1
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McCarver S, Hanna L, Samant A, Thompson AA, Seierstad M, Saha A, Wu D, Lord B, Sutton SW, Shah V, Milligan CM, Wennerholm M, Shelton J, Lebold TP, Shireman BT. Structure-Based Optimization of Selective and Brain Penetrant CK1δ Inhibitors for the Treatment of Circadian Disruptions. ACS Med Chem Lett 2024; 15:486-492. [PMID: 38628796 PMCID: PMC11017389 DOI: 10.1021/acsmedchemlett.3c00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024] Open
Abstract
Neuropsychiatric disorders such as major depressive disorders and schizophrenia are often associated with disruptions to the normal 24 h sleep wake cycle. Casein kinase 1 (CK1δ) is an integral part of the molecular machinery that regulates circadian rhythms. Starting from a cluster of bicyclic pyrazoles identified from a virtual screening effort, we utilized structure-based drug design to identify and reinforce a unique "hinge-flip" binding mode that provides a high degree of selectivity for CK1δ versus the kinome. Pharmacokinetics, brain exposure, and target engagement as measured by ex vivo autoradiography are described for advanced analogs.
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Affiliation(s)
- Stefan McCarver
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | | | | | - Aaron A. Thompson
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Mark Seierstad
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Arjun Saha
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Dongpei Wu
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Brian Lord
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Steven W. Sutton
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Vishal Shah
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Cynthia M. Milligan
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Michelle Wennerholm
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Jonathan Shelton
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Terry P. Lebold
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Brock T. Shireman
- Janssen Research and Development, San Diego, California 92121-1126, United
States
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2
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Martinez Perez P, Hanna L, Jaynes E, Gwiggner M. Infliximab rescue therapy in a case of severe granulomatous colitis associated with rituximab use. BMJ Case Rep 2024; 17:e257729. [PMID: 38423571 PMCID: PMC10910684 DOI: 10.1136/bcr-2023-257729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Colitis occurs in about 4% of individuals treated with rituximab. Optimal management of rituximab-induced colitis, which does not improve with cessation of the drug and supportive care alone, is poorly defined due to limited evidence. Severe refractory disease can lead to colectomy. We present a case of suspected rituximab-induced colitis occurring in a woman in her 70s suffering from rheumatoid arthritis. The patient achieved full clinical, endoscopic and histological remission of colitis with infliximab therapy. The use of biological therapy to treat rituximab-induced colitis can be a potentially organ-saving rescue therapy; however, it must be balanced against the increased risks of immunosuppression in patients already exposed to rituximab. While more evidence is required to fully understand the efficacy and risks of antitumour necrosis factor therapy in this scenario, our case provides an example of the successful use of infliximab for rituximab-induced colitis, which likely helped the patient avoid a colectomy.
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Affiliation(s)
| | - Luke Hanna
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eleanor Jaynes
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Markus Gwiggner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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3
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Anandabaskaran S, Hanna L, Iqbal N, Constable L, Tozer P, Hart A. Where Are We and Where to Next?-The Future of Perianal Crohn's Disease Management. J Clin Med 2023; 12:6379. [PMID: 37835022 PMCID: PMC10573672 DOI: 10.3390/jcm12196379] [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: 08/26/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Perianal fistulizing Crohn's Disease (pCD) affects about 25% of patients with Crohn's Disease (CD). It remains a difficult entity to manage with a therapeutic ceiling of treatment success despite improving medical and surgical management. The refractory nature of the disease calls for an imminent need to better understand its immunopathogenesis and classification to better streamline our treatment options. In this article, we overview the current state of pCD management and discuss where the future of its management may lie.
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Affiliation(s)
- Sulak Anandabaskaran
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, London W12 0NN, UK
- Robin Phillip’s Fistula Research Unit, St Mark’s Hospital and Academic Institute, London HA1 3UJ, UK
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Luke Hanna
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, London W12 0NN, UK
- Robin Phillip’s Fistula Research Unit, St Mark’s Hospital and Academic Institute, London HA1 3UJ, UK
| | - Nusrat Iqbal
- Robin Phillip’s Fistula Research Unit, St Mark’s Hospital and Academic Institute, London HA1 3UJ, UK
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2BX, UK
| | - Laura Constable
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, London W12 0NN, UK
| | - Phil Tozer
- Robin Phillip’s Fistula Research Unit, St Mark’s Hospital and Academic Institute, London HA1 3UJ, UK
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2BX, UK
| | - Ailsa Hart
- Robin Phillip’s Fistula Research Unit, St Mark’s Hospital and Academic Institute, London HA1 3UJ, UK
- Department of Surgery and Cancer, South Kensington Campus, Imperial College London, London SW7 2BX, UK
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4
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Hanna L, Burns C, O’Neill C, Coughlan E. A Systematic Review of the Implementation and Effectiveness of 'The Daily Mile' on Markers of Children's Health. Int J Environ Res Public Health 2023; 20:6203. [PMID: 37444051 PMCID: PMC10340552 DOI: 10.3390/ijerph20136203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Currently, a high percentage of children globally fail to meet the World Health Organisation's (WHO) recommended daily physical activity (PA) guidelines. The Daily Mile (TDM) is a school-based PA initiative, designed to improve primary school children's PA behaviour. The purpose of this review was to evaluate the extant TDM implementation process and identify its impact on health-related metrics. Three databases were used to search for articles from the time TDM originated in 2012 until February 2022. The identification and screening process of articles for their ability to meet this review's eligibility criteria were facilitated by use of PRISMA and Rayyan. Sixteen articles from the initial search (n = 202) were deemed eligible for inclusion. An analysis of these articles identified five common outcome categories that permeated throughout the research articles: (1) cardiorespiratory fitness (CRF); (2) anthropometry and body composition; (3) PA; (4) cognition; and (5) process evaluation. Results presented from the included articles suggests TDM positively impacts markers of a variety of health-related metrics, namely CRF and PA. However, implementation barriers including TDM's repetitive nature, time constraints associated with competing curriculum demands and inadequate facilities regularly necessitate the adaptation and development of the original TDM format by schools and teachers.
