1
|
Millington PM, Snaith B, Edwards L, Carus CA. Factors that influence the quality of the clinical supervision experience in a first contact physiotherapy (FCP) role - The perspectives of supervisors and supervisees - A qualitative analysis. Musculoskelet Sci Pract 2024; 70:102921. [PMID: 38354619 DOI: 10.1016/j.msksp.2024.102921] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE First contact practitioner (FCP) roles have been developed to supplement the primary care workforce in managing the burden of musculoskeletal conditions. In order to quality assure and standardise capability of these clinicians an educational framework was developed by NHS England. The Roadmap to Practice (2020) was the curriculum designed to support and develop capability for FCP roles. This secondary analysis of a broader research project aimed to understand the factors affecting the supervisory experience from both a supervisor and supervisee perspective. METHODS A qualitative design using group interviews and an online survey was utilised to examine the experiences of these clinicians on their journey navigating and supporting the Roadmap to Practice portfolio process. FINDINGS Three principal themes were identified that affected the supervisory process; preparation of both supervisors and supervisee; the person (supervisor) and the practicalities associated with supervision. CONCLUSION There were numerous factors influencing the quality of clinical supervision. Adequate preparation of the supervisor and supervisee is critical to success. The attributes of the supervisor were important in the enhancing the quality of supervisory process. Time afforded to undertake supervision and access to appropriate supervisors need to be adequate and accounted for in workforce planning. A paradigm shift in workplace culture is required so clinical supervision is seen as an integral component in maintaining quality and assuring patient safety.
Collapse
Affiliation(s)
- P M Millington
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK.
| | - B Snaith
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK; The Mid Yorkshire Teaching NHS Trust, Wakefield, UK
| | - L Edwards
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - C A Carus
- School of Allied Health Professions & Midwifery, Faculty of Health Studies, University of Bradford, Bradford, UK
| |
Collapse
|
2
|
Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [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: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
Collapse
Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
3
|
Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
Collapse
Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Edwards L, Osayimwen O, McCubbin J, Hill C. Evaluation of the novel Situational Sleepiness Scale for children with Narcolepsy. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
5
|
Newnham JP, Schilling C, Petrou S, Morris JM, Wallace EM, Brown K, Edwards L, Skubisz MM, White SW, Rynne B, Arrese CA, Doherty DA. The health and educational costs of preterm birth to 18 years of age in Australia. Aust N Z J Obstet Gynaecol 2021; 62:55-61. [PMID: 34268727 DOI: 10.1111/ajo.13405] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth is the greatest cause of death up to five years of age and an important contributor to lifelong disability. There is increasing evidence that a meaningful proportion of early births may be prevented, but widespread introduction of effective preventive strategies will require financial support. AIMS This study estimated the economic cost to the Australian government of preterm birth, up to 18 years of age. MATERIALS AND METHODS A decision-analytic model was developed to estimate the costs of preterm birth in Australia for a hypothetical cohort of 314 814 children, the number of live births in 2016. Costs to Australia's eight jurisdictions included medical expenditures and additional costs to educational services. RESULTS The total cost of preterm birth to the Australian government associated with the annual cohort was estimated at $1.413 billion (95% CI 1047-1781). Two-thirds of the costs were borne by healthcare services during the newborn period and one-quarter of the costs by educational services providing special assistance. For each child, the costs were highest for those born at the earliest survivable gestational age, but the larger numbers of children born at later gestational ages contributed heavily to the overall economic burden. CONCLUSION Preterm birth leaves many people with lifelong disabilities and generates a significant economic burden to society. The costs extend beyond those to the healthcare system and include additional educational needs. Assessments of economic costs should inform economic evaluations of interventions aimed at the prevention or treatment of preterm birth.
Collapse
Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Chris Schilling
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan M Morris
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Melbourne, Victoria, Australia
| | - Kiarna Brown
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lindsay Edwards
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Monika M Skubisz
- Department of Obstetrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Brendan Rynne
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Banerjee I, Edwards L, Halvey P, Alioto S, Cluckley D, Mitchell C, Cox C, Lurier E, Cianci M, Bengeri S, Borthakur S, Kis-Toth K, Higginson-Scott N, Viney J, Otipoby KL. AB0034 PD-1 AGONISM INHIBITS ACTIVATION OF PLASMACYTOID DENDRITIC CELLS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:T cell function is regulated by complex signaling networks of interconnected activators and inhibitors. Blockade of inhibitory receptors such as programmed death-1 (PD-1) has emerged as a novel treatment for multiple forms of cancer. One of the most common adverse events associated with blockade of the endogenous PD-1/PD-L1 pathway is the induction of autoimmune pathology in multiple tissues, demonstrating that PD-1 activation is necessary for normal immune homeostasis in humans (Kostine, et al., 2018). Given this body of clinical data, we sought to develop a PD-1 agonist antibody as a therapeutic approach to restore immune homeostasis in patients living with autoimmune diseases. PD-1 expression and function has been primarily described on T cells (Ishida, et al., 1992), with additional data available from several other immune cell populations (Ohaegbulam, et al., 2015).Objectives:To study the effect of PD-1 agonism on plasmacytoid dendritic cell (pDC) function.Methods:Human PBMCs stimulated with or without toll-like receptor (TLR)-9 agonist, CpG were analyzed by flow cytometry for PD-1 expression on immune cell subsets. To assess the impact of PD-1 agonist on pDC function human PBMCs were activated by CpG in the presence or absence of PD-1 agonist. Type-I interferon (IFN) levels were quantified using ELISA from culture supernatants. The expression of interferon stimulated genes was analyzed by qPCR as a measure of type-I IFN activation.Results:We have discovered that TLR9 activation can induce PD-1 expression on plasmacytoid dendritic cells, which has not been previously reported. Further, we have demonstrated that PD-1 agonism inhibits TLR9-mediated activation and the effector functions of plasmacytoid dendritic cells.Conclusion:These data suggest the potential of PD-1 as a target for regulating diseases with pathology generated by type-I IFN.References:[1]Ishida, Y., Agata, Y., Shihibahara, K., & Honjo, T. (1992). Induced expression of PD-1, a novel member of the immunoglobulin gene superfamily, upon programmed cell death. EMBO J., 11(11):3887-95.[2]Kostine, M., Rouxel, L., Barnetche, T., Veillon, R., Martin, F., Dutriaux, C., . . . Schaeverbeke, T. (2018). Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer-clinical aspects and relationship with tumour response: a single-centre prospective cohort study. Annual Rheumatic Disease, 77(3):393-398.[3]Ohaegbulam, K. C., Assal, A., Lazar-Molnar, E., Yao, Y., & Zang, X. (2015). Human cancer immunotherapy with antibodies to the PD-1 and PD-L1 pathway. Trends in Molecular Medicine, 21(1); 24-33.Disclosure of Interests:Ishita Banerjee Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Lindsay Edwards Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Patrick Halvey Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Salvatore Alioto Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, David Cluckley Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Caitlin Mitchell Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Christopher Cox Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Emily Lurier Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Michael Cianci Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Soumya Bengeri Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Susmita Borthakur Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Katalin Kis-Toth Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Nathan Higginson-Scott Shareholder of: Pandion Therapeutics, Consultant of: Biotech Companies, Employee of: Pandion Therapeutics, Jo Viney Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics, Kevin L. Otipoby Shareholder of: Pandion Therapeutics, Employee of: Pandion Therapeutics
Collapse
|
7
|
Edwards L, Schlundt D, Bonnet K, Chren M. 346 Ensuring the content validity of a quality-of-life measure for patients with chronic itch. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Wheless L, Edwards L, Hanlon A, Chren M. 303 No difference in skin cancer rates by transplanted organ type after the initial skin cancer. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Miles LF, Chuen J, Edwards L, Hohmann JD, Williams R, Peyton P, Grayden DB. The design and manufacture of 3D-printed adjuncts for powered air-purifying respirators. Anaesth Rep 2020; 8:e12055. [PMID: 32705085 PMCID: PMC7369400 DOI: 10.1002/anr3.12055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Spurred in part by literature published in the immediate aftermath of the severe acute respiratory syndrome epidemic in 2003, powered air‐purifying respirators have seen increased use worldwide during the COVID‐19 pandemic. Whereas these devices provide excellent protection of the user, there is an added element of risk during doffing and cleaning of the device. An additional layer of barrier protection, in the form of a polypropylene gown, to be worn over the hood and motor belt, can be used to minimise this risk. However, the device entrains air perpendicular to the lie of the gown, resulting in the impermeable material being sucked into the air intake, and partial occlusion of flow. In this report, we describe a clinical‐academic partnership whereby a bespoke filter guard was designed to disrupt airflow and prevent gown entrainment, thereby enabling full barrier protection of both the device and user. This intervention was simple, cheap, scalable and able to be mass produced.
