1
|
Palaniyappan N, Peach E, Pearce F, Dhaliwal A, Campos-Varela I, Cant MR, Dopazo C, Trotter J, Divani-Patel S, Hatta AAZ, Hopkins L, Testa G, Bilbao A, Kasmani Z, Faloon S, Mirza DF, Klintmalm GB, Bilbao I, Asrani SK, Rajoriya N, Aravinthan AD. Long-term outcomes (beyond 5 years) of liver transplant recipients-A transatlantic multicenter study. Liver Transpl 2024; 30:170-181. [PMID: 37589505 DOI: 10.1097/lvt.0000000000000244] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
The long-term (>5 y) outcomes following liver transplantation (LT) have not been extensively reported. The aim was to evaluate outcomes of LT recipients who have survived the first 5 years. A multicenter retrospective analysis of prospectively collected data from 3 high volume LT centers (Dallas-USA, Birmingham-UK, and Barcelona-Spain) was undertaken. All adult patients, who underwent LT since the inception of the program to December 31, 2010, and survived at least 5 years since their LT were included. Patient survival was the primary outcome. A total of 3682 patients who survived at least 5 years following LT (long-term survivors) were included. Overall, median age at LT was 52 years (IQR 44-58); 53.1% were males; and 84.6% were Caucasians. A total of 49.4% (n=1820) died during a follow-up period of 36,828 person-years (mean follow-up 10 y). A total of 80.2% (n=1460) of all deaths were premature deaths. Age-standardized all-cause mortality as compared to general population was 3 times higher for males and 5 times higher for females. On adjusted analysis, besides older recipients and older donors, predictors of long-term mortality were malignancy, cardiovascular disease, and dialysis. Implementation of strategies such as noninvasive cancer screening, minimizing immunosuppression, and intensive primary/secondary cardiovascular prevention could further improve survival.
Collapse
Affiliation(s)
- Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
| | - Emily Peach
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | - Fiona Pearce
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, UK
| | | | - Isabel Campos-Varela
- Liver Unit, Department of Medicine, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Matthew R Cant
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Cristina Dopazo
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James Trotter
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Laurence Hopkins
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Angela Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zain Kasmani
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sarah Faloon
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darius F Mirza
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, NIHR Birmingham Biomedical Research, University of Birmingham, Birmingham, UK
| | | | - Itxarone Bilbao
- Department of Hepatobiliopancreatic Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neil Rajoriya
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Immunology & Immunotherapy, University of Birmingham, UK
| | - Aloysious D Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, UK
| |
Collapse
|
2
|
Luton OW, Mortimer M, Hopkins L, Robinson DBT, Egeler C, Smart NJ, Harries R. Is there a role for botulinum toxin A in the emergency setting for delayed abdominal wall closure in the management of the open abdomen? A systematic review. Ann R Coll Surg Engl 2023; 105:306-313. [PMID: 35174720 PMCID: PMC10066655 DOI: 10.1308/rcsann.2021.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency laparotomy for either trauma or non-trauma indications is common and management is varied. Use of the open abdomen technique allowing for planned re-look is an option; however, performing delayed definitive fascial closure (DFC) following this can be a challenge. The use of botulinum toxin-A (BTX) infiltration into the lateral abdominal wall has been well documented within the elective setting; its use within the emergency setting is undecided. This systematic review assesses the efficacy and safety of BTX injection into the lateral abdominal wall muscles in the emergency setting. The primary outcome is DFC rate. METHODS Systematic review was performed according to the PROSPERO registered protocol (CRD42020205130). Papers were dual screened for eligibility, and included if they met pre-stated criteria where the primary outcome was DFC. Articles reporting fewer than five cases were excluded. Bias was assessed using the Cochrane Risk of Bias and Joanna Brigg's appraisal tools. FINDINGS Fourteen studies were screened for eligibility, twelve full texts were reviewed and two studies were included. Both studies showed evidence of bias due to confounding factors and lack of reporting. Both studies suggested significantly higher rates of DFC than reported in the literature against standard technique (90.7% vs 66%); however, these data are difficult to interpret due to strict study inclusion criteria or lack of a control population. CONCLUSION The use of BTX is deemed safe and its effects in the emergency situation may have great potential. Unfortunately, to date, there is insufficient evidence to facilitate opinion.
Collapse
Affiliation(s)
- OW Luton
- Health Education and Improvement Wales, UK
| | | | - L Hopkins
- Health Education and Improvement Wales, UK
| | | | - C Egeler
- Swansea Bay University Health Board, UK
| | - NJ Smart
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - R Harries
- Swansea Bay University Health Board, UK
| |
Collapse
|
3
|
Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
Collapse
Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Lebares CC, Powell AGMT, Lewis WG, Egan RJ. Enhanced stress-resilience training for surgical trainees. BJS Open 2021; 5:6330409. [PMID: 34323917 PMCID: PMC8320339 DOI: 10.1093/bjsopen/zrab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. Method All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. Results Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)). Discussion Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.
Collapse
Affiliation(s)
- O W Luton
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - K Mellor
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C Eley
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - L Hopkins
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - D B T Robinson
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C C Lebares
- University of California, San Francisco, California, USA
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - W G Lewis
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
| |
Collapse
|
5
|
Collins GP, Booth S, Cherrill LR, Slade D, Morland C, Hopkins L, Nagy E, Linton K, Fox CP, Lewis D, Davies A, Turner G, Rees G, Yap C, Cwynarski K. ROMIDEPSIN AND CARFILZOMIB IN RELAPSED / REFRACTORY PERIPHERAL T‐CELL LYMPHOMA WITH ASSESSMENT OF H23B AS A PREDICTIVE BIOMARKER – THE UK NCRI SEAMLESS PHASE 1/2 ROMICAR TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.126_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G. P. Collins
- NIHR Oxford Biomedical Research Centre Churchill Hospital Haematology Oxford UK
| | - S. Booth
- Churchill Hospital Clinical Haematology Oxford UK
| | - L. R. Cherrill
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - D. Slade
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - C. Morland
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - L. Hopkins
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - E. Nagy
- Birmingham University Cancer Research UK Clinical Trials Unit Birmingham UK
| | - K. Linton
- Christie Hospital Medical onology Manchester UK
| | - C. P. Fox
- Nottingham University Hospitals NHS Foundation Trust Haematology Nottingham UK
| | - D. Lewis
- Plymouth Hospitals NHS Trust Haematology Plymouth UK
| | - A. Davies
- University of Southampton CRUK/NIHR Experimental Cancer Medicines Centre Southampton UK
| | - G. Turner
- Oxford University Hospitals NHS Foundation Trust Cellular Pathology Oxford UK
| | - G. Rees
- Oxford University Hospitals NHS Foundation Trust Cellular Pathology Oxford UK
| | - C. Yap
- Institute of Cancer Research Clinical Studies London UK
| | - K. Cwynarski
- University College London Hospitals NHS Foundation Trust Haematology London UK
| |
Collapse
|
6
|
James OP, Stacey B, Hopkins L, Robinson DBT, Luton O, Williams IM, Egan RJ, Bailey DM, Lewis WG. Personal protective equipment impairs pulmonary gas exchange causing systemic hypercapnia-hypoxaemia and cerebral hyperperfusion-induced cephalalgia. Br J Surg 2021; 108:e205-e206. [PMID: 33644815 DOI: 10.1093/bjs/znab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 01/10/2023]
Affiliation(s)
- O P James
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - B Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Treforest, UK
| | - L Hopkins
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - D B T Robinson
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - O Luton
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - I M Williams
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea, UK.,School of Medicine, Swansea University, Swansea, UK
| | - D M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Treforest, UK
| | - W G Lewis
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK.,Department of Surgery, University Hospital of Wales, Cardiff, UK
| | | |
Collapse
|
7
|
Robinson DBT, Powell AGMT, Waterman J, Hopkins L, James OP, Egan RJ, Lewis WG. Predictive value of Altmetric score on citation rates and bibliometric impact. BJS Open 2021; 5:6073389. [PMID: 33609373 PMCID: PMC7893457 DOI: 10.1093/bjsopen/zraa039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Bibliometric and Altmetric analyses provide different perspectives regarding research impact. This study aimed to determine whether Altmetric score was associated with citation rate independent of established bibliometrics. Methods Citations related to a previous cohort of 100 most cited articles in surgery were collected and a 3-year interval citation gain calculated. Citation count, citation rate index, Altmetric score, 5-year impact factor, and Oxford Centre for Evidence-Based Medicine levels were used to estimate citation rate prospect. Results The median interval citation gain was 161 (i.q.r. 83–281); 74 and 62 articles had an increase in citation rate index (median increase 2.8 (i.q.r. –0.1 to 7.7)) and Altmetric score (median increase 3 (0–4)) respectively. Receiver operating characteristic (ROC) curve analysis revealed that citation rate index (area under the curve (AUC) 0.86, 95 per cent c.i. 0.79 to 0.93; P < 0.001) and Altmetric score (AUC 0.65, 0.55 to 0.76; P = 0.008) were associated with higher interval citation gain. An Altmetric score critical threshold of 2 or more was associated with a better interval citation gain when dichotomized at the interval citation gain median (odds ratio (OR) 4.94, 95 per cent c.i. 1.99 to 12.26; P = 0.001) or upper quartile (OR 4.13, 1.60 to 10.66; P = 0.003). Multivariable analysis revealed only citation rate index to be independently associated with interval citation gain when dichotomized at the median (OR 18.22, 6.70 to 49.55; P < 0.001) or upper quartile (OR 19.30, 4.23 to 88.15; P < 0.001). Conclusion Citation rate index and Altmetric score appear to be important predictors of interval citation gain, and better at predicting future citations than the historical and established impact factor and Oxford Centre for Evidence-Based Medicine quality descriptors.