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Affiliation(s)
- Luke Hanna
- Department of Sport, Leisure and Childhood Studies, Munster Technological University, Bishopstown, T12 P928 Cork, Ireland; (C.B.); (C.O.); (E.C.)
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Hanna L, Sounderajah V, Abdullah A, Marshall D, Salciccioli J, Shalhoub J, Gibbs R. Trends in Thoracic Aortic Aneurysm Hospital Admissions, Interventions, and Mortality in England between 1998 and 2020: An Observational Study. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.10.017] [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: 11/19/2022]
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Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal F, Acharya A, Normahani P, Ashrafian H, Markar S, Sounderajah V, Darzi A. 471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
The accuracy and safety of symptom checkers in diagnosing and triaging patients is of concern; especially those with life-threatening conditions. The study's aims were to: 1. assess the accuracy of symptom checkers in diagnosing and triaging myocardial infarctions (MI) and, 2. determine whether differences in gender or presentation type exist.
Method
This prospective diagnostic accuracy study assessed 8 symptom checkers using 100 MI patients of various presentations: typical or atypical. The ability of a symptom checker in providing MI as the first diagnosis (D1) and the first 3 (D3) diagnoses were diagnostic accuracy measures. Triage advice was deemed correct if the symptom checker recommended seeking emergency treatment.
Results
Symptom checkers correctly diagnosed 48.0±31.4% of cases with MI first. D3 accuracy was 72.6±20.2%. Mean triage accuracy was 82.6±12.6%.
24.0±16.2% of atypical cases had a correct primary diagnosis. D3 accuracy for atypical MI was 43.8±20.6%, significantly lower than that of typical MI (p<0.01). Atypical case triage accuracy was 52.7±20.0%, significantly lower than typical cases (84.2±14.7%, p<0.01).
10.0% of the atypical female cases were diagnosed correctly with MI as the first diagnosis. Female atypical cases had significantly lower accuracy than typical female cases for all accuracy measures (p<0.01).
Conclusions
Symptom checkers generally provide low accuracy for diagnosing MI. Approximately 20% of cases were under-triaged. Results varied between symptom checkers: patients who presented with atypical symptoms tended to be under-diagnosed and under-triaged, especially those who were female. This demonstrated potential gender bias and therefore raises questions regarding symptom checker regulation and safety.
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Affiliation(s)
- W Wallace
- Imperial College London , London , United Kingdom
| | - C Chan
- Imperial College London , London , United Kingdom
| | | | - L Hanna
- Imperial College London , London , United Kingdom
| | - F Iqbal
- Imperial College London , London , United Kingdom
| | - A Acharya
- Imperial College London , London , United Kingdom
| | - P Normahani
- Imperial College London , London , United Kingdom
| | - H Ashrafian
- Imperial College London , London , United Kingdom
| | - S Markar
- Karolinska Institutet , Stockholm , Sweden
- University of Oxford , Oxford , United Kingdom
| | | | - A Darzi
- Imperial College London , London , United Kingdom
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7
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Hanna L, Lam K, Agbeko A, Amoako J, Ashrafian H, Sounderajah V, Abdullah A, Gibbs R. Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.013] [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: 10/17/2022]
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8
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Yang QZC, Hanna L, Statton B, Armour C, ORegan D, Xu Y, Gibbs R. O024 Prognostic value of haemodynamic parameters in predicting adverse clinical events in type B aortic dissection. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Ascertain the prognostic role of in-vivo 4D-flow magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) aortic haemodynamic parameters as predictors of adverse dissection-related events in type B aortic dissection (TBAD).
Methods
A systematic literature search was conducted according to the PRISMA guidelines using electronic databases searched from 1946 to 2021 for studies reporting on the relationship between aortic haemodynamics and aortic dissection-related events defined as aortic growth, aneurysm development, false lumen thrombosis, need for surgery and aortic rupture.
Results
Fourteen studies were included; eleven studies used CFD and three studies used 4D-flow MRI. Two studies found increased FL ejection fraction (EF) significantly associated with aortic growth rate, and another study found increased FL stroke volume significantly associated with increased aortic expansion rate. Result for time-averaged wall shear stress (TAWSS) and relative residence time (RRT) are contradictory; one study found TAWSS significantly associated with aortic wall deformation, but another study found no significant difference. Five studies suggested possible associations between slow flowing regions or increased RRT and FL thrombosis, with another study finding significant associations between FL thrombosis and adverse aortic outcomes. However, one study revealed opposite findings where decreased RRT significantly correlated with aneurysm formation.
Conclusion
In-vivo aortic haemodynamic measurements such as FL EF, FL stroke volume, TAWSS and RRT show possible associations with FL and aortic expansion, as well as FL thrombosis. Larger prospective studies are now needed to determine the prognostic utility of in vivo aortic haemodynamic metrics in predicting TBAD clinical outcomes to guide management.
Take-home message
Aortic haemodynamic parameters measured by 4D-flow magnetic resonance imaging and computational fluid dynamics show promising potential as predictors of adverse dissection-related events in type B aortic dissection.
