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Phillips K, Sanders J, Warren LE. UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey. Midwifery 2024; 132:103952. [PMID: 38442530 DOI: 10.1016/j.midw.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
AIM This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.
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Affiliation(s)
- K Phillips
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom.
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
| | - L E Warren
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
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Liefaard MC, van der Voort A, van Seijen M, Thijssen B, Sanders J, Vonk S, Mittempergher L, Bhaskaran R, de Munck L, van Leeuwen-Stok AE, Salgado R, Horlings HM, Lips EH, Sonke GS. Tumor-infiltrating lymphocytes in HER2-positive breast cancer treated with neoadjuvant chemotherapy and dual HER2-blockade. NPJ Breast Cancer 2024; 10:29. [PMID: 38637568 PMCID: PMC11026378 DOI: 10.1038/s41523-024-00636-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
Tumor-infiltrating lymphocytes (TILs) have been associated with outcomes in HER2-positive breast cancer patients treated with neoadjuvant chemotherapy and trastuzumab. However, it remains unclear if TILs could be a prognostic and/or predictive biomarker in the context of dual HER2-targeting treatment. In this study, we evaluated the association between TILs and pathological response (pCR) and invasive-disease free survival (IDFS) in 389 patients with stage II-III HER2 positive breast cancer who received neoadjuvant anthracycline-containing or anthracycline-free chemotherapy combined with trastuzumab and pertuzumab in the TRAIN-2 trial. Although no significant association was seen between TILs and pCR, patients with TIL scores ≥60% demonstrated an excellent 3-year IDFS of 100% (95% CI 100-100), regardless of hormone receptor status, nodal stage and attainment of pCR. Additionally, in patients with hormone receptor positive disease, TILs as a continuous variable showed a trend to a positive association with pCR (adjusted Odds Ratio per 10% increase in TILs 1.15, 95% CI 0.99-1.34, p = 0.070) and IDFS (adjusted Hazard Ratio per 10% increase in TILs 0.71, 95% CI 0.50-1.01, p = 0.058). We found no interactions between TILs and anthracycline treatment. Our results suggest that high TIL scores might be able to identify stage II-III HER2-positive breast cancer patients with a favorable prognosis.
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Affiliation(s)
- M C Liefaard
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A van der Voort
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M van Seijen
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B Thijssen
- Division of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Oncode Institute, Utrecht, The Netherlands
| | - J Sanders
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Vonk
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Mittempergher
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - R Bhaskaran
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - L de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - A E van Leeuwen-Stok
- Dutch Breast Cancer Research Group, BOOG Study Center, Amsterdam, The Netherlands
| | - R Salgado
- Department of Pathology, GZA-ZNA Hospitals, Wilrijk, Antwerp, Belgium
| | - H M Horlings
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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de Boo LW, Jóźwiak K, Ter Hoeve ND, van Diest PJ, Opdam M, Wang Y, Schmidt MK, de Jong V, Kleiterp S, Cornelissen S, Baars D, Koornstra RHT, Kerver ED, van Dalen T, Bins AD, Beeker A, van den Heiligenberg SM, de Jong PC, Bakker SD, Rietbroek RC, Konings IR, Blankenburgh R, Bijlsma RM, Imholz ALT, Stathonikos N, Vreuls W, Sanders J, Rosenberg EH, Koop EA, Varga Z, van Deurzen CHM, Mooyaart AL, Córdoba A, Groen E, Bart J, Willems SM, Zolota V, Wesseling J, Sapino A, Chmielik E, Ryska A, Broeks A, Voogd AC, van der Wall E, Siesling S, Salgado R, Dackus GMHE, Hauptmann M, Kok M, Linn SC. Prognostic value of histopathologic traits independent of stromal tumor-infiltrating lymphocyte levels in chemotherapy-naïve patients with triple-negative breast cancer. ESMO Open 2024; 9:102923. [PMID: 38452438 PMCID: PMC10937239 DOI: 10.1016/j.esmoop.2024.102923] [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: 09/13/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND In the absence of prognostic biomarkers, most patients with early-stage triple-negative breast cancer (eTNBC) are treated with combination chemotherapy. The identification of biomarkers to select patients for whom treatment de-escalation or escalation could be considered remains an unmet need. We evaluated the prognostic value of histopathologic traits in a unique cohort of young, (neo)adjuvant chemotherapy-naïve patients with early-stage (stage I or II), node-negative TNBC and long-term follow-up, in relation to stromal tumor-infiltrating lymphocytes (sTILs) for which the prognostic value was recently reported. MATERIALS AND METHODS We studied all 485 patients with node-negative eTNBC from the population-based PARADIGM cohort which selected women aged <40 years diagnosed between 1989 and 2000. None of the patients had received (neo)adjuvant chemotherapy according to standard practice at the time. Associations between histopathologic traits and breast cancer-specific survival (BCSS) were analyzed with Cox proportional hazard models. RESULTS With a median follow-up of 20.0 years, an independent prognostic value for BCSS was observed for lymphovascular invasion (LVI) [adjusted (adj.) hazard ratio (HR) 2.35, 95% confidence interval (CI) 1.49-3.69], fibrotic focus (adj. HR 1.61, 95% CI 1.09-2.37) and sTILs (per 10% increment adj. HR 0.75, 95% CI 0.69-0.82). In the sTILs <30% subgroup, the presence of LVI resulted in a higher cumulative incidence of breast cancer death (at 20 years, 58%; 95% CI 41% to 72%) compared with when LVI was absent (at 20 years, 32%; 95% CI 26% to 39%). In the ≥75% sTILs subgroup, the presence of LVI might be associated with poor survival (HR 11.45, 95% CI 0.71-182.36, two deaths). We confirm the lack of prognostic value of androgen receptor expression and human epidermal growth factor receptor 2 -low status. CONCLUSIONS sTILs, LVI and fibrotic focus provide independent prognostic information in young women with node-negative eTNBC. Our results are of importance for the selection of patients for de-escalation and escalation trials.
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Affiliation(s)
- L W de Boo
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - N D Ter Hoeve
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Opdam
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Y Wang
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M K Schmidt
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - V de Jong
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Kleiterp
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Cornelissen
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Baars
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R H T Koornstra
- Department of Medical Oncology, Rijnstate Medical center, Arnhem, The Netherlands
| | - E D Kerver
- Department of Medical Oncology, OLVG, Amsterdam, The Netherlands
| | - T van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - A D Bins
- Department of Medical Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - P C de Jong
- Department of Medical Oncology, Sint Antonius Hospital, Utrecht, The Netherlands
| | - S D Bakker
- Department of Internal Medicine, Zaans Medical Centre, Zaandam, The Netherlands
| | - R C Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - I R Konings
- Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R Blankenburgh
- Department of Medical Oncology, Saxenburgh Medical Center, Hardenberg, The Netherlands
| | - R M Bijlsma
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands
| | - A L T Imholz
- Department of Internal Medicine, Deventer Hospital, Deventer, The Netherlands
| | - N Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Vreuls
- Department of Pathology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - J Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E H Rosenberg
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E A Koop
- Department of Pathology, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
| | - Z Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - C H M van Deurzen
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A L Mooyaart
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Córdoba
- Department of Pathology, Complejo Hospitalaria de Navarra, Pamplona, Spain
| | - E Groen
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Bart
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - S M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - V Zolota
- Department of Pathology, Rion University Hospital, Patras, Greece
| | - J Wesseling
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Sapino
- Department of Medical Sciences, University of Torino, Torino, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - E Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice, Poland
| | - A Ryska
- Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
| | - A Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - E van der Wall
- Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - R Salgado
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - G M H E Dackus
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - M Kok
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Tumorbiology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S C Linn
- Department of Molecular Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Versluis JM, Hoefsmit EP, Shehwana H, Dimitriadis P, Sanders J, Broeks A, Blank CU. Tumor characteristics of dissociated response to immune checkpoint inhibition in advanced melanoma. Cancer Immunol Immunother 2024; 73:28. [PMID: 38280045 PMCID: PMC10821835 DOI: 10.1007/s00262-023-03581-6] [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: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Immune checkpoint inhibition (ICI) has improved patients' outcomes in advanced melanoma, often resulting in durable response. However, not all patients have durable responses and the patients with dissociated response are a valuable subgroup to identify mechanisms of ICI resistance. METHODS Stage IV melanoma patients treated with ICI and dissociated response were retrospectively screened for available samples containing sufficient tumor at least at two time-points. Included were one patient with metachronous regressive and progressive lesions at the same site, two patients with regressive and novel lesion at different sites, and three patients with regressive and progressive lesions at different sites. In addition, four patients with acquired resistant tumor samples without a matched second sample were included. RESULTS In the majority of patients, the progressive tumor lesion contained higher CD8+ T cell counts/mm2 and interferon-gamma (IFNγ) signature level, but similar tumor PD-L1 expression. The tumor mutational burden levels were in 2 out 3 lesions higher compared to the corresponding regressive tumors lesion. In the acquired tumor lesions, high CD8+/mm2 and relatively high IFNγ signature levels were observed. In one patient in both the B2M and PTEN gene a stop gaining mutation and in another patient a pathogenic POLE mutation were found. CONCLUSION Intrapatient comparison of progressive versus regressive lesions indicates no defect in tumor T cell infiltration, and in general no tumor immune exclusion were observed.
