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Stark D, Denzinger M, Ebert L, Brandl R, Knorr C. Therapeutic approaches of diametaphyseal radius fractures in children. Arch Orthop Trauma Surg 2024; 144:1179-1188. [PMID: 38231205 DOI: 10.1007/s00402-023-05118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/28/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. METHODS This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). RESULTS During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. CONCLUSIONS The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.
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Affiliation(s)
- D Stark
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany.
| | - M Denzinger
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - L Ebert
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
| | - R Brandl
- Klinik für Radiologie, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
| | - C Knorr
- Klinik für Kinderchirurgie, Klinik St. Hedwig, Krankenhaus der Barmherzigen Brüder, Steinmetzstr. 1-3, 93047, Regensburg, Germany
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Wallace H, Stark D, Weaving P, Inkster T. Development of an infection prevention and control pathway to facilitate high-throughput cataract surgery in Scotland. J Hosp Infect 2024; 147:107-114. [PMID: 38423131 DOI: 10.1016/j.jhin.2024.02.009] [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: 01/08/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Cataract surgery offers significant improvement to quality of life for patients with cataracts. However, there are growing waiting lists and challenges in providing this type of surgery in a timely manner. Feedback from stakeholders had previously indicated infection prevention and control (IPC) as a potential barrier to high-throughput surgery. Antimicrobial Resistance and Healthcare Associated Infection Scotland was asked to support the implementation of high-throughput cataract surgery aimed at addressing these challenges. AIM To develop an IPC pathway to facilitate high-throughput surgery. This would be based on best practice, and would address any barriers identified by stakeholders. METHODS A short life working group with input from key stakeholders, including clinical teams, was established. A rapid literature review was also undertaken. RESULTS An agreed patient pathway was developed, with the aim of helping to facilitate high-throughput surgery. Pre-, intra- and postoperative phases were considered. Where literature was unavailable, expert/consensus opinion was utilized. Facilities for high-throughput surgery were also considered, including the Jack and Jill theatre arrangement which lends itself well to this concept. CONCLUSION Through collaboration with stakeholders, an IPC pathway was developed to facilitate high-throughput cataract surgery and address any potential IPC barriers to implementation. The process and the output described could be utilized to develop similar pathways for other surgeries that lend themselves well to high throughput, improving quality of life for patients and reducing waiting times. This study highlights the importance of establishing surveillance for postoperative endophthalmitis following implementation.
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Affiliation(s)
- H Wallace
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - D Stark
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - P Weaving
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK
| | - T Inkster
- Antimicrobial Resistance and Healthcare Associated Infection, National Services Scotland, Glasgow, UK.
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3
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Trama A, Stark D, Bozovic-Spasojevic I, Gaspar N, Peccatori F, Toss A, Bernasconi A, Quarello P, Scheinemann K, Jezdic S, Blondeel A, Mountzios G, Bielack S, Saloustros E, Ferrari A. Cancer burden in adolescents and young adults in Europe. ESMO Open 2023; 8:100744. [PMID: 36753992 PMCID: PMC10024081 DOI: 10.1016/j.esmoop.2022.100744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer epidemiology is unique in adolescents and young adults (AYAs; aged 15-39 years). The European Society for Medical Oncology/European Society for Paediatric Oncology (ESMO/SIOPE) AYA Working Group aims to describe the burden of cancers in AYAs in Europe and across European Union (EU) countries. PATIENTS AND METHODS We used data available on the Global Cancer Observatory. We retrieved crude and age-standardised (World Standard Population) incidence and mortality rates. We reported about AYA cancer burden in Europe and between 28 EU member states. We described incidence and mortality for all cancers and for the 13 cancers most relevant to the AYA population. RESULTS Incidence and mortality varied widely between countries with the highest mortality observed in Eastern EU countries. Cancers of the female breast, thyroid and male testis were the most common cancers across countries followed by melanoma of skin and cancers of the cervix. Variations in cancer incidence rates across different populations may reflect different distribution of risk factors, variations in the implementation or uptake of screening as well as overdiagnosis. AYA cancer mortality disparities may be due to variation in early-stage diagnoses, different public education and awareness of cancer symptoms, different degrees of access or availability of treatment. CONCLUSIONS Our results highlight the future health care needs and requirements for AYA-specialised services to ensure a homogeneous treatment across different countries as well as the urgency for preventive initiatives that can mitigate the increasing burden.
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Affiliation(s)
- A Trama
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - A Bernasconi
- Research Department, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - P Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy; University of Torino, Torino, Italy
| | - K Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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4
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Stark D, Nagrath N. 122 Tetanus Prophylaxis for Injuries Referred to a Plastic Surgery Service. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.067] [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: 11/14/2022]
Abstract
Abstract
Aim
To ascertain whether there is appropriate documentation of tetanus immunisation status. To determine whether appropriate tetanus prophylaxis is offered to those with an incomplete or unknown immunisation history for tetanus prone and high-risk tetanus prone wounds. To improve adherence to the green book of immunisation tetanus guidance.
Method
We performed an audit of wounds referred to plastic surgery in a 3-week period to ascertain whether the green book guidance was satisfied. A poster intervention for junior colleagues that illustrated the guidance was implemented. Re-audit was performed.
Results
Tetanus immunisation status was documented in 17 (34%) patients. Of 22 with tetanus prone wounds, 11 (50%) had an incomplete tetanus immunisation, but only 3 (27%) received a booster vaccine. Of the 11 high risk tetanus prone wounds, 10 (91%) had an incomplete tetanus immunisation status, but only 5 (50%) received a booster vaccine and none were offered tetanus immunoglobulins.
Following intervention, tetanus immunisation status was documented in 23 (46%) patients. In the re-audit, 12 (24%) sustained a tetanus prone injury and 4 (33%) of these had complete immunisation. Of the remaining 8, 7 (88%) received a booster vaccine and 1 patient refused. Of the 4 high risk tetanus prone wounds, 3 (75%) had an incomplete tetanus immunisation status, all of whom received a booster vaccine and 1 (25%) was offered tetanus immunoglobulins.
Conclusions
We observed greater engagement with the tetanus immunisation guidance and improvement in the assessment and management of tetanus prone injuries.