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Affiliation(s)
- QZC Yang
- School of Medicine, Imperial College London
| | - L Hanna
- Department of Surgery and Cancer, Imperial College London
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust
| | - B Statton
- MRC London Institute of Medical Sciences, Imperial College London
| | - C Armour
- Department of Chemical Engineering, Imperial College London
| | - D ORegan
- MRC London Institute of Medical Sciences, Imperial College London
| | - Y Xu
- Department of Chemical Engineering, Imperial College London
| | - R Gibbs
- Department of Surgery and Cancer, Imperial College London
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust
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9
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Frugtniet B, Morgan S, Murray A, Palmer-Smith S, White R, Jones R, Hanna L, Fuller C, Hudson E, Mullard A, Quinton AE. The detection of germline and somatic BRCA1/2 genetic variants through parallel testing of patients with high-grade serous ovarian cancer: a national retrospective audit. BJOG 2021; 129:433-442. [PMID: 34657373 PMCID: PMC9298909 DOI: 10.1111/1471-0528.16975] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 12/05/2022]
Abstract
Objective To determine the frequency of germline and somatic pathogenic BRCA1 and BRCA2 variants in patients with high‐grade serous ovarian cancer tested by next‐generation sequencing (NGS), with the aim of defining the best strategy to be implemented in future routine testing. Design National retrospective audit. Setting The All Wales Medical Genomics Service (AWMGS). Population Patients with high‐grade serous ovarian/fallopian tube/peritoneal cancer referred by oncologists to the AWMGS between February 2015 and February 2021 for germline and/or tumour testing of the BRCA1 and BRCA2 genes by NGS. Methods Analysis of NGS data from germline and/or tumour testing. Main outcome measures Frequency of BRCA1 and BRCA2 pathogenic variants. Results The overall observed germline/somatic pathogenic variant detection rate was 11.6% in the 844 patients included in this study, with a 9.2% (73/791) germline pathogenic variant detection rate. Parallel tumour and germline testing was carried out for 169 patients and the overall pathogenic variant detection rate for this cohort was 14.8%, with 6.5% (11/169) shown to have a somatic pathogenic variant. Two BRCA1 dosage variants were found during germline screens, representing 2.0% (2/98) of patients with a pathogenic variant that would have been missed through tumour testing alone. Conclusions Parallel germline and tumour BRCA1 and BRCA2 testing maximises the detection of pathogenic variants in patients with high‐grade serous ovarian cancer. Tweetable abstract Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer. Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer. Linked article This article is commented on by C Gourley, p. 443 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16978.
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Affiliation(s)
- B Frugtniet
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - S Morgan
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - A Murray
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - S Palmer-Smith
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - R White
- All Wales Medical Genomics Laboratory, University Hospital of Wales, Cardiff, UK
| | - R Jones
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - L Hanna
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - C Fuller
- Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board, Bangor, UK
| | - E Hudson
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - A Mullard
- Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board, Bangor, UK
| | - A E Quinton
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
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Johnston M, Majkowska A, Ahmad M, Kamaledeen S, New F, Beckett D, Bent C, Turner K, Hanna L. 324 Outcomes of Prostate Artery Embolisation In Catheterised Patients: A Case Series. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Prostate artery embolisation (PAE) is an approved treatment for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS). Evidence of efficacy for PAE in patients who are unable to void urine spontaneously is scant, however. Traditional treatments for BPH-LUTS have evidence in retention patients and this series aims to report outcomes for PAE in catheterised patients.
Method
The records of consecutive men with BPH-LUTS which required either an indwelling bladder catheter or clean intermittent self-catheterisation (CISC) who subsequently underwent PAE were retrospectively reviewed. Basic demographics were collected along with information on the prostate volume and PAE procedure specifics. The primary outcome was whether patients were catheter/CISC free at 3 months. Other outcomes include complications, use of medications and the need for other surgical treatments post-PAE.
Results
63 men underwent PAE for urinary retention and BPH-LUTS between 2013 and 2020. Of these, 7 underwent a unilateral embolisation for aberrant anatomy. The mean prostate volume was 128ml. 61% of men were free from a catheter/CISC post-treatment. 4 patients suffered post-PAE UTI, whilst 3 patients subsequently underwent Transurethral Resection of the Prostate following PAE for failure to become catheter free. 13 men were entirely free from BPH-LUTS medications.
Conclusions
PAE for catheterised men results in a similar catheter-free rate post procedure to several more invasive BPH treatments. It has a low side-effect profile and gives men with poor health an option to try to become catheter free. PAE should be discussed with men with catheters as a treatment option.
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Affiliation(s)
- M Johnston
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - A Majkowska
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - M Ahmad
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - S Kamaledeen
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - F New
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - D Beckett
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - C Bent
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - K Turner
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - L Hanna
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
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Jadon R, Hanna L, Parsons P, Staffurth J. Dose-Volume Predictors for Patient-reported Late Diarrhoea, Faecal Incontinence and Urgency after Pelvic Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:536-545. [PMID: 33875359 DOI: 10.1016/j.clon.2021.03.011] [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: 07/15/2020] [Revised: 02/09/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS Pelvic radiotherapy adds significantly to the curative treatment of many pelvic malignancies. However, this cure comes at a cost for many patients, where late bowel toxicities, such as faecal incontinence, urgency and diarrhoea, adversely affect quality of life. Despite the implementation of advanced radiotherapy techniques in many centres, there are deficiencies in our knowledge of how to make best use of these techniques to minimise these late toxicities, with dose-volume constraints specifically for late effects needing definition. The aims of this study were to establish dose-volume predictors for patient-reported late bowel toxicities and derive constraints for clinical use to reduce the risk of these toxicities. MATERIALS AND METHODS All radiotherapy patients treated in our institution between 2012 and 2014 for gynaecological and urological cancers (bladder, prostate where pelvic nodes are treated) were identified. Patients were sent patient-reported toxicity questionnaires at 12 and 24 months after treatment. Planning computed tomography scans were retrospectively contoured with different definitions of bowel as organs at risk (OARs). Dose-volume data for each OAR were collected and predictors of these toxicities found using multivariate analysis. For those dose-volume predictors found to be significant on multivariate analysis, statistically significant and clinically relevant dose-volume constraints were derived. Furthermore, data collected were used to validate constraints from published studies. RESULTS Faecal urgency, incontinence and diarrhoea rates were found in 52, 23.5 and 18.7% of the 203 patients included at 12 months following radiotherapy. Dose-volume parameters for sigmoid colon and large bowel were significant for these toxicities, and constraints for these OARs were derived, which are promising. A previously published constraint for bowel loops was validated with our data. CONCLUSIONS The sigmoid colon and large bowel are important OARs for the development of faecal urgency, incontinence and diarrhoea. Promising constraints for these OARs were derived, which require further validation before prospective clinical use.
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Affiliation(s)
- R Jadon
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK; Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge, UK.
| | - L Hanna
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - P Parsons
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - J Staffurth
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK; School of Medicine, Institute of Cancer and Genetics, Cardiff University, Velindre Cancer Centre, Cardiff, UK
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Roberts R, Borley A, Hanna L, Dolan G, Ganesh S, Williams EM. Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study. Clin Oncol (R Coll Radiol) 2020; 33:230-240. [PMID: 33308947 DOI: 10.1016/j.clon.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 11/15/2022]
Abstract
AIMS Anthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20-30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms. MATERIALS AND METHODS A prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments. RESULTS After three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001). CONCLUSION It is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.