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Affiliation(s)
- J M Versluis
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E P Hoefsmit
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Shehwana
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P Dimitriadis
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Sanders
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Division of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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Herness J, Sanders J, James J. Environmental Interventions for Preventing Falls in Older People Living in the Community. Am Fam Physician 2023; 108:450-451. [PMID: 37983695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Joel Herness
- David Grant USAF Medical Center, Travis Air Force Base, California
| | - Jacob Sanders
- David Grant USAF Medical Center, Travis Air Force Base, California
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Skipper A, Cousins DF, Peach MS, Sanders J, Libby B, McLaughlin C, Kundu D, Luminais C, Showalter TN, Romano K. Comparison of Low Dose Rate and High Dose Rate Brachytherapy Boost Techniques in Prostate Cancer: Evaluation of Toxicity. Int J Radiat Oncol Biol Phys 2023; 117:e437-e438. [PMID: 37785420 DOI: 10.1016/j.ijrobp.2023.06.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The ASCENDE-RT trial has been criticized for higher rates of chronic severe toxicity (18% genitourinary (GU)) than expected with a low dose rate (LDR) boost technique. We compared clinical outcomes of LDR and high dose rate (HDR) boost in the acute and chronic setting from a large single institution experience over a continuous 20-year period, with a focus on GU and gastrointestinal (GI) toxicity during treatment of prostate cancer. MATERIALS/METHODS We retrospectively reviewed patients treated with LDR boost (2003 - 2013) and HDR boost (2014 - 2018). Clinical and treatment-related prognostic factors including age, stage, androgen deprivation therapy (ADT), dosimetry details, and toxicity data were recorded. Toxicity was scored according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Multi-variable analysis (MVA) was performed to evaluate variables associated with toxicity. RESULTS A total of 184 men were evaluated (87 LDR and 97 HDR) with a median follow-up of 7.1 years and 4.0 years, respectively. Most patients (92% LDR and 57% HDR) received ADT in addition to BT. The median EBRT dose was 46 Gy for LDR and 45 Gy for HDR (range 25 - 50 Gy). Prostate D90% was similar at 104% and 105% in the LDR and HDR groups, respectively. Urethra D10% and Rectum V100% were both higher with LDR compared to HDR with 155% vs 119% and 0.436% vs 0.073%, respectively. Severe (grade 3+) toxicity was rare (Table 1), with 3.4% of LDR patients experiencing grade 3 chronic GU toxicity. With HDR, 3.1% and 1% of patients experienced acute and chronic grade 3 GU toxicity, respectively. Although non-severe GU toxicity (grade 1-2) was similar between groups (95% LDR vs 89% HDR, p = 0.16), LDR patients experienced more grade 2 GU events (80.5% acute; 82.8% chronic) compared to HDR patients (45.4% acute; 57.7% chronic). There were no severe GI toxicities in the acute or chronic period. Non-severe acute GI toxicity was more common with HDR, while non-severe chronic GI toxicity was more common with LDR. On MVA, acute GU toxicity (any grade) was associated with short term ADT (p = 0.01) and Urethra D10% (p < 0.05); Chronic GU toxicity (any grade) was associated with age (p = 0.09) and Prostate V150cc (p = 0.07) but not BT boost technique. CONCLUSION This comparative retrospective analysis of BT boost techniques reveals the overall rate of severe GU and GI toxicity to be low with both LDR and HDR. HDR boost appears to have a slightly more favorable ratio of Grade 1 to Grade 2 GU toxicity and improved urethra/rectum dosimetry. Our analysis suggests that the dosimetric advantages of HDR may deliver small reductions in GU toxicity.
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Affiliation(s)
- A Skipper
- University of Virginia, Charlottesville, VA, United States
| | - D F Cousins
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - M S Peach
- Department of Radiation Oncology, East Carolina University, Greenville, NC
| | - J Sanders
- University of Virginia Department of Radiation Oncology, Charlottesville, VA
| | - B Libby
- University of South Florida, Tampa, FL
| | - C McLaughlin
- University of Virginia, Department of Radiation Oncology, Charlottesville, VA
| | - D Kundu
- University of Virginia, Charlottesville, VA
| | - C Luminais
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | | | - K Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
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Wijesooriya K, Larner JM, Read PW, Showalter TN, Lum L, Conaway M, Nguyen C, Lain D, Thakur A, Romano K, McLaughlin C, Jr EMJ, Luminais C, Wood S, Cousins DF, Chen J, Muller DA, Dutta SW, Nesbit EA, Ward KA, Sanders J, Chavis Y, Asare E. Initial Report of a Randomized Trial Comparing Conventional vs. Novel Treatment Planning Technique to Ameliorate Immunosuppression from Lung SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e73-e74. [PMID: 37786124 DOI: 10.1016/j.ijrobp.2023.06.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) SBRT is highly effective against early-stage non-small cell lung cancer. Radiation Therapy (RT) is known to modulate the immune system and contribute to the generation of anti-tumor T cells and stimulate T cell infiltration into tumors. However, this anti-tumor activity is offset by radiation-induced immunosuppression (RIIS) which results in lower tumor control and survival. Lymphocytes are highly radiosensitive and RIIS means destroying existing as well as newly created cytotoxic and helper T lymphocytes. We hypothesized that optimizing RT treatment planning by considering circulating blood and lymphatics as a critical Organ at Risk (OAR) may mitigate RIIS. MATERIALS/METHODS We conducted an IRB approved NCI funded clinical trial for 50 early-stage lung cancer patients treated with SBRT alone, from 2020 to 2023, to investigate the ability to reduce RIIS by reducing dose to circulating blood and lymphatics with the aid of a predictive algorithm. All SBRT plans adhered to treatment parameters from RTOG 0813 (central) or RTOG 0915 (peripheral). Patients were randomized to two arms: experimental optimization for RIIS (to reduce dose to blood and lymphatic rich organs) versus standard SBRT planning (without optimization for RIIS). Peripheral blood samples were collected at baseline, end of Tx, 4 weeks and 6 months post Tx. Patients with baseline absolute lymphocyte counts (ALC) less than 0.5x109 cells/L were ineligible for the trial. Data acquired for all blood cell types as well as lymphocyte sub populations CD3+, CD4+, CD8+, CD19+, CD56+. Two sample t-test was used to determine the statistical significance between the cohorts at the time points. RESULTS The standard arm had an ALC reduction of 28% at one week post Tx and a nadir at 4 weeks with a 34% reduction. Absolute percentage reductions in ALC from baseline in the optimized arm compared to the standard arm are: end of treatment point (13%, p = 0.03), 4 weeks (12%, p = 0.08), 6 months (15%, p = 0.1), and all three time points together 13% (p = 0.001). ALC recovery appears to be faster in the optimized arm. Radiation induced suppression of all blood cell types are also reduced in the optimized arm with respect to standard arm (relative percentages): ALC (34%), WBC (47%), RBC (46%), platelets (40%), monocytes (100%), and neutrophils (62%) at 4-week mark. Average percentage reductions on integral doses, and V5 (volume receiving a 5 Gy dose) of optimized compared to standard plans are: aorta: 26%, 41% heart: 8%, 33%, vena cava: 32%, 52%, T spine: 51%, 81%, lymph nodes: 35%, 57%, total lung- ITV: 1.6%, 1%, body: 10%, 14%. CONCLUSION For the first time, we have shown that it is possible to reduce RIIS in a statistically significant manner, compared to standard of care, via optimized RT planning using a predictive model. This has implications in increasing the efficacy of immunotherapy by preserving the existing tumor reactive T cells in the immune system to enhance anti-tumor activity, and in reducing hospitalizations and improving survival.
