1
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Burgess L, Zeng L, Myrehaug SD, Soliman H, Tseng CL, Detsky J, Chen H, Palhares DM, Witiw CD, Zhang B, Maralani P, Sahgal A. Stereotactic Body Radiotherapy for Posterior Element Only Spinal Metastases: Outcomes and Validation of Recommended Clinical Target Volume Delineation Practice. Int J Radiat Oncol Biol Phys 2023; 117:e91. [PMID: 37786212 DOI: 10.1016/j.ijrobp.2023.06.849] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spine stereotactic body radiotherapy (SBRT) results in improved local control and pain response compared to conventional external beam radiotherapy. Consensus stipulates MRI-based delineation of the clinical target volume (CTV) is critical and is based on spine segment sector involvement. The applicability of these contouring guidelines to metastases confined to the posterior elements is unknown. The purpose of this study was to determine the patterns of failure, as well as the safety of treating posterior element metastases when the vertebral body was intentionally excluded from the CTV. MATERIALS/METHODS A retrospective review of a prospectively maintained database of 605 patients and 1412 spine segments treated with spine SBRT was performed. Only treated segments involving the posterior elements alone were included for the analyses. The primary outcome was local failure, as per SPINO recommendations, and secondary outcomes included patterns of failure, toxicities. Clinical and tumor factors were reported with descriptive statistics. The cumulative risk of local failure was estimated using the Fine-Gray method, accounting for death before local failure as a competing risk. RESULTS A total of 24/605 patients and 31/1412 segments within the database were treated to the posterior elements only. Local failure occurred in 11/31 segments. The cumulative rate of local recurrence was 9.7% at 12 months and 30.8% at 24 months. Amongst local failures, the most common histologies were renal cell carcinoma (36.4%) and non-small cell lung cancer (36.4%). At baseline, 4/11 (36.4%) segments with local failure (36.4%) had epidural disease and 8/11 (72.7%) had paraspinal disease. Most local failures were treated in the de novo setting (8/11, 72.7%). 6/11 (54.5%) failed exclusively within treated CTV sectors and 5/11 (45.5%) with both treated and adjacent untreated sectors. Of these five, four had disease progression within the untreated vertebral body. No failures occurred exclusively within the untreated vertebral body. One patient (4.2%) experienced a grade 4 skin toxicity and one patient (4.2%) developed an iatrogenic Grade 1 vertebral compression fracture. CONCLUSION Posterior element alone metastases are rare. Our analyses support SBRT consensus contouring guidelines such that the vertebral body can be excluded from CTV in spinal metastases confined to the posterior elements.
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Affiliation(s)
- L Burgess
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - L Zeng
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - S D Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C L Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - J Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - D M Palhares
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - C D Witiw
- St. Michaels Hospital, Toronto, ON, Canada
| | - B Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - P Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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LaVine N, Emmert K, Itty J, Martins-Welch D, Carney M, Block A, Burgess L, Volandes AE, Zupanc SN, Jacome S, Gromova V, Davis AD, Schwartz P, Alvarez-Suarez A, Burns E. Reaching Ambulatory Older Adults with Educational Tools: Comparative Efficacy and Cost of Varied Outreach Modalities in Primary Care. J Gen Intern Med 2023; 38:125-130. [PMID: 36217070 PMCID: PMC9550308 DOI: 10.1007/s11606-022-07808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/13/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Providing patients with access to health information that can be obtained outside of an office visit is an important part of education, yet little is known about the effectiveness of outreach modalities to connect older adults to online educational tools. The objective was to identify the effectiveness and cost of outreach modalities providing online information about advance care planning (ACP) for older adults. METHODS Six different outreach modalities were utilized to connect patients to online educational tools (ACP video decision aids). Participants were 13,582 patients aged 65 and older of 185 primary care providers with appointments over a 30-month period within a large health system in the greater New York City area. Main outcome measures were number of online video views and costs per outreach for each modality. KEY RESULTS There were 1150 video views for 21,407 remote outreach events. Text messages, sent to the largest volume of patients (8869), had the highest outcome rate (9.6%) and were the most economical ($0.09). Characterization of phone calls demonstrated 21.7% engagement in the topic of ACP but resulted in minimal video views (<1%) and incurred the highest cost per outreach ($2.88). In-office handouts had negligible results (<1%). CONCLUSIONS Text was the most cost-effective modality to connect older adults to an online educational tool in this pragmatic trial, though overall efficacy of all modalities was low.
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Affiliation(s)
- N LaVine
- Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - K Emmert
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - J Itty
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - D Martins-Welch
- Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - M Carney
- Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA.,Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - A Block
- New York Medical College School of Health Sciences and Practice, Westchester, NY, USA
| | - L Burgess
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - A E Volandes
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,ACP Decisions, Boston, MA, USA
| | - S N Zupanc
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S Jacome
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - V Gromova
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | | | - A Alvarez-Suarez
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Edith Burns
- Department of Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA. .,Institute for Health Systems Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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3
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Hammoud R, Tognin S, Burgess L, Bergou N, Smythe M, Gibbons J, Davidson N, Afifi A, Bakolis I, Mechelli A. Smartphone-based ecological momentary assessment reveals mental health benefits of birdlife. Sci Rep 2022; 12:17589. [PMID: 36302928 PMCID: PMC9614007 DOI: 10.1038/s41598-022-20207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/24/2022] [Accepted: 09/09/2022] [Indexed: 01/13/2023] Open
Abstract
The mental health benefits of everyday encounters with birdlife for mental health are poorly understood. Previous studies have typically relied on retrospective questionnaires or artificial set-ups with little ecological validity. In the present study, we used the Urban Mind smartphone application to examine the impact of seeing or hearing birds on self-reported mental wellbeing in real-life contexts. A sample of 1292 participants completed a total of 26,856 ecological momentary assessments between April 2018 and October 2021. Everyday encounters with birdlife were associated with time-lasting improvements in mental wellbeing. These improvements were evident not only in healthy people but also in those with a diagnosis of depression, the most common mental illness across the world. These findings have potential implications for both environmental and wildlife protection and mental healthcare policies. Specific measures, aimed at preserving and increasing everyday encounters with birdlife in urban areas, should be implemented.