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Affiliation(s)
- R Roberts
- Velindre Cancer Centre, Whitchurch, Cardiff, UK.
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - L Hanna
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - G Dolan
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - S Ganesh
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Johnston MJ, Johnston TJ, Hanna L. Editorial Comment to Development and content validation of the percutaneous nephrolithotomy assessment score. Int J Urol 2020; 27:965. [PMID: 33006192 DOI: 10.1111/iju.14391] [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: 11/28/2022]
Affiliation(s)
- Maximilian J Johnston
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Luke Hanna
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
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Abstract
Abstract
Dr Liz Hanna chairs the Environmental Health Working Group of the WFPHA. For more than a decade she has researched climate change adaptation (CCA), focusing on exposure risks, physiological health impacts, health sector preparedness and policy responses to analyze current and future climate health threats. Working in Prof Tony McMichael's team at the Australian National University, she convened the National CCA Research Network, and served as President of the Climate and Health Alliance.
Human history is littered with examples of climatic interruptions to food and water supplies leading to disease and famine, conflict and migration. Dr Hanna sets the scene for this challenging workshop by outlining selected historical examples and describing the pathways of interconnectedness. Previously, climatic, health and social upheavals were geographically restricted. Yet the world now faces climatic change on a global scale never before it witnessed by humans. Liz outlines how this global disruption threatens our most important environmental determinants of health.
Evidence of global warming acceleration is presented and linked with disruptions to vital ecosystems and interruptions to food and water resources. Dr Hanna then leads participants on a journey to the future by applying IPCC projections to demonstrate the escalated potential for health harm from further intensified disturbances to the hydrological patterns, ocean warming, acidification and sea level rise, global heating and increased heat extremes as these impact water sources, crop yields, stock health and their survival, the marine food web and human acclimatisation limitations.
Throughout this presentation, Dr Hanna weaves the interconnectedness of healthy ecosystems and healthy people, and our global interconnectedness as we collectively share this beautiful but fragile planet.
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Affiliation(s)
- L Hanna
- Fenner School for Environment and Society, Australian National University, Canberra, Australia
- Environmental Health Working Group, WFPHA, Geneva, Switzerland
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Hanna L. Australia’s 2020 summer shows our changed climate future - a public health preparedness challenge. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Humans have wandered this planet for hundreds of thousands of years, yet in the last 160 years we have dramatically disrupted planetary systems upon which we depend. Humanity has polluted the oceans, rivers, air and soils. Our persistent burning of fossil fuels to power opulent lifestyles is now perilously close to permanently disrupting global climatic systems.
Problem
It is clear. The problem is us. Australia's summer of horrors provides a terrifying glimpse into our collective future. This rich and exquisitely advantaged nation has voted for governments that have ignored fragile ecosystems, dismantled environmental protection laws, ignored climate science and expanded its fossil fuel exploration, extraction, consumption and exportation. It has systematically silenced science, ignored its duty of care to protect its present and future citizenry.
Evidence
The 2019-2020 summer brought unprecedented disasters to a country familiar with disasters. After the hottest and driest year on record came the world's largest bushfire, which started in winter, and burned uncontainable for 7 months across 5 states. Billions of animals perished, thousands of homes & businesses destroyed, 33 people burned alive. Continental-wide temperatures of 42oC. Smoke levels exceeded hazardous levels by a factor of 25, lingered 6weeks in the national capital, circumnavigated the southern hemisphere. 80% of Australians were affected by the fires in some way, and the nation fell into a deep grief.
The public health challenge
As the world faces new climate regimes, the associated health challenges are elevating to unheralded and unforeseen levels. Public health preparedness for past situations will inevitably fail. Events are no longer singular, short lived or readily managed. Today's events are multifaceted, expansive and protracted. Their sheer magnitude and scale prevent response activities, interrupt transport and supply chains and shut down power and communications.
Key messages
Unfettered human development has degraded planetary systems upon which humanity depends for survival and flourishing. Climate change is disrupting all our key environmental determinants of health. Environmental degradation and climate change now present a rapidly intensifying health emergency. Australia’s summer of disasters demonstrates we need an explosion of public health preparedness.
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Affiliation(s)
- L Hanna
- Australian National University, Canberra, Australia
- World Federation of Public Health Associations, Geneva, Switzerland
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Hanna L. Overestimation of heat tolerance calls for health promotion to limit occupational heat risk. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Global warming is accelerating. One degree C warming across Australia has generated a six-fold increase in heat extremes, as days above 35oC (and upwards of 45oC) are increasingly common. Many industries require staff to engage in outdoor work, often involving high levels of physical intensity. Compliance with occupational heat guidelines is reportedly low. Adoption of health protective strategies requires accurate risk perception. Australian heat exposed workers report discomfort when working in hot weather, yet little is known about their personal risk assessment.
Methods
Heat exposed outdoor workers across Australia (n = 112) completed pre-study surveys about their personal heat tolerance and completed daily heat diaries (n = 3421) to record their thermal comfort, heat symptoms and productivity, whilst on-site maximum temperatures and humidity were monitored.
Results
Daily maximum temperatures ranged from 18-43oC, and WBGT levels in parts of Australia exceed hazardous levels most days throughout summer. Significant overestimation of thermal tolerance was reported, as “feeling too hot to keep working” and emergence of symptoms occurred up to ten degrees lower than expected.
Conclusions
Heat exposed workers consistently over-estimate their thermotolerance and capacity to perform physically intensive work. Increasing frequency and intensity of heat waves escalates future risks of health harm and deaths among heat exposed workers. Health protection necessitates active health education/ health promotion campaigns to better align perceived and actual health risks. Main messages: Global warming presents intensifying health and productivity threats. Widespread lack of recognition of personal health threats suggests a critical need for heath education/promotion to increase heat guideline compliance
Key messages
Increasing frequency and intensity of heat waves from climate change escalates future risks of health harm and deaths among heat exposed workers who over-estimate their thermotolerance. Widespread lack of recognition of personal heat exposure threats suggests a critical need for health education/promotion to increase heat guidelines compliance.
