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Foley CM, McKenna D, Gallagher K, McLellan K, Alkhdher H, Lacassagne S, Moraitis E, Papadopoulou C, Pilkington C, Al Obaidi M, Eleftheriou D, Brogan P. Systemic juvenile idiopathic arthritis: The Great Ormond Street Hospital experience (2005-2021). Front Pediatr 2023; 11:1218312. [PMID: 37780048 PMCID: PMC10536248 DOI: 10.3389/fped.2023.1218312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a complex, systemic inflammatory disorder driven by both innate and adaptive immunity. Improved understanding of sJIA pathophysiology has led to recent therapeutic advances including a growing evidence base for the earlier use of IL-1 or IL-6 blockade as first-line treatment. We conducted a retrospective case notes review of patients diagnosed with sJIA over a 16-year period (October 2005-October 2021) at Great Ormond Street Hospital for Children. We describe the clinical presentation, therapeutic interventions, complications, and remission rates at different timepoints over the disease course. We examined our data, which spanned a period of changing therapeutic landscape, to try and identify potential therapeutic signals in patients who received biologic treatment early in the disease course compared to those who did not. A total of 76-children (female n = 40, 53%) were diagnosed with sJIA, median age 4.5 years (range 0.6-14.1); 36% (27/76) presented with suspected or confirmed macrophage activation syndrome. A biologic disease-modifying anti-rheumatic drug (bDMARD) alone was commenced as first-line treatment in 28% (n = 21/76) of the cohort; however, at last review, 84% (n = 64/76) had received treatment with a bDMARD. Clinically inactive disease (CID) was achieved by 88% (n = 67/76) of the cohort at last review; however, only 32% (24/76) achieved treatment-free CID. At 1-year follow-up, CID was achieved in a significantly greater proportion of children who received treatment with a bDMARD within 3 months of diagnosis compared to those who did not (90% vs. 53%, p = 0.002). Based on an ever-increasing evidence base for the earlier use of bDMARD in sJIA and our experience of the largest UK single-centre case series described to date, we now propose a new therapeutic pathway for children diagnosed with sJIA in the UK based on early use of bDMARDs. Reappraisal of the current National Health Service commissioning pathway for sJIA is now urgently required.
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Affiliation(s)
- C. M. Foley
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. McKenna
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. Gallagher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - K. McLellan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - H. Alkhdher
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - S. Lacassagne
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - E. Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - C. Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - M. Al Obaidi
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - D. Eleftheriou
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - P. Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Khadhouri S, Orecchia L, Banthia R, Piazza P, Mak D, Pyrgidis N, Narayan P, Abad Lopez P, Nawaz F, Thanh T, Claps F, Hogan D, Gomez Rivas J, Alonso S, Chibuzo I, Meghana K, Anbarasan T, Gallagher K, Kasivisvanathan V. External validation of the IDENTIFY risk calculator. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00654-1] [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: 02/12/2023]
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Ferrara M, Gallagher K, Yoviene Sykes LA, Markovich P, Li F, Pollard JM, Imetovski S, Cahill J, Guloksuz S, Srihari VH. Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative. Psychiatr Serv 2022; 73:1416-1419. [PMID: 35652190 PMCID: PMC9715806 DOI: 10.1176/appi.ps.202100374] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Duration of untreated psychosis (DUP), the period between psychosis onset and entry into care, is a time of great vulnerability. Longer DUP predicts poorer outcomes, and delayed treatment access can limit the effectiveness of coordinated specialty care (CSC) services. This column details one component of a broader early detection campaign, a quality improvement intervention focusing on reducing the delay between confirmation of eligibility and admission to care within a benchmark period of 7 days. Median delay significantly fell (from 13.5 to 3 days), and the proportion of admissions that met the benchmark increased (from 33% to 71%) over 4 years. This intervention provides a sustainable model to reduce wait times at CSC services.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Keith Gallagher
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Laura A Yoviene Sykes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Philip Markovich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Fangyong Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Jessica M Pollard
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Shannon Imetovski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - John Cahill
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz)
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Flatt A, Sheikh S, Peleckis A, Gallagher K, Alvarado P, Hadjiliadis D, Stefanovski D, Gallop R, Rubenstein R, Rickels M, Kelly A. 580 Preservation of beta-cell function in pancreatic insufficient cystic fibrosis with highly effective cystic fibrosis transmembrane conductance regulator modulator therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McNeill A, Hassan M, Taylor L, Rawlinson A, Good D, Gallagher K. Patient reported outcomes using EPIC-26 one year Post-RP: The impact of surgical approach and training. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00783-2] [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: 10/16/2022] Open
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Senapedis W, Gallagher K, Figueroa E, Farelli J, O'Donnell C, Newman J, McCauley T. P-307 Modulation of the MYC oncogene using programmable epigenetic mRNA therapeutics as a novel therapy for hepatocellular carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.396] [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: 11/17/2022] Open
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Haddad P, Hammoud D, Gallagher K. PO-09: Risk of intracranial hemorrhage of direct oral anticoagulants (DOACs) versus low molecular weight heparin (LMWH) in brain cancers: a meta-analysis of comparative studies. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Black C, Lo E, Gallagher K. Community Mental Health Centers' Roles in Depolicing Medicine. AMA J Ethics 2022; 24:E218-E225. [PMID: 35325523 DOI: 10.1001/amajethics.2022.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
America faces widespread gun violence and police brutality against Black citizens and persons with severe mental illness (SMI). Violence perpetrated against unarmed patients is common in health care, and evidence-based safety measures are needed to acknowledge and eradicate clinical violence. Community mental health centers (CMHCs) serve many patients of color and persons with SMI, so their overreliance on police or building security deserves ethical and clinical consideration. Policing of Black persons' health care begins in powerful, false narratives that White persons need protection from dangerous Black citizens who reside in urban areas or who have mental illness. This article considers White supremacist origins of the myths making CMHCs sites of policing and trauma rather than safety and healing and offers recommendations for advancing policy and practice.
