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Pisu F, Chen H, Jiang B, Zhu G, Usai MV, Austermann M, Shehada Y, Johansson E, Suri J, Lanzino G, Benson J, Nardi V, Lerman A, Wintermark M, Saba L. Machine learning detects symptomatic patients with carotid plaques based on 6-type calcium configuration classification on CT angiography. Eur Radiol 2023:10.1007/s00330-023-10347-2. [PMID: 37982835 DOI: 10.1007/s00330-023-10347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES While the link between carotid plaque composition and cerebrovascular vascular (CVE) events is recognized, the role of calcium configuration remains unclear. This study aimed to develop and validate a CT angiography (CTA)-based machine learning (ML) model that uses carotid plaques 6-type calcium grading, and clinical parameters to identify CVE patients with bilateral plaques. MATERIAL AND METHODS We conducted a multicenter, retrospective diagnostic study (March 2013-May 2020) approved by the institutional review board. We included adults (18 +) with bilateral carotid artery plaques, symptomatic patients having recently experienced a carotid territory ischemic event, and asymptomatic patients either after 3 months from symptom onset or with no such event. Four ML models (clinical factors, calcium configurations, and both with and without plaque grading [ML-All-G and ML-All-NG]) and logistic regression on all variables identified symptomatic patients. Internal validation assessed discrimination and calibration. External validation was also performed, and identified important variables and causes of misclassifications. RESULTS We included 790 patients (median age 72, IQR [61-80], 42% male, 64% symptomatic) for training and internal validation, and 159 patients (age 68 [63-76], 36% male, 39% symptomatic) for external testing. The ML-All-G model achieved an area-under-ROC curve of 0.71 (95% CI 0.58-0.78; p < .001) and sensitivity 80% (79-81). Performance was comparable on external testing. Calcified plaque, especially the positive rim sign on the right artery in older and hyperlipidemic patients, had a major impact on identifying symptomatic patients. CONCLUSION The developed model can identify symptomatic patients using plaques calcium configuration data and clinical information with reasonable diagnostic accuracy. CLINICAL RELEVANCE The analysis of the type of calcium configuration in carotid plaques into 6 classes, combined with clinical variables, allows for an effective identification of symptomatic patients. KEY POINTS • While the association between carotid plaques composition and cerebrovascular events is recognized, the role of calcium configuration remains unclear. • Machine learning of 6-type plaque grading can identify symptomatic patients. Calcified plaques on the right artery, advanced age, and hyperlipidemia were the most important predictors. • Fast acquisition of CTA enables rapid grading of plaques upon the patient's arrival at the hospital, which streamlines the diagnosis of symptoms using ML.
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Affiliation(s)
- Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato, Cagliari, Italy
| | - Hui Chen
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bin Jiang
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Guangming Zhu
- Department of Neurology, University of Arizona, Tucson, AZ, USA
| | - Marco Virgilio Usai
- Department of Vascular Surgery, St. Franziskus Hospital, University of Münster, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital, University of Münster, Münster, Germany
| | - Yousef Shehada
- Department of Vascular Surgery, St. Franziskus Hospital, University of Münster, Münster, Germany
| | - Elias Johansson
- Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Jasjit Suri
- Global Biomedical Technologies Inc., Roseville, CA, USA
| | | | - John Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Valentina Nardi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato, Cagliari, Italy.
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Brinjikji W, Madhavan A, Garza I, Whealy M, Kissoon N, Mark I, Morris PP, Verdoorn J, Benson J, Atkinson JLD, Kobeissi H, Cutsforth-Gregory JK. Clinical and imaging outcomes of 100 patients with cerebrospinal fluid-venous fistulas treated by transvenous embolization. J Neurointerv Surg 2023:jnis-2023-021012. [PMID: 37898553 DOI: 10.1136/jnis-2023-021012] [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: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Cerebrospinal fluid-venous fistulas (CSFVF) are a common cause of spontaneous intracranial hypotension (SIH). Transvenous embolization has emerged as a reliable treatment option. We review the clinical presentation, imaging, and clinical outcomes of 100 consecutive CSFVF patients who underwent embolization over 2 years. METHODS Baseline clinical characteristics, imaging findings (including Bern SIH score), technical outcomes, and long-term imaging and clinical outcomes were collected. All patients had at least 3 months of clinical follow-up and had baseline MRI. 99/100 patients underwent follow-up imaging at ≥3 months post-treatment. RESULTS 100 patients were included. Mean imaging and clinical follow-up duration was 8.3±7.7 months and 15.0±6.8 months, respectively. The mean duration of symptoms before embolization was 40.9±52 months. Mean baseline Bern SIH score was 5.9±3.3. The most common baseline symptoms were headache (96 patients), tinnitus (55 patients), and cognitive dysfunction (44 patients). Technical success rate was 100%. Mean post-treatment Bern SIH score was 0.9±1.6 (P<0.0001). Following treatment, 95% of patients reported significant improvement or resolution in symptoms (58 patients reporting resolution and 37 reporting improvement). 5 patients reported no improvement. There were no major procedural or periprocedural complications. 10 patients had minor procedural complications that did not result in any change in management (Onyx emboli, venous perforation). 19 patients had rebound intracranial hypertension requiring acetazolamide therapy. 7 patients had recurrent fistula at the initially treated level. CONCLUSIONS Transvenous embolization of CSFVF in SIH patients is safe and effective with a 95% treatment response, significant improvement in imaging outcomes, and a very low rate of complications.
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Affiliation(s)
- Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ajay Madhavan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivan Garza
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Whealy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Narayan Kissoon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian Mark
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pearse P Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jared Verdoorn
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John L D Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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3
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Kobeissi H, Kallmes DF, Benson J, Nagelschneider A, Madhavan A, Messina SA, Schwartz K, Campeau N, Carr CM, Nasr DM, Braksick S, Scharf EL, Klaas J, Woodhead ZVJ, Harston G, Briggs J, Joly O, Gerry S, Kuhn AL, Kostas AA, Nael K, AbdalKader M, Kadirvel R, Brinjikji W. Impact of e-ASPECTS software on the performance of physicians compared to a consensus ground truth: a multi-reader, multi-case study. Front Neurol 2023; 14:1221255. [PMID: 37745671 PMCID: PMC10513025 DOI: 10.3389/fneur.2023.1221255] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background The Alberta Stroke Program Early CT Score (ASPECTS) is used to quantify the extent of injury to the brain following acute ischemic stroke (AIS) and to inform treatment decisions. The e-ASPECTS software uses artificial intelligence methods to automatically process non-contrast CT (NCCT) brain scans from patients with AIS affecting the middle cerebral artery (MCA) territory and generate an ASPECTS. This study aimed to evaluate the impact of e-ASPECTS (Brainomix, Oxford, UK) on the performance of US physicians compared to a consensus ground truth. Methods The study used a multi-reader, multi-case design. A total of 10 US board-certified physicians (neurologists and neuroradiologists) scored 54 NCCT brain scans of patients with AIS affecting the MCA territory. Each reader scored each scan on two occasions: once with and once without reference to the e-ASPECTS software, in random order. Agreement with a reference standard (expert consensus read with reference to follow-up imaging) was evaluated with and without software support. Results A comparison of the area under the curve (AUC) for each reader showed a significant improvement from 0.81 to 0.83 (p = 0.028) with the support of the e-ASPECTS tool. The agreement of reader ASPECTS scoring with the reference standard was improved with e-ASPECTS compared to unassisted reading of scans: Cohen's kappa improved from 0.60 to 0.65, and the case-based weighted Kappa improved from 0.70 to 0.81. Conclusion Decision support with the e-ASPECTS software significantly improves the accuracy of ASPECTS scoring, even by expert US neurologists and neuroradiologists.
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Affiliation(s)
- Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - John Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Ajay Madhavan
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Kara Schwartz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Norbert Campeau
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Carrie M. Carr
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Deena M. Nasr
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Sherri Braksick
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Eugene L. Scharf
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - James Klaas
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - George Harston
- Brainomix Limited, Oxford, United Kingdom
- Acute Stroke Service, Oxford University Hospitals NHSFT, Oxford, United Kingdom
| | - James Briggs
- Brainomix Limited, Oxford, United Kingdom
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Anna L. Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, UMass Medical Center, Worcester, MA, United States
| | - Angelos A. Kostas
- Huntington Hospital and Hill Medical Imaging, Pasadena, CA, United States
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Mohamad AbdalKader
- Department of Radiology, Boston Medical Center, Boston, MA, United States
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
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Huang SP, DerSarkissian M, Gu YM, Duh MS, Wang MJ, Benson J, Vu JD, Averell CM, Bell CF. Health Care Costs With Sustained Oral Corticosteroid Use in Systemic Lupus Erythematosus. Clin Ther 2023; 45:619-626. [PMID: 37271712 DOI: 10.1016/j.clinthera.2023.04.013] [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: 09/27/2022] [Revised: 02/07/2023] [Accepted: 04/23/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The goal of this study was to compare health care costs, health care resource utilization, and adverse events associated with sustained oral corticosteroid (OCS) use versus no OCS use in systemic lupus erythematosus. METHODS This retrospective cohort study used claims data (January 1, 2006-July 31, 2019) from patients with systemic lupus erythematosus aged ≥5 years with ≥24 months of continuous enrollment. Health care costs, health care resource utilization, and OCS-related adverse events were assessed. The sustained OCS cohort (defined as ≥12 months of continuous OCS use) was divided into exposure categories based on the number of 6-month classification periods with >5 mg/d OCS (0, 1-2, or 3-4). FINDINGS Of the 6234 patients in the sustained OCS use cohort, there were 1587 (25.5%) patients with 0 periods of >5 mg/d OCS use, 2087 (33.5%) patients with 1 to 2 periods of >5 mg/d OCS use, and 2560 (41.1%) patients with 3 to 4 periods of >5 mg/d OCS use; the no OCS use cohort included 7828 patients. Adjusted health care cost differences (95% CIs) were significantly greater for patients with 0, 1 to 2, and 3 to 4 periods of OCS use >5 mg/d versus the no OCS use cohort ($7774 [5426-10,223], $21,738 [18,898-25,321], and $30,119 [26,492-33,774], respectively). A higher proportion of patients in all OCS exposure categories required health care resource utilization (≥99.7% vs 93.4%) and experienced OCS-related adverse events (94.3%-96.8% vs 82.6%) versus the no OCS use cohort, with more periods of OCS use >5 mg/d associated with increased health care resource utilization and adverse events. IMPLICATIONS Sustained OCS use in systemic lupus erythematosus was associated with high economic burden, health care resource utilization, and OCS-related adverse events. These data highlight the need for health care providers to carefully consider OCS use in systemic lupus erythematosus.
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Affiliation(s)
- Shirley P Huang
- GSK, US Value Evidence and Outcomes, Durham, North Carolina, USA
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Weber WP, Davide Gentilini O, Morrow M, Montagna G, de Boniface J, Fitzal F, Wyld L, Rubio IT, Matrai Z, King TA, Saccilotto R, Galimberti V, Maggi N, Andreozzi M, Sacchini V, Castrezana López L, Loesch J, Schwab FD, Eller R, Heidinger M, Haug M, Kurzeder C, Di Micco R, Banys-Paluchowski M, Ditsch N, Harder Y, Paulinelli RR, Urban C, Benson J, Bjelic-Radisic V, Potter S, Knauer M, Thill M, Vrancken Peeters MJ, Kuemmel S, Heil J, Gulluoglu BM, Tausch C, Ganz-Blaettler U, Shaw J, Dubsky P, Poortmans P, Kaidar-Person O, Kühn T, Gnant M. Uncertainties and controversies in axillary management of patients with breast cancer. Cancer Treat Rev 2023; 117:102556. [PMID: 37126938 PMCID: PMC10752145 DOI: 10.1016/j.ctrv.2023.102556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/01/2023] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register.
