1
|
Kolbe S, Garcia L, Yu N, Boonstra F, Clough M, Sinclair B, White O, van der Walt A, Butzkueven H, Fielding J, Law M. Lesion Volume in Relapsing Multiple Sclerosis is Associated with Perivascular Space Enlargement at the Level of the Basal Ganglia. AJNR Am J Neuroradiol 2022; 43:238-244. [PMID: 35121585 PMCID: PMC8985682 DOI: 10.3174/ajnr.a7398] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Perivascular spaces surround the blood vessels of the brain and are involved in neuroimmune functions and clearance of metabolites via the glymphatic system of the brain. Enlarged perivascular spaces could be a marker of dysfunction in these processes and, therefore, are highly relevant to monitoring disease activity in MS. This study aimed to compare the number of enlarged perivascular spaces in people with relapsing MS with MR imaging markers of inflammation and brain atrophy. MATERIALS AND METHODS Fifty-nine patients (18 with clinically isolated syndrome, 22 with early and 19 with late relapsing-remitting MS) were scanned longitudinally (mean follow-up duration = 19.6 [SD, 0.5] months) using T2-weighted, T1-weighted, and FLAIR MR imaging. Two expert raters identified and counted enlarged perivascular spaces on T2-weighted MR images from 3 ROIs (the centrum semiovale, basal ganglia, and midbrain). Baseline and change with time in the number of enlarged perivascular spaces were correlated with demographics and lesion and brain volumes. RESULTS Late relapsing-remitting MS had a greater average number of enlarged perivascular spaces at baseline at the level of the basal ganglia (72.3) compared with early relapsing-remitting MS (60.5) and clinically isolated syndrome (54.7) (F = 3.4, P = .042), and this finding correlated with lesion volume (R = 0.44, P = .0004) but not brain atrophy (R = -0.16). Enlarged perivascular spaces increased in number with time in all regions, and the rate of increase did not differ among clinical groups. CONCLUSIONS Enlarged perivascular spaces at the level of the basal ganglia are associated with greater neuroinflammatory burden, and the rate of enlargement appears constant in patients with relapsing-remitting disease phenotypes.
Collapse
Affiliation(s)
- S.C. Kolbe
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Departments of Radiology (S.C.K., M.L.)
| | - L.M. Garcia
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - N. Yu
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Department of Neurology (N.Y.), The Nanjing Brain Hospital Affiliated with Nanjing Medical University, Nanjing, Jiangsu, China
| | - F.M. Boonstra
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - M. Clough
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - B. Sinclair
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - O. White
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - A. van der Walt
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - H. Butzkueven
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Neurology (O.W., A.v.d.W., H.B.), Alfred Hospital, Melbourne, Victoria, Australia
| | - J. Fielding
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia
| | - M. Law
- From the Department of Neuroscience (S.C.K., L.M.G., N.Y., F.M.B., M.C., B.S., O.W., A.v.d.W., H.B., J.F., M.L.) Monash University, Melbourne, Victoria, Australia,Departments of Radiology (S.C.K., M.L.)
| |
Collapse
|
2
|
Clough M, Dobbing J, Stankovich J, Ternes A, Kolbe S, White OB, Fielding J. Cognitive processing speed deficits in multiple sclerosis: Dissociating sensorial and motor processing changes from cognitive processing speed. Mult Scler Relat Disord 2019; 38:101522. [PMID: 31785491 DOI: 10.1016/j.msard.2019.101522] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The assessment of cognitive information processing speed (IPS) is complicated in MS, with altered performance on tests such as the Symbol Digit Modalities Test (SDMT) potentially representing changes not only within cognitive networks but in the initial sensorial transmission of information to cognitive networks, and/or efferent transmission of the motor response. OBJECTIVE We aimed to isolate and characterise cognitive IPS deficits in MS using ocular motor tasks; a prosaccade task (used to assess and control for sensorial and motor IPS) which was then used to adjust performance on the Simon task (cognitive IPS). METHODS All participants (22 MS patients with early disease, 22 healthy controls) completed the ocular motor tasks and the SDMT. The Simon task assessed cognitive IPS by manipulating the relationship between a stimulus location and its associated response direction. Two trial types were interleaved: (1) congruent, where stimulus location = response direction; or (2) incongruent, where stimulus location ≠ response direction. RESULTS MS patients did not perform differently to controls on the SDMT. For OM tasks, when sensorial and motor IPS was controlled, MS patients had significantly slower cognitive IPS (incongruent trials only) and poorer conflict resolution. SDMT performance did not correlate with slower cognitive IPS in MS patients, highlighting the limitation of using SDMT performance to interpret cognitive IPS changes in patients with MS. CONCLUSION Cognitive IPS deficits in MS patients are dissociable from changes in other processing stages, manifesting as impaired conflict resolution between automatic and non-automatic processes. Importantly, these results raise concerns about the SDMT as an accurate measure of cognitive IPS in MS.
Collapse
Affiliation(s)
- M Clough
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - J Dobbing
- Department of Medicine, University of Melbourne, Melbourne, VIC, 3050, Australia
| | - J Stankovich
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Commercial Rd, Melbourne, VIC, 3004, Australia
| | - A Ternes
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| | - S Kolbe
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Commercial Rd, Melbourne, VIC, 3004, Australia
| | - O B White
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Commercial Rd, Melbourne, VIC, 3004, Australia
| | - J Fielding
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Centre, Commercial Rd, Melbourne, VIC, 3004, Australia; School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC, 3800, Australia
| |
Collapse
|
3
|
Katz DL, Karlsen MC, Chung M, Shams-White MM, Green LW, Fielding J, Saito A, Willett W. Hierarchies of evidence applied to lifestyle Medicine (HEALM): introduction of a strength-of-evidence approach based on a methodological systematic review. BMC Med Res Methodol 2019; 19:178. [PMID: 31429718 PMCID: PMC6701153 DOI: 10.1186/s12874-019-0811-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 04/18/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current methods for assessing strength of evidence prioritize the contributions of randomized controlled trials (RCTs). The objective of this study was to characterize strength of evidence (SOE) tools in recent use, identify their application to lifestyle interventions for improved longevity, vitality, or successful aging, and to assess implications of the findings. METHODS The search strategy was created in PubMed and modified as needed for four additional databases: Embase, AnthropologyPlus, PsycINFO, and Ageline, supplemented by manual searching. Systematic reviews and meta-analyses of intervention trials or observational studies relevant to lifestyle intervention were included if they used a specified SOE tool. Data was collected for each SOE tool. Conditions necessary for assigning the highest SOE grading and treatment of prospective cohort studies within each SOE rating framework were summarized. The expert panel convened to discuss the implications of findings for assessing evidence in the domain of lifestyle medicine. RESULTS AND CONCLUSIONS A total of 15 unique tools were identified. Ten were tools developed and used by governmental agencies or other equivalent professional bodies and were applicable in a variety of settings. Of these 10, four require consistent results from RCTs of high quality to award the highest rating of evidence. Most SOE tools include prospective cohort studies only to note their secondary contribution to overall SOE as compared to RCTs. We developed a new construct, Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM), to illustrate the feasibility of a tool based on the specific contributions of diverse research methods to understanding lifetime effects of health behaviors. Assessment of evidence relevant to lifestyle medicine requires a potential adaptation of SOE approaches when outcomes and/or exposures obviate exclusive or preferential reliance on RCTs. This systematic review was registered with the International Prospective Register of Systematic Reviews, PROSPERO [CRD42018082148].
