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Clough A, Chuter R, Hales RB, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, McDaid L, Choudhury A, Eccles CL. Impact of a contouring atlas on radiographer inter-observer variation in male pelvis radiotherapy. J Med Imaging Radiat Sci 2024:S1939-8654(24)00058-4. [PMID: 38609834 DOI: 10.1016/j.jmir.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE/OBJECTIVE To determine the impact of a MR-based contouring atlas for male pelvis radiotherapy delineation on inter-observer variation to support radiographer led real-time magnetic resonance image guided adaptive radiotherapy (MRgART). MATERIAL/METHODS Eight RTTs contoured 25 MR images in the Monaco treatment planning system (Monaco 5.40.01), from 5 patients. The prostate, seminal vesicles, bladder, and rectum were delineated before and after the introduction of an atlas developed through multi-disciplinary consensus. Inter-observer contour variations (volume), time to contour and observer contouring confidence were determined at both time-points using a 5-point Likert scale. Descriptive statistics were used to analyse both continuous and categorical variables. Dice similarity coefficient (DSC), Dice-Jaccard coefficient (DJC) and Hausdorff distance were used to calculate similarity between observers. RESULTS Although variation in volume definition decreased for all structures among all observers post intervention, the change was not statistically significant. DSC and DJC measurements remained consistent following the introduction of the atlas for all observers. The highest similarity was found in the bladder and prostate whilst the lowest was the seminal vesicles. The mean contouring time for all observers was reduced by 50% following the introduction of the atlas (53 to 27 minutes, p=0.01). For all structures across all observers, the mean contouring confidence increased significantly from 2.3 to 3.5 out of 5 (p=0.02). CONCLUSION Although no significant improvements were observed in contour variation amongst observers, the introduction of the consensus-based contouring atlas improved contouring confidence and speed; key factors for a real-time RTT-led MRgART.
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Affiliation(s)
- Abigael Clough
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Robert Chuter
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rosie B Hales
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacqui Parker
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - John McMahon
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lee Whiteside
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Louise McHugh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lucy Davies
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Rebecca Benson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Claire Nelder
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McDaid
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
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Nieto I, Mayo X, Davies L, Reece L, Strafford BW, Jimenez A. Consensus on a social return on investment model of physical activity and sport: a Delphi study protocol. Front Sports Act Living 2024; 6:1334805. [PMID: 38645726 PMCID: PMC11026584 DOI: 10.3389/fspor.2024.1334805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Background Physical activity and sport (PAS) have been related to many health outcomes and social benefits. The main aim of this research is to build a Social Return on Investment (SROI) model of PAS based on experts' opinion to clarify the domains of impact and how to measure and value them. Methods and analysis A Delphi method will be employed with a systematic review on the SROI framework applied to PAS and initial interviews with experts informing the design of the Delphi survey statements. Three iterative rounds of communication with the expert panel will be carried out. Participants will indicate their level of agreement with each statement on a five-point Likert scale. During the second and third iterative rounds, experts will reappraise the statements and will be provided with a summary of the group responses from the panel. A statement will have reached consensus if ≥70% of the panel agree/strongly agree or disagree/strongly disagree after round 3. Finally, group meetings (3-4 experts) will be conducted to ask about the measurement and valuation methods for each domain. Discussion The final goal of this project will result in the design of a toolkit for organizations, professionals, and policymakers on how to measure the social benefits of PAS.
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Affiliation(s)
- I. Nieto
- Sports Science Research Centre, King Juan Carlos University, Madrid, Spain
- THiNKactive, EuropeActive Research Centre, Brussels, Belgium
| | - X. Mayo
- Sports Science Research Centre, King Juan Carlos University, Madrid, Spain
- THiNKactive, EuropeActive Research Centre, Brussels, Belgium
| | - L. Davies
- Sport Policy Unit and Institute of Sport, Manchester Metropolitan University, Manchester, England
| | - L. Reece
- Sport and Community Capability, Australian Sport Commission, Canberra, ACT, Australia
| | - B. W. Strafford
- Sport and Physical Activity Research Centre (SPARC) and Academy of Sport and Physical Activity (ASPA), Sheffield Hallam University, Sheffield, England
| | - A. Jimenez
- Sports Science Research Centre, King Juan Carlos University, Madrid, Spain
- THiNKactive, EuropeActive Research Centre, Brussels, Belgium
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S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Taylor C, Dodwell D, McGale P, Hills RK, Berry R, Bradley R, Braybrooke J, Clarke M, Gray R, Holt F, Liu Z, Pan H, Peto R, Straiton E, Coles C, Duane F, Hennequin C, Jones G, Kühn T, Oliveros S, Overgaard J, Pritchard KI, Suh CO, Beake G, Boddington C, Davies C, Davies L, Evans V, Gay J, Gettins L, Godwin J, James S, Kerr A, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Nakahara M, Read S, Taylor H, Ferguson J, Scheurlen H, Zurrida S, Galimberti V, Ingle J, Valagussa P, Veronesi U, Anderson S, Tang G, Fisher B, Fossa S, Valborg Reinertsen K, Host H, Muss H, Holli K, Albain K, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, García-Sáenz JA, Gelber R, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas E, Martín M, McIntosh S, Mukai H, Nekljudova V, Norton L, Ohashi Y, Piccart M, Pierce L, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Salgado R, Slamon D, Spanic T, Sparano J, Steger G, Toi M, Tutt A, Viale G, Wang X, Wilcken N, Wolmark N, Yu KD, Cameron D, Bergh J, Swain S, Whelan T, Poortmans P. Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials. Lancet 2023; 402:1991-2003. [PMID: 37931633 DOI: 10.1016/s0140-6736(23)01082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras. METHODS In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals. FINDINGS We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067). INTERPRETATION Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s. FUNDING Cancer Research UK, Medical Research Council.
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Saadoun S, Grassner L, Belci M, Cook J, Knight R, Davies L, Asif H, Visagan R, Gallagher MJ, Thomé C, Hutchinson PJ, Zoumprouli A, Wade J, Farrar N, Papadopoulos MC. Duroplasty for injured cervical spinal cord with uncontrolled swelling: protocol of the DISCUS randomized controlled trial. Trials 2023; 24:497. [PMID: 37550727 PMCID: PMC10405486 DOI: 10.1186/s13063-023-07454-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Cervical traumatic spinal cord injury is a devastating condition. Current management (bony decompression) may be inadequate as after acute severe TSCI, the swollen spinal cord may become compressed against the surrounding tough membrane, the dura. DISCUS will test the hypothesis that, after acute, severe traumatic cervical spinal cord injury, the addition of dural decompression to bony decompression improves muscle strength in the limbs at 6 months, compared with bony decompression alone. METHODS This is a prospective, phase III, multicenter, randomized controlled superiority trial. We aim to recruit 222 adults with acute, severe, traumatic cervical spinal cord injury with an American Spinal Injury Association Impairment Scale grade A, B, or C who will be randomized 1:1 to undergo bony decompression alone or bony decompression with duroplasty. Patients and outcome assessors are blinded to study arm. The primary outcome is change in the motor score at 6 months vs. admission; secondary outcomes assess function (grasp, walking, urinary + anal sphincters), quality of life, complications, need for further surgery, and mortality, at 6 months and 12 months from randomization. A subgroup of at least 50 patients (25/arm) also has observational monitoring from the injury site using a pressure probe (intraspinal pressure, spinal cord perfusion pressure) and/or microdialysis catheter (cord metabolism: tissue glucose, lactate, pyruvate, lactate to pyruvate ratio, glutamate, glycerol; cord inflammation: tissue chemokines/cytokines). Patients are recruited from the UK and internationally, with UK recruitment supported by an integrated QuinteT recruitment intervention to optimize recruitment and informed consent processes. Estimated study duration is 72 months (6 months set-up, 48 months recruitment, 12 months to complete follow-up, 6 months data analysis and reporting results). DISCUSSION We anticipate that the addition of duroplasty to standard of care will improve muscle strength; this has benefits for patients and carers, as well as substantial gains for health services and society including economic implications. If the addition of duroplasty to standard treatment is beneficial, it is anticipated that duroplasty will become standard of care. TRIAL REGISTRATION IRAS: 292031 (England, Wales, Northern Ireland) - Registration date: 24 May 2021, 296518 (Scotland), ISRCTN: 25573423 (Registration date: 2 June 2021); ClinicalTrials.gov number : NCT04936620 (Registration date: 21 June 2021); NIHR CRN 48627 (Registration date: 24 May 2021).
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Affiliation(s)
- Samira Saadoun
- Academic Neurosurgery, Molecular and Clinical Sciences, St. George's, University of London, London, UK.
| | - Lukas Grassner
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Maurizio Belci
- National Spinal Injury Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, Bucks, UK
| | - Jonathan Cook
- Oxford Clinical Trials Research Unit, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Ruth Knight
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Lucy Davies
- Surgical Intervention Trials Unit, University of Oxford, Oxford, UK
| | - Hasan Asif
- Academic Neurosurgery, Molecular and Clinical Sciences, St. George's, University of London, London, UK
| | - Ravindran Visagan
- Academic Neurosurgery, Molecular and Clinical Sciences, St. George's, University of London, London, UK
| | - Mathew J Gallagher
- Academic Neurosurgery, Molecular and Clinical Sciences, St. George's, University of London, London, UK
| | - Claudius Thomé
- Department of Neurosurgery, Innsbruck Medical University, Innsbruck, Austria
| | | | - Argyro Zoumprouli
- Neuro-Intensive Care Unit, Atkinson Morley Wing, St. George's Hospital NHS Foundation Trust, London, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Farrar
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marios C Papadopoulos
- Academic Neurosurgery, Molecular and Clinical Sciences, St. George's, University of London, London, UK
- Neurosurgery, Atkinson Morley Wing, St. George's Hospital NHS Foundation Trust, London, UK
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Bryant RJ, Yamamoto H, Eddy B, Kommu S, Narahari K, Omer A, Leslie T, Catto JWF, Rosario DJ, Good DW, Gray R, Liew MPC, Lopez JF, Campbell T, Reynard JM, Tuck S, Barber VS, Medeghri N, Davies L, Parkes M, Hewitt A, Landeiro F, Wolstenholme J, Macpherson R, Verrill C, Marian IR, Williams R, Hamdy FC, Lamb AD. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int 2023; 131:694-704. [PMID: 36695816 DOI: 10.1111/bju.15978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa. SECONDARY OBJECTIVES to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy. PATIENTS AND METHODS The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited. CONCLUSIONS This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.