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Affiliation(s)
- K Wijesooriya
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - J M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - P W Read
- University of Virginia, Charlottesville, VA
| | - T N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA; University of Virginia, Charlottesville, VA
| | - L Lum
- University of Virginia, Charlottesville, VA
| | - M Conaway
- University of Virginia, Charlottesville, VA
| | - C Nguyen
- University of Virginia, Charlottesville, VA
| | - D Lain
- University of Virginia, Charlottesville, VA, United States
| | - A Thakur
- University of Virginia, Charlottesville, VA
| | - K Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - C McLaughlin
- University of Virginia, Department of Radiation Oncology, Charlottesville, VA
| | - E M Janowski Jr
- University of Virginia Department of Radiation Oncology, Charlottesville, VA
| | - C Luminais
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - S Wood
- University of Virginia, Charlottesville, VA
| | - D F Cousins
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - J Chen
- University of Virginia, Charlottesville, VA
| | - D A Muller
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - S W Dutta
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - E A Nesbit
- University of Virginia Department of Radiation Oncology, Charlottesville, VA
| | - K A Ward
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - J Sanders
- University of Virginia Department of Radiation Oncology, Charlottesville, VA
| | - Y Chavis
- University of Virginia Health Systems, Charlottesville, VA, United States
| | - E Asare
- University of Virginia Department of Radiation Oncology, Charlottesville, VA
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Liefaard MC, van der Voort A, van Ramshorst MS, Sanders J, Vonk S, Horlings HM, Siesling S, de Munck L, van Leeuwen AE, Kleijn M, Mittempergher L, Kuilman MM, Glas AM, Wesseling J, Lips EH, Sonke GS. BluePrint molecular subtypes predict response to neoadjuvant pertuzumab in HER2-positive breast cancer. Breast Cancer Res 2023; 25:71. [PMID: 37337299 DOI: 10.1186/s13058-023-01664-x] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/25/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The introduction of pertuzumab has greatly improved pathological complete response (pCR) rates in HER2-positive breast cancer, yet effects on long-term survival have been limited and it is uncertain which patients derive most benefit. In this study, we determine the prognostic value of BluePrint subtyping in HER2-positive breast cancer. Additionally, we evaluate its use as a biomarker for predicting response to trastuzumab-containing neoadjuvant chemotherapy with or without pertuzumab. METHODS From a cohort of patients with stage II-III HER2-positive breast cancer who were treated with neoadjuvant chemotherapy and trastuzumab with or without pertuzumab, 836 patients were selected for microarray gene expression analysis, followed by readout of BluePrint standard (HER2, Basal and Luminal) and dual subtypes (HER2-single, Basal-single, Luminal-single, HER2-Basal, Luminal-HER2, Luminal-HER2-Basal). The associations between subtypes and pathological complete response (pCR), overall survival (OS) and breast cancer-specific survival (BCSS) were assessed, and pertuzumab benefit was evaluated within the BluePrint subgroups. RESULTS BluePrint results were available for 719 patients. In patients with HER2-type tumors, the pCR rate was 71.9% in patients who received pertuzumab versus 43.5% in patients who did not (adjusted Odds Ratio 3.43, 95% CI 2.36-4.96). Additionally, a significantly decreased hazard was observed for both OS (adjusted hazard ratio [aHR] 0.45, 95% CI 0.25-0.80) and BCSS (aHR 0.46, 95% CI 0.24-0.86) with pertuzumab treatment. Findings were similar in the HER2-single subgroup. No significant benefit of pertuzumab was seen in other subtypes. CONCLUSIONS In patients with HER2-type or HER2-single-type tumors, pertuzumab significantly improved the pCR rate and decreased the risk of breast cancer mortality, which was not observed in other subtypes. BluePrint subtyping may be valuable in future studies to identify patients that are likely to be highly sensitive to HER2-targeting agents.
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Affiliation(s)
- M C Liefaard
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A van der Voort
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M S van Ramshorst
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Sanders
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Vonk
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Core Facility Molecular Pathology and Biobanking, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H M Horlings
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - L de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - A E van Leeuwen
- Dutch Breast Cancer Research Group, BOOG Study Center, Amsterdam, The Netherlands
| | - M Kleijn
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - L Mittempergher
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - M M Kuilman
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - A M Glas
- Department of Research and Development, Agendia NV, Amsterdam, The Netherlands
| | - J Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - E H Lips
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Venner E, Asare E, Sanders J, Kunk P, Hedrick T, Hoang S, Reilley M, Le T, Friel C, Janowski E. Outcomes Associated with Total Neoadjuvant Therapy (TNT) with Non-Operative Intent for Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sosa A, Choi S, Nguyen Q, Kudchadker R, Sanders J, Zhu X, Shah S, Mok H, Kuban D, Mayo L, Hoffman K, Tang C, McGuire S, Ausat N, Thames H, Frank S. Proton Therapy for Localized Prostate Cancer: Long-Term Clinical Outcomes at a Comprehensive Cancer Center. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1224] [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: 11/25/2022]
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11
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de Roode L, Sanders J, Guimaraes M, Van Leeuwen P, Van Der Poel H, De Boer L, Ruers T. Using optics to detect positive surgical margins intraoperatively during prostate cancer surgery. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02488-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Leite M, Melillo X, Lam N, Vonk S, de Bruijn B, Sanders J, Almekinders M, Visser L, Groen E, Van der Borden C, Mulder L, Kristel P, Lips E, Wesseling J, Precision T. Morphometric analysis of ductal carcinoma in situ identifies features associated with low risk of progression to invasive breast cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01594-5] [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: 11/21/2022]
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13
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Stone D, Sanders J, Tsung J. 205 Clinical Characteristics, Outcomes, and Interobserver Agreement of Point-of-Care Ultrasound Detected Mesenteric Adenitis in Non-Surgical Pediatric Abdominal Pain: A Retrospective Cohort Study. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.230] [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: 11/01/2022]
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14
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Milton R, Modibbo F, Gillespie D, Alkali FI, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Khalid RY, Muhammad MY, Bello M, Edwin CP, Ogudo E, Iregbu KC, Jones L, Hood K, Ghazal P, Sanders J, Hassan B, Belga FJ, Walsh TR. Incidence and sociodemographic, living environment and maternal health associations with stillbirth in a tertiary healthcare setting in Kano, Northern Nigeria. BMC Pregnancy Childbirth 2022; 22:692. [PMID: 36076161 PMCID: PMC9454147 DOI: 10.1186/s12884-022-04971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Almost two million stillbirths occur annually, most occurring in low- and middle-income countries. Nigeria is reported to have one of the highest stillbirth rates on the African continent. The aim was to identify sociodemographic, living environment, and health status factors associated with stillbirth and determine the associations between pregnancy and birth factors and stillbirth in the Murtala Mohammed Specialist Hospital, Kano, Nigeria. Methods A three-month single-site prospective observational feasibility study. Demographic and clinical data were collected. We fitted bivariable and multivariable models for stillbirth (yes/no) and three-category livebirth/macerated stillbirth/non-macerated stillbirth outcomes to explore their association with demographic and clinical factors. Findings 1,998 neonates and 1,926 mothers were enrolled. Higher odds of stillbirth were associated with low-levels of maternal education, a further distance to travel to the hospital, living in a shack, maternal hypertension, previous stillbirth, birthing complications, increased duration of labour, antepartum haemorrhage, prolonged or obstructed labour, vaginal breech delivery, emergency caesarean-section, and signs of trauma to the neonate following birth. Interpretation This work has obtained data on some factors influencing stillbirth. This in turn will facilitate the development of improved public health interventions to reduce preventable deaths and to progress maternal health within this site. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04971-x.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Modibbo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - D Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - R Y Khalid
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Y Muhammad
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - M Bello
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - C P Edwin
- Department of Microbiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - E Ogudo
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - L Jones
- Department of Medical Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hassan
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Belga
- Murtala Mohammed Specialist Hospital (MMSH), Kano, Nigeria
| | - T R Walsh
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Zoology, Ineos Institute of Antimicrobial Research, University of Oxford, Oxford, UK
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15
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Liefaard M, van der Voort A, van Seijen M, Sanders J, Vonk S, de Munck L, van Leeuwen-Stok A, Horlings H, Salgado R, Lips E, Sonke G. 145P Prognostic value of tumor-infiltrating lymphocytes in HER2-positive breast cancer treated with neoadjuvant chemotherapy and dual HER2-blockade: A TRAIN-2 sub study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.180] [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: 11/24/2022] Open
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16
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Bueser T, Phillips A, Kirkby C, Partridge J, Kearl F, Moss L, Evans C, Sanders J. A programme to support resilience and clinical excellence in inherited cardiac conditions nurses based in the hospital and charity sector during the COVID-19 pandemic and beyond. Eur J Cardiovasc Nurs 2022. [PMCID: PMC9384355 DOI: 10.1093/eurjcn/zvac060.078] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Burdett Trust for Nursing
Background
The COVID-19 pandemic affected health care systems profoundly. Inherited cardiac condition (ICC) specialist nurses were redeployed to intensive care or acute settings which either left services with no nurse or a single nurse manning a normally busy service (Bueser 2020). An exponential rise in patients reaching out to patient support charities was seen (Charity Today 2020) and at the peak of the pandemic, nurses based at an ICC charity dealt with 599 inquiries which was a 328% increase in activity. The toll on the mental health of nurses during the pandemic is well documented and programmes have been suggested to address this which includes peer support and psychological support by clinical psychologists
Purpose
The aim was to develop and strengthen collaborations between ICC specialist nurses in a tertiary hospital and those working in the community charity sector; and provide peer and psychological support to enable consistent high quality patient care.
Methods
The project was based on Wenger’s (1999) Communities of Practice (COP) framework model of situational learning, collaboration among peers, working to a common purpose. To develop the counselling aspect, a psychotherapist led a scoping exercise with the group. The 4Rs Skilled Helper Programme (SHP) of reflective learning, supervision and continuing professional development was then adapted as a bespoke programme - combining 30 hours of formal counselling, communication and reflective learning skills with equal attention to the normative, formative and restorative components of support and development needed to ensure practitioner health and wellbeing and the safety and quality of patient care
Results
Nine ICC nurses from a tertiary hospital and 3 from the charity sector participated in the project. Nine nurses undertook the tailored 4RS SHP course, adapting Egan's 3 stage problem-solving, decision-making and opportunity development framework as the vehicle for personalised, psychosocial, time-sensitive decision-making and informed consent for patients, and for the identification of support and development strategies that represent the 'best fit' for both clients and practitioners in their particular social and organisational circumstances. Counselling supervision is ongoing on a whole group, team and individual basis and provides opportunities to discuss collaborations, gain support for challenging clinical cases and work situations; and promoting psychological well-being.
