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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Trehan RS, McDonnell EP, McCoy JV, Ohman-Strickland PA, Donovan C, Quinoa TR, Morrison DS. Comparing the quantitative fit-testing results of half-mask respirators with various skin barriers in a crossover study design: a pilot study. J Hosp Infect 2021; 111:125-131. [PMID: 33600893 PMCID: PMC7883702 DOI: 10.1016/j.jhin.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/20/2022]
Abstract
Background Clinicians around the world are experiencing skin breakdown due to the prolonged usage of masks while working long hours to treat patients with COVID-19. The skin damage is a result of the increased friction and pressure at the mask–skin barrier. Throughout the COVID-19 pandemic, clinicians have been applying various skin barriers to prevent and ameliorate skin breakdown. However, there are no studies to our knowledge that assess the safety and efficacy of using these skin barriers without compromising a sufficient mask–face seal. Aim To conduct the largest study to date of various skin barriers and seal integrity with quantitative fit testing (QNFT). Methods This pilot study explored whether the placement of a silicone scar sheet (ScarAway®), Cavilon™, or Tegaderm™ affects 3M™ half-face mask respirator barrier integrity when compared to no barrier using QNFT. Data were collected from nine clinicians at an academic level 1 trauma centre in New Jersey. Findings The silicone scar sheet resulted in the lowest adequate fit, whereas Cavilon provided the highest fit factor when compared to other interventions (P < 0.05). Conclusion These findings help inform clinicians considering barriers for comfort when wearing facemasks during the COVID-19 pandemic and for future pandemics.
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Affiliation(s)
- R S Trehan
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| | - E P McDonnell
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - J V McCoy
- Department of Emergency Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - P A Ohman-Strickland
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - C Donovan
- Department of Emergency Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - T R Quinoa
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - D S Morrison
- Department of Emergency Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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Aldekhail NM, Morrison DS, Khojah H, Sloan B, McLoone P, MacNaughton S, Shearer R, Logue J. The association between diabetes medication and weight change in a non-surgical weight management intervention: an intervention cohort study. Diabet Med 2020; 37:248-255. [PMID: 31365143 DOI: 10.1111/dme.14093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
Abstract
AIM To compare weight change in a lifestyle-based weight management programme between participants taking weight-gaining, weight-neutral/loss and mixed diabetes medications. METHODS Electronic health records for individuals (≥ 18 years) with Type 2 diabetes who had been referred to a non-surgical weight management programme between February 2008 and May 2014 were studied. Diabetes medications were classified into three categories based on their effect on body weight. In this intervention cohort study, weight change was calculated for participants attending two or more sessions. RESULTS All 998 individuals who took oral diabetes medications and attended two or more sessions of weight management were included. Some 59.5% of participants were women, and participants had a mean BMI of 41.1 kg/m2 (women) and 40.2 kg/m2 (men). Of the diabetes medication combinations prescribed, 46.0% were weight-neutral/loss, 41.3% mixed and 12.7% weight-gaining. The mean weight change for participants on weight-gaining and weight-neutral/loss diabetes medications respectively was -2.5 kg [95% confidence interval (CI) -3.2 to -1.8) and -3.3 kg (95% CI -3.8 to -2.9) (P = 0.05) for those attending two or more sessions (n = 998). Compared with those prescribed weight-neutral medications, participants prescribed weight-gaining medication lost 0.86 kg less (95% CI 0.02 to 1.7; P = 0.045) in a model adjusted for age, sex, BMI and socio-economic status. CONCLUSIONS Participants on weight-neutral/loss diabetes medications had a greater absolute weight loss within a weight management intervention compared with those on weight-gaining medications. Diabetes medications should be reviewed ahead of planned weight-loss interventions to help ensure maximal effectiveness of the intervention.
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Affiliation(s)
- N M Aldekhail
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Security Forces Hospital Programme, Riyadh, Saudi Arabia
| | - D S Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H Khojah
- Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - B Sloan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - P McLoone
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - R Shearer
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Tweed EJ, Allardice GM, McLoone P, Morrison DS. Socio-economic inequalities in the incidence of four common cancers: a population-based registry study. Public Health 2017; 154:1-10. [PMID: 29128730 PMCID: PMC5764071 DOI: 10.1016/j.puhe.2017.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/20/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022]
Abstract
Objectives To investigate the relationship between socio-economic circumstances and cancer incidence in Scotland in recent years. Study design Population-based study using cancer registry data. Methods Data on incident cases of colorectal, lung, female breast, and prostate cancer diagnosed between 2001 and 2012 were obtained from a population-based cancer registry covering a population of approximately 2.5 million people in the West of Scotland. Socio-economic circumstances were assessed based on postcode of residence at diagnosis, using the Scottish Index of Multiple Deprivation (SIMD). For each cancer, crude and age-standardised incidence rates were calculated by quintile of SIMD score, and the number of excess cases associated with socio-economic deprivation was estimated. Results 93,866 cases met inclusion criteria, comprising 21,114 colorectal, 31,761 lung, 23,757 female breast, and 15,314 prostate cancers. Between 2001 and 2006, there was no consistent association between socio-economic circumstances and colorectal cancer incidence, but 2006–2012 saw an emerging deprivation gradient in both sexes. The incidence rate ratio (IRR) for colorectal cancer between most deprived and least deprived increased from 1.03 (95% confidence interval [CI] 0.91–1.16) to 1.24 (95% CI 1.11–1.39) during the study period. The incidence of lung cancer showed the strongest relationship with socio-economic circumstances, with inequalities widening across the study period among women from IRR 2.66 (95% CI 2.33–3.05) to 2.91 (95% CI 2.54–3.33) in 2001–03 and 2010–12, respectively. Breast and prostate cancer showed an inverse relationship with socio-economic circumstances, with lower incidence among people living in more deprived areas. Conclusion Significant socio-economic inequalities remain in cancer incidence in the West of Scotland, and in some cases are increasing. In particular, this study has identified an emerging, previously unreported, socio-economic gradient in colorectal cancer incidence among women as well as men. Actions to prevent, mitigate, and undo health inequalities should be a public health priority. There is an emerging social gradient in colorectal cancer incidence in both sexes. Profound socio-economic inequalities in lung cancer persist. Breast and prostate cancer remain more common among less deprived populations.
