare its safety and efficacy with open radical nephrectomy (ORN) in pediatric renal tumors (RT) and Wilms' tumors (WT). BACKGROUND ORN is the gold standard treatment for pediatric RT, consisting predominantly of WT. LRN is gaining popularity but remains controversial in pediatric surgical oncology. METHODS A systematic search was performed for all eligible studies on LRN and comparative studies between LRN and ORN in pediatric RT and WT. Meta-analysis, subgroup analysis, and sensitivity analysis were conducted. The main endpoints were cancer-related outcomes and surgical morbidity. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. RESULTS No levels I to II studies were identified. LRN was feasible in nearly 1 in 5 pediatric RT and WT after neoadjuvant chemotherapy, with pooled mid-term oncological outcomes (<7% local recurrence, >90% event-free survival) comparable with those of ORN. There was no strong evidence of an increased risk of intraoperative tumor spillage, but lymph node harvest was inadequate in LRN. Large tumors crossing the ipsilateral spinal border were associated with a trend for intraoperative complications and positive margins. Pooled complications rate and hospital stay duration were similar between LRN and ORN. Long-term (>3 years) outcomes are unknown. CONCLUSIONS Available level III evidence indicates that LRN is a safe alternative to ORN for carefully selected cases, with similar spillage rates and mid-term oncological outcomes. However, there was no advantage in surgical morbidity and lymph node harvest was inadequate with LRN. Tumor-matched-group studies with long-term follow-up are required. LEVEL OF EVIDENCE Level III.
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Lepre B, Job J, Martin Z, Kerrigan N, Jackson C. The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice. BMC Health Serv Res 2023; 23:1183. [PMID: 37907917 PMCID: PMC10617120 DOI: 10.1186/s12913-023-10189-0] [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: 03/31/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND There is a critical lack of medical workforce internationally, and this is particularly notable in rural and remote Australia where strategies to address workforce shortages are urgently required. This pilot study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the Australian rural primary care setting. METHODS The VIP model was developed using co-creation methodology and involves an urban GP joining a rural general practice team to provide ongoing care to patients remotely via secure telehealth. The pilot study was conducted in two western Queensland general practices, commencing in October 2021 with one rural practice and extending to an additional rural practice from November 2022. Evaluation included a retrospective review of service, billing and cost data, and an online survey for patients. Ethical approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2021/HE002434). RESULTS There were 1468 services provided through to December 2022, including general consults (n = 1197), therapeutic procedures (n = 68), mental health treatment plans (n = 68) and chronic disease management plans (n = 59). Patients were predominantly female (73.1%) and did not have their appointment at the practice (57.8%). Among 1282 occasions of service, less than 20% of consultations (n = 224) required support from staff (e.g., a nurse), and more than half were repeat patient encounters (53.0%). Survey respondents (n = 45) indicated that they were satisfied (9.3%) or highly satisfied (90.7%) with the care provided, and importantly, 95.5% of respondents reported that the service improved their access to the GP. More than 20% of respondents indicated that they would attend the Emergency Department if virtual care was not available. CONCLUSIONS Data from this pilot study has informed translation to an additional 20 vulnerable rural general practices in three further rural regions in Queensland in 2023 and evaluation is ongoing. This pilot study demonstrates the feasibility and acceptability of an innovative, digitally supported community-focussed, healthcare initiative to arrest the decline in rural general practice workforce, improve patient care access and support rural practice viability.
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Affiliation(s)
- Breanna Lepre
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, 4067, Australia
| | - Jennifer Job
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia
| | - Zena Martin
- Health Workforce Queensland, Level 4, 348 Edward Street, Brisbane, QLD, 4000, Australia
| | - Natalie Kerrigan
- Western Queensland Primary Health Network, 11 Barkly Hwy, Mount Isa 4825, Miles End QLD, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute (UQ/MRI), Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia.
- General Practice Clinical Unit, School of Medicine, University of Queensland, Royal Brisbane Hospital, Level 8, Health Sciences Building, Herston, QLD, 4029, Australia.
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Bhatia R, Mai A, George J, Cao Y, Siu C, Lee EE, Redmond KJ, Jackson C, Lim M, Bettegowda C, Kleinberg LR. Outcomes of Brain Metastases with Suspicious Imaging Undergoing Resection to Evaluate for Radionecrosis vs. Tumor Progression. Int J Radiat Oncol Biol Phys 2023; 117:e88. [PMID: 37786204 DOI: 10.1016/j.ijrobp.2023.06.843] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In patients treated with stereotactic radiosurgery (SRS) for brain metastases, radiographic changes on surveillance imaging may result from treatment effect/radionecrosis (RN) or tumor progression. Distinguishing between these processes is critical to appropriate management. We report long-term outcomes for a cohort of patients who demonstrated radiographic progression on serial imaging after initial radiation and ultimately underwent resection to inform further management. MATERIALS/METHODS A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022 that were initially treated with SRS, then demonstrated suspicious imaging changes developing through at least two scan time points that led to pathologic confirmation of either tumor or RN. We report clinical outcomes and details of further treatments. RESULTS Of the 82 lesions, 55 (67.1%) were found to be pathologically-confirmed viable tumor and were treated with repeat radiation and 27 (32.9%) were found to be strictly RN and conservatively managed. Over half of the lesions (14/27) ultimately found to be radionecrotic required use of steroids pre-operatively due to neurologic symptoms. Among the 27 that were found to be RN, the most common histology was melanoma (33.3%, n = 9). The most common dose fractionation regimen was 20 Gy in 1 fx (n = 11, 40.7%; range: 16-20 Gy x 1Fx), and the median BED (10) was 50.4 Gy (IQR 41.6 - 50 Gy). None of these lesions required further intervention with median post-surgery follow up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of pathologically-confirmed recurrent/progressive tumor who were consequently treated with repeat radiation with either Cs-131 brachytherapy (12 (21.8%)) or SRS (43 (78.2%)). The most common histology was NSCLC (37.2%, n = 19). The most common fractionation for repeat irradiation with SRS was 8 Gy x 3 fx (n = 15, 27.3%), followed by 5 Gy x 5 fx (n = 10, 18.2%), and 4 Gy x 5 fx (n = 8, 14.6%). Four individuals each had two lesions that were re-irradiated for local recurrence. Among patients treated with re-irradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). Radionecrosis was confirmed on pathology in 4/55 (7.2%) of lesions. The median follow-up from date of SRS2 to local failure was 14.1 months (95% CI 7.6-24.3 months). The 2-yr local control rate was 74.8% (95% CI 61.7-90.7%). CONCLUSION We recommend cautious monitoring of possible progression after radiosurgery, with consideration of resection for continuous progression, as a significant proportion of radiographic progression are ultimately pure RN. Management determined by pathology (observation for RN; additional radiation for confirmed tumor) leads to excellent control.