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Affiliation(s)
- D. Stark
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - N. Nagrath
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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5
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Chan D, Suk HJ, Jackson B, Milman NP, Stark D, Beach SD, Tsai LH. Induction of specific brain oscillations may restore neural circuits and be used for the treatment of Alzheimer's disease. J Intern Med 2021; 290:993-1009. [PMID: 34156133 DOI: 10.1111/joim.13329] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/22/2020] [Revised: 03/24/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023]
Abstract
Brain oscillations underlie the function of our brains, dictating how we both think and react to the world around us. The synchronous activity of neurons generates these rhythms, which allow different parts of the brain to communicate and orchestrate responses to internal and external stimuli. Perturbations of cognitive rhythms and the underlying oscillator neurons that synchronize different parts of the brain contribute to the pathophysiology of diseases including Alzheimer's disease, (AD), Parkinson's disease (PD), epilepsy and other diseases of rhythm that have been studied extensively by Gyorgy Buzsaki. In this review, we discuss how neurologists manipulate brain oscillations with neuromodulation to treat diseases and how this can be leveraged to improve cognition and pathology underlying AD. While multiple modalities of neuromodulation are currently clinically indicated for some disorders, nothing is yet approved for improving memory in AD. Recent investigations into novel methods of neuromodulation show potential for improving cognition in memory disorders. Here, we demonstrate that neuronal stimulation using audiovisual sensory stimulation that generated 40-HZ gamma waves reduced AD-specific pathology and improved performance in behavioural tests in mouse models of AD, making this new mode of neuromodulation a promising new avenue for developing a new therapeutic intervention for the treatment of dementia.
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Affiliation(s)
- D Chan
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - H-J Suk
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - B Jackson
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,McGovern Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - N P Milman
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - D Stark
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - S D Beach
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.,Division of Medical Sciences, Harvard Medical School, Boston, MA, USA
| | - L-H Tsai
- From the, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
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Birckhead A, Combs M, Croser E, Montgomery A, Peters A, Stark D, Malik R. Presumptive neural microsporidiosis in a young adult German Shepherd dog from rural Australia. Aust Vet J 2021; 99:351-355. [PMID: 33904161 DOI: 10.1111/avj.13071] [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: 12/06/2020] [Revised: 02/21/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
CASE REPORT A 1-year-old, neutered male German Shepherd was presented with a 5-month history of episodic lethargy, intermittent fever, weight loss and a hunched posture. The dog was diagnosed with presumptive microsporidian meningoencephalitis based on cytological findings on cerebrospinal fluid analysis and a positive PCR test. The dog initially responded favourably to a 4-week course of trimethoprim-sulfadiazine, pyrimethamine and fenbendazole, and remained well for 12 weeks following cessation of treatment. Disease then recurred, and despite an initial positive response to treatment, he deteriorated and was euthanased 11 weeks later, 7.5 months after definitive diagnosis and 13 months after clinical signs were first reported. CONCLUSION To the authors knowledge, this is the first case of canine microsporidiosis in Australia.
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Affiliation(s)
- A Birckhead
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - M Combs
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - E Croser
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Montgomery
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Peters
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - D Stark
- Microbiology Department, St Vincent's Hospital, Sydney, New South Wales, 2010, Australia
| | - R Malik
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia.,Centre for Veterinary Education, University of Sydney, Sydney, New South Wales, 2006, Australia
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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Dalvi R, Li CK, Yonemori K, Ariffin H, Lyu C, Farid M, Gonzales-Santos J, Zhou Q, Bielack S, Brugieres L, Blondeel A, Essiaf S, Peccatori F, Jezdic S, Stark D, Douillard JY, Saloustros E, Mountzios G. Adolescents and young adults with cancer care in Asia: The joint ESMO/SIOPE/SIOP ASIA survey. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy442.001] [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: 11/14/2022] Open
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Touati N, Schoffski P, Litière S, Judson I, Sleijfer S, van der Graaf W, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marreaud S, Gronchi A. EORTC experience with advanced/metastatic epithelioid sarcoma patients treated in prospective trials: Clinical profile and response to systemic therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.023] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Jones GL, Hughes J, Mahmoodi N, Greenfield D, Brauten-Smith G, Skull J, Gath J, Yeomanson D, Baskind E, Snowden JA, Jacques RM, Velikova G, Collins K, Stark D, Phillips R, Lane S, Bekker HL. Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol. BMJ Open 2017; 7:e013219. [PMID: 28289046 PMCID: PMC5353284 DOI: 10.1136/bmjopen-2016-013219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women's fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the 'Cancer, Fertility and Me' study is to develop and evaluate a new evidence-based patient decision aid (PtDA) for women with any cancer considering fertility preservation to address this unmet need. METHODS AND ANALYSIS This is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In stage 1, the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In stage 2, the aim is to assess the face validity of the PtDA. Feedback on its content and format will be ascertained using questionnaires and interviews with patients, user groups and key stakeholders. Finally, in stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice. Measures chosen include using count data of the PtDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t-tests and CIs; interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Research Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me patient decision aid (PtDA) will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of PtDAs and other relevant professional organisations, for example, the British Fertility Society. TRIAL REGISTRATION NUMBER NCT02753296; pre-results.
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Affiliation(s)
- G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - J Hughes
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - D Greenfield
- Department of Oncology, Sheffield Teaching NHS Hospitals Foundation Trust, Sheffield University, Sheffield, UK
| | | | - J Skull
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Gath
- Independent Cancer Patients' Voice, London, UK
| | - D Yeomanson
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - E Baskind
- Seacroft Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - R M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Velikova
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - D Stark
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - R Phillips
- Center for Review and Dissemination, University of York, Leeds General Infirmary, Leeds Teaching Hospitals, York, UK
| | - S Lane
- Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - H L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Faulkner D, Britton J, Eng S, Del Galdo F, Stark D, Buch M. FRI0272 Evaluation of Bleomycin Induced Raynaud's Phenomenon and Systemic Sclerosis Vasculopathy in Germ Cell Tumour Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1826] [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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Levine B, Boyd J, Jinivizian K, Jeschke M, Suhoski Davis M, Zheng Z, Stark D, Keir C, Wood P. Successful Technology Transfer of Chimeric Antigen Receptor (CAR) Targeting CD19 (CTL019) Cell Processing From Academia to Industry Enables Scale-Up to Support Global Clinical Trials. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Gibson F, Hibbins S, Grew T, Morgan S, Pearce S, Stark D, Fern LA. How young people describe the impact of living with and beyond a cancer diagnosis: feasibility of using social media as a research method. Psychooncology 2016; 25:1317-1323. [PMID: 26748434 DOI: 10.1002/pon.4061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 11/20/2015] [Accepted: 12/06/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Young people with cancer exhibit unique needs. During a time of normal physical and psychological change, multiple disease and treatment-related symptoms cause short and long-term physical and psychosocial effects. Little is known about how young people cope with the impact of cancer and its treatment on daily routines and their strategies to manage the challenges of cancer and treatments. We aimed to determine how young people describe these challenges through a social media site. METHODS Using the principles of virtual ethnography and watching videos on a social media site we gathered data from young people describing their cancer experience. Qualitative content analysis was employed to analyse and interpret the narrative from longitudinal 'video diaries' by 18 young people equating to 156 films and 27 h and 49 min of recording. Themes were described then organized and clustered into typologies grouping commonalities across themes. RESULTS Four typologies emerged reflective of the cancer trajectory: treatment and relenting side effects, rehabilitation and getting on with life, relapse, facing more treatment and coming to terms with dying. CONCLUSIONS This study confirms the need for young people to strive towards normality and creating a new normal, even where uncertainty prevailed. Strategies young people used to gain mastery over their illness and the types of stories they choose to tell provide the focus of the main narrative. Social Media sites can be examined as a source of data, to supplement or instead of more traditional routes of data collection known to be practically challenging with this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- F Gibson
- London South Bank University, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - S Hibbins
- London South Bank University, London, UK
| | - T Grew
- Oxford University Clinical Academic Graduate School, Oxford, UK
| | - S Morgan
- St James's University Hospital, Leeds, UK
| | - S Pearce
- University College London Hospitals NHS Foundation Trust, London, UK
| | - D Stark
- Section of Oncology and Clinical Research, Leeds Institute of Molecular Medicine, Leeds, UK
| | - L A Fern
- University College London Hospitals NHS Foundation Trust, London, UK.