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Affiliation(s)
- E J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK; Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK.
| | - G M Allardice
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK
| | - P McLoone
- Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - D S Morrison
- Directorate of Public Health, NHS Greater Glasgow and Clyde, West House, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK; Department of Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
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Alexander D, Allardice GM, Moug SJ, Morrison DS. A retrospective cohort study of the influence of lifestyle factors on the survival of patients undergoing surgery for colorectal cancer. Colorectal Dis 2017; 19:544-550. [PMID: 28027419 DOI: 10.1111/codi.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
AIM Several modifiable and nonmodifiable health-related behaviours are associated with the incidence of colorectal cancer (CRC), but there is little research on their association with survival. This work aimed to investigate possible relationships between modifiable behavioural factors and outcomes on a study cohort of CRC patients undergoing potentially curative surgery. METHOD A retrospective cohort study was carried out of patients diagnosed with nonmetastatic CRC residing in the NHS Greater Glasgow and Clyde area, UK and undergoing elective curative surgery (January 2011 to December 2012). Data were obtained from the Scottish Cancer Registry, National Scottish Death Records. Preoperative assessment of smoking, alcohol consumption, nurse-measured body mass index (BMI) and exercise levels were recorded, and patients were followed until death or censorship. Survival analysis was carried out and proportional hazards assumptions were assessed graphically using plots and were then formally tested using the PHTEST procedure in stata. RESULT Of the initial 527 patients, 181 (34%) satisfied the inclusion criteria. The total duration of follow-up was 480 person-years. At the preoperative assessment, 75% of patients were overweight or obese, 10.6% were current smokers, 13.1% recorded excess alcohol consumption and 8.5% had physical difficulty climbing stairs. Age, BMI, histopathological stage and physical capacity all independently affected survival (P < 0.05). Overweight patients [hazard ratio (HR) 2.81] and those who had difficulty climbing stairs (HR 3.31) had a significantly poorer survival. CONCLUSION This study found evidence that preoperative exercise capacity and BMI are important independent prognostic factors of survival in patients undergoing curative surgery for CRC.
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Affiliation(s)
| | - G M Allardice
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
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6
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Mansouri D, McMillan DC, McIlveen E, Crighton EM, Morrison DS, Horgan PG. A comparison of tumour and host prognostic factors in screen-detected vs nonscreen-detected colorectal cancer: a contemporaneous study. Colorectal Dis 2016; 18:967-975. [PMID: 26859503 DOI: 10.1111/codi.13295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/24/2015] [Indexed: 12/16/2022]
Abstract
AIM In addition to TNM stage there are adverse tumour and host factors, such as venous invasion and the presence of an elevated systemic inflammatory response (SIR), that influence the outcome in colorectal cancer. The present study aimed to examine how these factors varied in screen-detected (SD) and nonscreen-detected (NSD) tumours. METHOD Prospectively maintained databases of the prevalence round of a biennial population faecal occult blood test screening programme and a regional cancer audit database were analysed. Interval cancers (INT) were defined as cancers identified within 2 years of a negative screening test. RESULTS Of the 395 097 people invited, 204 535 (52%) responded, 6159 (3%) tested positive and 421 (9%) had cancer detected. A further 708 NSD patients were identified [468 (65%) nonresponders, 182 (25%) INT cancers and 58 (10%) who did not attend or did not have cancer diagnosed at colonoscopy]. Comparing SD and NSD patients, SD patients were more likely to be male, and have a tumour with a lower TNM stage (both P < 0.05). On stage-by-stage analysis, SD patients had less evidence of an elevated SIR (P < 0.05). Both the presence of venous invasion (P = 0.761) and an elevated SIR (P = 0.059) were similar in those with INT cancers and in those that arose in nonresponders. CONCLUSION Independent of TNM stage, SD tumours have more favourable host prognostic factors than NSD tumours. There is no evidence that INT cancers are biologically more aggressive than those that develop in the rest of the population and are hence likely to be due to limitations of screening in its current format.
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Affiliation(s)
- D Mansouri
- Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK.
| | - D C McMillan
- Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - E McIlveen
- Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - E M Crighton
- Department of Public Health Screening Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, University of Glasgow, Glasgow, UK
| | - P G Horgan
- Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
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7
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McLean RC, Morrison DS, Shearer R, Boyle S, Logue J. Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clin Obes 2016; 6:133-42. [PMID: 26842226 DOI: 10.1111/cob.12136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2) = 0.094, P < 0.001 and r(2) = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.
