1
|
Stewart CL, Warner SG, De Andrade J, Nguyen A, Heslin M. Correction to: Data-Driven Respectful Discourse in the Society of Surgical Oncology. Ann Surg Oncol 2022; 29:5436. [DOI: 10.1245/s10434-022-11573-6] [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: 11/18/2022]
|
2
|
Stewart CL, Warner SG, De Andrade J, Nguyen A, Heslin M. ASO Visual Abstract: Data-Driven Respectful Discourse in the Society of Surgical Oncology. Ann Surg Oncol 2021. [PMID: 34716516 DOI: 10.1245/s10434-021-10937-8] [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: 11/18/2022]
Affiliation(s)
- Camille L Stewart
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, AO1, Mail Stop C-313, Aurora, CO, 80045, USA.
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - James De Andrade
- Department of Surgery, School of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew Nguyen
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Martin Heslin
- Department of Surgery, University of South Alabama School of Medicine, Mobile, AL, USA
| |
Collapse
|
3
|
Stewart CL, Warner SG, De Andrade J, Nguyen A, Heslin M. Data-Driven Respectful Discourse in the Society of Surgical Oncology. Ann Surg Oncol 2021; 29:821-826. [PMID: 34564772 DOI: 10.1245/s10434-021-10808-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We previously reported that professional forms of address in speaker introductions were inconsistently used at the Society of Surgical Oncology (SSO) 2018 and 2019 annual meetings, suggesting unconscious bias in speaker introductions. We sought to better understand how speakers would like to be introduced, and if guidelines could improve consistency in speaker introductions. METHODS SSO 2021 abstract submitters received a survey regarding demographics and preferred form of address at the meeting. Respectful discourse guidelines were developed and distributed to meeting moderators. Speaker introductions were reviewed for the 2021 SSO annual meeting and were compared with the 2018 and 2019 meetings. RESULTS The survey response rate was 183/347 (53%) abstract submitters, most of whom (143/183, 78%) indicated preference for a professional form of address (Doctor/Professor) during speaker introductions, which was significantly greater than those who were introduced with a professional form of address during the 2018 and 2019 meetings (351/499, 70%; Chi-square = 4.08, p = 0.043). There was no difference in speaker introduction preference based on gender or race/ethnic identification. Respectful discourse guidelines were developed and distributed to meeting moderators. During the 2021 SSO annual meeting, professional forms of address were used for 104 (84%) speakers, significantly greater than during the 2018 and 2019 meetings (Chi-square = 9.23, p = 0.002). CONCLUSIONS More survey respondents preferred speaker introductions with a professional form of address than were used in prior meetings. This preference was similar across all demographic groups evaluated. Professional addresses during speaker introductions increased significantly after the distribution of guidelines encouraging consistency to decrease unconscious bias and promote an inclusive environment.
Collapse
Affiliation(s)
- Camille L Stewart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - James De Andrade
- Department of Surgery, School of Medicine, University of Iowa, Iowa City, IO, USA
| | - Andrew Nguyen
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Martin Heslin
- Department of Surgery, University of South Alabama School of Medicine, Mobile, AL, USA
| |
Collapse
|
4
|
Zheng-Pywell R, Fang A, AlKashash A, Awad S, Reddy S, Vickers S, Heslin M, Dudeja V, Chen H, Rose JB. Prognostic Impact of Tumor Size on Pancreatic Neuroendocrine Tumor Recurrence May Have Racial Variance. Pancreas 2021; 50:347-352. [PMID: 33835965 PMCID: PMC8041062 DOI: 10.1097/mpa.0000000000001776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The incidence of pancreatic neuroendocrine tumors (PNETs) has increased over the last decade. Black patients have worse survival outcomes. This study investigates whether oncologic outcomes are racially disparate at a single institution. METHODS Retrospective analysis was performed on 151 patients with resected PNETs between 2010 and 2019. RESULTS More White males and Black females presented with PNETs (P = 0.02). White patients were older (65 years vs 60 years; P = 0.03), more likely to be married (P < 0.01), and had higher median estimated yearly incomes ($28,973 vs $17,767; P < 0.01) than Black patients. Overall and disease-free survival were not different. Black patients had larger median tumor sizes (30 mm vs 23 mm; P = 0.02). Tumor size was predictive of recurrence only for White patients (hazard ratio, 1.02; P = 0.01). Collectively, tumors greater than 20 mm in size were more likely to have recurrence (P = 0.048), but this cutoff was not predictive in either racial cohort independently. CONCLUSIONS Black patients undergoing curative resection of PNETs at our institution presented with larger tumors, but that increased size is not predictive of disease-free survival in this population.