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Affiliation(s)
- Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes Hospital, Milton Keynes, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Rob Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Steve Tuck
- Oxfordshire Prostate Cancer Support Group, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nadjat Medeghri
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthew Parkes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanne Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Beesley R, Cauchi M, Davies L, Upcott M, Norton E, Loveless S, Anderson V, Wynford-Thomas R, Pickersgill T, Uzochukwu E, Wardle M, Robertson N, Tallantyre E, Willis M. Multiple sclerosis and COVID-19: Assessing risk perception, patient behaviors and access to disease-modifying therapies. Mult Scler Relat Disord 2022; 68:104121. [PMID: 36088727 PMCID: PMC9381979 DOI: 10.1016/j.msard.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Following the outbreak of COVID-19, global healthcare systems have had to rapidly adapt. People with multiple sclerosis (pwMS) were required to make decisions about their individual risk and consequent work and social behaviors. This study aimed to evaluate risk perception and patterns of shielding behavior amongst pwMS at the onset of the COVID-19 pandemic and the subsequent impact on patients' employment and access to disease modifying therapies (DMTs). METHODS Postal surveys were sent to 1690 people within a UK population-based MS cohort during the first wave of the COVID-19 pandemic. Patients were surveyed on: (i) perceived vulnerability to COVID-19; (ii) isolation behavior; (iii) interruption to DMT; (iv) employment status; (v) level of satisfaction with their current working arrangement. RESULTS Responses were received from 1000 pwMS. Two thirds of patients reported isolating at home during the first wave of the pandemic. This behavior was associated with increased age (p<0.0001), higher disability (p<0.0001) and use of high-efficacy DMTs (p = 0.02). The majority of patients reported feeling vulnerable (82%) with perceived vulnerability associated with higher EDSS (p<0.0001) and receiving a high-efficacy DMT (p = 0.04). Clinician-defined risk was associated with shielding behavior, with those at high-risk more likely to self-isolate/shield (p<0.0001). Patients on high-efficacy DMTs were more likely to have an interruption to their treatment (50%) during the first wave of the pandemic. Most pwMS experienced a change to their working environment, and most were satisfied with the adjustments. CONCLUSION This study highlights the risk perception, social behavioral practices and changes to treatment experienced by pwMS during the first wave of the COVID-19 pandemic in a large, well-described UK cohort. The results may help inform management of pwMS during future pandemic waves.
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Affiliation(s)
- R. Beesley
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - M. Cauchi
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - L. Davies
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - M. Upcott
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - E. Norton
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - S. Loveless
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - V. Anderson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - R. Wynford-Thomas
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - T.P. Pickersgill
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - E. Uzochukwu
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - M. Wardle
- Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - N.P. Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - E. Tallantyre
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - M.D. Willis
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK,Corresponding author
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D’Souza A, Hawley C, Davies L, Manning S, Flann PJ. An evaluation of the effectiveness of a lipid clinic in identifying people with familial hypercholesterolaemia and reducing their risk of cardiovascular disease. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.021] [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: 12/02/2022]
Abstract
Abstract
Introduction
The NHS Long Term Plan aims to ‘prevent up to 150,000 heart attacks, strokes and dementia cases over the next 10 years’.1 People with Familial Hypercholesterolaemia (FH) are considered to be at high-risk of heart attack, stroke and dementia but an estimated 90% remain undiagnosed.1 The Chesterfield and Dronfield Primary Care Network were commissioned to set-up a 12-month pharmacist-led clinic across 9 practices to identify, treat and refer FH patients. Patients with suspected FH benefit from referral to specialist services.2
Aim
This study aimed to evaluate the number of FH patients identified and any unintended benefits of the Lipid Clinic.
Methods
Ethical approval was not required for this service evaluation. Informed consent was sought prior to data collection and the dataset was anonymised. Searches of practice patient records identified patients with a previously raised lipid level (total Cholesterol >7.5mmol/L and/or non-HDL-C > 5.9mmol/L)2 for review in the Lipid Clinic. Patients reviewed in the Lipid Clinic were initiated/optimised on lipid lowering medication as appropriate.2 Data were collected for patients invited for review in the Lipid Clinic between May-July 2022. Patients’ attendance as well as decline/non-response to the Clinic was recorded. The data collected included family history, QRISK score (where applicable), lipid lowering treatment the patient was taking (if any) and blood tests results (serum lipids, HBA1c and thyroid function tests). If bloods were deranged it was documented whether or not it was a new finding. The data was analysed by categorising patients into potential FH, primary/secondary prevention of cardiovascular disease and whether they needed referral to secondary care.
Results
Out of the 260 patients invited for review, 219 attended the clinic. Of these, 30 (13.7%) were provided with lifestyle advice as they did not meet the criteria for treatment. Twenty-three patients (10.5%) met the Simon-Broom criteria for possible FH. A further 3 patients identified were known to have FH but had not undergone genetic cascade testing. These 26 patients (11.8%) were referred to secondary care for genetic testing and specialist input. Newly raised HbA1c indicative of either diabetes or non-diabetic hyperglycaemia was incidentally found in 39 patients (17.8%). Lipid-lowering medication was initiated/titrated in 189 patients (86.3%).
Discussion/Conclusion
The significant proportion of patients requiring follow up in secondary care (11.8%) suggesting targeted searches are effective in identifying patients with possible FH. Identifying FH patients, testing and treating their family members appropriately reduces their risk of cardiovascular events.2 The Lipid Clinic has identifying that nearly a fifth of patients were previously undiagnosed with either diabetes or non-diabetic hyperglycaemia (17.8%) suggests that this is also an opportunity to identify and treat these patients earlier than they would otherwise have been identified. The results highlight the need for primary care staff education on the new AAC NHS Guidelines2 relating to managing lipid results. One limitation of the study is although the Lipid Clinic has received good informal feedback, formal feedback is yet to be collected from patients and stake holders. In addition, the clinic is still ongoing, and more data is being collected.
References
1. NHS Long Term Plan. Chapter 3: Further progress on care quality and outcomes. Better care for major health conditions. Cardiovascular Disease. 2019. Available from: https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/better-care-for-major-health-conditions/cardiovascular-disease/
2. Khatib R, Neely D, on behalf of the AAC Clinical Subgroup. Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD, AAC NHS Guidelines, Nov 2021. Review date: Nov 2022. NICE endorsed Dec 2021.
3. National Institution for Health and Care Excellence (NICE). Cardiovascular disease: risk assessment and reduction, including lipid modification, Clinical guideline [CG181] Published: 18 July 2014 Last updated: 27 September 2016.
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Smith R, Campbell A, Montgomery S, Best L, Foad F, Davis N, O'Boyle S, Thirlby-Moore S, Macpherson S, Davies L, Barrie A. Is the time of appearance of vacuoles critical to live birth outcome? Reprod Biomed Online 2022. [DOI: 10.1016/j.rbmo.2022.08.034] [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: 11/16/2022]
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [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: 11/01/2022] Open
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13
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Benson R, Rodgers J, Nelder C, Clough A, Pitt E, Parker J, Whiteside L, Davies L, Bailey R, McMahon J, Kolbe H, Cree A, Dubec M, Van Herk M, Choudhury A, Hoskin P, Eccles C. The impact of an educational tool in cervix image registration across three imaging modalities. Br J Radiol 2022; 95:20211402. [PMID: 35616660 PMCID: PMC10996960 DOI: 10.1259/bjr.20211402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate image registration is vital in cervical cancer where changes in both planning target volume (PTV) and organs at risk (OARs) can make decisions regarding image registration complicated. This work aims to determine the impact of a dedicated educational tool compared with experience gained in MR-guided radiotherapy (MRgRT). METHODS 10 therapeutic radiographers acted as observers and were split into two groups based on previous experience with MRgRT and Monaco treatment planning system. Three CBCT-CT, three MR-CT and two MR-MR registrations were completed per patient by each observer. Observers recorded translations, time to complete image registration and confidence. Data were collected in two phases; prior to and following the introduction of a cervix registration guide. RESULTS No statistically significant differences were noted between imaging modalities. Each group was assessed independently pre- and post-education, no statistically significant differences were noted in either CBCT-CT or MR-CT imaging. Group 1 MR-MR imaging showed a statistically significant reduction in interobserver variability (p=0.04), in Group 2, the result was not statistically significant (p=0.06). Statistically significant increases in confidence were seen in all three modalities (p≤0.05). CONCLUSIONS At The Christie NHS Foundation Trust, radiographers consistently registered images across three different imaging modalities regardless of their previous experience. The implementation of an image registration guide had limited impact on inter- and intraobserver variability. Radiographers' confidence showed statistically significant improvements following the use of the registration manual. ADVANCES IN KNOWLEDGE This work helps evaluate training methods for novel roles that are developing in MRgRT.