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Affiliation(s)
- Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Breast Unit, Capio St Göran's Hospital, Stockholm, Sweden
| | - Florian Fitzal
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Austria; Austrian Breast and Colorectal Study Group ABCSG, Vienna, Austria
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Isabel T Rubio
- Breast Surgical Oncology Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Zoltan Matrai
- Hamad Medical Corporation, Dept of Oncoplastic Breast Surgery, Doha, Qatar
| | - Tari A King
- Division of Breast Surgery, Brigham and Women's Hospital, Dana Farber/Brigham Cancer Center, Boston, MA, USA
| | - Ramon Saccilotto
- University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Mariacarla Andreozzi
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Julie Loesch
- Gynecology Department, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne D Schwab
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Ruth Eller
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Haug
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosa Di Micco
- Breast Surgery, San Raffaele University and Research Hospital, Milan, Italy
| | - Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Nina Ditsch
- Department of Gynaecology and Obstetrics, University Hospital Augsburg, Augsburg, Germany
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Régis R Paulinelli
- Federal University of Goias, Goias, Brazil; Breast Unit, Araújo Jorge Hospital, Goias, Brazil
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Vesna Bjelic-Radisic
- Breast Unit, University Hospital Helios Wuppertal, University Witten/Herdecke, Wuppertal, Germany; Medical University Graz, Graz, Austria
| | | | - Michael Knauer
- Tumor and Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Marc Thill
- Department of Gynaecology and Gynaecological Oncology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Surgery, University Medical Center, Amsterdam, Netherlands
| | - Sherko Kuemmel
- Breast Unit, Hospital Essen-Mitte, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | | | | | | | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Peter Dubsky
- University of Lucerne, Faculty of Health Sciences and Medicine, Lucerne, Switzerland; Breast Centre, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Reproduction, Maastricht University Medical Centre, Dept. Radiation Oncologv (Maastro), Maastricht, Netherlands
| | - Thorsten Kühn
- Department of Gynecology, Hospital Esslingen, Esslingen, Germany
| | - Michael Gnant
- Austrian Breast and Colorectal Study Group ABCSG, Vienna, Austria; Comprehensive Cancer Center Medical University Vienna, Vienna, Austria
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DerSarkissian M, Gu YM, Duh MS, Benson J, Huang SP, Averell C, Vu J, Wang MJ, Bell CF. Clinical and Economic Burden in Patients With Systemic Lupus Erythematosus During the First Year After Initiating Oral Corticosteroids: A Retrospective US Database Study. ACR Open Rheumatol 2023. [PMID: 37226045 DOI: 10.1002/acr2.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To characterize health care resource utilization (HCRU), health care costs, and adverse events (AEs) among patients with systemic lupus erythematosus (SLE) initiating oral corticosteroids (OCS) versus patients without OCS use. METHODS In this retrospective cohort study (GSK Study 213061), eligible patients (aged ≥5 years at first OCS claim) with SLE from the IQVIA Real-World Data Adjudicated Claims-US database (January 2006 to July 2019) had continuous enrollment during the 6-month preindex (baseline) and 12-month postindex (observation) periods and one or more inpatient or emergency department SLE diagnosis codes or two or more outpatient SLE diagnosis codes during baseline. The "OCS-initiator cohort" comprised patients with one or more OCS pharmacy claims during the study period and no evidence of preindex OCS use and was classified into three exposure categories based on the number of 6-month periods of more than 5 mg/day of OCS use (0, 1, 2). The "no-OCS-use cohort" comprised patients without OCS claims, although patients may have received OCS prior to the study period. Clinical and economic outcomes were reported over the observation period. RESULTS Adjusted health care costs differed significantly ($6542 [95% confidence interval (CI): $5761-$7368], $19,149 [95% CI: $16,954-$21,471], $28,985 [95% CI: $25,546-$32,885]). HCRU incidence rates were significantly greater for all OCS-initiator exposure categories (n = 16,216) versus the no-OCS-use cohort (n = 11,137; adjusted incidence rate ratios [95% CI]: 1.22 [1.19-1.24], 1.39 [1.34-1.43], 1.66 [1.60-1.73]). OCS-related AEs were experienced by 67.1% to 74.1% of patients with OCS initiation, most commonly affecting the immune system. CONCLUSION Within 12 months of OCS initiation, patients with SLE experienced substantial clinical and economic burden, which may imply a need to minimize OCS use.
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Affiliation(s)
- Maral DerSarkissian
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - Yuqian M Gu
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - Mei Sheng Duh
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - John Benson
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - Shirley P Huang
- Shirley P. Huang, PharmD, MS (current address: Seagen Inc., Bothwell, WA, United States), Carlyne Averell, MS, SM (no current affiliation), Christopher F. Bell, PharmD, Research Triangle Park, North Carolina, United States
| | - Carlyne Averell
- Shirley P. Huang, PharmD, MS (current address: Seagen Inc., Bothwell, WA, United States), Carlyne Averell, MS, SM (no current affiliation), Christopher F. Bell, PharmD, Research Triangle Park, North Carolina, United States
| | - Jensen Vu
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - Min-Jung Wang
- Maral DerSarkissian, PhD, Yuqian M. Gu, MS (current address: Kaiser Permanente, Pasadena, CA, United States), Mei Sheng Duh, MPH, ScD, John Benson, MS, Jensen Vu, BA (current address: Republic, New York, NY, United States, and VietChallenge, Boston, MA, United States), Min-Jung Wang, ScD,MS (current address: Amgen Inc., Thousand Oaks, CA, United States): Analysis Group, Inc., Boston, Massachusetts, United States
| | - Christopher F Bell
- Shirley P. Huang, PharmD, MS (current address: Seagen Inc., Bothwell, WA, United States), Carlyne Averell, MS, SM (no current affiliation), Christopher F. Bell, PharmD, Research Triangle Park, North Carolina, United States
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Huang SP, DerSarkissian M, Gu YM, Duh MS, Wang MJ, Benson J, Vu J, Averell C, Bell CF. Prolonged oral corticosteroid treatment in patients with systemic lupus erythematosus: An evaluation of 12-month economic and clinical burden. J Manag Care Spec Pharm 2023; 29:365-377. [PMID: 36989451 PMCID: PMC10387938 DOI: 10.18553/jmcp.2023.29.4.365] [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: 03/31/2023]
Abstract
BACKGROUND: Prolonged, high-dose corticosteroid treatment for systemic lupus erythematosus (SLE) is associated with substantial health care costs, health care resource utilization (HCRU), and adverse events (AEs). OBJECTIVE: To compare all-cause health care costs, HCRU, and oral corticosteroid (OCS)-related AEs among patients with prevalent OCS use and patients without OCS use. METHODS: This retrospective, longitudinal cohort study (GSK study 214100) used claims data from the IQVIA Real-World Data Adjudicated Claims - US, IQVIA, Inc, database between January 1, 2006, and July 31, 2019, to identify patients with SLE. Patients with at least 1 OCS pharmacy claim during the study period and continuous OCS use during the 6-month pre-index (baseline) period (index date is the date of the first OCS claim following 6 months' continuous use) formed the "prevalent OCS use cohort." This cohort was subdivided based on the level of OCS exposure during the 12-month observation period, ie, the number of 6-month periods of greater than 5 mg/day OCS use (0, 1, or 2). Patients without OCS claims formed the "no OCS use cohort." All patients had continuous enrollment during the baseline and observation periods, had at least 1 inpatient or at least 2 outpatient SLE diagnosis codes during baseline, and were aged at least 5 years at index. A 2-part model, a generalized linear regression model with a negative binomial distribution, and a multivariate logistic regression model were used to compare health care costs, HCRU, and the odds of developing an OCS-related AE between cohorts, respectively. RESULTS: The no OCS use and prevalent OCS use cohorts included 21,517 and 16,209 patients, respectively. Adjusted health care cost differences (95% CI) were significantly lower for the no OCS use cohort vs all prevalent OCS use exposure categories ($5,439 [$4,537-$6,371] vs $17,856 [$16,368-$19,498]), driven by inpatient stays and outpatient visits; HCRU was also significantly lower (adjusted incidence rate ratios vs no OCS use cohort [95% CI]: 1.20 [1.16-1.23] vs 1.47 [1.41-1.52]). Health care costs and HCRU increased with increasing length of OCS exposure. OCS-related AEs occurred more frequently for all prevalent OCS use exposure categories vs the no OCS use cohort (odds ratio [95% CI]: 1.39 [1.25-1.55] vs 2.32 [2.02-2.68]), driven by hematologic/oncologic and immune system-related AEs. The mean (SD) average daily dose of OCS increased with increasing periods of prevalent OCS use (2.5 [1.3], 6.9 [31.1], and 34.6 [1,717.3] mg/day, respectively, for patients with 0, 1, and 2 periods of OCS use). CONCLUSIONS: Prevalent OCS use incurs a substantial clinical and economic burden, highlighting the need for restricted OCS doses and durations. DISCLOSURES: This study (GSK Study 214100) was funded by GSK. GSK was involved in designing the study, contributing to the collection, analysis, and interpretation of the data, supporting the authors in the development of the manuscript, and funding the medical writing assistance. All authors, including those employed by GSK, approved the content of the submitted manuscript and were involved in the decision to submit the manuscript for publication. Dr DerSarkissian, Dr Duh, and Mr Benson are employees of Analysis Group, which received research funding from GSK to conduct this study. Dr Wang, Ms Gu, and Mr Vu are former employees of Analysis Group. Mr Bell is an employee of GSK and holds stocks and shares in the company. Ms Averell and Dr Huang are former employees of GSK and held stocks and shares in the company at the time of the study.
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8
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Lyon A, Yu Q, Hu A, Benson J, Ahmed O. Abstract No. 572 Meta-Analysis of Genicular Artery Embolization for Treatment of Osteoarthritis of the Knee. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.430] [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: 02/27/2023] Open
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9
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Lyon A, Yu Q, Tran P, Ungchusri E, Hu A, Neale M, Benson J, Ahmed O. Abstract No. 594 Single Session Mechanical Thrombectomy of Ileofemoral Deep Vein Thrombosis with ClotTriever: Exploring its Possibilities in an Outpatient Setting. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.452] [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: 02/26/2023] Open
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10
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Jabal MS, Kallmes DF, Harston G, Campeau N, Schwartz K, Messina S, Carr C, Benson J, Little J, Nagelschneider A, Madhavan A, Nasr D, Braksick S, Klaas J, Scharf E, Bilgin C, Brinjikji W. Automated CT angiography collateral scoring in anterior large vessel occlusion stroke: A multireader study. Interv Neuroradiol 2023:15910199221150470. [PMID: 36650942 DOI: 10.1177/15910199221150470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Computed tomography (CT) angiography collateral score (CTA-CS) is an important clinical outcome predictor following mechanical thrombectomy for ischemic stroke with large vessel occlusion (LVO). The present multireader study aimed to evaluate the performance of e-CTA software for automated assistance in CTA-CS scoring. MATERIALS AND METHODS Brain CTA images of 56 patients with anterior LVO were retrospectively processed. Twelve readers of various clinical training, including junior neuroradiologists, senior neuroradiologists, and neurologists graded collateral flow using visual CTA-CS scale in two sessions separated by a washout period. Reference standard was the consensus of three expert readers. Duration of reading time, inter-rater reliability, and statistical comparison of readers' performance metrics were analyzed between the e-CTA assisted and unassisted sessions. RESULTS e-CTA assistance resulted in significant increase in mean accuracy (58.6% to 67.5%, p = 0.003), mean F1 score (0.574 to 0.676, p = 0.002), mean precision (58.8% to 68%, p = 0.007), and mean recall (58.7% to 69.9%, p = 0.002), especially with slight filling deficit (CTA-CS 2 and 3). Mean reading time was reduced across all readers (103.4 to 59.7 s, p = 0.001), and inter-rater agreement in CTA-CS assessment was increased (Krippendorff's alpha 0.366 to 0.676). Optimized occlusion laterality detection was also noted with mean accuracy (92.9% to 96.8%, p = 0.009). CONCLUSION Automated assistance for CTA-CS using e-CTA software provided helpful decision support for readers in terms of improving scoring accuracy and reading efficiency for physicians with a range of experience and training backgrounds and leading to significant improvements in inter-rater agreement.