Collapse
Affiliation(s)
- D. L. Katz
- American College of Lifestyle Medicine, PO Box 6432, Chesterfield, MO 63006 USA
- The True Health Initiative, Derby, CT USA
- Yale Griffith Prevention Research Center, 130 Division St, Derby, CT 06418 USA
| | - M. C. Karlsen
- American College of Lifestyle Medicine, PO Box 6432, Chesterfield, MO 63006 USA
- Applied Clinical Nutrition and Global Public Health Programs, University of New England, 11 Hills Beach Rd, Biddeford, ME 04005 USA
| | - M. Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - M. M. Shams-White
- Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, 4E204, Bethesda, MD 20850 USA
| | - L. W. Green
- Department of Epidemiology and Biostatistics, University of California at San Francisco School of Medicine, 550 16th Street, Second Floor, San Francisco, CA 94158 USA
| | - J. Fielding
- University of California Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095 USA
| | - A. Saito
- Brown University School of Public Health, 121 S Main St, Providence, RI 02903 USA
| | - W. Willett
- Harvard University T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| |
Collapse
|
4
|
Clough M, Foletta P, Frohman AN, Sears D, Ternes A, White OB, Fielding J. Multiple sclerosis: Executive dysfunction, task switching and the role of attention. Mult Scler J Exp Transl Clin 2018; 4:2055217318771781. [PMID: 29707228 PMCID: PMC5912274 DOI: 10.1177/2055217318771781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 01/07/2018] [Revised: 02/27/2018] [Accepted: 03/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background It has been suggested that switching ability might not be affected in multiple sclerosis (MS) as previously thought; however, whether this is true under more ‘real-world’ conditions when asymmetry in task difficulty is present has not been ascertained. Objective The objective of this paper is to examine the impact of task difficulty asymmetry on task switching ability in MS. Method An ocular motor (OM) paradigm that interleaves the simple task of looking towards a target (prosaccade, PS) with the cognitively more difficult task of looking away from a target (antisaccade, PS) was used. Two switching conditions: (1) PS switch cost, switching to a simple task from a difficult task (PS switch), relative to performing two simple tasks concurrently (PS repeat); (2) AS switch cost, switching to a difficult task from a simple task (AS switch) relative to performing two difficult tasks concurrently (AS repeat). Forty-five relapsing–remitting MS patients and 30 control individuals were compared. Results Controls and patients produced a similar magnitude PS switch cost, suggesting that task difficulty asymmetry does not detrimentally impact MS patients when transitioning from a more difficult task to a simpler task. However, MS patients alone found switching from the simpler PS trial to the more difficult AS trial easier (shorter latency and reduced error) than performing two AS trials consecutively (AS switch benefit). Further, MS patients performed significantly more errors than controls when required to repeat the same trial consecutively. Conclusion MS patients appear to find the maintenance of task-relevant processes difficult not switching per se, with deficits exacerbated under increased attentional demands.
Collapse
Affiliation(s)
- M Clough
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - P Foletta
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - A N Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, USA
| | - D Sears
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, USA
| | - A Ternes
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - O B White
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia
| | - J Fielding
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| |
Collapse
|
5
|
Scovelle A, Manousakis J, Fielding J, Drummond S, Anderson C. Age-related changes in sleep are associated with poor inhibitory control in older adults with subjective memory impairment. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Fielding J, Brantley L, Seigler N, McKie KT, Davison GW, Harris RA. Oxygen uptake kinetics and exercise capacity in children with cystic fibrosis. Pediatr Pulmonol 2015; 50:647-54. [PMID: 25847281 DOI: 10.1002/ppul.23189] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/17/2015] [Indexed: 12/16/2022]
Abstract
Exercise capacity, an objective measure of exercise intolerance, is known to predict quality of life and mortality in cystic fibrosis (CF). The mechanisms for exercise intolerance in patients with cystic fibrosis (CF), however, have yet to be fully elucidated. Accordingly, this study sought to investigate oxygen uptake kinetics and the impact of fat-free mass (FFM) on exercise capacity in young patients with CF. 16 young patients with CF (age 13 ± 4 years; 10 female) and 15 matched controls (age 14 ± 3 years; nine female) participated. Pulmonary function and a maximal exercise test on a cycle ergometer using the Godfrey protocol were performed. Exercise capacity (VO2 peak), VO2 response time (VO2 RT), and functional VO2 gain (ΔVO2 /ΔWR) were all determined. Lung function was the only demographic parameter significantly lower (P < 0.05) in CF compared to controls. Exercise capacity was lower in CF (P < 0.014) only when VO2 peak was normalized for FFM (43.5 ± 7.7 vs. 50.6 ± 7.4 ml/kg-FFM/min) or expressed as % predicted (70.1 ± 14.3 vs. 85.4 ± 16.0%). The VO2 RT was slower (36.1 ± 15.1 vs. 25.0 ± 12.4 sec; P = 0.03) and the ΔVO2 /ΔWR slope was lower (8.4 ± 3 ml/min/watt vs. 10.1 ± 1.4 ml/min/watt; P = 0.02) in patients compared to controls, respectively. In conclusion, a delayed VO2 response time coupled with the lower functional VO2 gain (ΔVO2 /ΔWR) suggest that young patients with CF have impairment in oxygen transport and oxygen utilization by the muscles. These data in addition to differences in VO2 peak normalized for FFM provide some insight that muscle mass and muscle metabolism contribute to exercise intolerance in CF.