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Affiliation(s)
- R C McLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, 1 Lilybank Gardens, Glasgow, UK
| | - R Shearer
- Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S Boyle
- Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Aldekhail NM, Logue J, McLoone P, Morrison DS. Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2015; 16:1071-80. [PMID: 26345590 DOI: 10.1111/obr.12318] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 01/30/2023]
Abstract
Orlistat is an effective adjunctive treatment to lifestyle modifications in the treatment of obesity. While the majority of current evidence is on the effect of orlistat in obese patients without diabetes, some studies suggest that patients who are obese and have diabetes mellitus lose more weight and have greater improvements in diabetic outcomes when treated with orlistat plus a lifestyle intervention than when treated by lifestyle interventions alone. The aim of this study was to review the evidence of the effects of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes. A systematic review of randomized controlled trials of orlistat in people with type 2 diabetes reporting diabetes outcomes in studies published between January 1990 and September 2013 was conducted. We searched for articles published in English in MEDLINE and EMBASE. Inclusion criteria included all randomized controlled trials of orlistat carried out on adult participants with a body mass index of 25 kg m(-2) or over diagnosed with type 2 diabetes, which reported weight change and at least one diabetic outcome. A total of 765 articles were identified out of which 12 fulfilled the inclusion criteria. The overall mean weight reduction (3, 6 and 12 months) in the orlistat group was -4.25 kg (95% CI: -4.5 to -3.9 kg). The mean weight difference between treatment and control groups was -2.10 kg (95% CI: -2.3 to -1.8 kg, P < 0.001), the mean HbA1c difference was -6.12 mmol mol(-1) (95% CI: -10.3 to -1.9 mmol mol(-1) , P < 0.004) and the mean fasting blood glucose difference was -1.16 mmol L(-1) (95% CI: -1.4 to -0.8 mmol L(-1) , P < 0.001). Treatment with orlistat plus lifestyle intervention resulted in significantly greater weight loss and improved glycaemic control in overweight and obese patients with type 2 diabetes compared with lifestyle intervention alone.
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Affiliation(s)
- N M Aldekhail
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - P McLoone
- West of Scotland Cancer Surveillance Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS. Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg 2013; 100:1388-95. [PMID: 23939852 DOI: 10.1002/bjs.9227] [Citation(s) in RCA: 47] [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] [Accepted: 06/10/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Reorganization of colorectal cancer services has led to surgery being increasingly, but not exclusively, delivered by specialist surgeons. Outcomes from colorectal cancer surgery have improved, but the exact determinants remain unclear. This study explored the determinants of outcome after colorectal cancer surgery over time. METHODS Postoperative mortality (within 30 days of surgery) and 5-year relative survival rates for patients in the West of Scotland undergoing surgery for colorectal cancer between 1991 and 1994 were compared with rates for those having surgery between 2001 and 2004. RESULTS The 1823 patients who had surgery in 2001-2004 were more likely to have had stage I or III tumours, and to have undergone surgery with curative intent than the 1715 patients operated on in 1991-1994. The proportion of patients presenting electively who received surgery by a specialist surgeon increased over time (from 14·9 to 72·8 per cent; P < 0·001). Postoperative mortality increased among patients treated by non-specialists over time (from 7·4 to 10·3 per cent; P = 0·026). Non-specialist surgery was associated with an increased risk of postoperative death (adjusted odds ratio 1·72, 95 per cent confidence interval (c.i.) 1·17 to 2·55; P = 0·006) compared with specialist surgery. The 5-year relative survival rate increased over time and was higher among those treated by specialist compared with non-specialist surgeons (62·1 versus 53·0 per cent; P < 0·001). Compared with the earlier period, the adjusted relative excess risk ratio for the later period was 0·69 (95 per cent c.i. 0·61 to 0·79; P < 0·001). Increased surgical specialization accounted for 18·9 per cent of the observed survival improvement. CONCLUSION Increased surgical specialization contributed significantly to the observed improvement in longer-term survival following colorectal cancer surgery.
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Affiliation(s)
- R Oliphant
- University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
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10
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McLoone P, Morrison DS. Risk of child obesity from parental obesity: analysis of repeat national cross-sectional surveys. Eur J Public Health 2012; 24:186-90. [DOI: 10.1093/eurpub/cks175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer 2012. [PMID: 22828611 DOI: 10.1038/bjc.2012.292)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The neutrophil lymphocyte ratio (NLR) has prognostic value in patients with a variety of cancers. Many chemotherapeutic trial databases hold information on white cell and neutrophil counts only. The aim of the present study was to compare the prognostic value of the NLR with a derived score (dNLR), composed of white cell and neutrophil counts. METHODS Patients (n=27,031) who were sampled incidentally between 2000 and 2007 for neutrophil, lymphocyte and white cell counts, and also had a diagnosis of cancer (Scottish Cancer Registry), were identified. Of this group, 12,118 patients who had been sampled within 2 years of their cancer diagnosis were studied. RESULTS On follow-up, there were 7366 deaths, of which 6198 (84%) were cancer deaths. The median time from blood sampling to diagnosis was 2.1 months. The area under the receiver-operating characteristic (ROC) curve for cancer-specific survival was 0.650 for the NLR and 0.640 for the dNLR. The NLR and dNLR were independently associated with survival in all cancers studied (all P<0.001). The optimal thresholds, on the basis of hazard ratios and area under the curve, were 4 : 1 for the NLR and 2 : 1 for the dNLR. CONCLUSION The results of the present study show that the dNLR has similar prognostic value to the NLR. Therefore, the universally available dNLR is to be commended for use in the risk stratification of patients undergoing chemotherapy.