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Affiliation(s)
| | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - George Harston
- Brainomix Limited, Oxford, UK
- 6397Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Norbert Campeau
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Kara Schwartz
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Steven Messina
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Carrie Carr
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - John Benson
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Jason Little
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | | | - Ajay Madhavan
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Deena Nasr
- Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA
| | - Sherry Braksick
- Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA
| | - James Klaas
- Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA
| | - Eugene Scharf
- Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
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11
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Burkett B, Kim DK, Benson J, Carr C, Morris JM. Infrapedicular approach to CT-guided thermal ablation in the thoracic spine. Neuroradiol J 2022; 35:736-741. [PMID: 35574645 PMCID: PMC9626838 DOI: 10.1177/19714009221096827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study is to introduce the infrapedicular approach to CT-guided spine interventions, a specialized technique that can safely expand the scope of spine lesions amenable to treatment, and to document the feasibility in a variety of procedural scenarios to the extent possible with a retrospective case series. METHODS Data from 24 cases performed at a single institution over a 10-year period were retrospectively reviewed to assess the technical feasibility and safety profile of the technique. RESULTS The infrapedicular approach enabled a technically satisfactory procedural result in 24 cases (mean age 63.9 years, range 35-83 years). Two peri-procedural complications occurred, including a small pneumothorax and a cerebrospinal fluid leak, both of which resolved with conservative treatment. No lasting injurious effects or additional complications were identified. The infrapedicular approach was found to be particularly useful in multiple technically challenging scenarios: it facilitates access to lesions in the inferior vertebral body, allows biopsy, cement augmentation, or ablation of high thoracic lesions difficult to treat due to limitations of steep angulation of fluoroscopy and CT scanners, and enables treatment of large lesions by using multiple overlapping probes.
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Affiliation(s)
- Brian Burkett
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - John Benson
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
- Mayo Clinic Rochester, Rochester, MN, USA
| | - Carrie Carr
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
- Mayo Clinic Rochester, Rochester, MN, USA
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
- Department of Radiology, Division of
Neuroradiology, Rochester, MN, USA
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12
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Bundred N, Dixon M, Acuthan R, Barrett E, Benson J, Courtney C, Skene A, Hoar F, Bhaskar P, Todd C, Macmillan D, Watterston D, Barnes N. Does the use of an Intraoperative device to assess margins reduce need for reexcison after breast conserving surgery: Multicentre Randomised Controlled Trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01358-2] [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: 11/19/2022]
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13
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Nardi V, Benson J, Saba L, Bois M, Meyer F, Lanzino G, Lilach L, Lerman A. Patients with carotid intraplaque hemorrhage have higher incidence of cerebral microbleeds. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1983] [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: 11/14/2022] Open
Abstract
Abstract
Background
Carotid intraplaque hemorrhage (IPH) is considered a strong marker of histologically defined plaque vulnerability leading to cerebrovascular ischemic events. Cerebral microbleeds (CMBs) represent hemorrhage-prone small vessel disease and they are a common finding on brain MRI in patients with cerebrovascular disease. However, the potential mechanism and the risk for CMBs are not clear. The characteristics of carotid lesions have been considered relevant in the relationship between carotid artery atherosclerosis and the presence of CMBs. The potential association between carotid IPH histologically defined and CMBs has not been investigated yet.
Purpose
We have previously reported the prevalence of IPH in patients with non-obstructive carotid disease in patients who underwent carotid endarterectomy (CEA). In this study, we aimed to investigate whether the presence and the extent of carotid IPH are related to the existence of CMBs. We hypothesized that patients with carotid IPH would have a higher risk of CMBs.
Methods
This retrospective study enrolled 101 consecutive patients undergoing CEA with symptomatic (including ischemic stroke, TIA, and amaurosis fugax) or asymptomatic ipsilateral carotid artery disease. Carotid plaque specimens were collected at CEA from all the patients and stained with Movat Pentachrome to identify the presence and the extent (%) of IPH. Neck CTA was obtained to measure the degree of carotid stenosis. Brain MRI was pre-surgically performed and CMBs were studied using T2*-weighted gradient-recalled echo (GRE) or susceptibility-weighted imaging (SWI) sequence. The CMBs were counted and localized. Clinical and biochemical data, comorbidities, and medications were recorded. The association between carotid IPH and CMBs was examined adjusted for other risk factors.
Results
The presence of carotid IPH was in 57 (56.4%) patients. CMBs were more observed in patients with carotid IPH compared to those without IPH [19 (33.3%) vs 5 (11.4%); p=0.010]. Logistic regression analysis demonstrated an association between the extent of IPH in the carotid atheroma and the presence of CMBs [OR 1.051 (95% CI 1.012–1.090); p=0.009]. Moreover, the carotid IPH extent was associated with the number of CMBs (p=0.004). In patients with CMBs, the median degree of ipsilateral carotid stenosis was 40% (35–65%) and it was 70% (50–80%) in those without CMBs, with a significant difference between the two groups (p=0.049).
Conclusions
In patients undergoing CEA, the histologically defined presence of carotid IPH and its extent are associated with CMBs on brain MR imaging. CMBs may be a potential mechanism for cerebrovascular events in patients with carotid atherosclerotic IPH and they may be an imaging marker that can distinguish the severity of the carotid artery disease.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Mayo Clinic Foundation
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Affiliation(s)
- V Nardi
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
| | - J Benson
- Mayo Clinic, Radiology , Rochester , United States of America
| | - L Saba
- University of Cagliari, Radiology , Cagliari , Italy
| | - M Bois
- Mayo Clinic, Laboratory Medicine and Pathology , Rochester , United States of America
| | - F Meyer
- Mayo Clinic, Neurologic Surgery , Rochester , United States of America
| | - G Lanzino
- Mayo Clinic, Neurologic Surgery , Rochester , United States of America
| | - L Lilach
- Mayo Clinic, Nephrology and Hypertension , Rochester , United States of America
| | - A Lerman
- Mayo Clinic, Cardiovascular Diseases , Rochester , United States of America
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14
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Weber WP, Shaw J, Pusic A, Wyld L, Morrow M, King T, Mátrai Z, Heil J, Fitzal F, Potter S, Rubio IT, Cardoso MJ, Gentilini OD, Galimberti V, Sacchini V, Rutgers EJT, Benson J, Allweis TM, Haug M, Paulinelli RR, Kovacs T, Harder Y, Gulluoglu BM, Gonzalez E, Faridi A, Elder E, Dubsky P, Blohmer JU, Bjelic-Radisic V, Barry M, Hay SD, Bowles K, French J, Reitsamer R, Koller R, Schrenk P, Kauer-Dorner D, Biazus J, Brenelli F, Letzkus J, Saccilotto R, Joukainen S, Kauhanen S, Karhunen-Enckell U, Hoffmann J, Kneser U, Kühn T, Kontos M, Tampaki EC, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Koppert L, Gouveia PF, Lagergren J, Svensjö T, Maggi N, Kappos EA, Schwab FD, Castrezana L, Steffens D, Krol J, Tausch C, Günthert A, Knauer M, Katapodi MC, Bucher S, Hauser N, Kurzeder C, Mucklow R, Tsoutsou PG, Sezer A, Çakmak GK, Karanlik H, Fairbrother P, Romics L, Montagna G, Urban C, Walker M, Formenti SC, Gruber G, Zimmermann F, Zwahlen DR, Kuemmel S, El-Tamer M, Vrancken Peeters MJ, Kaidar-Person O, Gnant M, Poortmans P, de Boniface J. Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. Breast 2022; 63:123-139. [PMID: 35366506 PMCID: PMC8976143 DOI: 10.1016/j.breast.2022.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/01/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/31/2022] Open
Abstract
Aim Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR Autologous breast reconstruction is increasingly preferred over implants in the setting of radiation therapy. Use of patient-reported outcomes is endorsed. Shape and size of reconstructed breasts can hinder radiotherapy planning. There is a need for randomised phase III trials.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Andrea Pusic
- Brigham and Women's/Dana Farber Cancer Center, USA
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Monica Morrow
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital / Dana Farber Cancer Institute, USA
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shelley Potter
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria-Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | | | | | - Virgilio Sacchini
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tanir M Allweis
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Martin Haug
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | - Regis R Paulinelli
- Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil
| | - Tibor Kovacs
- Jiahui Internatioonal Hospital Shanghai, China; Guy's and St. Thomas' NHS Foundation Trust London, UK
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Eduardo Gonzalez
- Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina
| | - Andree Faridi
- Department of Senology/Breast Center, University Hospital Bonn, Germany
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Peter Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany
| | - Mitchel Barry
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanne Dieroff Hay
- Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden
| | - Kimberly Bowles
- Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Roland Reitsamer
- Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rupert Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria
| | - Peter Schrenk
- Breast Cancer Center, Kepler University Hospital, Linz, Austria
| | | | - Jorge Biazus
- Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabricio Brenelli
- Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil
| | - Jaime Letzkus
- San Borja Arriaran Clinical Hospital, University of Chile, Chile
| | | | | | - Susanna Kauhanen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulla Karhunen-Enckell
- Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland
| | - Juergen Hoffmann
- Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Thorsten Kühn
- Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | | | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Tal Hadar
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Linetta Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pedro F Gouveia
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | - Jakob Lagergren
- Department of Surgery, Capio St Goran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tor Svensjö
- Department of Surgery, Central Hospital, Kristianstad, Sweden
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Daniel Steffens
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Janna Krol
- Breast Center, University Hospital Basel, Basel, Switzerland
| | | | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Maria C Katapodi
- University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Susanne Bucher
- Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Pelagia G Tsoutsou
- University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Atakan Sezer
- Department of Surgery, Trakya University Medical School Hospital, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Patricia Fairbrother
- Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital, Glasgow, UK
| | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - Melanie Walker
- Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia
| | - Silvia C Formenti
- Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA
| | - Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland
| | - Frank Zimmermann
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Sherko Kuemmel
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany
| | - Mahmoud El-Tamer
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marie Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
| | - Orit Kaidar-Person
- Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
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15
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Aslam A, Arshad Z, Ahmed A, Kazzazi F, Benson J, Forouhi P, Agrawal A, Benyon S, Irwin M, Malata C. Risk-reducing mastectomy and reconstruction - A ten-year review of methodological trends and outcomes. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2022.03.162] [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: 10/18/2022] Open
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16
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Soh CL, Muktar S, Malata C, Benson J. Reasons for choosing delayed rather than immediate contralateral prophylactic mastectomy (CPM) in patients with unilateral breast cancer. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2022.03.102] [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: 10/18/2022] Open
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Soh CL, Muktar S, Malata C, Benson J. Surgical outcomes for reconstruction after delayed contralateral prophylactic mastectomy (CPM). European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Soliman M, Benson J, Forouhi P, Ong CS, Agrawal A. Should the presence of DCIS component impact surgical decision in breast conserving surgery following neoadjuvant chemotherapy? European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2022.03.224] [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: 10/18/2022]
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Huang B(E, Sardeshmukh S, Benson J, Zhu Y. High performance work systems, employee creativity and organizational performance in the education sector. The International Journal of Human Resource Management 2022. [DOI: 10.1080/09585192.2022.2054283] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Binhua (Eva) Huang
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | | | - John Benson
- Department of Management, Monash University, Melbourne, Australia
| | - Ying Zhu
- UniSA Business, University of South Australia, Adelaide, Australia
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Wilke S, Benson J, Roller L. Uterine lipoleiomyoma: Case report and review of the literature. Radiol Case Rep 2022; 17:954-958. [PMID: 35096214 PMCID: PMC8783067 DOI: 10.1016/j.radcr.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/26/2022] Open
Abstract
Uterine lipoleiomyomas are variants of uterine leiomyomas that are often found incidentally, and do not require surgical intervention, unless symptomatic, and thus must be differentiated from lesions that need to be excised. While these tumors are benign, there have been reports of uterine lipoleiomyomas coexisting with other gynecological malignancies, metabolic diseases and abnormal estrogen statuses, as well as going through a malignant transformation into a liposarcoma. Here we present a 58-year-old female that presented with complaints of right upper quadrant abdominal pain. Ultrasonography and computed tomography performed in the workup incidentally demonstrated a fatty lesion arising from the uterine corpus, consistent with a lipoleiomyoma. This report exemplifies the importance of correctly distinguishing between non-malignant and malignant uterine masses in order to provide the correct management, as well as determining the need for further investigation relating to other malignancies, metabolic diseases, abnormal estrogen statuses and being aware of malignant transformation.