Collapse
Affiliation(s)
- Jeremy Fielding
- Division of Clinical Translational Science, Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, 30912, Georgia
| | - Lucy Brantley
- Division of Clinical Translational Science, Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, 30912, Georgia
| | - Nichole Seigler
- Division of Clinical Translational Science, Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, 30912, Georgia
| | - Katie T McKie
- Pediatric Pulmonology, Georgia Regents University, Augusta, 30912, Georgia
| | - Gareth W Davison
- Sport and Exercise Science Research Institute, University of Ulster, Jordanstown, Northern Ireland, UK
| | - Ryan A Harris
- Division of Clinical Translational Science, Georgia Prevention Institute, Department of Pediatrics, Georgia Regents University, Augusta, 30912, Georgia.,Sport and Exercise Science Research Institute, University of Ulster, Jordanstown, Northern Ireland, UK
| |
Collapse
|
7
|
Kraan CM, Hocking DR, Bradshaw JL, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Fielding J, Trollor J, Cohen J, Cornish KM. Symbolic sequence learning is associated with cognitive-affective profiles in female FMR1 premutation carriers. Genes Brain Behav 2014; 13:385-93. [PMID: 24521091 DOI: 10.1111/gbb.12122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/08/2014] [Accepted: 02/05/2014] [Indexed: 01/30/2023]
Abstract
This study examines implicit sequence learning impairments that may indicate at-risk cerebellar profiles proposed to underlie some aspects of subtle cognitive and affective dysfunctions found among female fragile X mental retardation 1 (FMR1) premutation (PM)-carriers. A total of 34 female PM-carriers and 33 age- and intelligence-matched controls completed an implicit symbolically primed serial reaction time task (SRTT) previously shown to be sensitive to cerebellar involvement. Implicit learning scores indicated a preservation of learning in both groups; however, PM-carriers demonstrated poorer learning through significantly elevated response latencies overall and at each specific block within the symbolic SRTT. Group comparisons also revealed a core deficit in response inhibition, alongside elevated inattentive symptoms in female PM-carriers. Finally, strong and significant associations were observed between poor symbolic SRTT performance and executive, visuospatial and affective deficits in the PM-carrier group. These associations remained strong even after controlling motor speed, and were not observed in age- and intelligence quotient-matched participants. The findings implicate cerebellar non-motor networks subserving the implicit sequencing of responses in cognitive-affective phenotypes previously observed in female PM-carriers. We contend that symbolic SRTT performance may offer clinical utility in future pharmaceutical interventions in female PM-carriers.
Collapse
Affiliation(s)
- C M Kraan
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Stamataki Z, Ellis JE, Costello J, Fielding J, Burns M, Molassiotis A. Chronicles of informal caregiving in cancer: using 'The Cancer Family Caregiving Experience' model as an explanatory framework. Support Care Cancer 2014; 22:435-44. [PMID: 24091719 DOI: 10.1007/s00520-013-1994-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer caregiving has emerged as a dominant focus of research in recent years. A striking feature of this vast amount of literature is that it is static, examining certain points of the cancer trajectory, mostly the diagnosis and palliative care. Only The Cancer Caregiving Experience Model conceptualised the caregiving experience and explored the conceptual implications of cancer family caregiving research. AIM The data from this paper aim to empirically support the Cancer Caregiving Experience model, by exploring the cancer caregiving experience longitudinally. METHODS Semi-structured interviews with 53 caregivers were carried out at patient's diagnosis (T1), 3 months (T2), 6 months (T3) and 12 months (T4) post diagnosis. RESULTS Analysis of 139 interviews generated four themes that reflected a complex and dynamic process. The themes that mapped those of the model were "Primary stressors", "Secondary stressors", "Appraisal", "Cognitive-Behavioural responses" and "Health and Well Being". CONCLUSIONS The study adds empirical support to The Cancer Caregiving Experience Model and confirms that different primary and secondary stressors influence how the caregivers perceive the caregiving demands, the coping mechanisms they employ and their health and well being during the cancer trajectory. Access to support services should be offered to all the caregivers from as early as the diagnosis period and take into account their specific needs.
Collapse
Affiliation(s)
- Z Stamataki
- Christie NHS Foundation Trust, Manchester, UK,
| | | | | | | | | | | |
Collapse
|
9
|
Johnson B, Rinehart N, White O, Millist L, Fielding J. Saccade adaptation in autism and Asperger’s disorder. Neuroscience 2013; 243:76-87. [DOI: 10.1016/j.neuroscience.2013.03.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022]
|
10
|
Kurien M, Hopper AD, Barker J, Peerally MF, Fielding J, Sanders DS. Is research declining amongst gastroenterology trainees in the United Kingdom? Clin Med (Lond) 2013; 13:118-9. [PMID: 23472519 PMCID: PMC5873694 DOI: 10.7861/clinmedicine.13-1-118a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
Collapse
Affiliation(s)
- S Williams
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Communicable Disease Prevention and Control Unit, Department of Health, Victoria, Australia
| | - H Vally
- School of Public Health, La Trobe University, Melbourne, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - J Fielding
- Communicable Disease Prevention and Control Unit, Department of Health, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | - B Cowie
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| |
Collapse
|
12
|
Abstract
Several factors influence the induction of sarcomas at the site of iron carbohydrate complex injection in high dosage, in animals. 1. Species specificity: tumours have been induced in rats, mice and hamsters but not in guinea pigs or dogs; 2. dose-response: a threshold dose may be defined and the yield of tumours increases with the dose; 3. the amount of residual iron at the injection site: the effect is a local oncogenesis; 4. the latent period relative to life span in the species: the probable latent period in man has been estimated to be 15-20 years. Since iron-dextran was introduced 22 years ago, nine malignancies in man allegedly related to iron-complex injection have been described in five reports during the period 1960-1977. A critical review of the information available on these cases suggests that in one case only is the data sufficiencyl strong to support the probability of iron-dextran induced sarcoma in man. Soft tissue tumours of the buttock are not rare: on the basis of this single case a causal relationship in man cannot yet be made.
Collapse
|
13
|
Fielding J, Doney V. Interaction between Ferastral and plasma factors. Scand J Haematol Suppl 2009; 32:192-6. [PMID: 272028 DOI: 10.1111/j.1600-0609.1977.tb01237.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Ferastral, iron-poly (sorbitol-gluconic acid) complex, in aqueous solution is completely adsorbed by magnesium carbonate; Ferastral in serum solution is only partially adsorbed by magnesium carbonate. Adsorption by magnesium carbonate removes the fraction of Ferastral in serum solution which donates iron more readily to transferrin. It is suggested that this fraction comprises the smaller molecular species of the Ferastral complex and that these species have a faster rate of absorption from an intramuscular injection site than the larger molecular species of the iron complex preparation. These findings shed some light on the patterns of serum transferrin bound iron compared with serum Ferastral concentrations which occur with time after intramuscular Ferastral injection.
Collapse
|
14
|
Doney VJ, Speyer BE, Fielding J. The assay of iron-poly (sorbitol-gluconic acid) complex (Ferastral) and its separation from transferrin in serum. Scand J Haematol Suppl 2009; 32:207-14. [PMID: 272029 DOI: 10.1111/j.1600-0609.1977.tb01239.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A new iron-poly (sorbitol-gluconic acid) complex (Ferastral) has been studied. A method of assay is described. The iron complex may be separated from serum transferrin using a Sephadex DEAE A50 column. This binds the iron complex and elutes iron-transferrin which can then be assayed. It is shown that the assay of serum transferrin unsaturated binding capacity using excess 59FeCl2 and MgCO3 adsorption, is valid in the presence of Ferastral. Serum unsaturated iron binding capacity may therefore be used to follow the binding of Ferastral iron by transferrin. These methods may be used to follow the distribution of iron in plasma after an intramuscular injection of Ferastral.