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15
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Stark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, Erdelyi D, Grew T, Hjorth L, Jazbec J, Kabickova E, Konsoulova A, Kowalczyk J, Lassaletta A, Laurence V, Lewis I, Monrabal A, Morgan S, Mountzios G, Olsen P, Renard M, Saeter G, van der Graaf W, Ferrari A. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care (Engl) 2015; 25:419-27. [DOI: 10.1111/ecc.12365] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Affiliation(s)
- D. Stark
- Leeds Institute of Cancer and Pathology; Leeds Institute of Oncology and St James's University Hospital; University of Leeds; Leeds UK
| | - S. Bielack
- Klinikum Stuttgart; Center for Pediatric and Adolescent Medicine; Pediatrics 5 (Oncology, Hematology, Immunology); Olgahospital; Stuttgart Germany
| | - L. Brugieres
- Department of Children and Adolescents Oncology; Institut Gustave Roussy; Villejuif France
| | - U. Dirksen
- University Hospital Muenster; Department of Pediatric Hematology and Oncology; Westfalian Wilhelms University; Muenster Germany
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - X. Duarte
- Instituto Português de Oncologia de Lisboa; Lisbon Portugal
| | - S. Dunn
- Teenage Cancer Trust; London UK
| | | | - T. Grew
- Oxford University Clinical Academic Graduate School; Oxford UK
| | - L. Hjorth
- Department of Pediatrics; Skåne University Hospital; Clinical Sciences Lund University; Lund Sweden
| | - J. Jazbec
- Division of Pediatrics; Unit of Hematooncology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | | | | | - J.R. Kowalczyk
- Children's University Hospital; Skubiszewski Medical University of Lublin; Lublin Poland
| | - A. Lassaletta
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - V. Laurence
- Department of Medical and Pediatric Oncology; Institut Curie; Paris France
| | - I. Lewis
- Alder Hey Children's NHS Foundation Trust; Liverpool
| | - A. Monrabal
- Spanish Association of Adolescents and Young Adult with Cancer; London
| | - S. Morgan
- Teenage Cancer Trust Unit; St James's University Hospital; Leeds UK
| | - G. Mountzios
- University of Athens School of Medicine; Athens Greece
| | - P.R. Olsen
- Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - M. Renard
- Department of Pediatric Hemato-Oncology; University Hospitals Leuven; Leuven Belgium
| | - G. Saeter
- Institute for Cancer Research; Oslo University Hospital; Oslo Norway
| | - W.T. van der Graaf
- Department of Medical Oncology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A. Ferrari
- Pediatric Oncology Unit; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
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Stark D, Cook A, Brown J, Velikova G, Brundage M, Embleton A, Raja F, Ledermann J. Quality of Life in a Randomised Double-Blind Phase III Trial of Cediranib (Azd2171) in Relapsed Platinum Sensitive Ovarian Cancer (Icon6). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Dunwoodie E, Watkins V, Lane M, van Laar M, Phillips R, Hall G, Stark D. When and Why Do Teenage and Young Adult Oncology Patients Die Early in the Cancer Pathway? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.22] [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: 11/13/2022] Open
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18
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Wilhelm M, Dirksen U, Bielack SS, Whelan JS, Lewis IJ, Jürgens H, Ferrari S, Sundby Hall K, Cleton-Jansen AM, Stark D. ENCCA WP17-WP7 consensus paper on teenagers and young adults (TYA) with bone sarcomas. Ann Oncol 2014; 25:1500-5. [PMID: 24962703 DOI: 10.1093/annonc/mdu153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 01/05/2023] Open
Abstract
Teenagers and young adults (TYA) cancer contributes substantially to morbidity and mortality in a population with much to offer society. TYA place distinct challenges upon cancer care services, many reporting feeling marginalized and their needs not being met in adult or paediatric cancer services. Bone tumours such as osteosarcoma and Ewing sarcoma, because of their age at presentation and the complexity of their care, are where challenges in managing (TYA) with cancer have often been most readily apparent. Bone sarcomas may be managed by paediatric or medical oncologists, and require fastidious attention to protocol. A lack of recent improvement in survival in TYA with bone tumours may be linked to a lack of specialist care, poor concordance with therapy in some situations and TYA-specific pharmacology. Participation in clinical trials, particularly of young adults, is low, hindering progress. All these requirements may be best met by a concerted effort to create collaborative care between adult and paediatric experts in bone sarcoma, working together to meet TYA patients' needs.
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Affiliation(s)
- M Wilhelm
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - U Dirksen
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S S Bielack
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - J S Whelan
- Teenage and Young Adult Unit, Department of Oncology, University College Hospital, London
| | - I J Lewis
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H Jürgens
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S Ferrari
- Italian Sarcoma Group (ISG), Chemioterapia, Bone Tumor Center, Istituto Rizzoli, Bologna, Italy
| | - K Sundby Hall
- Scandinavian Sarcoma Group (SSG), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A M Cleton-Jansen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Stark
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital Leeds, Leeds, UK
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19
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Affiliation(s)
- D. Stark
- Oncology, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - I. Lewis
- Alderhey Childrens Hospital, Childrens Services, Liverpool, United Kingdom
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20
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Wright C, Coad J, Morgan S, Stark D, Cable M. ‘Just in case’: The fertility information needs of teenagers and young adults with cancer. Eur J Cancer Care (Engl) 2013; 23:189-98. [DOI: 10.1111/ecc.12137] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C.I. Wright
- Faculty of Health & Life Sciences; Coventry University; Coventry UK
| | - J. Coad
- Centre of Children and Families Applied Research, CCFAR; Faculty of Health & Life Sciences; Coventry University; Coventry UK
| | - S. Morgan
- Teenage and Young Adult Cancer Service; Leeds Teaching Hospitals Trust; St James University Hospital; Leeds UK
| | - D. Stark
- The Leeds Institute of Cancer Studies and Pathology; St James's University Hospital Leeds; Leeds UK
- Leeds Institute of Oncology; St James's University Hospital Leeds; Leeds UK
| | - M. Cable
- Faculty of Health and Life Sciences; Coventry University; Coventry UK
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21
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Jarrett N, Scott I, Addington-Hall J, Amir Z, Brearley S, Hodges L, Richardson A, Sharpe M, Stamataki Z, Stark D, Siller C, Ziegler L, Foster C. Informing future research priorities into the psychological and social problems faced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 2013; 17:510-20. [PMID: 23619278 DOI: 10.1016/j.ejon.2013.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE To establish what is known regarding the psychological and social problems faced by adult cancer survivors (people who are living with and beyond a diagnosis of cancer) and identify areas future research should address. METHOD A rapid search of published literature reviews held in electronic data bases was under taken. Inclusion and exclusion criteria, and removal of duplicated papers, reduced the initial number of papers from 4051 to 38. Twenty-two review papers were excluded on grounds of quality and 16 review papers were selected for appraisal. RESULTS The psychological and social problems for cancer survivors are identified as depression, anxiety, distress, fear of recurrence, social support/function, relationships and impact on family, and quality of life. A substantial minority of people surviving cancer experience depression, anxiety, and distress or fear associated with recurrence or follow up. There is some indication that social support is positively associated with better outcomes. Quality of life for survivors of cancer appears generally good for most people, but an important minority experience a reduction in quality of life, especially those with more advanced disease and reduced social and economic resources. The majority of research knowledge is based on women with breast cancer. The longer term implications of cancer survival have not been adequately explored. CONCLUSIONS Focussing well designed research in the identified areas where less is already known about the psychological and social impact of cancer survival is likely to have the greatest impact on the wellbeing of people surviving cancer.