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Affiliation(s)
- Ryan Hammoud
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Stefania Tognin
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Lucie Burgess
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Nicol Bergou
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Michael Smythe
- Nomad Projects, Sunbury Workshops, 24, Swanfield St, London, E2 7LF UK
| | | | | | - Alia Afifi
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Ioannis Bakolis
- grid.13097.3c0000 0001 2322 6764Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrea Mechelli
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
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4
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Raal F, Abelson M, Blignaut S, Burgess L, Coetzer S, Ebrahim I, Gibbon A, Jansen van Rensburg D, Jaros M, Lombard L, Van Nieuwenhuizen E, Pretorius M, Van Tonder A, Urbach D. Safety and efficacy of inclisiran in South African patients at high cardiovascular risk: A subanalysis of the ORION phase III clinical trials. S Afr Med J 2022; 112:426-432. [PMID: 36217872] [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] [Received: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 06/16/2023] Open
Abstract
Inclisiran significantly reduced low-density lipoprotein cholesterol (LDL-C) in individuals with heterozygous familial hypercholesterolaemia, established atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk equivalents (type 2 diabetes, familial hypercholesterolaemia or a 10-year risk of a cardiovascular event ≥20%) in the ORION phase III clinical trials. Infrequent dosing at days 1, 90, 270 and 450 resulted in a mean LDL-C reduction of ~50%. A total of 298 participants from South Africa (SA) were enrolled. Local data are needed to support the use of inclisiran in the SA population, potentially addressing an unmet need for additional LDL-C-lowering therapies. Objectives. To analyse the ORION phase III trial data to assess the efficacy and safety of inclisiran in SA participants. Methods. ORION-9, 10 and 11 were randomised, double-blind, phase III trials. Participants were receiving maximally tolerated statins with or without other lipid-lowering therapies (excluding protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors). Participants were randomised 1:1 to inclisiran sodium 300 mg/284 mg (free acid) or placebo administered at days 1, 90, 270 and 450. The co-primary endpoints were the LDL-C percentage change from baseline to day 510 and the time-averaged percentage change in LDL-C from baseline after day 90 up to day 540. Key secondary endpoints included the absolute change in LDL-C from baseline to day 510, the time-averaged absolute change from baseline after day 90 up to day 540, and changes in other lipids and lipoproteins. Results. The mean age of the participants was 58.6 years (56% male). The mean LDL-C level at baseline was 3.6 mmol/L. At day 510, inclisiran reduced LDL-C levels by 54.2% compared with placebo (95% confidence interval (CI) -61.3 - -47.2; p<0.0001). The corresponding time-averaged reduction in LDL-C was 52.8% (95% CI -57.9 - -47.8; p<0.0001). Treatment-emergent adverse events at the injection site were more common with inclisiran compared with placebo (10.1% v. 0.7%); however, all were mild or moderate in nature and none were persistent. Conclusion. Inclisiran, given in addition to maximally tolerated standard lipid-lowering therapy, is effective and safe and results in robust reductions in LDL-C in SA patients at high cardiovascular risk.
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Affiliation(s)
- F Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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5
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Wright AL, Mattacola EL, Burgess L, Smith L, Finlay KA. The impact of flash glucose monitoring on the clinical practice of healthcare professionals working in diabetes care. Diabetes Res Clin Pract 2022; 183:109157. [PMID: 34863717 DOI: 10.1016/j.diabres.2021.109157] [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: 11/10/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/03/2022]
Abstract
AIMS Research has identified that healthcare professionals' attitudes in clinical consultations impact the efficacy of their communication with service users and the blood glucose monitoring behaviours of their clients. Yet no research has sought to understand the impact of flash glucose monitoring on the experience of undertaking clinical consultations. This qualitative study aimed to explore the impact that flash glucose monitoring has on the clinical practice of healthcare professionals. METHODS Semi-structured interviews were conducted with seventeen Healthcare Professionals (female: n = 13; male: n = 4) working with flash glucose monitoring, analysed via Thematic Analysis. RESULTS Three themes were identified: (1) Delivering Person-centred Care; (2) Shift in Diabetes Management; and (3) Time Burden. These themes highlight that flash glucose monitoring facilitates person-centred care through the provision of comprehensive data which improves communication between healthcare professionals and service users. However, preparing for consultations which integrate flash glucose monitoring requires a significant, potentially burdensome time investment. CONCLUSIONS Flash glucose monitoring enhances the strategic ability of healthcare professionals to provide evidence-based patient-centred care. This facilitates growth in service users' self-efficacy and encourages targeted diabetes self-management. However, further training is needed to optimise the ability of clinicians to rapidly interrogate and present monitoring data to users.
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Affiliation(s)
- A L Wright
- Department of Psychology, University of Buckingham, Buckingham, Buckinghamshire, MK18 1EG, UK
| | - E L Mattacola
- Department of Psychology, University of Buckingham, Buckingham, Buckinghamshire, MK18 1EG, UK
| | - L Burgess
- Diabetes Multidisciplinary Team, Northamptonshire Healthcare Foundation Trust, St Mary's Hospital, Kettering, Northamptonshire, NN15 7PW, UK
| | - L Smith
- Diabetes Multidisciplinary Team, Northamptonshire Healthcare Foundation Trust, St Mary's Hospital, Kettering, Northamptonshire, NN15 7PW, UK
| | - K A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, RG6 7BE, UK.
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6
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Hammoud R, Tognin S, Bakolis I, Ivanova D, Fitzpatrick N, Burgess L, Smythe M, Gibbons J, Davidson N, Mechelli A. Lonely in a crowd: investigating the association between overcrowding and loneliness using smartphone technologies. Sci Rep 2021; 11:24134. [PMID: 34930971 PMCID: PMC8688521 DOI: 10.1038/s41598-021-03398-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Loneliness is a major public health concern with links to social and environmental factors. Previous studies have typically investigated loneliness as a stable emotional state using retrospective cross-sectional designs. Yet people experience different levels of loneliness throughout the day depending on their surrounding environment. In the present study, we investigated the associations between loneliness and social and environmental factors (i.e. overcrowding, population density, social inclusivity and contact with nature) in real-time. Ecological momentary assessment data was collected from participants using the Urban Mind smartphone application. Data from 756 participants who completed 16,602 assessments between April 2018 and March 2020 were used in order to investigate associations between momentary feeling of loneliness, the social environment (i.e. overcrowding, social inclusivity, population density) and the built environment (i.e. contact with nature) using multilevel modelling. Increased overcrowding and population density were associated with higher levels of loneliness; in contrast, social inclusivity and contact with nature were associated with lower levels of loneliness. These associations remained significant after adjusting for age, gender, ethnicity, education and occupation. The positive association between social inclusivity and lower levels of loneliness was more pronounced when participants were in contact with nature, indicating an interaction between the social and built environment on loneliness. The feeling of loneliness changes in relation to both social and environmental factors. Our findings have potential implications for public health strategies and interventions aimed at reducing the burden of loneliness on society. Specific measures, which would increase social inclusion and contact with nature while reducing overcrowding, should be implemented, especially in densely populated cities.
