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Kearney R, Ellard D, Parsons H, Haque A, Mason J, Nwankwo H, Bradley H, Drew S, Modi C, Bush H, Torgerson D, Underwood M. Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the ARTISAN RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38695098 PMCID: PMC11089447 DOI: 10.3310/cmyw9226] [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] [Indexed: 05/15/2024] Open
Abstract
Background The extra benefit of a programme of physiotherapy in addition to advice alone, following first-time traumatic shoulder dislocation, is uncertain. We compared the clinical and cost-effectiveness of a single session of advice with a single session of advice and a programme of physiotherapy. Objective The primary objective was to quantify and draw inferences about observed differences in the Oxford Shoulder Instability Score between the trial treatment groups 6 months post randomisation, in adults with a first-time traumatic shoulder dislocation. Design A pragmatic, multicentre, superiority, randomised controlled trial with embedded qualitative study. Setting Forty-one hospitals in the UK NHS. Participants Adults with a radiologically confirmed first-time traumatic anterior shoulder dislocation, being managed non-operatively. People with neurovascular complications or bilateral dislocations, and those unable to adhere to trial procedures or unable to attend physiotherapy within 6 weeks of injury, or who had previously been randomised, were excluded. Interventions All participants received the same initial shoulder examination followed by advice to aid self-management, lasting up to 1 hour and administered by a physiotherapist (control). Participants randomised to receive an additional programme of physiotherapy were offered sessions lasting for up to 30 minutes, over a maximum duration of 4 months from the date of randomisation (intervention). Main outcome measures The primary outcome measure was the Oxford Shoulder Instability Score. This is a self-completed outcome measure containing 12 questions (0-4 points each), with possible scores from 0 (worst function) to 48 (best function). Measurements were collected at 6 weeks, 3 months, 6 months and 12 months by postal questionnaire; 6 months was the primary outcome time point. The primary health outcome for economic evaluation was the quality-adjusted life-year, in accordance with National Institute of Health and Care Excellence guidelines. Results Between 14 November 2018 and 14 March 2022, 482 participants were randomised to advice (n = 240) or advice and a programme of physiotherapy (n = 242). Participants were 34% female, with a mean age of 45 years, and treatment arms were balanced at baseline. There was not a statistically significant difference in the primary outcome between advice only and advice plus a programme of physiotherapy at 6 months for the primary intention-to-treat adjusted analysis (favours physiotherapy: 1.5, 95% confidence interval -0.3 to 3.5) or at earlier 3-month and 6-week time points on the Oxford Shoulder Instability Score (0-48; higher scores indicate better function). The probability of physiotherapy being cost-effective at a willingness-to-pay threshold of £30,000 was 0.95. Conclusions We found little difference in the primary outcome or other secondary outcomes. Advice with additional physiotherapy sessions was found likely to be cost-effective. However, small imprecise incremental costs and quality-adjusted life-years raise questions on whether it is the best use of scarce physiotherapy resources given current service demands. Limitations Loss to follow-up was 27%; however, the observed standard deviation was much smaller than anticipated. These changes in parameters reduced the number of participants required to observe the planned target difference of four points. Our post hoc sensitivity analysis, accounting for missing data, gives similar results. Future work Further research should be directed towards optimising self-management strategies. Study registration This study is registered as ISRCTN63184243. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/167/56) and is published in full in Health Technology Assessment; Vol. 28, No. 22. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - David Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Bradley
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Steve Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Modi
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Martin Underwood
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kearney RS, Ellard DR, Parsons H, Haque A, Mason J, Nwankwo H, Bradley H, Drew S, Modi C, Bush H, Torgerson D, Underwood M. Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial. BMJ 2024; 384:e076925. [PMID: 38233068 PMCID: PMC10792684 DOI: 10.1136/bmj-2023-076925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy. DESIGN Pragmatic, multicentre, randomised controlled trial (ARTISAN). SETTING AND PARTICIPANTS Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management. INTERVENTIONS One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses. MAIN OUTCOME MEASURES The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications. RESULTS 482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05). CONCLUSIONS An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy. TRIAL REGISTRATION Current Controlled Trials ISRCTN63184243.
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Affiliation(s)
| | - David R Ellard
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Aminul Haque
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - James Mason
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Bradley
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Stephen Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Modi
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
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Liew Z, Mazuquin B, Ellard DR, Karasouli E, Drew S, Modi C, Bush H, Underwood M, Kearney RS. Development of a single-session physiotherapy and self-management intervention for the treatment of primary traumatic anterior shoulder dislocation for the 'Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN)' multi centre RCT. Physiotherapy 2021; 113:80-87. [PMID: 34607077 PMCID: PMC8612274 DOI: 10.1016/j.physio.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Objective Optimum physiotherapy management for people with a conservatively managed primary traumatic anterior shoulder dislocation is not known. The purpose of the ARTISAN trial is to compare the clinical and cost-effectiveness of a course of usual care physiotherapy with a single session of physiotherapy and self-management, the ARTISAN intervention. ARTISAN is a UK multi-centre, two-arm, parallel group, randomised controlled trial with 1:1 treatment allocation. Design The intervention was developed following the Medical Research Council framework for developing and evaluating complex interventions and will be reported in line with the template for intervention description and replication checklist (TIDieR) and the Consensus on Exercise Reporting Template (CERT). It was informed by published research, national clinical guidelines, current clinical practice and patient and public involvement. Results The ARTISAN intervention comprises education (Phase 1), progressive exercise (Phase 2 and Phase 3) and an optional return to sport component (Phase 4). Behaviour change strategies are embedded throughout intervention. The single session of physiotherapy is delivered by a chartered physiotherapist, within the first six weeks of injury, in an NHS outpatient setting. At the end of the initial session, paper-based booklets and/or a patient website with the same content are provided to participants to aid self-management and progression though the four phases of the trial intervention. Conclusion The ARTISAN intervention was successfully implemented throughout the internal pilot and is suitable for testing in the subsequent definitive RCT ARTISAN trial.