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Affiliation(s)
- Rebecca Benson
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - John Rodgers
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Claire Nelder
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Abigael Clough
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Eleanor Pitt
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Jacqui Parker
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Lee Whiteside
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Lucy Davies
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Rachael Bailey
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - John McMahon
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Hope Kolbe
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Anthea Cree
- Department of Clinical Oncology, The Clatterbridge Cancer
Centre, Liverpool,
UK
| | - Michael Dubec
- Department of Medical Physics and Engineering, The Christie NHS
Foundation Trust, Manchester,
UK
| | - Marcel Van Herk
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Peter Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Cynthia Eccles
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al 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Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Pitt E, Clough A, Nelder C, Benson R, McDaid L, Whiteside L, Davies L, Parker J, Awofisoye T, Freear L, Chuter R, Berresford J, Marchant T, Crockett C, Salem A, Faivre-Finn C, Eccles CL. Considerations for the Clinical Implementation of MR-Guided ART for Lung Cancer. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pitt E, Clough A, Nelder C, Benson R, McDaid L, Whiteside L, Davies L, Parker J, Awofisoye T, Freear L, Chuter R, Berresford J, Marchant T, McPartlin A, Eccles CL. Considerations for the Clinical Implementation of MR-Guided ART for H&N Cancer. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [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] Open
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Webb D, Barnett R, Davies L. POS0083-PARE DRIVING IMPROVEMENT IN AXIAL SPONDYLOARTHRITIS SERVICES: THE USE OF QUALITY IMPROVEMENT APPROACHES AND TOOLS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundQuality Improvement (QI) methods have been used in healthcare since the late 1980s across a wide range of healthcare settings. However, in the UK they have not been applied widely within rheumatology including axial Spondyloarthritis (axial SpA). In 2017, the UK healthcare regulator, NICE, produced a national clinical guideline for axial SpA, but there was no mechanism to encourage uptake of its recommendations.The National Axial Spondyloarthritis Society created a programme to use QI approaches to help encourage uptake of the Guidelines and act as a catalyst for wider improvement in axial SpA care.ObjectivesTo encourage service improvement in axial Spondyloarthritis care through the use of quality improvement theory and methods.MethodsIn late 2019 six rheumatology departments were selected to participate in the first cohort. The programme design was underpinned by:• A framework for management grounded in systems theory1• A learning system that brings healthcare organisations together2• A set of tools to develop, test and implement changes: the Model for Improvement3.The teams met four times for training in QI methods, plus team-based online coaching. They had time to develop their projects and networking opportunities to share their data and experiences of implementation.We conducted a qualitative review of the programme in year one. We interviewed 31 programme participants and reviewed programme documentation.ResultsThe review found that:•A proven QI framework provides a strong basis to build improvement•A competitive programme helps foster motivation and accountability•The programme provides the time to use tools to understand the problem and construct improvement aims•Measurement is key to understand improvement and to create a story of change•Collaboration and engagement is key within the team and with other stakeholders.The teams have: Trained community–based physiotherapists, leading to improved rheumatology referrals Implemented an inflammatory back pain pathway from primary care Introduced an MRI spine IBP protocol to reduce variation in imaging Established a tertiary referral service which has improved time to diagnosis Implemented mental health interventions for patients and reduced the percentage of patients with abnormal scores Established a pathway for physiotherapy self–referral and reduced Did Not Attend rates Used audit to make the business case for an extended scope practitionerConclusionDespite the challenges of posed by the Covid-19 pandemic, a structured QI programme has enabled clinicians to stay engaged and implement projects to reduce diagnostic delay and improve care.References[1]Deming WE. The new economics for industry. Government, Education, Massachusetts Institute of Technology, Cambridge, MA. 1993;1:235.[2]Institute for Healthcare Improvement. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement. 2003.[3]Langley GJ, Nolan KM, Nolan TW, Norman L, Provost LP. The improvement guide. San Francisco: Jossey–Bass. 1996.Disclosure of InterestsDale Webb Grant/research support from: Grant funding from AbbVie, Biogen, Lilly, Janssen, Novartis & UCB, Rosie Barnett: None declared, Lucy Davies: None declared
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Clough A, Hales R, Choudhury A, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, Eccles CL. Impact of the implementation of a Contouring Atlas on Therapeutic Radiographer Inter-observer Contour Variation in Prostate Radiotherapy. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.045] [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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Clough A, Pitt E, Nelder C, Benson R, McDaid L, Whiteside L, Davies L, Parker J, Awofisoye T, Freear L, Berresford J, Marchant T, McPartlin A, Crockett C, Salem A, Cobben D, Eccles C. OC-0420 Considerations for the clinical implementation of MRI-guided ART for H&N and lung cancers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02556-7] [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: 10/18/2022]
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Teles Amaro P, McDaid L, Davies L, Whiteside L, Clough A, Faivre-Finn C, Parker J, Bailey R, Benson R, Nelder C, Pitt E, Eccles C, Crockett C, Salem A, Choudhury A. PO-1877 Initial experience delivering stereotactic radiotherapy to a gluteal metastasis on a 1.5T MR Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03840-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Davies L, Parker J, Teles Amaro P, Whiteside L, Eccles C, Bailey R, Falk S, Webb J, McHugh L. OC-0132 Identifying the priority challenges of facilitating national proton beam therapy clinical trials. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02508-7] [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: 10/18/2022]
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Bradley R, Braybrooke J, Gray R, Hills RK, Liu Z, Pan H, Peto R, Dodwell D, McGale P, Taylor C, Francis PA, Gnant M, Perrone F, Regan MM, Berry R, Boddington C, Clarke M, Davies C, Davies L, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Jakesz R, Fesl C, Pagani O, Gelber R, De Laurentiis M, De Placido S, Gallo C, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Pritchard KI, Raina V, Rea D, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Swain SM. Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials. Lancet Oncol 2022; 23:382-392. [PMID: 35123662 PMCID: PMC8885431 DOI: 10.1016/s1470-2045(21)00758-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND For women with early-stage oestrogen receptor (ER)-positive breast cancer, adjuvant tamoxifen reduces 15-year breast cancer mortality by a third. Aromatase inhibitors are more effective than tamoxifen in postmenopausal women but are ineffective in premenopausal women when used without ovarian suppression. We aimed to investigate whether premenopausal women treated with ovarian suppression benefit from aromatase inhibitors. METHODS We did a meta-analysis of individual patient data from randomised trials comparing aromatase inhibitors (anastrozole, exemestane, or letrozole) versus tamoxifen for 3 or 5 years in premenopausal women with ER-positive breast cancer receiving ovarian suppression (goserelin or triptorelin) or ablation. We collected data on baseline characteristics, dates and sites of any breast cancer recurrence or second primary cancer, and dates and causes of death. Primary outcomes were breast cancer recurrence (distant, locoregional, or contralateral), breast cancer mortality, death without recurrence, and all-cause mortality. As distant recurrence invariably results in death from breast cancer several years after the occurrence, whereas locoregional recurrence and new contralateral breast cancer are not usually fatal, the distant recurrence analysis is shown separately. Standard intention-to-treat log-rank analyses estimated first-event rate ratios (RR) and their confidence intervals (CIs). FINDINGS We obtained data from all four identified trials (ABCSG XII, SOFT, TEXT, and HOBOE trials), which included 7030 women with ER-positive tumours enrolled between June 17, 1999, and Aug 4, 2015. Median follow-up was 8·0 years (IQR 6·1-9·3). The rate of breast cancer recurrence was lower for women allocated to an aromatase inhibitor than for women assigned to tamoxifen (RR 0·79, 95% CI 0·69-0·90, p=0·0005). The main benefit was seen in years 0-4 (RR 0·68, 99% CI 0·55-0·85; p<0·0001), the period when treatments differed, with a 3·2% (95% CI 1·8-4·5) absolute reduction in 5-year recurrence risk (6·9% vs 10·1%). There was no further benefit, or loss of benefit, in years 5-9 (RR 0·98, 99% CI 0·73-1·33, p=0·89) or beyond year 10. Distant recurrence was reduced with aromatase inhibitor (RR 0·83, 95% CI 0·71-0·97; p=0·018). No significant differences were observed between treatments for breast cancer mortality (RR 1·01, 95% CI 0·82-1·24; p=0·94), death without recurrence (1·30, 0·75-2·25; p=0·34), or all-cause mortality (1·04, 0·86-1·27; p=0·68). There were more bone fractures with aromatase inhibitor than with tamoxifen (227 [6·4%] of 3528 women allocated to an aromatase inhibitor vs 180 [5·1%] of 3502 women allocated to tamoxifen; RR 1·27 [95% CI 1·04-1·54]; p=0·017). Non-breast cancer deaths (30 [0·9%] vs 24 [0·7%]; 1·30 [0·75-2·25]; p=0·36) and endometrial cancer (seven [0·2%] vs 15 [0·3%]; 0·52 [0·22-1·23]; p=0·14) were rare. INTERPRETATION Using an aromatase inhibitor rather than tamoxifen in premenopausal women receiving ovarian suppression reduces the risk of breast cancer recurrence. Longer follow-up is needed to assess any impact on breast cancer mortality. FUNDING Cancer Research UK, UK Medical Research Council.