Collapse
Affiliation(s)
- D B T Robinson
- Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - J Waterman
- Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Nantgarw, UK
| | - L Hopkins
- Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Nantgarw, UK
| | - R J Egan
- Morriston Hospital, Cwmrhydceirw, Swansea, UK.,Swansea University, Singleton Park, Sketty, Swansea, UK
| | - W G Lewis
- Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Nantgarw, UK
| |
Collapse
|
8
|
Robinson DBT, Hopkins L, James OP, Brown C, Powell AGMT, Hemington-Gorse S, Abdelrahman T, Lewis WG, Egan RJ. Surgical training rotation design: effects of hospital type, rotation theme and duration. BJS Open 2020; 4:970-976. [PMID: 32706526 PMCID: PMC7528516 DOI: 10.1002/bjs5.50326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/17/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Entrants into UK surgical specialty training undertake a 2-year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. METHODS Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace-based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). RESULTS A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant-validated WBAs completed during core surgical training were 48 (range 0-189), 54 (10-120) and 75 (6-94) during rotations consisting of 4-, 6- and 12-month posts respectively (P < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3-357), 110 (44-394) and 134 (56-366) (P < 0·001) and presentations to learned societies 0 (0-12), 0 (0-14) and 1 (0-5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets. CONCLUSION Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning.
Collapse
Affiliation(s)
- D B T Robinson
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - L Hopkins
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK.,Department of Surgery, Morriston Hospital, Swansea, UK
| | - O P James
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - C Brown
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - S Hemington-Gorse
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - T Abdelrahman
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - W G Lewis
- Wales Postgraduate Medical and Dental Education School of Surgery, Health Education and Improvement Wales, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea, UK.,Swansea Medical School, Swansea University, Swansea, UK
| |
Collapse
|
9
|
Robinson DBT, Powell AGMT, Hopkins L, James OP, Abdelrahman T, Egan R, Lewis WG. Proof of surgical publication prowess: prospective observational study of factors associated with surrogate markers of academic reach. BJS Open 2020; 4:724-729. [PMID: 32490575 PMCID: PMC7397360 DOI: 10.1002/bjs5.50307] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the UK, general surgery higher surgical trainees (HSTs) must publish at least three peer-reviewed scientific articles (as first, second or corresponding author) to qualify for certification of completion of training (CCT). This study aimed to identify the factors associated with success in this arena. METHODS Deanery rosters supplemented with data from the Intercollegiate Surgical Curriculum Programme, PubMed and ResearchGate were used to identify the profiles of consecutive HSTs. Primary outcomes were publication numbers at defined points in higher training (speciality training year (ST) 3-8); secondary outcomes were the Hirsch index and ResearchGate scores. RESULTS Fifty-nine consecutive HSTs (24 women, 35 men) were studied. The median publication number was 3 (range 0-30). At least three published articles were obtained by 30 HSTs (51 per cent), with 19 (38 per cent) of 50 HSTs achieving this by ST4 (of whom 15 (79 per cent) had undertaken out of programme for research (OOPR) time) and 24 (80 per cent) by ST6. Thirteen HSTs (22 per cent) (ST3, 6; ST4, 4; ST5, 2; ST8, 1) had yet to publish at the time of writing. OOPR was associated with achieving three publications (24 of 35 (69 per cent) versus 6 of 24 (25 per cent) with no formal research time; P = 0·001), higher overall number of publications (median 6 versus 1 respectively; P < 0·001), higher ResearchGate score (median 23·37 versus 5·27; P < 0·001) and higher Hirsch index (median 3 versus 1; P < 0·001). In multivariable analysis, training grade (odds ratio (OR) 1·89, 95 per cent c.i. 0·01 to 3·52; P = 0·045) and OOPR (OR 6·55, 2·04 to 21·04; P = 0·002) were associated with achieving three publications. CONCLUSION If CCT credentials are to include publication profiles, HST programmes should incorporate research training in workforce planning.
Collapse
Affiliation(s)
- D B T Robinson
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - L Hopkins
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - T Abdelrahman
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| | - R Egan
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - W G Lewis
- Health Education and Improvement Wales School of Surgery, Nantgarw, UK
| |
Collapse
|
10
|
Abstract
INTRODUCTION Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.
Collapse
Affiliation(s)
- S Lewis
- School of Surgery, Health Education and Improvement Wales.
*Joint first authors
| | - L Hopkins
- School of Surgery, Health Education and Improvement Wales.
*Joint first authors
| | - T Evans
- School of Surgery, Health Education and Improvement Wales.
*Joint first authors
| | - W Lewis
- School of Surgery, Health Education and Improvement Wales.
*Joint first authors
| | - R Harries
- School of Surgery, Health Education and Improvement Wales.
*Joint first authors
| |
Collapse
|
11
|
Wood S, James OP, Hopkins L, Harries R, Robinson DBT, Brown CM, Abdelrahman T, Egan RJ, Lewis WG. Variations in competencies needed to complete surgical training. BJS Open 2019; 3:852-856. [PMID: 31832592 PMCID: PMC6887895 DOI: 10.1002/bjs5.50200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/22/2019] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to analyse the degree of relative variation in specialty-specific competencies required for certification of completion of training (CCT) by the UK Joint Committee on Surgical Training. Methods Regulatory body guidance relating to operative and non-operative surgical skill competencies required for CCT were analysed and compared. Results Wide interspecialty variation was demonstrated in the required minimum number of logbook cases (median 1201 (range 60-2100)), indexed operations (13 (5-55)), procedure-based assessments (18 (7-60)), publications (2 (0-4)), communications to learned associations (0 (0-6)) and audits (4 (1-6)). Mandatory courses across multiple specialties included: Training the Trainers (10 of 10 specialties), Advanced Trauma Life Support (6 of 10), Good Clinical Practice (9 of 10) and Research Methodologies (8 of 10), although no common accord was evident. Discussion Certification guidelines for completion of surgical training were inconsistent, with metrics related to minimum operative caseload and academic reach having wide variation.
Collapse
Affiliation(s)
- S Wood
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - O P James
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - L Hopkins
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R Harries
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - D B T Robinson
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - C M Brown
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - T Abdelrahman
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| | - R J Egan
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK.,Department of Surgery Morriston Hospital, Heol Maes Eglwys Swansea UK
| | - W G Lewis
- Wales Deanery PGMDE School of Surgery Health Education and Improvement Wales, Cefn Coed Nantgarw UK
| |
Collapse
|
12
|
Jeffery DD, Hopkins L, Spevak CJ, Burke HB. Abstract P4-11-05: Opioid prescriptions in the military health system breast cancer population, FY2007 – FY2014. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-11-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Opioid use among individuals with breast cancer is a safety concern because of adverse events including misuse, overdose, and death. To date, there are two published U.S. population-based studies of opioid use among breast cancer patients, both which address persistent opioid use after surgery. Here, we examine rates, amount, and cost of opioids prescribed to breast cancer patients over an 8-year period.