Collapse
Affiliation(s)
- Rui Zheng-Pywell
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Trevillion K, Ryan EG, Pickles A, Heslin M, Byford S, Nath S, Bick D, Milgrom J, Mycroft R, Domoney J, Pariante C, Hunter MS, Howard LM. An exploratory parallel-group randomised controlled trial of antenatal Guided Self-Help (plus usual care) versus usual care alone for pregnant women with depression: DAWN trial. J Affect Disord 2020; 261:187-197. [PMID: 31634678 DOI: 10.1016/j.jad.2019.10.013] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 10/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Depression is a common antenatal mental disorder associated with significant maternal morbidity and adverse fetal outcomes. However, there is a lack of research on the effectiveness or cost-effectiveness of psychological interventions for antenatal depression. METHODS A parallel-group, exploratory randomised controlled trial across five hospitals. The trial compared Guided Self-Help, modified for pregnancy, plus usual care with usual care alone for pregnant women meeting DSM-IV criteria for mild-moderate depression. The trial objectives were to establish recruitment/follow-up rates, compliance and acceptability, and to provide preliminary evidence of intervention efficacy and cost-effectiveness. The primary outcome of depressive symptoms was assessed by blinded researchers using the Edinburgh Postnatal Depression Scale at 14-weeks post-randomisation. RESULTS 620 women were screened, 114 women were eligible and 53 (46.5%) were randomised. 26 women received Guided Self-Help - 18 (69%) attending ≥4 sessions - and 27 usual care; n = 3 women were lost to follow-up (follow-up rate for primary outcome 92%). Women receiving Guided Self-Help reported fewer depressive symptoms at follow-up than women receiving usual care (adjusted effect size -0.64 (95%CI: -1.30, 0.06) p = 0.07). There were no trial-related adverse events. The cost-effectiveness acceptability curve showed the probability of Guided Self-Help being cost-effective compared with usual care ranged from 10 to 50% with a willingness-to-pay range from £0 to £50,000. CONCLUSIONS AND LIMITATIONS Despite intense efforts we did not meet our anticipated recruitment target. However, high levels of acceptability, a lack of adverse events and a trend towards improvements in symptoms of depression post-treatment indicates this intervention is suitable for talking therapy services.
Collapse
Affiliation(s)
- K Trevillion
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom.
| | - E G Ryan
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - A Pickles
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M Heslin
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - S Nath
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - D Bick
- Departmentof Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - J Milgrom
- University of Melbourne and Parent-Infant Research Institute, Melbourne, Australia
| | - R Mycroft
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - J Domoney
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - C Pariante
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - M S Hunter
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| | - L M Howard
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, United Kingdom
| |
Collapse
|
6
|
Baker S, Waldrop MG, Swords J, Wang T, Heslin M, Contreras C, Reddy S. Timed Stair-Climbing as a Surrogate Marker for Sarcopenia Measurements in Predicting Surgical Outcomes. J Gastrointest Surg 2019; 23:2459-2465. [PMID: 30511131 DOI: 10.1007/s11605-018-4042-0] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Estimating sarcopenia by measuring psoas muscle density (PMD) has been advocated as a method to accurately predict post-operative morbidity. The aim of the present study was to determine whether the Timed Stair Climb (TSC) could be used to replace PMD measurements in predicting morbidity. METHODS Patients were prospectively enrolled from March 2014-2015 and were eligible if they were undergoing an abdominal operation. PMD was measured using pre-operative CT scans obtained within 90 days of surgery. Ninety-day complications were assessed using the Accordion Severity Grading System. Multivariable analysis was performed to identify risk factors associated with operative morbidity. RESULTS Of the patients, 298 were enrolled and completed TSC prior to undergoing an operation. Using the According Grading System, a grade 2 or higher complication occurred in 72 (24. 2%) patients with 8 (2.7%) deaths. There was an indirect relationship between PMD and TSC (P < 0.0001) and a direct relationship between TSC and complications (P = 0.04). On multivariable analysis decreasing PMD (P = 0.018) and increasing TSC (P = 0.026) were predictive of post-operative morbidity. Receiver operating characteristic curves demonstrated that the TSC was superior to both the ACS NSQIP Risk Calculator and PMD in predicting outcomes (TSC vs. PMD, P = 0.012; PMD vs. ACS NSQIP, P = 0.013; TSC vs. ACS NSQIP, P < 0.0001). CONCLUSION TSC, PMD, and the ACS NSQIP calculator are all useful tools; however, the TSC is superior in predicting post-operative morbidity.