Conclusions
The COP established through this project alongside the development of a bespoke counselling course and psychological supervision is an exemplar of how nurses can be empowered to continue to provide excellent care despite challenging circumstances. The 4RS SHP course also specifically addresses the competency needs for ICC nurses as move towards a genomics-driven, personalised health care delivery model.
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Affiliation(s)
- T Bueser
- St Bartholomew's Hospital , London , United Kingdom of Great Britain & Northern Ireland
| | - A Phillips
- Alan Phillips Associates , Manchester , United Kingdom of Great Britain & Northern Ireland
| | - C Kirkby
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - J Partridge
- Cardiomyopathy UK , London , United Kingdom of Great Britain & Northern Ireland
| | - F Kearl
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - L Moss
- St Bartholomew's Hospital, Barts Heart Centre , London , United Kingdom of Great Britain & Northern Ireland
| | - C Evans
- Cardiomyopathy UK , London , United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- St Bartholomews and Queen Mary University, William Harvey Research Institute , London , United Kingdom of Great Britain & Northern Ireland
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17
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Matthews S, O"neil A, Sanders J, Buttery A, Maraosco S, Fredericks S, Martorella G, Keenan N, Ganes A, Wynne R. Sex-specific differences in mortality after first time, isolated coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Evidence quantifying sex-specific differences in cardiac surgical outcomes is scant.
PURPOSE
The purpose of this review was to determine whether contemporary evidence indicates Coronary Artery Bypass Graft Surgery (CABGS) is differentially efficacious than alternative procedures by sex on mortality outcomes.
METHODS
EMBASE, CINAHL, Medline and Cochrane Library databases were searched (January 2010-April 2020). English language, randomized controlled trials, comparing isolated CABGS to an alternative revascularization strategy in adults, with analyses comparing sex-specific differences in mortality were included. Analyses of incidence data was performed using Mantel-Haenszel fixed-effects modelling, Cochrane RoB2 tool and CONSORT checklist. PROSPERO Registration ID: CRD42020181673.
RESULTS
The search yielded 4459 citations, with 29 articles for full-text review revealing 9 eligible studies with variability in time to follow-up. In contrast to men, mortality risk for women was lower in pooled analyses (RR 0.95, 95% CI 0.85-1.05, p = 0.33) but higher in sensitivity analyses excluding ‘high-risk’ patients (RR 1.18, 95% CI 0.99-1.40, p = 0.07). At 30-days and 10 years, women had an 18% (RR 0.82, 95% CI 0.66-1.02, p = 0.08) and 19% (RR 0.81, 95% CI 0.69-0.95, p = 0.01) mortality risk reduction. At 1-2 years women had a 7% (RR 1.07, 95% CI 0.69-1.64, p = 0.77), and at 2-5 years a 25% increase in risk of mortality compared to men (RR 1.25, 95% CI 1.03-1.53, p = 0.03). Women were increasingly under represented (23.2%) over time, comprising 29% (30-days) to 16% (10 years) of the pooled population.
CONCLUSION
Trials with sex-specific stratification are required to ensure appropriate treatment options for coronary revascularization.
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Affiliation(s)
- S Matthews
- National Heart Foundation of Australia, Melbounre, Australia
| | - A O"neil
- Deakin University, Melbourne, Australia
| | - J Sanders
- St Bartholomew"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Buttery
- National Heart Foundation of Australia, Melbounre, Australia
| | - S Maraosco
- The Alfred Hospital, Melbourne, Australia
| | | | - G Martorella
- Florida State University, Tallahasse, United States of America
| | - N Keenan
- St James Hospital, Dublin, Ireland
| | - A Ganes
- Barwon Health, Geelong, Australia
| | - R Wynne
- Western Sydney Local Health District, Sydney, Australia
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18
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Clough A, Sanders J, Banfill K, Faivre-Finn C, Price G, Eccles CL, Aznar MC, Van Herk M. A novel use for routine CBCT imaging during radiotherapy to detect COVID-19. Radiography (Lond) 2022; 28:17-23. [PMID: 34332857 PMCID: PMC8299223 DOI: 10.1016/j.radi.2021.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 07/11/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Thoracic CT is a useful tool in the early diagnosis of patients with COVID-19. Typical appearances include patchy ground glass shadowing. Thoracic radiotherapy uses daily cone beam CT imaging (CBCT) to check for changes in patient positioning and anatomy prior to treatment through a qualitative assessment of lung appearance by radiographers. Observation of changes related to COVID-19 infection during this process may facilitate earlier testing improving patient management and staff protection. METHODS A tool was developed to create overview reports for all CBCTs for each patient throughout their treatment. Reports contain coronal maximum intensity projection (MIP's) of all CBCTs and plots of lung density over time. A single therapeutic radiographer undertook a blinded off-line audit that reviewed 150 patient datasets for tool optimisation in which medical notes were compared to image findings. This cohort included 75 patients treated during the pandemic and 75 patients treated between 2014 and 2017. The process was repeated retrospectively on a subset of the 285 thoracic radiotherapy patients treated between January-June 2020 to assess the efficiency of the tool and process. RESULTS Three patients in the n = 150 optimisation cohort had confirmed COVID-19 infections during their radiotherapy. Two of these were detected by the reported image assessment process. The third case was not detected on CBCT due to minimal density changes in the visible part of the lungs. Within the retrospective cohort four patients had confirmed COVID-19 based on RT-PCR tests, three of which were retrospectively detected by the reported process. CONCLUSION The preliminary results indicate that the presence of COVID-19 can be detected on CBCT by therapeutic radiographers. IMPLICATIONS FOR PRACTICE This process has now been extended to clinical service with daily assessments of all thoracic CBCTs. Changes noted are referred for oncologist review.
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Affiliation(s)
- A Clough
- The Christie NHSFT, Manchester, United Kingdom.
| | - J Sanders
- The Christie NHSFT, Manchester, United Kingdom
| | - K Banfill
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - C Faivre-Finn
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - G Price
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - C L Eccles
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - M C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - M Van Herk
- The Christie NHSFT, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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19
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Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, Sa'ad FH, Tukur FM, Pell B, Hood K, Ghazal P, Iregbu KC. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth 2021; 21:830. [PMID: 34906118 PMCID: PMC8670111 DOI: 10.1186/s12884-021-04207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria. Design Qualitative, interpretative. Setting Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria. Sample Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth. Methods Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day. Results Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby. Conclusions As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04207-4.
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Affiliation(s)
- R Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F I Alkali
- Department of Biochemistry, Bayero University, Kano, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - A S Mukaddas
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - A Kassim
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - F H Sa'ad
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | - F M Tukur
- Department of Biological Sciences, Bayero University, Kano, Nigeria
| | - B Pell
- Centre for the Development and Evaluation of Complex Intervention for Public Health Improvement, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - P Ghazal
- Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - K C Iregbu
- Department of Medical Microbiology, National Hospital, Abuja, Nigeria
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20
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Savory NA, Hannigan B, John RM, Sanders J, Garay SM. Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey. Midwifery 2021; 103:103103. [PMID: 34392103 DOI: 10.1016/j.midw.2021.103103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the prevalence of self-reported mental health problems in a cohort of women in early pregnancy. To describe the relationship between poor mental health and sociodemographic characteristics, self-efficacy and support networks. To assess if participants were representative of the local antenatal population. RESEARCH DESIGN AND SETTING The UK government has pledged money to provide more support for women with perinatal mental health issues. Understanding the prevalence and predicting women who may need support will inform clinical practice. This paper reports part of the larger 'Mothers Mood Study', which explored women's and midwives' experience of mild to moderate perinatal mental health issues and service provision. Routinely collected population level data were analysed and a smaller cross-sectional survey design used to assess predictors of poor mental health in early pregnancy in one health board in Wales. PARTICIPANTS Routinely collected data were extracted for all women who registered for maternity care between May 2017 and May 2018 (n = 6312) from the electronic maternity information system (pregnant population). Over a three month period 302 of these women completed a questionnaire at the antenatal clinic after an ultrasound scan (participants). Eligible women were aged ≥18 years, with sufficient spoken and written English to complete the questionnaire and a viable pregnancy of ≤18 weeks' gestation. The questionnaire collected data on sociodemographic status, self-efficacy and support networks, self-reported mental health problems. Current anxiety and depression were assessed using the General Anxiety Disorders Assessment and Edinburgh Postnatal Depression Scale. FINDINGS Among the pregnant population 23% (n = 1490) disclosed a mental health problem during routine questioning with anxiety and depression being the most common conditions. Participants completing the detailed questionnaire were similar in age and parity to the pregnant population with similar levels of depression (15.6%; n = 15.6 v 17.3%, n = 1092). Edinburgh Postnatal Depression Scale and General Anxiety Disorder 7 scores identified 8% with symptoms of anxiety (n = 25) or depression (n = 26) and a further 24.2% (n = 73) with symptoms of mild anxiety and 25.2% (n = 76) with mild depression. Low self-efficacy (OR 1.27, 95% CI 1.12-1.45), a previous mental health problem (OR 3.95, 95% CI 1.37-11.33) and low support from family (OR 1.13, 95% CI 1.00-1.27) were found to be associated with early pregnancy anxiety and/or depression. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Around one in five women who register for maternity care may have a mental health problem. Mild to moderate anxiety and depression are common in early pregnancy. Services need to improve for women who do not currently meet the threshold for referral to perinatal mental health services. Assessment and active monitoring of mental health is recommended, in particular for pregnant women with risk factors including a history of previous mental health difficulties, poor family support or low self-efficacy.