Trial Registration Number ISRCTN63184243
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Affiliation(s)
- ZiHeng Liew
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom.
| | - Bruno Mazuquin
- Manchester Metropolitan University, Manchester, M15 6BH, United Kingdom.
| | - David R Ellard
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom.
| | - Eleni Karasouli
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom.
| | - Stephen Drew
- University Hospitals Coventry & Warwickshire NHS Trust, Trauma and Orthopaedics, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Chetan Modi
- University Hospitals Coventry & Warwickshire NHS Trust, Trauma and Orthopaedics, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Howard Bush
- University Hospitals Coventry & Warwickshire NHS Trust, Trauma and Orthopaedics, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Martin Underwood
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Trauma and Orthopaedics, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
| | - Rebecca S Kearney
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Trauma and Orthopaedics, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
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Kearney RS, Dhanjal G, Parsons N, Ellard D, Parsons H, Haque A, Karasouli E, Mason J, Nwankwo H, Brown J, Liew Z, Drew S, Modi C, Bush H, Torgerson D, Underwood M. Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e040623. [PMID: 33444204 PMCID: PMC7678365 DOI: 10.1136/bmjopen-2020-040623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD. METHODS AND ANALYSIS In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded.Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power.An embedded qualitative study will explore the participants' experiences of the trial interventions. ETHICS, REGISTRATION AND DISSEMINATION Funded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121). TRIAL REGISTRATION NUMBER ISRCTN63184243. (Trial stage: Pre-results).
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Affiliation(s)
| | - Gurmit Dhanjal
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - David Ellard
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Aminul Haque
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - ZiHeng Liew
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Drew
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Modi
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Metcalfe A, Gemperle Mannion E, Parsons H, Brown J, Parsons N, Fox J, Kearney R, Lawrence T, Bush H, McGowan K, Khan I, Mason J, Hutchinson C, Gates S, Stallard N, Underwood M, Drew S. Protocol for a randomised controlled trial of Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS). BMJ Open 2020; 10:e036829. [PMID: 32444433 PMCID: PMC7247380 DOI: 10.1136/bmjopen-2020-036829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Shoulder pain due to irreparable rotator cuff tears can cause substantial disability, but treatment options are limited. A balloon spacer is a relatively simple addition to a standard arthroscopic debridement procedure, but it is costly and there is no current randomised trial evidence to support its use. This trial will evaluate the clinical and cost-effectiveness of a subacromial balloon spacer for individuals undergoing arthroscopic debridement for irreparable rotator cuff tears.New surgical procedures can provide substantial benefit to patients. Good quality randomised controlled trials (RCTs) are needed, but trials in surgery are typically long and expensive, exposing patients to risk and the healthcare system to substantial costs. One way to improve the efficiency of trials is with an adaptive sample size. Such methods are well established in drug trials but have rarely, if ever, been used in surgical trials. METHODS AND ANALYSIS Subacromial spacer for Tears Affecting Rotator cuff Tendons: a Randomised, Efficient, Adaptive Clinical Trial in Surgery (START:REACTS) is a participant and assessor blinded, adaptive, multicentre RCT comparing arthroscopic debridement with the InSpace balloon (Stryker, USA) to arthroscopic debridement alone for people with a symptomatic irreparable rotator cuff tear. It uses a group sequential adaptive design where interim analyses are performed using all of the 3, 6 and 12-month data that are available at each time point. A maximum of 221 participants will be randomised (1:1 ratio), this will provide 90% power (at the 5% level) for a 6 point difference in the primary outcome; the Oxford Shoulder Score at 12 months. A substudy will use deltoid-active MRI scans in 56 participants to assess the function of the balloon. Analysis will be on an intention-to-treat basis and reported according to principles established in the Consolidated Standards of Reporting Trials statement. ETHICS AND DISSEMINATION NRES number 18/WM/0025. The results will be disseminated via peer-reviewed publications, presentations at conferences, lay summaries and social media. TRIAL REGISTRATION NUMBER ISRCTN17825590.
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Affiliation(s)
- Andrew Metcalfe
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Helen Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jaclyn Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Rebecca Kearney
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Tom Lawrence
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Howard Bush
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kerri McGowan
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Iftekhar Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Simon Gates
- Warwick Medical School, University of Warwick, Coventry, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Nigel Stallard
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Drew
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Emecen-Huja P, Li HF, Ebersole JL, Lambert J, Bush H. Epidemiologic evaluation of Nhanes for environmental Factors and periodontal disease. Sci Rep 2019; 9:8227. [PMID: 31160648 PMCID: PMC6547714 DOI: 10.1038/s41598-019-44445-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/15/2019] [Indexed: 01/22/2023] Open
Abstract
Periodontitis is a chronic inflammation that destroys periodontal tissues caused by the accumulation of bacterial biofilms that can be affected by environmental factors. This report describes an association study to evaluate the relationship of environmental factors to the expression of periodontitis using the National Health and Nutrition Examination Study (NHANES) from 1999–2004. A wide range of environmental variables (156) were assessed in patients categorized for periodontitis (n = 8884). Multiple statistical approaches were used to explore this dataset and identify environmental variable patterns that enhanced or lowered the prevalence of periodontitis. Our findings indicate an array of environmental variables were different in periodontitis in smokers, former smokers, or non-smokers, with a subset of specific environmental variables identified in each population subset. Discriminating environmental factors included blood levels of lead, phthalates, selected nutrients, and PCBs. Importantly, these factors were found to be coupled with more classical risk factors (i.e. age, gender, race/ethnicity) to create a model that indicated an increased disease prevalence of 2–4 fold across the sample population. Targeted environmental factors are statistically associated with the prevalence of periodontitis. Existing evidence suggests that these may contribute to altered gene expression and biologic processes that enhance inflammatory tissue destruction.