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Affiliation(s)
- R Bhatia
- Johns Hopkins University, Baltimore, MD
| | - A Mai
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA
| | - Y Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Siu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - E E Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Lim
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - C Bettegowda
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Petre J, Donald M, Jackson C. Supporting complex care in general practice via an eConsultant model of care: the Australian specialist perspective. Aust J Prim Health 2023; 29:455-462. [PMID: 37183355 DOI: 10.1071/py22243] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Accessing timely specialist physician advice and guidance is of critical importance to both Australian GP specialists (GPs) and their patients. The traditional method of referral, triage and subsequent face-to-face (FTF) consultation is facing challenges from an ever increasing volume of referrals and the needs of underserved populations. In response to such issues, electronic consults (eConsults) have been successfully used internationally to provide GPs with a means of asynchronously accessing specialist physician advice and guidance within 72h. Few studies have addressed the potential impact of eConsults from the view of the non-GP specialist receiving the request, and none specifically related to specialist adult medicine physicians. The aim of this study was to determine the perceptions of current Royal Australasian College of Physicians (RACP) adult medicine Fellows towards establishing an eConsult model of care within their own clinical practice. METHODS Semi-structured interviews were conducted with 14 RACP adult medicine Fellows between December 2019 and February 2020. Purposive and snowball sampling strategies were used to recruit physicians of differing ages and gender from diverse specialties and healthcare settings. The data were subjected to a descriptive thematic analysis. RESULTS We describe five key themes of relevance to study participants: (1) improved access to non-GP specialist care; (2) the business model in relation to remuneration and time; (3) enhanced GP-Physician relationships; (4) impact on physician work-life balance; and (5) the need for a structured model of care. There was broad consensus that a significant number of outpatient referrals to adult medicine physicians would be more appropriately addressed in primary care with support via an asynchronous eConsult arrangement. RACP Fellows agreed this could improve access to timely specialist advice, place downward pressure on outpatient FTF clinic waiting times and reduce unnecessary patient travel. CONCLUSION These findings identify the drivers and barriers to the establishment of an Australian eConsultant model of care from the adult medicine physician's perspective.
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Affiliation(s)
- Joel Petre
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
| | - Maria Donald
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
| | - Claire Jackson
- UQ Centre for Health System Reform and Integration, University of Queensland, Brisbane, Qld 4006, Australia
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Jackson C, Abramson DH, Nunez DA, Cohen GN, Randazzo J, Wexler LH, Wolden SL. Treatment of Recurrent Orbital Rhabdomyosarcoma with Exenteration and HDR Brachytherapy in a Custom Mold. Int J Radiat Oncol Biol Phys 2023; 117:e520-e521. [PMID: 37785622 DOI: 10.1016/j.ijrobp.2023.06.1789] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Rhabdomyosarcoma (RMS) is the most frequent cancer affecting the orbit in children. The orbit is classified as a favorable site for RMS as treatment with chemotherapy and radiation is effective. Local failure for patients with RMS of the orbit has ranged from 2-16% on IRS and COG protocols. In the event of local recurrence, survival is poor, and management is difficult. We report four patients with local recurrence of orbital RMS managed with orbital exenteration followed by high dose rate (HDR) brachytherapy. MATERIALS/METHODS Four patients were treated from 2016-2022. HDR brachytherapy with Ir-192 was delivered in a custom mold of the orbit made after the orbital exenteration procedure. Brachytherapy was given in 6-7 twice daily (BID) fractions starting 1 week after the orbital exenteration. RESULTS At the time of brachytherapy, patient ages were 3, 1, 7, and 7 years. Three patients had embryonal histology and underwent initial systemic therapy with ARST0331 regimen A. The fourth patient had alveolar, FOXO1 fusion positive RMS and was initially treated as per COG D9803 regimen A. All patients had received proton radiotherapy as part of initial treatment. Three received 50.40 Gy and one received 45 Gy. Patients developed biopsy-proven, recurrent disease an average of 56 weeks (range 38-77) after initial diagnosis. All patients received salvage chemotherapy before undergoing orbital exenteration at an average of 12 weeks after recurrence (range 5-16). Three patients received 30 Gy in 6 BID fractions, and one patient received 28 Gy in 7 fractions with HDR brachytherapy using an Ir-192 source. All four patients are alive without evidence of disease at an average of 27 months (range 6-70) from recurrence and 39 months (range 21-78) from initial diagnosis. All patients have acceptable orbit healing. Two patients have asymptomatic evidence of frontal lobe edema (and in one case possible necrosis) extending 1-2 cm above the orbit. This appears to be beyond the range of the brachytherapy dosimetry, but the combination of proton beam and brachytherapy are implicated. No other toxicities have occurred. CONCLUSION Orbital RMS has a favorable prognosis, but local failure after initial combined modality therapy can be fatal. Options for successful local salvage are limited. Orbital exenteration with HDR brachytherapy in a custom mold is an effective and safe procedure for local control in these difficult cases.
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Affiliation(s)
- C Jackson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D H Abramson
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - G N Cohen
- MSKCC, NY, NY; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Randazzo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S L Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY
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Baniel CC, Johnston L, Jackson C, Arai S, Hiniker SM, Hoppe RT, Binkley MS. Low Dose Splenic Radiotherapy for Myeloproliferative Neoplasms prior to Allogeneic Hematopoietic Stem Cell Transplant. Int J Radiat Oncol Biol Phys 2023; 117:e458. [PMID: 37785467 DOI: 10.1016/j.ijrobp.2023.06.1651] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Myeloproliferative neoplasms including primary and secondary myelofibrosis (MF) are a rare spectrum of chronic myeloproliferative disorders in which nearly 90% of patients experience splenomegaly. Importantly, splenic radiotherapy (SRT) may be used in combination with allogeneic stem cell transplant (alloSCT) to improve symptoms related to splenomegaly, though there currently is no consensus SRT dose/fractionation protocol reported in the literature for use in combination with alloSCT. We sought to report our institutional experience utilizing low dose SRT prior to alloSCT in the post-Jakafi era. MATERIALS/METHODS We performed a retrospective review of all patients diagnosed with MF at our institution from 2017-2022 who received reduced intensity alloHCT. Patients who underwent total lymphoid or body irradiation were excluded. Descriptive demographic and clinical characteristics of patients were summarized by means, medians, standard deviations, ranges and proportions as appropriate. RESULTS We identified 39 patients with MF who underwent reduced intensity conditioning (RIC) consisting of fludarabine/melphalan in preparation for alloHCT (median age 64.5, 12/16 males, median follow up 21 months). 16 patients with Jakafi-resistant splenomegaly completed low dose SRT prior to transplant (median spleen size: 24.5cm) with a median dose of 5Gy delivered in 5 fractions. 3D conformal therapy was used for all patients. All patients completed the planned total radiation course without treatment break or dose limiting acute toxicity. Thrombocytopenia was the most reported toxicity (CTCAE v5.0; 2 patients experienced grade 1, 1 patient experienced grade 2). No patients experienced grade 3 or higher acute cytopenias nor required transfusion during radiotherapy. All patients successfully received alloHCT a median of 7 days (range: 2-11) after the completion of SRT with a 94% (15/16) engraftment rate. Median neutrophil recovery (ANC > 500 × 3 days) time was 18 days (range: 13-31); median length of hospital stay was 23 days (range: 20-129). Overall survival was 75% in the SRT cohort (12/16, 2 with persistent disease, 2 due to other causes). Symptom burden data was available for 14/16 patients; 79% (11/14) of patients reported improvement in symptoms associated with splenomegaly or reduction in splenic size on physical examination. CONCLUSION In the largest reported experience of a low dose SRT only cohort to date, we observe low dose SRT is feasible, safe in combination with alloHCT with high engraftment rates, and may reduce symptoms related to splenomegaly thereby improving patient quality of life without compromising transplant related outcomes. A prospective study validating this protocol is currently underway.
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Affiliation(s)
- C C Baniel
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - S Arai
- Stanford University, Stanford, CA
| | - S M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - R T Hoppe
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Job J, Nicholson C, Donald M, Jackson C, Byrnes J. An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis. BMC Health Serv Res 2023; 23:478. [PMID: 37170265 PMCID: PMC10174616 DOI: 10.1186/s12913-023-09436-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. METHODS A cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. RESULTS The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. CONCLUSIONS The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.