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Affiliation(s)
- M J Proctor
- University Department of Surgery, Faculty of Medicine, Royal Infirmary, University of Glasgow, Glasgow G31 2 ER, UK.
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12
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Nicholson GA, Morrison DS, Finlay IG, Diament RH, Horgan PG, Molloy RG. Quality of care in rectal cancer surgery. Exploring influencing factors in the West of Scotland. Colorectal Dis 2012; 14:731-9. [PMID: 21831175 DOI: 10.1111/j.1463-1318.2011.02754.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To assess variability in the proportions of types of major resection for rectal cancer throughout the west of Scotland (WoS) and ascertain factors explaining the variability. METHOD Retrospective cohort study of a regional population clinical audit database. This was linked to cancer registrations and death certificates in order that outcome analyses could be derived. Univariate and multivariate binary logistic regression analyses were used to explore determinants of survival. RESULTS A total of 1574 patients met the inclusion criteria. The age range was from 22 to 97 years. The mean age was 67, median age 68 and the standard deviation was 11.5. The majority of patients (61%) were male. Unlike previous series, male patients and those with poorer socioeconomic circumstances (SEC) were no more likely to receive an abdominoperineal excision (APE) procedure for rectal cancer. CONCLUSION Variation exists in the west of Scotland regarding surgical treatment for rectal cancer. We found no difference in the type of procedure offered according to sex, intent of operation or socioeconomic circumstances with reference to APE and anterior resection (AR) for rectal cancer. We conclude therefore that our region provides an equitable service on grounds of sex and SEC. This demonstrates that an equitable surgical service has been provided for those suffering from rectal cancer. Circumferential margin positivity was four times more likely in an APE than an AR for rectal cancer. This is not explained by age, stage, sex, socioeconomic circumstances (SEC), volume of surgery, intent of operation, type of admission or year of incidence.
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Affiliation(s)
- G A Nicholson
- Department of Academic Surgery, University of Glasgow, Glasgow, UK.
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13
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Mcmillan DC, Morrison DS, Talwar D, Horgan PG, Proctor MJ. Inflammation-based prognostic scores to predict outcome in patients with cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e21154] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
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14
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Nicholson GA, Finlay IG, Diament RH, Molloy RG, Horgan PG, Morrison DS. Mechanical bowel preparation does not influence outcomes following colonic cancer resection. Br J Surg 2011; 98:866-71. [PMID: 21412756 DOI: 10.1002/bjs.7454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2011] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Meta-analyses have indicated that preoperative mechanical bowel preparation (MBP) confers no clear benefit and may indeed be harmful for patients with colorectal cancer. The effects of bowel preparation on longer-term outcomes have not been reported. The aim was to compare long-term survival and surgical complications in patients who did or did not receive MBP before surgery for colonic cancer.
Methods
This was a retrospective cohort study of all patients undergoing potentially curative surgery for colonic cancer after routine hospital admission in the West of Scotland between January 2000 and December 2005. Clinical audit data were linked to cancer registrations and death certificates. Kaplan–Meier and Cox proportional hazards models were used to explore determinants of survival.
Results
A total of 1730 patients underwent potentially curative surgery for colonic cancer, of whom 886 (51·2 per cent) were men. The mean(s.d.) age was 69·7(10·6) years. Some 1460 patients (84·4 per cent) received MBP. Median follow-up was 3·5 (range 0·1–6·7) years. There were no statistically significant differences in 30-day postoperative complication rates between groups. The unadjusted hazard ratio (HR) for death from all causes for patients treated with MBP (versus no MBP) was 0·72 (95 per cent confidence interval 0·57 to 0·91). Multivariable analysis with adjustment for age, sex, socioeconomic circumstances, disease stage and presentation for surgery showed that MBP had no independent effect on all-cause mortality (HR 0·85, 0·67 to 1·10).
Conclusion
Neither postoperative complications nor long-term survival are improved by MBP before colonic cancer surgery.