Collapse
Affiliation(s)
- L F Miles
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - J Chuen
- 3DMedLab Austin Health Melbourne Vic Australia
| | - L Edwards
- MSD Robotics Lab Melbourne School of Design Melbourne Vic Australia
| | - J D Hohmann
- Technician NExT Lab Melbourne School of Design Melbourne Vic Australia
| | - R Williams
- Melbourne Brain Centre Imaging Unit Melbourne Vic Australia
| | - P Peyton
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - D B Grayden
- Department of Biomedical Engineering The University of Melbourne Vic Australia
| |
Collapse
|
10
|
Nur A, Boerner S, Edwards L, Ryan K, James P. A275 REVISITING THE DIAGNOSTIC YIELD OF ERCP BRUSH CYTOLOGY FOR INDETERMINATE BILIARY STRICTURES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endoscopic Retrograde Cholangiopancreatography (ERCP) brush cytology is the most frequently used tool for sampling indeterminate biliary strictures. Previous studies have demonstrated that the diagnostic yield of brush cytology for malignant biliary strictures is 60%. With improved diagnostic tools, sampling techniques and specimen processing, the yield of ERCP brush cytology may be higher.
Aims
To assess the diagnostic yield of ERCP brush cytology in patients with indeterminate biliary strictures and to determine factors associated with positive diagnosis.
Methods
This is a retrospective study of all patients who underwent ERCP with brush cytology at University Health Network (UHN) from October 2016 to September 2019. The cytological samples were taken as follows: the cytology brush is introduced into the stricture ten times under direct fluoroscopy guidance. The brush was cut and placed into a methanol based buffered solution (CytoLyt®). Residual sample was then flushed out of the catheter with the solution and into the sample container. Patient demographic, clinical, procedural and pathological data was collected by chart review. All patients were followed for a minimum of three months after their index ERCP. Post-ERCP sampling via repeat ERCP brushings, endoscopic ultrasound fine needle biopsy, percutaneous biopsy or surgical resection was recorded.
Results
A total of 97 patients underwent ERCP with brush cytology during the study period (43 females, median age 69 years). Fifty-nine patients (84%) were diagnosed with malignancy via ERCP brush cytology. Using follow up sampling, surgical resection and clinical follow up as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 84%, 100%, 100%, and 71% respectively. Patient demographics, degree of cholestasis or stricture location had no significant impact on these outcomes.
Conclusions
This study shows a high diagnostic yield for ERCP with brush cytology for patients with indeterminate biliary strictures. Large prospective studies using updated tools, techniques and specimen handling processes are needed to confirm our observations.
Funding Agencies
None
Collapse
Affiliation(s)
- A Nur
- University Health Network, Toronto, ON, Canada
| | - S Boerner
- University Health Network, Toronto, ON, Canada
| | - L Edwards
- University Health Network, Toronto, ON, Canada
| | - K Ryan
- University Health Network, Toronto, ON, Canada
| | - P James
- University Health Network, Toronto, ON, Canada
| |
Collapse
|
11
|
George L, Taylor AR, Esteve‐Codina A, Soler Artigas M, Thun GA, Bates S, Pavlidis S, Wagers S, Boland A, Prasse A, Boschetto P, Parr DG, Nowinski A, Barta I, Hohlfeld J, Greulich T, van den Berge M, Hiemstra PS, Timens W, Hinks T, Wenzel S, Siddiqui S, Richardson M, Venge P, Heath S, Gut I, Tobin MD, Edwards L, Riley JH, Djukanovic R, Auffray C, De‐Meulder B, Erik‐Dahlen S, Adcock IM, Chung KF, Ziegler‐Heitbrock L, Sterk PJ, Singh D, Brightling CE. Blood eosinophil count and airway epithelial transcriptome relationships in COPD versus asthma. Allergy 2020; 75:370-380. [PMID: 31506971 PMCID: PMC7064968 DOI: 10.1111/all.14016] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether the clinical or pathophysiologic significance of the "treatable trait" high blood eosinophil count in COPD is the same as for asthma remains controversial. We sought to determine the relationship between the blood eosinophil count, clinical characteristics and gene expression from bronchial brushings in COPD and asthma. METHODS Subjects were recruited into a COPD (emphysema versus airway disease [EvA]) or asthma cohort (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes, U-BIOPRED). We determined gene expression using RNAseq in EvA (n = 283) and Affymetrix microarrays in U-BIOPRED (n = 85). We ran linear regression analysis of the bronchial brushings transcriptional signal versus blood eosinophil counts as well as differential expression using a blood eosinophil > 200 cells/μL as a cut-off. The false discovery rate was controlled at 1% (with continuous values) and 5% (with dichotomized values). RESULTS There were no differences in age, gender, lung function, exercise capacity and quantitative computed tomography between eosinophilic versus noneosinophilic COPD cases. Total serum IgE was increased in eosinophilic asthma and COPD. In EvA, there were 12 genes with a statistically significant positive association with the linear blood eosinophil count, whereas in U-BIOPRED, 1197 genes showed significant associations (266 positive and 931 negative). The transcriptome showed little overlap between genes and pathways associated with blood eosinophil counts in asthma versus COPD. Only CST1 was common to eosinophilic asthma and COPD and was replicated in independent cohorts. CONCLUSION Despite shared "treatable traits" between asthma and COPD, the molecular mechanisms underlying these clinical entities are predominately different.