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Affiliation(s)
- P Emecen-Huja
- Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - H-F Li
- Providence St. Joseph Health of Oregon, Medical Data and Research Center, Portland, OR, USA
| | - J L Ebersole
- School of Dental Medicine, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - J Lambert
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - H Bush
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
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Voigts K, Adegboyega A, Bush H, Hatcher J. Using Social Media to Reduce Multiple Risk Factors for CRC in Rural Appalachians: #CRCFREE. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1055-9965.epi-18-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: To examine the efficacy, acceptability, feasibility, and applicability of a Facebook (FB) intervention designed to reduce multiple colorectal cancer (CRC) risk factors in older adults residing in rural Appalachian Kentucky. Methods: We piloted a 12 week FB intervention culturally tailored for older adults residing in rural Eastern Kentucky to impact CRC risk factors, including: nutrition, physical activity, and screening. Participants were aged 50+, had internet access, and were at risk for CRC. During the 12 week study, the participants received three daily posts via secret FB group regarding CRC risk factors. Demographics, dietary measures, body mass index (BMI), and CRC screening were assessed at baseline and post intervention. FB engagement and physical activity were tracked throughout the intervention. Dietary measures included the Healthy Eating Index (HEI) and Dietary Inflammatory Index (DII). Physical activity was tracked using Fitbits. Post-intervention focus group interviews were conducted to assess feasibility and acceptability. Results: Participants (n = 57) were Caucasian, aged 58 ± 6 years, predominately female (67%), and the majority reported at least a high school education (77%). Post intervention, participants experienced significant increase in HEI scores (49.94 ± 9.84 vs. 58.60 ± 12.06, P = < 0.01). DII scores significantly decreased (2.44 ±1.12 vs. 1.60 ± 1.63, P = 0.003). There was no significant change in physical activity, BMI, or screening status. Participants, on average, viewed more than half of the posts. Focus group participants found FB posts to be useful and motivating. They reported that FB posts were educational and motivational. Conclusion: This pilot study shows promising preliminary data to support using a FB intervention in rural Appalachian older adults to decrease CRC risks. Participants were receptive to FB intervention, and FB provides a unique and accessible method for health promotion in hard to reach populations.
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Fukui N, Golabi P, Otgonsuren M, de Avila L, Bush H, Younossi ZM. Hospice care in Medicare patients with primary liver cancer: the impact on resource utilisation and mortality. Aliment Pharmacol Ther 2018; 47:680-688. [PMID: 29314093 DOI: 10.1111/apt.14484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/01/2017] [Accepted: 12/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few studies have assessed the impact of hospice care in patients with primary liver cancer. AIM To examine the determinants of hospice care and its effects on resource utilisation and survival among Medicare beneficiaries with primary liver cancer. METHODS We utilised the Surveillance, Epidemiology and End result Registry (SEER) database from 2002 to 2009 for this cross-sectional study. A total of 3385 patients with primary liver cancer were included. We used logistic regression to discern variables associated with hospice and Cox proportional hazards models to evaluate one-year mortality risk. RESULTS Compared to patients who enrolled in a hospice, those patients who did not, were younger, non-White and sicker (P < .05 for all). Half of all patients with primary liver cancer died within six months of diagnosis, and one-year mortality was similar in both groups (P = .413). After adjusting for baseline characteristics [age at diagnosis, race, disease severity, tumour stage and treatment], shorter time to hospice care was associated with reduced mortality (HR per day: 0.99 [95% CI, 0.98-0.99]). Older age, decompensated cirrhosis and advanced tumours stage were associated with decreased time to hospice, while Asian/Pacific Islander race and history of radiosurgery were associated with increased time to hospice (all P < .05). Hospitalisations were more costly for those who never enrolled in a hospice compared to hospice enrollees (median $31 607 [$18 394-$54 254] vs $22 316 [$13 741-$36 170], P < .0001). CONCLUSIONS Hospice enrolment of patients with primary liver cancer provides survival and resource utilisation benefits. Some clinical and demographic factors may represent barriers to hospice enrolment. Further studies are needed to fully understand these barriers in patients with primary liver cancer.