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Affiliation(s)
- L Hanna
- Fenner School for Environment & Society, Australian National University, Canberra, Australia
- Environmental Health Working Group, WFPHA, Geneva, Switzerland
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Karim SS, Hanna L, Geraghty R, Somani BK. Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Urolithiasis 2019; 48:263-270. [PMID: 31372691 PMCID: PMC7220875 DOI: 10.1007/s00240-019-01150-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
Controversies exist on the influence of lower pole anatomy (infundibular pelvic angle, IPA; infundibular length, IL; and infundibular width, IW) for success and outcomes related to the treatment of stones in the lower pole. We wanted to look at the role of lower pole anatomy to study clinical outcomes in patients treated for isolated lower pole stones (LPS) using retrograde intra renal surgery (RIRS), and also perform a review to look at the published literature on the influence of pelvicalyceal anatomy on success with RIRS. Data were prospectively collected (June 2013-June 2016) for all patients who underwent RIRS for LPS, and the imaging was then retrospectively reviewed to calculate the IPA, IL and IW using the Elbahnasy method. A systematic review was also conducted for all English language articles between January 2000 and April 2018, reporting on the impact of pelvicaliceal anatomy on RIRS. A total of 108 patients with LPS were included with a male to female ratio of 2:3 and a mean age of 54.7 years. The mean lower pole stone size was 9.3 mm (range 3-29 mm) and 102/108 (94.4%) patients were stone free (SF) at the end of their procedure. While steep IPA (< 30°), operative time duration and larger stone size were significant predictors of failure, the placement of ureteric access sheath, IW and IL did not influence treatment outcomes. Six studies (460 patients) met the inclusion criteria for our review. The IPA, IW, IL for failure ranged from 26° to 38°, 5.5-7 mm and 24-34 mm, respectively. The SFR ranged from 78 to 88% with a metaanalysis showing IPA as the most important predictor of treatment outcomes for LPS. Infundibular pelvic angle seems to be the most important predictor for the treatment of LPS using RIRS. Pelvicalyceal anatomy in conjunction with stone size and hardness seem to dictate the success, and decisions on the type of surgical interventions should reflect this.
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Affiliation(s)
- Sulaiman Sadaf Karim
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Luke Hanna
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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Hanna L, Kissick AL, McCroskey E, Holland JD. Resilience to disturbance is a cross‐scale phenomenon offering a solution to the disturbance paradox. Ecosphere 2019. [DOI: 10.1002/ecs2.2682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- L. Hanna
- Department of Entomology Purdue University 901 West State Street West Lafayette Indiana 47907 USA
| | - A. L. Kissick
- Department of Entomology Purdue University 901 West State Street West Lafayette Indiana 47907 USA
| | - E. McCroskey
- Department of Entomology Purdue University 901 West State Street West Lafayette Indiana 47907 USA
| | - J. D. Holland
- Department of Entomology Purdue University 901 West State Street West Lafayette Indiana 47907 USA
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Affiliation(s)
- Michael S Floyd
- Department of Urology, Salisbury NHS Foundation Trust, Wiltshire, SP2 8BJ, United Kingdom.
| | - Luke Hanna
- Department of Urology, Salisbury NHS Foundation Trust, Wiltshire, SP2 8BJ, United Kingdom
| | - Melissa C Davies
- Department of Urology, Salisbury NHS Foundation Trust, Wiltshire, SP2 8BJ, United Kingdom
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Hanna L, Chung V, Ali A, Ritchie R, Rogers A, Sullivan M, Keoghane S. Ureteroscopy in the diagnosis of upper tract transitional cell cancer: a 10-year experience providing outcome data for informed consent. Urologia 2017; 84:0. [PMID: 28604991 DOI: 10.5301/uj.5000241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to assess the effectiveness of ureteroscopy and biopsy in the diagnosis and management of upper tract urothelial carcinoma. METHODS We retrospectively collated data from pathology, radiology and operating theatre data sets from two large UK hospitals. During the 10-year period examined, 160 patients underwent ureteroscopy prior to nephro-ureterectomy (NU)/distal ureterectomy (DU). RESULTS Of the 160 patients identified, 140 were ureteroscopically evaluated and biopsied, 104 (74.3%) had positive biopsies, 5 (3.6%) had negative biopsies and 31 (22.1%) had nondiagnostic biopsies.One hundred and forty patients of 160 (88.8%) resulted in positive findings as a result of their ureteroscopy [positive biopsy/positive operative cytology/visible upper tract urothelial carcinoma (UTUC) at ureteroscopy)].A total of 108 patients had cytological samples sent for histological analysis where grade was able to be assessed at DU/NU. Of these samples, 35 had positive cytology, 58 had an abnormal result that was not diagnostic and 15 had negative cytology.Patients with positive biopsies had upstaging (58.4%) and/or upgrading (30.5%) of their initial ureteroscopic histology at NU/DU.The overall success rate of ureteroscopy for cancer diagnosis was 88.8%. CONCLUSIONS Upper tract endoscopy and biopsy yielded positive biopsy results in 74.3% of cases and confirmed a cancer diagnosis in 88.8%. Five patients had negative histology at biopsy, all of whom eventually underwent a NU/DU confirming cancer.