Collapse
|
15
|
Speyer BE, Doney VJ, Fielding J. Transfer of iron from Ferastral and other organic complexes to transferrin as measured by reticulocyte uptake. Scand J Haematol Suppl 2009; 32:215-21. [PMID: 272031 DOI: 10.1111/j.1600-0609.1977.tb01240.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The transfer of iron from the iron carbohydrate complexes, Ferastral, Imferon, and Jectofer, and from ferric chloride has been studied by the effect of such transfer in reducing reticulocyte uptake of 59Fe from labelled transferrin. There are plasma factors which augment the transfer of iron from complex to transferrin. The pattern of transfer from Ferastral and from Imferon are similar: at concentration of 5000 microgram/100 ml and 1250 microgram/100 ml in plasma these complexes transfer about 0.8% and 1.7%, respectively. Jectofer transfers about four times these amounts under similar conditions. In the case of Ferastral there is evidence of an equilibrium between transferrin-bound and Ferastral-bound iron. The characteristics of Ferastral assessed in this way suggest that it may prove suitable for therapeutic use as a total dose infusion.
Collapse
|
16
|
Fielding J, Doney VJ, Speyer BE. Patterns of plasma iron fractions after intramuscular Ferastral. Scand J Haematol Suppl 2009; 32:228-35. [PMID: 272033 DOI: 10.1111/j.1600-0609.1977.tb01242.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The distribution of plasma iron fractions after intramuscular Ferastral is described for times up to eight days after injection. Transferrin-bound iron reaches a peak value in 4-8 hours and falls towards normal values while circulating iron-complex concentration remains high. The peak concentration of iron-complex occurs 8-24 hours after injection, and is virtually cleared from the circulation in 6-8 days. An approximate T 1/2 of 30 hours for plasma Ferastral is deduced from the rate of fall from peak values. UIBC values fell as transferrin-bound iron increased, but did not reach zero in any subject studied.
Collapse
|
17
|
York D, Swartz A, Johnson A, Fielding J, Phillips JD. Prenatal detection and evaluation of an extralobar pulmonary sequestration in the posterior mediastinum. Ultrasound Obstet Gynecol 2006; 27:214-6. [PMID: 16435323 DOI: 10.1002/uog.2667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Extralobar pulmonary sequestration (EPS) is a rare developmental anomaly with aberrant nonfunctioning parenchymal tissue, associated with an increased risk of perinatal morbidity and, rarely, mortality owing to possible neonatal respiratory distress. In most cases supernumerary lobes are detected as isolated intra- or extrapleural lesions with independent systemic arterial blood supply. We report an atypical case of prenatal detection and perinatal outcome of a mediastinal EPS.
Collapse
Affiliation(s)
- D York
- Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | | | | | | | | |
Collapse
|
18
|
Tfelt-Hansen P, Gøthgen I, Fielding J, Donovan R, Burrows F, Hurlow R. Ergotism. Br J Surg 2005. [DOI: 10.1002/bjs.1800671122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P Tfelt-Hansen
- Department of Neurology and, Deparment of Anaesthesiology, Rigshospitalet University Hospital, DK-2100 Copenhangen Ø, Denmark
| | - I Gøthgen
- Department of Neurology and, Deparment of Anaesthesiology, Rigshospitalet University Hospital, DK-2100 Copenhangen Ø, Denmark
| | - J Fielding
- The Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH
| | - R Donovan
- The Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH
| | - F Burrows
- The Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH
| | - R Hurlow
- The Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH
| |
Collapse
|
19
|
Fielding J. Gastric cancer resection: D1 or D2? EJC Suppl 2005. [DOI: 10.1016/s1359-6349(05)80301-5] [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: 10/25/2022] Open
|
20
|
Abstract
We describe a rare neurogenic tumour presenting as a pilonidal sinus. This case illustrates the pitfalls associated with the management of a commonly occurring surgical condition. Pilonidal sinuses are often the province of trainee surgeons and while ependymomas are rare, this example emphasises the need to send the pilonidal sinus tract for histological examination.
Collapse
Affiliation(s)
- S Barton
- Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
| | | | | |
Collapse
|
21
|
Gilliam AD, Watson SA, Henwood M, McKenzie AJ, Humphreys JE, Elder J, Iftikhar SY, Welch N, Fielding J, Broome P, Michaeli D. A phase II study of G17DT in gastric carcinoma. Eur J Surg Oncol 2004; 30:536-43. [PMID: 15135483 DOI: 10.1016/j.ejso.2004.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2004] [Indexed: 02/08/2023] Open
Abstract
PURPOSE G17DT is a gastrin immunogen, raising antibodies that blockade gastrin-stimulated growth. The aim of the study was to characterise antibody response and assess safety and tolerability of G17DT given to patients with gastric cancer. EXPERIMENTAL DESIGN G17DT was administered to 52 patients with gastric adenocarcinoma at weeks 0, 2 and 6 by intramuscular injection at doses of 10, 100 and 250 microg. Antibody levels were measured by an ELISA assay. A radioligand displacement assay determined the ability of G17DT-immunised patients' sera to inhibit binding of 125IG17 to cholecystokinin (CCK)-2 receptors. RESULTS By week 12 of the study, 6/12 evaluable stage I-III patients achieved an antibody response in the 10 microg group, 7/11 in the 100 microg group, and 11/12 in the 250 microg group. Stage IV patients dosed at 250 microg achieved a similar response rate to stage I-III patients dosed at 10 or 100 microg. G17DT was well tolerated in 47/52 patients. Two patients suffered significant adverse reactions including injection site pain and abscess. G17DT antibodies displaced iodinated gastrin from CCK-2 receptors, with the level of displacement correlating with antibody titre. CONCLUSIONS G17DT immunisation is a well-tolerated method of raising functional antibodies to 17 amino acid gastrin forms in patients with gastric carcinomas.