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Affiliation(s)
- N A Savory
- Maternity Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - B Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, United Kingdom
| | - R M John
- Biomedicine division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, United Kingdom
| | - S M Garay
- Biomedicine division, School of Biosciences, Cardiff University, Cardiff CF10 3AX, United Kingdom
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Burton S, Hayes JA, Morrell-Scott N, Sanders J, Walthall H, Wright DJ, Jones ID. Should I stay or should I go? An exploration of the decision-making behavior of acute cardiac patients during the COVID-19 pandemic. Heart Lung 2021; 52:16-21. [PMID: 34823051 PMCID: PMC8606948 DOI: 10.1016/j.hrtlng.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022]
Abstract
Background During the SARS-COV-2 (COVID-19) pandemic efforts to reduce virus transmission resulted in non-emergency patients being deterred from seeking help. The number of patients presenting with acute cardiac conditions reduced, significantly Objectives To explore the decision-making process, and influential factors in that process, of patients and their family during an acute cardiac event. Methods A qualitative research design was employed using purposive sampling of patients who experienced an acute cardiac event during the social containment mandates. Semi-structured interviews were conducted, with thematic analysis of interview transcripts. Results Twenty-five participants were recruited from three UK hospitals. Themes identified were reliance on informal support network, lack of awareness of cardiac symptoms leading to delayed help-seeking, and an indirect COVID-19 effect (e.g. avoiding treatment). Conclusions These results highlight the need for informed public health messages, targeting patients and their support networks, that allow those in need of treatment to access care.
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Affiliation(s)
- S Burton
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom
| | - J A Hayes
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom
| | - N Morrell-Scott
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom
| | - J Sanders
- Barts Health NHS Trust William Harvey Research Institute, St Bartholomew's Hospital, Queen Mary University of London, United Kingdom
| | - H Walthall
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - D J Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom
| | - I D Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Tithebarn Building, Liverpool L2 2ER, United Kingdom; Liverpool Centre for Cardiovascular Science, United Kingdom.
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Asare E, Sanders J, Goldbeck L, Muller D, Janowski E. Incidence and Impact of Lymphopenia Associated With Total Neoadjuvant Therapy for Low-Lying Rectal Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Wang L, Poenisch F, Sanders J, Sahoo N, Zhu X, Ma J, Choi S, Nguyen Q, Mok H, Tang C, McGuire S, Hoffman K, Shah S, Frank S. The Dosimetric Effect of MRI Positive-Contrast Markers vs. Negative-Contrast Fiducial Markers on Proton Radiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.561] [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: 11/29/2022]
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Ward K, Muller D, Dutta S, Malhi J, Sanders J, Luminais C, Millard T, Showalter T, Showalter S, Janowski E. Long-Term Adherence to Adjuvant Endocrine Therapy Following Various Radiotherapy Modalities in Hormone Receptor Positive Breast Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sanders J, Mok H, Tang C, Hanania A, Venkatesan A, Bruno T, Kudchadker R, Thames H, Frank S. Benchmarking Automatic Segmentation Algorithms Against Human Interobserver Variability of Prostate and Organs at Risk Delineation on Prostate MRI. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.926] [Citation(s) in RCA: 1] [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: 11/30/2022]
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26
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Cousins D, Sanders J, Muller D, Ward K, Asare E, Libby B, Showalter T, Romano K. Disease Characteristics and Patterns of Failure by Histologic Type for Patients Treated With Definitive Radiation for Cervical Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Clough A, Hales R, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, Choudhury A, Eccles C. PD-0938 impact of an atlas on radiographer inter-observer contour variation in prostate radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07217-0] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bueser T, Clayton T, Dodd M, Beaumont E, Owens G, Murray S, Sepehripour A, Oo A, Sanders J. The impact of COVID-19 on recovery after heart surgery: preliminary findings from the CardiacCovid Study. Eur J Cardiovasc Nurs 2021. [PMCID: PMC8344890 DOI: 10.1093/eurjcn/zvab060.051] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background/Introduction The COVID-19 pandemic has had far-reaching effects on everyday life leading to stress and anxiety, which may be heightened in those undergoing cardiac surgery. Health impacts following a traumatic event may be apparent at one month but can also present after many months. Purpose The aim of the CardiacCovid study was to explore the effect of the pandemic on recovery from cardiac surgery. We report the preliminary results from a single centre study in the UK during the early phase of the COVID-19 pandemic. Methods Patients >18 years old undergoing any form of cardiac surgery between 23rd March 2020 (UK lockdown) to 4th July 2020 (lifting of most restrictions) were recruited to this prospective observational study. Those too unwell or unable to give consent/complete study questionnaires were excluded. Participants completed a Quality of Life (QoL) (EQ-5D), impact of event (IES-R), depression (CES-D) and health service use questionnaire at baseline, 1 week after hospital discharge, and 6 weeks after surgery. Questionnaires were completed electronically on the Amplitude platform or via post. Ethics approval (20/YH/0132) was obtained and the study was registered (Clinicaltrials.gov:NCT04366167). Results A total of 395 patients had surgery of which 298 (91.7%) were screened and 203 (68.1%) were enrolled to the study. Participants were mostly male (74.6%), with a mean age of 63 years, undergoing urgent/emergency (57.9%) CABG +/-valve (70.1%). Mean inpatient stay was 8.6 days and in-hospital mortality was 0.5%. No patients had Covid-19. The initial findings suggest a deterioration of QoL at 1 week post discharge with near restoration to baseline level at 6 weeks post-surgery. Mean scores for CES-D and IES-R remained within subclinical levels at all available time points. However, at 6 weeks, a proportion of patients reached levels for depression on the CES-D and had high IES-R scores indicating possible post-traumatic stress. Conclusion We believe that this is the largest/only study exploring the impact of the pandemic on cardiac surgery recovery, including QoL, spanning the immediate recovery phase but will continue until 1 year. The findings so far show that recovery from cardiac surgery during the Covid-19 pandemic is similar to that reported prior to the pandemic (Cromhout et al 2018) and reinforces the need for psychosocial assessments to identify patients who may require additional support during the immediate recovery phase.
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Affiliation(s)
- T Bueser
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - T Clayton
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - M Dodd
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - E Beaumont
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom of Great Britain & Northern Ireland
| | - G Owens
- Chair, Aortic Dissection Awareness UK & Ireland, London, United Kingdom of Great Britain & Northern Ireland
| | - S Murray
- National Institute for Cardiovascular Outcomes Research, Patient Engagement Lead; Society for Cardiothoracic Surgery, Lay Representative, London, United Kingdom of Great Britain & Northern Ireland
| | - A Sepehripour
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - A Oo
- St Bartholomew"s Hospital, Barts Heart Centre; Queen Mary University, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- St Bartholomew"s Hospital, Barts Heart Centre; Queen Mary University, William Harvey Research Institute, London, United Kingdom of Great Britain & Northern Ireland
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Thomas A, Griffiths M, Kalakoutas A, Yates M, Sanders J. Recovery from aortic valve surgery: the trajectory of muscle mass, strength, and quality, and health-related quality of life (HRQoL). Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity
OnBehalf
Queen Mary University of London (QMUL) and Barts Health NHS Trust
Background/Introduction:
The impact of intensive care unit-acquired weakness (ICUAW) is considerable and is associated with reduced physical function and impaired health-related quality of life (HRQoL). Patients’ undergoing elective cardiac surgery are known to lose significant muscle mass and strength in the first seven days after surgery, but little is known beyond that time.
Purpose
We sought to investigate the effect of cardiac surgery on ICUAW (including muscle mass, strength, muscle quality) and HRQoL (including anxiety and depression and reintegration into society) until out-patient follow-up.
Methods
Eligible patients included adults undergoing a surgical elective aortic valve replacement without any pre-existing causes of severe muscle weakness or wasting. Muscle mass was measured using ultrasound of the rectus femoris cross-sectional area (RFcsa). Muscle quality was calculated using histogram analysis, specifically pixel intensity (PI), whereby a lower value is indicative of healthier muscle tissue. Muscle strength was measured using hand-held dynamometry specifically grip strength. HRQoL (EQ5D), anxiety and depression (hospital anxiety and depression scale (HADS)) and reintegration to normal living (RNLI index) were also collected. Measurements were assessed preoperatively, at day 7 and at out-patient follow-up.