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Affiliation(s)
- Luke Hanna
- Department of Urology, Queen Alexandra Hospital, Portsmouth - UK
| | - Vera Chung
- Department of Urology, Oxford University Hospitals, Oxford - UK
| | - Ahmed Ali
- Department of Urology, Queen Alexandra Hospital, Portsmouth - UK
| | - Robert Ritchie
- Department of Urology, Oxford University Hospitals, Oxford - UK
| | - Ann Rogers
- Department of Urology, Queen Alexandra Hospital, Portsmouth - UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals, Oxford - UK
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Jadon R, Parsons P, Hanna L, Evans M, Staffurth J. PO-0725: Sigmoid colon is an important organ at risk for high-grade faecal urgency after pelvic radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31162-3] [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: 10/19/2022]
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Fitzsimons D, Mullan D, Wilson J, Chew E, Conway B, Corcoran B, Gamble J, Hanna L, Mcmullan G, Mcma-Hon M, Mulholland P, Stewart C, Stockdale P. 1375: The palliative care needs of patients with heart failure from the perspective of the patient, carer and clinical team. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/14745151060050s163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D. Fitzsimons
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
- Institute of Nursing Research, University of Ulster
| | - D. Mullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Wilson
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - E. Chew
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Conway
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - B. Corcoran
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - J. Gamble
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - L. Hanna
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - G. Mcmullan
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - M. Mcma-Hon
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Mulholland
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - C. Stewart
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
| | - P. Stockdale
- Belfast City Hospital Trust, Belfast, N Ireland BT9 7AB
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Affiliation(s)
| | - Luke Hanna
- Royal Bournemouth Hospital, Bournemouth, UK
| | - Melissa Davies
- Department of Urology, Salisbury District Hospital, Salisbury, Wiltshire, UK
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Taylor S, Byrne A, Adams R, Turner J, Hanna L, Staffurth J, Farnell D, Sivell S, Nelson A, Green J. The Three-item ALERT-B Questionnaire Provides a Validated Screening Tool to Detect Chronic Gastrointestinal Symptoms after Pelvic Radiotherapy in Cancer Survivors. Clin Oncol (R Coll Radiol) 2016; 28:e139-e147. [PMID: 27369458 DOI: 10.1016/j.clon.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/22/2016] [Revised: 05/05/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023]
Abstract
AIMS Although pelvic radiotherapy is an effective treatment for various malignancies, around half of patients develop significant gastrointestinal problems. These symptoms often remain undetected, despite the existence of effective treatments. This study developed and refined a simple screening tool to detect common gastrointestinal symptoms in outpatient clinics. These symptoms have a significant effect on quality of life. This tool will increase detection rates and so enable access to specialist gastroenterologists, which will in turn lead to improved symptom control and quality of life after treatment. MATERIALS AND METHODS A literature review and expert consensus meeting identified four items for the ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) screening tool. ALERT-B was face tested for its usability and acceptability using cognitive interviews with 12 patients experiencing late gastrointestinal symptoms after pelvic radiotherapy. Thematic analysis and probe category were used to analyse interview transcripts. Interview data were presented to a group of experts to agree on the final content and format of the tool. ALERT-B was assessed for reliability and tested for validity against the Gastrointestinal Symptom Rating Scale in a clinical study (EAGLE). RESULTS Overall, the tool was found to be acceptable in terms of wording, response format and completion time. Participant-reported experiences, including lifestyle modifications and the psychological effect of the symptoms, led to further modifications of the tool. The refined tool includes three questions covering rectal bleeding, incontinence, nocturnal bowel movements and impact on quality of life, including mood, relationships and socialising. ALERT-B was successfully validated against the Gastrointestinal Symptom Rating Scale in the EAGLE study with the tool shown broadly to be internally consistent (Cronbach's α = 0.61 and all item-subscale correlation [Spearman] coefficients are > 0.6). CONCLUSION The ALERT-B screening tool can be used in clinical practice to improve post-treatment supportive care by triggering the clinical assessment of patients suitable for referral to a gastroenterologist.
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Affiliation(s)
- S Taylor
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.
| | - A Byrne
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - R Adams
- Velindre Cancer Centre, Cardiff, UK
| | - J Turner
- Department of Gastroenterology, University Hospital of Llandough, Llandough, Penarth, UK
| | - L Hanna
- Velindre Cancer Centre, Cardiff, UK
| | | | - D Farnell
- School of Dentistry, Cardiff University, Cardiff, UK
| | - S Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - A Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Green
- Department of Gastroenterology, University Hospital of Llandough, Llandough, Penarth, UK
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Hulin-Curtis SL, Uusi-Kerttula H, Jones R, Hanna L, Chester JD, Parker AL. Evaluation of CD46 re-targeted adenoviral vectors for clinical ovarian cancer intraperitoneal therapy. Cancer Gene Ther 2016; 23:229-34. [PMID: 27229159 PMCID: PMC4947523 DOI: 10.1038/cgt.2016.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
Ovarian cancer accounts for >140 000 deaths globally each year. Typically, disease is asymptomatic until an advanced, incurable stage. Although response to cytotoxic chemotherapy is frequently observed, resistance to conventional platinum-based therapies develop rapidly. Improved treatments are therefore urgently required. Virotherapy offers great potential for ovarian cancer, where the application of local, intraperitoneal delivery circumvents some of the limitations of intravenous strategies. To develop effective, adenovirus (Ad)-based platforms for ovarian cancer, we profiled the fluid and cellular components of patient ascites for factors known to influence adenoviral transduction. Levels of factor X (FX) and neutralizing antibodies (nAbs) in ascitic fluid were quantified and tumor cells were assessed for the expression of coxsackie virus and adenovirus receptor (CAR) and CD46. We show that clinical ascites contains significant levels of FX but consistently high CD46 expression. We therefore evaluated in vitro the relative transduction of epithelial ovarian cancers (EOCs) by Ad5 (via CAR) and Ad5 pseudotyped with the fiber of Ad35 (Ad5T*F35++) via CD46. Ad5T*F35++ achieved significantly increased transduction in comparison to Ad5 (P<0.001), independent of FX and nAb levels. We therefore propose selective transduction of CD46 over-expressing EOCs using re-targeted, Ad35-pseudotyped Ad vectors may represent a promising virotherapy for ovarian cancer.