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Affiliation(s)
- Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniela Ivanova
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Fitzpatrick
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucie Burgess
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael Smythe
- Nomad Projects, Sunbury Workshops, 24 Swanfield St., London, UK
| | | | | | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Wylie TAF, Shah C, Burgess L, Robertson E, Dupont D, Swindell R, Hovorka R, Murphy HR, Heller SR. Optimizing the use of technology to support people with diabetes: research recommendations from Diabetes UK's 2019 diabetes and technology workshop. Diabet Med 2021; 38:e14647. [PMID: 34270822 DOI: 10.1111/dme.14647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/07/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To identify key gaps in the research evidence base that could help improve how technology supports people with diabetes, and provide recommendations to researchers and research funders on how best to address them. METHODS A research workshop was conducted, bringing together research experts in diabetes, research experts in technology, people living with diabetes and healthcare professionals. RESULTS The following key areas within this field were identified, and research recommendations for each were developed: Matching the pace of research with that of technology development Time in range as a measure Health inequalities and high-risk groups How to train people to use technology most effectively Impact of technology usage on mental health CONCLUSIONS: This position statement outlines recommendations through which research could improve how technology is employed to care for and support people living with diabetes, and calls on the research community and funders to address them in future research programmes and strategies.
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Affiliation(s)
| | | | | | | | - David Dupont
- Diabetes UK Clinical Studies Group Member, London, UK
| | | | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Helen R Murphy
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK
| | - Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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8
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Burgess L, Indelicato D, Hartsell W, Hill-Kayser C, Paulino A, Perkins S, Gallotto S, Weyman E, Yock T. The Role of Socioeconomic Status (SES) in Disease Outcomes in Pediatric Cancer Patients Receiving Proton Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Low M, Burgess L, Wainwright T. Patient information leaflets for lumbar spine surgery: An opportunity for improvement in ERAS pathways. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.121] [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: 10/26/2022]
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10
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Sisak K, Darch R, Burgess L, Middleton R, Wainwright T. For which patients is attending a pre-operative education session most important in a total hip and knee replacement eras pathway? Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.062] [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: 10/26/2022]
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11
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Burgess L, Arundel J, Wainwright T. The inclusion of preoperative education in Eras spinal surgery pathways: A systematic review. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.031] [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: 10/26/2022]
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12
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Sisak K, Darch R, Burgess L, Middleton R, Wainwright T. A preoperative education class reduces length of stay for total knee replacement patients identified at risk of an extended length of stay. J Rehabil Med 2019; 51:788-796. [DOI: 10.2340/16501977-2602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Pool E, Winston A, Bagkeris E, Vera JH, Mallon P, Sachikonye M, Post FA, Pozniak A, Boffito M, Anderson J, Williams I, Johnson M, Burgess L, Sabin CA. High-risk behaviours, and their associations with mental health, adherence to antiretroviral therapy and HIV parameters, in HIV-positive men who have sex with men. HIV Med 2018; 20:131-136. [PMID: 30548745 PMCID: PMC6519017 DOI: 10.1111/hiv.12690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 11/28/2022]
Abstract
Objectives To investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among men who have sex with men (MSM) living with HIV. Methods Cross sectional study. Results 147 out of 819 HIV‐positive MSM exhibited a high‐risk phenotype (defined as >3 of smoking, excess alcohol, sexually transmitted infection and recent recreational drug use). This phenotype was associated with younger age, depressive symptoms and <90% adherence in multivariable logistic regression. Conclusion In a cohort of MSM, a small, but significant proportion exhibited multiple concurrent risk behaviours.
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Affiliation(s)
- Erm Pool
- University College London, London, UK.,Brighton and Sussex Medical School, Brighton, UK
| | | | | | - J H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - Pwg Mallon
- University College Dublin, Dublin, Ireland
| | | | - F A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - A Pozniak
- Imperial College London, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - M Boffito
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | - M Johnson
- Royal Free Centre for HIV Medicine, Royal Free Hospital, London, UK
| | | | - C A Sabin
- University College London, London, UK
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14
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Foster A, Boyes L, Burgess L, Carless S, Bowyer V, Jenkinson H, Parulekar M, Ainsworth J, Hungerford J, Onadim Z, Sagoo M, Rosser E, Reddy MA, Cole T. Patient understanding of genetic information influences reproductive decision making in retinoblastoma. Clin Genet 2017; 92:587-593. [PMID: 28397259 DOI: 10.1111/cge.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/10/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinoblastoma is the most common malignant tumour of the eye in childhood, with nearly all bilateral tumours and around 17% to 18% of unilateral tumours due to an oncogenic mutation in the RB1 gene in the germline. Genetic testing enables accurate risk assessment and optimal clinical management for the affected individual, siblings, and future offspring. MATERIAL AND METHODS We carried out the first UK-wide audit of understanding of genetic testing in individuals with retinoblastoma. A total of 292 individuals aged 16 to 45 years were included. RESULTS Patients with bilateral disease were significantly more likely to understand the implications of retinoblastoma for siblings and children. There was a significant association between not knowing the results of genetic testing or not understanding the implications and not having children, particularly in women. Surprisingly, this was also true for individuals treated for unilateral disease with a low risk of retinoblastoma for their offspring. CONCLUSION We are concerned that individuals may be making life choices based on insufficient information regarding risks of retinoblastoma and reproductive options. We suggest that improvement in transition care is needed to enable individuals to make informed reproductive decisions and to ensure optimal care for children born at risk of retinoblastoma.