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Affiliation(s)
- Jenny Job
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia.
| | - Caroline Nicholson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
| | - Maria Donald
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Claire Jackson
- UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women's Hospital Campus, Brisbane, QLD, 4029, Australia
- General Practice and Primary Care Research, The University of Queensland, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Health Economics School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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Calleja Z, Job J, Jackson C. Offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice: A rapid review of the literature. Aust J Rural Health 2023; 31:5-18. [PMID: 36037328 DOI: 10.1111/ajr.12920] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Rural and remote general practices face increasing demands for care without the workforce required to meet patient needs. The coronavirus pandemic has created an opportunity to explore sustainable, telehealth-driven solutions to this chronic and complex problem. OBJECTIVE This review examined interventions using offsite primary care providers to deliver ongoing patient care via telehealth to support rural and remote general practices. We aimed to understand the impact of such interventions on the Quadruple Aim (patient experience, provider experience, health care costs, and health outcomes). DESIGN A rapid review of studies published from 2011 and grey literature published from 2016. FINDINGS Six studies met the eligibility criteria. No eligible Australian studies were identified. Most studies investigated ongoing primary care services provided via telehealth by offsite pharmacists. Patients and rural primary care staff reported positive experiences with the interventions. One study demonstrated potential return on investment for rural practices. While one study reported clinically and statistically significant improvements in health outcomes over time, two studies did not observe statistically significant differences in health outcomes between intervention and control cohorts. DISCUSSION The Quadruple Aim should be carefully considered when designing, implementing, and evaluating interventions that involve offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice. CONCLUSION Sustainable solutions to workforce shortages in rural and remote general practice are needed urgently. Using offsite primary care providers to deliver telehealth and support practices in these regions is one possible solution that warrants further investigation, particularly in Australia.
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Affiliation(s)
- Zoe Calleja
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia.,School of Medicine and Dentistry, Griffith University, Brisbane, Qld, Australia
| | - Jennifer Job
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, Mater Research Institute-University of Queensland (MRI-UQ), Herston, Qld, Australia
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11
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Humbert MV, Spalluto CM, Bell J, Blume C, Conforti F, Davies ER, Dean LSN, Elkington P, Haitchi HM, Jackson C, Jones MG, Loxham M, Lucas JS, Morgan H, Polak M, Staples KJ, Swindle EJ, Tezera L, Watson A, Wilkinson TMA. Towards an artificial human lung: modelling organ-like complexity to aid mechanistic understanding. Eur Respir J 2022; 60:2200455. [PMID: 35777774 DOI: 10.1183/13993003.00455-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 03/01/2022] [Accepted: 06/11/2022] [Indexed: 11/05/2022]
Abstract
Respiratory diseases account for over 5 million deaths yearly and are a huge burden to healthcare systems worldwide. Murine models have been of paramount importance to decode human lung biology in vivo, but their genetic, anatomical, physiological and immunological differences with humans significantly hamper successful translation of research into clinical practice. Thus, to clearly understand human lung physiology, development, homeostasis and mechanistic dysregulation that may lead to disease, it is essential to develop models that accurately recreate the extraordinary complexity of the human pulmonary architecture and biology. Recent advances in micro-engineering technology and tissue engineering have allowed the development of more sophisticated models intending to bridge the gap between the native lung and its replicates in vitro Alongside advanced culture techniques, remarkable technological growth in downstream analyses has significantly increased the predictive power of human biology-based in vitro models by allowing capture and quantification of complex signals. Refined integrated multi-omics readouts could lead to an acceleration of the translational pipeline from in vitro experimental settings to drug development and clinical testing in the future. This review highlights the range and complexity of state-of-the-art lung models for different areas of the respiratory system, from nasal to large airways, small airways and alveoli, with consideration of various aspects of disease states and their potential applications, including pre-clinical drug testing. We explore how development of optimised physiologically relevant in vitro human lung models could accelerate the identification of novel therapeutics with increased potential to translate successfully from the bench to the patient's bedside.
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Affiliation(s)
- Maria Victoria Humbert
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Cosma Mirella Spalluto
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- M.V. Humbert and C.M. Spalluto are co-first authors and contributed equally to this work
| | - Joseph Bell
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Cornelia Blume
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Franco Conforti
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Elizabeth R Davies
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lareb S N Dean
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Paul Elkington
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hans Michael Haitchi
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Claire Jackson
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mark G Jones
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Matthew Loxham
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Jane S Lucas
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Hywel Morgan
- Institute for Life Sciences, University of Southampton, Southampton, UK
- Electronics and Computer Science, Faculty of Physical Sciences and Engineering, University of Southampton, Southampton, UK
| | - Marta Polak
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Karl J Staples
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Emily J Swindle
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Liku Tezera
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Infection and Immunity, Faculty of Medicine, University College London, London, UK
| | - Alastair Watson
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Tom M A Wilkinson
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Urquhart C, Fleming B, Harper I, Aloj L, Armstrong R, Hook L, Long AM, Jackson C, Gallagher FA, McLean MA, Tarpey P, Kosmoliaptsis V, Nicholson J, Hendriks AEJ, Casey RT. The use of temozolomide in paediatric metastatic phaeochromocytoma/paraganglioma: A case report and literature review. Front Endocrinol (Lausanne) 2022; 13:1066208. [PMID: 36440187 PMCID: PMC9681996 DOI: 10.3389/fendo.2022.1066208] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
There is increasing evidence to support the use of temozolomide therapy for the treatment of metastatic phaeochromocytoma/paraganglioma (PPGL) in adults, particularly in patients with SDHx mutations. In children however, very little data is available. In this report, we present the case of a 12-year-old female with a SDHB-related metastatic paraganglioma treated with surgery followed by temozolomide therapy. The patient presented with symptoms of palpitations, sweating, flushing and hypertension and was diagnosed with a paraganglioma. The primary mass was surgically resected six weeks later after appropriate alpha- and beta-blockade. During the surgery extensive nodal disease was identified that had been masked by the larger paraganglioma. Histological review confirmed a diagnosis of a metastatic SDHB-deficient paraganglioma with nodal involvement. Post-operatively, these nodal lesions demonstrated tracer uptake on 18F-FDG PET-CT. Due to poor tumour tracer uptake on 68Ga-DOTATATE and 123I-MIBG functional imaging studies radionuclide therapy was not undertaken as a potential therapeutic option for this patient. Due to the low tumour burden and lack of clinical symptoms, the multi-disciplinary team opted for close surveillance for the first year, during which time the patient continued to thrive and progress through puberty. 13 months after surgery, evidence of radiological and biochemical progression prompted the decision to start systemic monotherapy using temozolomide. The patient has now completed ten cycles of therapy with limited adverse effects and has benefited from a partial radiological and biochemical response.