Collapse
Affiliation(s)
- Leena George
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | | | - Anna Esteve‐Codina
- Centre for Genomic RegulationCNAG‐CRG Centre Nacional d'Anàlisi Genòmica, Barcelona Institute for Science and TechnologyBarcelonaSpain
| | - María Soler Artigas
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
- Centre for Genomic RegulationCNAG‐CRG Centre Nacional d'Anàlisi Genòmica, Barcelona Institute for Science and TechnologyBarcelonaSpain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and AddictionVall d'Hebron Research Institute (VHIR), Universitat Autònoma de BarcelonaBarcelonaSpain
- Instituto de Salud Carlos IIIBiomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
| | - Gian Andri Thun
- Centre for Genomic RegulationCNAG‐CRG Centre Nacional d'Anàlisi Genòmica, Barcelona Institute for Science and TechnologyBarcelonaSpain
| | | | - Stelios Pavlidis
- Airway Disease SectionNational Heart & Lung Institute, Imperial College LondonLondonUK
- Data Science InstituteImperial College LondonLondonUK
| | | | - Anne Boland
- Institut de Génomique, CEACNG Centre National de GénotypageEvryFrance
| | - Antje Prasse
- Department of PneumologyUniversity Medical CenterFreiburgGermany
| | - Piera Boschetto
- Department of Medical SciencesUniversity of Ferrara and Ferrara City HospitalFerraraItaly
| | - David G. Parr
- Department of Respiratory MedicineUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Adam Nowinski
- Department of Respiratory MedicineNational Institute of Tuberculosis and Lung DiseasesWarsawPoland
| | - Imre Barta
- Department of PathophysiologyNational Koranyi Institute for TB and PulmonologyBudapestHungary
| | - Jens Hohlfeld
- Fraunhofer Institute for Toxicology and Experimental MedicineHannoverGermany
| | - Timm Greulich
- Department of Medicine, Pulmonary and Critical Care MedicineUniversity Medical Center Giessen and Marburg, Philipps‐Universität MarburgMarburgGermany
- Member of the German Center for Lung Research (DZL)GroßhansdorfGermany
| | - Maarten van den Berge
- Department of Pulmonary DiseasesUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Pieter S. Hiemstra
- Department of Pulmonary DiseasesLeiden University Medical Center, University of LeidenLeidenThe Netherlands
| | - Wim Timens
- Department of Pathology and Medical BiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | | | - Sally Wenzel
- Department of MedicineUniversity of PittsburghPittsburghPAUSA
- Department of ImmunologyUniversity of PittsburghPittsburghPAUSA
| | - Salman Siddiqui
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Matthew Richardson
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Per Venge
- Department of Medical Sciences, Clinical ChemistryUppsala UniversityUppsalaSweden
| | - Simon Heath
- Centre for Genomic RegulationCNAG‐CRG Centre Nacional d'Anàlisi Genòmica, Barcelona Institute for Science and TechnologyBarcelonaSpain
| | - Ivo Gut
- Centre for Genomic RegulationCNAG‐CRG Centre Nacional d'Anàlisi Genòmica, Barcelona Institute for Science and TechnologyBarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
| | - Martin D. Tobin
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | | | | | - Ratko Djukanovic
- NIHR Southampton Respiratory Biomedical Research Unit and Clinical and Experimental SciencesSouthamptonUK
| | - Charles Auffray
- European Institute for Systems Biology and Medicine (EISBM)CNRS‐ENS‐UCBL, Université de LyonLyon cedex 07France
| | - Bertrand De‐Meulder
- European Institute for Systems Biology and Medicine (EISBM)CNRS‐ENS‐UCBL, Université de LyonLyon cedex 07France
| | | | - Ian M. Adcock
- Instituto de Salud Carlos IIIBiomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
| | - Kian Fan Chung
- Instituto de Salud Carlos IIIBiomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
| | | | - Peter J. Sterk
- Department Respiratory MedicineAmsterdam University Medical Centres, University of AmsterdamAmsterdamThe Netherlands
| | - Dave Singh
- Centre for Respiratory Medicine and AllergyThe University of ManchesterManchesterUK
- Medicines Evaluation UnitUniversity Hospital of South Manchester NHS Foundation TrustManchesterUK
| | - Christopher E. Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | | |
Collapse
|
12
|
Knight T, Edwards L, Rajasekaran A, Clare S, Lasserson D. Point-of-care lung ultrasound in the assessment of suspected COVID-19: a retrospective service evaluation with a severity score. Acute Med 2020; 19:192-200. [PMID: 33215172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Point-of-care lung ultrasound (POCUS) has been advocated as a tool to assess the severity of COVID19 and thereby aid risk stratification. METHODS We conducted a retrospective service evaluation between the 3rd March and the 5th May 2020 to describe and characterise the use of POCUS within an acute care pathway designed specifically for the assessment of suspected or confirmed COVID-19. A novel POCUS severity scale was formulated by assessing pleural and interstitial abnormalities within six anatomical zones (three for each lung). An aggregated score was calculated for each patient and evaluated as a marker of disease severity using standard metrics of discriminatory performance. RESULTS POCUS was performed in the assessment of 100 patients presenting with suspected COVID-19. POCUS was consistent with COVID-19 infection in 92% (n = 92) of the patients assessed. Severity, as assessed by POCUS, showed good discriminatory performance to predict all-cause inpatient mortality, death or critical care admission, and escalated oxygen requirements (AUC .80, .80, 82). The risk of all-cause mortality in patients with scores in lowest quartile was 2.5% (95%CI 0.12- 12.95) compared with 42.9% (95CI 15.8 - 75.0%) in the highest quartile. POCUS assessed severity correlated with length of stay and duration of supplemental oxygen therapy. CONCLUSION A simple aggregated score formed by the summating the degree of pleural and interstitial change within six anatomical lung zones showed good discriminatory performance in predicting a range of adverse outcomes in patients with suspected COVID-19.
Collapse
Affiliation(s)
- T Knight
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - L Edwards
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - A Rajasekaran
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - S Clare
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| | - D Lasserson
- Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom
| |
Collapse
|
13
|
Ruot C, Holick R, Edwards L. Use Of A Clinic-Based ACL Prediction Algorithm In Division III Female Soccer And Basketball Players. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563342.70158.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Wheless L, Wang L, Edwards L, Anand N, Birdwell K, Hanlon A, Chren M. 280 Validation of algorithms to identify transplant recipients from the electronic health record. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Edwards L, Farrington R. 2.11-P7Exploring the healthcare concerns of pregnant women and new mothers seeking asylum in the United Kingdom. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.079] [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: 11/15/2022] Open
Affiliation(s)
- L Edwards
- The University of Manchester, United Kingdom
| | | |
Collapse
|
16
|
Abstract
Fetal structural anomalies are found in up to 3% of all pregnancies and ultrasound-based screening has been an integral part of routine prenatal care for decades. The prenatal detection of fetal anomalies allows for optimal perinatal management, providing expectant parents with opportunities for additional imaging, genetic testing, and the provision of information regarding prognosis and management options. Approximately one-half of all major structural anomalies can now be detected in the first trimester, including acrania/anencephaly, abdominal wall defects, holoprosencephaly and cystic hygromata. Due to the ongoing development of some organ systems however, some anomalies will not be evident until later in the pregnancy. To this extent, the second trimester anatomy is recommended by professional societies as the standard investigation for the detection of fetal structural anomalies. The reported detection rates of structural anomalies vary according to the organ system being examined, and are also dependent upon factors such as the equipment settings and sonographer experience. Technological advances over the past two decades continue to support the role of ultrasound as the primary imaging modality in pregnancy, and the safety of ultrasound for the developing fetus is well established. With increasing capabilities and experience, detailed examination of the central nervous system and cardiovascular system is possible, with dedicated examinations such as the fetal neurosonogram and the fetal echocardiogram now widely performed in tertiary centers. Magnetic resonance imaging (MRI) is well recognized for its role in the assessment of fetal brain anomalies; other potential indications for fetal MRI include lung volume measurement (in cases of congenital diaphragmatic hernia), and pre-surgical planning prior to fetal spina bifida repair. When a major structural abnormality is detected prenatally, genetic testing with chromosomal microarray is recommended over routine karyotype due to its higher genomic resolution.