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Sayed L, Valand P, Brewin M, Matthews A, Robson M, Nayaran N, Alexander A, Davies L, Scott E, Steele J, McMullen E. Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study. J Plast Reconstr Aesthet Surg 2022; 75:2127-2134. [PMID: 35367161 PMCID: PMC8855640 DOI: 10.1016/j.bjps.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
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Gilbert AW, Davies L, Doyle J, Patel S, Martin L, Jagpal D, Billany JCT, Bateson J. Leadership reflections a year on from the rapid roll-out of virtual clinics due to COVID-19: a commentary. leader 2021. [DOI: 10.1136/leader-2020-000363] [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: 11/03/2022]
Abstract
COVID-19 changed the way we delivered care to our patients at our Hospital. Prior to the pandemic, no patient facing video clinics and only a small number of telephone clinics were held. In this paper, we share our experience of rapidly implementing virtual clinics (VCs) due to COVID-19. This commentary is based on focused discussions between hospital leaders and provides a reflective account and commentary on leadership lessons learnt from our experience of deploying VCs. We outline success factors (being able to capitalise on existing strategy, having time and space to establish VCs, using an agreed improvement framework, empowering a diverse and expert implementation team with a flat hierarchy, using efficient decision pathways, communication and staff willingness to change), technical challenges (patient capability and skills to use technology, patient connectivity and platform capacity) and considerations for the future (sustaining new ways of working, platform selection, integration, business continuity and commissioning considerations, barriers regarding capability and communication, effectiveness and clinical outcomes). Finally, we provide an overview of the leadership lessons from this project and identify key areas of focus for delivering successful change projects in future (the vision, allocation of resources, methodology selection and managing the skills gap).
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Bradley R, Braybrooke J, Gray R, Hills R, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Anderson S, Gelber R, Gianni L, Jacot W, Joensuu H, Moreno-Aspitia A, Piccart M, Press M, Romond E, Slamon D, Suman V, Berry R, Boddington C, Clarke M, Davies C, Duane F, Evans V, Gay J, Gettins L, Godwin J, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Straiton E, Wang Y, Crown J, de Azambuja E, Delaloge S, Fung H, Geyer C, Spielmann M, Valagussa P, Albain K, Anderson S, Arriagada R, Bartlett J, Bergsten-Nordström E, Bliss J, Brain E, Carey L, Coleman R, Cuzick J, Davidson N, Del Mastro L, Di Leo A, Dignam J, Dowsett M, Ejlertsen B, Francis P, Gnant M, Goetz M, Goodwin P, Halpin-Murphy P, Hayes D, Hill C, Jagsi R, Janni W, Loibl S, Mamounas EP, Martín M, Mukai H, Nekljudova V, Norton L, Ohashi Y, Pierce L, Poortmans P, Raina V, Rea D, Regan M, Robertson J, Rutgers E, Spanic T, Sparano J, Steger G, Tang G, Toi M, Tutt A, Viale G, Wang X, Whelan T, Wilcken N, Wolmark N, Cameron D, Bergh J, Pritchard KI, Swain SM. Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials. Lancet Oncol 2021; 22:1139-1150. [PMID: 34339645 PMCID: PMC8324484 DOI: 10.1016/s1470-2045(21)00288-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Trastuzumab targets the extracellular domain of the HER2 protein. Adding trastuzumab to chemotherapy for patients with early-stage, HER2-positive breast cancer reduces the risk of recurrence and death, but is associated with cardiac toxicity. We investigated the long-term benefits and risks of adjuvant trastuzumab on breast cancer recurrence and cause-specific mortality. METHODS We did a collaborative meta-analysis of individual patient data from randomised trials assessing chemotherapy plus trastuzumab versus the same chemotherapy alone. Randomised trials that enrolled women with node-negative or node-positive, operable breast cancer were included. We collected individual patient-level data on baseline characteristics, dates and sites of first distant breast cancer recurrence and any previous local recurrence or second primary cancer, and the date and underlying cause of death. Primary outcomes were breast cancer recurrence, breast cancer mortality, death without recurrence, and all-cause mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, oestrogen receptor (ER) status, and trial yielded first-event rate ratios (RRs). FINDINGS Seven randomised trials met the inclusion criteria, and included 13 864 patients enrolled between February, 2000, and December, 2005. Mean scheduled treatment duration was 14·4 months and median follow-up was 10·7 years (IQR 9·5 to 11·9). The risks of breast cancer recurrence (RR 0·66, 95% CI 0·62 to 0·71; p<0·0001) and death from breast cancer (0·67, 0·61 to 0·73; p<0·0001) were lower with trastuzumab plus chemotherapy than with chemotherapy alone. Absolute 10-year recurrence risk was reduced by 9·0% (95% CI 7·4 to 10·7; p<0·0001) and 10-year breast cancer mortality was reduced by 6·4% (4·9 to 7·8; p<0·0001), with a 6·5% reduction (5·0 to 8·0; p<0·0001) in all-cause mortality, and no increase in death without recurrence (0·4%, -0·3 to 1·1; p=0·35). The proportional reduction in recurrence was largest in years 0-1 after randomisation (0·53, 99% CI 0·46 to 0·61), with benefits persisting through years 2-4 (0·73, 0·62 to 0·85) and 5-9 (0·80, 0·64 to 1·01), and little follow-up beyond year 10. Proportional recurrence reductions were similar irrespective of recorded patient and tumour characteristics, including ER status. The more high risk the tumour, the larger the absolute reductions in 5-year recurrence (eg, 5·7% [95% CI 3·1 to 8·3], 6·8% [4·7 to 9·0], and 10·7% [7·7 to 13·6] in N0, N1-3, and N4+ disease). INTERPRETATION Adding trastuzumab to chemotherapy for early-stage, HER2-positive breast cancer reduces recurrence of, and mortality from, breast cancer by a third, with worthwhile proportional reductions irrespective of recorded patient and tumour characteristics. FUNDING Cancer Research UK, UK Medical Research Council.
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Clough A, Hales R, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, Choudhury A, Eccles C. PD-0938 impact of an atlas on radiographer inter-observer contour variation in prostate radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nanda A, Hung I, Kwong A, Man VC, Roy P, Davies L, Douek M. Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial. J Evid Based Med 2021; 14:97-111. [PMID: 33565274 PMCID: PMC8014575 DOI: 10.1111/jebm.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recommendations for widespread use of face mask, including suggested type, should reflect the current published evidence and concurrently be studied. This review evaluates the preclinical and clinical evidence on use of cloth and surgical face masks in SARS-CoV-2 transmission and proposes a trial to gather further evidence. METHODS PubMed, EMbase, and the Cochrane Library were searched. Studies of SARS-CoV-2 and face masks and randomized controlled trials (RCTs) of n ≥ 50 for other respiratory illnesses were included. RESULTS Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. CONCLUSION There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance.
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Affiliation(s)
- Akriti Nanda
- Oxford University Clinical Academic Graduate School, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Ivan Hung
- Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Vivian Chi‐Mei Man
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Lucy Davies
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Michael Douek
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
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Carlsson P, Espes D, Davies L, Svahn M. Protrans wharton’s jelly mesenchymal stromal cells preserve beta cell function in newly diagnosed type I diabetes patients – a randomised, double-blinded, placebo controlled phase II trial. Cytotherapy 2021. [DOI: 10.1016/s1465324921003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brett B, Savva C, Davies L, Douek M, Copson E, Cutress R. P041. Systematic review of surgical and patient reported outcomes of neoadjuvant endocrine therapy for breast cancer. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.045] [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
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Husen P, Boffa C, Jochmans I, Krikke C, Davies L, Mazilescu L, Brat A, Knight S, Wettstein D, Cseprekal O, Banga N, Bellini MI, Szabo L, Ablorsu E, Darius T, Quiroga I, Mourad M, Pratschke J, Papalois V, Mathe Z, Leuvenink HGD, Minor T, Pirenne J, Ploeg RJ, Paul A. Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant: A Randomized Clinical Trial. JAMA Surg 2021; 156:517-525. [PMID: 33881456 DOI: 10.1001/jamasurg.2021.0949] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Continuous hypothermic machine perfusion during organ preservation has a beneficial effect on graft function and survival in kidney transplant when compared with static cold storage (SCS). Objective To compare the effect of short-term oxygenated hypothermic machine perfusion preservation (end-HMPo2) after SCS vs SCS alone on 1-year graft survival in expanded criteria donor kidneys from donors who are brain dead. Design, Setting, and Participants In a prospective, randomized, multicenter trial, kidneys from expanded criteria donors were randomized to either SCS alone or SCS followed by end-HMPo2 prior to implantation with a minimum machine perfusion time of 120 minutes. Kidneys were randomized between January 2015 and May 2018, and analysis began May 2019. Analysis was intention to treat. Interventions On randomization and before implantation, deceased donor kidneys were either kept on SCS or placed on HMPo2. Main Outcome and Measures Primary end point was 1-year graft survival, with delayed graft function, primary nonfunction, acute rejection, estimated glomerular filtration rate, and patient survival as secondary end points. Results Centers in 5 European countries randomized 305 kidneys (median [range] donor age, 64 [50-84] years), of which 262 kidneys (127 [48.5%] in the end-HMPo2 group vs 135 [51.5%] in the SCS group) were successfully transplanted. Median (range) cold ischemia time was 13.2 (5.1-28.7) hours in the end-HMPo2 group and 12.9 (4-29.2) hours in the SCS group; median (range) duration in the end-HMPo2 group was 4.7 (0.8-17.1) hours. One-year graft survival was 92.1% (n = 117) in the end-HMPo2 group vs 93.3% (n = 126) in the SCS group (95% CI, -7.5 to 5.1; P = .71). The secondary end point analysis showed no significant between-group differences for delayed graft function, primary nonfunction, estimated glomerular filtration rate, and acute rejection. Conclusions and Relevance Reconditioning of expanded criteria donor kidneys from donors who are brain dead using end-HMPo2 after SCS does not improve graft survival or function compared with SCS alone. This study is underpowered owing to the high overall graft survival rate, limiting interpretation. Trial Registration isrctn.org Identifier: ISRCTN63852508.