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Affiliation(s)
- N Fukui
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA
| | - P Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Otgonsuren
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - L de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - H Bush
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Z M Younossi
- Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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McGuinness P, Cook N, Bush H, Lind H, Vuijk P, Doyle A, Braaten E. B-09Cognitive and Executive Function Profile in Children and Adolescents with Autism Spectrum Disorder, with and without Specific Learning Disorder. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.94] [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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McCoy S, Effgen S, Chiarello L, Jeffries L, Bush H. Relationship of school-based physical therapy to outcomes for children with disabilities in the United States. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effgen S, Westcott McCoy S, Chiarello L, Jeffries L, Bush H. Outcomes of school-based physical therapy for children with disabilities in the United States. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.551] [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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Rodriguez J, DeMuth KE, Hernandez M, Bush H, Fromkin K, Stubbe H, Forzolli ND, Galindo D, Piloto R, Ciocon J, Loquias J, Russell A, Gascon JA, Salguero P, Harris CM, Starling R, Shen M. THE IMPACT OF SYSTEMATIC IMPLEMENTATION OF SPECT APPROPRIATENESS CRITERIA IN CARDIOLOGY AND PRIMARY CARE ON SPECT AND SUBSEQUENT invasive PROCEDURES: A PROSPECTivE AND RANDOMIZED CLINICAL TRIAL WITH ONE-YEAR FOLLOW-UP. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Students in higher education are being encouraged to become active, independent and life-long learners. The use of progress files has been endorsed to encourage this approach. A portfolio intended to fulfil the role of a progress file and to promote student-centred learning and reflection was introduced as a central component of the revised undergraduate degree at the Glasgow Dental School in 2004. This article evaluates its role in promoting reflection. Students following the Bachelor of Dental Surgery (BDS) programme completed three written reflections per year using structured proformas, and discussed them with their mentor and mentoring group. Their views of the portfolio and of reflection were gathered using a five-point Likert scale. In BDS1 2004-5, 84% completed a questionnaire, as did 89% in BDS1 2005-6 and 99% in BDS2 2005-6. Most students did not enjoy reflecting (a finding commonly reported elsewhere) or feel that reflection identified their learning needs. It appears that students disliked writing reflections, rather than reflecting per se. In contrast, they took a positive view of mentor group discussions and of having a mentor, both essential components of the portfolio model described. Comparisons of BDS1 2004-5 and BDS2 2005-6 data suggest that students are becoming more comfortable with reflection. The data provide some limited encouragement that students are beginning to acquire the skills which will enable them to reflect purposefully in their professional lives, although it will be some years before this assertion can be substantiated.
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Affiliation(s)
- H Bush
- University of Glasgow, Glasgow Dental School, Glasgow, UK.
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14
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Shen M, Ortiz L, Bush H, Vargas E, Dandes E. Simultaneous assessment of coronary stenosis, myocardial perfusion, and ventricular function in a patient with acute myocardial infarction. J Cardiovasc Comput Tomogr 2008; 2:123-5. [DOI: 10.1016/j.jcct.2008.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 01/11/2008] [Accepted: 01/16/2008] [Indexed: 10/22/2022]
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15
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Anderson AS, Bush H, Lean M, Bradby H, Williams R, Lea E. Evolution of atherogenic diets in South Asian and Italian women after migration to a higher risk region. J Hum Nutr Diet 2005; 18:33-43. [PMID: 15647097 DOI: 10.1111/j.1365-277x.2004.00584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND To identify differences in the evolution of the diets of South Asian and Italian migrants, a cross-sectional, multiethnic study was undertaken in Glasgow, Scotland. METHODS Five groups of women aged 20-42 years comprising general population (n = 35), South Asian migrants (n = 35) British-born controls (n = 37), Italian migrants (n = 30) and British-born (n = 38) participated in an interviewer administered structured questionnaire on issues relating to health, diet and food selection. Anthropometric measurements were made and subjects completed a 7-day weighed diet inventory. RESULTS Compared with the general population, dietary differences were greatest amongst first generation migrant groups. There were major differences between the two migrant groups. South Asian migrants tended to display a more atherogenic profile (fat 42.4% energy, saturated fat 15.0% energy, vitamin C 5.1 mg per 1000 kJ) than the general population (fat 39.1% energy, saturated fat 13.5% energy, vitamin C 6.8 mg per 1000 kJ), and Italian migrants (fat 35.7% energy, saturated fat 12.1% energy, vitamin C 10.9 mg per 1000 kJ). However, South Asian groups had higher intakes of polyunsaturated fatty acids which may be cardioprotective. CONCLUSIONS South Asian migrants to Scotland appear to develop adverse dietary elements in the first generation, which are modified in subsequent generations, whereas Italians' diets remain cardioprotective in the migrant generation but deteriorate in subsequent generations.
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Affiliation(s)
- A S Anderson
- Centre for Public Health Nutrition Research, Department of Medicine, Ninewells Medical University of Dundee, Dundee, UK.