Collapse
Affiliation(s)
- Lindsay Edwards
- Feto-Maternal Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, Victoria, Australia; Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia; Public Health Genetics Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| |
Collapse
|
17
|
Terebuh P, Adija A, Edwards L, Rowe T, Jenkins S, Kleene J, Fukuda K, Katz JM, Bridges CB. Human infection with avian influenza A(H7N2) virus-Virginia, 2002. Influenza Other Respir Viruses 2018; 12:529-532. [PMID: 29430844 PMCID: PMC6005590 DOI: 10.1111/irv.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background In March 2002, an outbreak of low‐pathogenic avian influenza (LPAI) A(H7N2) was detected among commercial poultry operations in Virginia. Methods We performed a serosurvey of 80 government workers involved in efforts to control the outbreak. Results One study participant who assisted with disposal of infected birds tested positive for neutralizing antibodies to influenza A(H7N2) by microneutralization assay and H7‐specific IgM antibodies by enzyme‐linked immunosorbent assay (ELISA). The acute infection was temporally associated with an influenza‐like illness that resolved without hospitalization. Conclusion This study documents the earliest evidence of human infection with an H7 influenza virus of the North American lineage.
Collapse
Affiliation(s)
- Pauline Terebuh
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Akini Adija
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsay Edwards
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Rowe
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer Kleene
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Keiji Fukuda
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | |
Collapse
|
18
|
Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Donovan JL. Cat-PROM5: a brief psychometrically robust self-report questionnaire instrument for cataract surgery. Eye (Lond) 2018. [PMID: 29521952 PMCID: PMC5898878 DOI: 10.1038/eye.2018.1] [Citation(s) in RCA: 22] [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] [Indexed: 11/09/2022] Open
Abstract
Purpose To develop a short, psychometrically robust and responsive cataract patient reported outcome measure suitable for use in high-volume surgical environments. Methods A prospective study in which participants completed development versions of questionnaires exploring the quality of their eyesight using items harvested from two existing United Kingdom developed parent questionnaires. Participants were 822 patients awaiting cataract surgery recruited from 4 cataract surgical centres based in the UK. Exclusion criteria were other visually significant comorbidities and age <50 years. An iterative multi-stage process of evaluation using Rasch and factor analyses with sequential item reduction was undertaken. Results A definitive item set of just five items delivered performance in accordance with the requirements of the Rasch model: no threshold disordering, no misfitting items, Rasch-based reliability 0.90, person separation 2.98, Cronbach’s α 0.89, good targeting of questions to patients with cataract with pre-operative item mean −0.41 logits and absence of significant floor or ceiling effects, minor deviations of item invariance, and confirmed unidimensionality. The test–re-test repeatability intra-class correlation coefficient was 0.89 with excellent responsiveness to surgery, Cohen’s d −1.45 SD. Rasch calibration values are provided for Cat-PROM5 users. Conclusions A psychometrically robust and highly responsive five-item cataract surgery patient reported outcome measure has been developed, which is suitable for use in high-volume cataract surgical services.
Collapse
Affiliation(s)
- J M Sparrow
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - A Loose
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
19
|
Jones PA, Pittam MR, Moxon RA, Edwards L. Double-ended Pigtail Polyethylene Stents in Management of Benign and Malignant Ureteric Obstruction. J R Soc Med 2018; 76:458-62. [PMID: 6864718 PMCID: PMC1439223 DOI: 10.1177/014107688307600605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.
Collapse
|
20
|
Sparrow JM, Grzeda MT, Frost NA, Johnston RL, Liu CSC, Edwards L, Loose A, Elliott D, Donovan JL. Cataract surgery patient-reported outcome measures: a head-to-head comparison of the psychometric performance and patient acceptability of the Cat-PROM5 and Catquest-9SF self-report questionnaires. Eye (Lond) 2018; 32:788-795. [PMID: 29386619 PMCID: PMC5898871 DOI: 10.1038/eye.2017.297] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 08/04/2017] [Accepted: 11/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Cataract surgery is the most frequently undertaken NHS surgical procedure. Visual acuity (VA) provides a poor indication of visual difficulty in a complex visual world. In the absence of a suitable outcome metric, recent efforts have been directed towards the development of a cataract patient-reported outcome measure (PROM) of sufficient brevity, precision, and responsiveness to be implementable in routine high volume clinical services. Aim To compare and contrast the two most promising candidate PROMs for routine cataract surgery. Method The psychometric performance and patient acceptability of the recently UK developed five-item Cat-PROM5 questionnaire was compared with the English translation of the Swedish nine-item Catquest-9SF using Rasch-based performance metrics and qualitative semistructured interviews. Results Rasch-based performance was assessed in 822 typical NHS cataract surgery patients across four centres in England. Both questionnaires demonstrated good to excellent performance for all metrics assessed, including Person Reliability Indices of 0.90 (Cat-PROM5) and 0.88 (Catquest-9SF), responsiveness to surgery (Cohen’s standardized effect size) of 1.45 SD (Cat-PROM5) and 1.47 SD (Catquest-9SF) and they were highly correlated with each other (R=0.85). Qualitative assessments confirmed that both questionnaires were acceptable to patients, including in the presence of ocular comorbidities. Preferences were expressed for the shorter Cat-PROM5, which allowed patients to map their own issues to the questions as opposed to the more restrictive specific scenarios of Catquest-9SF. Conclusion The recently UK developed Cat-PROM5 cataract surgery questionnaire is shorter, with performance and patient acceptability at least as good or better than the previous ‘best of class’ Catquest-9SF instrument.
Collapse
Affiliation(s)
- J M Sparrow
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - M T Grzeda
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N A Frost
- Torbay Hospital, Lawes Bridge, Torquay, UK
| | - R L Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - C S C Liu
- Sussex Eye Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - L Edwards
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
| | - A Loose
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - D Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J L Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Trust, Bristol, UK
| |
Collapse
|
21
|
Bernhardt A, Hakmi S, Levin A, Stehlik J, Edwards L, Wagner F, Benden C, Reichenspurner H. “Old-for-Old” in Lung Transplantation? Insights from the ISHLT Database. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Bernhardt
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Levin
- Columbia University, New York City, United States
| | - J. Stehlik
- University of Utah, Salt Lake City, United States
| | - L. Edwards
- United Networks of Organ Sharing, Richmond, United States
| | - F. Wagner
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Benden
- Universitätsspital Zürich, Zürich, Switzerland
| | - H. Reichenspurner
- Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| |
Collapse
|
22
|
Vallis M, Lee-Baggley D, Sampalli T, Ryer A, Ryan-Carson S, Kumanan K, Edwards L. Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework. Public Health 2017; 154:70-78. [PMID: 29216495 DOI: 10.1016/j.puhe.2017.10.022] [Citation(s) in RCA: 13] [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] [Received: 05/08/2017] [Revised: 10/06/2017] [Accepted: 10/25/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is an urgent need for healthcare providers and healthcare systems to support productive interactions with patients that promote sustained health behaviour change in order to improve patient and population health outcomes. Behaviour change theories and interventions have been developed and evaluated in experimental contexts; however, most healthcare providers have little training, and therefore low confidence in, behaviour change counselling. Particularly important is how to integrate theory and method to support healthcare providers to engage in behaviour change counselling competently. In this article, we describe a general training model developed from theory, evidence, experience and stakeholder engagement. This model will set the stage for future evaluation research on training needed to achieve competency, sustainability of competency, as well as effectiveness/cost-effectiveness of training in supporting behaviour change. DESIGN AND METHODS A framework to support competency based training in behaviour change counselling is described in this article. This framework is designed to be integrative, sustainable, scalable and capable of being evaluated in follow-up studies. RESULTS AND DISCUSSION Effective training in behaviour change counselling is critical to meet the current and future healthcare needs of patients living with, or at risk of, chronic diseases. Increasing competency in establishing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification and addressing psychosocial issues will be value added to the healthcare system.