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Affiliation(s)
- S L Hulin-Curtis
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - H Uusi-Kerttula
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - R Jones
- Velindre Cancer Centre, Cardiff, UK
| | - L Hanna
- Velindre Cancer Centre, Cardiff, UK
| | - J D Chester
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK.,Velindre Cancer Centre, Cardiff, UK
| | - A L Parker
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
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Jadon R, Spezi E, Hanna L, Palaniappan N, Evans M, Hudson E, Staffurth J. EP-1819: Plan of the Day is the optimal approach to address organ motion for cervical cancer IMRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33070-5] [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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Lander N, Hanna L, Brown H, Telford A, Morgan P, Salmon J, Barnett L. Physical literacy development in Australian youth: A current concern. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.155] [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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Hanna L, Gill SD, Newstead L, Hawkins M, Osbourne RH. Patient perspectives on a personally controlled electronic health record used in regional Australia. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jadon R, Younger E, Jenkins S, Hanna L, Hudson E, Staffurth J. Prospective audit of acute toxicity following radiotherapy for gynaecological malignancies using conformal and volumetric modulated arc radiotherapy (VMAT) techniques. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2015.04.013] [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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Alazraki NP, Ziffer JA, Fajman W, Galt J, Halkar R, Hanna L. Renal imaging of thallium-201 during cardiac evaluation. Contrib Nephrol 2015; 79:36-40. [PMID: 2225865 DOI: 10.1159/000418146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- N P Alazraki
- Emory University School of Medicine, Atlanta, Ga
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Buist MD, Jaffray L, Bell E, Hanna L, Weinstein P, Kumar S, Grimmer K. Utilisation of beds on the general medical unit by 'non-acute medical' patients: a retrospective study of incidence and cost in two Tasmanian regional medical hospital units. Intern Med J 2015; 44:171-7. [PMID: 24320789 DOI: 10.1111/imj.12335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/10/2013] [Accepted: 11/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Demand for healthcare services threatens to overwhelm the Australian healthcare system. Public hospitals have the largest component of expenditure growth and as such represent the largest opportunity for efficiency gains. Utilisation of inpatient hospital beds and in particular those on general medical units has not been studied in Australia. AIM To undertake a retrospective patient medical record review of 200 sequential admissions to the medical wards in two regional Tasmanian hospitals to determine the incidence of non-acute medical patient admission to the medical unit, and the subsequent days in hospital that were not required for medical reasons. The cost of these days was estimated. RESULTS Sixteen patient admissions (8%) could not be justified on medical grounds. Forty-eight (24%) patient admissions had at least one day hospital day that could not be justified on medical grounds. Of the 1438 total bed days, 475 (33%) were for non-medical reasons. The estimated cost of those non-medical bed days for this cohort was $764 800. CONCLUSIONS The incidence of non-acute medical admissions and non-acute medical bed days to the medical unit and associated cost was significant. Further research is needed to design alternative care provision for such patients particularly in regional Australia. The potential savings to the Australian healthcare system could be significant.
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Affiliation(s)
- M D Buist
- Centre for Health Services Research, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
BACKGROUND AND PURPOSE An increase in the prevalence of urologic stone disease and the refinement of endourologic techniques has seen a concomitant rise in the use of fluoroscopy during surgery. As such, there has been increasing concern in regard to the intraoperative radiation exposure to both clinicians and patients. The objective of the study was to audit contemporary data on radiation exposure during percutaneous nephrolithotomy (PCNL), in comparison with published series, and demonstrate that relatively low levels are achievable with clinical vigilance and attention to technique Methods: A retrospective analysis was performed of all PCNLs undertaken between July 2005 and December 2011. The primary outcome measure was fluoroscopy times and associated radiation exposure, measured as dose area product (DAP). No statistical analysis was undertaken. RESULTS Between July 2005 and October 2011, 376 PCNLs were performed. Data were available on 348 patients including 16 pediatric patients. Mean DAP and screening time (ST) over the whole study period were 45 cGy/cm(2) and 96s, respectively. On a year by year basis, the ST and DAP reduced from 917 to 375 and from 180 to 65, respectively. We acknowledge the limitation of this being a retrospective case series. CONCLUSIONS This study represents the largest series to date on radiation exposure during PCNL and compares favorably with other published series, including those purporting novel techniques. Subtle changes in surgical technique and experience over time can lead to low screening times and can be potentially achieved by all operators performing PCNL within a high throughput center. It is now recognized that surgical outcome in stone surgery is related to caseload. The radiation dose the patient receives during PCNL is increasingly recognized to be an important factor and can be reduced by careful technique and experience.
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Affiliation(s)
- Luke Hanna
- 1 Department of Urology, Portsmouth NHS Trust , Portsmouth, United Kingdom
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Evans R, Johns E, Button M, Brewster A, Hanna L, Lester J, Tanguay J. 68: Surgical resection and adjuvant chemotherapy in non small cell lung cancer (NSCLC): a review of practice in South East Wales. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Luke Hanna
- Department of Urology; Royal Wolverhampton Hospitals NHS Trust; Wolverhampton UK
| | - Sarvpreet S. Ubee
- Department of Urology; Royal Wolverhampton Hospitals NHS Trust; Wolverhampton UK
| | - Jane Boddy
- Department of Urology; Royal Wolverhampton Hospitals NHS Trust; Wolverhampton UK
| | - Peter W. Cooke
- Department of Urology; Royal Wolverhampton Hospitals NHS Trust; Wolverhampton UK
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Tanguay J, Wheeler P, Button M, Stevens R, Shaw P, Brewster A, Hanna L, Lester J. 179 Limited stage small cell lung cancer (LS SCLC) – South East Wales experience. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ridgers N, Barnett L, Hanna L, Salmon J. Parents and children's perceptions of whether active video games can help children's fundamental movement skills. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.144] [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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Benstead K, Gilson D, Hanna L, Radhakrishna G, McAleer J, Bloomfield D, Jyothirmayi R, Campbell A, Booth J. Training in clinical oncology: results of the Royal College of Radiologists' survey of new consultants. Clin Oncol (R Coll Radiol) 2012; 24:e143-8. [PMID: 22981545 DOI: 10.1016/j.clon.2012.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 07/23/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022]
Abstract
AIMS To seek the views of consultants appointed less than 2 years ago on the appropriateness of their training in fitting them to carry out their present posts, the FRCR examination, experience of research and the prevalence and value of out of programme experience and acting up as a consultant. MATERIALS AND METHODS All the consultants identified from the Royal College of Radiologists' database as having been appointed to a consultant post in the last 2 years were emailed inviting them to take part in a web-based survey. RESULTS The response rate was 60% (32 of 53 consultants). Ninety-four per cent agreed or strongly agreed that training had equipped them for clinical work as a consultant, but only 44% agreed or strongly agreed that training had equipped them to fulfil the management roles. Free text answers stressed the importance of management skills, getting involved with trial set-up and producing publications early in their career. Ninety-four per cent agreed or strongly agreed that they had adequate opportunity to develop skills in systemic therapy and radiotherapy planning, but only 56% thought this was the case for intensity-modulated radiotherapy and image-guided radiotherapy. Although 87% agreed or strongly agreed they had sufficient opportunity to develop teaching skills, this was only the case in 62% with regard to research skills. They published a median number of three papers in peer-reviewed journals. Twenty-five per cent of respondents studied for research degrees; 69% of consultants had undertaken out of programme experience and 50% had acted up as a consultant and these were generally found to be valuable experiences. There was strong support for the FRCR examination. CONCLUSIONS Consultants appointed in the last 2 years are generally satisfied with their training. Training in intensity-modulated radiotherapy and image-guided radiotherapy should be improved and the advanced specialist training requires reviewing to better fit consultants for subspecialisation, management and research.