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Affiliation(s)
- Peri Husen
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Catherine Boffa
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Ina Jochmans
- Transplant Research Group, Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Christina Krikke
- Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Laura Mazilescu
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Aukje Brat
- Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Simon Knight
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Daniel Wettstein
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekal
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.,International Nephrology Research and Training Center (INRTC), Budapest, Hungary
| | - Neal Banga
- Department of General Surgery, Royal Free Hospital, London, United Kingdom
| | | | - Laszlo Szabo
- Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, United Kingdom
| | - Elijah Ablorsu
- Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, United Kingdom
| | - Tom Darius
- Surgery and Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Isabel Quiroga
- Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Michel Mourad
- Surgery and Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | - Zoltan Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.,Department of Transplantation and Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Minor
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Jacques Pirenne
- Transplant Research Group, Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rutger J Ploeg
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Gathercole R, Bradley R, Harper E, Davies L, Pank L, Lam N, Davies A, Talbot E, Hooper E, Winson R, Scutt B, Montano VO, Nunn S, Lavelle G, Lariviere M, Hirani S, Brini S, Bateman A, Bentham P, Burns A, Dunk B, Forsyth K, Fox C, Henderson C, Knapp M, Leroi I, Newman S, O'Brien J, Poland F, Woolham J, Gray R, Howard R. Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT. Health Technol Assess 2021; 25:1-156. [PMID: 33755548 DOI: 10.3310/hta25190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. OBJECTIVES This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. DESIGN This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. SETTING This trial was set in 12 councils in England with adult social services responsibilities. PARTICIPANTS Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. INTERVENTIONS Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). MAIN OUTCOME MEASURES The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. RESULTS Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. LIMITATIONS Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. CONCLUSIONS A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. FUTURE WORK Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. TRIAL REGISTRATION Current Controlled Trials ISRCTN86537017. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Rosie Bradley
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Emma Harper
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Lucy Davies
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Lynn Pank
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Natalie Lam
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Anna Davies
- School of Health Sciences, City, University of London, London, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Emma Talbot
- Norfolk and Suffolk NHS Foundation Trust, Stowmarket, UK
| | - Emma Hooper
- Lancashire Care NHS Foundation Trust, Preston, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rachel Winson
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Bethany Scutt
- Department of Old Age Psychiatry, King's College London, London, UK
| | | | - Samantha Nunn
- Cambridgeshire Community Services NHS Trust, Cambridge, UK
| | - Grace Lavelle
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Matthew Lariviere
- Centre for International Research on Care, Labour and Equalities, University of Sheffield, Sheffield, UK
| | | | - Stefano Brini
- School of Health Sciences, City, University of London, London, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Peter Bentham
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Alistair Burns
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Dunk
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Stanton Newman
- School of Health Sciences, City, University of London, London, UK
| | - John O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - John Woolham
- National Institute for Health Research (NIHR) Health & Social Care Workforce Research Unit, King's College London, London, UK
| | - Richard Gray
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
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Saturno G, Lopes F, Niculescu-Duvaz I, Niculescu-Duvaz D, Zambon A, Davies L, Johnson L, Preece N, Lee R, Viros A, Holovanchuk D, Pedersen M, McLeary R, Lorigan P, Dhomen N, Fisher C, Banerji U, Dean E, Krebs MG, Gore M, Larkin J, Marais R, Springer C. The paradox-breaking panRAF plus SRC family kinase inhibitor, CCT3833, is effective in mutant KRAS-driven cancers. Ann Oncol 2021; 32:269-278. [PMID: 33130216 PMCID: PMC7839839 DOI: 10.1016/j.annonc.2020.10.483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND KRAS is mutated in ∼90% of pancreatic ductal adenocarcinomas, ∼35% of colorectal cancers and ∼20% of non-small-cell lung cancers. There has been recent progress in targeting G12CKRAS specifically, but therapeutic options for other mutant forms of KRAS are limited, largely because the complexity of downstream signaling and feedback mechanisms mean that targeting individual pathway components is ineffective. DESIGN The protein kinases RAF and SRC are validated therapeutic targets in KRAS-mutant pancreatic ductal adenocarcinomas, colorectal cancers and non-small-cell lung cancers and we show that both must be inhibited to block growth of these cancers. We describe CCT3833, a new drug that inhibits both RAF and SRC, which may be effective in KRAS-mutant cancers. RESULTS We show that CCT3833 inhibits RAF and SRC in KRAS-mutant tumors in vitro and in vivo, and that it inhibits tumor growth at well-tolerated doses in mice. CCT3833 has been evaluated in a phase I clinical trial (NCT02437227) and we report here that it significantly prolongs progression-free survival of a patient with a G12VKRAS spindle cell sarcoma who did not respond to a multikinase inhibitor and therefore had limited treatment options. CONCLUSIONS New drug CCT3833 elicits significant preclinical therapeutic efficacy in KRAS-mutant colorectal, lung and pancreatic tumor xenografts, demonstrating a treatment option for several areas of unmet clinical need. Based on these preclinical data and the phase I clinical unconfirmed response in a patient with KRAS-mutant spindle cell sarcoma, CCT3833 requires further evaluation in patients with other KRAS-mutant cancers.
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Affiliation(s)
- G Saturno
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - F Lopes
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - I Niculescu-Duvaz
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - D Niculescu-Duvaz
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - A Zambon
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Davies
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - L Johnson
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - N Preece
- Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - R Lee
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - A Viros
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - D Holovanchuk
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - M Pedersen
- Targeted Therapy Team, the Institute of Cancer Research, London, UK
| | - R McLeary
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK
| | - P Lorigan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N Dhomen
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK
| | - C Fisher
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dean
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Gore
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK.
| | - C Springer
- Drug Discovery Unit, Cancer Research UK Manchester Institute, the University of Manchester, Alderley Park, Manchester, UK; Gene and Oncogene Targeting Team, CR-UK Cancer Therapeutics Unit, the Institute of Cancer Research, London, UK.
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Mentasti M, David S, Sands K, Khan S, Davies L, Turner L, Wootton M. Rapid detection and differentiation of mobile colistin resistance (mcr-1 to mcr-10) genes by real-time PCR and melt-curve analysis. J Hosp Infect 2021; 110:148-155. [PMID: 33485969 DOI: 10.1016/j.jhin.2021.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The emergence of multi-drug-resistant (MDR) micro-organisms prompted new interest in older antibiotics, such as colistin, that had been abandoned previously due to limited efficacy or high toxicity. Over the years, several chromosomal-encoded colistin resistance mechanisms have been described; more recently, 10 plasmid-mediated mobile colistin resistance (mcr) genes have been identified. Spread of these genes among MDR Gram-negative bacteria is a matter of serious concern; therefore, reliable and timely mcr detection is paramount. AIM To design and validate a multiplex real-time polymerase chain reaction (PCR) assay for detection and differentiation of mcr genes. METHODS All available mcr alleles were downloaded from the National Center for Biotechnology Information Reference Gene Catalogue, aligned with Clustal Omega and primers designed using Primer-BLAST. Real-time PCR monoplexes were optimized and validated using a panel of 120 characterized Gram-negative strains carrying a wide range of resistance genes, often in combination. Melt-curve analysis was used to confirm positive results. FINDINGS In-silico analysis enabled the design of a 'screening' assay for detection of mcr-1/2/6, mcr-3, mcr-4, mcr-5, mcr-7, mcr-8 and mcr-9/10, paired with an internal control assay to discount inhibition. A 'supplementary' assay was subsequently designed to differentiate mcr-1, mcr-2, mcr-6, mcr-9 and mcr-10. Expected results were obtained for all strains (100% sensitivity and specificity). Melt-curve analysis showed consistent melting temperature results. Inhibition was not observed. CONCLUSIONS The assay is rapid and easy to perform, enabling unequivocal mcr detection and differentiation even when more than one variant is present. Adoption by clinical and veterinary microbiology laboratories would aid the surveillance of mcr genes amongst Gram-negative bacteria.
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Affiliation(s)
- M Mentasti
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK.