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Affiliation(s)
- A Foster
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Boyes
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Burgess
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - S Carless
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - V Bowyer
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
| | - H Jenkinson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - M Parulekar
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Ainsworth
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Hungerford
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - Z Onadim
- Retinoblastoma Genetic Screening Unit, Barts Health NHS Trust, London, UK
| | - M Sagoo
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - E Rosser
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Reddy
- Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.,Moorfields Eye Hospital NHS Trust, London, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital NHS Foundation Trust, Birmingham, UK
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Burgess L, Pulsifer M, Yeap B, Grieco J, Weinstein E, MacDonald S, Tarbell N, Yock T. Estimated IQ (EIQ) Systematically Overestimates Full-Scale IQ (FSIQ) in Survivors Irradiated for Pediatric Brain Tumors. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Burgess L. Rights in the Digital Era. Archives and Manuscripts 2015. [DOI: 10.1080/01576895.2015.1088500] [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]
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17
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Schumm-Draeger PM, Burgess L, Korányi L, Hruba V, Hamer-Maansson JE, de Bruin TWA. Twice-daily dapagliflozin co-administered with metformin in type 2 diabetes: a 16-week randomized, placebo-controlled clinical trial. Diabetes Obes Metab 2015; 17:42-51. [PMID: 25200570 DOI: 10.1111/dom.12387] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/19/2014] [Accepted: 08/30/2014] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the efficacy and safety of twice-daily dosing of dapagliflozin and metformin, exploring the feasibility of a fixed-dose combination. METHODS In this 16-week, phase III, randomized, double-blind placebo-controlled study, adults who were receiving metformin administered twice daily (≥1500 mg/day) and had inadequate glycaemic control were randomized 1:1:1:1 to receive dapagliflozin twice daily (2.5 or 5 mg), placebo or dapagliflozin 10 mg once daily (which was included as a benchmark). The primary endpoint was change from baseline glycated haemoglobin (HbA1c) level. Secondary endpoints included changes in fasting plasma glucose (FPG) level and body weight. RESULTS Four hundred adults were randomized to dapagliflozin (2.5 mg twice daily, 5 mg twice daily, 10 mg once daily) or placebo co-administered with metformin twice daily. At 16 weeks, the adjusted mean change in HbA1c from baseline was significantly reduced in the dapagliflozin 2.5 mg twice daily and 5 mg twice daily groups versus placebo (-0.52 vs. -0.30%, p = 0.0106 and -0.65% vs. -0.30%, p < 0.0001). There were also significantly greater improvements for dapagliflozin twice daily groups versus placebo in FPG body weight and achievement of HbA1c level of <7%. Efficacy outcomes for dapagliflozin twice daily were numerically similar to those for dapagliflozin once daily. Dapagliflozin twice daily was well tolerated. CONCLUSIONS Dapagliflozin 2.5 or 5 mg twice daily added to metformin was effective in reducing glycaemic levels in patients with type 2 diabetes inadequately controlled with metformin alone. This study supports the development of a fixed-dose combination regimen.
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Affiliation(s)
- P-M Schumm-Draeger
- Clinic for Endocrinology, Diabetology, Angiology, Academic Teaching Hospital, Munich, Germany
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Morgan C, Burgess L, McGowan P, Turner M. OP016: Hyperalimentation and Blood Glucose Control in Very Preterm Infants: A Randomised Controlled Parenteral Nutrition Study. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Crawford S, Malvy CP, Vauthier C, Bertrand JR, Ramon AL, Winkler J, Burgess L, Laird E, Weaver D, Chantry D, Hernandez JC, Guerrero CA, Acosta O, Granja S, Lee CT, Park MY, Eo EY, Lee JH. Poster session 1. Target identification & validation. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt043] [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
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20
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Winkler J, Burgess L, Laird E, Weaver D, Chantry D. Phenotypic Screening for Kinase Targets Using Small Molecule Inhibitors with Proven Cell Penetration. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt043.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Robertson J, Ye H, Wallace M, Burgess L. The Relationship between Chronic Bowel Dysfunction and the Small Bowel Dose Volume Histogram of Rectal Cancer Survivors. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Parzuchowski JS, Jordon J, Burgess L, Witsell M, Sobol L, Rontal M, Balaraman S, Ignatius R, Venuturumilli P, Krauss D, Chen P, Fontanesi J, Akervall J. Lead-time from diagnosis to start of radiation shortened by 44% for head and neck cancer when patients go through a multidisciplinary clinic. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16627] [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: 11/20/2022] Open
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Laver K, Ratcliffe J, George S, Lester L, Walker R, Burgess L, Crotty M. Early rehabilitation management after stroke: What do stroke patients prefer? J Rehabil Med 2011; 43:354-8. [DOI: 10.2340/16501977-0678] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Carter L, Shiraishi Y, Shin Y, Burgess L, Eberhardt C, Wright A, Klopfenstein N, McVean M, Gomez A, Chantry D, Cook A, Takeda K, Gelfand E. Potent and Selective CRTH2 Antagonists are Efficacious in Models of Asthma, Allergic Rhinitis (AR) and Atopic Dermatitis (AD). J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.489] [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: 12/01/2022]
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Abstract
BACKGROUND Definitive diagnosis of tuberculous pericarditis requires isolation of the tubercle bacillus from pericardial fluid, but isolating the organism is often difficult. AIM To improve diagnostic efficiency for tuberculous pericarditis, using available tests. DESIGN Prospective observational study. METHODS Consecutive patients (n = 233) presenting with pericardial effusions underwent a predetermined diagnostic work-up. This included (i) clinical examination; (ii) pericardial fluid tests: biochemistry, microbiology, cytology, differential white blood cell (WBC) count, gamma interferon (IFN-gamma), adenosine deaminase (ADA) levels, polymerase chain reaction testing for Mycobacterium tuberculosis; (iii) HIV; (iv) sputum smear and culture; (v) blood biochemistry; and (vi) differential WBC count. A model was developed using 'classification and regression tree' analysis. The cut-off for the total diagnostic index (DI) was optimized using receiver operating characteristic (ROC) curves. RESULTS Fever, night sweats, weight loss, serum globulin (>40 g/l) and peripheral blood leukocyte count (<10 x 10(9)/l) were independently predictive. The derived prediction model had 86% sensitivity and 84% specificity when applied to the study population. Pericardial fluid IFN-gamma >or=50 pg/ml, concentration had 92% sensitivity, 100% specificity and a positive predictive value (PPV) of 100% for the diagnosis of tuberculous pericarditis; pericardial fluid ADA >or=40 U/l had 87% sensitivity and 89% specificity. A diagnostic model including pericardial ADA, lymphocyte/neutrophil ratio, peripheral leukocyte count and HIV status had 96% sensitivity and 97% specificity; substituting pericardial IFN-gamma for ADA yielded 98% sensitivity and 100% specificity. DISCUSSION Basic clinical and laboratory features can aid the diagnosis of tuberculous pericarditis. If available, pericardial IFN-gamma is the most useful diagnostic test. Otherwise we propose a prediction model that incorporates pericardial ADA and differential WBC counts.