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Affiliation(s)
- Carmen Black
- Assistant professor of psychiatry at the Yale University School of Medicine in New Haven, Connecticut, with a primary clinical appointment at the Connecticut Mental Health Center
| | - Emma Lo
- Assistant professor of psychiatry at the Yale University School of Medicine in New Haven, Connecticut
| | - Keith Gallagher
- Assistant professor of psychiatry at the Yale University School of Medicine in New Haven, Connecticut
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Gallagher K, Ferrara M, Pollard J, Yoviene Sykes L, Li F, Imetovski S, Cahill J, Mathis W, Srihari VH. Taking the next step: Improving care transitions from a first-episode psychosis service. Early Interv Psychiatry 2022; 16:91-96. [PMID: 35029048 DOI: 10.1111/eip.13127] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
AIMS First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these time-limited services. METHODS A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months are presented. A planning phase was followed by recurrent Plan-Do-Study-Act cycles (PDSA) that included the introduction of proactive efforts targeting disposition planning (with patients and families) and follow-up to facilitate transfer after discharge. Fisher's exact test was used to compare disposition and transfer outcomes across the QI phases. RESULTS This QI approach was sustained through a three-fold escalation in discharge volume. Transfer status at 3 months was significantly different between the pre- and post PDSA phases (p = .02). A greater proportion were confirmed transfers post-PDSA (54.3 vs. 37%), but of those with known status at 3 months, similar proportions were successfully transferred (76, 73%). Patients discharged post-PDSA were less likely to have unknown treatment status (26 vs. 51%). Disposition outcomes were also significantly improved post-PDSA (p = .03). Patients were more likely to engage with discharge planning (69.7 vs. 48.6%) and less likely to be lost to follow-up (13.8 vs. 25.7%), or to refuse assistance (11.0 vs. 20.0%). CONCLUSION This QI approach offers a feasible way to improve disposition and transfer after FES and can be built upon in efforts to sustain functional gains in onward pathways.
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Affiliation(s)
- Keith Gallagher
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Maria Ferrara
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Jessica Pollard
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Laura Yoviene Sykes
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences (YCAS), New Haven, Connecticut, USA
| | - Shannon Imetovski
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - John Cahill
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Walter Mathis
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
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Hall J, Fried D, Marks L, Gupta G, Jones E, Elmore S, Downs-Canner S, Gallagher K, Carr J, Ogunleye Y, Casey D. Dosimetric and Clinical Factors Associated With Increased Risk of Reconstruction Complications in Patients With Breast Cancer Receiving Post-Mastectomy Radiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bottomley C, Otiende M, Uyoga S, Gallagher K, Kagucia EW, Etyang AO, Mugo D, Gitonga J, Karanja H, Nyagwange J, Adetifa IMO, Agweyu A, Nokes DJ, Warimwe GM, Scott JAG. Quantifying previous SARS-CoV-2 infection through mixture modelling of antibody levels. Nat Commun 2021; 12:6196. [PMID: 34702829 PMCID: PMC8548402 DOI: 10.1038/s41467-021-26452-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022] Open
Abstract
As countries decide on vaccination strategies and how to ease movement restrictions, estimating the proportion of the population previously infected with SARS-CoV-2 is important for predicting the future burden of COVID-19. This proportion is usually estimated from serosurvey data in two steps: first the proportion above a threshold antibody level is calculated, then the crude estimate is adjusted using external estimates of sensitivity and specificity. A drawback of this approach is that the PCR-confirmed cases used to estimate the sensitivity of the threshold may not be representative of cases in the wider population-e.g., they may be more recently infected and more severely symptomatic. Mixture modelling offers an alternative approach that does not require external data from PCR-confirmed cases. Here we illustrate the bias in the standard threshold-based approach by comparing both approaches using data from several Kenyan serosurveys. We show that the mixture model analysis produces estimates of previous infection that are often substantially higher than the standard threshold analysis.
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Affiliation(s)
- C Bottomley
- International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - M Otiende
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - S Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Gallagher
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - E W Kagucia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - A O Etyang
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D Mugo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Gitonga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - H Karanja
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Nyagwange
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - I M O Adetifa
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - A Agweyu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - D J Nokes
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences, University of Warwick, Coventry, UK
| | - G M Warimwe
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - J A G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
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Boyle C, Gallagher K, Leung S, Good D, McNeill SA, Laird A. 218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic. Br J Surg 2021. [PMCID: PMC8524596 DOI: 10.1093/bjs/znab259.1072] [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] [Indexed: 11/20/2022]
Abstract
Aim Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff. Method From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases. Results 87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening. Conclusions Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.