| | - S David
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Cambridge, UK
| | - K Sands
- School of Medicine, Cardiff University, Cardiff, UK; Department of Zoology, University of Oxford, Oxford, UK
| | - S Khan
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - L Davies
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - L Turner
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - M Wootton
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
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35
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Ranasinha N, Omer A, Philippou Y, Harriss E, Davies L, Chow K, Chetta PM, Erickson A, Rajakumar T, Mills IG, Bryant RJ, Hamdy FC, Murphy DG, Loda M, Hovens CM, Corcoran NM, Verrill C, Lamb AD. Ductal adenocarcinoma of the prostate: A systematic review and meta-analysis of incidence, presentation, prognosis, and management. BJUI Compass 2021; 2:13-23. [PMID: 35474657 PMCID: PMC8988764 DOI: 10.1002/bco2.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023] Open
Abstract
Context Ductal adenocarcinoma (DAC) is relatively rare, but is nonetheless the second most common subtype of prostate cancer. First described in 1967, opinion is still divided regarding its biology, prognosis, and outcome. Objectives To systematically interrogate the literature to clarify the epidemiology, diagnosis, management, progression, and survival statistics of DAC. Materials and methods We conducted a literature search of five medical databases from inception to May 04 2020 according to PRISMA criteria using search terms "prostate ductal adenocarcinoma" OR "endometriod adenocarcinoma of prostate" and variations of each. Results Some 114 studies were eligible for inclusion, presenting 2 907 170 prostate cancer cases, of which 5911 were DAC. [Correction added on 16 January 2021 after the first online publication: the preceding statement has been corrected in this current version.] DAC accounts for 0.17% of prostate cancer on meta-analysis (range 0.0837%-13.4%). The majority of DAC cases were admixed with predominant acinar adenocarcinoma (AAC). Median Prostate Specific Antigen at diagnosis ranged from 4.2 to 9.6 ng/mL in the case series.DAC was more likely to present as T3 (RR1.71; 95%CI 1.53-1.91) and T4 (RR7.56; 95%CI 5.19-11.01) stages, with far higher likelihood of metastatic disease (RR4.62; 95%CI 3.84-5.56; all P-values < .0001), compared to AAC. Common first treatments included surgery (radical prostatectomy (RP) or cystoprostatectomy for select cases) or radiotherapy (RT) for localized disease, and hormonal or chemo-therapy for metastatic disease. Few studies compared RP and RT modalities, and those that did present mixed findings, although cancer-specific survival rates seem worse after RP.Biochemical recurrence rates were increased with DAC compared to AAC. Additionally, DAC metastasized to unusual sites, including penile and peritoneal metastases. Where compared, all studies reported worse survival for DAC compared to AAC. Conclusion When drawing conclusions about DAC it is important to note the heterogenous nature of the data. DAC is often diagnosed incidentally post-treatment, perhaps due to lack of a single, universally applied histopathological definition. As such, DAC is likely underreported in clinical practice and the literature. Poorer prognosis and outcomes for DAC compared to AAC merit further research into genetic composition, evolution, diagnosis, and treatment of this surprisingly common prostate cancer sub-type. Patient summary Ductal prostate cancer is a rare but important form of prostate cancer. This review demonstrates that it tends to be more serious at detection and more likely to spread to unusual parts of the body. Overall survival is worse with this type of prostate cancer and urologists need to be aware of the presence of ductal prostate cancer to alter management decisions and follow-up.
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Affiliation(s)
- Nithesh Ranasinha
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Altan Omer
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Yiannis Philippou
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Eli Harriss
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - Lucy Davies
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Ken Chow
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | | | - Andrew Erickson
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Timothy Rajakumar
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Ian G. Mills
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Richard J. Bryant
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
| | - Declan G. Murphy
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleVICAustralia
| | - Massimo Loda
- Dana Farber Cancer InstituteHarvardMAUSA
- Weill Cornell Medical SchoolNew YorkNYUSA
| | - Christopher M. Hovens
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | - Niall M. Corcoran
- Department of SurgeryRoyal Melbourne HospitalUniversity of MelbourneMelbourneVICAustralia
| | - Clare Verrill
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreUniversity of Oxford, John Radcliffe HospitalOxfordUK
| | - Alastair D. Lamb
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
- Department of UrologyOxford University Hospitals NHS Foundation Trust, Roosevelt DriveOxfordUK
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Jochmans I, Brat A, Davies L, Hofker HS, van de Leemkolk FEM, Leuvenink HGD, Knight SR, Pirenne J, Ploeg RJ. Oxygenated versus standard cold perfusion preservation in kidney transplantation (COMPARE): a randomised, double-blind, paired, phase 3 trial. Lancet 2020; 396:1653-1662. [PMID: 33220737 DOI: 10.1016/s0140-6736(20)32411-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Deceased donor kidneys are preserved in cold hypoxic conditions. Providing oxygen during preservation might improve post-transplant outcomes, particularly for kidneys subjected to greater degrees of preservation injury. This study aimed to investigate whether supplemental oxygen during hypothermic machine perfusion (HMP) could improve the outcome of kidneys donated after circulatory death. METHODS This randomised, double-blind, paired, phase 3 trial was done in 19 European transplant centres. Kidney pairs from donors aged 50 years or older, donated after circulatory death, were eligible if both kidneys were transplanted into two different recipients. One kidney from each donor was randomly assigned using permuted blocks to oxygenated hypothermic machine perfusion (HMPO2), the other to HMP without oxygenation. Perfusion was maintained from organ retrieval to implantation. The primary outcome was 12-month estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation in pairs of donated kidneys in which both transplanted kidneys were functioning at the end of follow-up. Safety outcomes were reported for all transplanted kidneys. Intention-to-treat analyses were done. This trial is registered with the ISRCTN Registry, ISRCTN32967929, and is now closed. FINDINGS Between March 15, 2015, and April 11, 2017, 197 kidney pairs were randomised with 106 pairs transplanted into eligible recipients. 23 kidney pairs were excluded from the primary analysis because of kidney failure or patient death. Mean eGFR at 12 months was 50·5 mL/min per 1·73 m2 (SD 19·3) in the HMPO2 group versus 46·7 mL/min per 1·73m2 (17·1) in HMP (mean difference 3·7 mL/min per 1·73m2, 95% CI -1·0 to 8·4; p=0·12). Fewer severe complications (Clavien-Dindo grade IIIb or more) were reported in the HMPO2 group (46 of 417, 11%, 95% CI 8% to 14%) than in the HMP group (76 of 474, 16%, 13% to 20%; p=0·032). Graft failure was lower with HMPO2 (three [3%] of 106) compared with HMP (11 [10%] of 106; hazard ratio 0·27, 95% CI 0·07 to 0·95; p=0·028). INTERPRETATION HMPO2 of kidneys donated after circulatory death is safe and reduces post-transplant complications (grade IIIb or more). The 12-month difference in eGFR between the HMPO2 and HMP groups was not significant when both kidneys from the same donor were still functioning 1-year post-transplant, but potential beneficial effects of HMPO2 were suggested by analysis of secondary outcomes. FUNDING European Commission 7th Framework Programme.
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Affiliation(s)
- Ina Jochmans
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Aukje Brat
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - H Sijbrand Hofker
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | | | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jacques Pirenne
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rutger J Ploeg
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK; Transplant Center, Leiden University Medical Center, Leiden, Netherlands
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Affiliation(s)
- Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7DQ, UK.
| | | | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7DQ, UK
| | - Bleddyn Jones
- Department of Clinical Radiobiology, University of Oxford, Oxford OX3 7DQ, UK
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Davies A, Brini S, Hirani S, Gathercole R, Forsyth K, Henderson C, Bradley R, Davies L, Dunk B, Harper E, Lam N, Pank L, Leroi I, Woolham J, Fox C, O'Brien J, Bateman A, Poland F, Bentham P, Burns A, Gray R, Knapp M, Talbot E, Hooper E, Winson R, Scutt B, Ordonez V, Nunn S, Lavelle G, Howard R, Newman S. The impact of assistive technology on burden and psychological well-being in informal caregivers of people with dementia (ATTILA Study). Alzheimers Dement (N Y) 2020; 6:e12064. [PMID: 33043107 PMCID: PMC7539670 DOI: 10.1002/trc2.12064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/02/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Assistive technology and telecare (ATT) may alleviate psychological burden in informal caregivers of people with dementia. This study assessed the impact of ATT on informal caregivers' burden and psychological well-being. METHODS Individuals with dementia and their informal caregivers were recruited to a randomized-controlled trial assessing effectiveness of ATT. Caregivers were allocated to two groups according to their cared-for person's randomization to a full or basic package of ATT and were assessed on caregiver burden, state anxiety, and depression. Caregivers' data from three assessments over 6 months of the trial were analyzed. RESULTS No significant between- or within-group differences at any time point on caregivers' burden, anxiety, and depression levels were found. DISCUSSION Full ATT for people with dementia did not impact caregivers' psychological outcomes compared to basic ATT. The length of follow up was restricted to 6 months.