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Nardi V, Benson J, Bois MC, Saba L, Larson AS, Özcan I, Ahmad A, Morse DW, Meyer FB, Brinjikji W, Lanzino G, Lerman LO, Savastano LE, Lerman A. Carotid Plaques From Symptomatic Patients With Mild Stenosis Is Associated With Intraplaque Hemorrhage. Hypertension 2022; 79:271-282. [PMID: 34878895 DOI: 10.1161/hypertensionaha.121.18128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid plaque vulnerability features beyond the degree of stenosis may play a key role in the pathogenesis and recurrence of ischemic cerebrovascular events. This study sought to compare intraplaque hemorrhage (IPH) as a marker of plaque vulnerability in symptomatic patients with mild (<50%), moderate (50%-69%), and severe (≥70%) carotid artery stenosis. We included patients who experienced ischemic cerebrovascular events with no other identifiable sources and underwent carotid endarterectomy for mild (n=32), moderate (n=47), and severe (n=58) carotid artery stenosis. The degree of stenosis and imaging hallmarks were assessed by computed tomography angiography or magnetic resonance angiography. Plaque specimens were stained with hematoxylin and eosin and Movat pentachrome staining. Carotid plaques of patients with mild stenosis had a higher extent of IPH (%) on tissue analysis compared with patients with moderate (mild, 15.7% [interquartile range, 7.8%-26.7%]; moderate, 3.9% [0.0%-9.2%]; P<0.001) and severe carotid artery stenosis (mild, 15.7% [interquartile range, 7.8%-26.7%]; severe, 2.5% [interquartile range, 0.0%-11.2%]; P<0.001). When considering the degree of carotid artery stenosis as a continuous variable, a lower lumen narrowing was associated with higher extent of IPH (P<0.001; R, -0.329). Our major finding is the association of IPH with mild carotid artery stenosis based on histological analysis. The current study may suggest that IPH potentially plays a role in the mechanism of stroke in patients with nonobstructive carotid stenosis.
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Affiliation(s)
- Valentina Nardi
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - John Benson
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology (M.C.B.), Mayo Clinic, Rochester, MN
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy (L.S.)
| | - Anthony S Larson
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Ilke Özcan
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - Ali Ahmad
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - David W Morse
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - Fredric B Meyer
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Waleed Brinjikji
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Giuseppe Lanzino
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Department of Nephrology and Hypertension (L.O.L.), Mayo Clinic, Rochester, MN
| | - Luis E Savastano
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
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22
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Lin Soh C, Moyle P, Scott-Blagrove J, Benson J. Corrigendum to 'Sebaceous carcinoma of the chest wall: A case report' [Radiology Case Reports 16 (2021) 1870-1873]. Radiol Case Rep 2021; 16:3618. [PMID: 34646406 PMCID: PMC8500849 DOI: 10.1016/j.radcr.2021.08.043] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chien Lin Soh
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, CB2 0SP, Cambridge, UK
| | | | | | - John Benson
- Cambridge University Hospital NHS Trust, Cambridge and Anglia Ruskin School of Medicine, Cambridge, UK
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Torres-Zegarra C, Sundararajan D, Benson J, Seagle H, Witten M, Walders-Abramson N, Simon SL, Huguelet P, Nokoff NJ, Cree-Green M. Care for Adolescents With Polycystic Ovary Syndrome: Development and Prescribing Patterns of a Multidisciplinary Clinic. J Pediatr Adolesc Gynecol 2021; 34:617-625. [PMID: 33794340 PMCID: PMC8808364 DOI: 10.1016/j.jpag.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Based on updated guidelines and expressed patient needs, we created a multidisciplinary clinic including endocrinology, gynecology/adolescent medicine, dermatology, psychology, and nutrition to provide comprehensive care to adolescent girls with polycystic ovary syndrome (PCOS). We describe the patient population presenting to this clinic, and prescribing patterns when a multidisciplinary approach is used. DESIGN Retrospective chart review. SETTING Tertiary care hospital. PARTICIPANTS Female patients, aged 11-24 years, presenting for initial assessment in a multidisciplinary PCOS clinic. INTERVENTIONS None. MAIN OUTCOME MEASURES Medical history, physical examination findings, laboratory measurements and prescribed therapies. RESULTS A total of 92 patients seen from 2014 to 2018 are described (age 15.9 years, range 11-24 years, body mass index 35.6 kg/m2, range 19.9-53.5). Metabolic syndrome features were common: 26% had a prediabetes hemoglobin A1c (>5.6%), 83% had a high-density lipoprotein (HDL) <50 mg/dL, 40% had a systolic blood pressure >120 mm Hg, and 43% had an alanine aminotransferase level of >30 U/L. Dermatologic findings included acne 93%, hirsutism 38%, acanthosis nigricans 85%, hidradenitis suppurativa 16%, and androgenic alopecia 2%. Of the patients, 33% had a diagnosis of depression or anxiety, 16% of patients had a diagnosis of obstructive sleep apnea, and an additional 59% had symptoms warranting a sleep study The most commonly prescribed medications were topical acne preparations (62%), followed by estrogen-containing hormonal therapy (56%) and metformin (40%). CONCLUSION In adolescents with PCOS and obesity, metabolic, dermatologic, and psychologic co-morbidities are common. The use of a multidisciplinary clinic model including dermatology in addition to endocrinology, gynecology, psychology, and lifestyle experts provides care for most aspects of PCOS.
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Affiliation(s)
- C Torres-Zegarra
- (1)Department of Surgery, Division of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - D Sundararajan
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - J Benson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - H Seagle
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - M Witten
- Department of Nutrition, Children's Hospital Colorado, Aurora, Colorado
| | - N Walders-Abramson
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S L Simon
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - P Huguelet
- Department of Obstetrics and Gynecology, Section of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - N J Nokoff
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - M Cree-Green
- Department of Pediatrics, Division of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Yee LM, McGee P, Bailit JL, Wapner RJ, Varner MW, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE, Mallett G, Grobman W, Ramos-Brinson M, Roy A, Stein L, Campbell P, Collins C, Jackson N, Dinsmoor M, Senka J, Paychek K, Peaceman A, Talucci M, Zylfijaj M, Reid Z, Leed R, Benson J, Forester S, Kitto C, Davis S, Falk M, Perez C, Hill K, Sowles A, Postma J, Alexander S, Andersen G, Scott V, Morby V, Jolley K, Miller J, Berg B, Dorman K, Mitchell J, Kaluta E, Clark K, Spicer K, Timlin S, Wilson K, Moseley L, Leveno K, Santillan M, Price J, Buentipo K, Bludau V, Thomas T, Fay L, Melton C, Kingsbery J, Benezue R, Simhan H, Bickus M, Fischer D, Kamon T, DeAngelis D, Mercer B, Milluzzi C, Dalton W, Dotson T, McDonald P, Brezine C, McGrail A, Latimer C, Guzzo L, Johnson F, Gerwig L, Fyffe S, Loux D, Frantz S, Cline D, Wylie S, Iams J, Wallace M, Northen A, Grant J, Colquitt C, Rouse D, Andrews W, Moss J, Salazar A, Acosta A, Hankins G, Hauff N, Palmer L, Lockhart P, Driscoll D, Wynn L, Sudz C, Dengate D, Girard C, Field S, Breault P, Smith F, Annunziata N, Allard D, Silva J, Gamage M, Hunt J, Tillinghast J, Corcoran N, Jimenez M, Ortiz F, Givens P, Rech B, Moran C, Hutchinson M, Spears Z, Carreno C, Heaps B, Zamora G, Seguin J, Rincon M, Snyder J, Farrar C, Lairson E, Bonino C, Smith W, Beach K, Van Dyke S, Butcher S, Thom E, Rice M, Zhao Y, Momirova V, Palugod R, Reamer B, Larsen M, Spong C, Tolivaisa S, VanDorsten J. Differences in obstetrical care and outcomes associated with the proportion of the obstetrician's shift completed. Am J Obstet Gynecol 2021; 225:430.e1-430.e11. [PMID: 33812810 DOI: 10.1016/j.ajog.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Understanding and improving obstetrical quality and safety is an important goal of professional societies, and many interventions such as checklists, safety bundles, educational interventions, or other culture changes have been implemented to improve the quality of care provided to obstetrical patients. Although many factors contribute to delivery decisions, a reduced workload has addressed how provider issues such as fatigue or behaviors surrounding impending shift changes may influence the delivery mode and outcomes. OBJECTIVE The objective was to assess whether intrapartum obstetrical interventions and adverse outcomes differ based on the temporal proximity of the delivery to the attending's shift change. STUDY DESIGN This was a secondary analysis from a multicenter obstetrical cohort in which all patients with cephalic, singleton gestations who attempted vaginal birth were eligible for inclusion. The primary exposure used to quantify the relationship between the proximity of the provider to their shift change and a delivery intervention was the ratio of time from the most recent attending shift change to vaginal delivery or decision for cesarean delivery to the total length of the shift. Ratios were used to represent the proportion of time completed in the shift by normalizing for varying shift lengths. A sensitivity analysis restricted to patients who were delivered by physicians working 12-hour shifts was performed. Outcomes chosen included cesarean delivery, episiotomy, third- or fourth-degree perineal laceration, 5-minute Apgar score of <4, and neonatal intensive care unit admission. Chi-squared tests were used to evaluate outcomes based on the proportion of the attending's shift completed. Adjusted and unadjusted logistic models fitting a cubic spline (when indicated) were used to determine whether the frequency of outcomes throughout the shift occurred in a statistically significant, nonlinear pattern RESULTS: Of the 82,851 patients eligible for inclusion, 47,262 (57%) had ratio data available and constituted the analyzable sample. Deliveries were evenly distributed throughout shifts, with 50.6% taking place in the first half of shifts. There were no statistically significant differences in the frequency of cesarean delivery, episiotomy, third- or fourth-degree perineal lacerations, or 5-minute Apgar scores of <4 based on the proportion of the shift completed. The findings were unchanged when evaluated with a cubic spline in unadjusted and adjusted logistic models. Sensitivity analyses performed on the 22.2% of patients who were delivered by a physician completing a 12-hour shift showed similar findings. There was a small increase in the frequency of neonatal intensive care unit admissions with a greater proportion of the shift completed (adjusted P=.009), but the findings did not persist in the sensitivity analysis. CONCLUSION Clinically significant differences in obstetrical interventions and outcomes do not seem to exist based on the temporal proximity to the attending physician's shift change. Future work should attempt to directly study unit culture and provider fatigue to further investigate opportunities to improve obstetrical quality of care, and additional studies are needed to corroborate these findings in community settings.