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Affiliation(s)
- N Jarrett
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
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22
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van Laar M, McKinney PA, Parslow RC, Glaser A, Kinsey SE, Lewis IJ, Picton SV, Richards M, Shenton G, Stark D, Norman P, Feltbower RG. Erratum: Cancer incidence among the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK. Br J Cancer 2013. [PMCID: PMC3619078 DOI: 10.1038/bjc.2013.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Roberts T, Stark D, Harkness J, Ellis J. Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis 2012; 32:335-43. [PMID: 22996007 DOI: 10.1007/s10096-012-1746-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/31/2012] [Indexed: 12/01/2022]
Abstract
Blastocystis is one of the most common enteric parasites present in humans. There is still much uncertainty about the pathogenic potential of this parasite, and it was suggested that its pathogenicity could be subtype-related. This report aimed to study 98 Blastocystis isolates found in human stool specimens to identify the subtypes present and carry out phylogenetic analysis on these isolates. This study also aimed to show the relationship between subtype and symptoms. Five-hundred and thirteen stool samples were submitted to five different diagnostic techniques for the detection of Blastocystis. Polymerase chain reaction (PCR)-positive samples were then sequenced and the small subunit (SSU) rDNA sequences were aligned and submitted to phylogenetic analysis. Ninety-eight samples were positive by any of the diagnostic methods for Blastocystis and 96 were positive by PCR. There were seven different subtypes (1, 2, 3, 4, 6, 7 and 8) identified by PCR and sequencing. This is the first large-scale study to examine the occurrence of Blastocystis in Australia. This study reports the high incidence of subtype 3 (44 %) in this population and discusses the emerging idea of subtype-dependent pathogenicity.
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Affiliation(s)
- T Roberts
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St., Darlinghurst, 2010 NSW, Australia.
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24
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Field A, Paik J, Stark D, Qiu M, Morey A, Plit M, Canning E, Glanville A. Myositis due to the microsporidianAnncaliia (Brachiola) algeraein a lung transplant recipient. Transpl Infect Dis 2012; 14:169-76. [DOI: 10.1111/j.1399-3062.2012.00724.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/12/2012] [Accepted: 01/16/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A.S. Field
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - J.Y. Paik
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - D. Stark
- Division of Microbiology; St Vincent's Hospital; Sydney NSW Australia
| | - M.R. Qiu
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - A. Morey
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - M.L. Plit
- Department of Thoracic Medicine; St Vincent's Hospital; Sydney NSW Australia
| | | | - A.R. Glanville
- Department of Thoracic Medicine; St Vincent's Hospital; Sydney NSW Australia
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Cicutto L, Julien B, Li NY, Nguyen-Luu NU, Butler J, Clarke A, Elliott SJ, Harada L, McGhan S, Stark D, Vander Leek TK, Waserman S. Comparing school environments with and without legislation for the prevention and management of anaphylaxis. Allergy 2012; 67:131-7. [PMID: 21951319 DOI: 10.1111/j.1398-9995.2011.02721.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND School personnel in contact with students with life-threatening allergies often lack necessary supports, creating a potentially dangerous situation. Sabrina's Law, the first legislation in the world designed to protect such children, requires all Ontario public schools to have a plan to protect children at risk. Although it has captured international attention, the differences a legislative approach makes have not been identified. Our study compared the approaches to anaphylaxis prevention and management in schools with and without legislation. METHODS Legislated (Ontario) and nonlegislated (Alberta, British Columbia, Newfoundland and Labrador, and Quebec) environments were compared. School board anaphylaxis policies were assessed for consistency with Canadian anaphylaxis guidelines. Parents of at-risk children and school personnel were surveyed to determine their perspectives on school practices. School personnel's EpiPen5 technique was assessed. RESULTS Consistency of school board policies with anaphylaxis guidelines was significantly better in a legislated environment (P=0.009). Parents in a legislated environment reported more comprehensive anaphylaxis emergency forms (P<0.001), while school personnel in nonlegislated environments reported more comprehensive forms (P=0.004). Despite school personnel in both environments receiving EpiPen5 training (>80%), suboptimal technique was commonly observed. However, school personnel in the legislated environment had better technique (P<0.001). CONCLUSION Our results suggest that school boards in legislated environments have made greater efforts to support students at risk for anaphylaxis compared to nonlegislated environments. However, significant gaps exist in both environments, especially with respect to EpiPen5 administration, content, and distribution of anaphylaxis emergency forms, and awareness of school procedures by school personnel and parents.
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Affiliation(s)
- L Cicutto
- National Jewish Health Faculty of Nursing, University of Toronto, Ontario, Canada.