Collapse
Affiliation(s)
- M Vallis
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada.
| | - D Lee-Baggley
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - T Sampalli
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - A Ryer
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - S Ryan-Carson
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - K Kumanan
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| | - L Edwards
- Primary Care, Nova Scotia Health Authority & Dalhousie University, Halifax, Canada
| |
Collapse
|
23
|
Asfari A, Ahmed M, Edwards L, Irby K, Agarwal A, Pasala S, Prodhan P, Frazier B, Sanders R. Survival from Septic Shock Secondary to Disseminated Group A Streptococcal Infection after Central Extracorporeal Membrane Oxygenation. JCS 2017. [DOI: 10.1055/s-0037-1607312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective The objective of this study was to describe a case of severe life-threatening acute respiratory distress syndrome (ARDS) and septic shock in a child who responded to a prolonged extracorporeal membrane oxygenation (ECMO) support course utilizing different cannulation techniques depending on the physiological derangement until he recovered.
Design This is a case report.
Setting This study was done at the medical–surgical pediatric intensive care unit in an academic freestanding children's hospital.
Patient A previously healthy 4-year-old boy was presented with respiratory distress and fever. He was diagnosed with respiratory syncytial viral upper respiratory tract infection and group A β-hemolytic Streptococcus septic shock.
Interventions The patient was referred to peripheral ECMO for hemodynamic, ventilatory, and oxygenation support; conversion to central ECMO to augment blood flow; and transition to extracorporeal carbon dioxide removal before successful wean off extracorporeal support.
Measurements and Main Results Patient experienced severe pediatric ARDS and septic shock that were refractory to maximal medical therapy. Patient was able to be decannulated after 75 days of extracorporeal support. He was weaned completely off of mechanical ventilation and oxygen after 6 months. The only neurological deficit he exhibited was poor fine motor skills of his hands for which he continued to receive physical therapy.
Conclusion Central ECMO may benefit children with pediatric ARDS and septic shock who require higher flows than what can be provided from peripheral ECMO. Extracorporeal membrane carbon dioxide removal may be an effective option in children who do not respond to mechanical ventilation alone.
Collapse
Affiliation(s)
- A. Asfari
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - M. Ahmed
- Section of Critical Care, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, United States
| | - L. Edwards
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - K. Irby
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - A. Agarwal
- Section of Pulmonology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - S. Pasala
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - P. Prodhan
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
- Section of Cardiology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - B. Frazier
- Department of Extracorporeal Membrane Oxygenation, Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - R. Sanders
- Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| |
Collapse
|
24
|
Pérez-Schindler J, Kanhere A, Edwards L, Allwood JW, Dunn WB, Schenk S, Philp A. Exercise and high-fat feeding remodel transcript-metabolite interactive networks in mouse skeletal muscle. Sci Rep 2017; 7:13485. [PMID: 29044196 PMCID: PMC5647435 DOI: 10.1038/s41598-017-14081-w] [Citation(s) in RCA: 12] [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: 07/14/2017] [Accepted: 10/05/2017] [Indexed: 01/16/2023] Open
Abstract
Enhanced coverage and sensitivity of next-generation ‘omic’ platforms has allowed the characterization of gene, metabolite and protein responses in highly metabolic tissues, such as, skeletal muscle. A limitation, however, is the capability to determine interaction between dynamic biological networks. To address this limitation, we applied Weighted Analyte Correlation Network Analysis (WACNA) to RNA-seq and metabolomic datasets to identify correlated subnetworks of transcripts and metabolites in response to a high-fat diet (HFD)-induced obesity and/or exercise. HFD altered skeletal muscle lipid profiles and up-regulated genes involved in lipid catabolism, while decreasing 241 exercise-responsive genes related to skeletal muscle plasticity. WACNA identified the interplay between transcript and metabolite subnetworks linked to lipid metabolism, inflammation and glycerophospholipid metabolism that were associated with IL6, AMPK and PPAR signal pathways. Collectively, this novel experimental approach provides an integrative resource to study transcriptional and metabolic networks in skeletal muscle in the context of health and disease.
Collapse
Affiliation(s)
- Joaquín Pérez-Schindler
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B152TT, UK. .,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK. .,Biozentrum, University of Basel, Basel, 4056, Switzerland.
| | - Aditi Kanhere
- School of Biosciences, University of Birmingham, Birmingham, B152TT, UK
| | - Lindsay Edwards
- Respiratory Therapy Area Unit, GlaxoSmithKline Medicines Research Centre, Stevenage, SG1 2NY, UK
| | - J William Allwood
- School of Biosciences, University of Birmingham, Birmingham, B152TT, UK.,Phenome Centre Birmingham, University of Birmingham, Birmingham, B152TT, UK.,Environmental and Biochemical Sciences, The James Hutton Institute, Dundee, DD2 5DA, Scotland
| | - Warwick B Dunn
- School of Biosciences, University of Birmingham, Birmingham, B152TT, UK.,Phenome Centre Birmingham, University of Birmingham, Birmingham, B152TT, UK
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, 92093-0863, USA.,Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, 92093-0863, USA
| | - Andrew Philp
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B152TT, UK. .,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK.
| |
Collapse
|
25
|
Edwards L, Meyers B, Heydinger E, Navarre H, Josiah K, Belton A, Riojas L, Knackstedt A, Brewer L. A Quick and Effective Approach to Nutrition Education and Health Literacy in Primary Care. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.219] [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: 10/19/2022]
|
26
|
Jimenez-Liñan LM, Edwards L, Abhishek A, Doherty M. Adequacy of Online Patient Information Resources on Gout and Potentially Curative Urate-Lowering Treatment. Arthritis Care Res (Hoboken) 2017; 69:748-752. [PMID: 27390083 DOI: 10.1002/acr.22981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/03/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the content and readability of online patient information resources against the current understanding of gout. METHODS An online survey was undertaken using Google UK, USA, Australia, and Canada. Information was assessed for content and accuracy on 19 key points regarding core content for gout patient information resources. Readability was assessed using the Flesch-Kincaid Reading Ease score. Fifteen randomly selected websites were reviewed by a blinded second observer. RESULTS A total of 85 websites were selected. More than 50% of the websites provided no information or had inaccuracies regarding the pathogenesis of gout. Most websites contained information on dietary and lifestyle modifications for treating gout and did not emphasize urate-lowering therapy (ULT) and its potential for cure. Over 75% of the websites had no/inaccurate information on the role of ULT or prophylaxis for preventing gout attacks on starting ULT. The majority of websites were difficult to read, with information in 68% of the websites rated at least fairly difficult. CONCLUSION Only a few web-based patient information resources provide accurate and easy-to-read information on gout. This study will help physicians direct patients to currently reliable resources, but there is a need to improve many web-based patient information resources, which at present act as barriers to care.