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Affiliation(s)
- C Boyle
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - K Gallagher
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - S Leung
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - D Good
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - S A McNeill
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
| | - A Laird
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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Ferrara M, Guloksuz S, Mathis WS, Li F, Lin IH, Syed S, Gallagher K, Shah J, Kline E, Tek C, Keshavan M, Srihari VH. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1359-1369. [PMID: 33948678 PMCID: PMC8319102 DOI: 10.1007/s00127-021-02090-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Delay in receiving effective treatment for psychosis adversely impacts outcomes. We investigated the timing of the first help-seeking attempt in individuals with recent onset non-affective psychosis by comparing those who sought help during the prodrome to those who sought help after psychosis onset across sociodemographic and clinical characteristics, overall functioning, and occurrence of aversive events during their pathways to care. METHODS Patients were admitted from February 1st, 2014 to January 31st, 2019 to the Program for Specialized Treatment Early in Psychosis (STEP) in New Haven, CT. Psychosis-onset date was ascertained using the Structured Interview for Psychosis-risk Syndromes. Key dates before and after psychosis onset, along with initiators and aversive events, were collected via semi-structured interview. RESULTS Within 168 individuals, 82% had their first help-seeking episode after psychosis onset and did not differ in terms of sociodemographic characteristics from prodrome help seekers. When the first help-seeking episode started before (i.e., during prodrome) vs after psychosis onset it was mostly initiated by patients vs family members (Cramer's V = 0.23, p = 0.031) and led to a faster prescription of an antipsychotic once full-blown psychosis emerged (time to antipsychotic since psychosis onset = 21 vs 56 days, p = 0.03). No difference in aversive events before STEP enrollment was detected across groups. CONCLUSION Help seeking during the prodrome is associated with faster initiation of antipsychotic treatment and is more likely to be self-initiated, compared to help seeking after psychosis onset. Early detection efforts that target prodromal samples may improve the length and experience of pathways to care.
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Affiliation(s)
- Maria Ferrara
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA.
| | - Sinan Guloksuz
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, MHeNs, Maastricht University, Maastricht, The Netherlands
| | - Walter S Mathis
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Fangyong Li
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - I-Hsin Lin
- Center for Science and Social Science Information, YCAS Yale University, PO Box 208111, New Haven, CT, 06520, USA
| | - Sumaiyah Syed
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Keith Gallagher
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Jai Shah
- PEPP-Montreal, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Emily Kline
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cenk Tek
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vinod H Srihari
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
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14
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Khadhouri S, Gallagher K, MacKenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambiar A, Mannas M, Lee T, Marra G, Gomez Rivas J, Marcq G, Assmus M, Ucar T, Claps F, Boltri M, Montagna GL, Burnhope T, Nkwam N, Austin T, Boxall N, Downey A, Sukhu T, Anton-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green J, Nielsen M, Takwoingi Y, McGrath J, Kasivisvanathan V. 92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study. Br J Surg 2021. [PMCID: PMC8135806 DOI: 10.1093/bjs/znab135.029] [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] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.
Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.
Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.
Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
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Affiliation(s)
- S Khadhouri
- University of Aberdeen, Aberdeen, United Kingdom
- BURST, London, United Kingdom
| | - K Gallagher
- Western General Hospital, Edinburgh, United Kingdom
- BURST, London, United Kingdom
| | - K MacKenzie
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - T Shah
- Charing Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - C Gao
- Addenbrookes Hospital, Cambridge, United Kingdom
- BURST, London, United Kingdom
| | - S Moore
- Wrexham Maelor Hospital, Wrexham, United Kingdom
- BURST, London, United Kingdom
| | - E Zimmermann
- Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
- BURST, London, United Kingdom
| | - E Edison
- Whipps Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - M Jefferies
- Morriston Hospital, Swansea, United Kingdom
- BURST, London, United Kingdom
| | - A Nambiar
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - M Mannas
- University of British Columbia, Vancouver, Canada
| | - T Lee
- University of British Columbia, Vancouver, Canada
| | - G Marra
- University of Turin, Turin, Italy
| | | | - G Marcq
- University of Lille, Lille, France
| | - M Assmus
- University of Alberta, Edmonton, Canada
| | - T Ucar
- Istanbul Medeniyet University, Istanbul, Turkey
| | - F Claps
- University of Trieste, Trieste, Italy
| | - M Boltri
- University of Trieste, Trieste, Italy
| | | | - T Burnhope
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - N Nkwam
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Austin
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - N Boxall
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - A Downey
- Doncaster Royal Infirmary, Doncaster, United Kingdom
| | - T Sukhu
- University of North Carolina Hospitals, Chapel Hill, USA
| | | | - S Rai
- St James University Hospital, Leeds, United Kingdom
| | - Y F Chin
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - M Moore
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Drake
- The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - J Green
- Whipps Cross Hospital, London, United Kingdom
| | - M Nielsen
- University of North Carolina Hospitals, Chapel Hill, USA
| | - Y Takwoingi
- University of Birmingham, Birmingham, United Kingdom
| | - J McGrath
- University of Exeter Medical School, Exeter, United Kingdom
| | - V Kasivisvanathan
- University College London, London, United Kingdom
- BURST, London, United Kingdom
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15
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Light A, Gallagher K, Bhatt N, Clement K, Kulkarni MA, Khadhouri S, Zimmermann E, Gao C, Lam C, Anbarasan T, Chan V, Rossi S, Jayaraajan K, Asif A, Shah T, Kasivisvanathan V. 377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.
Method
RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.
Results
As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusions
RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.