Collapse
Affiliation(s)
- Samantha Baker
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Mary Glen Waldrop
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Joshua Swords
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Thomas Wang
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Martin Heslin
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Carlo Contreras
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Sushanth Reddy
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA.
| |
Collapse
|
7
|
Leung CJ, Fosuaah A, Frerichs J, Heslin M, Kabir T, Lee TMC, McGuire P, Meek C, Mouchlianitis E, Nath AS, Peters E, Shergill S, Stahl D, Trotta A, Yiend J. A qualitative study of the acceptability of cognitive bias modification for paranoia (CBM-pa) in patients with psychosis. BMC Psychiatry 2019; 19:225. [PMID: 31337373 PMCID: PMC6651961 DOI: 10.1186/s12888-019-2215-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/17/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cognitive Bias Modification (CBM) has been used successfully as a computer-based intervention in disorders such as anxiety. However, CBM to modify interpretations of ambiguous information relevant to paranoia has not yet been tested. We conducted a qualitative investigation of a novel intervention called CBM for paranoia (CBM-pa) to examine its acceptability in patients with psychosis. METHODS Eight participants with psychosis who completed CBM-pa were identified by purposive sampling and invited for a semi-structured interview to explore the facilitators and barriers to participation, optimum form of delivery, perceived usefulness of CBM-pa and their opinions on applying CBM-pa as a computerised intervention. The interviews were transcribed and analysed using thematic analysis by researchers working in collaboration with service users. RESULTS Themes emerged relating to participants' perception about delivery, engagement, programme understanding, factors influencing experience, perceived impact and application of CBM-pa. CBM-pa was regarded as easy, straightforward and enjoyable. It was well-accepted among those we interviewed, who understood the procedure as a psychological intervention. Patients reported that it increased their capacity for adopting alternative interpretations of emotionally ambiguous scenarios. Although participants all agreed on the test-like nature of the current CBM-pa format, they considered that taking part in sessions had improved their overall wellbeing. Most of them valued the computer-based interface of CBM-pa but favoured the idea of combining CBM-pa with some form of human interaction. CONCLUSIONS CBM-pa is an acceptable intervention that was well-received by our sample of patients with paranoia. The current findings reflect positively on the acceptability and experience of CBM-pa in the target population. Patient opinion supports further development and testing of CBM-pa as a possible adjunct treatment for paranoia. TRIAL REGISTRATION Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.
Collapse
Affiliation(s)
- C. J. Leung
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000000121742757grid.194645.bLaboratory of Neuropsychology, The University of Hong Kong, Hongkong, Hong Kong
| | - A. Fosuaah
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J. Frerichs
- grid.490917.2The McPin Foundation, London, UK
| | - M. Heslin
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - T. Kabir
- grid.490917.2The McPin Foundation, London, UK
| | - T. M. C. Lee
- 0000000121742757grid.194645.bLaboratory of Neuropsychology, The University of Hong Kong, Hongkong, Hong Kong ,0000000121742757grid.194645.bThe State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hongkong, Hong Kong
| | - P. McGuire
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - C. Meek
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E. Mouchlianitis
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A. S. Nath
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - E. Peters
- 0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK ,0000 0001 2322 6764grid.13097.3cDepartment of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S. Shergill
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000 0001 2324 5535grid.415717.1South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX UK
| | - D. Stahl
- 0000 0001 2322 6764grid.13097.3cDepartment of Biostatistics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - A. Trotta
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J. Yiend
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| |
Collapse
|
8
|
Paluri R, Manne U, Williams G, Rose B, Heslin M, Reddy S, Kyanam Kabir Baig K, Vickers S, Ali A, Gbolahan O, Smith C, Jacob R. Neoadjuvant modified FOLFIRINOX or gemcitabine-nab paclitaxel followed by stereotactic body radiotherapy for patients with locally advanced pancreatic cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
Jacob R, McDonald A, Manne U, Reddy S, Vickers S, Heslin M, Kyanam Kabir Baig K, Smith C, Williams G, Ali A, Gbolahan O, Rose B, Everett AA, Kasi A, Paluri R. Stereotactic body radiotherapy in locally advanced pancreatic adenocarcinoma: A single institution experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Lappin JM, Heslin M, Lomas B, Jones PB, Doody GA, Reininghaus UA, Croudace T, Craig T, Fearon P, Murray RM, Dazzan P, Morgan C. Early sustained recovery following first episode psychosis: Evidence from the AESOP10 follow-up study. Schizophr Res 2018; 199:341-345. [PMID: 29571751 DOI: 10.1016/j.schres.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/24/2018] [Accepted: 03/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the characteristics of individuals with early sustained recovery following first episode psychosis. METHODS Individuals with a first episode psychosis were followed-up for ten years. Comparisons were made between those with Early Sustained Recovery and those with Other Course types. RESULTS Of 345 individuals, n=43 (12.5%) had Early Sustained Recovery. They were more likely than those with Other Course types to be female (OR=2.45; 95% CI: 1.25-4.81); employed (OR=2.39; 95% CI: 1.22-4.69); in a relationship (OR=2.68; 95% CI: 1.35-5.32); have a short DUP (OR=2.86; 95% CI: 1.37-5.88); and have a diagnosis other than schizophrenia, particularly mania (OR=6.39; 95% CI: 2.52-16.18) or brief psychosis (OR=3.64; 95% CI: 1.10-12.10). CONCLUSIONS Sustained recovery from first episode psychosis occurs in a minority.