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Affiliation(s)
- H Reuter
- Cardiology Unit/TREAD Research, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
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Jolly S, Grills I, Kestin L, Wu Q, Burgess L, Williams V, Martinez A, Yan D, Vicini F. 1078. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.343] [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]
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Tournas VH, Heeres J, Burgess L. Moulds and yeasts in fruit salads and fruit juices. Food Microbiol 2006; 23:684-8. [PMID: 16943069 DOI: 10.1016/j.fm.2006.01.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 01/17/2006] [Accepted: 01/17/2006] [Indexed: 11/24/2022]
Abstract
Thirty-eight fruit salad samples including cantaloupe, citrus fruits, honeydew, pineapple, cut strawberries and mixed fruit salads, and 65 pasteurized fruit juice samples (apple, carrot, grapefruit, grape and orange juices, apple cider, and soy milk) were purchased from local supermarkets in the Washington, DC area and tested for fungal contamination. The majority of fruit salad samples (97%) were contaminated with yeasts at levels ranging from <2.0 to 9.72 log10 of colony forming units per gram (cfu/g). Frequently encountered yeasts were Pichia spp., Candida pulcherrima, C. lambica, C. sake, Rhodotorula spp., and Debaryomyces polymorphus. Low numbers of Penicillium spp. were found in pineapple salads, whereas Cladosporium spp. were present in mixed fruit and cut strawberry salads. Twenty-two per cent of the fruit juice samples tested showed fungal contamination. Yeasts were the predominant contaminants ranging from <1.0 to 6.83 log10 cfu/ml. Yeasts commonly found in fruit juices were C. lambica, C. sake, and Rhodotorula rubra. Geotrichum spp. and low numbers of Penicillium and Fusarium spp. (1.70 and 1.60 log10 cfu/ml, respectively) were present in grapefruit juice.
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Affiliation(s)
- V H Tournas
- Center for Food Safety and Applied Nutrition (HFS-315), Food and Drug Administration, College Park, MD 20740, USA.
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Burgess L, Yan D. TU-E-T-6C-01: Intensity Modulated Radiation Therapy for the Treatment of Breast Cancer. Med Phys 2005. [DOI: 10.1118/1.1999714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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32
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Ihezue CU, Smart J, Dewbury KC, Mehta R, Burgess L. Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications. Clin Radiol 2005; 60:459-63; discussion 457-8. [PMID: 15767103 DOI: 10.1016/j.crad.2004.10.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Revised: 10/12/2004] [Accepted: 10/18/2004] [Indexed: 11/23/2022]
Abstract
AIM To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS). METHODS Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure. A TRUS-guided biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Follow-up telephone calls were made to those who had not replied within the stipulated period. RESULTS Of the 1000 patients who replied, 49 were receiving warfarin, 220 were receiving aspirin and 731 were not receiving any anticoagulant drugs. Of the 49 subjects reporting current use of warfarin, 18 (36.7%) experienced haematuria, compared with 440 (60.2%) of the patients receiving no anti-coagulant drugs who reported haematuria. This was statistically significant (p = 0.001). Of the group receiving warfarin, 4 (8.2%) experienced haematospermia whereas 153 (21%) of the group receiving no anticoagulant medication reported haematospermia. This difference also was statistically significant (p = 0.030). Rectal bleeding was experienced by 7 (14.3%) of the group receiving warfarin compared with 95 (13%) in the group without anticoagulant medication, but this was not statistically significant (p = 0.80). We also demonstrated that there was no statistically significant association between the severity of the bleeding complications and medication with warfarin. CONCLUSION None of the group receiving warfarin experienced clinically important bleeding complications. Our results suggest that the frequency and severity of bleeding complications were no worse in the warfarin group than in the control group and that discontinuing anticoagulation medication before prostate biopsy may be unnecessary.
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Affiliation(s)
- C U Ihezue
- Department of Radiology, Southampton General Hospital, UK
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White DA, Morris AJ, Burgess L, Hamburger J, Hamburger R. Facilitators and barriers to improving the quality of referrals for potential oral cancer. Br Dent J 2004; 197:537-40. [PMID: 15543109 DOI: 10.1038/sj.bdj.4811800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 10/13/2003] [Indexed: 11/08/2022]
Abstract
The quality and content of referral letters are important for prioritisation of patients who may have oral cancer. Referrals letters to the Oral Medicine Clinic at Birmingham Dental Hospital were analysed and practitioners interviewed. Whilst acceptable for general purposes, most letters did not contain sufficient information to allow effective prioritisation. Interviews disclosed a misunderstanding amongst practitioners about the way in which referrals were handled. A number of barriers to increasing the information included in letters were identified. Referral guidelines and a standardised proforma might help improve the ability of the service to operate a fast-track system.
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Affiliation(s)
- D A White
- Dental Public Health, School of Dentistry, University of Birmingham.
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Abstract
AIMS An audit of acute treatment-related toxicity during chemo-radiotherapy for cervical cancer was carried out to assess its tolerance outside research settings. MATERIALS AND METHODS Between May 1999 and April 2003, 74 patients with carcinoma of the cervix were treated with radical radiotherapy given concurrently with weekly cisplatin chemotherapy. Fifty-nine (79.7%) patients received chemo-radiotherapy as primary radical treatment, 10 (13.5%) patients were treated adjuvantly for poor-prognosis features after radical surgery, and the remaining five (6.8%) were given chemo-radiotherapy for pelvic recurrences after previous surgery. Acute treatment-related toxicity was graded prospectively at weekly intervals during chemo-radiotherapy using the National Cancer Institute Common Toxicity Criteria. RESULTS The most common adverse effects were diarrhoea (80.6%), malaise (66.7%) and nausea (62.5%). The most common haematological toxicity was anaemia, with 41.7% patients developing grade 1 or 2 toxicity. Only three (4.2%) patients had grade 3 or 4 toxicity. One patient had grade 3 thrombocytopenia, another had grade 4 neutropenia and the third patient had grade 3 diarrhoea. A statistically significant correlation was found between maximum treatment-related toxicity, larger treatment volumes (P = 0.006) and disease stage (P = 0.04). A total of 97.3% of patients completed external beam radiotherapy without any interruptions for treatment-related toxicity. Only two patients (3.4%) experienced a delay in brachytherapy for treatment-related toxicity. Two patients died during external beam radiotherapy, and one patient suffered a fatal pulmonary embolism 1 week after completing brachytherapy treatment. A total of 70.2% patients completed the planned number of chemotherapy cycles, with a further 20.3% receiving at least three cycles. The most common reason for failure to complete chemotherapy as planned was gastrointestinal toxicity. There was no correlation between failure to complete planned chemotherapy and patient age, disease stage, radiotherapy treatment volumes or postoperative treatment. CONCLUSION Our study has shown that cisplatin-based chemo-radiotherapy for carcinoma of the cervix is well tolerated when given to a largely unselected population of patients outside research settings. The effectiveness of the treatment should therefore mirror the efficacy obtained in clinical trials.