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Affiliation(s)
- K Benstead
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, UK.
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Affiliation(s)
- S Datta
- Department of Obstetrics and Gynaecology, St Thomas's Hospital,Westminster, London, UK.
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Caley A, Hickman A, Frantzeskou K, Hudson E, Parker K, Appadurai I, Rayment R, Noble S, Hanna L. PO-257 DEEP VENOUS THROMBOSIS (DVT) RATES IN PATIENTS RECEIVING BRACHYTHERAPY FOR CERVICAL CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72223-5] [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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Ball SV, Maxwell JL, Cruikshank MK, Douglas S, Price V, Davidson JE, Hanna L, Brown L, Watson L, Kelly J, Baildam EM, Cleary AG, McCann LM, Beresford MW, Hawley DP, Baildam EM, Amin TS, Cruikshank MK, Davidson J, Dixon J, Ennals G, Gulati R, Ohlsson V, Rangaraj S, Riley P, Sundaramoorthy C, Walsh J, Foster HE, Hendry GJ, Gardner-Medwin J, Turner DE, Woodburn J, Lorgelly PK, Hendry GJ, Steultjens MPM, Gardner-Medwin J, Woodburn J, Turner DE, Jandial S, Stewart J, Kay L, Foster HE, Leone V, McDonagh J, Pilkington C, Rangaraj S, Tizard EJ, Beresford MW, McErlane F, Kulkani P, Nicholl K, Foster HE, McErlane F, Foster HE, Symmons D, Hyrich K, Midgley A, Beresford MW, Pain CE, McCann LJ, Cleary AG, Beresford MW, Barnes N, Landes C, Baildam EM, Pain CE, Gargh K, McCann LJ, Rapley T, Heaven B, May C, Kay L, Foster H, Rapley T, Avery P, May C, Beresford M, Foster H, Rapley TR, May C, Foster HE, Sen ES, Mandal K, Hinchcliffe A, Dick AD, Ramanan AV, Thorbinson C, Midgley A, Beresford MW, Watson L, Midgley A, Hanna L, Jones C, Holt R, Pilkington C, Tullus K, Beresford MW, Wyllie R, Craig L. BSPAR ANNUAL CONFERENCE ABSTRACTS (presented in alphabetical order of first author). Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/keq394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brewster A, Jordan C, Gunter T, Poole S, Button M, Hanna L, Stevens R, Lester J. 14 Results of patient satisfaction survey conducted across SE Wales on patients undergoing chemotherapy for lung cancer. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Banner R, Button M, Hanna L, Brewster A, Tanguay J, Stevens R, Lester J. Erlotinib prescribing for the second-line treatment of non-small cell lung cancer (NSCLC): The effect of National Institute for Health and Clinical Excellence (NICE) Technology Appraisal 162 (TA162). Lung Cancer 2010. [DOI: 10.1016/s0169-5002(10)70017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- T El-Toukhy
- Queen Mary's University Hospital, Sidcup NHS Trust, Kent, UK.
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Affiliation(s)
- E Church
- Department of Obstetrics and Gynaecology, Tameside General Hospital, Lancashire, UK.
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Wills L, Hudson E, Hanna L, Williams L, Macbeth F, Lester J. Variability in lung cancer target volume definition between clinicians: a comparative study. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70094-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Micallef R, Birch E, Baker J, Brewster A, Hanna L, Lester J, Linnane S, Macbeth F. Efficacy and tolerability of docetaxel as second line treatment in patients with non-small cell lung cancer: an experience in three centres. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70068-0] [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: 10/22/2022]
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Abstract
This study sought to investigate the impact of parity on the outcome of external cephalic version (ECV) over a 3-year period. In the study, 163 women with singleton uncomplicated breech pregnancy at term were offered ECV and 103 (63%) underwent the procedure. In 42 women, ECV was successful and 74% had a vaginal vertex delivery; whereas 61 women had a failed ECV and none had a vaginal vertex delivery. The probability of vaginal vertex delivery after ECV increased five-fold in nulliparous women (OR 5.2, 95% CI 1 - 42.8) and four-fold (OR 3.8, 95% CI 1.3 - 11.5) in multiparous women. After successful ECV, 50% of nulliparous women and 88.5% of multiparous women had a vaginal vertex delivery (p = 0.006). Neonatal outcome was favourable in all patients. We conclude that parity has little impact on efficacy of ECV, but significantly influences the overall chance of vaginal vertex delivery in women with an uncomplicated breech presentation at term.
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Affiliation(s)
- T El-Toukhy
- Department of Obstetrics and Gynaecology, Queen Mary's Hospital NHS Trust, Sidcup, UK.
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Hudson E, Johns C, Hanna L, Brewster A, Macbeth F, Bailey H, Lester J. 33 Radical radiotherapy for non small cell lung cancer (NSCLC): can chemotherapy make the untreatable treatable? Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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