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Affiliation(s)
- Calum Urquhart
- Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ben Fleming
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ines Harper
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Armstrong
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Liz Hook
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna-May Long
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Claire Jackson
- Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Mary A. McLean
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Patrick Tarpey
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery and NIHR Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - A. Emile J. Hendriks
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatric Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ruth T. Casey
- Department of Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
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Bhatia R, George J, Siu C, Baker B, Lee E, Redmond K, Jackson C, Bettegowda C, Lim M, Kleinberg L. Outcomes of Brain Metastases Managed with Resection and Aggressive Reirradiation after Initial Radiosurgery Failure. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.781] [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: 10/31/2022]
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14
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Job J, Nicholson C, Calleja Z, Jackson C, Donald M. Implementing a general practitioner-to-general physician eConsult service (eConsultant) in Australia. BMC Health Serv Res 2022; 22:1278. [PMID: 36280832 PMCID: PMC9589630 DOI: 10.1186/s12913-022-08663-2] [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: 05/25/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background In response to lengthy wait times for specialist outpatient appointments, electronic consultation (eConsult) services have developed globally, providing asynchronous, secure and timely communication between general practitioner (GP) and specialist. This study aims to track adoption of a Queensland eConsultant service in two Australian Primary Health Networks (Western Queensland and Brisbane South) to understand key barriers and enablers to adoption and inform modification of the implementation strategy. Methods Our theory-informed mixed-methods evaluation assessed implementation between July 2020 and March 2022. Adoption and implementation activities were prospectively recorded in bespoke tracking spreadsheets with implementation activities coded against the Expert Recommendations for Implementing Change (ERIC) strategies. Semi-structured interviews with GPs and stakeholders informed by the Consolidated Framework for Implementation Research (CFIR) were conducted to understand determinants of implementation. Results Of the 40 practices invited to take part in the eConsultant service, 20 (50%) enrolled. Of the 97 GPs who consented, 38 sent at least one Request for Advice (RFA) to the eConsultant with a total of 112 RFA sent. Implementation was predominantly guided by eight strategies. Qualitative interviews were conducted with 11 GPs and 4 stakeholders (12 from rural/remote regions, 11 females and two sole practitioners). Interviewees felt the eConsultant service supported outpatient appointment avoidance and provided efficient, timely access to specialist support for GPs and their patients. Barriers identified to using eConsultant related to digital infrastructure, competing priorities, and keeping the service ‘front of mind’. Key enablers identified were the relative advantage of eConsultant over other options, patient benefits and COVD-19 facilitating the use of digital technology. Conclusions This evaluation highlighted service enablers as well as user priorities for broader implementation. A focus on a well-integrated digital system and availability of a variety of eConsultant specialties are seen as key strategies to embedding the eConsultant option in GP advice processes in Australia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08663-2.
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Affiliation(s)
- Jennifer Job
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia
| | - Caroline Nicholson
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,Integrated Care and Innovation Translation, Mater Misericordiae Ltd, Brisbane, Australia
| | - Zoe Calleja
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia
| | - Claire Jackson
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,grid.1003.20000 0000 9320 7537Primary Care Faculty of Medicine, The University of Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Maria Donald
- grid.1003.20000 0000 9320 7537UQ-MRI Centre for Health System Reform and Integration, Mater Research Institute, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD 4029 Australia ,grid.1003.20000 0000 9320 7537General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Loughnan SA, Boyle FM, Ellwood D, Crocker S, Lancaster A, Astell C, Dean J, Horey D, Callander E, Jackson C, Shand A, Flenady V. Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death. Trials 2022; 23:464. [PMID: 35668502 PMCID: PMC9167910 DOI: 10.1186/s13063-022-06363-0] [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: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth and neonatal death are devastating pregnancy outcomes with long-lasting psychosocial consequences for parents and families, and wide-ranging economic impacts on health systems and society. It is essential that parents and families have access to appropriate support, yet services are often limited. Internet-based programs may provide another option of psychosocial support for parents following the death of a baby. We aim to evaluate the efficacy and acceptability of a self-guided internet-based perinatal bereavement support program "Living with Loss" (LWL) in reducing psychological distress and improving the wellbeing of parents following stillbirth or neonatal death. METHODS This trial is a two-arm parallel group randomized controlled trial comparing the intervention arm (LWL) with a care as usual control arm (CAU). We anticipate recruiting 150 women and men across Australia who have experienced a stillbirth or neonatal death in the past 2 years. Participants randomized to the LWL group will receive the six-module internet-based program over 8 weeks including automated email notifications and reminders. Baseline, post-intervention, and 3-month follow-up assessments will be conducted to assess primary and secondary outcomes for both arms. The primary outcome will be the change in Kessler Psychological Distress Scale (K10) scores from baseline to 3-month follow-up. Secondary outcomes include perinatal grief, anxiety, depression, quality of life, program satisfaction and acceptability, and cost-effectiveness. Analysis will use intention-to-treat linear mixed models to examine psychological distress symptom scores at 3-month follow-up. Subgroup analyses by severity of symptoms at baseline will be undertaken. DISCUSSION The LWL program aims to provide an evidence-based accessible and flexible support option for bereaved parents following stillbirth or neonatal death. This may be particularly useful for parents and healthcare professionals residing in rural regions where services and supports are limited. This RCT seeks to provide evidence of the efficacy, acceptability, and cost-effectiveness of the LWL program and contribute to our understanding of the role digital services may play in addressing the gap in the availability of specific bereavement support resources for parents following the death of a baby, particularly for men. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12621000631808 . Registered prospectively on 27 May 2021.
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Affiliation(s)
- Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, Australia
| | - David Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,School of Medicine, Griffith University, Parklands Drive, Gold Coast, QLD, Australia.,Gold Coast University Hospital, 1 Hospital Drive, Southport, QLD, Australia
| | - Sara Crocker
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Ann Lancaster
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Chrissie Astell
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
| | - Julie Dean
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, Australia
| | - Dell Horey
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia.,La Trobe University, Plenty Rd &, Kingsbury Dr, Bundoora, VIC, Australia
| | - Emily Callander
- Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
| | | | - Antonia Shand
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Vicki Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute-University of Queensland, Raymond Terrace, Level 3 Aubigny Place, South Brisbane, QLD, Australia
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16
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Jackson C. Telehealth, care access and workforce – are the stars finally aligning? AUST HEALTH REV 2022; 46:260-261. [PMID: 35653272 DOI: 10.1071/ah22127] [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] [Received: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Claire Jackson
- UQ/MRI Centre for Health System Reform and Integration, University of Queensland, Qld, Australia
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Kim J, Jackson C, Raai H. An Impulsive Suicide Attempt in a Patient with No Psychiatric History and a Recent COVID-19 Diagnosis: A case report. Eur Psychiatry 2022. [PMCID: PMC9567568 DOI: 10.1192/j.eurpsy.2022.1204] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
The coronavirus disease 19 (COVID-19) pandemic has prompted concerns regarding increased suicide rates and exacerbation of underlying mental illness symptoms. •There is evidence suggesting neurocognitive changes as well as immune response in COVID-19 infection may increase a patient’s propensity for suicidal ideation. • Patients who are diagnosed with COVID-19 may be affected by psychological factors of anxiety, stress related to having this novel virus as well as depression, post-traumatic stress disorder and sleep disorders throughout treatment and post-treatment of continued concerns. •The combination of psychiatric, neurological, and physical symptoms associated with COVID-19 may elevate suicide risk
Objectives
We present a case of a female with no prior psychiatric history who impulsively attempted suicide after a recent COVID-19 diagnosis and subsequent quarantine. Will explore possible link between increase of suicidal ideation and COVID-19 infection.
Methods
A case report.
Results
Link between increase of suicidal ideation and COVID-19 infection has not been clearly established but there have been reports, as in our case, of the possible vulnerability to mental illness and new onset suicidal ideation that COVID-19 survivors may experience. It may be useful to screen all patients for depressive symptoms after a COVID-19 infection. Early identification and treatment of depression in recovered COVID-19 patients will help to improve psychological impact on COVID-19 survivors and potentially reduce suicide rates.
Conclusions
As COVID-19 infection may trigger new onset mental illness, exacerbate symptoms of underlying mental illness, and may increase suicidal ideation, further research is needed to evaluate links between COVID-19 infection and depression with suicidal ideation
Disclosure
No significant relationships.