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Torul H, Yarali E, Eksin E, Ganguly A, Benson J, Tamer U, Papakonstantinou P, Erdem A. Paper-Based Electrochemical Biosensors for Voltammetric Detection of miRNA Biomarkers Using Reduced Graphene Oxide or MoS 2 Nanosheets Decorated with Gold Nanoparticle Electrodes. Biosensors (Basel) 2021; 11:236. [PMID: 34356708 PMCID: PMC8301884 DOI: 10.3390/bios11070236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
Paper-based biosensors are considered simple and cost-efficient sensing platforms for analytical tests and diagnostics. Here, a paper-based electrochemical biosensor was developed for the rapid and sensitive detection of microRNAs (miRNA-155 and miRNA-21) related to early diagnosis of lung cancer. Hydrophobic barriers to creating electrode areas were manufactured by wax printing, whereas a three-electrode system was fabricated by a simple stencil approach. A carbon-based working electrode was modified using either reduced graphene oxide or molybdenum disulfide nanosheets modified with gold nanoparticle (AuNPs/RGO, AuNPs/MoS2) hybrid structures. The resulting paper-based biosensors offered sensitive detection of miRNA-155 and miRNA-21 by differential pulse voltammetry (DPV) in only 5.0 µL sample. The duration in our assay from the point of electrode modification to the final detection of miRNA was completed within only 35 min. The detection limits for miRNA-21 and miRNA-155 were found to be 12.0 and 25.7 nM for AuNPs/RGO and 51.6 and 59.6 nM for AuNPs/MoS2 sensors in the case of perfectly matched probe-target hybrids. These biosensors were found to be selective enough to distinguish the target miRNA in the presence of single-base mismatch miRNA or noncomplementary miRNA sequences.
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Affiliation(s)
- Hilal Torul
- Department of Analytical Chemistry, Faculty of Pharmacy, Gazi University, Ankara 06330, Turkey; (H.T.); (U.T.)
| | - Ece Yarali
- Department of Analytical Chemistry, Faculty of Pharmacy, Ege University, Bornova 35100, Turkey; (E.Y.); (E.E.)
| | - Ece Eksin
- Department of Analytical Chemistry, Faculty of Pharmacy, Ege University, Bornova 35100, Turkey; (E.Y.); (E.E.)
| | - Abhijit Ganguly
- School of Engineering, Engineering Research Institute, Ulster University, Newtownabbey BT37 0QB, UK;
| | - John Benson
- 2-DTech, Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK;
| | - Ugur Tamer
- Department of Analytical Chemistry, Faculty of Pharmacy, Gazi University, Ankara 06330, Turkey; (H.T.); (U.T.)
| | - Pagona Papakonstantinou
- School of Engineering, Engineering Research Institute, Ulster University, Newtownabbey BT37 0QB, UK;
| | - Arzum Erdem
- Department of Analytical Chemistry, Faculty of Pharmacy, Ege University, Bornova 35100, Turkey; (E.Y.); (E.E.)
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Larson A, Nardi V, Brinjikji W, Benson J, Lanzino G, Savastano L. Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis. Stroke Vasc Neurol 2021; 7:6-12. [PMID: 34244446 PMCID: PMC8899633 DOI: 10.1136/svn-2021-001122] [Citation(s) in RCA: 6] [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: 05/20/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To systematically analyse prior reports of carotid endarterectomy (CEA) performed in cases of ≤50% carotid stenosis in order to understand patient tolerance and potential benefit. Methods A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English-language search was performed of online databases using librarian-selected search terms. Abstracts were reviewed for relevance which included mention of carotid endarterectomy and stenosis. Prospective or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal (≤50%) luminal stenosis with reported outcomes were included. Results Six studies (which included our institutional series) with a total of 143 patients met the inclusion criteria. The weighted mean age at the time of CEA was 72.3 years; 113 (79.0%) were male. 55.8% of patients with available data had recurrent ipsilateral ischaemic events despite medical therapy. Two patients out of 129 with available perioperative data (1.6%) had perioperative MRI findings of acute ischaemic stroke, both within the hemisphere contralateral to the side of CEA. Of the 138 patients with available follow-up (mean, 36 months), none had recurrent ipsilateral ischaemic events. Conclusions Endarterectomy for symptomatic carotid disease causing ≤50% stenosis may be a potentially beneficial strategy to prevent stroke recurrence. Studies with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.
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Affiliation(s)
- Anthony Larson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Valentina Nardi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Faller E, Wyse A, Barry R, Conlon K, Everard C, Finnegan P, Foran C, Herlihy E, Kerr G, Lapthorne S, McGreal-Bellone A, Morrissey E, O'Sullivan D, O'Sullivan G, Eustace JA, Spillane D, Dempsey C, Benson J, Prentice M, Gallagher J, MacSharry J, Fanning LJ, O'Riordan S, Horgan M, Sadlier C. Seroprevalence study of SARS-CoV-2 antibodies in healthcare workers following the first wave of the COVID-19 pandemic in a tertiary-level hospital in the south of Ireland. BMJ Open 2021; 11:e051415. [PMID: 34103324 PMCID: PMC8189753 DOI: 10.1136/bmjopen-2021-051415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study investigated seroprevalence of SARS-CoV-2-specific IgG antibodies, using the Abbott antinucleocapsid IgG chemiluminescent microparticle immunoassay (CMIA) assay, in five prespecified healthcare worker (HCW) subgroups following the first wave of the COVID-19 pandemic. SETTING An 800-bed tertiary-level teaching hospital in the south of Ireland. PARTICIPANTS Serum was collected for anti-SARS-CoV-2 nucleocapsid IgG using the Abbott ARCHITECT SARS-CoV-2 IgG CMIA qualitative assay, as per the manufacturer's specifications.The groups were as follows: (1) HCWs who had real-time PCR (RT-PCR) confirmed COVID-19 infection (>1-month postpositive RT-PCR); (2) HCWs identified as close contacts of persons with COVID-19 infection and who subsequently developed symptoms (virus not detected by RT-PCR on oropharyngeal/nasopharyngeal swab); (3) HCWs identified as close contacts of COVID-19 cases and who remained asymptomatic (not screened by RT-PCR); (4) HCWs not included in the aforementioned groups working in areas determined as high-risk clinical areas; and (5) HCWs not included in the aforementioned groups working in areas determined as low-risk clinical areas. RESULTS Six of 404 (1.49%) HCWs not previously diagnosed with SARS-CoV-2 infection (groups 2-5) were seropositive for SARS-CoV-2 at the time of recruitment into the study.Out of the 99 participants in group 1, 72 had detectable IgG to SARS-CoV-2 on laboratory testing (73%). Antibody positivity correlated with shorter length of time between RT-PCR positivity and antibody testing.Quantification cycle value on RT-PCR was not found to be correlated with antibody positivity. CONCLUSIONS Seroprevalence of SARS-CoV-2 antibodies in HCWs who had not previously tested RT-PCR positive for COVID-19 was low compared with similar studies.
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Affiliation(s)
- Eamonn Faller
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Adrianne Wyse
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Rachel Barry
- Department of Microbiology, Cork University Hospital, Cork, Ireland
| | - Kevin Conlon
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Cormac Everard
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Paula Finnegan
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Claire Foran
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Emer Herlihy
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | - Gerry Kerr
- Department of Occupational Health, Cork University Hospital Group, Cork, Ireland
| | - Susan Lapthorne
- Department of Microbiology, Cork University Hospital, Cork, Ireland
| | | | - Edmond Morrissey
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
| | | | - Grainne O'Sullivan
- Department of Occupational Health, Cork University Hospital Group, Cork, Ireland
| | - Joseph A Eustace
- School of Medicine, University College Cork, Cork, Cork, Ireland
| | - Declan Spillane
- Department of Microbiology, Cork University Hospital, Cork, Ireland
| | | | - John Benson
- Department of Microbiology, Cork University Hospital, Cork, Ireland
| | - Mike Prentice
- Department of Microbiology, Cork University Hospital, Cork, Ireland
| | - John Gallagher
- Department of Occupational Health, Cork University Hospital Group, Cork, Ireland
| | - John MacSharry
- School of Medicine, University College Cork, Cork, Cork, Ireland
| | - Liam J Fanning
- School of Medicine, University College Cork, Cork, Cork, Ireland
| | | | - Mary Horgan
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
- School of Medicine, University College Cork, Cork, Cork, Ireland
| | - Corinna Sadlier
- Department of Infectious Disease, Cork University Hospital, Cork, Ireland
- School of Medicine, University College Cork, Cork, Cork, Ireland
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Seyedsaadat S, Neuhaus A, Nicholson P, Polley E, Hilditch C, Mihal D, Krings T, Benson J, Mark I, Kallmes D, Brinjikji W, Schaafsma J. Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1104-1108. [PMID: 33926898 PMCID: PMC8191662 DOI: 10.3174/ajnr.a7096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is the leading cause of long-term disability in adults, but our ability to prognosticate from baseline imaging data is limited. The ASPECTS measures ischemic change in the middle cerebral artery territory on noncontrast CT based on 10 anatomic regions. Here, we investigated whether infarction in particular regions was associated with worse long-term outcome. MATERIALS AND METHODS We identified consecutive patients receiving mechanical thrombectomy for ICA/MCA occlusion at 2 comprehensive stroke centers. Pretreatment ASPECTS was assessed by 2 blinded reviewers. Clinical data including demographics, baseline NIHSS score, and 90-day mRS were collected. The relationship between individual ASPECTS regions and the mRS score (0-2 versus 3-6) was assessed using multivariable logistic regression. RESULTS Three hundred fifty-three patients were included (mean age, 70 years; 46% men), of whom 214 had poor outcome (mRS = 3-6). Caudate (OR = 3.26; 95% CI, 1.33-8.82), M4 region (OR = 2.94; 95% CI, 1.09-9.46), and insula (OR = 1.75; 95% CI, 1.08-2.85) infarcts were associated with significantly greater odds of poor outcome, whereas M1 region infarction reduced the odds of poor outcome (OR = 0.38; 95% CI, 0.14-0.99). This finding remained unchanged when restricted to only patients with good recanalization. No significant associations were found by laterality. Similarly, no region was predictive of neurologic improvement during the first 24 hours or of symptomatic intracerebral hemorrhage. CONCLUSIONS Our results indicate that ASPECTS regions are not equal in their contribution to functional outcome. This finding suggests that patient selection based on total ASPECTS alone might be insufficient, and infarct topography should be considered when deciding eligibility for thrombectomy.
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Affiliation(s)
- S.M. Seyedsaadat
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Radiology (S.M.S.), Mayo Clinic, Jacksonville, Florida
| | - A.A. Neuhaus
- Radcliffe Department of Medicine (A.A.N.), University of Oxford, Oxford, UK
| | - P.J. Nicholson
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - E.C. Polley
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C.A. Hilditch
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada,Department of Neuroradiology (C.A.H.), Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - D.C. Mihal
- Department of Radiology (D.C.M.), Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio
| | - T. Krings
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - J. Benson
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - I. Mark
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - D.F. Kallmes
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W. Brinjikji
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
| | - J.D. Schaafsma
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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Vidya R, Leff DR, Green M, McIntosh SA, St John E, Kirwan CC, Romics L, Cutress RI, Potter S, Carmichael A, Subramanian A, O'Connell R, Fairbrother P, Fenlon D, Benson J, Holcombe C. Innovations for the future of breast surgery. Br J Surg 2021; 108:908-916. [PMID: 34059874 DOI: 10.1093/bjs/znab147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/06/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. METHODS Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. RESULTS Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. CONCLUSION Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.