Methods: We used Military Health System (MHS) outpatient, inpatient, and pharmacy claims data to select beneficiaries with a primary diagnoses of breast cancer, fiscal years (FY) 2007- 2014. Logistic regression models were used to identify predictors of having received > 1 opioid prescription within a year, and having received > 4 filled opioid prescriptions within a year. Simple linear regression and multiple regression were used to examine trends and predictors of reimbursed opioid cost.
Results: Among 25,500 non-elderly breast cancer patients treated in the MHS each year, most were age 55-64, located in the southern U.S., and treated in civilian facilities only. On average per year, 75% had surgery, 90% radiation therapy, 19% chemotherapy, and 8% hospice care. Annual rates of receiving > 1 opiate prescription were stable across 8 years, 48.1% (FY2007) to 50.5% (FY2012 and FY2013). The annual number of opioid prescriptions per patient was also stable, 4.26 (FY2014) to 4.39 (FY2007). Average reimbursed cost of opioids steadily increased over time, $135 (FY2007) to $260 (FY2014) (p < 0.001). Based on regression models, the strongest predictors (p < 0.001) of having received > 1 opioid prescription were (in order of statistical significance): surgery, chemotherapy, civilian care only or mixed use civilian and military care, number of physical comorbid conditions, hospice use, and depression. The strongest predictors (p < 0.001) of > 4 opioid prescriptions per year were: depression, hospice use, number of physical comorbidities, and chemotherapy, followed by anxiety disorder, alcohol use disorder, and drug use disorder. The strongest predictors (p < 0.001) of high reimbursed opioid cost were: drug use disorder, hospice use, depression, civilian care only or mixed use civilian and military care, alcohol use disorder, number of physical comorbid conditions, receipt of chemotherapy, fiscal year, and anxiety disorder.
Discussion: Half of individuals with a primary breast cancer diagnosis receive > 1 opioid prescription per year. Four overlapping constructs predict opioid prescriptions and cost: treatment modalities, physical and mental health comorbidities, severity of illness, and system of care. Increased cost over time coincides with current U.S. population reports suggesting rising daily opioid dosage. Despite limitations with claims data, the results suggest that opioid use among breast cancer patients need to be monitored and accompanied by documented clinical management plans. We recommend that oncology providers implement risk reduction strategies including screening for history of substance use and mental health comorbidities, and implementing guidelines specific for cancer patients such as those found in the Veterans Administration/Department of Defense Clinical Practice Guidelines for Opioid Therapy for Chronic Pain, v. 3.0.
Citation Format: Jeffery DD, Hopkins L, Spevak CJ, Burke HB. Opioid prescriptions in the military health system breast cancer population, FY2007 – FY2014 [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 P4-11-05.
Collapse
Affiliation(s)
- DD Jeffery
- Department of Defense, Defense Health Agency, Medical Affairs, Clinical Support Division, Falls Church, VA; Kennell and Associates, Inc., Falls Church, VA; Department of Defense, Defense Health Agency, Walter Reed National Military Medical Center, Bethesda, MD; Department of Defense, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - L Hopkins
- Department of Defense, Defense Health Agency, Medical Affairs, Clinical Support Division, Falls Church, VA; Kennell and Associates, Inc., Falls Church, VA; Department of Defense, Defense Health Agency, Walter Reed National Military Medical Center, Bethesda, MD; Department of Defense, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - CJ Spevak
- Department of Defense, Defense Health Agency, Medical Affairs, Clinical Support Division, Falls Church, VA; Kennell and Associates, Inc., Falls Church, VA; Department of Defense, Defense Health Agency, Walter Reed National Military Medical Center, Bethesda, MD; Department of Defense, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - HB Burke
- Department of Defense, Defense Health Agency, Medical Affairs, Clinical Support Division, Falls Church, VA; Kennell and Associates, Inc., Falls Church, VA; Department of Defense, Defense Health Agency, Walter Reed National Military Medical Center, Bethesda, MD; Department of Defense, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
13
|
Sedra S, Mallick R, Bougie O, Hopkins L, Singh S, Arendas K, Chen I. Risk Factors for Venous Thromboembolism in Women Undergoing Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
14
|
Dewi M, Hopkins L, Davies C. Do vascular surgery interventions increase frailty? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
15
|
Gwilym B, Hopkins L, Cunningham A, Conrad B, Von-Oppell U, Williams I. The Development of Lower Limb Neurology Following Operative and Endovascular Intervention of Thoracoabdominal Aortic Disease in South East Wales. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.546] [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]
|
16
|
Hopkins L, Gaines E, Brown C, Roberts M, Evans T, Lewis M. Comparison of functional outcomes post 10 week home exercise programme and a 10 week supervised exercise programme in intermittent claudication patients. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.485] [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]
|
17
|
Chen I, Mallick R, Singh SS, Hopkins L, Schramm D. Association Between Endometriosis and Surgical Site Infection in Women Undergoing Hysterectomy. J Minim Invasive Gynecol 2016; 22:S168. [PMID: 27678927 DOI: 10.1016/j.jmig.2015.08.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I Chen
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - R Mallick
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - S S Singh
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - L Hopkins
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - D Schramm
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
18
|
Abstract
The paper reports on an intervention to help psychology students write better essays by using an Essay Feedback Checklist (EFC). A sample of first year and third year psychology students were asked to rate their own essays in terms of how confident they felt they had been in meeting the departmental assessment criteria. Tutors used the same rating scale when marking the essays and used any mismatches between their rating and that of the student to target their feedback. The aims of the study were to look at the effects of using the EFC in i) writing an essay and ii) clarifying written tutor feedback. Findings showed some mismatches between students and their tutors particularly in the third year. Students were mainly positive about the EFC, although some comments indicated that more help was needed. The implications of these findings are discussed in terms of an action research framework and student self-assessment.
Collapse
|
19
|
Hopkins L. Acute stroke intervention: The heart of the matter. Cor Vasa 2016. [DOI: 10.1016/j.crvasa.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
20
|
Widimský P, Kožnar B, Abelson M, Blaško P, Lanzer P, Mazighi M, Meuwissen M, Procházka V, Sievert H, de Vries J, Hopkins L. Stent or balloon: How to treat proximal internal carotid artery occlusion in the acute phase of ischemic stroke? Results of a short survey. Cor Vasa 2016. [DOI: 10.1016/j.crvasa.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Brewster DH, Clark D, Hopkins L, Bauer J, Wild SH, Edgar AB, Wallace WH. Subsequent hospitalisation experience of 5-year survivors of childhood, adolescent, and young adult cancer in Scotland: a population based, retrospective cohort study. Br J Cancer 2013; 110:1342-50. [PMID: 24366296 PMCID: PMC3950849 DOI: 10.1038/bjc.2013.788] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 12/28/2022] Open
Abstract
Background: Survivors of childhood, adolescent, and young adult cancer are known to be at risk of late effects of their disease and its treatment. Most population-based studies of cancer survivors have reported on second primary cancers and mortality. The aim of this study was to research acute and psychiatric hospital admission rates and length of stay in 5-year survivors of cancer diagnosed before the age of 25 years. Methods: This was a population-based retrospective cohort study using linked national cancer registry, acute hospital discharge, psychiatric hospital, and mortality records. The study population consisted of 5229 individuals who were diagnosed with cancer before the age of 25 years between 1981 and 2003, and who survived at least 5 years after the date of diagnosis of their primary cancer. Indirect standardisation for age and sex was used to calculate standardised bed days and hospitalisation ratios (SBDR and SHR) for both acute and psychiatric hospital admissions, and absolute excess risks (AERs) compared with the general Scottish population. Results: Five-year survivors of cancer, diagnosed before the age of 25 years, are at increased risk of admission to acute hospitals (SHR 2.8; 95% confidence interval 2.7–2.9) and of spending more time in hospital (SBDR 3.7; 3.6–3.7). Corresponding AERs were 6.4 (6.0–6.6) admissions and 64.8 (64.4–66.9) bed days per 100 cancer survivors per year. In contrast, 5-year survivors were not at higher risk of admission to psychiatric hospital (SHR 0.9; 0.8–1.2), and they spent significantly less time as psychiatric in-patients (SBDR 0.4; 0.4–0.4) compared with the whole population. Conclusion: Using routinely collected linked records, our population-based study has demonstrated increased rates of hospitalisation in 5-year survivors of cancer diagnosed before the age of 25 years. Long-term clinical follow-up of survivors of cancer in this age group should focus on the prevention and treatment of the late effects of cancer in those patients at highest risk of hospitalisation.