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Affiliation(s)
- G A Nicholson
- West of Scotland Cancer Surveillance Unit, Section of Public Health and Health Policy, Faculty of Medicine, University of Glasgow, UK
| | - I G Finlay
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - R H Diament
- Department of Surgery, Crosshouse Hospital, Kilmarnock, UK
| | - R G Molloy
- Department of Surgery, Gartnavel General Hospital, UK
| | - P G Horgan
- Department of Academic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, Section of Public Health and Health Policy, Faculty of Medicine, University of Glasgow, UK
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Proctor MJ, Morrison DS, Talwar D, Balmer SM, O'Reilly DSJ, Foulis AK, Horgan PG, McMillan DC. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011; 104:726-34. [PMID: 21266974 PMCID: PMC3049591 DOI: 10.1038/sj.bjc.6606087] [Citation(s) in RCA: 388] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: A selective combination of C-reactive protein and albumin (termed the modified Glasgow Prognostic Score, mGPS) has been shown to have prognostic value, independent of tumour stage, in lung, gastrointestinal and renal cancers. It is also of interest that liver function tests such as bilirubin, alkaline phosphatase and γ-glutamyl transferase, as well as serum calcium, have also been reported to predict cancer survival. The aim of the present study was to examine the relationship between an inflammation-based prognostic score (mGPS), biochemical parameters, tumour site and survival in a large cohort of patients with cancer. Methods: Patients (n=21 669) who had an incidental blood sample taken between 2000 and 2006 for C-reactive protein, albumin and calcium (and liver function tests where available) and a diagnosis of cancer were identified. Of this group 9608 patients who had an ongoing malignant process were studied (sampled within 2 years before diagnosis). Also a subgroup of 5397 sampled at the time of diagnosis (sampled within 2 months prior to diagnosis) were examined. Cancers were grouped by tumour site in accordance with International Classification of Diseases 10 (ICD 10). Results: On follow up, there were 6005 (63%) deaths of which 5122 (53%) were cancer deaths. The median time from blood sampling to diagnosis was 1.4 months. Increasing age, male gender and increasing deprivation was associated with a reduced 5-year overall and cancer-specific survival (all P<0.001). An elevated mGPS, adjusted calcium, bilirubin, alkaline phosphatase, aspartate transaminase, alanine transaminase and γ-glutamyl transferase were associated with a reduced 5-year overall and cancer-specific survival (independent of age, sex and deprivation in all patients sampled), as well as within the time of diagnosis subgroup (all P<0.001). An increasing mGPS was predictive of a reduced cancer-specific survival in all cancers (all P<0.001). Conclusion: The results of the present study indicate that the mGPS is a powerful prognostic factor when compared with other biochemical parameters and independent of tumour site in patients with cancer.
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Affiliation(s)
- M J Proctor
- University Department of Surgery, Faculty of Medicine-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK.
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16
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Harrison JK, Sloan B, Dawson J, Lees KR, Morrison DS. The ABCD and ABCD2 as predictors of stroke in transient ischemic attack clinic outpatients: a retrospective cohort study over 14 years. QJM 2010; 103:679-85. [PMID: 20601651 DOI: 10.1093/qjmed/hcq108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The ABCD and ABCD2 scores have been validated for use as predictors of stroke in community populations up to 90 days after a transient ischemic attack (TIA). TIA outpatient clinics may see a selective group of patients who have not had an early stroke but may be at raised risk in the medium to long term and therefore benefit from preventive treatment. AIM To describe the prognostic values of the ABCD and ABCD2 scores on long-term stroke risk. DESIGN Retrospective cohort study of TIA clinic outpatients followed for up to 14 years. METHODS Absolute and relative stroke risks, Kaplan-Meier survival curves and cumulative stroke incidence were calculated. Receiver Operating Characteristic curves (ROCs) and areas under the curve were calculated for both scores. RESULTS Seven hundred and ninety-five patients were included and 138 (17.3%) experienced a stroke within 13.8 years follow-up after first TIA clinic visit, a crude risk of 26.3 per 1000 person-years. Compared with baseline scores of 0-2, risk ratios for ABCD of 3-4 were 2.95 (95% CI 1.52-6.40), and for 5-6 were 3.42 (95% CI 1.72-7.54); for the ABCD2, risk ratios for 3-4 were 2.68 (95% CI 1.37-5.84), and for 5-7 were 3.55 (95% CI 1.80-7.79). Scores of > or = 3 for either ABCD or ABCD2 predicted raised stroke risks at 90 days, 1, 5 and 10 years. Areas under the curve were 0.619 (95% CI 0.571-0.668) and 0.630 (95% CI 0.582-0.677) for the ABCD and ABCD2 scores, respectively. CONCLUSION ABCD and ABCD2 scores of > or = 3 may be clinically useful in identifying TIA outpatients at raised risk of stroke in the medium to long term.
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Affiliation(s)
- J K Harrison
- Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow G12 8RZ, UK
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17
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Morrison DS. A much loved institution: the UK National Health Service. Br J Soc Med 2009. [DOI: 10.1136/jech.2008.082701] [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: 11/03/2022]
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18
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Morrison DS, Thomson H, Petticrew M. Effects of disseminating research findings on response rates in a community survey: a randomised controlled trial. J Epidemiol Community Health 2003; 57:536-7. [PMID: 12821704 PMCID: PMC1732498 DOI: 10.1136/jech.57.7.536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morrison DS, Petticrew M, Thomson H. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews. J Epidemiol Community Health 2003; 57:327-33. [PMID: 12700214 PMCID: PMC1732458 DOI: 10.1136/jech.57.5.327] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [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: 11/04/2022]
Abstract
STUDY OBJECTIVE To review systematic review literature that describes the effectiveness of transport interventions in improving population health. METHODS Systematic review methodology was used to evaluate published and unpublished systematic reviews in any language that described the measured health effects of any mode of transport intervention. MAIN RESULTS 28 systematic reviews were identified. The highest quality reviews indicate that the most effective transport interventions to improve health are health promotion campaigns (to prevent childhood injuries, to increase bicycle and motorcycle helmet use, and to promote children's car seat and seatbelt use), traffic calming, and specific legislation against drink driving. Driver improvement and education courses are associated with increases in crash involvement and violations. CONCLUSIONS Systematic reviews are able to provide evidence about effective ways of improving health through transport related interventions and also identify well intentioned but harmful interventions. Valuable additional information may exist in primary studies and systematic reviews have a role in evaluating and synthesising their findings.