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Affiliation(s)
- R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - D R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Green
- The Walsall NHS Trust, Walsall, UK
| | - S A McIntosh
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - E St John
- Locum Consultant Oncoplastic Breast Surgeon, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - C C Kirwan
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Romics
- New Victoria Hospital Glasgow, Glasgow, UK
| | - R I Cutress
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton, Southampton, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - A Carmichael
- University Hospital of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
| | | | - R O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Benson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,School of Medicine, Anglia Ruskin University, Chelmsford and Cambridge, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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Nardi V, Bois MC, Benson J, Ozcan I, Ahmad A, Meyer F, Lerman L, Lerman A. CAROTID PLAQUES FROM SYMPTOMATIC PATIENTS WITH MILD STENOSIS IS ASSOCIATED WITH INTRAPLAQUE HEMORRHAGE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03209-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taher W, Benson J, Leinster S. The effectiveness of mammography surveillance after treatment of primary breast cancer: A single centre retrospective cohort study. Ann Med Surg (Lond) 2021; 65:102272. [PMID: 33912343 PMCID: PMC8066407 DOI: 10.1016/j.amsu.2021.102272] [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: 02/25/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction There is a little evidence that routine follow-up of patients treated for early breast cancer (BC) to detect ibsilateral breast tumour recurrence (IBTR), or contralateral breast cancer (CBC), is either effective or offers any mortality benefits. We report our experience of following patients with early BC for recurrences and new primaries in order to determine the role of mammogram surveillance. Methods Single centre, retrospective primary observational study was designed. Patients who had BC during year 2001-2006 were included and followed for a minimum of ten years. Patients were divided based on the modalities of detecting BC in to screen detected group and clinically detected one i.e. symptomatic BC. These two groups were compared. Results Total number of patients considered for analysis was 2530 (screen detected BC - 703 patients and symptomatic BC - 1827 patients). The rate of recurrence including regional and distant metastasis in screen detected BC group was 8% (57/703) and 2% (43/1827) in symptomatic one. However, the prevalence of IBTR/CBC in the whole cohort was 2% (62/2530). Mammography surveillance identified 60% (37/62) of patients who had IBTRs/CBCs.Mammography surveillance detected 85% (29/34) of all IBTRs/CBCs in the screen detected BC group. In contrast, it picked up only 29% (8/28) in the other group (Chi squared 20.5 p < 0.005). Conclusions Mammography surveillance is efficient for the screen detected BC group but not for the symptomatic one. Hence, it is worth suggesting different follow-up strategies for both groups. Further studies are therefore recommended.
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Affiliation(s)
- Wafa Taher
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - John Benson
- School of Medicine, Anglia Ruskin School of Medicine, Chelmsford, Cambridge, UK
| | - Samuel Leinster
- Norwich Medical School, University of East Anglia. Norwich Research Park, Norwich, NR4 7TJ, UK
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Desai U, Kharat A, Hess CN, Milentijevic D, Laliberté F, Zuckerman P, Benson J, Lefebvre P, Hiatt WR, Bonaca MP. Incidence of Major Atherothrombotic Vascular Events among Patients with Peripheral Artery Disease after Revascularization. Ann Vasc Surg 2021; 75:217-226. [PMID: 33819600 DOI: 10.1016/j.avsg.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) treated with lower extremity revascularization are at increased risk of major atherothrombotic vascular events (acute limb ischemia (ALI), major non-traumatic lower-limb amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular (CV)-related death). This study assessed the incidence of major atherothrombotic vascular events, venous thromboembolism (VTE) events and rates of subsequent lower extremity revascularizations in the real-world among patients with PAD after revascularization. METHODS Patients aged ≥50 years with PAD who underwent peripheral revascularization were identified from Optum Clinformatics Data Mart claims database (Q1/2014-Q2/2019). The first lower extremity revascularization after PAD diagnosis was defined as index date. Incidence rates of major atherothrombotic vascular events (i.e., composite of ALI, major non-traumatic lower-limb amputation, MI, ischemic stroke, and CV-related death) and VTE were assessed during follow-up as the number of events divided by patient-years of observation (censored at the first event). Rates of subsequent revascularizations and VTE were estimated overall and compared between patients with major atherothrombotic vascular events and those without. RESULTS Of the 38,439 patients included, 6,675 (17.4%) had a major atherothrombotic vascular event during a median follow-up of 1.0 year. The composite major atherothrombotic vascular and VTE incidence rates were 13.81/100 patient years and 1.77/100 patient years, respectively, and 40.2% of patients experienced subsequent revascularizations. Patients with a post-revascularization major atherothrombotic vascular event had significantly higher rates of subsequent revascularizations (64.6% vs. 35.1%, standardized difference [SD] ≥10%) and VTE (4.6% vs. 2.1%, SD ≥10%) versus those without. CONCLUSION One-in-six PAD patients aged ≥50 years who underwent peripheral revascularization experienced a major atherothrombotic vascular event within one year, and consequently, experienced higher rates of subsequent revascularizations compared with those without a major atherothrombotic vascular event post-revascularization. These findings highlight the need to improve strategies to prevent major atherothrombotic vascular events after revascularization.
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Affiliation(s)
- Urvi Desai
- Analysis Group, Inc., Boston, Massachusetts.
| | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Connie N Hess
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
| | | | | | | | | | | | - William R Hiatt
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
| | - Marc P Bonaca
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
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Benson J, Kyriacou H, Giono I, Dumitru D. Abstract PS1-48: Factors influencing choice of contralateral prophylactic mastectomy in patients with unilateral breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-48] [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
Background: Rates of contralateral prophylactic mastectomy (CPM) have more than doubled in the past decade irrespective of inherited predisposition related to high penetrance genes. Increasing numbers of women with unilateral breast cancer are opting for removal of both the affected ipsilateral and contralateral ‘normal’ breast when otherwise suitable for breast conserving surgery. Reasons for this surge in women choosing maximal surgery are poorly understood but trends in CPM are most evident for younger patients (<40 years) and those with non-invasive and stage I disease. Patient decision-making and surgeon interaction may be dominated by ‘fear of recurrence’ and ‘avoidance of decisional regret’ with healthcare professionals feeling pressurized to accede to demands in the wider context of patient-centered care. Methods: A retrospective analysis examined breast cancer patients undergoing unilateral mastectomy with or without CPM between January 2014 and December 2018. Patient information was extracted from an electronic database with documentation of demographic/clinico-pathological details for each group. A cross-sectional survey was undertaken that was compiled and based on validated questionnaires and responses to defined statements generated using a 5-point Likert scale. This questionnaire was posted to patients and contained specific sections relating to reasons for requesting CPM or not. The questionnaire contained a section on pre-surgical discussion and whether the surgeon’s opinion influenced decisions not only for CPM but also immediate breast reconstruction. Results: A total of 403 unilateral therapeutic mastectomy procedures were performed during the study period. The annual number of CPM cases increased by 50% from 14 in 2014 to 20 in 2018. The total number of CPM cases over this period of 5 years was 78 - mean rate of 16.2% per annum. Amongst those CPM patients who were sent questionnaires (n=75), response rate was almost two-thirds (47/75=63%); more than half of respondents (n=46) had simultaneous CPM with immediate breast reconstruction (IBR) whilst 13 patients had immediate CPM without reconstruction. A total of 16 patients had delayed CPM with (n=10) or without (n=6) IBR. The most common reason for seeking CPM was prevention of recurrent breast cancer (mean score 4.5) followed by a desire for “peace of mind” (mean score 4.4). The third most cited reason was to enable patients to move on with their lives as soon as possible (mean score 4.2). Interestingly, patients undergoing CPM were more likely to have no regrets about their decision than patients who chose not to undergo CPM either as a delayed or immediate procedure (mean score 3.0). The least popular reasons for requesting CPM were to avoid regular check ups (mean score 2.7) and to be balanced and minimize chances of back pain (mean score 2.6).Conclusion: This study revealed a relatively high rate of CPM attributable primarily to patient-driven factors including perceived risk of contralateral recurrence, desire for ‘peace of mind’ and resumption of a normal lifestyle. Patients did not sense surgeons being against patient-led proposals for CPM. Patient education is crucial in promoting psychological comfort without the necessity for surgical risk reduction and is consonant with a patient-centric approach that addresses issues of surgical safety and quality of life.
Citation Format: John Benson, Harry Kyriacou, Ilaria Giono, Dorin Dumitru. Factors influencing choice of contralateral prophylactic mastectomy in patients with unilateral breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-48.
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Affiliation(s)
- John Benson
- Cambridge University NHS Hospitals Foundation Trust, Cambridge, United Kingdom
| | - Harry Kyriacou
- Cambridge University NHS Hospitals Foundation Trust, Cambridge, United Kingdom
| | - Ilaria Giono
- Cambridge University NHS Hospitals Foundation Trust, Cambridge, United Kingdom
| | - Dorin Dumitru
- Cambridge University NHS Hospitals Foundation Trust, Cambridge, United Kingdom
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Valappil MO, Ganguly A, Benson J, Pillai VK, Alwarappan S, Papakonstantinou P. Correction: Bismuthene nanosheets produced by ionic liquid assisted grinding exfoliation and their use for oxygen reduction reaction. RSC Adv 2021; 11:6447. [PMID: 35427037 PMCID: PMC8694896 DOI: 10.1039/d1ra90001c] [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] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
Abstract
Correction for ‘Bismuthene nanosheets produced by ionic liquid assisted grinding exfoliation and their use for oxygen reduction reaction’ by Manila Ozhukil Valappil et al., RSC Adv., 2020, 10, 43585–43591, DOI: 10.1039/D0RA09763B.
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Affiliation(s)
| | - Abhijit Ganguly
- Engineering Research Institute
- School of Engineering
- Ulster University
- Newtownabbey BT37 0QB
- UK
| | - John Benson
- 2-DTech Ltd
- Core Technology Facility
- Manchester M13 9NT
- UK
| | | | - Subbiah Alwarappan
- Electrodics and Electrocatalysis Division
- CSIR-Central Electrochemical Research Institute
- Karaikudi
- India
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Desai U, Kharat A, Hess CN, Milentijevic D, Laliberté F, Zuckerman P, Benson J, Lefebvre P, Hiatt WR, Bonaca MP. Healthcare resource utilization and costs of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization. J Med Econ 2021; 24:402-409. [PMID: 33634723 DOI: 10.1080/13696998.2021.1891089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Peripheral artery disease (PAD), often treated with lower extremity revascularization, is associated with risk of major atherothrombotic vascular events (acute limb ischemia [ALI], major non-traumatic lower-limb amputation, myocardial infarction [MI], ischemic stroke, cardiovascular death). This study aims to assess healthcare resource utilization and costs of such events among patients with PAD after revascularization. MATERIALS AND METHODS Patients aged ≥50 years with PAD who were treated with lower-extremity revascularization were identified from Optum Clinformatics Data Mart claims database (01/2014-06/2019). The first lower extremity revascularization after PAD diagnosis was defined as the index date. Patients had ≥6 months of health plan enrollment before the index date. Patients were followed until the earliest of 1) end of enrollment or data; 2) diagnosis of atrial fibrillation or venous thromboembolism; or 3) oral anticoagulant use. All-cause healthcare resource use per-patient-year was compared before and after a major atherothrombotic vascular event post-revascularization among those with an event. Additionally, event-related healthcare costs per-patient-year were reported for each event type. RESULTS Of the 38,439 PAD patients meeting the study criteria, 6,675 (17.4%) had a major atherothrombotic vascular event. On average, patients were observed for 7.3 months before an event and 6.2 months after an event. Patients with an event had significantly higher all-cause healthcare resource use versus similar metrics pre-event (e.g. inpatient visits among those with ALI: 3.5 ± 5.8 post-event vs. 2.0 ± 8.1 pre-event, p < .05). Event-related costs ranged from $57,825±$131,810 per-patient-year for ischemic stroke to $108,302±$150,168 for major non-traumatic lower-limb amputation. LIMITATIONS Data do not contain clinical information. Additionally, results are limited to commercially insured and Medicare Advantage beneficiaries. CONCLUSION Patients with PAD who experience major atherothrombotic vascular events post-revascularization have considerably higher healthcare resource use and costs compared with similar metrics pre-event. Therefore, reducing the rate of such events could reduce overall healthcare costs for this population.