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Reece LJ, Owen K, Graney M, Jackson C, Shields M, Turner G, Wellington C. Barriers to initiating and maintaining participation in parkrun. BMC Public Health 2022; 22:83. [PMID: 35027014 PMCID: PMC8759213 DOI: 10.1186/s12889-022-12546-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractInterventions that increase population physical activity are required to promote health and wellbeing. parkrun delivers community-based, 5 km events worldwide yet 43% who register never participate in a parkrun event. This research had two objectives; i) explore the demographics of people who register for parkrun in United Kingdom, Australia, Ireland, and don’t initiate or maintain participation ii) understand the barriers to participating in parkrun amongst these people. Mandatory data at parkrun registration provided demographic characteristics of parkrun registrants. A bespoke online survey distributed across the three countries captured the reasons for not participating or only participating once. Of 680,255 parkrun registrants between 2017 and 19, 293,542 (43%) did not participate in any parkrun events and 147,148 (22%) only participated in one parkrun event. Females, 16–34 years and physically inactive were more likely to not participate or not return to parkrun. Inconvenient start time was the most frequently reported barrier to participating, with females more likely than males to report the psychological barrier of feeling too unfit to participate. Co-creating strategies with and for people living with a chronic disease, women, young adults, and physically inactive people, could increase physical activity participation within parkrun.
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Lin T, Siu C, Redmond K, Bettegowda C, Jackson C, Lim M, Kleinberg L. Utility of Short Initial MRI Brain in Brain Metastases Patients Treated With Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1545] [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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Chabrera C, Dobrowolska B, Jackson C, Kane R, Kasimovskaya N, Kennedy S, Lovrić R, Palese A, Treslova M, Cabrera E. Simulation in Nursing Education Programs: Findings From an International Exploratory Study. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jackson C, Allington L, Chang Y, McClelland J, Gulliford S. PO-1976 Has the Covid-19 Pandemic increased willingness to engage with remote collection of outcome data? Radiother Oncol 2021. [PMCID: PMC8629146 DOI: 10.1016/s0167-8140(21)08427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Keep J, Berry T, Budden S, Chuilon B, Colling B, Flynn E, Ha S, Jackson C, Keech G, Leong W, Mathew G, Organ E, Shaw C, Wilde A. DEMO double null architectural study. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Flook M, Jackson C, Vasileiou E, Simpson CR, Muckian MD, Agrawal U, McCowan C, Jia Y, Murray JLK, Ritchie LD, Robertson C, Stock SJ, Wang X, Woolhouse MEJ, Sheikh A, Stagg HR. Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality. BMC Infect Dis 2021; 21:342. [PMID: 33845766 PMCID: PMC8040367 DOI: 10.1186/s12879-021-05992-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. METHODS Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. RESULTS One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. CONCLUSIONS The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. REGISTRATION This review was registered on PROSPERO as CRD42020177714 .
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Affiliation(s)
- M Flook
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - C Jackson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - E Vasileiou
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - C R Simpson
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - M D Muckian
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - U Agrawal
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - C McCowan
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - Y Jia
- Freelance consultant, Beijing, People's Republic of China
| | - J L K Murray
- National Health Service Fife, Kirkcaldy, UK
- Public Health Scotland, Glasgow, UK
| | - L D Ritchie
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S J Stock
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - X Wang
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - M E J Woolhouse
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - H R Stagg
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK.
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24
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Abstract
PURPOSE To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure. METHODS A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression. RESULTS Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year. CONCLUSIONS TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Georgina Bough
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Lambert
- Department of Physics, University of Otago, Dunedin, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
| | - Florin Djendov
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Claire Jackson
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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25
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Chenard S, Jackson C, Vidotto T, Chen L, Hardy C, Jamaspishvilli T, Berman DM, Siemens DR, Koti M. Investigating sexual dimorphism in the tumour immune microenvironment of non-muscle invasive bladder cancer. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.060] [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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26
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Ahmad A, Pepin X, Aarons L, Wang Y, Darwich AS, Wood JM, Tannergren C, Karlsson E, Patterson C, Thörn H, Ruston L, Mattinson A, Carlert S, Berg S, Murphy D, Engman H, Laru J, Barker R, Flanagan T, Abrahamsson B, Budhdeo S, Franek F, Moir A, Hanisch G, Pathak SM, Turner D, Jamei M, Brown J, Good D, Vaidhyanathan S, Jackson C, Nicolas O, Beilles S, Nguefack JF, Louit G, Henrion L, Ollier C, Boulu L, Xu C, Heimbach T, Ren X, Lin W, Nguyen-Trung AT, Zhang J, He H, Wu F, Bolger MB, Mullin JM, van Osdol B, Szeto K, Korjamo T, Pappinen S, Tuunainen J, Zhu W, Xia B, Daublain P, Wong S, Varma MV, Modi S, Schäfer KJ, Schmid K, Lloyd R, Patel A, Tistaert C, Bevernage J, Nguyen MA, Lindley D, Carr R, Rostami-Hodjegan A. IMI – Oral biopharmaceutics tools project – Evaluation of bottom-up PBPK prediction success part 4: Prediction accuracy and software comparisons with improved data and modelling strategies. Eur J Pharm Biopharm 2020; 156:50-63. [DOI: 10.1016/j.ejpb.2020.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
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27
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Abstract
HIV-1 infects an estimated 37 million people worldwide, while the rarer HIV-2 infects 1–2 million worldwide. HIV-2 is mainly restricted to West African countries. The majority of patients in Scotland are diagnosed with HIV-1, but in 2013 the West of Scotland Specialist Virology Centre (WoSSVC) diagnosed Scotland’s first HIV-2 positive case in a patient from Côte d’Ivoire. HIV-2 differs from HIV-1 in terms of structural viral proteins, viral transmissibility, prolonged period of latency, intrinsic resistance to certain antivirals and how to monitor the effectiveness of treatment. Over the course of 5 years the patient has required several changes in treatment due to both side effects and pill burden. This case highlights the complexity of HIV-2 patient management over time.
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Affiliation(s)
- S J Shepherd
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
| | - C Sykes
- Infectious Diseases Unit, The Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | - C Jackson
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
| | - D J Bell
- Infectious Diseases Unit, The Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | - R N Gunson
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
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28
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Jackson C, Burton W, Nicholson C. COVID-19: Pump-priming positive healthcare reform. Aust J Gen Pract 2020; 49. [PMID: 33051636 DOI: 10.31128/ajgp-covid-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: 11/19/2022]
Abstract
This case study of GP Shared Care provides an interesting lens though which to view the current opportunities for improved healthcare partnerships as we respond to the COVID-19 challenges.
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Affiliation(s)
- Claire Jackson
- MBBS, MD, MPH, CertHEcon, GradCert Management, FRACGP, FAICD Professor in General Practice and Primary Health Care Research, University of Qld, Primary Care Clinical Unit, Faculty of Medicine, Brisbane, Qld; Director, Centre for Health System Reform and Integration, University of Qld, Mater Hospital, Brisbane, Qld; Independent Director, Hospitals Contribution Fund of Australia; Chair, biennial International Health Care Reform Conference, Australia; Sessional GP, Camp Hill Health Centre, Brisbane, Qld.