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Affiliation(s)
- L T Tan
- Oncology Centre, Addenbrookes's Hospital, Cambridge, UK.
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Cheetham DR, Burgess L, Ellis M, Williams A, Greenhalgh RM, Davies AH. Does Supervised Exercise Offer Adjuvant Benefit Over Exercise Advice Alone for the Treatment of Intermittent Claudication? A Randomised Trial. Eur J Vasc Endovasc Surg 2004; 27:17-23. [PMID: 14652832 DOI: 10.1016/j.ejvs.2003.09.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Exercise advice is the main treatment for symptom relief in the UK for patients with mild to moderate Intermittent Claudication (IC). Would a weekly exercise and motivation class for 6 months offer adjuvant benefit over written and verbal exercise advice alone? PATIENTS AND METHODS Fifty-nine patients attending a regional vascular centre for whom IC was the main factor affecting mobility were randomised to either exercise advice alone (n=30) or exercise advice with a once a week 45 min supervised exercise/motivation class (n=29). The mean age was 68 years. Baseline and 6-month assessment included a Quality of Life Questionnaire--the Short-Form-36, the Charing Cross Symptom Specific Claudication Questionnaire (CCCQ) and treadmill walking distance (3.5 km/h 12%). RESULTS At 6-month follow-up the supervised exercise group had improved their treadmill walking by 129% compared to 69% in the advice alone group (p=0.001). This significant improvement was maintained at the subsequent 9 and 12-month follow-up assessments. By the 9-month stage the advice only group CCCQ score had improved 16% from baseline, while the supervised exercise group had a significantly better 43% improvement in base line score (p<0.05). Self reported frequency of walks was higher in the exercise class group being significant for improvement in CCCQ score. CONCLUSION A weekly, supervised exercise and motivation class for a 6-month period provides a significant improvement in patients' symptoms, quality of life, and distance walked compared with advice alone and this improvement continues after attendance at class has ceased.
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Affiliation(s)
- D R Cheetham
- Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK
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Coles CE, Burgess L, Tan LT. An audit of delays before and during radical radiotherapy for cervical cancer--effect on tumour cure probability. Clin Oncol (R Coll Radiol) 2003; 15:47-54. [PMID: 12708710 DOI: 10.1053/clon.2002.0178] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To evaluate the potential impact of time delay before and during radical radiotherapy for cervical carcinoma at Addenbrooke's Hospital. MATERIALS AND METHODS An audit was undertaken which recorded the number of gaps during external beam radiotherapy (EBRT), overall treatment time, and delay between first oncology consultation to start of radiotherapy, for patients receiving primary radical radiotherapy for cervical cancer in 1996, 1998 and 2001. Radiobiological modelling was used to calculate the tumour control probability (TCP). A questionnaire survey of 62 oncology departments in the U.K. was carried out for comparison. RESULTS The percentage of patients completing EBRT without any interruptions was 22, 67 and 94% in 1996, 1998, and 2001, respectively (P = 0.0009). The median overall treatment time was 49, 42 and 39 days in 1996, 1998 and 2001, respectively (P = 0.001). However, the median waiting time to start of radiotherapy increased from 14 days in 1996 to 18 days in 1998 and 35 days in 2001 (P = 0.007). CONCLUSION The results from the national survey showed that this pattern of improved overall treatment times accompanied by deterioration in waiting times was also seen in most other U.K. centres. Radiobiological modelling showed that any potential gain in TCP resulting from shorter overall treatment times could be offset entirely by the adverse effect of increasing waiting times. The calculations suggest that the tumours most likely to be adversely affected by long waiting times are those with shorter volume doubling times or a medium chance of tumour control at the outset of treatment. A system of patient triage, and prioritization of patients deemed most likely to benefit from a reduced waiting time, may be necessary in the current climate of limited radiotherapy resources.
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Affiliation(s)
- C E Coles
- Oncology Centre, Addenbrooke's Hospital, Cambridge, U.K.
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Burgess L, Hackett AF, Kirby S, Maxwell S, Nathan I. A reassessment of the fat intake of children from meat and meat products and an estimate of haem iron intakes. J Hum Nutr Diet 2001; 14:55-61. [PMID: 11301933 DOI: 10.1046/j.1365-277x.2001.00271.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is possible that fat intake from red meat has declined as a consequence of changes in animal husbandry and butchery practices. In particular, a study of the intake of vegetarian and meat-eating children concluded that their fat intakes were similar, but the most recent information on the fat content of meat was not available. In addition, iron availability is probably as important as the total amount of iron consumed but estimates of haem iron intake are rarely made. METHODS The dietary intake of 50 omnivorous children was reanalysed to produce new estimates of fat and haem iron intakes. Fat intake from meat and meat products only was recalculated using supplements to the food tables not available to the initial survey. Haem iron intake was calculated by discriminating between the different types of meat consumed and estimates of the proportion of iron which is in the haem form. RESULTS The recalculated diets had significantly lower energy (8.03-7.50 MJ), fat (79-73 g) and carbohydrate (257-237 g) levels. The proportions of energy from fat (36%) and carbohydrate (51%) were unaffected. Meat supplied 3.2 mg (33%) of the iron intake (9.6 mg) of which 1.3-1.5 mg (13-16% of the total) was estimated to be in the haem form. Children may be relatively unaffected by the changes in the composition of meat as such, if they consume highly processed foods which include, for example, rusk, pastry, breadcrumbs and batter. CONCLUSIONS The original estimates of the intake of fat of these omnivorous children from meat and meat products do appear to have been overestimates, but only as the weight of fat consumed not as a percentage of energy. Haem iron was found to supply a substantial proportion of the iron intake of these children and may account for their higher haemoglobin values.