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Lean ME, Han TS, Bush H, Anderson AS, Bradby H, Williams R. Ethnic differences in anthropometric and lifestyle measures related to coronary heart disease risk between South Asian, Italian and general-population British women living in the west of Scotland. Int J Obes (Lond) 2001; 25:1800-5. [PMID: 11781761 DOI: 10.1038/sj.ijo.0801823] [Citation(s) in RCA: 42] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2001] [Accepted: 04/16/2001] [Indexed: 02/06/2023]
Abstract
AIMS To compare anthropometric measurements and to define their behavioural associations in migrant and British-born South Asians (who have increased cardiovascular risk) or Italians (who have reduced cardiovascular risk), and in the general population of British women living in the west of Scotland. STUDY DESIGN Cross-sectional survey of women aged 20-42 y, selected mainly from birth registration data, which included 63 migrant South Asians, 56 British-born South Asians, 39 migrant Italians, 51 British-born Italians, and 50 subjects representative of the general population of women, all resident in the west of Scotland. MEASUREMENTS Height, weight, body mass index (BMI), and waist and hip circumferences. RESULTS With age adjustment, migrant South Asians (0.88) had greater waist-to-hip ratio than British-born South Asians (0.84; P<0.05), while there was no difference between migrant (0.81) and British-born (0.79) Italian groups. Both migrant (P<0.001) and British-born South Asian (P<0.05) groups had higher waist-to-hip ratio and were about 3 cm shorter than Italian groups and the general population. Neither weight nor BMI were different between ethnic groups. Waist and hip circumferences were not different between migrant and British-born ethnic minority groups. Migrant South Asians (86.8 cm) had significantly (P<0.05) larger waist circumference than the general population (78.6 cm). British-born Italian women (103.0 cm) had larger hip circumference than the general population of women (96.4 cm), while other groups had similar hip circumferences. Additional adjustments for physical activity, smoking, alcohol consumption and parity reduced the differences in anthropometric measurements: only waist-to-hip ratio of migrant South Asians remained significantly (P<0.01) higher than that of the general population women. CONCLUSIONS The adverse anthropometric indicators of cardiovascular risk in migrant South Asian women are substantially explained by their lifestyle factors and parity. British-born South Asian women are more similar to the general population women. Anthropometric differences between migrant or British-born Italians and the general population women are small.
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Affiliation(s)
- M E Lean
- University of Glasgow Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow, UK
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Griffin E, Re A, Hamel N, Fu C, Bush H, McCaffrey T, Asch AS. A link between diabetes and atherosclerosis: Glucose regulates expression of CD36 at the level of translation. Nat Med 2001; 7:840-6. [PMID: 11433350 DOI: 10.1038/89969] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.3] [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: 11/08/2022]
Abstract
Both the risk and the rate of development of atherosclerosis are increased in diabetics, but the mechanisms involved are unknown. Here we report a glucose-mediated increase in CD36 mRNA translation efficiency that results in increased expression of the macrophage scavenger receptor CD36. Expression of CD36 was increased in endarterectomy lesions from patients with a history of hyperglycemia. Macrophages that were differentiated from human peripheral blood monocytes in the presence of high glucose concentrations showed increased expression of cell-surface CD36 secondary to an increase in translational efficiency of CD36 mRNA. We obtained similar data from primary cells isolated from human vascular lesions, and we found that glucose sensitivity is a function of ribosomal reinitiation following translation of an upstream open reading frame (uORF). Increased translation of macrophage CD36 transcript under high glucose conditions provides a mechanism for accelerated atherosclerosis in diabetics.
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Affiliation(s)
- E Griffin
- Weill Medical College of Cornell University, New York, NY, USA
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18
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Du B, Fu C, Kent KC, Bush H, Schulick AH, Kreiger K, Collins T, McCaffrey TA. Elevated Egr-1 in human atherosclerotic cells transcriptionally represses the transforming growth factor-beta type II receptor. J Biol Chem 2000; 275:39039-47. [PMID: 10982796 DOI: 10.1074/jbc.m005159200] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [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: 11/06/2022] Open
Abstract
Atherosclerotic lesions may progress due to a "failure to die" by vascular repair cells. Egr-1, a zinc finger transcription factor, is elevated more than 5-fold in human carotid lesions relative to the adjacent tunica media. Lesion cells in vitro also express 2-3-fold higher Egr-1 mRNA and protein levels but express much lower levels of the transforming growth factor-beta (TGF-beta) Type II receptor (TbetaR-2) and are functionally resistant to the antiproliferative effects of TGF-beta. Lesion cells fail to express a TbetaR-2 promoter/chloramphenicol acetyltransferase (CAT) construct but overexpress an Egr-1-inducible platelet-derived growth factor-A promoter/CAT construct. Transfection of Egr-1 cDNA represses TbetaR-2/CAT constructs but induces PDGF-A/CAT. Egr-1 transfection reduces the levels of TbetaR-2 and confers resistance to the antiproliferative effect of TGF-beta1. Egr-1 can interact directly with both the -143 Sp1 site and the positive regulatory element 2 (PRE2) (ERT/ets) region of the TbetaR-2 promoter. Thus, although activating a family of stress-responsive genes, Egr-1 also transcriptionally represses one of the major inhibitory pathways that restrains vascular repair.