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Woodward E, Jessop M, Glaser A, Stark D. Late effects in survivors of teenage and young adult cancer: does age matter? Ann Oncol 2011; 22:2561-2568. [DOI: 10.1093/annonc/mdr044] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Stark D, Nankivell M, Hilpert F, Elit L, Brown J, Lanceley A, Valikova G, Oza A, Swart A, Perren T. Quality of Life in the ICON7 GCIG Phase III Randomised Clinical Trial. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dharni N, Hanif N, Bradley C, Velikova G, Stark D, Wright P. The social difficulties of cancer patients of South Asian Indian and Pakistani origin: a cross-sectional questionnaire and interview study. BMJ Support Palliat Care 2011; 1:154-61. [DOI: 10.1136/bmjspcare-2011-000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hamilton P, Hall P, Seligmann J, Lord S, Marples M, Stark D. 9406 ORAL Can Serum D-dimer Monitoring Reduce the Frequency of Radiological Assessment in Patients Receiving Palliative Imatinib for Gasto-intestinal Stromal Tumour (GIST)? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72550-3] [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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30
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Rimmer Y, Chester J, Joffe J, Stark D, Shamash J, Powles T, White J, Wason J, Parashar D, Armstrong G, Mazhar D, Williams MV. Accelerated BEP: a phase I trial of dose-dense BEP for intermediate and poor prognosis metastatic germ cell tumour. Br J Cancer 2011; 105:766-72. [PMID: 21847130 PMCID: PMC3171015 DOI: 10.1038/bjc.2011.309] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: We used bleomycin, etoposide, cisplatin (BEP), the most effective regimen in the treatment of germ cell tumours (GCTs) and increased dose-density by using pegfilgrastim to shorten cycle length. Our aim was to assess safety and tolerability. Methods: Sixteen male patients with intermediate or poor prognosis metastatic GCT were treated with four cycles of 3-day BEP with G-CSF on a 14-day cycle for a planned relative dose-density of 1.5 compared with standard BEP. Results: Eleven intermediate and five poor prognosis patients were treated. In all, 14 of 16 patients completed the study treatment. Toxicities were comparable to previous studies using standard BEP, except for mucositis and haematological toxicity that were more severe. The overall relative dose-density for all 16 patients was mean 1.38 (range 0.72–1.5; median 1.46). Complete response was achieved after chemotherapy alone in two patients (13%) and following chemotherapy plus surgery in nine additional patients (56%). Four patients (25%) had a partial response and normalised their marker levels. At a median follow-up of 4.4 years (range 2.1–6.8) the estimated 5-year progression-free survival probability is 81% (95% CI 64–100%). Conclusion: Accelerated BEP is tolerable without major additional toxicity. A randomised controlled trial will be required to obtain comparative efficacy data.
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Affiliation(s)
- Y Rimmer
- Oncology Centre, Box 193, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, UK
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Dharni N, Hanif N, Bradley C, Velikova G, Stark D, Wright P. The social difficulties of cancer patients of South Asian Indian and Pakistani origin. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Murray S, Higginson I, Stark D. COMPASS - COMPlex interventions: Assessment, trialS and implementation of Services: Welcome to the COMPASS 2011 Annual Scientific Meeting (14-15 April 2011). BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000020.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Background: The development of practical patient-reported outcome measures (PROM) to assess the user view of health programmes is increasingly important. Valid, shorter instruments are more likely to be used and completed than extensive questionnaires. Methods: Consecutive adult outpatient attendees who were long-term survivors of childhood cancer completed the 16-item Patient Satisfaction with Communication Questionnaire (PSCQ). These data were used to develop a three-item questionnaire. The brief PROM was validated against data from a second, independent survey conducted in a similar fashion. Results: In all, 93 individuals contributed PSCQ data, a response rate of 63%. The brief PROM was highly correlated with the original PSCQ in derivation (ρ=0.87, P<0.001) and validation (ρ=0.82, P<0.001) data sets. Using a cutoff of scores <9 to indicate dissatisfaction showed fair discrimination in derivation (sensitivity 85%, specificity 80%) and validation data sets (sensitivity 75%, specificity 78%). Conclusion: It is possible to quickly and efficiently assess satisfaction with follow-up clinics with three questions. This brief PROM could prove useful in monitoring services quality by allowing clinic users to provide timely feedback on their care.
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Affiliation(s)
- R Phillips
- Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals Trust, Beckett Street, Leeds LS9 7TF, UK.
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Wasserman RL, Irani AM, Tracy J, Tsoukas C, Stark D, Levy R, Chen J, Sorrells S, Roberts R, Gupta S. Pharmacokinetics and safety of subcutaneous immune globulin (human), 10% caprylate/chromatography purified in patients with primary immunodeficiency disease. Clin Exp Immunol 2011; 161:518-26. [PMID: 20550549 DOI: 10.1111/j.1365-2249.2010.04195.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Subcutaneous administration of intravenous immunoglobulin G (IgG) preparations provides an additional level of patient convenience and more options for patients with poor venous access or a history of intravenous IgG reactions. An open-label, pharmacokinetic trial (n = 32) determined the non-inferiority of the subcutaneous versus intravenous route of 10% caprylate/chromatography purified human immune globulin intravenous (IGIV-C; Gamunex®) administration by comparing the steady-state area under the concentration-versus-time curve (AUC) of total plasma IgG in patients with primary immunodeficiency disease. Patients on stable IGIV-C received two intravenous infusions (administered 3 or 4 weeks apart). Seven to 10 days after the second intravenous infusion, all patients switched to a weekly infusion of subcutaneous IGIV-C, with the dose equal to 137% of the previous weekly equivalent intravenous dose, for up to 24 weeks. Samples for pharmacokinetic analysis were collected during steady state for intravenous and subcutaneous IGIV-C treatments. The AUC(0-) τ geometric least-squares mean ratio was 0·89 (90% confidence interval, 0·86-0·92) and met the criteria for non-inferiority. The overall mean steady-state trough concentration of plasma total IgG with subcutaneous IGIV-C was 11·4 mg/ml, 18·8% higher than intravenous IGIV-C (9·6 mg/ml). Subcutaneous IGIV-C was safe and well tolerated. Subcutaneous IGIV-C infusion-site reactions were generally mild/moderate and the incidence decreased over time. No serious bacterial infections were reported. Weekly subcutaneous IGIV-C infusion using 137% of the weekly equivalent intravenous immunoglobulin dose provides an AUC comparable to intravenous administration, thus allowing patients to maintain the same IgG preparation/formulation if switching between intravenous and subcutaneous infusions.
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Abstract
There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.
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Affiliation(s)
- J L N Barratt
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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van Laar M, McKinney PA, Parslow RC, Glaser A, Kinsey SE, Lewis IJ, Picton SV, Richards M, Shenton G, Stark D, Norman P, Feltbower RG. Cancer incidence among the south Asian and non-south Asian population under 30 years of age in Yorkshire, UK. Br J Cancer 2010; 103:1448-52. [PMID: 20842119 PMCID: PMC2990599 DOI: 10.1038/sj.bjc.6605903] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Few studies have examined epidemiological differences between ethnic groups for children and young adults with cancer. Methods: Subjects aged 0–29 years, diagnosed between 1990 and 2005 in the former Yorkshire Regional Health Authority, were included in the analysis. Ethnicity (south Asian or not) was assigned using name analysis program and Hospital Episode Statistics data. Differences in incidence (per 1 000 000 person-years) rates and trends were analysed using joinpoint and Poisson regression analysis. Results: Overall cancer incidence was similar for south Asians (12.1, 95% CI: 10.7–13.5; n=275) and non-south Asians (12.6, 95% CI: 12.2–13.1; n=3259). Annual incidence rates increased significantly by 1.9% per year on average (95% CI: 1.2–2.6%), especially for south Asians (7.0% 95% CI: 4.2–9.9%). Conclusion: If present trends continue, the higher rate of increase seen among south Asians aged 0–29 years in Yorkshire will result in three times higher cancer incidence than non-south Asians by 2020.