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Affiliation(s)
- D S Morrison
- Greater Glasgow NHS Board, Homelessness Partnership, Glasgow,
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20
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Morrison DS. Room for one homeless person. Br J Soc Med 2003. [DOI: 10.1136/jech.57.3.163] [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: 11/03/2022]
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21
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Morrison DS, Gilchrist G, Ahmed S. Potential of specialist drug services to deliver hepatitis B vaccination. Commun Dis Public Health 2002; 5:321-3. [PMID: 12564250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The city of Glasgow has a large population of injecting drug users (IDUs) who are likely to be susceptible to acute hepatitis B infection. We evaluated the effectiveness of a hepatitis B vaccination programme delivered at three existing types of services for IDUs. It was found that while uptake rates were generally low, they were higher at services where throughput of patients was lower, where clients had continuing relationships with services and where staff training and confidence were better.
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Abstract
BACKGROUND Hospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland. METHODS Linked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45-6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex. RESULTS There were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children. CONCLUSIONS After a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.
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Affiliation(s)
- D S Morrison
- MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
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Morrison DS, Gilchrist G. Prison admission health screening as a measure of health needs. Health Bull (Edinb) 2001; 59:114-9. [PMID: 12664725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To assess the validity of routine prison screening admission data for measuring health needs and planning health services. DESIGN Retrospective descriptive study of routinely collected admission data. SETTING The largest Scottish men's prison with an annual throughput of around 20,000 men. SUBJECTS All adult male (> or = 21 years) prisoners admitted during January 1998. RESULTS Nine hundred and six men were screened in January 1998. Thirty-eight per cent of men entering prison said they currently or had previously used illegal drugs and 22% of all admissions gave a history of intravenous drug use. Six men (0.7%) reported hepatitis C infection and two (0.2%) reported hepatitis B infection. A history of major mental illness was reported by 10% of all prisoners, 7% of drug users and 15% of problem drinkers. Deliberate self-harm was reported by 10% of all prisoners, 9% of drug users and 17% of problem drinkers. CONCLUSION There is a high prevalence of reported substance misuse and its sequelae and mental illness in prisoners. However, mental illness, substance use and some infectious diseases (such as HIV, hepatitis B and hepatitis C) may be under-reported, possibly because of social stigma or low expectations of treatment in prison. Health screening on admission to prison presents a unique opportunity to identify health needs at an early stage. However, there is a need to improve detection of some stigmatized conditions if individual care and health service planning are to be improved.
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Affiliation(s)
- D S Morrison
- MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow
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Morrison DS. Reducing speed limit to 20 mph in urban areas. Evidence based principles should be applied to non-health sector interventions. BMJ 2001; 322:50. [PMID: 11280290 PMCID: PMC1119319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
Understanding the pathophysiology and treatment of rotator cuff disorders is the key to understanding all other aspects of shoulder rehabilitation. Impingement rehabilitation focuses on strengthening the humeral head depressors, while ignoring the deltoid and supraspinatus muscles. Later treatment includes specific retraining of scapular balancing muscles. The final phase of treatment includes strengthening the prime humeral movers in positions that avoid further stress to the injured rotator cuff tendons and, last of all, specifically strengthening the supraspinatus muscle.
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Affiliation(s)
- D S Morrison
- Southern California Center for Sports Medicine, Long Beach, CA 90806, USA
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Abstract
To examine neural aspects of motor control in the glenohumeral joint, this study evaluates utilization of an innate spinal segmental pathway, the spinal stretch reflex, as an investigational tool that reflects neural circuitry. The purpose of this study was to determine if this reflex could be evoked from the infraspinatus muscle, if the testing apparatus and protocol for elicitation were reliable, and if the reflex response varies between groups of subjects and therefore could be useful clinically. These reflex characteristics were evaluated in the infraspinatus muscle, since rotator cuff muscle activity in subjects with glenohumeral instability exhibits differences in electromyographic activity and coordination patterns, implicating its role in dynamic stability. Normal shoulders were compared with athletic shoulders and shoulders with multidirectional instability. The spinal stretch reflex was elicited in a controlled and reliable manner. Shoulders with multidirectional instability exhibited a more-prominent spinal stretch reflex response than normal shoulders, whereas athletic shoulders exhibited a more-quiescent spinal stretch reflex response. As the spinal stretch reflex probably plays a role in motor control, variation in this reflex profile may reflect some differences in development that contribute to the variable expression of dynamic glenohumeral stability. This study suggests that the spinal stretch reflex profile may be a useful clinical tool to assist in discriminating between the normal and pathologic state. This information may also be useful in the evaluation of new treatment approaches exploiting spinal cord plasticity and spinal stretch reflex mutability through neuromuscular training.