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Affiliation(s)
- L Burgess
- Liverpool John Moores University, School of Education and Community Studies, Liverpool, UK
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Smedema JP, Katjitae I, Reuter H, Burgess L, Louw V, Pretorius M, Doubell AF. Twelve-lead electrocardiography in tuberculous pericarditis. Cardiovasc J S Afr 2001; 12:31-4. [PMID: 11447490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVES This study is part of an ongoing initiative started in 1995 to investigate the therapeutic efficacy of adjuvant corticosteroids in the management of tuberculosis (TB) pericarditis. In this retrospective, descriptive study we describe the changes found on the 12-lead electrocardiogram (ECG) in patients with TB pericarditis, with and without cardiac tamponade. We determined the diagnostic accuracy of ECG parameters for cardiac tamponade. METHODS All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a thorough clinical assessment followed by pericardiocentesis and drainage using an indwelling pigtail catheter. The amount of drained effusion was measured, and fluid was sent for diagnostic assessment. Patients were grouped into those with or without cardiac tamponade. The following ECG parameters were assessed: rate, rhythm, microvoltage, electrical alternans, PR segment and ST segment abnormalities. RESULTS Of the 157 patients assessed, 88 were diagnosed with TB pericarditis All had abnormal ECGs and 83% had changes of chronic pericarditis. Microvoltage in the extremity and/or precordial leads correlated with the presence of large effusions (> 750 ml). None of the studied parameters correlated with the presence of cardiac tamponade. CONCLUSIONS Twelve-lead ECG is of supportive but not diagnostic value in cardiac tamponade. The presence of microvoltage suggests the presence of a large effusion. The absence of microvoltage makes the presence of cardiac tamponade unlikely.
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Affiliation(s)
- J P Smedema
- Department of Internal Medicine, Cardiology Unit, Tygerberg Hospital, Western Cape, South Africa
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Affiliation(s)
- L Burgess
- Pediatric Intensive Care Unit, Presbyterian Hospital, Charlotte, N.C., USA
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Bailit MH, Burgess L. Dissecting the carve-out. States try to learn from one another's experiences. Behav Healthc Tomorrow 1999; 8:18-22. [PMID: 10747578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- M H Bailit
- Bailit Health Purchasing, LLC, in Needham, Mass., USA
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Abstract
The number of people who avoid eating meat is growing, especially among young people. Benefits to health from a vegetarian diet have been reported in adults but it is not clear to what extent these benefits are due to diet or to other aspects of lifestyles. In children concern has been expressed concerning the adequacy of vegetarian diets especially with regard to growth. The risks/benefits seem to be related to the degree of restriction of he diet; anaemia is probably both the main and the most serious risk but this also applies to omnivores. Vegan diets are more likely to be associated with malnutrition, especially if the diets are the result of authoritarian dogma. Overall, lacto-ovo-vegetarian children consume diets closer to recommendations than omnivores and their pre-pubertal growth is at least as good. The simplest strategy when becoming vegetarian may involve reliance on vegetarian convenience foods which are not necessarily superior in nutritional composition. The vegetarian sector of the food industry could do more to produce foods closer to recommendations. Vegetarian diets can be, but are not necessarily, adequate for children, providing vigilance is maintained, particularly to ensure variety. Identical comments apply to omnivorous diets. Three threats to the diet of children are too much reliance on convenience foods, lack of variety and lack of exercise.
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Affiliation(s)
- A Hackett
- Centre for Consumer Education and Research, Liverpool John Moores University
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Seifer C, McNeill B, O’Donnell M, Daly K, Kellett J, McGee HM, Montogomery AJ, O’Callaghan D, Horgan JH, Mahon NG, Codd M, Brennan J, Egan B, McCann HA, Sugrue DD, Menown IBA, Patterson RSHW, McMechan SR, Hameed S, Adgey AAJ, Baird SH, McBride SJ, Trouton TG, Wilson C, McRedmond JP, Fitzgerald DJ, Crowley JJ, Tanguay JF, Santos RM, Stack RS, Mahon NG, Keelan P, McCann HA, Sugrue DD, McKenna CJ, AuBuchon R, Camrud AR, Holmes DR, Schwartz RS, McKenna CJ, Camrud AR, Wolff R, Edwards WD, Holmes DR, Schwartz RS, Hanratty C, McAuley D, Young I, Murtagh G, O’Keeffe B, Richardson G, Scott M, Chew EW, Bailie NA, Graham AMJ, O’Kane H, McKenna CJ, Kwon HM, Ellis L, Holmes DR, Virmani R, Schwartz RS, Noelke L, Wood AE, Javadpour H, Veerasingham D, Wood AE, O’Kane D, Allen JD, Adgey AAJ, Hennessy T, Johnson P, Hildick-Smith D, Winter E, Shapiro L, McKenna CJ, Edwards WD, Lerman A, Holmes DR, Schwartz RS, McGrath LT, Passmore P, Silke B, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, Lovell SL, McDowell G, McEneany D, Riley MS, Nicholls DP, Gilligan D, Sargent D, Dan D, Gilligan D, Elam G, Rhee B, Keane D, Zhou L, McGovern B, Garan H, Ruskin J, O’Shea JC, Tan HC, Zidar JP, Stack RS, Crowley JJ, O’Keeffe DB, Graffin S, Fitzsimmons D, Brown S, Duff D, Denham B, Woods F, Neligan M, Oslizlok P, Connolly CK, Danton MHD, O’Kane H, Danton M, Gladstone DJ, Craig B, Mulholland HC, Casey F, Chaudhuri S, Hinchion J, Wood AE, Hinchion J, Wood AE, Menown IBA, Patterson RHSW, MacKenzie G, Adgey AAJ, Harbinson MT, Burgess LM, Moohan V, McEneaney DJ, Adgey AAJ, Menown IBA, MacKenzie G, Patterson RSHW, Adgey AAJ, Finnegan OC, Doherty L, Silke B, Riddell JG, Meleady R, Daly L, Graham I, Quinn M, Foley B, Lee J, Mulvihill N, Crean P, Walsh M, O’Morain C, Quinn M, Crean P, Foley B, Walsh M, Hynes C, King SM, David S, Newton H, Maguire M, Rafferty F, Horgan JH, Sullivan PA, Murphy D, Gallagher S, Menown IBA, Allen J, Anderson JM, Adgey AAJ, Dan D, Hoag J, Eckberg D, Gilligan D, Galvin J, Garan H, McGovern B, Ruskin J, Mahon NG, Diamond P, Neilan T, Keelan E, H. A., McCarthy C, Sugrue DD, Harbinson MT, Moohan VP, McEneaney DJ, Burgess LM, Anderson JM, Ayers GM, Adgey AAJ, Roberts M, Burgess L, Anderson C, Wilson C, Khan M, Clements IP, Miller WL, Seifer C, O’Donnell M, McNeill B, Daly K, Turtle F, McDowell G, Long H, McNair W, Campbell NPS, Mathew TP, Turtle F, Smye M, Nesbitt GS, Young IS, Adgey AAJ, Meleady R, Mulcahy D, Graham IM, Moore D, Menown IBA, McMechan SR, MacKenzie G, Adgey AAJ, Diamond P, Sugrue D, Codd MB, Galvin J, Zimmerman P, Winget J, Capeless M, Galvin J, Garan H, McGovern B, Ruskin J, McKelvey TA, Danton MHD, Sarsam MIA, McEneaney D, Roberts M, Burgess L, Anderson C, Wilson C, Khan M. Irish cardiac society. Ir J Med Sci 1998. [DOI: 10.1007/bf02937898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hadaegh A, Burns J, Burgess L, Rose R, Rowe E, LaMorte WW, Becker JM. Effects of hyaluronic