Collapse
Affiliation(s)
- A D Gilliam
- Academic Unit of Cancer Studies, D Floor, West Block, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
The majority of local health departments perform routine restaurant inspections. In Los Angeles County (LAC), California, approximately $10 million/year is spent on restaurant inspections. However, data are limited as to whether or not certain characteristics of restaurants make them more likely to be associated with foodborne incident reports. We used data from the LAC Environmental Health Management Information System (EHMIS), which records the results of all routine restaurant inspections as well as data regarding all consumer-generated foodborne incidents that led to a special restaurant inspection by a sanitarian (investigated foodborne incidents [IFBIs]). We analyzed a cohort of 10,267 restaurants inspected from 1 July 1997 to 15 November 1997. We defined a "case restaurant" as any restaurant with a routine inspection from 1 July 1997 to 15 November 1997 and a subsequent IFBI from 1 July 1997 to 30 June 1998. Noncase restaurants did not have an IFBI from I July 1997 to 30 June 1998. We looked for specific characteristics of restaurants that might be associated with the restaurant subsequently having an IFBI, including the size of restaurant (assessed by number of seats), any previous IFBIs, the overall inspection score, and a set of 38 violation codes. We identified 158 case restaurants and 10,109 noncase restaurants. In univariate analysis, middle-sized restaurants (61 to 150 seats; n = 1,681) were 2.8 times (95% confidence interval [CI] = 2.0 to 4.0) and large restaurants (>150 seats; n = 621) were 4.6 times (95% CI = 3.0 to 7.0) more likely than small restaurants (< or =60 seats; n = 7,965) to become case restaurants. In addition, the likelihood of a restaurant becoming a case restaurant increased as the number of IFBIs in the prior year increased (chi2 for linear trend, P value = 0.0005). Other factors significantly associated with the occurrence of an IFBI included a lower overall inspection score, the incorrect storage of food, the reuse of food, the lack of employee hand washing, the lack of thermometers, and the presence of any food protection violation. In multivariate analysis, the size of restaurant, the incorrect storage of food, the reuse of food, and the presence of any food protection violation remained significant predictors for becoming a case restaurant. Our data suggest that routine restaurant inspections should concentrate on those establishments that have a large seating capacity or a poor inspection history. Evaluation of inspection data bases in individual local health departments and translation of those findings into inspection guidelines could lead to an increased efficiency and perhaps cost-effectiveness of local inspection programs.
Collapse
Affiliation(s)
- U Buchholz
- Los Angeles County Department of Health Services, Acute Communicable Disease Control, California 90012, USA.
| | | | | | | | | |
Collapse
|
23
|
Jethwa P, Keogh A, Young I, Stezhka L, Hallissey M, Fielding J. Moynihan 06. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.15_6.x] [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: 11/20/2022]
|
24
|
Fielding J, Weeden S. Patient survival after D1 and D2 resections for gastric cancer: long-term results of MRC randomized surgical trial. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
25
|
Fielding J, Long MB, Fielding G, Komiyama M. Systematic errors in optical-flow velocimetry for turbulent flows and flames. Appl Opt 2001; 40:757-764. [PMID: 18357055 DOI: 10.1364/ao.40.000757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Optical-flow (OF) velocimetry is based on extracting velocity information from two-dimensional scalar images and represents an unseeded alternative to particle-image velocimetry in turbulent flows. The performance of the technique is examined by direct comparison with simultaneous particle-image velocimetry in both an isothermal turbulent flow and a turbulent flame by use of acetone-OH laser-induced fluorescence. Two representative region-based correlation OF algorithms are applied to assess the general accuracy of the technique. Systematic discrepancies between particle-imaging velocimetry and OF velocimetry are identified with increasing distance from the center line, indicating potential limitations of the current OF techniques. Directional errors are present at all radial positions, with differences in excess of 10 degrees being typical. An experimental measurement setup is described that allows the simultaneous measurement of Mie scattering from seed particles and laser-induced fluorescence on the same CCD camera at two distinct times for validation studies.
Collapse
|
26
|
Walsh KT, Fielding J, Long MB. Effect of light-collection geometry on reconstruction errors in Abel inversions. Opt Lett 2000; 25:457-459. [PMID: 18064078 DOI: 10.1364/ol.25.000457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Abel inversion, used to reconstruct axisymmetric radial profiles from line-of-sight intensity measurements, is increasingly used to make spatially resolved combustion measurements. An Abel deconvolution is valid only when incoming rays are parallel, whereas most practical optical setups used for emission imaging consist of single-lens and multilens systems that collect light in a cone, over a nonzero solid angle. A ray-tracing simulation was performed to aid in understanding how optical collection geometry affects measured intensity signals and the resultant reconstructed emissivity profiles. Simulation results are compared with emission tomography measurements performed on an axisymmetric laminar diffusion flame.
Collapse
|
27
|
Anderson L, Fullilove M, Scrimshaw S, Fielding J, Normand J, Zaza S, Wright-DeAguero L, Higgins D. A framework for evidenced-based reviews of interventions for supportive social environments. Ann N Y Acad Sci 2000; 896:487-9. [PMID: 10681958 DOI: 10.1111/j.1749-6632.1999.tb08177.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Carande-Kulis VG, Maciosek MV, Briss PA, Teutsch SM, Zaza S, Truman BI, Messonnier ML, Pappaioanou M, Harris JR, Fielding J. Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med 2000; 18:75-91. [PMID: 10806980 DOI: 10.1016/s0749-3797(99)00120-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This paper describes the methods used in the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) for conducting systematic reviews of economic evaluations across community health-promotion and disease-prevention interventions. The lack of standardized methods to improve the comparability of results from economic evaluations has hampered the use of data on costs and financial benefits in evidence-based reviews of effectiveness. The methods and instruments developed for the Guide provide an explicit and systematic approach for abstracting economic evaluation data and increase the usefulness of economic information for policy making in health care and public health. METHODS The following steps were taken for systematic reviews of economic evaluations: (1) systematic searches were conducted; (2) studies using economic analytic methods, such as cost analysis or cost-effectiveness, cost-benefit or cost-utility analysis, were selected according to explicit inclusion criteria; (3) economic data were abstracted and adjusted using a standardized abstraction form; and (4) adjusted summary measures were listed in summary tables. RESULTS These methods were used in a review of 10 interventions designed to improve vaccination coverage in children, adolescents and adults. Ten average costs and 14 cost-effectiveness ratios were abstracted or calculated from data reported in 24 studies and expressed in 1997 USD. The types of costs included in the analysis and intervention definitions varied extensively. Gaps in data were found for many interventions.
Collapse
Affiliation(s)
- V G Carande-Kulis
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30341, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
The UK Medical Research Council (MRC) randomized trial of gastric surgery, ST01, compared conventional (D1) with radical (D2) surgery. Sample size estimation was based upon the consensus opinion of the surgical members of the design team, which suggested that a change in 5-year survival from 20% (D1) to 34% (D2) could be realistic and medically important. On the basis of these survival rates, the sample size for the trial was 400 patients. However, this trial was exceptional in the way that a survey of surgeons' opinions was made at the start of the trial, in 1986, and again before results were analysed but after termination of the trial in 1994. At the initial survey, the three surgeons from the trial steering committee and 23 other surgeons experienced in treating gastric carcinoma were given detailed questionnaires. They were asked about the expected survival rate in the D1 group, anticipated difference in survival from D2 surgery, and what difference would be medically important and influence future treatment of patients. The consensus opinion of those surveyed was that there might be a survival improvement of 9.4%. In 1994, prior to closure of the trial, and before any survival information was disclosed, the survey was repeated with 21 of the original 26 surgeons. At this second survey, the opinion of the trial steering committee was that 9.5% difference was more realistic. This was in accord with the opinion of the larger group, which remained little changed since 1986. The baseline 5-year D1 survival was thought likely to be about 32%, which corresponded closely to the actual survival of recruited patients. Revised sample size calculations suggested that, on the basis of these more recent opinions, between 800 and 1200 patients would have been required. Both surveys assessed the level of treatment benefit that was deemed to be sufficient for causing surgeons to change their practice. This showed that the 13% difference in survival used as the study target was clinically relevant, but also indicated that many clinicians would remain unwilling to change their practice if the difference is only 9.5%. The experience of this carefully designed trial illustrates the problems of designing long-term, randomized trials. It raises interesting questions about the common practice of basing sample size estimates upon the beliefs of a trial design committee that may include a number of enthusiasts for the trial treatment. If their opinion of anticipated effect sizes drives the design of the trial, rather than the opinion of a larger community of experts that includes sceptics as well as enthusiasts, there is likely to be a serious miscalculation of sample size requirements.