Collapse
Affiliation(s)
- J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - B Lomas
- Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - P B Jones
- University of Cambridge, Cambridge, UK
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | | | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
11
|
Abstract
Psychotic major depression is an under-researched and under-identified disorder. We highlight the major challenges both in clinical practice and in conducting research with people with this disorder. We also suggest which major issues need addressing to move treatment and knowledge of this disorder forward. Declaration of interest M.H. and A.H.Y. both report grants from the National Institute for Health Research (NIHR).
Collapse
Affiliation(s)
- M Heslin
- Health Services and Population Research Department,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - A H Young
- Department of Psychological Medicine,Institute of Psychiatry,Psychology and Neuroscience,King's College London and South London and Maudsley NHS Foundation Trust,UK
| |
Collapse
|
12
|
Affiliation(s)
- Brandon Singletary
- Department of Surgery, The University of Alabama at Birmingham
- The Office of the Chief of Medical Staff, The University of Alabama at Birmingham Hospital
| | - Nisha Patel
- The Office of the Chief of Medical Staff, The University of Alabama at Birmingham Hospital
| | - Martin Heslin
- Department of Surgery, The University of Alabama at Birmingham
- The Office of the Chief of Medical Staff, The University of Alabama at Birmingham Hospital
| |
Collapse
|
13
|
Demjaha A, Lappin JM, Stahl D, Patel MX, MacCabe JH, Howes OD, Heslin M, Reininghaus UA, Donoghue K, Lomas B, Charalambides M, Onyejiaka A, Fearon P, Jones P, Doody G, Morgan C, Dazzan P, Murray RM. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med 2017; 47:1981-1989. [PMID: 28395674 DOI: 10.1017/s0033291717000435] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors. METHOD The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance. RESULTS From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset. CONCLUSIONS The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.
Collapse
Affiliation(s)
- A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, NSW,Australia
| | - D Stahl
- Department of Biostatistics,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M X Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - O D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Heslin
- Health Service and Population Research Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - K Donoghue
- Addictions Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - B Lomas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Charalambides
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Fearon
- Department of Psychiatry,Trinity College,Dublin, Republic ofIreland
| | - P Jones
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - G Doody
- Division of Psychiatry,University of Nottingham,Nottingham,UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| |
Collapse
|
14
|
Singletary B, Patel N, Mims A, Smedley A, Swords J, O'Bierne R, Morris MS, Safford M, Heslin M. Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel. Am Surg 2017. [DOI: 10.1177/000313481708300743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency. This mixed method study included 1) prospective study of all patients undergoing a surgery at an academic medical center between September 2014 and March 2016 and 2) nominal groups of physicians, caregivers, and waiting room personnel (WRP). Nominal groups ranked standard of care themes needing intervention. Multivariate logistic regression estimated the association of surgeon and procedure characteristics with POC practices considering both location and contact method. Data on 15,820 operations showed that surgical specialty (P ≤ 0.0001), inpatient status (P ≤ 0.0001), planned discharge destination (P = 0.0003), patient race (P = 0.02), and caregiver relationship (P ≤ 0.0001) were all significantly associated with receiving a private POC. Nominal group results provided opportunities for improvement: regular updates (caregivers), locating the caregivers postoperation (surgeons), clear communication between caregivers and surgeons (WRP). This study examines the perioperative communication. Surgeons, caregivers, and WRP identified effective communication as a top intervention priority. Managing caregiver expectations, addressing concerns of WRP, and creating an efficient environment for surgeons appear to be critical components to communication.