Results
Thirty-one patients were recruited, with 22 (70.9%) patients attending follow-up. Patients lost 6.5% RFcsa (p= <0.0001) in the first seven days post-surgery and 10.1% (p = 0.0014) between preoperative assessment and follow-up. Hand-held grip strength decreased significantly (10.6%, p= <0.0001) in the first seven days post-surgery, however, differing to RFcsa, recovered considerably between day 7 and follow-up (7.7%, p = 0.018). Decreased muscle quality was observed solely in the first seven days after surgery (8.3%, p = 0.0094). The EQ5D visual analogue scale and crosswalk index increased significantly from preoperative assessment to follow-up (10%, p = 0.0250; 17.6%, p = 0.022 respectively) and day 7 to follow-up (11.7%, p = 0.0311; 27.9%, p = 0.011 respectively). While depression scores significantly decreased between the same time points as the EQ5D, changes in anxiety and RNLI scores, were non-significant.
Conclusion
Patients undergoing surgical aortic valve replacements lose considerable muscle mass in hospital, failing to recover even at out-patient follow-up. Furthermore, muscle quality decreases in the first seven days after surgery in line with the acute muscle loss. However, the impact on strength is less extensive as patients appear to recover the loss by follow-up. Patients’ health scores, function index and depression scores also improve, suggesting that muscle mass is the only outcome to not recover at follow-up. Therefore, patients appear to recover well from AVR surgery even surpassing some of their preoperative results, with the exception of the RFcsa.
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Affiliation(s)
- A Thomas
- St Bartholomews and Queen Mary University, Adult Critical Care Unit (ACCU), London, United Kingdom of Great Britain & Northern Ireland
| | - M Griffiths
- Barts Health NHS Trust, Adult Critical Care Unit (ACCU), London, United Kingdom of Great Britain & Northern Ireland
| | - A Kalakoutas
- Barts and The London School of Medicine and Dentistry, London, United Kingdom of Great Britain & Northern Ireland
| | - M Yates
- Barts Health NHS Trust, Cardiac Surgery, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- Barts Health NHS Trust, Director of Nursing and Allied Health Professional Research, London, United Kingdom of Great Britain & Northern Ireland
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Burton S, Hayes J, Scott-Morell N, Jones I, Sanders J, Walthall H, Wright J. Should I stay or should I go? An exploration of the decision-making behaviour of acute cardiac patients during the Covid-19 pandemic. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Liverpool John Moores University
Background
The Covid-19 pandemic has resulted in excess mortality. With efforts to reduce population movement and the spread of the disease, non-emergency patients are deterred from seeking help. Reduction in the number of patients presenting with acute cardiac conditions has dropped significantly, impacting initial and follow-up treatment. In a national survey, 71% reported they were afraid to visit hospital due to fear of being exposed to the virus, and 46% worried about putting pressure on the health service. Internet searches for chest pain symptoms increased following the announcement of lockdown and public health messages, suggesting an influence of government messaging on patient behaviour. Current work suggests that patients are turning to informal support networks to facilitate decision making, while more formalised networks are blocked.
Purpose
To qualitatively explore decision making of patients and their family members’ when faced with an acute cardiac event. This methodology provides insight into why patients made said decisions, and what factors influenced their decision making, during the Covid-19 pandemic.
Methods
A qualitative methodology was employed using purposive sampling of cardiac patients, who had attended hospital during a Covid-19 lockdown. Data was collected using semi-structured, digitally recorded, telephone or video call interviews. Interviews were transcribed verbatim and subjected to thematic analysis.
Results
Twenty-four participants were recruited, from three sites throughout England.
Three themes were generated from the study
Reliance on informal support network, including disclosing their symptoms to family and friends, in turn leading to displaced or co-decision making. Secondly, a lack of awareness of cardiac symptoms leading to delayed help-seeking. Finally, an indirect Covid-19 effect, in which patients suggest that Covid-19 did not influence their decisions, yet a perception that their condition was non-urgent combined with a belief that GP services were limited resulted in delayed help-seeking
Conclusions
Patients have turned to informal health support networks, especially when the cause of symptoms are unknown. While the presence of Covid-19 is not explicitly noted as being influential, indirect effects are noted. Findings highlight the need for informed public health messages, that allow those in need of treatment to access care as and when they need.
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Affiliation(s)
- S Burton
- Liverpool John Moores University, School of Nursing and Allied Health, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Hayes
- Liverpool John Moores University, School of Nursing and Allied Health, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - N Scott-Morell
- Liverpool John Moores University, School of Nursing and Allied Health, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - I Jones
- Liverpool John Moores University, School of Nursing and Allied Health, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Sanders
- The William Harvey Research Institute, St Bartholomew’s Hospital & Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Walthall
- Oxford University Hospitals Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - J Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Aktuerk D, Ali J, Badran A, Balmforth D, Bleetman D, Brown C, Suelo-Calanao R, Cartwright J, Casey L, Chiwera L, Fudulu D, Garner M, Gradinariu G, Harky A, Hussain A, Hutton S, Kew E, Loubani M, Mani K, Martin J, Rochon M, Moawad N, Mohamed S, Muretti M, Murphy G, Olivieri G, Paglinawan I, Quijano-Campos J, Rizzo V, Robertson S, Rogers L, Roman M, Salmon K, Sanders J, Talukder S, Tanner J, Vaja R, Zientara A, Green S, Miles R, Lamagni T, Harrington P. National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland. J Hosp Infect 2020; 106:812-819. [DOI: 10.1016/j.jhin.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
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32
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Dalwadi S, Thames H, Tang C, Crook J, Sanders J, Blanchard P, Ciezki J, Keyes M, Merrick G, Catton C, Razlee H, Stock R, Sullivan F, Millar J, Frank S. Is The Phoenix Criterion Of Biochemical Failure (BF) In Men Treated With Low-Dose Rate Prostate Brachytherapy Appropriate? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.535] [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: 11/15/2022]
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33
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Sanders J, Venkatesan A, Davis J, Kudchadker R, Tang C, Bruno T, Ma J, Frank S. OC-1040: Computer aided brachytherapy: assisting the practice of prostate brachytherapy with machine learning. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01977-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanders J, Frank S, Venkatesan A, Bathala T, Tang C, Kudchadker R, Bruno T, Pagel M, Ma J. OC-1034: Parallel imaging compressed sensing for prostate MRI without an endorectal coil: a prospective study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01973-3] [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: 10/22/2022]
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Hockman L, Bailey J, Sanders J, Muzzey C, Wakefield M, Christensen A, Murray K. A Qualitative Assessment of Patient Satisfaction with Radical Cystectomy for Bladder Cancer at a Single Institution: How Can We Improve? Res Rep Urol 2020; 12:447-453. [PMID: 33117744 PMCID: PMC7550214 DOI: 10.2147/rru.s269405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made. Materials and Methods We developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction. Results We identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience. Conclusion Although the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.
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Affiliation(s)
- Lukas Hockman
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Bailey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Sanders
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Catherine Muzzey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Mark Wakefield
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Amy Christensen
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Katie Murray
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Turok D, Gero A, Simmons R, Kaiser J, Stoddard G, Sexsmith C, Gawron L, Sanders J. O4 The levonorgestrel vs. copper intrauterine device for emergency contraception: A non-inferiority randomized controlled trial. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.012] [Citation(s) in RCA: 1] [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: 10/23/2022]
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Self JE, Dunn MJ, Erichsen JT, Gottlob I, Griffiths HJ, Harris C, Lee H, Owen J, Sanders J, Shawkat F, Theodorou M, Whittle JP. Management of nystagmus in children: a review of the literature and current practice in UK specialist services. Eye (Lond) 2020; 34:1515-1534. [PMID: 31919431 PMCID: PMC7608566 DOI: 10.1038/s41433-019-0741-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 11/09/2022] Open
Abstract
Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.
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Affiliation(s)
- J E Self
- University Hospital Southampton, Southampton, UK.
- Clinical and Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK.
| | - M J Dunn
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - J T Erichsen
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - I Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - H J Griffiths
- Division of Ophthalmology and Orthoptics, Health Sciences School, University of Sheffield, Sheffield, UK
| | - C Harris
- Royal Eye Infirmary, Derriford Hospital, Plymouth, UK
| | - H Lee
- University Hospital Southampton, Southampton, UK
- Clinical and Experimental Sciences, School of Medicine, University of Southampton, Southampton, UK
| | - J Owen
- Royal Eye Infirmary, Derriford Hospital, Plymouth, UK
| | - J Sanders
- Patient Representative, Plymouth, UK
| | - F Shawkat
- University Hospital Southampton, Southampton, UK
| | - M Theodorou
- Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital, London, UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - J P Whittle
- Eye Department, Sheffield Children's Hospital, Sheffield, UK
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Williams A, Shigrekar A, Galbreth G, Sanders J. Application and testing of a triple bubbler sensor in molten salts. Nuclear Engineering and Technology 2020. [DOI: 10.1016/j.net.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Furmaniak J, Sanders J, Sanders P, Miller-Gallacher J, Ryder MM, Rees Smith B. Practical applications of studies on the TSH receptor and TSH receptor autoantibodies. Endocrine 2020; 68:261-264. [PMID: 32472423 PMCID: PMC7266850 DOI: 10.1007/s12020-019-02180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/26/2019] [Indexed: 10/28/2022]
Abstract
Studies on the TSH receptor (TSHR) have numerous practical applications in vitro and in vivo. For example human monoclonal autoantibodies (MAbs) to the TSHR are useful reagents for in vitro diagnostics. Measurement of TSHR autoantibodies (TRAbs) is helpful in diagnosis and management of autoimmune thyroid disease. Currently available highly sensitive and specific assays to measure TRAbs use the human TSHR MAb M22 instead of the TSH. Furthermore, preparations of the human TSHR MAb M22 are useful as the World Health Organisation International Standard for thyroid stimulating antibody and for calibration of the assays for measuring TRAbs. Preparations of thermostabilised TSHR extracellular domain have recently become available and this is likely to have an impact on improvements in specificity testing for TRAb assays. In addition the stable TSHR preparations have practical application for specific immunoadsorption of patient serum TRAbs. Human TSHR MAbs also have promising prospects as new therapeutics. Autoantibodies with TSHR antagonistic activities are "natural" inhibitors of TSHR stimulation and are expected to be helpful in controlling TSHR activity in patients with Graves' disease, Graves' ophthalmopathy and thyroid cancer.