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Affiliation(s)
- A Light
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Gallagher
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Western General Hospital, Edinburgh, United Kingdom
| | - N Bhatt
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Queen Elizabeth Hospital, King's Lynn, United Kingdom
| | - K Clement
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Royal Alexandra Hospital, Paisley, United Kingdom
| | - M a Kulkarni
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Guy's Hospital, London, United Kingdom
| | - S Khadhouri
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - E Zimmermann
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Torbay Hospital, Torbay, United Kingdom
| | - C Gao
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- William Harvey Hospital, Ashford, United Kingdom
| | - C Lam
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Bronglais Hospital, Aberystwyth, United Kingdom
| | - T Anbarasan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - V Chan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leeds School of Medicine, Leeds, United Kingdom
| | - S Rossi
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Jayaraajan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Imperial College School of Medicine, London, United Kingdom
| | - A Asif
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leicester Medical School, Leicester, United Kingdom
| | - T Shah
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Charing Cross Hospital, London, United Kingdom
| | - V Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- University College London, London, United Kingdom
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Sarkar M, Uppala R, Zeng C, Billi A, Tsoi L, Kidder A, Xing X, Perez White B, Shao S, Plazyo O, Sirobhushanam S, Xing E, Jiang Y, Gallagher K, Voorhees J, Kahlenberg J, Gudjonsson J. 168 STING-IFN-κ-APOBEC3G pathway mediates resistance to CRISPR transfection in keratinocytes. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Wolf S, Audu C, Joshi A, denDekker A, Melvin W, Xing X, Wasikowski R, Tsoi L, Kunkel S, Gudjonsson J, O'Riordan M, Kahlenberg J, Gallagher K. 633 Regulation of IFN kappa in keratinocytes of diabetic wounds. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Lam CM, Gallagher K, Bhatt N, Clement K, Zimmermann E, Shah T, Khadhouri S, Kulkarni M, Gao C, Light A, Jayaraajan K, Asif A, Anbarasan T, Chan V, Kasivisvanathan V. P57 Global recruitment for the RESECT study (transurethral REsection and Single-instillation intravesical chemotherapy Evaluation in bladder Cancer Treatment) - an international observational cohort study aiming to improve the quality of surgery for non-muscle invasive bladder cancer. BJS Open 2021. [PMCID: PMC8153804 DOI: 10.1093/bjsopen/zrab032.056] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.
Methods
RESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.
Results
As of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusion
RESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.
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Affiliation(s)
- C M Lam
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Gallagher
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - N Bhatt
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Clement
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - E Zimmermann
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Shah
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - S Khadhouri
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - M Kulkarni
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - C Gao
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Light
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Jayaraajan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Asif
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Anbarasan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Chan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Kasivisvanathan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
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Haddad P, Gallagher K, Hammoud D. PO-07 Comparison of primary thromboprophylaxis agents (PTA) efficacy in multiple myeloma (MM) treated with immunomodulators (IMID): a network meta-analysis. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Haddad P, Hammoud D, Gallagher K. P26.01 Survival Impact of Adjuvant Postoperative Radiation Therapy (PORT) in Locally Advanced Thymic Carcinoma (TC): An Up-To-Date Meta-Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Haddad P, Hammoud D, Gallagher K. P26.02 The Impact of Clinicopathologic Factors on the Overall Survival of Thymic Neuroendocrine Tumors (TNET): A Pooled Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Gallagher K. What Will White Psychiatrists Sacrifice? Psychiatr Serv 2021; 72:227-228. [PMID: 32966165 DOI: 10.1176/appi.ps.711201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Keith Gallagher
- Department of Psychiatry, Yale University, New Haven, Connecticut. Patricia E. Deegan, Ph.D., and William C. Torrey, M.D., are editors of this column
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23
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Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKM. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop 2021. [PMID: 32862265 DOI: 10.1007/s00264-020-04739-y/figures/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. METHODS A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. RESULTS Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. CONCLUSION COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
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Affiliation(s)
- A Narang
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - G Chan
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - A Aframian
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Z Ali
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - A Carr
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - H Goodier
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - C Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Park
- St Mary's Hospital, London, London, UK
| | - K Sugand
- St Mary's Hospital, London, London, UK
| | - T Walton
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Wilson
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - A Belgaumkar
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - K Gallagher
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - K Ghosh
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - C Gibbons
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Keightley
- Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Z Nawaz
- Frimley Park Hospital, Camberley, UK
| | - C Wakeling
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - K Sarraf
- St Mary's Hospital, London, London, UK
| | - B A Rogers
- Brighton and Sussex University Hospitals, Brighton, UK
| | - W K M Kieffer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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24
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Millman ZB, Gallagher K, Demro C, Schiffman J, Reeves GM, Gold JM, Rakhshan PJ, Fitzgerald J, Andorko N, Redman S, Buchanan R, Rowland L, Waltz JA. Evidence of reward system dysfunction in youth at clinical high-risk for psychosis from two event-related fMRI paradigms. Schizophr Res 2020; 226:111-119. [PMID: 30995969 PMCID: PMC6801019 DOI: 10.1016/j.schres.2019.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/11/2022]
Abstract
Abnormal reward processing is thought to play an important role in the development of psychosis, but relatively few studies have examined reward prediction errors, reinforcement learning (RL), and the reward circuitry that subserves these interconnected processes among individuals at clinical high-risk (CHR) for the disorder. Here, we present behavioral and functional neuroimaging results of two experimental tasks designed to measure overlapping aspects of reward processing among individuals at CHR (n = 22) and healthy controls (n = 19). We found no group differences in response times to positive, negative, or neutral outcome-signaling cues, and no significant differences in brain activation during reward anticipation or receipt. Youth at CHR, however, displayed clear RL impairments, as well as attenuated responses to rewards and blunted prediction error signals in the ventral striatum, dorsal anterior cingulate cortex (dACC), and ventromedial prefrontal cortex (vmPFC). Greater contrasts for cue valence (gain-loss) and outcome magnitude (large-small) in the vmPFC were associated with more severe negative symptoms, and deficits in dACC signaling during RL were associated with more depressive symptoms. Our results provide evidence for RL deficits and abnormal prediction error signaling in the brain's reward circuitry among individuals at CHR, while also suggesting that reward motivation may be relatively preserved at this stage in development. Longitudinal studies, medication-free participants, and comparison of neurobehavioral measures against both healthy and clinical controls are needed to better understand the role of reward system abnormalities in the development of psychosis.