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Affiliation(s)
- W K Augé
- Center for Orthopaedic and Sports Performance Research, The Northern New Mexico Orthopaedic Center, Public Health Service, United States Department of Health and Human Services, Santa Fe
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Morrison DS, Ahmed S. Innovation in vaccine provision for drug users. Commun Dis Public Health 1999; 2:296. [PMID: 10598392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Morrison DS. Control of house dust mite in managing asthma. Peak expiratory flow rates in populations are not valid measure of asthma. BMJ 1999; 318:870; author reply 871. [PMID: 10223797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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McLeone P, Morrison DS. Trends in asthma mortality. Short-term fluctuations may obscure more meaningful, longer term, changes. BMJ 1997; 315:1013-4. [PMID: 9365308 PMCID: PMC2127648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
We performed a retrospective study of 616 patients (636 shoulders) who had subacromial impingement syndrome to assess the results of non-operative treatment. The diagnosis was made on the basis of a positive impingement sign and the absence of other abnormalities of the shoulder, such as full-thickness tears of the rotator cuff, osteoarthrosis of the acromioclavicular joint, instability of the glenohumeral joint, or adhesive capsulitis. All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen consisting of isotonic exercises for strengthening of the rotator cuff. The average duration of follow-up was twenty-seven months (range, six to eighty-one months). Over-all, 413 patients (67 per cent) had a satisfactory result. One hundred and seventy-two patients (28 per cent) had no improvement and went on to have an arthroscopic subacromial decompression. Thirty-one patients (5 per cent) had an unsatisfactory result but declined additional treatment. Seventy-four (18 per cent) of the 413 patients who had a successful result had a recurrence of the symptoms during the follow-up period; the symptoms resolved with rest or after resumption of the exercise program. The patients were stratified according to age, the duration of symptoms, and acromial morphology. Patients who were twenty years old or less and those who were forty-one to sixty years old fared better than those who were twenty-one to forty years old. Patients who were more than sixty years old had the poorest results. Sixty-seven (78 per cent) of the eighty-six patients in whom the symptoms had been present for less than four weeks had a satisfactory result, compared with 144 (63 per cent) of the 228 who had had the symptoms for one to six months and with 202 (67 per cent) of the 302 who had had the symptoms for more than six months. Thirty-two (91 per cent) of the thirty-five patients who had a type-I acromion had a successful result, compared with 173 (68 per cent) of the 256 who had a type-II acromion and with 208 (64 per cent) of the 325 who had a type-III acromion. Shoulder dominance, gender, and concomitant tenderness of the acromioclavicular joint did not affect the result significantly (p = 0.084, 0.555, and 0.365, respectively).
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Affiliation(s)
- D S Morrison
- Southern California Center for Sports Medicine, Long Beach 90866, USA
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Kramer RL, Gilson GJ, Morrison DS, Martin D, Gonzales JL, Qualls CR. A randomized trial of misoprostol and oxytocin for induction of labor: safety and efficacy. Obstet Gynecol 1997; 89:387-91. [PMID: 9052591 DOI: 10.1016/s0029-7844(97)00363-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [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: 02/03/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of misoprostol and oxytocin for induction of labor. METHODS One hundred thirty women requiring induction of labor were randomized to receive either intravenous oxytocin or 100 micrograms misoprostol, administered intravaginally every 4 hours until labor was established. RESULTS Compared with women receiving oxytocin, a greater percentage of women in the misoprostol group had Bishop scores of 3 or less (58 versus 38%, P < .05). Nonetheless, the median induction-to-delivery interval was significantly shorter (585 versus 885 minutes, P < .001) in the misoprostol group. Women in the misoprostol group were more likely to deliver vaginally within 24 hours of the start of induction (77 versus 55%, P < .002). Epidural analgesia was used more frequently in women receiving oxytocin than in those receiving misoprostol (73 versus 50%, P = .025). The total percentage of cesarean deliveries was not significantly different, although the percentage of cesarean deliveries for dystocia was lower in the misoprostol group (8 versus 21%, P = .02). Uterine tachysystole was significantly more common (70 versus 11%, P < .001) and hospital charges significantly less with misoprostol. CONCLUSION Compared with oxytocin for labor induction, misoprostol results in a shorter induction-to-delivery interval, a reduction in the rate of cesarean delivery for dystocia, and a decreased use of epidural analgesia. Uterine tachysystole is significantly more common with the use of misoprostol.
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Affiliation(s)
- R L Kramer
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, USA
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Affiliation(s)
- R L Friedman
- Southern California Center for Sports Medicine, Long Beach 90806, USA
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Morrison DS, Schaefer RK, Friedman RL. The relationship between subacromial space pressure, blood pressure, and visual clarity during arthroscopic subacromial decompression. Arthroscopy 1995; 11:557-60. [PMID: 8534296 DOI: 10.1016/0749-8063(95)90131-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-two consecutive patients with subacromial impingement syndrome underwent arthroscopic subacromial decompression. Measurements of the subacromial space pressure and the blood pressure were recorded along with the clarity of the visual field. The clarity of the visual field was objectively determined based on the pressure at which bleeding was observed from trabecular bone or the soft tissue capillaries. A direct correlation was found between systolic blood pressure (SBP), subacromial space pressure (SASP), and the clarity of the visual field. On average, maintaining a pressure difference (SBP-SASP) of 49 mm Hg or less prevented bleeding and permitted good visualization. With a greater differential, significant bleeding occurred. Furthermore, the use of relative hypotensive anesthesia permits lower irrigation pressures and significantly reduces the risk of fluid extravasation into the subcutaneous tissues of the shoulder.
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Affiliation(s)
- D S Morrison
- Southern California Center for Sports Medicine, Long Beach 90806, USA
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Abstract
The elbow is one of the most common sites of overuse injuries in adolescent baseball players. The term "little league elbow" has been used to describe a number of entities. This article reports three cases of painful persistence of the olecranon epiphyseal plate in adolescent pitchers. Symptoms associated with this entity may improve with rest and avoidance of the aggravating activity. However, if symptoms persist and the contralateral growth plate has closed, internal fixation may be necessary and is effective in relieving the symptoms.