Collapse
Affiliation(s)
- D H Brewster
- 1] Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK [2] Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - D Clark
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - L Hopkins
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - J Bauer
- Information Services Division, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - A B Edgar
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| | - W H Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
| |
Collapse
|
22
|
Gupta A, Yao X, Verma S, Mackay H, Hopkins L. Chemotherapy (gemcitabine, docetaxel plus gemcitabine, doxorubicin, or trabectedin) in inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma: a clinical practice guideline. Curr Oncol 2013; 20:e448-54. [PMID: 24155641 PMCID: PMC3805413 DOI: 10.3747/co.20.1357] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
QUESTIONS Does chemotherapy-that is, gemcitabine, gemcitabine plus docetaxel, doxorubicin, or trabectedin-improve clinical outcomes in women with inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma (lms)? Is there a difference in the tumour response rate to chemotherapy between recurrent pelvic disease and extrapelvic metastases in the target patients? METHODS This guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, the Sarcoma Disease Site Group (dsg), and the Gynecologic Cancer dsg. The core methodology was the systematic review. The medline and embase databases (2004 to June 2011), the Cochrane Library, main guideline Web sites, and relevant annual meeting abstracts (2005-2010) were searched. Internal and external reviews were conducted, with final approval by the dsgs and the Program in Evidence-Based Care. CLINICAL PRACTICE GUIDELINE Based on currently available evidence from the medical literature (four single-arm phase ii studies, one arm of a randomized controlled trial, and one abstract), doxorubicin alone, gemcitabine alone, or gemcitabine plus docetaxel may be treatment options in first- or second-line therapy (or both) for women with inoperable, locally advanced, recurrent, or metastatic uterine lms. Hematologic toxicity is common and should be monitored, and granulocyte colony-stimulating factor should be considered when gemcitabine plus docetaxel is used. Other toxicities, such as neurotoxicity, pulmonary toxicity, and cardiovascular toxicity should be monitored. No recommendation is made for or against the use of trabectedin in the targeted patients. No data were available concerning differences in response in recurrent pelvic disease or extrapelvic metastases, or concerning quality of life.
Collapse
Affiliation(s)
- A.A. Gupta
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON
| | - X. Yao
- Cancer Care Ontario, Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON
| | - S. Verma
- Department of Medical Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON
| | - H. Mackay
- Department of Medical Oncology, University Health Network, Princess Margaret Hospital, Toronto, ON
| | - L. Hopkins
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, ON
| |
Collapse
|
23
|
Sarwar KN, Huda MSB, Van de Velde V, Hopkins L, Luck S, Preston R, McGowan BM, Carroll PV, Powrie JK. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab 2013; 98:2362-7. [PMID: 23585661 DOI: 10.1210/jc.2013-1249] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Incidental pituitary hemorrhage, without full pituitary apoplexy, is a recognized radiological finding, but little information exists on its clinical behavior, with most reports describing surgically treated macroprolactinoma or nonfunctioning adenoma. OBJECTIVE Our aim was to characterize the prevalence, natural history, and risk factors associated with pituitary hemorrhage in a large clinic prolactinoma population. DESIGN The design consisted of a retrospective analysis of a clinic population. SETTING The setting was a tertiary endocrine center in a large teaching hospital. PATIENTS We studied three hundred sixty-eight patients with prolactinoma. The presence of hemorrhage was documented on magnetic resonance imaging. MAIN OUTCOME MEASURE The main outcome measures were the prevalence, risk factors, and natural history of pituitary hemorrhage. RESULTS Pituitary hemorrhage was found in 25 patients, giving an overall prevalence of 6.8%, and was significantly higher in macroprolactinoma (20.3%) compared to microprolactinoma (3.1%, P < .0001). Three patients had classical pituitary apoplexy. The majority of patients in the hemorrhage group had macroprolactinomas (16/25 [64%]) and were women (22/25 [88%]). The proportion of women with macroprolactinoma was higher in the hemorrhage group (14/16 macroprolactinomas [87.5%]) than in the nonhemorrhage group (36/63 macroprolactinomas [57.1%], P = .02). The majority of pituitary hemorrhages (92%) were treated conservatively with dopamine agonist therapy for hyperprolactinemia. Eighty-seven percent of patients had complete resolution of their hemorrhage within 26.6 ± 23.3 (mean ± SD) months. The presence of macroprolactinoma (odds ratio 9.00 [95%CI 3.79-23.88], P < .001) and being female (odds ratio 8.03 [95%confidence interval 1.22-52.95], P = .03) were independently associated with hemorrhage. CONCLUSIONS These data show that incidental hemorrhage in prolactinoma is not uncommon. It is more likely to occur in macroprolactinoma, where 1 in 5 develop hemorrhage, and is particularly common in women with macroprolactinoma. The majority are asymptomatic and resolve spontaneously.
Collapse
Affiliation(s)
- K N Sarwar
- Department of Endocrinology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London SE1 9RT, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Gupta AA, Yao X, Verma S, Mackay H, Hopkins L. Systematic chemotherapy for inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma: a systematic review. Clin Oncol (R Coll Radiol) 2013; 25:346-55. [PMID: 23295078 DOI: 10.1016/j.clon.2012.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
The goal of this systematic review was to investigate and compare the treatment effects of systemic chemotherapy (i.e. doxorubicin, gemcitabine, gemcitabine plus docetaxel, or trabectedin) in women with inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma. A 2005 systematic review (searching the literature from 1980 to June 2004) on systemic therapy in advanced uterine sarcoma was used as the basis for this updated review. MEDLINE and EMBASE (from January 2004 to June 2011), the Cochrane Library, some main guideline websites and the American Society of Clinical Oncology and the Connective Tissue Oncology Society annual meeting abstracts were searched. One arm from a randomised controlled trial (RCT), four single-arm phase II trials and one abstract were included in this systematic review. The studies of gemcitabine plus docetaxel have reported numerically longer median overall survival (14.7-17.9 months versus 12.1 months) and numerically higher objective response rates (27-53% versus 25%) than those reported in the study of doxorubicin alone. The combination of gemcitabine plus docetaxel resulted in more toxicity than doxorubicin alone. The available study for single-agent gemcitabine reported a tumour response rate of 21%, which is not superior to the 25% response rate with doxorubicin alone. One abstract (pooling data from two RCTs) failed to show the superiority of gemcitabine plus docetaxel over gemcitabine alone for tumour response rate (23% versus 18%) and progression-free survival (6 versus 4.9 months). To date, there is insufficient evidence to support or refute the use of trabectedin in the target patients. Doxorubicin, gemcitabine, and gemcitabine plus docetaxel are treatment options in women with inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma as first- or second-line therapy. Well-designed and good-quality RCTs are required to investigate the efficacy of chemotherapy and quality of life in target patients with uterine leiomyosarcoma.
Collapse
Affiliation(s)
- A A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
25
|
Jones HG, Hopkins L, Clayton A, McKain E. A perforated duodenal ulcer presenting as inferior lead ST elevation following amphetamine use. Ann R Coll Surg Engl 2012; 94:e144-5. [PMID: 22613281 DOI: 10.1308/003588412x13171221588659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Typical symptoms of duodenal ulcers include epigastric pain, nausea, vomiting, chest pain and shortness of breath. Here we present the case of a 39-year-old man who had a sudden onset of chest and epigastric pain following the use of recreational amphetamines. There were ST changes in the inferior leads of his electrocardiogram, indicating the possibility of a myocardial infarction. Following double contrast computed tomography of the abdomen and an urgent laparotomy, a diagnosis of a perforated duodenal ulcer was made. We discuss the aetiologies, presentation, investigation and treatment of the disorder, and make recommendations on the management.