Collapse
Affiliation(s)
- P M Fayers
- Cancer Division, MRC Clinical Trials Unit, London, UK.
| | | | | | | | | | | |
Collapse
|
30
|
Truman BI, Smith-Akin CK, Hinman AR, Gebbie KM, Brownson R, Novick LF, Lawrence RS, Pappaioanou M, Fielding J, Evans CA, Guerra FA, Vogel-Taylor M, Mahan CS, Fullilove M, Zaza S. Developing the Guide to Community Preventive Services--overview and rationale. The Task Force on Community Preventive Services. Am J Prev Med 2000; 18:18-26. [PMID: 10806976 DOI: 10.1016/s0749-3797(99)00124-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
When the GUIDE TO COMMUNITY PREVENTIVE SERVICES: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will make recommendations regarding public health interventions to reduce illness, disability, premature death, and environmental hazards that impair community health and quality of life. The Guide is being developed under the guidance of the Task Force on Community Preventive Services (the Task Force)-a 15-member, nonfederal, independent panel of experts. Subject matter experts, methodologists, and scientific staff are supporting the Task Force in using explicit rules to conduct systematic literature reviews of evidence of effectiveness, economic efficiency, and feasibility on which to base recommendations for community action. Contributors to the Guide are building on the experience of others to confront methodologic challenges unique to the assessment of complex multicomponent intervention studies with nonexperimental or nonrandomized designs and diverse measures of outcome and effectiveness. Persons who plan, fund, and implement population-based services and policies to improve health at the state and local levels are invited to scrutinize the work in progress and to communicate with contributors. When the Guide is complete, readers are encouraged to consider critically the value and relevance of its contents, the implementation of interventions the Task Force recommends, the abandonment of interventions the Task Force does not recommend, and the need for rigorous evaluation of the benefits and harms of promising interventions of unknown effectiveness.
Collapse
Affiliation(s)
- B I Truman
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Briss PA, Zaza S, Pappaioanou M, Fielding J, Wright-De Agüero L, Truman BI, Hopkins DP, Mullen PD, Thompson RS, Woolf SH, Carande-Kulis VG, Anderson L, Hinman AR, McQueen DV, Teutsch SM, Harris JR. Developing an evidence-based Guide to Community Preventive Services--methods. The Task Force on Community Preventive Services. Am J Prev Med 2000; 18:35-43. [PMID: 10806978 DOI: 10.1016/s0749-3797(99)00119-1] [Citation(s) in RCA: 411] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Systematic reviews and evidence-based recommendations are increasingly important for decision making in health and medicine. Over the past 20 years, information on the science of synthesizing research results has exploded. However, some approaches to systematic reviews of the effectiveness of clinical preventive services and medical care may be less appropriate for evaluating population-based interventions. Furthermore, methods for linking evidence to recommendations are less well developed than methods for synthesizing evidence. The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (the Guide) will evaluate and make recommendations on population-based and public health interventions. This paper provides an overview of the Guide's process to systematically review evidence and translate that evidence into recommendations. The Guide reviews evidence on effectiveness, the applicability of effectiveness data, (i.e., the extent to which available effectiveness data is thought to apply to additional populations and settings), the intervention's other effects (i.e., important side effects), economic impact, and barriers to implementation of interventions. The steps for obtaining and evaluating evidence into recommendations involve: (1) forming multidisciplinary chapter development teams, (2) developing a conceptual approach to organizing, grouping, selecting and evaluating the interventions in each chapter; (3) selecting interventions to be evaluated; (4) searching for and retrieving evidence; (5) assessing the quality of and summarizing the body of evidence of effectiveness; (6) translating the body of evidence of effectiveness into recommendations; (7) considering information on evidence other than effectiveness; and (8) identifying and summarizing research gaps. Systematic reviews of and evidence-based recommendations for population-health interventions are challenging and methods will continue to evolve. However, using an evidence-based approach to identify and recommend effective interventions directed at specific public health goals may reduce errors in how information is collected and interpreted, identify important gaps in current knowledge thus guiding further research, and enhance the Guide users' ability to assess whether recommendations are valid and prudent from their own perspectives. Over time, all of these advantages could help to increase agreement regarding appropriate community health strategies and help to increase their implementation.
Collapse
Affiliation(s)
- P A Briss
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30341, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999; 79:1522-30. [PMID: 10188901 PMCID: PMC2362742 DOI: 10.1038/sj.bjc.6690243] [Citation(s) in RCA: 982] [Impact Index Per Article: 39.3] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D2 resections that involve a radical extended regional lymphadenectomy than with the standard D1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.5 years. In this prospective trial D1 resection (removal of regional perigastric nodes) was compared with D2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes). Central randomization followed a staging laparotomy. Out of 737 patients with histologically proven gastric adenocarcinoma registered, 337 patients were ineligible by staging laparotomy because of advanced disease and 400 were randomized. The 5-year survival rates were 35% for D1 resection and 33% for D2 resection (difference -2%, 95% CI = -12%-8%). There was no difference in the overall 5-year survival between the two arms (HR = 1.10, 95% CI 0.87-1.39, where HR > 1 implies a survival benefit to D1 surgery). Survival based on death from gastric cancer as the event was similar in the D1 and D2 groups (HR = 1.05, 95% CI 0.79-1.39) as was recurrence-free survival (HR = 1.03, 95% CI 0.82-1.29). In a multivariate analysis, clinical stages II and III, old age, male sex and removal of spleen and pancreas were independently associated with poor survival. These findings indicate that the classical Japanese D2 resection offers no survival advantage over D1 surgery. However, the possibility that D2 resection without pancreatico-splenectomy may be better than standard D1 resection cannot be dismissed by the results of this trial.
Collapse
Affiliation(s)
- A Cuschieri
- University Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Reliability of nursing observations often is estimated using Cohen's kappa, a chance-adjusted measure of agreement between observer RNs. However, use of kappa as an omnibus measure sometimes can be misleading. In a study partly designed to describe the frequency and reliability of nursing diagnoses in long-term care facilities, 360 residents each were assessed independently by two registered nurses, and kappa and observed proportion of agreement were calculated as estimates of reliability. For some diagnoses we observed high proportions of agreement, yet paradoxically low kappa values. This article presents an in-depth statistical analysis to resolve this paradox. Results from our analysis also suggest means for planning improvements in the diagnostic performance of participating RNs. Consequently, our approach can be used in similar studies of diagnosis reliability to enhance nursing research, education, and practice.