| | - Wendy Burton
- MBBS, FRACGP, Clinical Lead Maternity Care, Brisbane South Primary Health Network, Qld
| | - Caroline Nicholson
- PhD, MBA, GradDipPhty, GAICD, Deputy Director, Centre for Health System Reform @ Integration, Mater Research Institute @ University of Queensland, Qld; Director, Care Innovation Centre, Mater Misericordiae Ltd, Qld; Honorary Senior Lecturer, Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Qld
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29
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Fenner MF, Carstensen H, Dalgas Nissen S, Melis Hesselkilde E, Scott Lunddahl C, Adler Hess Jensen M, Loft-Andersen AV, Sattler SM, Platonov P, El-Haou S, Jackson C, Tang R, Kirby R, Ford J, Schotten U, Milnes J, Svane Sørensen U, Jespersen T, Buhl R. Effect of selective I K,ACh inhibition by XAF-1407 in an equine model of tachypacing-induced persistent atrial fibrillation. Br J Pharmacol 2020; 177:3778-3794. [PMID: 32436234 DOI: 10.1111/bph.15100] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 03/20/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Inhibition of the G-protein gated ACh-activated inward rectifier potassium current, IK,ACh may be an effective atrial selective treatment strategy for atrial fibrillation (AF). Therefore, the anti-arrhythmic and electrophysiological properties of a novel putatively potent and highly specific IK,ACh inhibitor, XAF-1407 (3-methyl-1-[5-phenyl-4-[4-(2-pyrrolidin-1-ylethoxymethyl)-1-piperidyl]thieno[2,3-d]pyrimidin-6-yl]azetidin-3-ol), were characterised for the first time in vitro and investigated in horses with persistent AF. EXPERIMENTAL APPROACH The pharmacological ion channel profile of XAF-1407 was investigated using cell lines expressing relevant ion channels. In addition, eleven horses were implanted with implantable cardioverter defibrillators enabling atrial tachypacing into self-sustained AF. The electrophysiological effects of XAF-1407 were investigated after serial cardioversions over a period of 1 month. Cardioversion success, drug-induced changes of atrial tissue refractoriness, and ventricular electrophysiology were assessed at baseline (day 0) and days 3, 5, 11, 17, and 29 after AF induction. KEY RESULTS XAF-1407 potently and selectively inhibited Kir 3.1/3.4 and Kir 3.4/3.4, underlying the IK,ACh current. XAF-1407 treatment in horses prolonged atrial effective refractory period as well as decreased atrial fibrillatory rate significantly (~20%) and successfully cardioverted AF, although with a decreasing efficacy over time. XAF-1407 shortened atrioventricular-nodal refractoriness, without effect on QRS duration. QTc prolongation (4%) within 15 min of drug infusion was observed, however, without any evidence of ventricular arrhythmia. CONCLUSION AND IMPLICATIONS XAF-1407 efficiently cardioverted sustained tachypacing-induced AF of short duration in horses without notable side effects. This supports IK,ACh inhibition as a potentially safe treatment of paroxysmal AF in horses, suggesting potential clinical value for other species including humans.
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Affiliation(s)
- Merle Friederike Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Sarah Dalgas Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva Melis Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Christine Scott Lunddahl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Maja Adler Hess Jensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Ameli Victoria Loft-Andersen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Stefan Michael Sattler
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University Munich (LMU), Munich, Germany
| | - Pyotr Platonov
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | | | | | | | | | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | | | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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30
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Eriksson J, Landfeldt E, Ireland S, Jackson C, Wyatt E, Gaudig M. Stated preferences for relapsed or refractory mantle cell lymphoma treatments in Sweden and Germany. Future Oncol 2020; 16:859-868. [PMID: 32292062 DOI: 10.2217/fon-2020-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/21/2022] Open
Abstract
Background: We aimed to elicit treatment preferences in relapsed/refractory mantle cell lymphoma (r/r MCL). Materials & methods: A discrete-choice experiment comprising six attributes ('overall survival', 'progression-free survival', 'fatigue', 'nausea', 'risk of serious infections' and 'treatment administration') was administered to r/r MCL patients, physicians and the general population (GP) in Sweden and Germany. Results: 18 patients, 68 physicians and 191 GP members participated. 'Overall survival' was the most important attribute, followed by 'risk of serious infection' and 'progression-free survival' among physicians and the GP. In contrast, 'treatment administration' was the second most important attribute to patients, followed by 'risk of serious infection.' Conclusion: Preferences for characteristics differentiating treatments of r/r MCL varies between patients, physicians and members of the GP.
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Affiliation(s)
| | - Erik Landfeldt
- ICON plc, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Steve Ireland
- Janssen EMEA Business Intelligence, High Wycombe, UK
| | | | | | - Maren Gaudig
- Janssen Health Economics & Market Access EMEA, Neuss, Germany
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31
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Delwiche SR, Pierce RO, Chung OK, Seabourn BW, Baker L, Boyd T, Brenner C, Cain L, Chung E, Cohoef E, Delwiche S, Drapcho C, Flemm J, Gell A, Gerjets L, Gipson N, Guillemette R, Hughes R, Hurburgh C, Jackson C, Jessop D, Johnson D, Johnson D, Krouse R, LaCour CP, Lego M, Lewis V, Mbuvi S, McCaig T, Perbix K, Psotka J, Seabourn B. Protein Content of Wheat by Near-Infrared Spectroscopy of Whole Grain: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.3.587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
abstract
A collaborative study was performed to assess accuracy, repeatability, and reproducibility of a nearinfrared (near-IR) method for determining crude protein content (PC) of whole-grain wheat. Four types of commercially available near-IR instruments, representing various combinations of wavelength region, mode of energy capture, method of energy dispersion, and treatment of spectral data, were used. Eight, 9,10, and 11 collaborators were involved, the exact number depending on instrument type. All collaborators received 22 samples of whole-grain hard red winter (HRW) wheat. They were furnished reference PCs (i.e., protein concentrations, w/w) corrected to a 12% moisture basis for instrument standardization. AOAC Method 990.03— combustion analysis—was the reference procedure. Standardization consisted of performing one of the following treatments to the instrument manufacturer's (or federal agency's) PC equation: (1) bias correction, (2) slope and intercept correction, or (3) recalibration with inclusion of standardization sample spectra. Standardized equations were then applied to a test set of 12 unknown HRW wheat sample spectra, with 2 samples blindly duplicated. The PCs of test samples ranged from 9 to 16%. Near-IR predictions were compared with reference measurements. Averaged within instrument type, root mean square of differences were 0.22, 0.24, 0.25, and 0.26% PC, depending on instrument. Corrected for bias within the test set, standard errors became 0.22, 0.18, 0.21, and 0.24% PC, respectively. These values were approximately twice the estimated lower limit for error (representing sample inhomogeneity). Overall repeatability relative standard deviation (RSD,) values were 0.92, 0.36, 0.42, and 0.74%, respectively. Overall reproducibility relative standard deviation (RSDR) values were 1.15, 0.61,1.53, and 1.38%. Such values for within-laboratory and between-laboratory variations of the near- IR methods were equivalent to values reported for the combustion method (990.03) for wheat. An inhouse study that examined all 6 U.S. wheat classes with one of the 4 instrument types produced repeatability and reproducibility values similar to those of the collaborative study, suggesting that the near-IR technique may be applied to red, white, hard, soft, and durum wheats. The near-IR method for determination of PC of whole-grain wheat has been adopted First Action (997.06) by AOAC INTERNATIONAL.