Collapse
Affiliation(s)
- L M Jimenez-Liñan
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - L Edwards
- University of Nottingham and Nottingham City Hospital, Nottingham, and Royal Derby Hospital, Derby, UK
| | - A Abhishek
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| | - Michael Doherty
- University of Nottingham and Nottingham City Hospital, Nottingham, UK
| |
Collapse
|
27
|
Gleeson M, Peckitt C, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Chua S, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP VERSUS GEM-P IN THE FIRST-LINE TREATMENT OF T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NRCI PHASE II RANDOMISED CHEMO-T TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology Research; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Victoria Hospital; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; The Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology; Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology; Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| |
Collapse
|
28
|
Gleeson M, Peckitt C, Cunningham D, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Chua S. THE ROLE OF 18F FDG-PET/CT IN PERIPHERAL T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NCRI MULTICENTRE PHASE II RANDOMISED CHEMO-T TRIAL PET/CT SUBSTUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_108] [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: 11/06/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Teaching Hospitals; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| |
Collapse
|
29
|
Kuhnl A, Shaikh R, Cunningham D, Counsell N, Barrans S, Burton C, Bentley M, Gleeson M, Edwards L, Ulrich L, Smith P, Clifton-Hadley L, Schofield O, Lawrie A, Linch D, Hubank M, Kaiser M. DNMT3A-2
EXPRESSION LEVELS CHARACTERISE DIFFUSE LARGE B-CELL LYMPHOMA WITH DISTINCT METHYLATION PATTERNS AND OUTCOME. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_7] [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: 11/07/2022]
Affiliation(s)
- A. Kuhnl
- Department of Medicine; Royal Marsden Hospital; London UK
| | - R. Shaikh
- Centre for Molecular Pathology; Royal Marsden Hospital; London UK
| | - D. Cunningham
- Department of Medicine; Royal Marsden Hospital; London UK
| | - N. Counsell
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - S. Barrans
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - C. Burton
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - M. Bentley
- HMDS St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | - M. Gleeson
- Department of Medicine; Royal Marsden Hospital; London UK
| | - L. Edwards
- Department of Medicine; Royal Marsden Hospital; London UK
| | - L. Ulrich
- Department of Medicine; Royal Marsden Hospital; London UK
| | - P. Smith
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - L. Clifton-Hadley
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - O. Schofield
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - A. Lawrie
- Cancer Research UK and UCL Cancer Trials Centre; University College London; London UK
| | - D. Linch
- Department of Hematology; University College London; London UK
| | - M. Hubank
- Centre for Molecular Pathology; Royal Marsden Hospital; London UK
| | - M. Kaiser
- Division of Molecular Pathology; The Institute of Cancer Research; Sutton UK
| |
Collapse
|
30
|
Shah S, Edwards L, Robinson A, Crosthwaite A, Houlihan C, Paizis K. A rare cause of hypertension in pregnancy: Phaeochromocytoma. Obstet Med 2017; 10:83-84. [DOI: 10.1177/1753495x16669995] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/26/2016] [Indexed: 12/25/2022] Open
Abstract
A 26-year-old primigravida at 35 weeks’ gestation was transferred to our institution from a regional hospital for management of presumed preeclampsia. Due to the labile nature of her hypertension, further investigation was undertaken which revealed a right-sided phaeochromocytoma. Alpha blockade was commenced, and an uncomplicated elective caesarean delivery was performed at 38 weeks’ gestation under spinal anaesthetic. The patient underwent an elective right laparoscopic adrenalectomy six weeks post-partum. This case highlights the importance of investigating young women for secondary causes of hypertension to avoid mislabelling as essential or gestational hypertension.
Collapse
Affiliation(s)
- Sonali Shah
- Department of Endocrinology, Austin and Mercy Health, Melbourne, Australia
| | | | - Andrew Robinson
- Department of Anaesthesia, Mercy Health, Melbourne, Australia
| | - Amy Crosthwaite
- Department of Renal, Austin and Mercy Health, Melbourne, Australia
| | - Christine Houlihan
- Department of Endocrinology, Austin and Mercy Health, Melbourne, Australia
| | - Kathy Paizis
- Department of Renal, Austin and Mercy Health, Melbourne, Australia
| |
Collapse
|
31
|
Lewis S, Edwards L, Glasbey J, Johansen A. 9MEASURING HEALTH-RELATED QUALITY OF LIFE IN HIP FRACTURE - A PILOT STUDY. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Bernhardt A, Levin A, Stehlik J, Benden C, Edwards L, Wagner F, Reichenspurner H. Is There a Rationale for an “Old-for-Old” Program in Lung Transplantation? A Comparative Study Using the International Society of Heart and Lung Transplantation Database. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
33
|
Loor G, Camp P, D'Ovidio F, Edwards L, Erasmus M, Glanville A, Hertz M, Hopkins P, Keshavjee S, Levvey B, McCurry K, Musk M, Patterson G, Snell G, Stehlik J, Urban R, Van Raemdonck D. Comparison of Long-Term Survival Outcomes in Recipients of Lungs from Donation After Circulatory Death (DCD) and Donation After Brain Death (DBD). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.377] [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: 10/19/2022] Open
|
34
|
Judge CB, DeBarge R, Choi E, O'Callaghan K, Edwards L, Schultes B, Ettenberg S, Huet HA. Abstract A77: Efficient targeting of HER-2-positive cancers by Antibody-Coupled T cell Receptor (ACTR) engineered autologous T cells. Cancer Immunol Res 2017. [DOI: 10.1158/2326-6074.tumimm16-a77] [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
HER2 gene amplification occurs in 20-30% of aggressive breast and gastric cancer diagnoses, often signifying poor prognosis. The current standard of care for HER2 amplified cancer is the HER2 targeting antibody trastuzumab with chemotherapy. In the setting of HER2 amplified breast cancer, the combination of HER2 targeting antibodies trastuzumab and pertuzumab with the chemotherapeutic docetaxel is the frontline therapy. Despite the success of targeting the HER2 pathway, there are still many patients who are refractory or relapse following HER2 targeting regimens. Outside of the setting of HER2 overexpression or gene amplification, targeting HER2-positive cancers has thus far been ineffective. Engineered autologous T-cells, including chimeric antigen receptors (CARs) and high affinity T-cell receptors (TCRs), have gained attention recently due to their potent efficacy, with overall response rates reaching 80% and examples of long lasting remissions, particularly in advanced lymphoma and leukemia. However, initial clinical attempts to target HER2-amplified breast cancer with CAR-T cell therapy met with either acute toxicities or lack of efficacy. The Antibody-Coupled T-cell Receptor (ACTR) platform is a universal, engineered T cell therapy technology developed to mediate anti-tumor activity in combination with tumor-targeting antibodies. The ACTR chimeric construct is composed of the high-affinity CD16 (FCGR3A) V158 variant with the signaling domains from CD3z and 4-1BB. ACTR is designed to engage the Fc domain of human IgG1 antibodies when opsonized to the cognate target cells and deliver an activation signal to the engineered T cells. ACTR T cells combined with either HER2 targeting trastuzumab or pertuzumab exhibited potent cytotoxic activity, cytokine response and proliferation on a HER2 amplified tumor cell lines. ACTR activity was specific to antibody treated cells, and had little activity on HER2 low or negative tumor lines. Furthermore, the effectiveness of ACTR T cells in a non-amplified HER2 (HER2 low) setting was tested in the presence of a combination of trastuzumab and pertuzumab. This multi-antibody combination increased the cytotoxicity by ACTR T cells, whereas trastuzumab or pertuzumab as single antibody combinations with ACTR had little effect, suggesting a potential therapeutic approach for this disease setting with high unmet medical need. Importantly, the ACTR platform decouples the targeting moiety from the engineered T cell allowing for an antibody dose response which may spare cytotoxicity on normal cells. The specific response to HER2 positive tumor cells in the presence of trastuzumab, pertuzumab or the combination of HER2 directed antibodies demonstrates the potential therapeutic activity of ACTR T cells and supports consideration of clinical testing of ACTR T cells in HER2-positive cancers. Furthermore, combining multiple targeting antibodies to achieve greater potency and efficacy is unique to the ACTR technology and demonstrates the potential for such activity across many other tumor targets and tumor targeting antibodies.