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Affiliation(s)
- Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Keith Gallagher
- Department of Psychiatry, University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore MD 21201 USA
| | - Caroline Demro
- Department of Psychiatry, University of Minnesota Medical School, 2312 S. 6th St., Floor 2, Suite F-275, Minneapolis, MD, 55454
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| | - Gloria M. Reeves
- Department of Psychiatry, University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore MD 21201 USA
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - Pamela J. Rakhshan
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - John Fitzgerald
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Nicole Andorko
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Samantha Redman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Robert Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - Laura Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
| | - James A. Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, 55 Wade Ave, Catonsville, MD, 21228
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25
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Haddad P, Hammoud D, Gallagher K. Comparison of Treatment Modalities in Frontline Therapy of Stages I&IIE NK/T-Cell Lymphoma (ENKTL): An Updated Network Meta-analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.911] [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: 11/30/2022]
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26
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Haddad P, Akhtar F, Gallagher K. The Impact of Postoperative Radiation Therapy (PORT) on Clinical Outcomes of Resected Atypical Meningioma: A Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.168] [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: 11/30/2022]
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27
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Haddad P, Hammoud D, Gallagher K. The Survival Impact of Adding Postoperative Radiation Therapy (PORT) to Adjuvant Therapies in Locally Advanced Resected Thymic Carcinoma (TC): A Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haddad P, Hammoud D, Gallagher K. The Impact of Postoperative Radiation Therapy (PORT) on the Overall Survival (OS) of Completely Resected Masaoka/Masaoka-Koga Stage II Thymoma: An Updated Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1176] [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: 10/23/2022]
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Marcq G, Olivier J, Xylinas E, Ouzaid I, Lebacle C, Uzan A, Schneider A, Bardet F, Pradère B, Khadhouri S, Gallagher K, Mackenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambia A, Kasivisvanathan V. Étude de la détection des néoplasies urologiques chez les patients consultant pour suspicion de cancer du tractus urinaire : résultat d’IDENTIFY étude multicentrique prospective. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.163] [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: 10/23/2022]
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Bazan J, Stephens J, Agnese D, Skoracki R, Reiland J, Arneson K, Gupta G, Gallagher K, McElroy S, Park K, Grignol V, Lee C, Sisk G, Schulz S, Chetta M, Jhawar S, Grecula J, Martin D, Carson W, Farrar W, Carlson M, Gupta N, White J. PO-0933: Prospective Evaulation Of Iort Boost In Women Undergoing Lumpectomy With Oncoplastic Reconstruction. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haddad P, Hammoud D, Gallagher K. The Impact of Adjuvant Chemoradiotherapy on the Overall Survival of Completely Resected Ampullary and Periampullary Carcinoma: An Updated Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1788] [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: 10/23/2022]
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Murphy SC, Negron ME, Pieracci EG, Deressa A, Bekele W, Regassa F, Wassie BA, Afera B, Hajito KW, Walelign E, Abebe G, Newman S, Rwego IB, Mutonga D, Gulima D, Kebede N, Smith WA, Kramer LM, Kibria A, Bonnenfant YT, Mortenson JA, Vieira AR, Kadzik M, Sugerman D, Amare B, Kanter T, Walke H, Belay E, Gallagher K. One Health collaborations for zoonotic disease control in Ethiopia. REV SCI TECH OIE 2019; 38:51-60. [PMID: 31564741 DOI: 10.20506/rst.38.1.2940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.
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Presley C, Janse S, Anderson E, Gallagher K, Ferris A, Janssen E, Basu Roy U, Bridges J. P1.16-21 Does Age Affect What Patients Value When Considering Lung Cancer Treatments? Evidence from a National Survey. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1247] [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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Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Abstract OT2-04-04: Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-04] [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: In women amenable to breast conserving therapy, lumpectomy followed by adjuvant whole breast irradiation (WBI) remains the standard of care. Randomized trials demonstrate that addition of a lumpectomy cavity boost significantly reduces the risk of ipsilateral breast tumor recurrences but also increases the risk of breast fibrosis. Contemporary randomized trials define the lumpectomy cavity boost volume as a 1.7 cm isometric expansion on the lumpectomy cavity as delineated on CT. However, identifying the lumpectomy cavity can be challenging, especially in women that receive adjuvant chemotherapy and in cases in which surgical clips are not present. Recently, the use of oncoplastic techniques in breast conserving surgery has increased. These techniques are used to prevent the poor cosmetic results that can occur when a large volume of breast tissue is resected. Women that undergo oncoplastic reconstruction represent especially difficult cases for lumpectomy cavity delineation. Retrospective series have evaluated the use of intraoperative electron radiotherapy (IOERT) as a boost prior to WBI in women receiving lumpectomy without oncoplastic reconstruction. In the largest series of IOERT boost prior to WBI the local control rate of this approach was >99%. Prospective data regarding IOERT boost in women undergoing oncoplastic reconstruction are limited. The advantages of this approach include direct visualization/irradiation of the tumor bed, sparing the skin of irradiation, and reducing the treatment time by ˜1 week. We hypothesize that IOERT boost followed by WBI will result in acceptably low rates of grade 3 fibrosis in women undergoing lumpectomy with oncoplastic reconstruction.
Trial Design: This is a single-arm, prospective study to evaluate the safety, toxicity and efficacy of IOERT boost at the time of breast conserving surgery in women with early-stage breast cancer undergoing oncoplastic reconstruction. Eligible women will receive 1 dose of 8 Gy to the surgical bed after lumpectomy but prior to oncoplastic reconstruction. Women will then receive adjuvant WBI of 40 Gy in 15 fractions or 50 Gy in 25 fractions.
Eligibility: Key criteria include age≥18 yo, clinically node-negative stage I/II, any breast cancer subtype.
Specific Aims: To determine the rate of grade 3 breast fibrosis at 1 year. Additional aims include surgical complication rates, cosmesis, and local regional cancer control.
Statistical Methods: Safety will be evaluated by the rate of surgical complications necessitating hospital readmission or return to the operating room within 30 days of surgery+IOERT. If ≥4 events in the first 10 patients, ≥7 events in the first 20 patients, or ≥9 events in the first 30 patients are seen, the study will be halted. We hypothesize that the grade 3 fibrosis rate in our study will be ≤5%. Assuming an actual rate of 4%, an unacceptable rate of 9%, and a drop-out rate of 10%, the expected sample size is 176.