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Affiliation(s)
- Stephen R Delwiche
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Instrumentation and Sensing Laboratory, Bldg 303, BARC-East, Beltsville, MD 20705-2350
| | - Richard O Pierce
- U.S. Department of Agriculture, Grain Inspection, Packers, and Stockyards Administration, Federal Grain Inspection Service, Technical Services Division, 10383 N. Executive Hills Blvd, Kansas City, MO 64153
| | - Okkyung K Chung
- U.S. Department of Agriculture, Agricultural Research Service, U.S. Grain Marketing and Production Research Laboratory, 1515 College Ave, Manhattan, KS 66502
| | - Bradford W Seabourn
- U.S. Department of Agriculture, Agricultural Research Service, U.S. Grain Marketing and Production Research Laboratory, 1515 College Ave, Manhattan, KS 66502
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32
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Fassad MR, Patel MP, Shoemark A, Cullup T, Hayward J, Dixon M, Rogers AV, Ollosson S, Jackson C, Goggin P, Hirst RA, Rutman A, Thompson J, Jenkins L, Aurora P, Moya E, Chetcuti P, O'Callaghan C, Morris-Rosendahl DJ, Watson CM, Wilson R, Carr S, Walker W, Pitno A, Lopes S, Morsy H, Shoman W, Pereira L, Constant C, Loebinger MR, Chung EMK, Kenia P, Rumman N, Fasseeh N, Lucas JS, Hogg C, Mitchison HM. Clinical utility of NGS diagnosis and disease stratification in a multiethnic primary ciliary dyskinesia cohort. J Med Genet 2019; 57:322-330. [PMID: 31879361 DOI: 10.1136/jmedgenet-2019-106501] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 08/13/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD), a genetically heterogeneous condition enriched in some consanguineous populations, results from recessive mutations affecting cilia biogenesis and motility. Currently, diagnosis requires multiple expert tests. METHODS The diagnostic utility of multigene panel next-generation sequencing (NGS) was evaluated in 161 unrelated families from multiple population ancestries. RESULTS Most (82%) families had affected individuals with biallelic or hemizygous (75%) or single (7%) pathogenic causal alleles in known PCD genes. Loss-of-function alleles dominate (73% frameshift, stop-gain, splice site), most (58%) being homozygous, even in non-consanguineous families. Although 57% (88) of the total 155 diagnostic disease variants were novel, recurrent mutations and mutated genes were detected. These differed markedly between white European (52% of families carry DNAH5 or DNAH11 mutations), Arab (42% of families carry CCDC39 or CCDC40 mutations) and South Asian (single LRRC6 or CCDC103 mutations carried in 36% of families) patients, revealing a striking genetic stratification according to population of origin in PCD. Genetics facilitated successful diagnosis of 81% of families with normal or inconclusive ultrastructure and 67% missing prior ultrastructure results. CONCLUSIONS This study shows the added value of high-throughput targeted NGS in expediting PCD diagnosis. Therefore, there is potential significant patient benefit in wider and/or earlier implementation of genetic screening.
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Affiliation(s)
- Mahmoud R Fassad
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mitali P Patel
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amelia Shoemark
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Thomas Cullup
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Jane Hayward
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Mellisa Dixon
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew V Rogers
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sarah Ollosson
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Claire Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Andrew Rutman
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lucy Jenkins
- NE Thames Regional Molecular Genetics Laboratory, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Paul Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eduardo Moya
- Children's Services (Paediatrics), Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Philip Chetcuti
- Department of Respiratory Paediatrics, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.,Department of Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deborah J Morris-Rosendahl
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Robert Wilson
- Host Defence Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Siobhan Carr
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Woolf Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreia Pitno
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Laboratório de Histologia e Patologia Comparada, Instituto de Medicina Molecular, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Susana Lopes
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Heba Morsy
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Walaa Shoman
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Luisa Pereira
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Carolina Constant
- Paediatric Pulmonology Unit, Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | | | - Eddie M K Chung
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Priti Kenia
- Department of Respiratory Paediatrics, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Nisreen Rumman
- Pediatrics Department, Makassed Hospital, East Jerusalem, Israel
| | - Nader Fasseeh
- Department of Pediatrics, Faculty of Medicine, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust and Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claire Hogg
- PCD Diagnostic Team and Department of Pediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Hannah M Mitchison
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Jackson C, Tremblay G. Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections. Can Commun Dis Rep 2019; 45:323-326. [PMID: 32167085 PMCID: PMC7041658 DOI: 10.14745/ccdr.v45i12a04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexually transmitted and blood-borne infections (STBBI)-which include HIV, hepatitis B and C, chlamydia, gonorrhea, syphilis and human papillomavirus-remain significant public health issues both nationally and globally. In 2018, a Pan-Canadian STBBI Framework for Action (the Framework) was released by federal, provincial and territorial governments to provide an overarching and comprehensive approach to addressing STBBI for all those involved. This includes all levels of government, First Nations, Inuit and Métis communities and leadership, frontline service providers, clinicians, public health practitioners, non-governmental organizations and researchers. The Framework includes strategic goals, guiding principles and pillars for action to address STBBI in Canada. In response, the Government of Canada released its own action plan in July 2019: Accelerating Our Response - Government of Canada Five-Year Action Plan on Sexually Transmitted and Blood-Borne Infections (the Action Plan). This document identifies seven priority areas for federal action on STBBI over the next five years: 1) moving toward truth and reconciliation with First Nations, Inuit and Métis Peoples; 2) stigma and discrimination; 3) community innovation-putting a priority on prevention; 4) reaching the undiagnosed-increasing access to STBBI testing; 5) providing prevention, treatment and care to populations that receive health services or coverage of health care benefits from the federal government; 6) leveraging existing knowledge and targeting future research; and 7) measuring impact-monitoring and reporting on trends and results. The Government of Canada is currently working with provincial and territorial governments, First Nations, Inuit and Métis partners, and other stakeholders to develop STBBI indicators and targets for the Canadian context that are appropriate, feasible and measurable against the shared strategic goals of the Framework and the Action Plan. In addition, the Government of Canada has also committed to reporting annually on its progress in implementing the priority areas laid out in the Action Plan.
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Affiliation(s)
- C Jackson
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - G Tremblay
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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Arnold C, Kadaria D, Iyer P, Jackson C, Khan A, McDonald A, Pattanaik D, Shrestha R, Singh U, VanValkinburgh D, Sodhi A. 76 Airway Complications in Angioedema. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.080] [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: 10/25/2022]
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Jackson C, Noorbakhsh S, Kalathil A, Sundaram R, Bindra R. MGMT-Deficiency Is a Biomarker to Guide Treatment of Solid Tumors with Temozolomide and ATR Inhibitors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1097] [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: 11/16/2022]
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Jackson C, Kalathil A, Sundaram R, Bindra R. Temozolomide-Resistant Glioma Cells Are Sensitive to Chloroethylating Nitrosourea Compounds in Combination with ATR Inhibitors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1098] [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: 10/26/2022]
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Sloan L, Sen R, Doucet M, Blosser L, Shpitser I, Cheng Z, Katulis L, Wemmer J, Jackson C, Hu C, McNutt T, Grossman S, Holdhoff M, Lim M, Redmond K, Eberhart C, Quon H, Pardoll D, Ganguly S, Kleinberg L. The Immunodynamics of Myeloid-Derived Suppressor Cell and Monocyte Populations in the Peripheral Blood in Patients with Newly Diagnosed Glioblastoma Undergoing Adjuvant Temozolomide and Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1029] [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: 10/26/2022]
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Yellamaty V, Ball L, Crossland L, Jackson C. General practitioners with special interests: An integrative review of their role, impact and potential for the future. Aust J Gen Pract 2019; 48:639-643. [DOI: 10.31128/ajgp-02-19-4849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Benjamin AT, Ganesh R, Gaspar BL, Lucas J, Jackson C, Legendre M, Mani R, Escudier E. A Novel Homozygous Nonsense HYDIN Gene Mutation p.(Arg951*) in Primary Ciliary Dyskinesia. Indian J Pediatr 2019; 86:664-665. [PMID: 31089940 DOI: 10.1007/s12098-019-02970-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/22/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Antony Terance Benjamin
- Department of Molecular Pathology, Primary Ciliary Dyskinesia Unit, G Kuppusamy Naidu Memorial Hospital, Coimbatore, 641037, India
| | - Ram Ganesh
- Department of Molecular Pathology, Primary Ciliary Dyskinesia Unit, G Kuppusamy Naidu Memorial Hospital, Coimbatore, 641037, India
| | - Balan Louis Gaspar
- Department of Molecular Pathology, Primary Ciliary Dyskinesia Unit, G Kuppusamy Naidu Memorial Hospital, Coimbatore, 641037, India.