Citation Format: Casey B. Judge, Rachel DeBarge, Eugene Choi, Katie O'Callaghan, Lindsay Edwards, Birgit Schultes, Seth Ettenberg, Heather A. Huet. Efficient targeting of HER-2-positive cancers by Antibody-Coupled T cell Receptor (ACTR) engineered autologous T cells. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr A77.
Collapse
|
35
|
Bernhardt A, Levin A, Stehlik J, Benden C, Edwards L, Wagner F, Reichenspurner H. The Impact of Donor Age on Post–Lung Transplant Survival: How Far Can We Go? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A. Bernhardt
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| | - A.P. Levin
- Columbia University Medical Center, New York City, United States
| | - J. Stehlik
- University of Utah, Salt Lake City, United States
| | - C. Benden
- UniversitätsSpital Zürich, Zürich, Switzerland
| | - L. Edwards
- United Network for Organ Sharing, Richmond, United States
| | - F.M. Wagner
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| | - H. Reichenspurner
- Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
| |
Collapse
|
36
|
Stone J, Waern S, Khabra K, Wharram B, Middleton A, Edwards L, Kuhlthau K, Crouch C, Marshall L, Zacharoulis S, Vaidya S, Powell K, Saran F, Yock T, Mandeville H. Impact of toxicities and neurocognitive impairment on the health related quality of life (HR-QoL) for survivors of medulloblastoma. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30631-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Martin HJ, Turner MA, Bandelow S, Edwards L, Riazanskaia S, Thomas CLP. Volatile organic compound markers of psychological stress in skin: a pilot study. J Breath Res 2016; 10:046012. [DOI: 10.1088/1752-7155/10/4/046012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
38
|
Herring K, Ganesan R, Rao A, Edwards L, Pascoe J, Williams S. Ovarian granulosa cell tumours: hormone receptor positivity and response to aromatase inhibitors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.31] [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: 11/12/2022] Open
|
39
|
Schwarting A, Dooley MA, Roth DA, Edwards L, Thompson A, Wilson B. Impact of concomitant medication use on belimumab efficacy and safety in patients with systemic lupus erythematosus. Lupus 2016; 25:1587-1596. [PMID: 27488472 PMCID: PMC5089223 DOI: 10.1177/0961203316655215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022]
Abstract
Practicing physicians have requested efficacy and safety data for belimumab, when used with specific systemic lupus erythematosus (SLE) medications. This was a post hoc analysis of pooled efficacy and safety data from patients who received belimumab 10 mg/kg plus standard of care (SoC) or placebo (SoC) in two Phase III, randomized trials, BLISS-52 and BLISS-76. Patients were categorized into four groups based on baseline concomitant medication usage: steroids only; antimalarials (AM) only; steroids + AM; or steroids + AM + immunosuppressants (IS). The primary endpoint was the SLE Responder Index (SRI) at Week 52. SRI over time and individual SRI components were secondary endpoints. Time to first flare and changes in concomitant medications were exploratory endpoints. Safety was assessed using adverse event (AE) reporting. Across 834 patients, steroids + AM was the largest group (n = 346, 41.5%) and AM only was the smallest (n = 77, 9.2%). Disease duration was shortest in the steroids + AM group (5.7 years vs 6.4–7.1 years); SELENA-SLEDAI scores were similar across groups. At Week 52, the percentage of SRI responders was greatest in the steroids + AM group for belimumab 10 mg/kg (59%) compared with placebo (44%); treatment response and SRI component improvements were also observed across other groups. The probability of experiencing an SLE flare was reduced in the steroids-only group for patients who received belimumab 10 mg/kg compared with placebo (64.3% vs 78.1%; hazard ratio 0.64; 95% confidence interval: 0.42–0.96). There was little or no change in daily AM or IS dose in any group. For all groups, there was a general decrease in steroid dose over time; a quarter to a third of patients experienced decreased steroid doses at Week 52. The overall safety profile was similar across treatment arms and concomitant medication groups, with the exception of serious AEs in the steroids + AM group (belimumab 10 mg/kg 16%, placebo 8%). The efficacy and safety of belimumab in combination with SoC was demonstrated for various groupings of steroids, AM and IS. These findings may improve the understanding of the safety and efficacy of adding belimumab to different treatments.
Collapse
Affiliation(s)
- A Schwarting
- University Hospital Mainz, ACURA Rheumatology Center, Bad Kreuznach, Germany
| | - M A Dooley
- University of North Carolina, Chapel Hill, NC, USA
| | | | - L Edwards
- GSK, Research Triangle Park, NC, USA
| | | | - B Wilson
- GSK, Research Triangle Park, NC, USA
| |
Collapse
|
40
|
Samuel V, Gamble C, Cullington H, Bathgate F, Bennett E, Coop N, Cropper J, Emond A, Kentish R, Edwards L. Brief Assessment of Parental Perception (BAPP): Development and validation of a new measure for assessing paediatric outcomes after bilateral cochlear implantation. Int J Audiol 2016; 55:699-705. [PMID: 27434545 DOI: 10.1080/14992027.2016.1204669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In contrast to previous clinical practice, current guidelines recommend bilateral cochlear implantation in children, resulting in a cohort of children who initially received one implant, but have subsequently had a second, contralateral implant. This study aimed to explore satisfaction and quality of life in children implanted simultaneously or sequentially. DESIGN A novel measure of satisfaction and quality of life following paediatric bilateral cochlear implantation (the Brief Assessment of Parental Perception; BAPP) was developed and preliminary validation undertaken as part of a large, national project of bilateral implantation. Children's parents completed the measure yearly for up to three years following implantation. STUDY SAMPLE Children from 14 UK implant centres were recruited into the study; data were available for 410 children one year post-implantation. RESULTS The BAPP was found to have good face and convergent validity, and internal consistency. Results indicated very high levels of satisfaction with the devices, and improvements in quality of life. However there was evidence that children implanted sequentially were less willing to wear their second implant in the first two years than those children receiving simultaneous implants. CONCLUSION Simultaneous and sequential cochlear implants have a positive impact on the quality of life of deaf children.