Collapse
|
26
|
Hopkins L, Chang SH, Kirstein LJ, Fulop T, Malamud SC, Chadha M, Boolbol SK. Does mammography affect the nodal status at presentation in 40- to 49-year-old breast cancer patients? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.55] [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: 11/20/2022] Open
Abstract
55 Background: It has previously been demonstrated that mammographically-detected breast cancers present as earlier stage disease than those detected as a palpable finding. In addition, it is well known that the single most important prognostic indicator in breast cancer is lymph node status. The benefit of screening mammography in women age 40-49 has been questioned recently, and has led to a change in the recommendations by the United States Preventative Services Task Force (USPSTF) to begin screening mammography in the average risk woman at age 50, rather than 40. In this study, we sought to determine whether detection of breast cancer in 40-49 year old women by screening mammography is associated with negative nodal status at presentation. Methods: A prospectively collected database was reviewed to identify 460 women ages 40-49 diagnosed with invasive breast cancer from 2003-2008. The method of detection of the breast cancer was noted, and the lymph node status at presentation was identified. Results: There were 460 eligible patients with invasive breast cancer for whom information regarding nodal status was available. Of these, 205 patients were diagnosed with a mammographic finding, and 255 patients presented with a palpable abnormality. In the group whose cancers were detected on mammography, 18% presented with lymph node metastases. This is significantly lower than the 41% who presented with a palpable finding (p<0.0001). For 40-49 year old women with invasive breast cancer, the likelihood of having a positive lymph node at presentation is 3.2 times higher if her cancer is detected as a palpable abnormality rather than on mammography (odds ratio) (CI: 2.1-5.0) (Table). Conclusions: Our analysis demonstrates that a patient diagnosed with invasive breast cancer in her 40s is more likely to present with lymph node metastases if her cancer is detected as a palpable mass, compared to those detected on mammography. This has certain prognostic importance, and provides an additional rationale for performing screening mammography in women of this age group. [Table: see text]
Collapse
Affiliation(s)
- L. Hopkins
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - S. H. Chang
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - L. J. Kirstein
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - T. Fulop
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - S. C. Malamud
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - M. Chadha
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| | - S. K. Boolbol
- St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, NY; Beth Israel Medical Center, New York, NY
| |
Collapse
|
27
|
Le T, Latifah H, Jolicoeur L, Weberpals J, Faught W, Hopkins L, Fung MFK. Does intraperitoneal chemotherapy benefit optimally debulked epithelial ovarian cancer patients after neoadjuvant chemotherapy? Gynecol Oncol 2011; 121:451-4. [DOI: 10.1016/j.ygyno.2011.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 02/02/2011] [Accepted: 02/09/2011] [Indexed: 11/30/2022]
|
28
|
Heazell AEP, Riches J, Hopkins L, Myers JE. Fetal blood sampling in early labour: is there an increased risk of operative delivery and fetal morbidity? BJOG 2011; 118:849-55. [DOI: 10.1111/j.1471-0528.2011.02922.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Child S, Luck FT, Schofield C, Hopkins L, Nampijja M, Duff S, Taylor J, Otero S, Mannay D, Kefalidou G, Young JB. Reviews: Child Development, Culture and Psychological Development, Discovering Statistics Using SPSS (3rd ed.), Doing Qualitative Research in Psychology: A Practical Guide, Essential Psychology: A Concise Introduction, Movies and Mental Illness: Using Films to Understand Psychopathology (3rd ed.), Psychological Groupwork with Acute Psychiatric Patients, Psychology: The Science of Mind and Behaviour, Theories of Developmental Psychology, Your Psychology Project Handbook: Becoming a Researcher, Loftus Speaks. Psychology Learning & Teaching 2011. [DOI: 10.2304/plat.2011.10.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Simon Child
- School of Psychological Sciences, University of Manchester, United Kingdom
| | | | - Cathy Schofield
- University of Plymouth Colleges, Truro College campus, United Kingdom
| | - Laurence Hopkins
- Department of Psychology, Liverpool Hope University, United Kingdom
| | | | - Simon Duff
- Division of Clinical Psychology, University of Liverpool, United Kingdom
| | - Julie Taylor
- Applied Psychology, University of Cumbria, United Kingdom
| | | | - Dawn Mannay
- School of Social Sciences, Cardiff University, United Kingdom
| | | | | |
Collapse
|
30
|
Margarit L, Taylor A, Roberts MH, Hopkins L, Davies C, Brenton AG, Conlan RS, Bunkheila A, Joels L, White JO, Gonzalez D. MUC1 as a discriminator between endometrium from fertile and infertile patients with PCOS and endometriosis. J Clin Endocrinol Metab 2010; 95:5320-9. [PMID: 20826587 DOI: 10.1210/jc.2010-0603] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Endometrium of fertile women expresses progesterone-regulated Mucin 1 (MUC1) that carries selectin ligands recognized by the human blastocyst. Altered MUC1 expression at the time of implantation may contribute to endometrial infertility. OBJECTIVE The aim was to assess the expression of MUC1 in the endometrium from polycystic ovary syndrome (PCOS), endometriosis, and fertile women in comparison with other hormone-regulated proteins [hydroxysteroid dehydrogenase (HSD) 1, HSD2, estrogen receptor (ER) and progesterone receptor (PR)]. DESIGN AND PATIENTS Endometrial samples were obtained from 33 fertile patients, 26 ovulatory PCOS patients, 15 anovulatory PCOS patients, and 25 endometriosis patients. MAIN OUTCOME MEASURE Immunohistochemistry assessed the expression of MUC1 subunits ER, PR, HSD1, and HSD2 in endometrial epithelium. Endometrial MUC1 expression was quantified by immunoblots and RT-PCR. HSD1 and HSD2 expression was assayed by RT-PCR. RESULTS MUC1ND expression was significantly higher in ovulatory PCOS than in fertile and anovulatory PCOS patients, even after progesterone stimulation. MUC1ND and -CD expression was lower in anovulatory PCOS than in fertile patients. Only MUC1CD expression was lower in endometriosis patients. Endometrial ER expression was significantly higher in PCOS and endometriosis patients, whereas PR expression was significantly higher in PCOS than in fertile patients. The expression of HSD1 was significantly higher in anovulatory PCOS than in fertile patients. Expression of HSD2 was significantly higher in PCOS patients and lower in endometriosis patients. CONCLUSION Expression of MUC1 subunits in the infertile endometrium is significantly different from fertile and appears to be a component of altered gene expression that potentially contributes to endometrial insufficiency.
Collapse
Affiliation(s)
- L Margarit
- Institute of Life Science, School of Medicine, Swansea University, and Abertawe Bro Morgannwg University Trust, Singleton Hospital, Swansea SA2 8PP, Wales, United Kingdom
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Steinman J, Hopkins L, Wang Z. SU-GG-T-95: The Effect of Cloth and Paper Gowns on Skin Dose for 6 MeV Total Skin Electron Treatments. Med Phys 2010. [DOI: 10.1118/1.3468483] [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
|
32
|
Hopkins L, Myla S, Grube E, Eles G, Dave R, Jaff M, Allocco D. Carotid artery revascularisation in high-surgical-risk patients with the NexStent and the FilterWire EX/EZ: 3-year results from the CABERNET trial. EUROINTERVENTION 2010. [DOI: 10.4244/eijv5i8a155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Hopkins L, Pye V, Fraser B, Holt J, Jones K, McLaughlin E. 320. THE ROLE OF FIZZY RELATED 1 IN MALE MEIOSIS. Reprod Fertil Dev 2010. [DOI: 10.1071/srb10abs320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Accurate chromosome segregation during mitosis and meiosis is facilitated by a regulatory complex known as the Anaphase Promoting Cyclosome (APC), an ubiquitin ligase complex that tags proteins with ubiquitin. Subsequently targeted proteins are recognised by the 26S proteosome and degraded. In mammalian cells, two temporally regulated co-activators are required for the APC to function; fizzy and fzr1. In studies of female oocyte development fzr1 has been demonstrated to play an important role in maintaining G2 arrest during meiosis by controlling spatial levels of the cell cycle protein Cyclin B1 but the role of Fzr1 in spermatogenesis remains unknown. Germ cell specific conditional knockout fzr1mice were generated using the DDX4-Cre and flox/flox fzr1 mouse lines and initial gross morphological analysis indicated that at 7 weeks of age null mice possessed significantly smaller testes (21.81mg ± 0.23mg) when compared to heterozygote (99.86mg ± 1.58mg) and wildtype littermates (93.06mg ± 1.16mg) n = 3 P < 0.0001. Quantitative gene expression analysis confirmed almost complete absence of fzr1 transcript in testes (20-fold decrease) in comparison to wild-type. Immunoblotting and immunohistochemistry revealed no expression of Fzr1 protein in meiotic and post meiotic germ cells when compared to heterozygote and wild type littermates. Histomorphological analysis of testes tissue sections revealed Fzr1 null males exhibited spermatogenic arrest and a complete absence of round spermatids with concomitant apoptosis in the residual spermatocytes. Epididymal examination confirmed a complete lack of mature spermatozoa in the cauda epididymis of null males. In contrast, both wild type and heterozygote mice displayed normal spermatogenesis and epididymal sperm analysis indicated no distinguishable differences in seminal characteristics with normal motility, morphology and sperm-zona binding capacity. Based on these observations we hypothesise that Fzr1 plays a significant role in the establishment and maintenance of meiosis possibly through regulation of key cell cycle proteins.