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Affiliation(s)
| | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | | | | | | | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Marc P Bonaca
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
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Rocco N, Montagna G, Di Micco R, Benson J, Criscitiello C, Chen L, Di Pace B, Esgueva Colmenarejo AJ, Harder Y, Karakatsanis A, Maglia A, Mele M, Nafissi N, Ferreira PS, Taher W, Tejerina A, Vinci A, Nava M, Catanuto G. The Impact of the COVID-19 Pandemic on Surgical Management of Breast Cancer: Global Trends and Future Perspectives. Oncologist 2020; 26:e66-e77. [PMID: 33044007 PMCID: PMC7675306 DOI: 10.1002/onco.13560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The rapid spread of COVID-19 across the globe is forcing surgical oncologists to change their daily practice. We sought to evaluate how breast surgeons are adapting their surgical activity to limit viral spread and spare hospital resources. METHODS A panel of 12 breast surgeons from the most affected regions of the world convened a virtual meeting on April 7, 2020, to discuss the changes in their local surgical practice during the COVID-19 pandemic. Similarly, a Web-based poll based was created to evaluate changes in surgical practice among breast surgeons from several countries. RESULTS The virtual meeting showed that distinct countries and regions were experiencing different phases of the pandemic. Surgical priority was given to patients with aggressive disease not candidate for primary systemic therapy, those with progressive disease under neoadjuvant systemic therapy, and patients who have finished neoadjuvant therapy. One hundred breast surgeons filled out the poll. The trend showed reductions in operating room schedules, indications for surgery, and consultations, with an increasingly restrictive approach to elective surgery with worsening of the pandemic. CONCLUSION The COVID-19 emergency should not compromise treatment of a potentially lethal disease such as breast cancer. Our results reveal that physicians are instinctively reluctant to abandon conventional standards of care when possible. However, as the situation deteriorates, alternative strategies of de-escalation are being adopted. IMPLICATIONS FOR PRACTICE This study aimed to characterize how the COVID-19 pandemic is affecting breast cancer surgery and which strategies are being adopted to cope with the situation.
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Affiliation(s)
- Nicola Rocco
- Group for Reconstructive and Therapeutic Advancements (G.Re.T.A.), Milan, Naples, Catania, Italy
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rosa Di Micco
- Breast Surgery, San Raffaele University and Research Hospital, Milan, Italy.,Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - John Benson
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Li Chen
- Breast Center, Southwest Hospital, China Army Medical University, Chongqing, People's Republic of China
| | - Bruno Di Pace
- School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," PhD School of Translational Medicine of Development and Active Aging, University of Salerno, Salerno, Italy.,Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.,Second Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Andreas Karakatsanis
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department for Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Maglia
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Marco Mele
- Breast Surgery Department, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nahid Nafissi
- Department of Breast Surgery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Wafa Taher
- Breast Surgery, Northampton General Hospital, Northampton, United Kingdom
| | - Antonio Tejerina
- Breast Surgery Department, Centro de Patología de la Mama, Fundación Tejerina, Madrid, Spain
| | - Alessio Vinci
- Department of Breast Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Maurizio Nava
- Group for Reconstructive and Therapeutic Advancements (G.Re.T.A.), Milan, Naples, Catania, Italy
| | - Giuseppe Catanuto
- Group for Reconstructive and Therapeutic Advancements (G.Re.T.A.), Milan, Naples, Catania, Italy.,Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
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Borkar N, Provenzano E, Garreffa E, Benson J, Forouhi P, Hugh-Davies L, Wilson C, McAdam K, Russell S, Agrawal A. Does Neo-adjuvant chemotherapy response in the primary breast tumour correlate with axillary response in proven node positive ER positive HER2 negative disease? Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weber WP, Morrow M, Boniface JD, Pusic A, Montagna G, Kappos EA, Ritter M, Haug M, Kurzeder C, Saccilotto R, Schulz A, Benson J, Fitzal F, Matrai Z, Shaw J, Peeters MJV, Potter S, Heil J, González E, Elzayat M, Koller R, Gnant M, Brenelli F, Paulinelli RR, Zobel V, Joukainen S, Karhunen-Enckell U, Kauhanen S, Piat JM, Bjelic-Radisic V, Faridi A, Heitmann C, Hoffmann J, Kneser U, Kümmel S, Kühn T, Kontos M, Tampaki EC, Barry M, Allweis TM, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Gentilini OD, Knox S, Klein B, Koppert L, Gouveia PF, Svensjö T, Bucher HC, Ess S, Ganz-Blättler U, Günthert A, Hauser N, Hynes N, Knauer M, Pfeiffer M, Rochlitz C, Tausch C, Harder Y, Zimmermann F, Schwab FD, D'Amico V, Soysal SD, Castrezana Lopez L, Fulco I, Hemkens LG, Lohsiriwat V, Gulluoglu BM, Karadeniz G, Karanlik H, Sezer A, Gulcelik MA, Emiroglu M, Kovacs T, Rattay T, Romics L, Vidya R, Wyld L, El-Tamer M, Sacchini V. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol 2020; 21:e375-e385. [DOI: 10.1016/s1470-2045(20)30084-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
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Giono I, Tasoulis MK, Cordina C, Lau HY, Agrawal A, Forouhi P, Benson J. P070: Axillary management following Neoadjuvant Chemotherapy (NACT) in node positive patients. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.109] [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] Open
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Thiemann P, Brimicombe J, Benson J, Quince T. When investigating depression and anxiety in undergraduate medical students timing of assessment is an important factor - a multicentre cross-sectional study. BMC Med Educ 2020; 20:125. [PMID: 32326926 PMCID: PMC7181528 DOI: 10.1186/s12909-020-02029-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/01/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. Evidence about students' depression and anxiety including prevalence, trajectory during medical education, gender differences and comparisons with age-matched peers is conflicting. However few studies of medical students' mental health specify the precise time of assessment. Proximity to examinations may be relevant. Precise identification of the time of data collection might help explain contradictory findings and facilitate provision of more timely support. METHODS This study addressed whether: 1)Proximity of final examinations affected students' depression and anxiety symptoms2)Males and females differed in this respect. We analysed data provided by 446 final year students from 6 UK medical schools. These students were a subset of data provided by 14 UK medical schools which participated in an online survey comparing first and final year students and in which final year response rates exceeded 30%. We used the Hospital Anxiety and Depression Scale to assess symptoms of depression and anxiety and the norms to indicate potentially clinically relevant cases. We grouped students into those for whom final exams were imminent i.e. within 2 months of completing the survey (n = 164) and those for whom exams were more distant or had been taken (n = 282). We used parametric and non-parametric tests to compare both groups and gender differences in respect of depression and anxiety sum scores and cases rates. RESULTS For both depression and anxiety male and female students facing imminent final exams recorded greater prevalence and significantly higher mean scores. The effect size of differences for anxiety were large. No substantial gender differences were found for depression. Regardless of the timing of final exams female students recorded both significantly higher mean scores and clinically relevant rates for anxiety. CONCLUSIONS Proximity to final exams negatively affected the mental health of both male and female final year students. The study suggests that there may be times in the undergraduate medical curriculum when additional or targeted support is needed. It also highlights the need for research to provide a greater specificity of context when investigating medical students' mental health.
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Affiliation(s)
- Pia Thiemann
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Benson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Dumitru D, Gnanakumar S, Provenzano E, Benson J. Abstract P4-02-05: Indocyanine green (ICG) fluorescence mapping for sentinel lymph node (SLN) localization in early breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-02-05] [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
Background:Dual localization methods with blue dye and radioisotope are commonly employed for SLN identification but allergic reactions together with staining of skin and surgical tissues disadvantage blue dye. A previous feasibility study using blue dye, radioisotope and ICG confirmed high sensitivity of ICG fluorescence for SLN detection with three-quarters of nodes both radioactive and fluorescent.1 This follow-on study has evaluated a combination of ICG with radioisotope for SLN identification. Methods: In a prospective observational study, 79 patients with unilateral clinically node negative tumors scheduled to undergo routine SLN biopsy for core-biopsy proven invasive (n= 78) or non-invasive (n = 1) breast cancer were identified at multidisciplinary meetings [43 screen-detected; 36 symptomatic]. All patients received dual localization with radiocolloid (Technetium nanocolloid, 20MBq) and ICG (0.5%) and had pre-operative axillary ultrasound. The number of nodes was recorded numerically and whether radioactive, fluorescent or both. Lymphatic and nodal tissue were visualized with a Photodynamic Eye camera and sensitivity of individual tracers alone and in combination calculated. Institutional approval was granted for use of ICG instead of blue dye. Statistical analysis was performed using Stata (version 15.1) with student t-test for normal distribution and Mann-Whitney test for other variables. The main objective was to assess non-inferiority of fluorescent (ICG) compared with standard radioisotopic localization. This was based on a confidence interval for the difference in percentage detection rate with a non-inferiority margin of 5%. Results: A total of 162 nodes were retrieved from 79 patients with an average nodal count of 2.04 (range 1 - 4) and an overall identification rate of 98.7% (78/79). Amongst these excised nodes, 154 displayed uptake of tracer and were either fluorescent, radioactive or both (8 nodes were removed incidentally or were palpably suspicious and tracer negative). More than 90% (151/154) of nodes were fluorescent and 73.4% (113/154) were radioactive with at least 10% activity of the hottest node. These results yielded an overall concordance rate of 71.4%. Nodal detection rates for ICG alone or combined with radioisotope were 98.1% (151/154) and 73.4% (113/154) respectively whilst procedural detection rates were 97.5% (77/79) for radioisotope and 98.7% (78/79) for ICG. Metastases were present in 13 nodes (all fluorescent and hot) with 13 patients having a single positive node containing macrometastases (n= 5), micrometastases (n = 6) or isolated tumor cells (n = 2). The node positivity rate was 14.1% for macro- or micrometastases and 2.5% for isolated tumor cells. ICG was non-inferior to radioisotope for both procedural and nodal detection rates with the lower confidence interval not crossing within the pre-defined limit. No serious adverse reactions were recorded. Conclusion: ICG fluorescence imaging permits real-time visualization of lymphatics and provides an additional dimension to SLN biopsy that is safe and effective. These results confirm high sensitivity for fluorescence localization with comparable performance to the gold standard using radioisotope. ICG can reliably be employed as a sole tracer that avoids potential drawbacks of standard tracer agents including availability and costs of radioisotope.
1. Wishart GC, Jones LC, Loh S-W, Benson JR. A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer. Eur J Surg Oncol 2012; Jun 13
Citation Format: Dorin Dumitru, Sujit Gnanakumar, Elena Provenzano, John Benson. Indocyanine green (ICG) fluorescence mapping for sentinel lymph node (SLN) localization in early breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-05.