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Affiliation(s)
| | - J Sanders
- FIRS Laboratories, RSR Ltd, Cardiff, UK
| | - P Sanders
- FIRS Laboratories, RSR Ltd, Cardiff, UK
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Lugg-Widger F, Robling M, Lau M, Paranjothy S, Pell J, Sanders J, White J, Cannings-John R. Evaluation of the effectiveness of the Family Nurse Partnership home visiting programme in first time young mothers in Scotland: a protocol for a natural experiment. Int J Popul Data Sci 2020; 5:1154. [PMID: 32935057 PMCID: PMC7473263 DOI: 10.23889/ijpds.v5i1.1154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Introduction Individual, social and economic circumstances faced by young mothers (19 years or under) can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which aims to improve prenatal health behaviours, birth outcomes, child development and health outcomes, and maternal life course. Establishing evidence of effectiveness beyond the original US setting is important to understand where further adaptation is required within a country specific context. Objective This study will form one strand of the Scottish Government’s plan to evaluate the effectiveness of FNP as compared to usual care for mothers and their children in Scotland and will focus only on outcomes that can be identified using routine administrative data systems. Methods This study is a natural experiment with a case-cohort design using linked anonymised routine health, educational and social care data. Cases will be women enrolled as FNP Clients in ten NHS Health Boards in Scotland and Controls will be women who met FNP eligibility criteria but were pregnant at a time when the programme was not recruiting. Outcomes are mapped to the Scottish FNP logic model. All comparative analyses will be pre-specified, conducted on an intention to treat basis and will use multilevel regression models to compare outcomes between groups. Discussion The study protocol is based upon the specification of FNP commissioned by the Scottish Government. This study design is novel for the evaluation of the FNP/NFP programmes which are primarily evaluated with an RCT. Outcomes included within the study have been selected on the basis that they are outcomes FNP aims to influence and where there is routine data available to assess the outcome
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Affiliation(s)
- F Lugg-Widger
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
| | - M Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS.,Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD
| | - M Lau
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
| | - S Paranjothy
- Division of Population Medicine, Cardiff University, Cardiff, CF14 4YS
| | - J Pell
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, CF14 4XN
| | - J White
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS.,Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, CF10 3BD
| | - R Cannings-John
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
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Baltussen EJM, Brouwer de Koning SG, Sanders J, Aalbers AGJ, Kok NFM, Beets GL, Hendriks BHW, Sterenborg HJCM, Kuhlmann KFD, Ruers TJM. Tissue diagnosis during colorectal cancer surgery using optical sensing: an in vivo study. J Transl Med 2019; 17:333. [PMID: 31578153 PMCID: PMC6775650 DOI: 10.1186/s12967-019-2083-0] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/23/2019] [Indexed: 01/20/2023] Open
Abstract
Background In colorectal cancer surgery there is a delicate balance between complete removal of the tumor and sparing as much healthy tissue as possible. Especially in rectal cancer, intraoperative tissue recognition could be of great benefit in preventing positive resection margins and sparing as much healthy tissue as possible. To better guide the surgeon, we evaluated the accuracy of diffuse reflectance spectroscopy (DRS) for tissue characterization during colorectal cancer surgery and determined the added value of DRS when compared to clinical judgement. Methods DRS spectra were obtained from fat, healthy colorectal wall and tumor tissue during colorectal cancer surgery and results were compared to histopathology examination of the measurement locations. All spectra were first normalized at 800 nm, thereafter two support vector machines (SVM) were trained using a tenfold cross-validation. With the first SVM fat was separated from healthy colorectal wall and tumor tissue, the second SVM distinguished healthy colorectal wall from tumor tissue. Results Patients were included based on preoperative imaging, indicating advanced local stage colorectal cancer. Based on the measurement results of 32 patients, the classification resulted in a mean accuracy for fat, healthy colorectal wall and tumor of 0.92, 0.89 and 0.95 respectively. If the classification threshold was adjusted such that no false negatives were allowed, the percentage of false positive measurement locations by DRS was 25% compared to 69% by clinical judgement. Conclusion This study shows the potential of DRS for the use of tissue classification during colorectal cancer surgery. Especially the low false positive rate obtained for a false negative rate of zero shows the added value for the surgeons. Trail registration This trail was performed under approval from the internal review board committee (Dutch Trail Register NTR5315), registered on 04/13/2015, https://www.trialregister.nl/trial/5175.
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Affiliation(s)
- E J M Baltussen
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - S G Brouwer de Koning
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Sanders
- Department of Pathology, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A G J Aalbers
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N F M Kok
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G L Beets
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B H W Hendriks
- Department of In-body Systems, Philips Research, Eindhoven, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - H J C M Sterenborg
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - K F D Kuhlmann
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T J M Ruers
- Department of Surgery, Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty TNW, Group Nanobiophysics, Twente University, Enschede, The Netherlands
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De Boo L, Cimino-Mathews A, Lubeck Y, Daletzakis A, Opdam M, Sanders J, Hooijberg E, van Rossum A, Loncova Z, Rieder D, Trajanoski Z, Vollebergh M, Sobral-Leite M, Van de Vijver K, Broeks A, van der Wiel R, van Tinteren H, Linn S, Horlings H, Kok M. Tumour-infiltrating lymphocytes and BRCA-like status in stage III breast cancer patients treated with intensified carboplatin-based chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.063] [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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Zhou Z, Sanders J, Johnson J, Guha-Thakurta N, Chen M, Briere T, Wang Y, Son J, Li J, Ma J. Machine Learning Based Detection of Brain Cancer Metastases in MR Images for Stereotactic Radiosurgery Using Single-Shot Detectors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Crook J, Tang C, Thames H, Blanchard P, Sanders J, Ciezki J, Keyes M, Merrick G, Catton C, Raziee H, Sullivan F, Stock R, Anscher M, Frank S. A Biochemical Definition of Cure Following Brachytherapy for Prostate Cancer: A Multi-Institution International Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wastlund D, Moraitis AA, Thornton JG, Sanders J, White IR, Brocklehurst P, Smith G, Wilson E. The cost-effectiveness of universal late-pregnancy screening for macrosomia in nulliparous women: a decision analysis. BJOG 2019; 126:1243-1250. [PMID: 31066982 PMCID: PMC6771727 DOI: 10.1111/1471-0528.15809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
Objective To identify the most cost‐effective policy for detection and management of fetal macrosomia in late‐stage pregnancy. Design Health economic simulation model. Setting All English NHS antenatal services. Population Nulliparous women in the third trimester treated within the UK NHS. Methods A health economic simulation model was used to compare long‐term maternal–fetal health and cost outcomes for two detection strategies (universal ultrasound scanning at approximately 36 weeks of gestation versus selective ultrasound scanning), combined with three management strategies (planned caesarean section versus induction of labour versus expectant management) of suspected fetal macrosomia. Probabilities, costs and health outcomes were taken from literature. Main outcome measures Expected costs to the NHS and quality‐adjusted life‐years (QALYs) gained from each strategy, calculation of net benefit and hence identification of most cost‐effective strategy. Results Compared with selective ultrasound, universal ultrasound increased QALYs by 0.0038 (95% CI 0.0012–0.0076), but also costs by £123.50 (95% CI 99.6–149.9). Overall, the health gains were too small to justify the cost increase given current UK thresholds cost‐effective policy was selective ultrasound coupled with induction of labour where macrosomia was suspected. Conclusions The most cost‐effective policy for detection and management of fetal macrosomia is selective ultrasound scanning coupled with induction of labour for all suspected cases of macrosomia. Universal ultrasound scanning for macrosomia in late‐stage pregnancy is not cost‐effective. Tweetable abstract Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted. Universal late‐pregnancy ultrasound screening for fetal macrosomia is not warranted.