Collapse
|
34
|
Margarit L, Gonzalez D, Lewis PD, Hopkins L, Davies C, Conlan RS, Joels L, White JO. L-selectin ligands in human endometrium: comparison of fertile and infertile subjects. Hum Reprod 2009; 24:2767-77. [PMID: 19625313 PMCID: PMC2763128 DOI: 10.1093/humrep/dep247] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND L-selectin ligands, localized to the luminal epithelium at the time of implantation, may support the early stages of blastocyst attachment. We have assessed the expression of two L-selectin ligands, defined by MECA-79 and HECA-452 monoclonal antibodies, and the sulfotransferase GlcNAc6ST-2, involved in generation of L-selectin ligand epitopes, in the secretory phase of the endometrium from fertile and infertile patients. METHODS Endometrial samples were obtained from 33 fertile, 26 PCOS, 25 endometriosis and 33 patients diagnosed with unexplained infertility. L-selectin ligands and GlcNAc6ST-2 expression was assessed by immunohistochemistry and immunoblotting. RESULTS Immunohistochemical staining of uterine epithelium, from fertile and infertile women, demonstrated differential expression of MECA-79 and HECA-452 epitopes. In fertile women in the secretory phase MECA-79 was more strongly expressed, particularly on the lumen, than in infertile women. HECA-452 staining was significantly stronger in the glands in PCOS and endometriosis patients than in fertile women. GlcNAc6ST-2 expression was reduced in infertile patients, correlating with MECA-79 expression. CONCLUSIONS This study demonstrated significant differences in expression of L-selectin ligands between fertile and infertile women in natural cycles, and could contribute to patient assessment prior to initiating fertility treatment.
Collapse
Affiliation(s)
- L Margarit
- Institute of Life Science, School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Catling S, Williams S, Freites O, Rees M, Davies C, Hopkins L. Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood. Anaesthesia 2008. [PMID: 19032302 DOI: 10.1111/j.1365-2044.2008.05637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
SUMMARY The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.
Collapse
|
36
|
Catling S, Williams S, Freites O, Rees M, Davies C, Hopkins L. Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood. Anaesthesia 2008; 63:1332-8. [PMID: 19032302 DOI: 10.1111/j.1365-2044.2008.05637.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SUMMARY The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.
Collapse
|
37
|
Le T, Hopkins L, Baines KA, Rambout L, Fung-Kee-Fung M. Prospective evaluation of weekly topotecan in recurrent platinum-resistant epithelial ovarian cancer. Int J Gynecol Cancer 2008; 18:428-31. [PMID: 17692088 DOI: 10.1111/j.1525-1438.2007.01041.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Topotecan administered on a weekly basis has been reported to possess antineoplastic activities with lower toxicities than the standard 5-day regimen every 3 weeks. We studied the activity of weekly topotecan regimen in recurrent platinum-resistant epithelial ovarian cancer patients. Ovarian cancer patients with documented platinum-resistant recurrences were treated with weekly intravenous topotecan (4 mg/m2) on days 1, 8, and 15 on a 28-day cycle. Prospective data collection included patients' demographics together with disease- and treatment-related toxicities. Responses were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) and CA125 criteria. Progression-free survival and overall survival time from commencement of weekly treatment were estimated using the Kaplan–Meier method. All P values less than 0.05 were considered to be statistically significant. Twenty-two patients were treated. Weekly topotecan was used most commonly as third-line chemotherapy (range 1–5). A total of 244 weekly treatments were administered, with a median of 12 weekly treatments per patient. Two patients (9%) reported grade 3/4 gastrointestinal and two had grade 3/4 hematologic toxicities respectively. No dose reduction or treatment delay was required. Partial response was observed in two patients (9.1%) and another seven patients (31.8%) showed stable disease. No significant association was observed between best clinical response and patients' initial platinum sensitivity status. The estimated median progression-free survival was 20.9 weeks (95% CI 11.2–30.5) from the start of the weekly regimen. Weekly topotecan is well tolerated in patients with recurrent platinum-resistant ovarian cancer with modest activity.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | | | |
Collapse
|
38
|
Le T, Hopkins L, Faught W, Fung-Kee-Fung M. The lack of significance of Ca125 response in epithelial ovarian cancer patients treated with neoadjuvant chemotherapy and delayed primary surgical debulking. Gynecol Oncol 2007; 105:712-5. [PMID: 17400284 DOI: 10.1016/j.ygyno.2007.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Revised: 02/07/2007] [Accepted: 02/08/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the prognostic significance of Ca125 response to neoadjuvant chemotherapy and delayed primary surgical debulking in epithelial ovarian cancer patients. METHODS Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer patients treated with neoadjuvant chemotherapy. Ca125 response was defined as being a decrease of at least 50% from baseline assessment. Ca125 response was assessed in two phases: prior to surgical debulking to reflect the response to neoadjuvant chemotherapy and at the end of primary chemotherapy to assess the response to debulking surgery and further chemotherapy. Cox proportional hazard models were built to model progression-free intervals using predictor variables of: age, cancer stage, tumour grade, residual disease, and Ca125 response. RESULTS Ninety-one patients were included. About 83% had a positive Ca125 response following three cycles of neoadjuvant chemotherapy preoperatively. Cox regressions revealed two significant predictive variables of prolonged time to first progression: younger age (p=0.002) and microscopic residual disease compared to suboptimal residual disease (p=0.003). Ca125 response to neoadjuvant chemotherapy was not significantly predictive of progression-free survivals. The estimated median survival was 71.42 months (95% CI: 44.34-78.50) in patients with >50% Ca125 decrease from surgery and further chemotherapy whereas in those with no response, the corresponding survival estimate was 44.02 months (95% CI: 33.26-54.79). CONCLUSION The lack of Ca125 response from neoadjuvant chemotherapy is not an independent prognostic factor. All patients treated with neoadjuvant chemotherapy should undergo radical debulking surgery.
Collapse
Affiliation(s)
- T Le
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa General Hospital, Ottawa, Ontario, Canada K1H 8L6.
| | | | | | | |
Collapse
|
39
|
Le T, Shahriari P, Hopkins L, Faught W, Fung Kee Fung M. Prognostic significance of tumor necrosis in ovarian cancer patients treated with neoadjuvant chemotherapy and interval surgical debulking. Int J Gynecol Cancer 2007; 16:986-90. [PMID: 16803473 DOI: 10.1111/j.1525-1438.2006.00594.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to study the significance of tumor necrosis documented at the time of interval surgical debulking after neoadjuvant chemotherapy. Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer patients treated with neoadjuvant chemotherapy. Patients' demographics together with disease characteristics, treatment-related variables, and outcomes were recorded. Cox proportional hazard models were built to model time to progression using predictor variables such as age, cancer stage, tumor grade, residual disease, percentage change in CA125 level from baseline, and degree of necrosis in resected tumor specimens. One hundred one patients were included in the study. Optimal debulking was achieved in 74% of the patients. Cox regressions revealed three significant predictive variables of time to first progression: younger age (hazard ratio [HR] = 0.95, 95% CI 0.92-0.98, P= 0.004), residual disease (P= 0.048), and the absence/minimal tumor necrosis after three cycles of neoadjuvant chemotherapy (HR = 1.97, 95% CI 1.01-3.87, P= 0.048). The estimated median survival was 50.66 months (95% CI 46.12-55.20). The lack of or minimal tumor necrosis after neoadjuvant chemotherapy is an independent risk factor for recurrent disease.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario, Canada.
| | | | | | | | | |
Collapse
|
40
|
Abstract
The objectives of this study were to: a) assess the position of Canadian gynecological oncologists (GOC) toward intraperitoneal (IP) chemotherapy as primary treatment for ovarian cancer, b) initiate a process of communication among GOC, and c) assess the perception of barriers to implementing IP chemotherapy across Canada. An electronic practice survey was mailed to all GOC in January 2006. The response rate was 62%. GOC accept IP chemotherapy as the standard of care in the primary treatment of optimally debulked epithelial ovarian cancer. The majority of respondents were working on implementation strategies at their local institutions. The cost of administration and use of additional resources were identified as sources of moderate and high concerns, respectively. Moderate concerns were expressed with regard to the management of systemic and local toxicity, catheter complications, patients' acceptance, and quality of life. Catheter insertion issues were of low concern to most respondents. Previous experience with IP administration did not significantly impact the perceived level of concern. GOC support the use of IP chemotherapy for appropriate patients with ovarian cancer. This survey identifies important implementation challenges of IP therapy for Canada, and processes must be developed before successful delivery of IP chemotherapy can be realized. This survey serves to initiate a process of communication among GOC. A collaborative effort will be needed to facilitate this change in practice. Further study of the implementation process is warranted as more experience is gained with this modality of treatment.