| | - Jane Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claire Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marie Legendre
- U.F. de Génétique moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Rahma Mani
- U.F. de Génétique moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Estelle Escudier
- U.F. de Génétique moléculaire, Hôpital Armand Trousseau, Paris, France
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Binkley M, Rauf M, Milgrom S, Pinnix C, Tsang R, Ng A, Roberts K, Gao S, Ricardi U, Levis M, Casulo C, Stolten M, Kelsey C, Brady J, Mikhaeel N, Hoppe B, Terezakis S, Kirova Y, Akhtar S, Maghfoor I, Koenig J, Jackson C, Song E, Segal S, Advani R, Natkunam Y, Constine L, Eich H, Wirth A, Hoppe R. STAGE I-II NODULAR LYMPHOCYTE-PREDOMINANT HODGKIN LYMPHOMA IN THE MODERN ERA: A MULTI-INSTITUTIONAL EXPERIENCE OF ADULT PATIENTS BY ILROG. Hematol Oncol 2019. [DOI: 10.1002/hon.103_2629] [Citation(s) in RCA: 1] [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: 11/10/2022]
Affiliation(s)
- M.S. Binkley
- Radiation Oncology; Stanford University School of Medicine; Stanford United States
| | - M. Rauf
- Medical Oncology; King Faisal Specialist Hospital and Research Centre; Riyadh Saudi Arabia
| | - S.A. Milgrom
- Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston United States
| | - C.C. Pinnix
- Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston United States
| | - R. Tsang
- Radiation Oncology; Princess Margaret Cancer Center; Toronto Canada
| | - A. Ng
- Radiation Oncology; Dana Farber and Harvard University School of Medicine; Boston United States
| | - K.B. Roberts
- Radiation Oncology; Yale University; New Haven United States
| | - S. Gao
- Radiation Oncology; Yale University; New Haven United States
| | - U. Ricardi
- Oncology; University of Turin; Torino Italy
| | - M. Levis
- Oncology; University of Turin; Torino Italy
| | - C. Casulo
- Medical Oncology; University of Rochester; Rochester United States
| | - M. Stolten
- Radiation Oncology; University of Rochester; Rochester United States
| | - C.R. Kelsey
- Radiation Oncology; Duke University School of Medicine; Durham United States
| | - J.L. Brady
- Radiation Oncology; Guy's Cancer Centre, Guy's and St Thomas’ NHS Hospital; London United Kingdom
| | - N. Mikhaeel
- Radiation Oncology; Guy's Cancer Centre, Guy's and St Thomas’ NHS Hospital; London United Kingdom
| | - B.S. Hoppe
- Radiation Oncology; University of Florida; Jacksonville United States
| | - S.A. Terezakis
- Radiation Oncology; The Johns Hopkins University School of Medicine; Baltimore United States
| | - Y. Kirova
- Radiation Oncology; Institut Curie; Paris France
| | - S. Akhtar
- Medical Oncology; King Faisal Specialist Hospital and Research Centre; Riyadh Saudi Arabia
| | - I. Maghfoor
- Medical Oncology; King Faisal Specialist Hospital and Research Centre; Riyadh Saudi Arabia
| | - J.L. Koenig
- Radiation Oncology; Stanford University School of Medicine; Stanford United States
| | - C. Jackson
- Radiation Oncology; Yale University; New Haven United States
| | - E. Song
- Radiation Oncology; Duke University School of Medicine; Durham United States
| | - S. Segal
- Radiation Oncology; The Johns Hopkins University School of Medicine; Baltimore United States
| | - R.H. Advani
- Medical Oncology; Stanford University School of Medicine; Stanford United States
| | - Y. Natkunam
- Pathology; Stanford University School of Medicine; Stanford United States
| | - L.S. Constine
- Radiation Oncology; University of Rochester; Rochester United States
| | - H. Eich
- Radiation Oncology; Munster University; Munster Germany
| | - A. Wirth
- Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - R.T. Hoppe
- Radiation Oncology; Stanford University School of Medicine; Stanford United States
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Coughlin S, Bahaadini S, Rohani N, Zevin M, Patane O, Harandi M, Jackson C, Noroozi V, Allen S, Areeda J, Coughlin M, Ruiz P, Berry C, Crowston K, Katsaggelos A, Lundgren A, Østerlund C, Smith J, Trouille L, Kalogera V. Classifying the unknown: Discovering novel gravitational-wave detector glitches using similarity learning. Int J Clin Exp Med 2019. [DOI: 10.1103/physrevd.99.082002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cherian B, Jackson C. Evaluation of a group based exercise programme for community dwelling stroke survivors. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.101] [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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Ball LE, Barnes KA, Crossland L, Nicholson C, Jackson C. Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review. BMC Health Serv Res 2018; 18:866. [PMID: 30453957 PMCID: PMC6245854 DOI: 10.1186/s12913-018-3687-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/15/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care. Methods MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation. Results Twenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool. Conclusions This study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.
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Affiliation(s)
- Lauren E Ball
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
| | - Katelyn A Barnes
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Lisa Crossland
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Caroline Nicholson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
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Dearden L, Shalet N, Artenie C, Mills A, Jackson C, Grant L, Gater A. Fatigue, treatment satisfaction and health-related quality of life among patients receiving novel drugs suppressing androgen signalling for the treatment of metastatic castrate-resistant prostate cancer. Eur J Cancer Care (Engl) 2018; 28:e12949. [DOI: 10.1111/ecc.12949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/23/2017] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
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Maxwell R, Luksik A, Garzon-Muvdi T, Hung A, Kim E, Wu A, Xia Y, Belcaid Z, Gorelick N, Theodros D, Jackson C, Ye X, Tran P, Redmond K, Brem H, Pardoll D, Kleinberg L, Lim M. Impact of Corticosteroids on the Efficacy of Anti-PD-1 Therapy for Tumors Located Within or Outside the Central Nervous System. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.035] [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: 11/15/2022]
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Jackson C, Gunson RN, Bradley-Stewart A, Bennett S, Black H, Kennedy N, Bell DJ. Epidemiology and patient characteristics of hepatitis D virus infection in the West of Scotland 2011-2016. J Viral Hepat 2018; 25:1395-1396. [PMID: 29851188 DOI: 10.1111/jvh.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C Jackson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK.,The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK
| | - R N Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - A Bradley-Stewart
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - S Bennett
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - H Black
- Monklands Hospital, Airdrie, UK
| | | | - D J Bell
- The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK
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Jackson C, Noorbakhsh S, Bindra R. Elucidation of an Exquisite Synergistic Interaction Between ATR Inhibitors and Alkylating Agents in MGMT-Methylated Glioma Cells. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.774] [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: 10/28/2022]
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Hassan S, Lee C, Beleznai T, Nyjo S, Jackson C, Fenlon K, Llewellyn J, Douglas H, Kanagala P, Sankaranarayanan R. P276Heart failure specialist nurse-led day case ambulatory management with intravenous diuretics reduces hospitalisations for acute decompensated heart failure irrespective of ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Hassan
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - C Lee
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - T Beleznai
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - S Nyjo
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - C Jackson
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - K Fenlon
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - J Llewellyn
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - H Douglas
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
| | - P Kanagala
- Aintree University Hospital, Cardiology, Liverpool, United Kingdom
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Prigge R, Wild S, Jackson C. The association between different measures of depression and subsequent major cardiovascular events. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.070] [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: 10/28/2022] Open
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