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Affiliation(s)
- Anna Davies
- School of Health SciencesCityUniversity of LondonLondonUK
| | - Stefano Brini
- School of Health SciencesCityUniversity of LondonLondonUK
| | | | | | - Kirsty Forsyth
- School of Health SciencesQueen Margaret UniversityEdinburghUK
| | | | | | | | - Barbara Dunk
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | - Lynn Pank
- Medical Research Council Population Health Research UnitOxford UniversityOxfordUK
| | - Iracema Leroi
- Global Brain Health InstituteTrinity College DublinDublin 2Ireland
| | - John Woolham
- Social Care Workforce Research UnitKing's College LondonLondonUK
| | - Chris Fox
- School of MedicineHealth Policy and PracticeUniversity of East AngliaNorwichNorfolkUK
| | - John O'Brien
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Andrew Bateman
- Oliver Zangwill Centre for Neuropsychological RehabilitationPrincess of Wales HospitalElyUK
| | - Fiona Poland
- School of Allied Health ProfessionalsUniversity of East AngliaNorwichNorfolkUK
| | | | - Alistar Burns
- Global Brain Health InstituteTrinity College DublinDublin 2Ireland
| | | | - Martin Knapp
- Department of Old Age PsychiatryInstitute of PsychiatryLondonUK
| | - Emma Talbot
- Norfolk and Suffolk NHS Foundation TrustSuffolkUK
| | - Emma Hooper
- Lancashire Care NHS Foundation TrustPrestonUK
| | - Rachel Winson
- Cambridgeshire Community Services NHS TrustOliver Zangwill CentreElyUK
| | - Bethany Scutt
- Department of Old Age PsychiatryInstitute of PsychiatryLondonUK
| | - Victoria Ordonez
- Cambridgeshire Community Services NHS TrustOliver Zangwill CentreElyUK
| | - Samantha Nunn
- Cambridgeshire Community Services NHS TrustOliver Zangwill CentreElyUK
| | - Grace Lavelle
- Department of Old Age PsychiatryInstitute of PsychiatryLondonUK
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
- Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
- Oxford Health NHS Foundation TrustWarneford HospitalHeadingtonOxfordUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Stanton Newman
- School of Health SciencesCityUniversity of LondonLondonUK
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Sathianathen NJ, Omer A, Harriss E, Davies L, Kasivisvanathan V, Punwani S, Moore CM, Kastner C, Barrett T, Van Den Bergh RC, Eddy BA, Gleeson F, Macpherson R, Bryant RJ, Catto JWF, Murphy DG, Hamdy FC, Ahmed HU, Lamb AD. Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis. Eur Urol 2020; 78:402-414. [PMID: 32444265 DOI: 10.1016/j.eururo.2020.03.048] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/28/2020] [Indexed: 01/24/2023]
Abstract
CONTEXT Prebiopsy multiparametric magnetic resonance imaging (mpMRI) is increasingly used in prostate cancer diagnosis. The reported negative predictive value (NPV) of mpMRI is used by some clinicians to aid in decision making about whether or not to proceed to biopsy. OBJECTIVE We aim to perform a contemporary systematic review that reflects the latest literature on optimal mpMRI techniques and scoring systems to update the NPV of mpMRI for clinically significant prostate cancer (csPCa). EVIDENCE ACQUISITION We conducted a systematic literature search and included studies from 2016 to September 4, 2019, which assessed the NPV of mpMRI for csPCa, using biopsy or clinical follow-up as the reference standard. To ensure that studies included in this analysis reflect contemporary practice, we only included studies in which mpMRI findings were interpreted according to the Prostate Imaging Reporting and Data System (PIRADS) or similar Likert grading system. We define negative mpMRI as either (1) PIRADS/Likert 1-2 or (2) PIRADS/Likert 1-3; csPCa was defined as either (1) Gleason grade group ≥2 or (2) Gleason grade group ≥3. We calculated NPV separately for each combination of negative mpMRI and csPCa. EVIDENCE SYNTHESIS A total of 42 studies with 7321 patients met our inclusion criteria and were included for analysis. Using definition (1) for negative mpMRI and csPCa, the pooled NPV for biopsy-naïve men was 90.8% (95% confidence interval [CI] 88.1-93.1%). When defining csPCa using definition (2), the NPV for csPCa was 97.1% (95% CI 94.9-98.7%). Calculation of the pooled NPV using definition (2) for negative mpMRI and definition (1) for csPCa yielded the following: 86.8% (95% CI 80.1-92.4%). Using definition (2) for both negative mpMRI and csPCa, the pooled NPV from two studies was 96.1% (95% CI 93.4-98.2%). CONCLUSIONS Multiparametric MRI of the prostate is generally an accurate test for ruling out csPCa. However, we observed heterogeneity in the NPV estimates, and local institutional data should form the basis of decision making if available. PATIENT SUMMARY The negative predictive values should assist in decision making for clinicians considering not proceeding to biopsy in men with elevated age-specific prostate-specific antigen and multiparametric magnetic resonance imaging reported as negative (or equivocal) on Prostate Imaging Reporting and Data System/Likert scoring. Some 7-10% of men, depending on the setting, will miss a diagnosis of clinically significant cancer if they do not proceed to biopsy. Given the institutional variation in results, it is of upmost importance to base decision making on local data if available.
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Affiliation(s)
- Niranjan J Sathianathen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
| | - Altan Omer
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Eli Harriss
- University of Oxford, Bodleian Health Care Libraries, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Shonit Punwani
- Department of Urology, University College London Hospital, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospital, London, UK
| | - Christof Kastner
- CamPARI Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ben A Eddy
- Department of Urology, Canterbury Hospital, Canterbury, Kent, UK
| | - Fergus Gleeson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Declan G Murphy
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Division of Surgery, Faculty of Medicine, Imperial College London, London, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Gilbert AW, Billany JCT, Adam R, Martin L, Tobin R, Bagdai S, Galvin N, Farr I, Allain A, Davies L, Bateson J. Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. BMJ Open Qual 2020; 9:bmjoq-2020-000985. [PMID: 32439740 PMCID: PMC7247397 DOI: 10.1136/bmjoq-2020-000985] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [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: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time. LOCAL PROBLEM The Royal National Orthopaedic Hospital (RNOH) sees on average 11 200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH. METHODS The COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles. RESULTS Following the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6 weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected. CONCLUSIONS This report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19. REGISTRATION This project was submitted to the RNOH's Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).
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Affiliation(s)
- Anthony William Gilbert
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK .,School of Health Sciences, University of Southampton, Southampton, UK
| | - Joe C T Billany
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Ruth Adam
- Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Luke Martin
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Rebecca Tobin
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Shiv Bagdai
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Noreen Galvin
- Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Ian Farr
- Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Adam Allain
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Lucy Davies
- Operational Management, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - John Bateson
- Improvement Team, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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Davies L, McHugh L, Eccles C. Streamlining the Image-Guided Radiotherapy Process for Proton Beam Therapy: A Service Evaluation. Radiography (Lond) 2020. [DOI: 10.1016/j.radi.2019.11.028] [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: 12/01/2022]
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Philippou Y, Harriss E, Davies L, Jubber I, Leslie T, Bell RW, Bryant RJ, Hamdy FC, Verrill C, Lamb AD. Prostatic capsular incision during radical prostatectomy has important oncological implications: a systematic review and meta-analysis. BJU Int 2019; 124:554-566. [PMID: 30113754 DOI: 10.1111/bju.14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Prostatic capsular incision (CapI) is an iatrogenic breach of the prostatic capsule during radical prostatectomy (RP) that can cause positive surgical margins (PSMs) in organ-confined (pT2) prostate cancer, or the retention of benign prostatic tissue. We systematically interrogated the literature in order to clarify the definition of CapI, and the implications of this event for rates of PSM and biochemical recurrence (BCR). METHODS A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria using the search terms 'capsular incision' AND 'prostatectomy', and variations of each. In all, 18 studies were eligible for inclusion. RESULTS A total of 51 057 RP specimens were included. The incidence of CapI ranged from 1.3% to 54.3%. CapI definitions varied and included a breach of the prostatic capsule 'exposing both benign or malignant prostate cancer cells', 'malignant tissue only', or 'benign tissue only'. The incidence of PSMs due to CapI ranged from 2.8% to 71.7%. Our meta-analysis results found that when CapI was defined as 'exposing malignant tissue only in organ-confined prostate cancer' there was an increased risk of BCR compared to patients with pT2 disease and no CapI (relative risk 3.53, 95% confidence interval 2.82-4.41; P < 0.001). CONCLUSIONS The absolute impact of CapI on oncological outcomes is currently unclear due to inconsistent definitions. However, the data imply an association between CapI and PSMs and BCR. Reporting of possible areas of CapI on the operation note, or marking areas of concern on the specimen, are critical to assist CapI recognition by the pathologist.
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Affiliation(s)
- Yiannis Philippou
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Lucy Davies
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ibrahim Jubber
- Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Tom Leslie
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Richard W Bell
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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Gray R, Bradley R, Braybrooke J, Liu Z, Peto R, Davies L, Dodwell D, McGale P, Pan H, Taylor C, Barlow W, Bliss J, Bruzzi P, Cameron D, Fountzilas G, Loibl S, Mackey J, Martin M, Del Mastro L, Möbus V, Nekljudova V, De Placido S, Swain S, Untch M, Pritchard KI, Bergh J, Norton L, Boddington C, Burrett J, Clarke M, Davies C, Duane F, Evans V, Gettins L, Godwin J, Hills R, James S, Liu H, MacKinnon E, Mannu G, McHugh T, Morris P, Read S, Wang Y, Wang Z, Fasching P, Harbeck N, Piedbois P, Gnant M, Steger G, Di Leo A, Dolci S, Francis P, Larsimont D, Nogaret JM, Philippson C, Piccart M, Linn S, Peer P, Tjan-Heijnen V, Vliek S, Mackey J, Slamon D, Bartlett J, Bramwell VH, Chen B, Chia S, Gelmon K, Goss P, Levine M, Parulekar W, Pater J, Rakovitch E, Shepherd L, Tu D, Whelan T, Berry D, Broadwater G, Cirrincione C, Muss H, Weiss R, Shan Y, Shao YF, Wang X, Xu B, Zhao DB, Bartelink H, Bijker N, Bogaerts J, Cardoso F, Cufer T, Julien JP, Poortmans P, Rutgers E, van de Velde C, Carrasco E, Segui MA, Blohmer JU, Costa S, Gerber B, Jackisch C, von Minckwitz G, Giuliano M, De Laurentiis M, Bamia C, Koliou GA, Mavroudis D, A'Hern R, Ellis P, Kilburn L, Morden J, Yarnold J, Sadoon M, Tulusan AH, Anderson S, Bass G, Costantino J, Dignam J, Fisher B, Geyer C, Mamounas EP, Paik S, Redmond C, Wickerham DL, Venturini M, Bighin C, Pastorino S, Pronzato P, Sertoli MR, Foukakis T, Albain K, Arriagada R, Bergsten Nordström E, Boccardo F, Brain E, Carey L, Coates A, Coleman R, Correa C, Cuzick J, Davidson N, Dowsett M, Ewertz M, Forbes J, Gelber R, Goldhirsch A, Goodwin P, Hayes D, Hill C, Ingle J, Jagsi R, Janni W, Mukai H, Ohashi Y, Pierce L, Raina V, Ravdin P, Rea D, Regan M, Robertson J, Sparano J, Tutt A, Viale G, Wilcken N, Wolmark N, Wood W, Zambetti M. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials. Lancet 2019; 393:1440-1452. [PMID: 30739743 PMCID: PMC6451189 DOI: 10.1016/s0140-6736(18)33137-4] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/11/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy. METHODS To clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs). FINDINGS Individual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82-0·89; p<0·0001). 10-year breast cancer mortality was similarly reduced (18·9% vs 21·3%; RR 0·87, 95% CI 0·83-0·92; p<0·0001), as was all-cause mortality (22·1% vs 24·8%; RR 0·87, 95% CI 0·83-0·91; p<0·0001). Death without recurrence was, if anything, lower with dose-intense than with standard-schedule chemotherapy (10-year risk 4·1% vs 4·6%; RR 0·88, 95% CI 0·78-0·99; p=0·034). Recurrence reductions were similar in the seven trials (n=10 004) that compared 2-weekly chemotherapy with the same chemotherapy given 3-weekly (10-year risk 24·0% vs 28·3%; RR 0·83, 95% CI 0·76-0·91; p<0·0001), in the six trials (n=11 028) of sequential versus concurrent anthracycline plus taxane chemotherapy (28·1% vs 31·3%; RR 0·87, 95% CI 0·80-0·94; p=0·0006), and in the six trials (n=6532) testing both shorter intervals and sequential administration (30·4% vs 35·0%; RR 0·82, 95% CI 0·74-0·90; p<0·0001). The proportional reductions in recurrence with dose-intense chemotherapy were similar and highly significant (p<0·0001) in oestrogen receptor (ER)-positive and ER-negative disease and did not differ significantly by other patient or tumour characteristics. INTERPRETATION Increasing the dose intensity of adjuvant chemotherapy by shortening the interval between treatment cycles, or by giving individual drugs sequentially rather than giving the same drugs concurrently, moderately reduces the 10-year risk of recurrence and death from breast cancer without increasing mortality from other causes. FUNDING Cancer Research UK, Medical Research Council.