Sites: Ohio State University, Avera Medical Group, University of North Carolina-Chapel Hill
Patient Accrual: Current accrual is 5/176.
Contact Information: Jose Bazan (jose.bazan2@osumc.edu)
Funding Source: Intraop Medical
Citation Format: Bazan JG, Stephens J, Agnese D, Skoracki R, Arneson K, Reiland J, Gupta G, Gallagher K, McElroy S, Gupta N, White JR. Multi-institution phase II trial of intraoperative electron beam radiotherapy boost at the time of breast conserving surgery with oncoplastic reconstruction in women with early-stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-04-04.
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Affiliation(s)
- JG Bazan
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Stephens
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - D Agnese
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - R Skoracki
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Arneson
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - J Reiland
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - G Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - K Gallagher
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - S McElroy
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - N Gupta
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - JR White
- The Ohio State University, Columbus, OH; Avera Medical Group, Sioux Falls, SD; University of North Carolina-Chapel Hill, Chapel Hill, NC
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Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Abstract PD8-07: Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-07] [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
INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings.
METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing partial mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard partial mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention.
RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of partial mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors.
FactorShave (n=197)No Shave (n=201)p-valueAge (years); median (range)67 (36-94)64 (29-89)0.585Race 0.062-- White173 (87.8%)164 (81.6%) -- Black20 (10.2%)33 (16.4%) -- Asian2 (1.0%)2 (1.0%) -- Native American0 (0%)2 (1.0%) -- Unknown/Declined2 (1.0%)0 (0%) Hispanic ethnicity28 (14.2%)32 (15.9%)0.806Invasive tumor size (cm); median (range)1.30 (0.09-8.00)1.20 (0.05-7.50)0.282DCIS extent (cm); median (range)0.80 (0.10-6.40)1.00 (0.05-5.50)0.906Invasive histology 0.556-- Ductal177 (89.8%)186 (92.5%) -- Lobular16 (8.1%)13 (6.5%) -- Mucinous3 (1.5%)2 (1.0%) -- Other1 (0.5%)0 (0%) Neoadjuvant therapy15 (7.6%)19 (9.5%)0.592Palpable tumor57 (28.9%)56 (27.9%)0.825Node positive*24 (16.3%)16 (10.6%)0.175*Of the 298 patients who had lymph nodes evaluated
Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p<0.001). They were also less likely to require re-excision or mastectomy for margin clearance (8.6% vs. 23.9%, p<0.001). There were no significant differences between the two groups in terms of adverse events (p=0.280). Rates of seroma (1.5% vs. 0.5%, p=0.368), hematoma (0.5% vs. 0.5%, p=1.000) and abscess (0.3% vs. 0%, p=0.495) were similar between the “shave” and “no shave” groups, respectively.
CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing partial mastectomy.
Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.
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Affiliation(s)
- AB Chagpar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - T Tsangaris
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - C Garcia-Cantu
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Howard-McNatt
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Chiba
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AC Berger
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Levine
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JS Gass
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - K Gallagher
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SS Lum
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - RD Martinez
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - AI Willis
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SV Pandya
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - EA Brown
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Fenton
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - A Mendiola
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Murray
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - V Haddad
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NL Solomon
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Senthil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - H Bansil
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Ollila
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - SK Snyder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - D Edmonson
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Lazar
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - JP Namm
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - F Li
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - M Butler
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - NE McGowan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - ME Herrera
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - YP Avitan
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - B Yoder
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
| | - E Dupont
- Yale University, New Haven, CT; Thomas Jefferson University, Philadelphia, PA; Doctors Hospital at Renaissance, Edinburg, TX; Wake Forest University, Winston-Salem, NC; Women and Infrants Hospital, Providence, RI; University of North Carolina, Chapel Hill, NC; Loma Linda University, Loma Linda, CA; Beaumont Hospital, Troy, MI; Cleveland Clinic Akron General, Akron, OH; Watson Clinic, Lakeland, FL; MicroPath Laboratories, Lakeland, FL
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Chew E, Gallagher K. CKD rates after radical and partial nephrectomy in patients with normal pre-operative renal function after 8 years of follow-up. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gallagher K, Youssef B, Georges R, Mahajan A, Feghali J, Tannous J, Nabha R, Ayoub Z, Jalbout W, Taddei P. EP-1861: Predicted reduction in fatal second cancers by proton therapy of childhood intracranial tumors. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32170-4] [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: 10/14/2022]
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Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Abstract P4-02-06: Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-06] [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: Applying the PAM50 classifier to targeted RNA-Sequencing data allows HER2+ tumors to be sub-categorized into intrinsic breast cancer subtypes. HER2+ breast cancers belonging to the HER2-enriched [HER2-E] subtype exhibit the highest rate of response to neoadjuvant therapy with combination of HER2-blockade and chemotherapy, as well as dual-HER2 blockade alone. A non-invasive predictor of PAM50 subtype from clinical dynamic contrast-enhanced MRI [DCE-MRI] could provide valuable clinical guidance in the treatment of HER2+ breast cancer. In this work, we identify a set of computer-extracted heterogeneity features computed within the lesion and its surrounding peritumoral region capable of distinguishing HER2-E from other HER2+ breast cancers [Non-HER2-E]. We then demonstrate that this imaging signature of HER2-E is also predictive of pathological complete response [pCR] in an independent HER2+ testing set, consistent with the HER2-E subtype's elevated response to HER2-targeted therapy.