Collapse
Affiliation(s)
- M Banerjee
- Department of Pathology, Wayne State University, Detroit, MI 48201, USA
| | | |
Collapse
|
34
|
Fielding J, Beaton S, Baier L, Rallis D, Ryan RM, Siripornsawan D. Generic nursing outcome objectives for use in long-term care facilities. J N Y State Nurses Assoc 1997; 28:4-7. [PMID: 9369654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Twenty-two registered nurses employed in four long-term care facilities generated data for a study about nursing diagnoses in long-term care (N = 360). Generic outcome objectives were developed as an integral part of the project. The research team also specified exceptions to the outcomes: instances where meeting outcome objectives might not be possible. The outcome objectives and exceptions for the sample's 20 most frequently occurring nursing diagnoses are presented as working statements. The authors expect that these outcome objectives and exceptions will be revised by nurses who use them in practice, basic and continuing education, and research.
Collapse
|
35
|
O'Farrell BJ, Rajan E, Albloushi SS, Courtney MG, Fielding J, Shattock AG. The reliability of saliva as a sample for the detection of hepatitis A immunoglobulins under various sampling conditions. Clin Diagn Virol 1997; 7:153-7. [PMID: 9126684 DOI: 10.1016/s0928-0197(96)00265-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Saliva is increasingly being investigated as an alternative to serum for diagnostic and epidemiological testing even though antibody levels are substantially lower in buccal cavity fluids. However, there has been little study on whether buccal cavity activity and/or the timing of saliva sampling affects the diagnostic outcome, particularly in seropositive subjects. The absence of influence by these factors may be critical to the use of saliva for pre-vaccination screening for example. OBJECTIVES The effects of eating, brushing of teeth and circadian rhythm on the measureable salivary immune status of 42 healthy individuals known to be serum and saliva anti-HAV positive were examined. STUDY DESIGN A total of 141 saliva samples obtained from the 42 healthy subjects, before and after meals, before and after brushing of teeth and at various timepoints throughout the day, were assayed for total anti-HAV using an in-house saliva based enzyme-immunoassay, previously shown to have a 100% correlation in terms of sensitivity and specificity with a serum based assay. RESULTS The results indicated that total anti-HAV titres varied according to the time of day and that eating had no significant effect on the total anti-HAV titre, but brushing of teeth did. Titres never varied to the extent that a result was falsely negative at any timepoint. CONCLUSION These results confirm the usefulness of saliva as a diagnostic sample for the detection of hepatitis A antibody, regardless of sampling times, eating or tooth-brushing.
Collapse
Affiliation(s)
- B J O'Farrell
- Department of Medical Microbiology, University College Dublin, Belfield, Ireland
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
Hepatomegaly was noted in a 63-year-old man who presented with an exacerbation of chronic pulmonary disease. A diagnosis of hepatic leiomyosarcoma was made by fine needle aspiration biopsy. Intensive investigations failed to reveal a primary source. The patient was treated conservatively.
Collapse
Affiliation(s)
- H Holloway
- Department of Medicine, Royal College of Surgeons, Dublin, Ireland
| | | | | | | |
Collapse
|
37
|
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347:995-9. [PMID: 8606613 DOI: 10.1016/s0140-6736(96)90144-0] [Citation(s) in RCA: 675] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In Japan the surgical approach to treatment of potentially curable gastric cancer, including extended lymphadenectomy, seems in retrospective surveys to give better results than the less radical procedures favoured in Western countries. There has, however, been no evidence from randomised trials that extended lymphadenectomy (D2 gastric resection) confers a survival advantage. This question was addressed in a trial involving thirty-two surgeons in Europe. METHODS In a prospective randomised controlled trial, D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). Central randomisation (200 patients in each arm) followed a staging laparotomy. FINDINGS The D2 group had greater postoperative hospital mortality (13% vs 6.5%; p=0.04 [95% Cl 9-18% for D2, 4-11% for D1] and higher overall postoperative morbidity (46% vs 28%; p<0.001); their postoperative stay was also longer. The excess postoperative morbidity and mortality in the D2 group was accounted for by distal pancreaticosplenectomy and splenectomy. In the whole group (400 patients), survival beyond three years was 30% in patients whose gastrectomy included en-bloc pancreatico-splenic resection versus 50% in the remainder. INTERPRETATION D2 gastric resections are followed by higher morbidity and mortality than D1 resections. These disadvantages are consequent upon additional pancreatectomies and distal splenectomies, and in long-term follow-up the higher mortality when the pancreas and spleen are resected may prove to nullify any survival benefit from D2 procedures.
Collapse
Affiliation(s)
- A Cuschieri
- Department of Surgery, Ninewells Hospital & Medical School, Dundee, UK
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
This paper reviews the relationship between health and inadequate employment, especially unemployment. Poor physical or mental health can lead, via poor work performance, to job loss; however, studies that control for such selection effects are still scarce except for a few health outcomes. For example, aggregate-level studies typically find a positive association between unemployment and suicide rates over time. At the individual level of analysis, panel surveys of laid-off workers tend to find increased psychiatric problems such as depression and substance abuse. Few studies have evaluated interventions to prevent or reduce the adverse health effects of job loss. There have been even fewer studies of the health effects of other types of inadequate employment such as the increasingly prevalent forms of underemployment.
Collapse
Affiliation(s)
- D Dooley
- School of Social Ecology, University of California, Irvine 92717, USA
| | | | | |
Collapse
|
39
|
Fielding J, Halfon N. Where is the health in health system reform? JAMA 1994; 272:1292-6. [PMID: 7933375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J Fielding
- Department of Health Services, School of Public Health, University of California-Los Angeles 90024-1772
| | | |
Collapse
|
40
|
Courtney MG, O'Mahoney M, Albloushi S, Sachithanandan S, Walshe J, Carmody M, Donoghue J, Parfrey N, Shattock AG, Fielding J. Hepatitis E virus antibody prevalence. Lancet 1994; 344:1166. [PMID: 7802828 DOI: 10.1016/s0140-6736(94)90678-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
41
|
Goetzel R, Sepulveda M, Knight K, Eisen M, Wade S, Wong J, Fielding J. Association of IBM's "A Plan for Life" health promotion program with changes in employees' health risk status. J Occup Med 1994; 36:1005-1009. [PMID: 7823211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To evaluate the association of participation in IBM's "A Plan for Life" program with changes in blood pressure, serum total, high-density lipoprotein, and non-high-density lipoprotein cholesterol, body mass index, and cigarette smoking, we compared changes in these measures over a 1- to 5-year period among program participants and nonparticipants initially found to be at risk. After adjustment for age, sex, time to follow-up, and baseline values, the proportion of participants no longer at high risk was significantly greater than the corresponding proportion of nonparticipants in the areas of blood pressure total and non-high-density lipoprotein cholesterol and smoking cessation.