Collapse
Affiliation(s)
- M Alhayki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
| | | | | | | |
Collapse
|
41
|
Abstract
5026 Background: Despite biologic rationale, endocrine therapeutic strategies have been under investigated in ovarian cancer. This is the first study to report the efficacy of an aromatase inhibitor, E, in patients (pts) with ROC. Methods: This was a pilot, phase II, single-centre, non-comparative, open-label study. Pts with ROC stage II - IV who had received no more than 2 lines of prior chemotherapy, had ECOG PS ≤ 2, and measurable disease or non-measurable disease with a CA 125 ≥ 30 U/mL and/or ascites were eligible. All pts must have received prior platinum and taxane chemotherapy. Treatment consisted of E 25mg p.o. daily until disease progression. The primary endpoint was objective response rate (ORR) and secondary endpoints were time to progression (TTP), duration of response (DR) and toxicity. Results: 24 pts have been enrolled to date. Only 2 pts who withdrew consent or never started E were excluded from this analysis. Subjects had stage III (77%) or IV (18%) ovarian cancer, the majority were grade 3,serous histology. 15 pts (68%) had 2 prior lines of therapy and 7 pts (32%) had only 1 prior line of therapy. Treatment was commenced in the majority immediately after progression on chemotherapy. There were no objective clinical responses; however 8/22 (36%) pts had stable disease (SD) >14 weeks (med. duration 23 wks). One pt remains with SD > 95 wks duration. The median TTP was 8.8 wks. Receptor status was available in 16/22 pts: ER+ (41%), PgR+ (32%), BCL-2+ (23%) and HER2+ (0%). Correlation of ORR/SD with receptors and CA 125 will be presented. Toxicity was evaluated in all pts who received at least one dose of E. Hyponatremia (gr 4), attributed to disease, was observed in 1 pt. All other toxicities were NCI CTC grade ≤ 2: fatigue (14%), hot flashes (9%), skin reaction (5%), and fluid retention (5%). Conclusions: In this highly refractory ROC pt population, E was associated with an impressive, clinically meaningful SD rate of 36%. As this potentially represents a less toxic, well-tolerated therapeutic option for women with ROC, further investigation is warranted. Supported by a grant from Pfizer Canada No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. Verma
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - M. Alhayki
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - T. Le
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - K. Baines
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - L. Rambout
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - L. Hopkins
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - M. Fung Kee Fung
- Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| |
Collapse
|
42
|
Howard A, Rigby C, Thomas D, Northev G, Hopkins L, Evans M, Sarvotham T. WITHDRAWN: A case-control study of risk factors and clinical outcome for ciprofloxacin-resistant campylobacter infection. J Infect 2006. [DOI: 10.1016/j.jinf.2005.11.068] [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: 10/24/2022]
|
43
|
Le T, Hopkins L, Menard C, Hicks-Boucher W, Lefebvre J, Fung Kee Fung M. Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia. Int J Gynecol Cancer 2006; 16:1089-93. [PMID: 16803490 DOI: 10.1111/j.1525-1438.2006.00599.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 11/29/2022] Open
Abstract
The objective of this study was to assess and compare anxiety and distress in patients undergoing colposcopic examinations and loop electrosurgical excision procedure (LEEP). Patients seen for evaluation of cervical intraepithelial neoplasia (CIN) and LEEP were recruited. All patients received further teaching with respect to their abnormality right after the colposcopic evaluation by nursing staff. The Hospital anxiety and Depression Scale (HADS) and the Psychosocial Effects of Abnormal Pap Smears (PEAPS) questionnaires were used to measure and compare distress between the two groups. Linear regression models were built to identify significant predictive variables for psychologic morbidities. Twenty-one colposcopy and 20 LEEP patients participated in this study. No significant demographic differences were noted. Eighty-one percent of patients having colposcopy and 65% of those undergoing LEEP can be classified as having significant anxiety and depression based on the HADS questionnaire. Patients undergoing LEEP scored significantly better than colposcopy patients on the mean total PEAPS score and on the self-belief/cancer concern and effects on sexual relationship dimension scores. Significant psychologic morbidities exist in patients diagnosed with CIN. Face-to-face individualized education and support after colposcopy can decrease patients' distress at subsequent treatment visits.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
44
|
Le T, Shahriari P, Hopkins L, Faught W, Fung MFK. Prognostic significance of tumor necrosis in ovarian cancer patients treated with neoadjuvant chemotherapy and interval surgical debulking. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200605000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of this study was to study the significance of tumor necrosis documented at the time of interval surgical debulking after neoadjuvant chemotherapy. Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer patients treated with neoadjuvant chemotherapy. Patients' demographics together with disease characteristics, treatment-related variables, and outcomes were recorded. Cox proportional hazard models were built to model time to progression using predictor variables such as age, cancer stage, tumor grade, residual disease, percentage change in CA125 level from baseline, and degree of necrosis in resected tumor specimens. One hundred one patients were included in the study. Optimal debulking was achieved in 74% of the patients. Cox regressions revealed three significant predictive variables of time to first progression: younger age (hazard ratio [HR] = 0.95, 95% CI 0.92–0.98, P = 0.004), residual disease (P = 0.048), and the absence/minimal tumor necrosis after three cycles of neoadjuvant chemotherapy (HR = 1.97, 95% CI 1.01–3.87, P = 0.048). The estimated median survival was 50.66 months (95% CI 46.12–55.20). The lack of or minimal tumor necrosis after neoadjuvant chemotherapy is an independent risk factor for recurrent disease.
Collapse
|
45
|
Le T, Hopkins L, Menard C, Hicks-Boucher W, Lefebvre J, Fung MFK. Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia. Int J Gynecol Cancer 2006. [DOI: 10.1136/ijgc-00009577-200605000-00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of this study was to assess and compare anxiety and distress in patients undergoing colposcopic examinations and loop electrosurgical excision procedure (LEEP). Patients seen for evaluation of cervical intraepithelial neoplasia (CIN) and LEEP were recruited. All patients received further teaching with respect to their abnormality right after the colposcopic evaluation by nursing staff. The Hospital anxiety and Depression Scale (HADS) and the Psychosocial Effects of Abnormal Pap Smears (PEAPS) questionnaires were used to measure and compare distress between the two groups. Linear regression models were built to identify significant predictive variables for psychologic morbidities. Twenty-one colposcopy and 20 LEEP patients participated in this study. No significant demographic differences were noted. Eighty-one percent of patients having colposcopy and 65% of those undergoing LEEP can be classified as having significant anxiety and depression based on the HADS questionnaire. Patients undergoing LEEP scored significantly better than colposcopy patients on the mean total PEAPS score and on the self-belief/cancer concern and effects on sexual relationship dimension scores. Significant psychologic morbidities exist in patients diagnosed with CIN. Face-to-face individualized education and support after colposcopy can decrease patients' distress at subsequent treatment visits.
Collapse
|
46
|
Le T, Hopkins L, Baines KA, Rambout L, Al Hayki M, Kee Fung MF. Prospective evaluations of continuous weekly paclitaxel regimen in recurrent platinum-resistant epithelial ovarian cancer. Gynecol Oncol 2005; 102:49-53. [PMID: 16375951 DOI: 10.1016/j.ygyno.2005.11.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 11/04/2005] [Accepted: 11/10/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Paclitaxel administered on a weekly basis has been reported to possess both anti-angiogenic and apoptotic-inducing effects. We investigated the activity of a weekly continuous paclitaxel regimen in patients with recurrent platinum-resistant ovarian cancer. METHODS Patients with recurrent ovarian cancer and documented platinum-resistant disease were treated with weekly intravenous paclitaxel (60-80 mg/m(2)) continuously for up to 24 weeks over an 18-month period. Prospective data collection included: information on patients' demographics together with disease- and treatment-related toxicities. Response was evaluated using radiographic and Ca125 criteria. Chi-square tests were used to test for significant associations between categorical variables. Progression-free survival and overall survival time from commencement of weekly treatment were estimated using the Kaplan-Meier method. All P values less than 0.05 were considered to be statistically significant. RESULTS Thirty-four patients were treated on protocol. Five patients (15%) reported grade 3/4 neurotoxicity at the end of 12 weeks. No dose reduction or treatment delay was required. No significant hematologic toxicity was observed. Responses were evaluable in thirty-two patients. Complete response was observed in three patients (9%), and another 14 patients showed a partial response (44%). Seven patients (22%) had disease stabilization. The estimated median progression-free survival and overall survival were 6.10 months (95% CI:3.81-8.39) and 10.43 months (95% CI: 8.49-12.38) respectively from the start of the regimen. CONCLUSION Continuous weekly paclitaxel is a well-tolerated and active regimen in patients with recurrent platinum-resistant ovarian cancer.