acid/carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit. J Gastrointest Surg 1997; 1:569-75. [PMID: 9834393 DOI: 10.1016/s1091-255x(97)80074-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intra-abdominal adhesions form in more than 90% of patients undergoing major abdominal surgery and can lead to significant complications. Application of a bioresorbable gel consisting of chemically modified hyaluronic acid (HA) and carboxymethylcellulose (CMC) has shown promise as a means of preventing intra-abdominal adhesions, but there have been concerns that the presence of the gel might interfere with the integrity and healing of bowel anastomoses. We tested the effects of HA/CMC gel on adhesion formation and anastomotic healing in 60 New Zealand white rabbits after transection and complete (100%) or incomplete (90%) anastomosis of the ileum. Half of the animals underwent application of HA/CMC gel and half served as control subjects. Animals were killed at 4, 7, or 14 days after surgery. Anastomotic adhesions were scored in a blinded fashion. Integrity of the anastomosis was tested by measuring bursting pressure at the anastomotic site and in an adjacent section of intact bowel. With complete anastomosis, HA/CMC gel significantly reduced adhesion formation at 7 and 14 days after surgery (P<0.05), but gel application did not inhibit adhesion formation when the anastomosis was incomplete. Anastomosed segments of bowel burst at a lower pressure than intact bowel 4 days after surgery, but bursting pressures were normal at 7 and 14 days. Burst pressures of anastomoses receiving an application of HA/CMC gel were nearly identical to control anastomoses at all three time points. HA/CMC gel did not interfere with the normal healing process of bowel anastomoses. Furthermore, HA/CMC gel decreased adhesion formation after complete anastomoses, yet it did not affect adhesion formation in the presence of anastomotic disruption.
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Affiliation(s)
- A Hadaegh
- Division of Surgery, Boston University School of Medicine, Boston, MA 02118, USA
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Burns JW, Skinner K, Colt MJ, Burgess L, Rose R, Diamond MP. A hyaluronate based gel for the prevention of postsurgical adhesions: evaluation in two animal species. Fertil Steril 1996; 66:814-21. [PMID: 8893691] [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: 02/02/2023]
Abstract
OBJECTIVE To assess in two animal surgery models, the efficacy of a bioabsorbable gel to prevent postoperative adhesions. DESIGN A randomized, prospective, blinded study using animal abdominal surgery models. SETTING Two animals species with surgical traumas to induce adhesion formation. INTERVENTIONS A chemically modified hyaluronate and carboxymethylcellulose-based gel formulation. MAIN OUTCOME MEASURES The number of animals with no adhesions, mean number of adhesions, and total adhesion score. RESULTS Treatment with the bioabsorbable gel increased the number of animals without any adhesion by 70% in a rat cecal abrasion model and by > 90% in a rabbit sidewall defect-bowel abrasion model when compared with nontreatment control animals. Other outcome measures showed similar efficacy. CONCLUSION The modified hyaluronate-carboxymethylcellulose gel was effective in two animal species after surgery in the abdominal cavity. The gel appears to act as a physical barrier between damaged peritoneal tissue and may be appropriate for human clinical trials in open and laparoscopic surgical procedures.
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Affiliation(s)
- J W Burns
- Biomaterials and Surgical Products Research Department, Genzyme Corporation, Cambridge, Massachusetts 02139-1562, USA
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Burgess L. Mixed-sex wards--the NT survey results. Nurs Times 1994; 90:35-8. [PMID: 8065976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The practice of rigidly separating men and women in hospital has broken down in recent years; the RCN estimates that half of all acute hospital wards are now mixed. In January, NT invited readers to give their opinions on mixing males and females in the same wards and to describe their own areas of work. Chief areas of concern that emerged were: patients not being informed about the ward being mixed before admission; lack of privacy (especially in bathroom and lavatory areas); and in patients' unhappiness with the proximity of patients of the opposite sex. Although complaints were common, most were informal. Further research, preferably from a 'neutral' source, is needed.
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Abstract
Lactoferricin B (LF-B) is a peptide derived from acid-pepsin digestion of bovine lactoferrin, which has antimicrobial properties. In order to assess the antimicrobial spectrum of LF-B and its possible in vivo uses, the minimum inhibitory and microbicidal concentrations of pure lactoferricin B were determined for a range of bacterial species and under varying conditions of growth including growth phase and size of the inoculum, pH and ionic strength of the medium. Lactoferricin B was bactericidal against a wide range of bacteria and Candida albicans. Proteus spp., Pseudomonas cepacia and Serratia spp. were resistant. The bactericidal activity of LF-B was inhibited by increasing ionic strength and bacterial inoculum and at acid pH. The activity of lactoferricin B was completely inhibited by the addition of 5% whole cow's milk and was reduced in the presence of increasing concentrations of mucin. These results indicate the potential of LF-B to reduce the numbers of organisms in a simple medium, but raise doubts about its role in vivo because of its sensitivity to changes in physical variables. It may be that lactoferricin exerts a transient antimicrobial effect at mucosal surfaces.
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Affiliation(s)
- E M Jones
- Department of Microbiology, Bristol Royal Infirmary, UK
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Abstract
There are many facets and ideas surrounding the concept of body image, which are of particular importance to patients with defects of the head and neck who may have had to suffer extensive alterations to their appearance and bodily functions. This article discusses how nursing models can be used to help patients cope with their altered body image and the attitudes of society and the media to their disfigurement.
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Burgess L. An epidemic of massive proportions: Smoking and the health of the nation. Prof Nurse 1994; 9:566-72. [PMID: 8008772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The number of deaths from smoking-related illness is still unacceptably high. The government aims to reduce cigarette consumption by the year 2000, but this can only be achieved if the social, psychological and political factors that induce people to start smoking are addressed.
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Burgess L. Mixed-sex wards. Mixed responses. Nurs Times 1994; 90:30-4. [PMID: 8302644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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