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Affiliation(s)
- Dorin Dumitru
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sujit Gnanakumar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Elena Provenzano
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John Benson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Brinjikji W, Benson J, Rabinstein AA, Kallmes DF. Abstract WMP20: Effect of Leukoaraiosis on Outcomes of Mechanical Thrombectomy and Proposed New Leukoaraiosis-Aspects Score. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp20] [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
Background and Purpose:
Leukoaraiosis is a poor prognostic marker for patients with acute ischemic stroke (AIS). This study sought to assess if severity of leukoaraiosis is associated with outcome in patients with AIS following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score to improve its predictive value for good outcome.
Methods:
We analyzed consecutive patients with AIS that underwent mechanical thrombectomy for anterior circulation large vessel occlusion at our comprehensive stroke center. Leukoaraiosis burden was graded using the Fazekas scale (combined scores from two locations categorically divided into no leukoaraiosis (score = 0), mild (1-2), moderate (3-4) and severe (5-6)). The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting values from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe).
Results:
Of 174 included patients, 89 (51.2%) were female; average age was 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (p=0.0005) as well as those that were successfully revascularized (p=0.0002). A multivariate analysis confirmed that leukoaraiosis burden was associated with worse 90-day mRS among all patients (mild: p=0.006; moderate: p=0.002; severe: p=0.03), as well as those that underwent successful thrombectomies (p=0.005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the association was stronger with L-ASPECTS (p<0.0001 and AUC=0.7 for L-ASPECTS; p=0.04 and AUC=0.59 for ASPECTS).
Conclusion:
Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.
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D’Aoust JY, Sewell AM, Greco P, Benson J, Boleszczuk P, Brodsky M, Cirigliano M, Coignaud C, Fain A, Flowers R, Gour L, Hamann WT, Huszczynski G, Jesset K, Konkel P, Lacasse P, Laffey PJ, Laperriere G, Mclntyre K, Morrow A, Oggel J, Philippe LM, Purvis U, Richter ER, Thomas MD, West W, Zandstra W. Detection of Salmonella in Dry Foods Using Refrigerated Pre-Enrichment and Enrichment Broth Cultures: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.4.814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
An interlaboratory study was performed in 11 laboratories to validate the use of pre-enrichment and tetrathionate brilliant green (TBG35) and selenite cystine (SC35) enrichment cultures refrigerated 72 h at 2-5°C for greater analytical flexibility in the detection of Salmonella in dry foods. Productivities of refrigerated pre-enrichment and enrichment cultures were compared with that of the AOAC/Bacteriological Analytical Manual (BAM) procedure using 4 food types: whole egg powder, milk chocolate, animal feed, and instantized skim milk powder. Uninoculated and inoculated samples were included in each food group. There was complete agreement between the results obtained by the standard AOAC/BAM procedure and the 2 refrigeration procedures. Of 660 samples tested, the AOAC/BAM procedure identified 393 contaminated samples that were readily detected from the corresponding refrigerated pre-enrichment cultures and from the combined productivity of homologous refrigerated TBG35 and SC35 cultures. Refrigeration (72 h) of preenrichment or enrichment cultures for greater analytical flexibility and laboratory productivity in the examination of dry foods is under review for adoption by AOAC International.
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Affiliation(s)
- Jean-Yves D’Aoust
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
| | - Anne M Sewell
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
| | - Paula Greco
- Health and Welfare Canada, Food Directorate, Sir EG. Banting Research Centre, Tunney’s Pasture, Ottawa, ON, Kl A 0L2, Canada
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Ozhukil Valappil M, Ganguly A, Benson J, Pillai VK, Alwarappan S, Papakonstantinou P. Bismuthene nanosheets produced by ionic liquid assisted grinding exfoliation and their use for oxygen reduction reaction. RSC Adv 2020; 10:43585-43591. [PMID: 35519672 PMCID: PMC9058491 DOI: 10.1039/d0ra09763b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 11/25/2020] [Indexed: 01/12/2023] Open
Abstract
We report the simple synthesis of bismuthene nanosheets (BiNS) by ionic liquid assisted grinding exfoliation, followed by size selection sequential centrifugation steps for the first time. The exfoliation process results in the formation of self-assembled spherule-like superstructures with abundant edge sites, which are able to catalyze the oxygen reduction reaction (ORR) via a two-electron pathway, with a higher efficiency than the bulk Bismuth. We rationalize the enhanced ORR activity of the BiNS to: (i) the presence of 1 dimensional topological edge states, which provide strong conduction channels for electron hopping between the bismuth layers and (ii) the more active role of edge sites in facilitating O2 adsorption and dissociation of O–O bonds compared to the basal plane. The present study provides a pathway for employing 2D topological insulators as a new class of electrocatalysts for clean energy applications. Bismuthene nanosheets were synthesized by ionic liquid assisted grinding exfoliation. Solvent evaporation led to the formation of self-assembled nanospherules. The electron rich edges of the nanosheets enhanced the oxygen reduction reaction.![]()
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Affiliation(s)
- Manila Ozhukil Valappil
- Engineering Research Institute
- School of Engineering
- Ulster University
- UK
- Electrodics and Electrocatalysis Division
| | - Abhijit Ganguly
- Engineering Research Institute
- School of Engineering
- Ulster University
- UK
| | | | | | - Subbiah Alwarappan
- Electrodics and Electrocatalysis Division
- CSIR-Central Electrochemical Research Institute
- Karaikudi
- India
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Liao Y, Benson J, Higgins S, Drakatos P, Kaler J, O'Regan D, Tsai CC, Gnoni V, Muza R, Nesbitt A, Young A, Stokes P, Leschziner G, Rosenzweig I. Sleep architecture and comorbid sleep disorders in patients with bipolar affective disorder and recurrent depressive disorder. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.357] [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: 11/25/2022]
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Nair V, Bik-Yu Hui A, Chabon J, Esfahani M, Stehr H, Nabet B, Benson J, Chaudhuri A, Zhou L, Ayers K, Bedi H, Ramsey M, Van Wert R, Sung A, Lui N, Backhus L, Berry M, Massion P, Shrager J, Alizadeh A, Diehn M. P2.05-01 Broad Genomic Profiling of Bronchoalveolar Lavage Fluid in Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1600] [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]
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Karacosta L, Anchang B, Ignatiadis N, Kimmey S, Benson J, Shrager J, Sung A, Neal J, Wakelee H, Tibshirani R, Bendall S, Plevritis S. OA08.03 A Single-Cell Resolution Map of EMT and Drug Resistance States for Evaluating NSCLC Clinical Specimens. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.449] [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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Benson J, Burgstahler M, Zhang L, Rischall M. The value of structured radiology reports to categorize intracranial metastases following radiation therapy. Neuroradiol J 2019; 32:267-272. [PMID: 31017073 DOI: 10.1177/1971400919845365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Radiology descriptions of intracranial metastases following radiotherapy are often imprecise. This study sought to improve such reports by creating and disseminating a structured template that encourages discrete categorization of intracranial lesions. METHODS Following initiation of the structured template, a retrospective review assessed patients with intracranial metastases that underwent radiotherapy, comparing 'pre-template' with 'post-template' reports. A total of 139 patients were included; 94 patients (67.6%) were imaged pre-template, 45 (32.4%) post-template. Reports were assessed for discrete versus non-specific descriptions of lesions: '(presumed) new metastases', 'treated metastases', and 'indeterminate lesions'. Non-specific language was subdivided based on the type of lesion(s) described: e.g. 'stable enhancing foci' was deemed a non-specific description of 'treated metastases'. RESULTS Non-specific descriptions of lesions were used in 25/94 reports (26.6%) pre-template, and eight reports (17.8%) post-template. No significant difference was found in the frequency of inappropriate/ambiguous descriptions of intracranial lesions following template initiation (P = 0.52). However, only 27/45 (60.0%) of the reports in the post-template time period used the structured report; the other reports were written as free prose. Of the reports that did use the structured template, the authors used significantly less ambiguous language structured template (P = 0.02). CONCLUSION When utilized, a structured report template resulted in decreased non-specific descriptions and improved discrete characterization of intracranial metastases in patients treated with radiation. However, the frequency of non-specific language usage before and after template initiation was unchanged, probably due to poor compliance with template utilization.
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Affiliation(s)
| | | | - Lei Zhang
- 3 Clinical and Translational Science Institute, University of Minnesota, USA
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Kim B, Dave R, Potter S, Langlands F, Weston-Petrides G, Ashken L, Benson J, Tansley A, Doughty J. Is the current training pathway for oncoplastic breast surgeons fit for purpose? ACTA ACUST UNITED AC 2019. [DOI: 10.1308/rcsbull.2019.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We take a look at the results of a Mammary Fold members' survey to find out.
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Affiliation(s)
- B Kim
- Leeds Teaching Hospitals NHS Trust
| | - R Dave
- Manchester University NHS Foundation Trust
| | - S Potter
- Royal Liverpool and Broadgreen University Hospitals Trust
| | | | | | | | - J Benson
- Cambridge University Hospitals NHS Foundation Trust
| | - A Tansley
- Royal Liverpool and Broadgreen University Hospitals Trust
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Early F, Wilson P, Deaton C, Wellwood I, Dickerson T, Ward J, Jongepier L, Barlow R, Singh SJ, Benson J, Brimicombe J, Kim L, Haque H, Fuld J. Developing an intervention to increase REferral and uptake TO pulmonary REhabilitation in primary care in patients with chronic obstructive pulmonary disease (the REsTORE study): mixed methods study protocol. BMJ Open 2019; 9:e024806. [PMID: 30670521 PMCID: PMC6347857 DOI: 10.1136/bmjopen-2018-024806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a progressive lung disease associated with breathlessness, inability to exercise, frequent infections, hospitalisation and reduced quality of life. Pulmonary rehabilitation (PR), providing supervised exercise and education, is an effective and cost-effective treatment for COPD but is significantly underused. Interventions to improve referral and uptake have been tested and some positive results reported. However, interventions are diverse and no clear recommendations for practice can be made. This study aims to understand the challenges to referral and uptake in primary care, where most referrals originate, and to develop a flexible toolkit of resources to support referral and uptake to PR in primary care in the UK. METHODS AND ANALYSIS This is a mixed methods study informed by normalisation process theory and burden of treatment theory. In the first phase, general practitioners, practice nurses and PR providers will be invited to complete an online survey to inform a broad exploration of the topic areas. In phase 2 interviews and focus groups will be conducted with patients, healthcare professionals (HCP) in primary care, PR providers and commissioners to gain an in-depth understanding of the issues and needs. Toolkit development in phase 3 will draw together the learning from phases 1 and 2 and employ an iterative development process to build the toolkit jointly with patients and HCPs. It will be tested in primary care for usability and acceptability. ETHICS AND DISSEMINATION The study has ethical and Health Research Authority approval (Research Ethics Committee reference number 17/EE/0136). It is registered with the International Standard Registered Clinical/Social Study Number (ISRCTN) registry (trial ID: ISRCTN20669629, assignment date 20 March 2018, trial start date 1 April 2016). Dissemination will be aimed at patients, carers/families, service providers, commissioners and national interest groups. Methods will include conferences, presentations, academic publications and plain English reports and will be supported by the British Lung Foundation. TRIAL REGISTRATION NUMBER ISRCTN20669629 ; Pre-results.
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Affiliation(s)
- Frances Early
- Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patricia Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Christi Deaton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ian Wellwood
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Terry Dickerson
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Lianne Jongepier
- COPD Team, NHS North East Essex Clinical Commissioning Group, Colchester, UK
| | - Ruth Barlow
- Provide Community Interest Company, Colchester, UK
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John Benson
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lois Kim
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Hena Haque
- Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan Fuld
- Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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