Collapse
Affiliation(s)
- V Samuel
- a South Wales Doctoral Programme in Clinical Psychology, School of Psychology, Cardiff University , UK
| | - C Gamble
- b University of Southampton Auditory Implant Service (USAIS) , Southampton , UK
| | - H Cullington
- b University of Southampton Auditory Implant Service (USAIS) , Southampton , UK
| | - F Bathgate
- c Cochlear Implant Programme, Great Ormond Street Hospital for Children , London , UK
| | - E Bennett
- d Nottingham Auditory Implant Programme , Nottingham , UK
| | - N Coop
- c Cochlear Implant Programme, Great Ormond Street Hospital for Children , London , UK
| | - J Cropper
- e Guy's and St Thomas' Hearing Implant Centre , London , UK
| | - A Emond
- f Cochlear Implant Programme , Royal National Throat, Nose and Ear Hospital , London , UK
| | - R Kentish
- f Cochlear Implant Programme , Royal National Throat, Nose and Ear Hospital , London , UK
| | - L Edwards
- c Cochlear Implant Programme, Great Ormond Street Hospital for Children , London , UK
| |
Collapse
|
41
|
Jiménez-Liñán L, Edwards L, Abhishek A, Doherty M. AB0814 Online Patient Information Resources on Gout Provide Inadequate Information and Minimal Emphasis on Potentially Curative Urate Lowering Treatment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5392] [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: 11/03/2022]
|
42
|
Bernhardt A, Levin A, Stehlik J, Benden C, Edwards L, Reichenspurner H, Wagner F. Does Donor Age Impact Recipient Survival Post-Lung Transplant: A Study of the International Society of Heart and Lung Transplantation Database. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.278] [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: 11/28/2022] Open
|
43
|
Urban M, Edwards L, Stehlik J, Booth K, Pirk J, Netuka I. Differences in the Impact of Donor-Related Variables on Post-Heart Transplantation Outcomes in Mechanically Bridged Recipients and Recipients without Prior Mechanical Support - An Analysis from the ISHLT Registry. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
44
|
Raemdonck DV, Levvey B, Edwards L, Stehlik J, Erasmus M, Glanville A, Hertz M, Hopkins P, Chambers D, Musk M, Budev M, Mason D, Puri V, Yusen R, D’Ovidio F, Keshavjee S, Cypel M, Snell G. Characteristics of Various Categories of Controlled Donors after Circulatory Death Do Not Affect Outcome after Lung Transplantation; an Analysis of ISHLT DCD Registry Data. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
45
|
Goldenberg SD, Brown S, Edwards L, Gnanarajah D, Howard P, Jenkins D, Nayar D, Pasztor M, Oliver S, Planche T, Sandoe JAT, Wade P, Whitney L. The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations. Eur J Clin Microbiol Infect Dis 2015; 35:251-9. [PMID: 26661400 PMCID: PMC4724367 DOI: 10.1007/s10096-015-2538-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 08/14/2015] [Accepted: 11/09/2015] [Indexed: 11/24/2022]
Abstract
Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment.
Collapse
Affiliation(s)
- S D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's and St Thomas' NHS Foundation Trust, 5th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - S Brown
- Department of Microbiology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - L Edwards
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - P Howard
- Department of Microbiology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Nayar
- Department of Microbiology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - M Pasztor
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | | | - T Planche
- St George's Healthcare NHS Trust, London, UK
| | - J A T Sandoe
- Department of Microbiology, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Wade
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's and St Thomas' NHS Foundation Trust, 5th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - L Whitney
- St George's Healthcare NHS Trust, London, UK
| |
Collapse
|
46
|
Keegan R, Edwards L, Jones A, Morgan K, Bryant A. Physical literacy development in Australian youth: A current concern. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Telford D, Keegan R, Barnett L, Rudd J, Telford R, Olive L, Edwards L, Lander N, Keegan S. Physical literacy development in Australian youth: A current concern. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.151] [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]
|
48
|
Cross E, Edwards L, Kedl R. Follicular CD8+ T cells: a novel subset in immune protection and antibody responses. (VAC3P.1062). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.71.9] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Endogenous antigen-specific CD8 T cells have been detected within B cell zones of the splenic white pulp during the primary response to multiple infections. The physiologic implications of CD8 T cell recruitment to B cell zones are unknown. However, such CD8 T cell localization may be beneficial for immunity in multiple ways, including, but not limited to: 1) direct CD8 T cell-mediated costimulation of B cells, 2) CD8 T cell-derived signals lowering the threshold of help required from CD4 follicular helper T cells (Tfh) for B cell maturation, and/or 3) direct CD8 T cell-mediated support of Tfh cells. We show here that after a combined TLR agonist and anti-CD40 antibody immunization (TLR/CD40) the follicular-homing CD8 T cell population is increased compared to infection, particularly at 2-3 days post-immunization. Concurrently, CD8 T cells upregulate Tfh cell-associated markers including CXCR5, PD-1, and ICOS. IL-21 is secreted robustly by CD8 T cells at this time point, which could help support B cell germinal center maintenance, class-switching, and Tfh cell differentiation. Indeed, in the context of TLR/CD40 immunization, the absence of CD8 T cells does not affect the IgM response, but reduces an isotype thought to be directed by IL-21, IgG2c, to levels seen in CD4 T cell-depleted animals. Our data indicates that CD8 T cells can assume a Tfh-like phenotype, we call follicular cytotoxic T cells (Tfc), early after challenge and direct antibody responses.
Collapse
|
49
|
Ciarka A, Edwards L, Stehlik J, Lund L. Association Between Age, Bridge to Transplant Continuous Flow LVAD Use, and Outcomes After Heart Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
50
|
Kobashigawa JA, Johnson M, Rogers J, Vega JD, Colvin-Adams M, Edwards L, Meyer D, Luu M, Reinsmoen N, Dipchand AI, Feldman D, Kormos R, Mancini D, Webber S. Report from a forum on US heart allocation policy. Am J Transplant 2015; 15:55-63. [PMID: 25534656 DOI: 10.1111/ajt.13033] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/23/2014] [Accepted: 08/03/2014] [Indexed: 01/25/2023]
Abstract
Since the latest revision in US heart allocation policy (2006), the landscape and volume of transplant waitlists have changed considerably. Advances in mechanical circulatory support (MCS) prolong survival, but Status 1A mortality remains high. Several patient subgroups may be disadvantaged by current listing criteria and geographical disparity remains in waitlist time. This forum on US heart allocation policy was organized to discuss these issues and highlight concepts for consideration in the policy development process. A 25-question survey on heart allocation policy was conducted. Among attendees/respondents were 84 participants with clinical/published experience in heart transplant representing 51 US transplant centers, and OPTN/UNOS and SRTR representatives. The survey results and forum discussions demonstrated very strong interest in change to a further-tiered system, accounting for disadvantaged subgroups and lowering use of exceptions. However, a heart allocation score is not yet viable due to the long-term viability of variables (used in the score) in an ever-developing field. There is strong interest in more refined prioritization of patients with MCS complications, highly sensitized patients and those with severe arrhythmias or restrictive physiology. There is also strong interest in distribution by geographic boundaries modified according to population. Differences of opinion exist between small and large centers.
Collapse
|