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Affiliation(s)
- M van Laar
- Paediatric Epidemiology Group, Division of Epidemiology, University of Leeds, Leeds LS2 9NL, UK
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van Laar M, McKinney PA, Parslow RC, Glaser A, Kinsey SE, Lewis IJ, Picton SV, Richards M, Shenton G, Stark D, Norman P, Feltbower RG. 078 Incidence rates and survival trends of cancer in 0-29-year-olds by ethnic group in Yorkshire, UK. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120956.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK, Kaplan A, Kastner M. Management of anaphylaxis in primary care: Canadian expert consensus recommendations. Allergy 2010; 65:1082-92. [PMID: 20584005 DOI: 10.1111/j.1398-9995.2010.02418.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anaphylaxis is often managed inadequately. We used findings from a systematic review of gaps in anaphylaxis management to develop evidence-based recommendations for gaps rated as clinically important by a panel of Canadian allergy experts. METHODS The nominal group technique (NGT) consensus methodology was used to develop evidence-based recommendations for the management of anaphylaxis in primary care. Physician-specific gaps from our systematic review were prioritized by consensus meeting participants in two rounds, which involved the rating, discussion, and re-rating of gaps. Using current anaphylaxis guidelines, recommendations were then developed for each category of gaps that were identified by the panel as clinically important. RESULTS Thirty unique physician gaps from the systematic review were categorized according to gaps of knowledge and anaphylaxis practice behaviors. The panel rated diagnosis of anaphylaxis, and when and how to use epinephrine auto-injectors as clinically important knowledge gaps; and rated infrequent or delayed epinephrine administration, low rate of auto-injector prescription, and infrequent or no referrals to allergy specialists after a reaction as important practice behavior gaps. Evidence from four guidelines was used to support the consensus recommendation statements for three resulting categories of gap themes: anaphylaxis management, epinephrine use, and follow-up care. CONCLUSION We used an NGT consensus methodology to develop an educational resource for primary care physicians and allergists to better understand how to manage patients with anaphylaxis. Next steps include testing our findings against observed data in primary care settings and to develop other strategies or tools to overcome gaps in anaphylaxis management.
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Affiliation(s)
- S Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
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Gudziol H, Stark D, Lehnich H, Bitter T, Guntinas-Lichius O. Hyposmiker haben weniger evozierte respiratorische Orientierungsreaktionen als Normosmiker. Laryngorhinootologie 2010; 89:477-82. [DOI: 10.1055/s-0030-1253372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stark D, Barratt JLN, van Hal S, Marriott D, Harkness J, Ellis JT. Clinical significance of enteric protozoa in the immunosuppressed human population. Clin Microbiol Rev 2009; 22:634-50. [PMID: 19822892 PMCID: PMC2772358 DOI: 10.1128/cmr.00017-09] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [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: 12/22/2022] Open
Abstract
Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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Stark D, van Hal S, Barratt J, Ellis J, Marriott D, Harkness J. Limited genetic diversity among genotypes of Enterocytozoon bieneusi strains isolated from HIV-infected patients from Sydney, Australia. J Med Microbiol 2009; 58:355-357. [PMID: 19208886 DOI: 10.1099/jmm.0.006445-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Microsporidia are intracellular parasites, with over 1200 species belonging to 143 genera described to date. They are opportunistic pathogens in humans and can cause chronic diarrhoea in immunosuppressed patients. Both Enterocytozoon bieneusi and Encephalitozoon intestinalis cause intestinal disease, with Enterocytozoon bieneusi more commonly identified in patients with human immunodeficiency virus (HIV) infection. In this study, intestinal microsporidial clinical isolates from patients in Sydney, Australia, were genotyped. All specimens were from HIV-infected men with low CD4(+) T-cell counts (<100 cells mm(-3)). Genotyping of the internal transcribed spacer regions of the rRNA gene showed the presence of only one genotype, the anthroponotic Enterocytozoon bieneusi genotype B strain. This study thus highlighted the limited genetic diversity among Australian Enterocytozoon bieneusi isolates, and it is hypothesized that, due to the reduced incidence of microsporidia and the subsequent reduction in the human reservoir of the anthroponotic genotype B, locally acquired intestinal microsporidiosis will rarely be seen in HIV-infected persons undergoing highly active antiretroviral therapy in the future in Australia.
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Affiliation(s)
- D Stark
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia.,St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - S van Hal
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Barratt
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia.,St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Ellis
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia
| | - D Marriott
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Harkness
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
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Kollmar R, Stark D, Schellinger P, Schwab S. Hypothermie und Dekompression nach großer intrazerebraler Blutung (HyDe-H) – erste Ergebnisse. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van Hal S, Stark D, Marriott D, Harkness J. Achromobacter xylosoxidans subsp. xylosoxidans prosthetic aortic valve infective endocarditis and aortic root abscesses. J Med Microbiol 2008; 57:525-527. [PMID: 18349376 DOI: 10.1099/jmm.0.47496-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of prosthetic valve infective endocarditis and aortic root abscesses caused by Achromobacter xylosoxidans subsp. xylosoxidans. The patient was an intravenous drug user and had injected amphetamines using 'duck pond water' as a diluent. After surgical intervention and 6 weeks of intravenous meropenem therapy, the patient made an uneventful recovery.
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Affiliation(s)
- S van Hal
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - D Stark
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - D Marriott
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - J Harkness
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
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Stark D, van Hal S, Fotedar R, Butcher A, Marriott D, Ellis J, Harkness J. Comparison of stool antigen detection kits to PCR for diagnosis of amebiasis. J Clin Microbiol 2008; 46:1678-81. [PMID: 18367563 PMCID: PMC2395085 DOI: 10.1128/jcm.02261-07] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/16/2008] [Accepted: 03/18/2008] [Indexed: 11/20/2022] Open
Abstract
The present study was conducted to compare two stool antigen detection kits with PCR for the diagnosis of Entamoeba histolytica infections by using fecal specimens submitted to the Department of Microbiology at St. Vincent's Hospital, Sydney, and the Institute of Medical and Veterinary Science, Adelaide, Australia. A total of 279 stool samples containing the E complex (E. histolytica, Entamoeba dispar, and Entamoeba moshkovskii) were included in this study. The stool specimens were tested by using two commercially produced enzyme immunoassays (the Entamoeba CELISA PATH and TechLab E. histolytica II kits) to detect antigens of E. histolytica. DNA was extracted from all of the samples with a Qiagen DNA stool mini kit (Qiagen, Hilden, Germany), and a PCR targeting the small-subunit ribosomal DNA was performed on all of the samples. When PCR was used as a reference standard, the CELISA PATH kit showed 28% sensitivity and 100% specificity. The TechLab ELISA (enzyme-linked immunosorbent assay) kit did not prove to be useful in detecting E. histolytica, as it failed to identify any of the E. histolytica samples which were positive by PCR. With the TechLab kit, cross-reactivity was observed for three specimens, one of which was positive for both E. dispar and E. moshkovskii while the other two samples contained E. moshkovskii. Quantitative assessment of the PCR and ELISA results obtained showed that the ELISA kits were 1,000 to 10,000 times less sensitive, and our results show that the CELISA PATH kit and the TechLab ELISA are not useful for the detection of E. histolytica in stool samples from patients in geographical regions where this parasite is not endemic.