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Affiliation(s)
- W D Lowery
- Southern California Center for Sports Medicine, Long Beach 90806, USA
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Abstract
A total of 110 patients with a diagnosis of acromioclavicular joint separation were seen at our clinic between 1986 and 1991. Of these, 14 patients (12.7%) with grade III, IV, or V injuries required surgical reconstruction and were examined 2 years after surgery. All 14 patients underwent acromioclavicular reconstruction using a synthetic loop passed through drill holes in the base of the coracoid and the anterior third of the clavicle. When the loop is tightened, the clavicle is reduced anatomically without the anterior subluxation caused by simple clavicular cerclage. At an average followup of 44.2 months, patients were evaluated using the University of California, Los Angeles, rating scale. Twelve of the 14 had good or excellent results and returned to normal sport and work activities at 6 months. Of the two initial poor results, one required revision 1 month post-operatively because the patient was noncompliant, and the other required manipulation under anesthesia 3 months after surgery. The results in these two patients at 2 years were good and excellent, respectively. We concluded that, when medically indicated, fixation of the clavicle to the coracoid using this technique yields satisfactory results in an athletic population.
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Affiliation(s)
- D S Morrison
- Southern California Center for Sports Medicine, Long Beach 90806
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Abstract
One hundred consecutive patients with symptoms of chronic subacromial impingement syndrome were evaluated by both arthrography and magnetic resonance imaging (MRI) techniques. By comparing intermediate and T2 weighted images, the ability to identify the normal and abnormal anatomy of the rotator cuff with the MRI was excellent. All 51 patients with arthrogram-proven rotator cuff tears had abnormal MRI scans (100% sensitivity). However, six of the 49 patients with normal arthrograms had abnormal MRI scans (88% specificity). At arthroscopy, four of these patients were found to have moderate to severe partial thickness rotator cuff tears. These findings indicate that in patients with longstanding subacromial impingement syndrome the MRI has an exceptionally high sensitivity for damage to the rotator cuff.
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Affiliation(s)
- D S Morrison
- Southern California Center for Sports Medicine, Long Beach 90806
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Abstract
A new technique for harvesting the patella tendon for anterior cruciate ligament reconstruction is described. A circular oscillating saw is used to harvest the bone plugs. We feel that this technique offers reproducibility that is difficult to obtain with more conventional methods of graft harvesting.
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Affiliation(s)
- D W Jackson
- Southern California Center for Sports Medicine, Long Beach 90806
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Abstract
During the course of MRI examinations of the knee for possible internal derangement, the hip for avascular necrosis, and the shoulder for rotator cuff tears, we have encountered many examples of unsuspected fractures of the tibial plateau, femoral condyles, pelvis, hip and proximal humerus. These fractures were either radiographically inapparent or demonstrated very subtle abnormalities that were missed on prospective interpretation. In addition, a large number of patients have been found to demonstrate evidence of intraosseous trabecular disruption, or edema and hemorrhage of medullary bone, or stress type injuries, all of which are radiographically occult. The clinical significance of these osseous abnormalities varies and is dependent upon the degree of injury. It is believed that an awareness of these osseous abnormalities will improve the accuracy of MRI interpretation, will heighten an appreciation of the subtle radiographic abnormalities that may be present, and will improve patient evaluation and management.
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Affiliation(s)
- P E Berger
- Department of Radiology, Memorial Medical Center of Long Beach, California
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Neer CS, Morrison DS. Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am 1988; 70:1154-62. [PMID: 3047131] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abnormal glenoid architecture resulting from loss of bone usually is listed among the contraindications to total shoulder arthroplasty using an unconstrained prosthesis. However, in a series of 463 consecutive replacement procedures that were performed between 1973 and 1985, in only two patients did the lack of bone make the implantation of a glenoid component impossible. Of the remaining sixty-five shoulders that had an abnormal glenoid, twenty were successfully treated with a large, internally fixed bone graft or grafts and forty-five, with smaller bone grafts that were not internally fixed. Nineteen of the twenty shoulders that had a large graft or grafts were followed for two years or more (average, 4.4 years). The clinical results were judged to be excellent in sixteen and satisfactory in one, and the desired limited goals were obtained in two. Two fixation screws broke and one screw was worn by contact with the humeral component. None of the glenoid components clinically loosened or migrated, and no patient has needed further surgical treatment. Although bone-grafting was necessary in only twenty (4.3 per cent) of the 463 replacement procedures, this procedure provided sufficient osseous support to allow implantation of a component in a severely damaged glenoid.
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Affiliation(s)
- C S Neer
- Columbia University College of Physicians and Surgeons, New York City, N.Y. 10032
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Rasmussen CR, Villani Jnr FJ, Griffin EA, Morrison DS, Olofson RA. 2-Imino-N-phenyl-3-thiazolidinecarboxamide, C10H11N3OS. Acta Crystallogr C 1984. [DOI: 10.1107/s0108270184010878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Although in referral medical centers, laboratory tests related to patient management decisions may be more numerous than tests used for diagnostic decisions, little emphasis has been placed on the development of decision support systems that focus on laboratory tests in management decisions. Many of these decisions hinge on time-related series of laboratory test results. Graphical presentation of such data might be a more effective means of facilitating patient management decision making than is the conventional tabular report. The authors developed an easily used system for the graphical display of time-related laboratory results. The system presents the physician a convenient and rapid means of selecting the patient, test, and time period of interest, and provides a number of different graphical display formats. Physician acceptance of the display system has been enthusiastic. Careful attention to human factors considerations may promote physician acceptance of computer-based aids of this form.
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