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MESH Headings
- Arteries/metabolism
- Arteriosclerosis/metabolism
- Binding Sites
- Blotting, Western
- Cell Division
- Cell Nucleus/metabolism
- Cells, Cultured
- Chloramphenicol O-Acetyltransferase/metabolism
- Cloning, Molecular
- DNA, Complementary/metabolism
- DNA-Binding Proteins/biosynthesis
- Densitometry
- Dose-Response Relationship, Drug
- Early Growth Response Protein 1
- Fibroblast Growth Factor 2/metabolism
- Genes, Reporter
- Humans
- Immediate-Early Proteins
- Nerve Growth Factor/metabolism
- Platelet-Derived Growth Factor/metabolism
- Promoter Regions, Genetic
- Protein Serine-Threonine Kinases
- RNA/metabolism
- RNA, Messenger/metabolism
- Receptor, Transforming Growth Factor-beta Type II
- Receptors, Transforming Growth Factor beta/metabolism
- Recombinant Proteins/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Time Factors
- Transcription Factors/biosynthesis
- Transcription, Genetic
- Transfection
- Veins/metabolism
- Zinc Fingers
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Affiliation(s)
- B Du
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University New York, New York 10021, USA
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McCaffrey TA, Fu C, Du B, Eksinar S, Kent KC, Bush H, Kreiger K, Rosengart T, Cybulsky MI, Silverman ES, Collins T. High-level expression of Egr-1 and Egr-1-inducible genes in mouse and human atherosclerosis. J Clin Invest 2000; 105:653-62. [PMID: 10712437 PMCID: PMC289183 DOI: 10.1172/jci8592] [Citation(s) in RCA: 237] [Impact Index Per Article: 9.9] [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: 11/17/2022] Open
Abstract
To understand the mRNA transcript profile in the human atherosclerotic lesion, RNA was prepared from the fibrous cap versus adjacent media of 13 patients undergoing carotid endarterectomy. cDNA expression arrays bearing 588 known genes indicated that lesions express unexpectedly high levels of the early growth response gene, Egr-1 (NGFI-A), a zinc-finger transcription factor that modulates a cluster of stress-responsive genes including PDGF and TGF-beta. Expression of Egr-1 was an average of 5-fold higher in the lesion than in the adjacent media, a result confirmed by RT-PCR, and many Egr-1-inducible genes were also strongly elevated in the lesion. Time-course analyses revealed that Egr-1 was not induced ex vivo. Immunocytochemistry indicated that Egr-1 was expressed prominently in the smooth muscle-actin positive cells, particularly in areas of macrophage infiltration, and in other cell types, including endothelial cells. Induction of atherosclerosis in LDL receptor-null mice by feeding them a high-fat diet resulted in a progressive increase in Egr-1 expression in the aorta. Thus, induction of Egr-1 by atherogenic factors may be a key step in coordinating the cellular events that result in vascular lesions.
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Affiliation(s)
- T A McCaffrey
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Abstract
Preparative liquid chromatographic methods were developed for the chiral resolution of two different cyclopentenone precursors of a synthetic prostaglandin. Various solvent combinations of alcohols and alkanes were investigated to determine the method which has the greatest throughput. The effect of particle size on the chiral resolution was also investigated. In addition, the preparative system was automated to allow for unattended operation for up to 10 h.
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Affiliation(s)
- L Miller
- Chemical Development Department, G.D. Searle and Co., Skokie, IL 60077
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21
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Levine M, Sackett D, Bush H. Heroin vs Morphine for Cancer Pain? J Urol 1986. [DOI: 10.1016/s0022-5347(17)46104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M.N. Levine
- Departments of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario
- Department of Radiation Oncology, University of Western Ontario, London, Ontario
- Ontario Cancer Foundation Hamilton and London Regional Treatment Centers, Ontario, Canada
| | - D.L. Sackett
- Departments of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario
- Department of Radiation Oncology, University of Western Ontario, London, Ontario
- Ontario Cancer Foundation Hamilton and London Regional Treatment Centers, Ontario, Canada
| | - H. Bush
- Departments of Clinical Epidemiology and Biostatistics, and Medicine, McMaster University, Hamilton, Ontario
- Department of Radiation Oncology, University of Western Ontario, London, Ontario
- Ontario Cancer Foundation Hamilton and London Regional Treatment Centers, Ontario, Canada
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22
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Levine MN, Sackett DL, Bush H. Heroin vs morphine for cancer pain? Arch Intern Med 1986; 146:353-6. [PMID: 2418799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Narcotic analgesics are the mainstay of pain control in patients with cancer. A controversy has been raging in the United States and Canada as to the legalization of heroin. We have reviewed the literature in order to determine the relative efficacy of heroin and morphine in cancer pain. We applied the following methodologic criteria: Was the assignment of patients to the different opiates randomized? Were all clinically relevant outcomes reported? Were the patients recognizable? Were both clinical and statistical significance considered? Was the opiate regimen feasible in routine clinical practice? Were all patients who entered the study accounted for at its conclusion? Two trials satisfied our first standard. The first, a double-blind cross-over trial, failed to meet standard 4 (the negative conclusion may represent a type 2 error) and only 21% of patients completed both treatment periods. The second study, which compared intramuscular heroin and morphine among patients with postoperative pain, failed to meet standards 3 (patients not described in sufficient detail and only tangentially related to chronic cancer pain) and 4 (type 2 error). Thus the relative efficacy of heroin and morphine in the relief of chronic cancer pain remains unknown. Randomized trials that meet all six methodologic standards must therefore be carried out for this controversy to be resolved.
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Howell A, Bush H, George WD, Howat JM, Crowther D, Sellwood RA, Rubens RD, Hayward JL, Bulbrook RD, Fentiman IS. Controlled trial of adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil for breast cancer. Lancet 1984; 2:307-11. [PMID: 6146861 DOI: 10.1016/s0140-6736(84)92684-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
327 patients with cancer of the breast and involvement of axillary lymph nodes were randomised, after total mastectomy and axillary clearance, to receive either no additional treatment or oral cyclophosphamide 80 mg/m2 on days 1-14, intravenous methotrexate 32 mg/m2 on days 1 and 8, and intravenous fluorouracil 480 mg/m2 on days 1 and 8 (CMF), which was repeated every 28 days for twelve cycles. There was a significantly longer relapse-free survival (RFS) in patients treated with CMF. A prolonged RFS was seen in premenopausal patients, those with 1-3 nodes involved, and those with 4 or more nodes involved, but a similar trend in postmenopausal patients failed to reach statistical significance. RFS was greater in patients with CMF-induced amenorrhoea than in controls and in treated patients whose primary tumour contained progesterone receptors. Dose of chemotherapy did not have a significant effect on RFS. Survival was not influenced by treatment.