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Tan D, Davies L, Williams M, Jones S, Bales N, Beswick C, Wheeler P. OC-0619 Using continuous quality improvement to improve safety and reduce imaging errors in radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Davies R, Taylor K, Davies L. "Six-Pack Ileus" - Profound paralytic ileus after strenuous abdominal resistance exercise. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lee CK, Lord S, Marschner I, Wu YL, Sequist L, Rosell R, Fukuoka M, Mitsudomi T, Asher R, Davies L, Gebski V, Gralla R, Mok T, Yang JCH. The Value of Early Depth of Response in Predicting Long-Term Outcome in EGFR-Mutant Lung Cancer. J Thorac Oncol 2018; 13:792-800. [DOI: 10.1016/j.jtho.2018.03.010] [Citation(s) in RCA: 15] [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] [Received: 11/29/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 01/11/2023]
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Bamias A, Gibbs E, Khoon Lee C, Davies L, Dimopoulos M, Zagouri F, Veillard AS, Kosse J, Santaballa A, Mirza MR, Tabaro G, Vergote I, Bloemendal H, Lykka M, Floquet A, Gebski V, Pujade-Lauraine E. Bevacizumab with or after chemotherapy for platinum-resistant recurrent ovarian cancer: exploratory analyses of the AURELIA trial. Ann Oncol 2018; 28:1842-1848. [PMID: 28481967 DOI: 10.1093/annonc/mdx228] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In the open-label randomized phase III AURELIA trial, adding bevacizumab to chemotherapy for platinum-resistant ovarian cancer (PROC) significantly improved progression-free survival and response rate versus chemotherapy alone, but not overall survival (OS). We explored the effect of bevacizumab use after disease progression (PD) in patients randomized to chemotherapy alone. Patients and methods In AURELIA, 361 women with PROC were randomized to chemotherapy alone or with bevacizumab. Patients initially randomized to chemotherapy were offered bevacizumab after PD. Post hoc analyses assessed efficacy and safety in three subgroups: chemotherapy alone, chemotherapy followed by bevacizumab after PD, and chemotherapy plus bevacizumab at randomization. Results Of the 182 patients randomized to chemotherapy alone, 72 (40%) received bevacizumab after PD and 110 (60%) never received bevacizumab. There were no significant differences in patient and disease characteristics between these subgroups at baseline or the time of PD. Compared with patients never receiving bevacizumab, the risk of death was significantly reduced in patients receiving bevacizumab either upfront with chemotherapy [hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.52-0.90] or after PD (HR = 0.60, 95% CI 0.43-0.86). The tolerability of bevacizumab was similar with administration upfront or after PD. Conclusions Post-PD bevacizumab use may have confounded OS results in AURELIA. In these exploratory analyses of non-randomized subgroups, bevacizumab use, either with chemotherapy or after PD on chemotherapy alone, improved OS compared with no bevacizumab. Combining bevacizumab with chemotherapy at first appearance of platinum resistance maximises the likelihood of patients receiving this active treatment for PROC. ClinicalTrials.gov: NCT00976911.
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Affiliation(s)
- A Bamias
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Gibbs
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - C Khoon Lee
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - L Davies
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - M Dimopoulos
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - F Zagouri
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A-S Veillard
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - J Kosse
- AGO and Department of Gynaecology, Sana Klinikum Offenbach, Offenbach, Germany
| | - A Santaballa
- GEICO and Medical Oncology Department, University Hospital and Polytechnic, Valencia, Spain
| | - M R Mirza
- NSGO and Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - G Tabaro
- MITO and USCC/Dir. Scientifica, Centro di Riferimento Oncologico, CRO-IRCCS, Aviano, Italy
| | - I Vergote
- BGOG and Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - H Bloemendal
- DGOG and Department of Internal Medicine/Oncology, Meander Medical Center, Amersfoort, The Netherlands
| | - M Lykka
- HECOG and Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Floquet
- GINECO and Medical Oncology and Genetics Department, Institut Bergonié, Bordeaux
| | - V Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - E Pujade-Lauraine
- GINECO and Paris Descartes University, AP-HP Central Paris University Hospitals, Paris, France
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Davies L, Board-Davies E, Tour G, Shamlou B, Sloan A, Stephens P, LeBlanc K. Oral progenitor cell regulation of first line defense and its dysregulation in chronic graft versus host disease. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.085] [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]
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Polkinghorne RJ, Philpott J, Perovic J, Lau J, Davies L, Mudannayake W, Watson R, Tarr G, Thompson JM. The effect of packaging on consumer eating quality of beef. Meat Sci 2018; 142:59-64. [PMID: 29660545 DOI: 10.1016/j.meatsci.2018.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/31/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
This experiment examined 3 packaging systems: overwrap packaging using oxygen permeable film (OWP); vacuum skin packaging (VSP) and modified atmosphere packaging (MAP, 80%O2 and 20%CO2) on consumer sensory. Three primals from 48 carcasses were aged in vacuum packs for 5, 12 or 40 days. Steaks from longissimus lumborum, gluteus medius and psoas major muscles were packed in OWP, VSP and MAP for 9 days. Untrained consumers scored grilled steaks for tenderness, juiciness, liking of flavour and overall acceptability. Steaks in MAP had 10-12 points lower sensory scores (on a 100 point scale) compared to the OWP, or VSP systems (P < 0.001). The packaging effect was independent of days aging and muscle. It was concluded that high oxygen MAP has the potential to be included as an input variable in the Meat Standards Australia beef grading model. This would be contingent upon research into when the MAP effect occurred and the effect of using different gas mixtures on eating quality.
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Affiliation(s)
- R J Polkinghorne
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia; Birkenwood Pty. Ltd, 431 Timor Rd, Murrurundi, NSW 2338, Australia
| | - J Philpott
- Birkenwood Pty. Ltd, 431 Timor Rd, Murrurundi, NSW 2338, Australia
| | - Jessira Perovic
- MSA, The Short Run, University of New England, Armidale, NSW 2351, Australia
| | - J Lau
- MSA, The Short Run, University of New England, Armidale, NSW 2351, Australia
| | - L Davies
- Teys Australia Pty Ltd, 2728, Logan Road, Eight Mile Plains, QLD 4113, Australia
| | - W Mudannayake
- Teys Australia Pty Ltd, Lakes Creek Rd, North Rockhampton, QLD 4701, Australia
| | - R Watson
- School of Mathematics and Statistics, University of Melbourne, VIC 3010, Australia
| | - G Tarr
- School of Mathematics and Statistics, The University of Sydney, NSW 2006, Australia
| | - J M Thompson
- School of Environmental and Rural Science, University of New England, Armidale, NSW 2351, Australia.
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Whitley NC, Davies L, Gaskin J, Waldrop T, Connelly F, Seanima T, Speir A, Stephens M, Tedrow A, Burke P, Butcher S, Sheffield M, Dawson J, Hammond K. 123 Small Ruminant Beginning Farmer Training. J Anim Sci 2018. [DOI: 10.1093/jas/sky027.123] [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: 11/13/2022] Open
Affiliation(s)
- N C Whitley
- Fort Valley State University, Fort Valley, GA
| | - L Davies
- University of Georgia Extension, Athens, GA
| | - J Gaskin
- University of Georgia Extension, Athens, GA
| | - T Waldrop
- Georgia Department of Education, Tifton, GA
| | - F Connelly
- University of Georgia Extension, Athens, GA
| | | | - A Speir
- University of Georgia Extension, Athens, GA
| | - M Stephens
- University of Georgia Extension, Athens, GA
| | - A Tedrow
- University of Georgia Extension, Athens, GA
| | - P Burke
- University of Georgia Extension, Athens, GA
| | - S Butcher
- University of Georgia Extension, Athens, GA
| | | | - J Dawson
- Fort Valley State University, Fort Valley, GA
| | - K Hammond
- University of Georgia Extension, Athens, GA
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