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Affiliation(s)
- D Stark
- St. Vincent's Hospital, Department of Microbiology, Sydney, Australia.
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Schulz A, Vestweber AM, Leis W, Stark D, Dressler D. [An improved model of a catheterised human bladder for screening bactericidal agents]. Aktuelle Urol 2008; 39:53-7. [PMID: 18228188 DOI: 10.1055/s-2007-980096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Catheter encrustation and associated blockage by a crystalline Proteus mirabilis biofilm constitute a continuous problem in long-term catheterised patients. The objective of the present work was to verify a new, physiological bladder model possessing the ability to show that triclosan-blocking solutions exert bactericidal and bacteriostatic activities. MATERIAL AND METHODS Catheterised sterile infusion bags served as human bladder models. Artificial urine inoculated with Proteus mirabilis was administered by a further aperture. Samples for measurement of pH value and microbial count were collected at intervals of 24 h. Upon completion of testing catheter encrustation was assessed and visualised by scanning electron microscopy. RESULTS In contrast to the application of placebo solution, in models filled with triclosan-blocking solution the catheters drained freely for the experimental period. Similar results were obtained for pH values and microbial count. The pH of the artificial urine did not exceed a critical value of pH 7 and the numbers of organisms correspond approximately to the initially inoculated number of organisms. CONCLUSION In the model developed here, triclosan inhibits the growth of Proteus mirabilis over the test period by diffusing into the artificial urine through the catheter balloon. Thus, triclosan acts against the pH increase as well as the formation of a crystalline biofilm. Taken together, the adaptability of this new, physiological model of the human bladder could be shown.
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Main C, Bojke L, Griffin S, Norman G, Barbieri M, Mather L, Stark D, Palmer S, Riemsma R. Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer: a systematic review and economic evaluation. Health Technol Assess 2007; 10:1-132. iii-iv. [PMID: 16545208 DOI: 10.3310/hta10090] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the clinical effectiveness and cost-effectiveness of intravenous formulations of topotecan monotherapy, pegylated liposomal doxorubicin hydorocholoride (PLDH) monotherapy and paclitaxel used alone or in combination with a platinum-based compound for the second-line or subsequent treatment of advanced ovarian cancer. DATA SOURCES Electronic databases covering publication years 2000-4. Company submissions. REVIEW METHODS Seventeen databases were searched for randomised controlled trials (RCTs) and systematic reviews for the clinical effectiveness of PLDH, topotecan and paclitaxel and economic evaluations of the cost-effectiveness of PLDH, topotecan and paclitaxel. Selected studies were quality assessed and data extracted, as were the three company submissions. A new model was developed to assess the costs of the alternative treatments, the differential mean survival duration and the impact of health-related quality of life. Monte-Carlo simulation was used to reflect uncertainty in the cost-effectiveness results. RESULTS Nine RCTs were identified. In five of these trials, both the comparators were used within their licensed indications. Of these five, three included participants with both platinum-resistant and platinum-sensitive advanced ovarian cancer, and a further two only included participants with platinum-sensitive disease. The comparators that were assessed in the three trials that included both subtypes of participants were PLDH versus topotecan, topotecan versus paclitaxel and PLDH versus paclitaxel. In the further two trials that included participants with the subtype of platinum-sensitive disease, the comparators that were assessed were single-agent paclitaxel versus a combination of cyclophosphamide, doxorubicin and cisplatin (CAP) and paclitaxel plus platinum-based chemotherapy versus conventional platinum-based therapy alone. A further four trials were identified and included in the review in which one of the comparators in the trial was used outside its licensed indication. The comparators assessed in these trials were oxaliplatin versus paclitaxel, paclitaxel given weekly versus every 3 weeks, paclitaxel at two different dose levels and oral versus intravenous topotecan. Four studies met the inclusion criteria for the cost-effectiveness review. The review of the economic evidence from the literature and industry submissions identified a number of significant limitations in existing studies assessing the cost-effectiveness of PLDH, topotecan and paclitaxel. Analysis 1 assessed the cost-effectiveness of PLDH, topotecan and paclitaxel administered as monotherapies. Sensitivity analysis was undertaken to explore the impact of patient heterogeneity (e.g. platinum-sensitive and platinum-resistant/refractory patients), the inclusion of additional trial data and alternative assumptions regarding treatment and monitoring costs. In the base-case results for Analysis 1, paclitaxel monotherapy emerged as the cheapest treatment. When the incremental cost-effectiveness ratios (ICERs) were estimated, topotecan was dominated by PLDH. Hence the options considered in the estimation of the ICERs were paclitaxel and PLDH. The ICER for PLDH compared with paclitaxel was pound 7033 per quality-adjusted life-year (QALY) in the overall patient population (comprising platinum-sensitive, -refractory and -resistant patients). The ICER was more favourable in the platinum-sensitive group ( pound 5777 per QALY) and less favourable in the platinum-refractory/resistant group ( pound 9555 per QALY). The cost-effectiveness results for the base-case analysis were sensitive to the inclusion of additional trial data. Incorporating the results of the additional trial data resulted in less favourable estimates for the ICER for PLDH versus paclitaxel compared with the base-case results. The ICER of PLDH compared with paclitaxel was pound 20,620 per QALY in the overall patient population, pound 16,183 per QALY in the platinum-sensitive population and pound 26,867 per QALY in the platinum-resistant and -refractory population. The results from Analysis 2 explored the cost-effectiveness of the full range of treatment comparators for platinum-sensitive patients. The treatment options considered in this model comprised PLDH, topotecan, paclitaxel-monotherapy, CAP, paclitaxel/platinum combination therapy and platinum monotherapy. Owing to the less robust approaches that were employed to synthesise the available evidence and the heterogeneity between the different trials, the reliability of these results should be interpreted with some caution. Topotecan, paclitaxel monotherapy and PLDH were all dominated by platinum monotherapy (i.e. higher costs and lower QALYs). After excluding these alternatives, the treatments that remained under consideration were platinum monotherapy, CAP and paclitaxel-platinum combination therapy. Of these three alternatives, platinum monotherapy was the least costly and least effective. The ICER for CAP compared with platinum monotherapy was pound 16,421 per QALY. The ICER for paclitaxel-platinum combination therapy compared with CAP was pound 20,950 per QALY. CONCLUSIONS For participants with platinum-resistant disease there was a low probability of response to treatment with PLDH, topotecan or paclitaxel. Furthermore, there was little difference between the three comparators in relation to overall survival. The comparators