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Affiliation(s)
- D Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - A A Moraitis
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - J G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - I R White
- MRC Clinical Trials Unit, University College London, London, UK
| | - P Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Ecf Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.,Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Sanders J, Channon S, Gobat N, Bennert K, Addison K, Robling M. Implementation of the Family Nurse Partnership programme in England: experiences of key health professionals explored through trial parallel process evaluation. BMC Nurs 2019; 18:13. [PMID: 30976196 PMCID: PMC6444391 DOI: 10.1186/s12912-019-0338-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/19/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Family Nurse Partnership (FNP) programme was introduced to support young first-time mothers. A randomised trial found FNP added little short-term benefit compared to usual care. The study included a comprehensive parallel process evaluation, including focus groups, conducted to aid understanding of the introduction of the programme into a new service and social context. The aim of the focus groups was to investigate views of key health professionals towards the integration and delivery of FNP programme in England. METHODS Focus groups were conducted separately with Family Nurses, Health Visitors and Midwives at trial sites during 2011-2012. Transcripts from audio-recordings were analysed thematically. RESULTS A total of 122 professionals participated in one of 19 focus groups. Family Nurses were confident in the effectiveness of FNP, although they experienced practical difficulties meeting programme fidelity targets and considered that programme goals did not sufficiently reflect client or community priorities. Health Visitors and Midwives regarded FNP as well-resourced and beneficial to clients, describing their own services as undervalued and struggling. They wished to work closely with Family Nurses, but felt excluded from doing so by practical barriers and programme protection. CONCLUSION FNP was described as well-resourced and delivered by highly motivated and well supported Family Nurses. FNP eligibility, content and outcomes conflicted with individual client and community priorities. These factors may have restricted the potential effectiveness of a programme developed and previously tested in a different social milieu. Building Blocks ISRCTN23019866 Registered 20/04/2009.
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Affiliation(s)
- J. Sanders
- Clinical Nursing and Midwifery, School of Healthcare Sciences, Room 1.7, Ty Dewi Sant,Heath Park, Cardiff, CF14 4XN UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS UK
| | - Nina Gobat
- Division of Population Medicine, Cardiff University, Cardiff, CF14 4YS UK
| | - Kristina Bennert
- Department of Psychology, Clinical Psychology, Bath, Somerset BA2 7AY UK
| | - Katy Addison
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS UK
| | - Mike Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS UK
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Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen KJ, ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Horlings HM, Sanders J, Levin MD, Sonke GS. Abstract P6-17-19: What to do with trastuzumab therapy after achieving radiological complete remission (rCR) in HER2+ metastatic breast cancer (MBC)? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-19] [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: 11/16/2022]
Abstract
Abstract
Intro MBC is generally considered incurable, but patients with HER2+ disease treated with trastuzumab do relatively well and some have an exceptional durable response and survive over 10 years. We analyzed the clinical-pathological characteristics associated with long-term survival in patients with HER2+ MBC treated with trastuzumab. In addition, we studied the effect of stopping trastuzumab in case of rCR.
Methods We included all patients with HER2+ MBC treated with first- or second-line trastuzumab-based palliative therapy between January 2000 and December 2014 in 8 Dutch hospitals (Netherlands Cancer Institute, Erasmus Medical Center, Albert Schweitzer Hospital, Reinier de Graaf Hospital, Amphia Hospital, St. Antonius Hospital, Ikazia Hospital, Haga Hospital). Patients were identified through the Netherlands Cancer Registry and linkage with the institutes' tumor registries. Data was collected from medical records using case record forms. Primary endpoint was overall survival (OS), defined as first-date of MBC until death due to any cause. Kaplan-Meier survival estimates were calculated and multivariable Cox-regression models used to identify prognostic factors for improved survival. Time to progression (TTP) after achieving rCR for patients who continued and stopped trastuzumab and breast cancer specific survival were secondary outcomes.
Results We included 744 patients (median age 53, range 24-87). Median follow-up (FU) was 109 months (range 0-178). Clinical factors associated with improved survival in multivariable analyses were single-organ metastases, ER-positivity, no skin or liver metastases, no prior trastuzumab, local therapy of metastatic disease and achievement of rCR. In line with our first single center analyses1, achievement of rCR was the strongest predictor of improved survival (multivariable HR 0.30, 95%CI 0.20-0.46). RCR was observed in 71 patients (10%), of whom 60 had been treated with trastuzumab and chemotherapy, 9 with trastuzumab and hormonal therapy, and 2 with hormonal therapy. In patients with rCR the estimated 10-year OS was 53% versus 7% in patients who did not achieve rCR (p<0.001).
Thirty patients stopped trastuzumab after achieving rCR. Median time between onset of rCR and last gift of trastuzumab in these patients was 6 months (0-132). Twenty-one patients (70%) remain in complete remission after a median FU of 75 months (range 54-90) since onset of rCR. Nine patients experienced disease progression after a median time of 14 months (range 9-62) since last gift of trastuzumab. Of these, 8 patients died due to MBC and one again achieved an ongoing rCR. Out of 39 patients who continued trastuzumab after achieving rCR, 12 are in ongoing remission after a median FU of 71 months (range 51-91). In this group median TTP was 14 months (range 5-23).
Conclusion Achieving rCR is strongly associated with long-term survival in patients with HER2+ MBC. Seventy percent of patients who stopped trastuzumab after achieving rCR remained in remission, suggesting this can be an attractive approach in selected patients. External validation of these findings is required, however, as well as additional analyses to characterize the patients -and their tumors- who achieved rCR.
1 Steenbruggen, CancerRes 2017
Citation Format: Steenbruggen TG, Bouwer NI, Smorenburg CH, Rier HN, Jager A, Beelen KJ, ten Tije AJ, de Jong PC, Drooger JC, Holterhues C, Horlings HM, Sanders J, Levin M-D, Sonke GS. What to do with trastuzumab therapy after achieving radiological complete remission (rCR) in HER2+ metastatic breast cancer (MBC)? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-19.
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Affiliation(s)
- TG Steenbruggen
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - NI Bouwer
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - CH Smorenburg
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - HN Rier
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - A Jager
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - KJ Beelen
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - AJ ten Tije
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - PC de Jong
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - JC Drooger
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - C Holterhues
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - HM Horlings
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - J Sanders
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - M-D Levin
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
| | - GS Sonke
- The Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands; Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, Netherlands; Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, Netherlands; Reinier de Graaf Hospital, Delft, Zuid-Holland, Netherlands; Amphia Hospital, Breda, Brabant, Netherlands; Sint Antonius Hospital, Utrecht, Netherlands; Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands; Haga Hospital, The Hague, Zuid-Holland, Netherlands
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Baltussen L, Kok E, Brouwer de Koning S, Sanders J, Aalbers A, Kok N, Beets G, Flohil C, Bruin S, Kuhlmann K, Sterenborg H, Ruers T. Hyperspectral imaging for real-time tissue classification during colorectal cancer surgery. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.194] [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: 11/29/2022] Open
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Ubink I, van Eden WJ, Snaebjornsson P, Kok NFM, van Kuik J, van Grevenstein WMU, Laclé MM, Sanders J, Fijneman RJA, Elias SG, Borel Rinkes IHM, Aalbers AGJ, Kranenburg O. Histopathological and molecular classification of colorectal cancer and corresponding peritoneal metastases. Br J Surg 2018; 105:e204-e211. [PMID: 29341165 DOI: 10.1002/bjs.10788] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/19/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with colorectal peritoneal carcinomatosis have a very poor prognosis. The recently developed consensus molecular subtype (CMS) classification of primary colorectal cancer categorizes tumours into four robust subtypes, which could guide subtype-targeted therapy. CMS4, also known as the mesenchymal subtype, has the greatest propensity to form distant metastases. CMS4 status and histopathological features of colorectal peritoneal carcinomatosis were investigated in this study. METHODS Fresh-frozen tissue samples from primary colorectal cancer and paired peritoneal metastases from patients who underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy were collected. Histopathological features were analysed, and a reverse transcriptase-quantitative PCR test was used to assess CMS4 status of all collected lesions. RESULTS Colorectal peritoneal carcinomatosis was associated with adverse histopathological characteristics, including a high percentage of stroma in both primary tumours and metastases, and poor differentiation grade and high-grade tumour budding in primary tumours. Furthermore, CMS4 was significantly enriched in primary tumours with peritoneal metastases, compared with unselected stage I-IV tumours (60 per cent (12 of 20) versus 23 per cent; P = 0.002). The majority of peritoneal metastases (75 per cent, 21 of 28) were also classified as CMS4. Considerable intrapatient subtype heterogeneity was observed. Notably, 15 of 16 patients with paired tumours had at least one CMS4-positive tumour location. CONCLUSION Significant enrichment for CMS4 was observed in colorectal peritoneal carcinomatosis. Surgical relevance Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival of selected patients with colorectal peritoneal carcinomatosis, but recurrence is common. Histopathological and molecular analysis of colorectal peritoneal carcinomatosis could provide clues for development of novel therapies. In this study, colorectal peritoneal carcinomatosis was found to be enriched for tumours with high stromal content and CMS4-positive status. To further improve prognosis for patients with colorectal peritoneal carcinomatosis, therapies that target tumour-stroma interaction could be added to CRS-HIPEC.
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Affiliation(s)
- I Ubink
- Department of Surgical Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - W J van Eden
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J van Kuik
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - W M U van Grevenstein
- Department of Surgical Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M M Laclé
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Sanders
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R J A Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S G Elias
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgical Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A G J Aalbers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - O Kranenburg
- Department of Surgical Oncology, Cancer Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Biomedical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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50
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Geist C, Sanders J, Myers K, Simmons R, Everett B, Gawron L, Turok D. Changing lives, dynamic plans? 12-month shifts in pregnancy intentions. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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