Collapse
Affiliation(s)
- T Le
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
47
|
Le T, Faught W, Hopkins L, Fung Kee Fung M. Primary chemotherapy and adjuvant tumor debulking in the management of advanced-stage epithelial ovarian cancer. Int J Gynecol Cancer 2005; 15:770-5. [PMID: 16174222 DOI: 10.1111/j.1525-1438.2005.00134.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 11/29/2022] Open
Abstract
The aim of this article was to review the experience with neoadjuvant chemotherapy and interval surgical debulking in patients with metastatic epithelial ovarian cancer. A retrospective chart review was carried out to identify patients treated with neoadjuvant platinum/Taxol chemotherapy and interval debulking. Cox regression modeling was used to identify significant predictors of progression-free interval. The Kaplan-Meier method was used to estimate the survival statistic for the study group. Sixty-one patients were identified after being treated with neoadjuvant chemotherapy and interval debulking surgeries. All surgeries were performed after three cycles of platinum/Taxol combination chemotherapy. Eighty percent of patients had a residual disease status of 2 cm or less after surgery. Suboptimal debulking was statistically associated with tumor involvement of the upper abdominal organs (P < 0.001) and non-normalization of CA125 before surgery (P= 0.03). The perioperative complication rate was 7%. At a mean follow-up time of 19 months, 77% of patients were still alive. Cox regression modeling identified the microscopic tumor residual status as the only significant predictor of progression-free interval. The estimated median survival for the group was 41.70 months (95% confidence interval = 13.84-69.56 months). Neoadjuvant chemotherapy with interval debulking surgery appeared to be safe and feasible in patients with metastatic epithelial ovarian carcinoma.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | | | |
Collapse
|
48
|
Abstract
To study the immediate and long-term effects of chemotherapy on quality of life (QoL) of advanced ovarian cancer patients. All consecutive patients undergoing chemotherapy for metastatic ovarian cancer and those presenting for follow-up post chemotherapy were recruited. Participants were asked to fill out a short QoL questionnaire (Functional Assessment Cancer Therapy-Ovarian) during each clinic visit. Two-factor analysis of variance analyses were used to examine the effects of chemotherapy treatment and current disease status on QoL scores. Ninety-four patients on chemotherapy and 159 follow-up patients participated. Patients on chemotherapy for recurrent disease had a significantly worsened overall, emotional, and ovarian cancer-specific concerns QoL scores compared to those receiving first-line chemotherapy. There were favorable significant differences between those on follow-up compared to those on chemotherapy in the mean overall QoL scores and in the means of physical, functional, and concern scores. There were significant differences favoring patients with complete response compared to those with partial response or progressive disease in the mean overall QoL scores as well as the physical, emotional, functional, and concern domains mean scores. There were improvements in most QoL measures after completion of chemotherapy. Complete disease remission remained important in maintaining improved QoL.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
| | | | | |
Collapse
|
49
|
Le T, Hopkins L, Kee Fung MF. Quality of life assessment during adjuvant and salvage chemotherapy for advance stage epithelial ovarian cancer. Gynecol Oncol 2005; 98:39-44. [PMID: 15907986 DOI: 10.1016/j.ygyno.2005.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 03/10/2005] [Accepted: 03/18/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This report assessed the quality of life of ovarian cancer patients undergoing adjuvant and salvage chemotherapy treatment. METHODS All epithelial ovarian cancer patients requiring chemotherapy to manage their disease were recruited from university based gynecologic oncology clinics. Quality of life was measured using the FACT-O (Functional Assessment of Cancer Therapy-Ovarian module version 4) questionnaire. Descriptive statistics and two-way analysis of variance were used to compare the effect on the mean quality of life scores with respect to the indications of chemotherapy and best radiologic response. Any P value of less than 0.10 was considered worthy of interest. RESULTS Ninety-three patients participated. In the adjuvant setting, there was a trend towards better quality of life with better response to therapy. In patients with a first recurrence, complete response to therapy clearly had a beneficial effect on overall quality of life compared to stable or partial response. There was no significant quality of life difference between those with partial response versus stable disease in a first recurrent setting. In patients with more than one recurrence, no large change in overall quality of life was observed across the range of tumor responses. CONCLUSION Chemotherapy is beneficial to improve quality of life of ovarian cancer patients. Differential effect of tumor response status on quality of life at different treatment phases requires further investigations.
Collapse
Affiliation(s)
- T Le
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa General Hospital, 501 Smyth Road, Room 8130, Ottawa, Ontario, Canada.
| | | | | |
Collapse
|
50
|
Le T, Hicks W, Menard C, Boyd D, Hewson T, Hopkins L, Kee Fung MF. Human papilloma virus testing knowledge and attitudes among women attending colposcopy clinic with ASCUS/LGSIL pap smears. J Obstet Gynaecol Can 2005; 26:788-92. [PMID: 15361273 DOI: 10.1016/s1701-2163(16)30149-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study women's knowledge regarding the role of human papilloma virus (HPV) in cervical intraepithelial neoplasia and their attitudes toward the integration of HPV testing as part of routine follow-up of atypical squamous cell of uncertain significance/low-grade squamous intraepithelial lesion (ASCUS/LGSIL) abnormalities. METHODS Over a 12-month period, all women attending the University of Ottawa colposcopy clinic for evaluation and follow-up of ASCUS/LGSIL Pap smears were recruited. Demographic data included age, nature of the Pap smear abnormality, gravidity, parity, occupation and education level, smoking history, previous history of abnormal smears, colposcopic examination and treatment, and current method of contraception. The women were asked to rate their level of concern over their Pap smear abnormality, from 0 (not concerned) to 10 (very concerned). Women's knowledge regarding the role of HPV in cervical intraepithelial neoplasia and the rationale behind the use of HPV testing was assessed by the clinic nurse as being minimal, moderate, or good, as defined by pre-specified criteria. Upon explanation by the nurses of the results of the recent ALTS (ASCUS/LGSIL Triage Study) trial, the women were asked to state whether they preferred to continue with regular colposcopic surveillance every 6 months, or to use the results of the HPV test, if negative, to reduce the number of colposcopy examinations to one annually. Descriptive statistics and logistic regression analysis were used to identify significant demographic factors associated with the women's preference for incorporation of HPV testing in their follow-up. All P values less than.10 were considered to be statistically significant, due to the exploratory nature of the study. RESULTS Of the 100 women who participated in the study, 42% presented with ASCUS. The mean age (+/- SD) of the women was 33.63 +/- 11.25 years (range, 18-75 years); 66% were office workers with at least a community college degree, 86% reported previous abnormal Pap smears, and 67% had previously been seen for colposcopy. Fifty-eight percent of the women rated their concern level as being 6 or more, while 15% ranked their concerns as maximal at 10. In terms of knowledge about HPV, 75% of the women had no or very minimal knowledge of the role of HPV in cervical intraepithelial neoplasia. With regard to HPV testing, 84% of the study group had either never heard of the test or had only a minimal knowledge of HPV testing. After being informed of the ALTS results, 64% of the women chose to use HPV testing to help in triaging the needs for frequent colposcopy. Logistic regression modelling showed that a college level education (odds ratio [OR], 2.27; 95% confidence interval [CI], 0.95-;5.45; P =.06) and history of previous treatment for abnormal Pap smears (OR, 3.31; CI, 0.88- 12.46; P =.07) were closely associated with the adoption of HPV testing in clinical management. CONCLUSION There exists a significant lack of knowledge about HPV and its role in the pathogenesis of cervical intraepithelial neoplasia. Women who have received previous treatments for cervical intraepithelial neoplasia and those with college-level educations were more likely to adopt this new technology as part of their care.
Collapse
Affiliation(s)
- T Le
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa ON
| | | | | | | | | | | | | |
Collapse
|