did, however, differ considerably in their toxicity profiles. Given the low survival times and response rates, it appears that the maintenance of quality of life and the control of symptoms and toxicity are paramount in this patient group. As the three comparators differed significantly in terms of their toxicity profiles, patient and physician choice is also an important element that should be addressed when decisions are made regarding second-line therapy. It can also be suggested that this group of patients may benefit from being included in further clinical trials of new drugs. For participants with platinum-sensitive disease there was a considerable range of median survival times observed across the trials. The most favourable survival times and response rates were observed for paclitaxel and platinum combination therapy. This suggests that treatment with combination therapy may be more beneficial than treatment with a single-agent chemotherapeutic regimen. In terms of single-agent compounds, the evidence suggests that PLDH is more effective than topotecan. Evidence from a further trial that compared PLDH and paclitaxel suggests that there is no significant difference between these two comparators in this trial. The three comparators did, however, differ significantly in terms of their toxicity profiles across the trials. Although treatment with PLDH may therefore be more beneficial than that with topotecan, patient and physician choice as to the potential toxicities associated with each of the comparators and the patient's ability and willingness to tolerate these are of importance. Assuming the NHS is willing to pay up to pound 20,000-40,000 per additional QALY, PLDH appears to be cost-effective compared with topotecan and paclitaxel monotherapy, in terms of the overall patient population and the main subgroups considered. The cost-effectiveness results for the base-case analysis were sensitive to the inclusion of additional trial data. Incorporating the results of additional trial data gave less favourable estimates for the ICER for PLDH versus paclitaxel monotherapy, compared with the base-case results. Although the ICER of PLDH compared with paclitaxel monotherapy was less favourable, PLDH was still cost-effective compared with topotecan and paclitaxel monotherapy. For platinum-sensitive patients, the combination of paclitaxel and platinum appears to be cost-effective. On the strength of the evidence reviewed here, it can be suggested that participants with platinum-resistant disease may benefit from being included in further clinical trials of new drugs. To assess the effectiveness of combination therapy against a single-agent non-platinum-based compound, it can be suggested that a trial that compared paclitaxel in combination with a platinum-based therapy versus single-agent PLDH would be a reasonable option.
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Affiliation(s)
- C Main
- Centre for Reviews and Dissemination, University of York, UK
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van Hal SJ, Stark D, Lockwood B, Marriott D, Harkness J. Methicillin-resistant Staphylococcus aureus (MRSA) detection: comparison of two molecular methods (IDI-MRSA PCR assay and GenoType MRSA Direct PCR assay) with three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA) for use with infection-control swabs. J Clin Microbiol 2007; 45:2486-90. [PMID: 17537949 PMCID: PMC1951204 DOI: 10.1128/jcm.00139-07] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [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: 01/19/2007] [Revised: 03/15/2007] [Accepted: 05/17/2007] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing problem. Rapid detection of MRSA-colonized patients has the potential to limit spread of the organism. We evaluated the sensitivities and specificities of MRSA detection by two molecular methods (IDI-MRSA PCR assay and GenoType MRSA Direct PCR assay) and three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA), using 205 (101 nasal, 52 groin, and 52 axillary samples) samples from consecutive known MRSA-infected and/or -colonized patients. All detection methods had higher MRSA detection rates for nasal swabs than for axillary and groin swabs. Detection of MRSA by IDI-MRSA was the most sensitive method, independent of the site (94% for nasal samples, 80% for nonnasal samples, and 90% overall). The sensitivities of the GenoType MRSA Direct assay and the MRSA ID, MRSASelect, and CHROMagar MRSA agars with nasal swabs were 70%, 72%, 68%, and 75%, respectively. All detection methods had high specificities (95 to 99%), independent of the swab site. Extended incubation for a further 24 h with selective MRSA agars increased the detection of MRSA, with a corresponding decline in specificity secondary to a significant increase in false-positive results. There was a noticeable difference in test performance of the GenoType MRSA Direct assay in detection of MRSA (28/38 samples [74%]) compared with detection of nonmultiresistant MRSA (17/31 samples [55%]) (susceptible to two or more non-beta-lactam antibiotics). This was not observed with selective MRSA agar plates or IDI-MRSA. Although it is more expensive, in addition to rapid turnaround times of 2 to 4 h, IDI-MRSA offers greater detection of MRSA colonization, independent of the swab site, than do conventional selective agars and GenoType MRSA Direct.
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Affiliation(s)
- S J van Hal
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010 NSW, Australia.
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van Hal SJ, Muthiah K, Matthews G, Harkness J, Stark D, Cooper D, Marriott D. Declining incidence of intestinal microsporidiosis and reduction in AIDS-related mortality following introduction of HAART in Sydney, Australia. Trans R Soc Trop Med Hyg 2007; 101:1096-100. [PMID: 17662322 DOI: 10.1016/j.trstmh.2007.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 03/07/2007] [Revised: 06/01/2007] [Accepted: 06/01/2007] [Indexed: 11/29/2022] Open
Abstract
Limited data exist regarding the incidence of intestinal microsporidiosis following the introduction of highly active antiretroviral therapy (HAART) in Australia. At St Vincent's Hospital, Sydney, all faecal samples submitted for diarrhoea from HIV-infected patients between 1995 and 2006 underwent screening for microsporidiosis. A total of 3564 patients (7366 faecal specimens) was examined, resulting in 159 patients identified with microsporidiosis. The incidence of microsporidiosis declined from 11% in 1995 to 0% from 2004 onwards. At presentation the majority of patients were severely immunocompromised (median CD4 105 cells/mm(3)), with only 16% of patients on effective HAART. Twenty-four patients (24/76, 32%) died within a median of 22 months following microsporidiosis diagnosis. Significant predictors of AIDS-related mortality at presentation included the level of immunodeficiency and receiving no or ineffective HAART (P<0.05). Patients presenting after 1998 had a significant reduction in the risk of AIDS-related mortality compared with patients presenting before 1998 (hazard ratio 0.27, 95% CI 0.79-0.92). All 52 (68%) surviving patients were on effective HAART, with a median CD4 count 382 cells/mm(3) and HIV RNA of < 50 copies/ml at follow-up (median 4 years). The dramatic decline of intestinal microsporidiosis in our study reconfirms the importance of effective HAART in preventing advanced immunodeficiency, opportunistic infections and associated AIDS-related deaths.
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Affiliation(s)
- S J van Hal
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Sydney, Australia.
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