Methods: The training set consisted of 42 HER2+ patients with both 1.5 or 3 T DCE-MRI and targeted RNA sequencing collected prior to neoadjuvant treatment from a multicenter trial [BrUOG 211B, n=35] and The Cancer Genome Atlas-Breast Cancer project [TCGA-BRCA, n=7]. Intrinsic subtypes were assigned by unsupervised hierarchical clustering of the PAM50 gene set. 19 patients were determined to belong to the HER2-E subtype, while the remaining 23 represented non-HER2-E subtypes [19 HER2-Luminal, 4 HER2-basal]. Lesion boundaries were annotated by an expertly trained radiologist and expanded to 5 annular peritumoral regions in 3 mm increments out to a maximum radius of 15 mm. Computer-extracted heterogeneity features were computed voxelwise within intratumoral and peritumoral regions by first order statistics. A top HER2-E-associated feature from each region was identified by Wilcoxon feature selection and used to train a diagonal linear discriminant analysis [DLDA] classifier to predict HER2-E in a 3-fold cross-validation setting. This classifier was then applied to pCR prediction from DCE-MRI in a testing set of 28 HER2+ patients with available post neoadjuvant chemotherapy surgical specimens at one institution. 16 patients achieved pCR (ypT0/is), while the remainder had partial or no response (non-pCR).
Results: A combination of heterogeneity features within the intratumoral region and annular peritumoral regions out to 12 mm from the tumor yielded optimal results within the training set, with an average HER2-E prediction AUC of .77 +/- .03. When applied to response prediction in an independent testing set, this HER2-E classifier was predictive of pCR (AUC = .72).
Conclusions: Computer-extracted heterogeneity features calculated within the tumor and the surrounding peritumoral environment on DCE-MRI were able to distinguish the HER2-E PAM50 intrinsic subtype from other HER2+ breast cancers. HER2-E was characterized by elevated expression of intratumoral and peritumoral heterogeneity features, indicating a more disordered imaging phenotype within and around the tumor. Additional independent validation of these findings is needed.
Citation Format: Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-06.
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Affiliation(s)
- N Braman
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - P Prasanna
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - S Singh
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - N Beig
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - H Gilmore
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - M Etesami
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Bates
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - K Gallagher
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - BN Bloch
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - G Somlo
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - W Sikov
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - L Harris
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Plecha
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - V Varadan
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - A Madabhushi
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
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McDaid J, Abburi C, Wolfman SL, Gallagher K, McGehee DS. Ethanol-Induced Motor Impairment Mediated by Inhibition of α7 Nicotinic Receptors. J Neurosci 2016; 36:7768-78. [PMID: 27445152 PMCID: PMC4951579 DOI: 10.1523/jneurosci.0154-16.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/14/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 01/30/2023] Open
Abstract
UNLABELLED Nicotine and ethanol (EtOH) are among the most widely co-abused substances, and nicotinic acetylcholine receptors (nAChRs) contribute to the behavioral effects of both drugs. Along with their role in addiction, nAChRs also contribute to motor control circuitry. The α7 nAChR subtype is highly expressed in the laterodorsal tegmental nucleus (LDTg), a brainstem cholinergic center that contributes to motor performance through its projections to thalamic motor relay centers, including the mediodorsal thalamus. We demonstrate that EtOH concentrations just above the legal limits for intoxication in humans can inhibit α7 nAChRs in LDTg neurons from rats. This EtOH-induced inhibition is mediated by a decrease in cAMP/PKA signaling. The α7 nAChR-positive allosteric modulator PNU120596 [N-(5-chloro-2,4-dimethoxyphenyl)-N'-(5-methyl-3-isoxazolyl)-urea], which interferes with receptor desensitization, completely eliminated EtOH modulation of these receptors. These data suggest that EtOH inhibits α7 responses through a PKA-dependent enhancement of receptor desensitization. EtOH also inhibited the effects of nicotine at presynaptic α7 nAChRs on glutamate terminals in the mediodorsal thalamus. In vivo administration of PNU120596 either into the cerebral ventricles or directly into the mediodorsal thalamus attenuated EtOH-induced motor impairment. Thus, α7 nAChRs are likely important mediators of the motor impairing effects of moderate EtOH consumption. SIGNIFICANCE STATEMENT The motor-impairing effects of ethanol contribute to intoxication-related injury and death. Here we explore the cellular and neural circuit mechanisms underlying ethanol-induced motor impairment. Physiologically relevant concentrations of ethanol inhibit activity of a nicotinic receptor subtype that is expressed in brain areas associated with motor control. That receptor inhibition is mediated by decreased receptor phosphorylation, suggesting an indirect modulation of cell signaling pathways to achieve the physiological effects.
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Affiliation(s)
- John McDaid
- Department of Anesthesia and Critical Care and
| | | | - Shannon L Wolfman
- Committee on Neurobiology, University of Chicago, Chicago, Illinois 60637
| | | | - Daniel S McGehee
- Department of Anesthesia and Critical Care and Committee on Neurobiology, University of Chicago, Chicago, Illinois 60637
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Abstract
INTRODUCTION Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. METHODS Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. RESULTS There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). CONCLUSIONS The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.