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Howell A, Rubens RD, Bush H, George WD, Howat JM, Crowther D, Sellwood RA, Hayward JL, Knight RK, Bulbrook RD. A controlled trial of adjuvant chemotherapy with melphalan versus cyclophosphamide, methotrexate, and fluorouracil for breast cancer. Recent Results Cancer Res 1984; 96:74-89. [PMID: 6396780 DOI: 10.1007/978-3-642-82357-2_10] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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26
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Rubens RD, Hayward JL, Knight RK, Bulbrook RD, Fentiman IS, Chaudary M, Howell A, Bush H, Crowther D, Sellwood RA, George WD, Howat JM. Controlled trial of adjuvant chemotherapy with melphalan for breast cancer. Lancet 1983; 1:839-43. [PMID: 6132179 DOI: 10.1016/s0140-6736(83)91385-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
370 patients who had carcinoma of the breast with involved axillary lymph-nodes were randomised after total mastectomy and axillary clearance to receive either no additional treatment or melphalan 6 mg/m2 daily for 5 days every 6 weeks for sixteen cycles. There was a trend towards longer relapse-free survival (RFS) in patients treated with melphalan, but this was not significant either in the whole series or in sub-groups according to menopausal status or extent of nodal involvement. In patients receiving melphalan RFS was not significantly affected by either the occurrence of amenorrhoea or the dosage of melphalan received. Overall survival did not differ significantly between the two groups. The results of this trial suggest that there is no place for the use of melphalan as adjuvant therapy in the management of early breast cancer.
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Gross ML, Bush H, Weinger R, Hamburger RJ, Flamenbaum W. A comparison of ticlopidine and heparin on hemodialysis in dogs. J Lab Clin Med 1982; 100:887-95. [PMID: 7142790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The efficacies of low-dose heparin and low-dose heparin plus ticlopidine as anticoagulants during hemodialysis in acutely uremic dogs were compared and evaluated. Heparin was administered as a bolus at a dose of 100 U/kg. In preliminary experiments it was determined that dogs dialyzed with ticlopidine alone demonstrated gross clotting of the artificial kidney within 2.5 hr. Ticlopidine was administered by gavage at a dose of 50 mg/kg/day starting 72 hr prior to hemodialysis and continuing throughout the period of hemodialysis (4 days). Each dog was dialyzed four times with either heparin alone or heparin plus ticlopidine. Each hemodialysis lasted 3.5 hr. Parameters followed included dialysis clearance of urea and creatinine, ultrafiltration rate, residual blood volume, gross clotting episodes, platelet count, and levels of fibrinogen and thromboxane B2. A lesser degree of hemodialysis-associated thrombocytopenia, a lower residual blood volume, fewer episodes of gross clotting, no reduction in fibrinogen levels, and no increase in thromboxane B2 levels were observed in the heparin plus ticlopidine group as compared to the heparin group alone. Although ticlopidine at the dosage employed should not be used as the sole anticoagulant for hemodialysis, it may be useful when added to low-dose heparin. The salutary effects demonstrated in this study suggest clinical benefits of the combination.
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28
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Bush H. ASHA constituents--a status report. J Sch Health 1982; 52:337-338. [PMID: 6922309 DOI: 10.1111/j.1746-1561.1982.tb07129.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Gross M, Bush H, McTigue H, Hamburger RJ, Flamenbaum W. A comparison of prostacyclin and heparin on hemodialyses in dogs. Prostaglandins 1981; 21:879-88. [PMID: 7027320 DOI: 10.1016/0090-6980(81)90157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A comparison of the efficacy of prostacyclin and heparin as anticoagulants during hemodialysis in uremic dogs was evaluated. Prostacyclin was infused continuously into the arterial limb of the dialyzer (100 ng/kg/min) while heparin was administered as a 5000 unit bolus at the beginning of dialysis. Prostacyclin and heparin were alternated and a total of 4 dialyses/dog were performed. Parameters followed to assess the efficacy of dialyses included: dialysance (ml/min) of urea, creatinine, ultrafiltration rate (ml/hr), residual volume and platelet count (% of baseline). A lesser degree of hemodialysis associated thrombocytopenia, and a higher ultrafiltration rate were observed with prostacyclin. These studies demonstrate that prostacyclin can be used alone as an anticoagulant in a uremic dog model, and in contrast to heparin it maintains the platelet count and improves the ultrafiltration rate during hemodialysis.
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MacFarlane IA, Barnes D, Howat JM, Swindell R, Durning P, Beardwell CG, Bush H, Sellwood RA. Serum glycoprotein hormone alpha subunit, hormone receptors and disease stage in patients with breast cancer. Br J Cancer 1980; 42:645-50. [PMID: 6161628 PMCID: PMC2010551 DOI: 10.1038/bjc.1980.297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The concentration of the common alpha subunit of the glycoprotein hormones was high in the serum of 21/56 (38%) of premenopausal patients and 22/106 (21%) of postmenopausal patients with primary breast cancer, at the time of presentation. 7/59 (12%) of patients with benign disease also had high alpha subunit levels. Tumour cytosol oestrogen and progesterone receptor status was determined in 80% of the patients with cancer, and there was a trend towards higher alpha levels in patients without receptors, but this was not statistically significant. In the premenopausal patients with cancer there was a significant correlation between alpha subunit level and disease stage, R = 0.47, P = 0.0001, but not in the postmenopausal patients. In view of the correlation with disease stage, high levels of alpha subunit in premenopausal patients with breast cancer at presentation with the primary tumour may indicate poor prognosis.