Collapse
Affiliation(s)
- R Goetzel
- Johnson & Johnson Advanced Behavioral Technologies, Inc, Washington, DC 20008
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
This study compares hospital- (n = 67) and community-based (n = 55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self-returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well-being differed. Finally, analyses of the community data revealed that those nurses with 'flexitime' arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working 'fixed-time' schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.
Collapse
Affiliation(s)
- J Fielding
- Multi-Agency Training Services, Education Centre, De la Pole Hospital, Hull, England
| | | |
Collapse
|
43
|
Fielding J, Beaton S, Appavoo M, Baier L, Iacobacci H, Samuel A. Exploratory research as andragogic continuing education. J Nurs Staff Dev 1994; 10:27-30. [PMID: 8120643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The continuing education aspect of an exploratory research project was evaluated in terms of Knowles's learning assumptions and teaching design factors. Although most of the project's assumptions were congruent with Knowles's andragogic assumptions, the design factors were found to be more pedagogic. Using more andragogic design factors in the future would strengthen this continuing education approach.
Collapse
|
44
|
Fielding J. The doctor's aim in a pluralistic society. J R Soc Med 1993; 86:619. [PMID: 20894889 PMCID: PMC1294158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- J Fielding
- Professions for Social Responsibility, 1 North End, London NW3 7HH, UK
| |
Collapse
|
45
|
George JM, Reed TF, Ballard KA, Colin J, Fielding J. Contact with AIDS patients as a source of work-related distress: effects of organizational and social support. Acad Manage J 1993; 36:157-171. [PMID: 10123743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this study, we hypothesized that a nurse's exposure to acquired immunodeficiency syndrome (AIDS) patients as part of the work role is positively associated with distress as indexed by negative mood at work. Given this expected relation, we sought to identify factors that might reduce the negative effects of caring for AIDS patients on nurses. We predicted that both organizational and social support would moderate the relationship between extent of exposure and negative mood, with the relationship being strongest when support is low and weakest when support is high. The results of tests among a sample of 256 nurses supported all the hypotheses. We discuss implications of this study and directions for future research.
Collapse
Affiliation(s)
- J M George
- Department of Management, Texas A&M University
| | | | | | | | | |
Collapse
|
46
|
Crowley JJ, Naughton MA, King G, Maurer J, Quigley PJ, McNeill AJ, Fioretti PM, Salustri A, Pozzolu MMA, Broekema CC, Elsaid EM, Roelandt JR, Garadaha MT, Algazzar AH, Dayem H, Crean P, Cairn HAM, Blanchard DG, Rivera I, Peterson KL, Buchbinder M, Dittrick H, MacGowan GA, Herlihy M, O’Brien E, Horgan JH, Purvis JA, Roberts MJD, Cave M, Webb SW, Campbell NPS, Patterson GC, Wilson CM, Khan MM, Adgey AAJ, McClements DM, Cochrane D, Jauch W, Scriven AJ, Cobbe SM, Jauch W, Sheehan R, McAdam B, Foley D, Kinsella A, Walsh N, White U, Gearty G, Walsh M, Rush R, Cooper A, Crowe P, Young IS, Trimble ER, Adgey AAJ, Jauch W, Sheehan R, McAdam B, Sheehan R, Kinsella A, Walsh N, White U, Gearty G, Walsh M, King. G, Elgaylani N, Hamilton D, Gearty G, Walsh M, McAleer B, Ruane B, Dalton G, Varma MPS, Sheahan R, Freyne PJ, Kidney DD, Gearty GF, Ryan M, Cooke T, Robinson K, Younger K, Feely J, Graham I, Hurley J, McDonagh PM, White M, Phelan D, Luke D, McGovem E, Clements B, Ruane B, Dalton G, Varma MPS, Lonergan M, Daly L, Wood AE, Craig B, Mulholland D, Gladstone D, O’Kane H, Cleland J, Rajan L, Murphy S, Fielding J, Smith E, Pahy G, Deb B, Graham I, Campbell NPS, Elliott J, Maguire C, Wilson M, McEneaney D, Adgey J, Anderson J, Foley D, Sheahan R, Gibney M, Primrose ED, Savage JM, Cran GW, Mulholland H, Thomas PJ, Donnelly MDI, Kenny RA, Traynor G, Burges L, Wilson C, Gladstone DJ, Walsh K, Sreeram NS, Franks R, Arnold R, Gaylani NEL, White U, McAdam B, Gearty G, Walsh M, Jaison TN, Daly L, McGovern E, O’Sullivan J, Wren C, Bain HH, Hunter S, O’Donnell AF, Lonergan M, McGovern E, Jayakrishnan AG, Desai J, Forsyth AT. Irish cardiac society. Ir J Med Sci 1992. [DOI: 10.1007/bf02942092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
47
|
Fielding J. Standards of care: residential scare homes. Nurs Stand 1992; 6:55. [PMID: 1547124 DOI: 10.7748/ns.6.21.55.s59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
48
|
Fielding J, Beaton S. Quality assurance generated by professional nursing practice in long-term care. J Nurs Care Qual 1992; 6:41-5. [PMID: 1728328 DOI: 10.1097/00001786-199201000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
49
|
Crowson MC, Jewkes AJ, Acheson N, Fielding J. Haemoccult testing as an indicator of recurrent colorectal cancer: a 5-year prospective study. Eur J Surg Oncol 1991; 17:281-4. [PMID: 2044781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A prospective study was conducted to assess the value of routine haemoccult testing as an indicator of early luminal recurrence of colorectal cancer. One hundred patients (mean age 72 years) undergoing radical resection (70% Dukes' B and 30% Dukes' C) for colorectal carcinoma were asked to provide 3-monthly haemoccult tests to a special follow-up clinic for a minimum of 5 years. Positive tests underwent further investigation with barium enema and colonoscopy. Patient compliance was 84%. Positive tests were obtained in 14 asymptomatic individuals, five of whom proved to have anastomotic recurrence. Recurrence was also identified in a further patient despite a negative haemoccult test. Three patients with anastomotic recurrence were able to undergo further radical surgery; two were still alive over 5 years after detection of recurrent disease. Haemoccult screening appears to detect increased numbers of patients with luminal recurrence (7.2%) when compared to historical controls (2.1%). Larger studies will be needed to determine if this increased detection rate results in improved long-term survival.
Collapse
Affiliation(s)
- M C Crowson
- Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | | | | | |
Collapse
|
50
|
Fielding J. 'Sister, what's this?'. Nurs Stand 1990; 5:50-1. [PMID: 2123674 DOI: 10.7748/ns.5.12.50.s54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|