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Affiliation(s)
- W K M Kieffer
- Brighton and Sussex University Hospitals NHS Trust , UK
| | | | - K Gallagher
- Brighton and Sussex University Hospitals NHS Trust , UK
| | - I McFadyen
- University Hospitals of North Midlands NHS Trust, UK , UK
| | - J Bernard
- St George's University Hospitals NHS Foundation Trust, UK , UK
| | - B A Rogers
- Brighton and Sussex University Hospitals NHS Trust , UK
- Brighton and Sussex Medical School, UK , UK
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Kieffer W, Michalik D, Gallagher K, McFadyen I, Bernard J, Rogers B, Flood C. Temporal variation in major trauma admissions: Is there a trauma season? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giulvezan S, Gallagher K, Davies N. Assessment of interlinked double staircase acuity test. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Giulvezan
- Ophthalmology; Chelsea and Westminster Hospital; London United Kingdom
| | - K. Gallagher
- Education; Moorfields Eye Hospital; London United Kingdom
| | - N. Davies
- Ophthalmology; Chelsea and Westminster Hospital; London United Kingdom
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Wong J, Gallagher K, Zhang J. TU-F-CAMPUS-T-02: Vernier Picket Fence Test: A Non-Imaging Method to Localize the Radiation Isocenter with Submillimeter Accuracy. Med Phys 2015. [DOI: 10.1118/1.4925802] [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: 11/07/2022] Open
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Gallagher K, Tannous J, Nabha R, Feghali J, Ayoub Z, Jalbout W, Youssef B, Taddei P. TU-F-CAMPUS-T-05: Replacement Computational Phantoms to Estimate Dose in Out-Of-Field Organs and Tissues. Med Phys 2015. [DOI: 10.1118/1.4925790] [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: 11/07/2022] Open
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Mehta H, Sim DA, Keane PA, Zarranz-Ventura J, Gallagher K, Egan CA, Westcott M, Lee RWJ, Tufail A, Pavesio CE. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis. Eye (Lond) 2015; 29:1060-8. [PMID: 26021867 DOI: 10.1038/eye.2015.65] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/21/2015] [Indexed: 12/31/2022] Open
Abstract
AIM The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). METHODS Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. RESULTS The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA <0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04). CONCLUSION A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.
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Affiliation(s)
- H Mehta
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D A Sim
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - P A Keane
- 1] NIHR Moorfields Biomedical Research Centre, London, UK [2] Institute of Ophthalmology, University London, London, UK
| | - J Zarranz-Ventura
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] Vitreo-Retinal Service, Bristol Eye Hospital, Bristol, UK
| | - K Gallagher
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - M Westcott
- Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R W J Lee
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK [4] School of Clinical Sciences, University of Bristol, Bristol, UK
| | - A Tufail
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK [3] Institute of Ophthalmology, University London, London, UK
| | - C E Pavesio
- 1] Medical Retina and Uveitis Service, Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK [2] NIHR Moorfields Biomedical Research Centre, London, UK
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Affiliation(s)
| | | | - BA Rogers
- Consultant Trauma and Orthopaedic Surgeon
| | - L Leonard
- Consultant Trauma and Orthopaedic Surgeon, Department of Orthopaedics, Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE
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Sauk J, Coron E, Kava L, Suter M, Gora M, Gallagher K, Rosenberg M, Ananthakrishnan A, Nishioka N, Lauwers G, Woods K, Brugge W, Forcione D, Bouma BE, Tearney G. Interobserver agreement for the detection of Barrett's esophagus with optical frequency domain imaging. Dig Dis Sci 2013; 58:2261-5. [PMID: 23508980 PMCID: PMC3732518 DOI: 10.1007/s10620-013-2625-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optical frequency domain imaging (OFDI) is a second-generation form of optical coherence tomography (OCT) providing comprehensive cross-sectional views of the distal esophagus at a resolution of ~7 μm. AIM Using validated OCT criteria for squamous mucosa, gastric cardia mucosa, and Barrett's esophagus (BE), the objective of this study was to determine the inter- and intra-observer agreements by a large number of OFDI readers for differentiating these tissues. METHODS OFDI images were obtained from nine subjects undergoing screening and surveillance for BE. Sixty-four OFDI image regions of interest were randomly selected for review. A training set of 19 images was compiled distinguishing squamous mucosa from gastric cardia and BE using previously validated OCT criteria. The ten readers then interpreted images in a test set of 45 different images of squamous mucosa (n = 15), gastric cardia (n = 15), or BE (n = 15). Interobserver agreement differentiating the three tissue types and BE versus non-BE mucosa was determined using multi-rater Fleiss's κ value. The images were later randomized again and four readers repeated the test 3 weeks later to assess intraobserver reliability. RESULTS All ten readers showed excellent agreement for the differentiation of BE versus non-BE mucosa (κ = 0.811 p < 0.0001) and for differentiating BE versus gastric cardia versus squamous mucosa (κ = 0.866, p < 0.0001). For the four readers who repeated the test, the median intraobserver agreement (BE vs. non-BE) was high (κ = 0.975, IQR: 0.94, 1.0). CONCLUSIONS Trained readers have a high interobserver agreement for differentiating BE, squamous, and gastric cardia mucosa using OFDI.
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Affiliation(s)
- J Sauk
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - E Coron
- Department of Gastroenterology and Hepatology; University Hospital; Nantes, France
| | - L Kava
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Suter
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Gora
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - K Gallagher
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Rosenberg
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - A Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - N Nishioka
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - G Lauwers
- Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
| | - K Woods
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts,Digestive Diseases, Interventional Endoscopy, Emory University School of Medicine; Atlanta, Georgia
| | - W Brugge
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - D Forcione
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - BE Bouma
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - G Tearney
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
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Kieffer WKM, Gallagher K, Rogers BA, Leonard L. Hand infections. Br J Hosp Med (Lond) 2013; 74:C124-C127. [PMID: 23959039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kieffer W, Gallagher K, Rogers B, Leonard L. Hand infections. Br J Hosp Med (Lond) 2013; 74:C124-C127. [PMID: 24145673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Hand infections account for a significant number of attendances to the emergency department, with the NHS reporting an incidence of hand cellulitis alone as 16.4/1000 person years (Office of Population Censuses and Surveys, 1992; Masson, 2002). Prompt treatment allows a rapid return of function; however, delayed diagnosis risks significant disability and suboptimal outcomes for patients. The spectrum of clinical presentation and pathophysiology varies immensely and can be diagnostically challenging.
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Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.010] [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: 10/27/2022]
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