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Blackledge G, Bush H, Chang J, Crowther D, Deakin DP, Dodge OG, Garrett JV, Palmer M, Pearson D, Scarffe JH, Todd ID, Wilkinson PM. Intensive combination chemotherapy with vincristine, adriamycin and prednisolone (VAP) in the treatment of diffuse histology non-Hodgkin's lymphoma. (A report of 89 cases with extensive disease from the Manchester Lymphoma Group). Eur J Cancer 1980; 16:1459-68. [PMID: 7014226 DOI: 10.1016/0014-2964(80)90056-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Maguire GP, Tait A, Brooke M, Thomas C, Howat JM, Sellwood RA, Bush H. Psychiatric morbidity and physical toxicity associated with adjuvant chemotherapy after mastectomy. Br Med J 1980; 281:1179-80. [PMID: 7427625 PMCID: PMC1714474 DOI: 10.1136/bmj.281.6249.1179] [Citation(s) in RCA: 84] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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MacFarlane IA, Robinson EL, Bush H, Durning P, Howat JM, Beardwell CG, Shalet SM. Thyroid function in patients with benign and malignant breast disease. Br J Cancer 1980; 41:478-80. [PMID: 7387836 PMCID: PMC2010243 DOI: 10.1038/bjc.1980.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Bush H. Postgraduate Courses on Clinical Cancer Chemotherapy (2nd Edn). Manual for Course Participants. UICC Technical Report Series, Vol. 47. Br J Cancer 1980. [DOI: 10.1038/bjc.1980.53] [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: 11/09/2022] Open
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35
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Bush H. The Year Book of Cancer. Br J Cancer 1979. [DOI: 10.1038/bjc.1979.294] [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: 11/09/2022] Open
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36
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Blackledge G, Bush H, Dodge OG, Crowther D. A study of gastro-intestinal lymphoma. Clin Oncol (R Coll Radiol) 1979; 5:209-19. [PMID: 498613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Spittle MF, Bush H, James SE, Hellmann K. Clinical trial of razoxane and radiotherapy for inoperable carcinoma of the bronchus. Int J Radiat Oncol Biol Phys 1979; 5:1649-51. [PMID: 231597 DOI: 10.1016/0360-3016(79)90790-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
In this review of the management of invasive carcinoma of the bladder the results of primary and systemic therapies are evaluated in the light of the natural history of the disease. The clinical and pathological causes of treatment failure are assessed in an attempt to identify new approaches that may be used in the future management of patients with bladder cancer. To improve survival in this disease requires different approaches to both the control of local disease and the early control of metastatic disease.
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Bush H. Advances in Tumour Prevention, Detection and Characterization Volume 4. Characterization and Treatment of Human Tumours. Br J Cancer 1979. [DOI: 10.1038/bjc.1979.63] [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: 11/09/2022] Open
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Bush H. Adjuvant chemotherapy: an approach to the management of malignant disease. Br J Hosp Med (Lond) 1978; 20:260-75. [PMID: 213151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The definition of the roles of surgery and radiation therapy in controlling local malignant disease has become much clearer in the past two decades. Nonetheless, most patients who die of their malignancy do so from metastatic disease. With the advent of effective combination chemotherapy for many patients with advanced malignant disease, the employment of systemic treatment at an earlier stage has become a clinical possibility. Important advances in the systemic control of a number of malignancies have been described. These are examples of a few of the presently ongoing trials (Salmon and Jones, 1977). For the merits and demerits of prophylactic systemic treatments to be accurately determined in malignant disease, it is important that the future role of adjuvant chemotherapy in man be evaluated only in the context of carefully controlled clinical trials. The fact that adjuvant therapy is effective in prolonging survival in some malignant diseases is established; its role in many of the commoner malignant diseases awaits more complete evaluation.
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Bush H. Progress in Cancer Research and Therapy, Vol. 5—Cancer Invasion and Metastasis: biological Mechanisms and Therapy. Br J Cancer 1978. [DOI: 10.1038/bjc.1978.183] [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: 11/09/2022] Open
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Bush H, Shodell M. Uptake of low molecular weight substances by SV40-transformed 3T3 cells is invariant with growth rates in the presence and absence of serum. Exp Cell Res 1978; 114:27-30. [PMID: 658157 DOI: 10.1016/0014-4827(78)90031-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Polyoma transformed hamster cells (PyBHK) and SV40 transformed mouse cells (SV3T3) were transferred in culture using crystalline trypsin followed by neutralisation with soybean trypsin inhibitor. Such cells were able to proliferate freely in defined medium without any serum supplement and without any intervening period of adaptation. However, growth rates were reduced under serum-free conditions. Re-establishment of rapid growth rates could be achieved by addition of serum, with the rate attained being proportional to the serum concentration. Irrespective of the prevailing rates of growth, percentages of cells synthesising DNA were the same. However, the rate at which DNA was being synthesised was found to change proportionately with the changes in overall growth rate.
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Bush H. Clinical Cancer Chemotherapy. Clin Mol Pathol 1976. [DOI: 10.1136/jcp.29.8.764-d] [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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Bush H, Ponder B, Rubens RD. Oncological Centres. West J Med 1974. [DOI: 10.1136/bmj.1.5901.243-a] [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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Bush H. Proliferative behaviour of normal and malignant mammalian cells in culture. Proc R Soc Med 1973; 66:1242-3. [PMID: 4798190 PMCID: PMC1645295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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