Collapse
Affiliation(s)
- Brandon Singletary
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nisha Patel
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Mims
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Smedley
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jacob Swords
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronan O'Bierne
- Division of Continuing Medical Education, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Melanie S. Morris
- Division of Continuing Medical Education, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika Safford
- Department of Medicine, Division of Preventative Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Martin Heslin
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
15
|
Singletary B, Patel N, Mims A, Smedley A, Swords J, O'Bierne R, Morris MS, Safford M, Heslin M. Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel. Am Surg 2017; 83:812-820. [PMID: 28738957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency. This mixed method study included 1) prospective study of all patients undergoing a surgery at an academic medical center between September 2014 and March 2016 and 2) nominal groups of physicians, caregivers, and waiting room personnel (WRP). Nominal groups ranked standard of care themes needing intervention. Multivariate logistic regression estimated the association of surgeon and procedure characteristics with POC practices considering both location and contact method. Data on 15,820 operations showed that surgical specialty (P ≤ 0.0001), inpatient status (P ≤ 0.0001), planned discharge destination (P = 0.0003), patient race (P = 0.02), and caregiver relationship (P ≤ 0.0001) were all significantly associated with receiving a private POC. Nominal group results provided opportunities for improvement: regular updates (caregivers), locating the caregivers postoperation (surgeons), clear communication between caregivers and surgeons (WRP). This study examines the perioperative communication. Surgeons, caregivers, and WRP identified effective communication as a top intervention priority. Managing caregiver expectations, addressing concerns of WRP, and creating an efficient environment for surgeons appear to be critical components to communication.
Collapse
|
16
|
Contreras CM, Lin CP, Oster RA, Reddy S, Wang T, Vickers S, Heslin M. Increased pancreatic cancer survival with greater lymph node retrieval in the National Cancer Data Base. Am J Surg 2017; 214:442-449. [PMID: 28687101 DOI: 10.1016/j.amjsurg.2017.06.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/23/2017] [Accepted: 06/14/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND We evaluated the role of lymph node (LN) retrieval in pancreatic adenocarcinoma (PA) patients undergoing pancreaticoduodenectomy (PD). METHODS We utilized the National Cancer Data Base; Cox regression models and logistic regression models were used for statistical evaluation. RESULTS We evaluated 26,792 patients with PA who underwent PD. The mean LN retrieved in LN(-) patients was 10.8 vs 14.4 for LN(+) patients (P < 0.0001). Greater LN retrieval is an independent predictor of a negative microscopic margin and decreased length of stay. The median survival of LN(-) patients exceeded that of LN(+) patients (24.5 vs 15.1 months, P < 0.0001). Increasing LN retrieval is a significant predictor of survival in all patients, and in LN(-) patients. The relationship of increased LN retrieval and enhanced survival is a nearly linear trend. CONCLUSIONS Rather than demonstrating an inflection point that defines the extent of adequate lymphadenectomy, this dataset demonstrates an incremental relationship between LN retrieval and survival.
Collapse
Affiliation(s)
- Carlo M Contreras
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA.
| | - Chee Paul Lin
- University of Alabama at Birmingham, Center for Clinical and Translational Science, Birmingham, AL, USA
| | - Robert A Oster
- University of Alabama at Birmingham, Department of Preventive Medicine, Birmingham, AL, USA
| | - Sushanth Reddy
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Thomas Wang
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Selwyn Vickers
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Martin Heslin
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| |
Collapse
|
17
|
Manne A, Reddy S, Heslin M, Jacob R, Vickers SM, Contreras CM, Kasi A, Christein J, Li P, Posey J, Paluri RK. Retrospective review of FOLFIRINOX in local advanced pancreatic cancer: Single institution experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15714 Background: Although combination of fluorouracil, irinotecan, Leucovorin and oxaliplatin [FOLFIRINOX] significantly increases survival in metastatic pancreatic cancer (MPC) compared to gemcitabine based on ACCORD trial, the efficacy and toxicities may be different in non-metastatic setting. We reviewed our institution’s experience with FOLFIRINOX in locally advanced pancreatic cancer (LAPC). Methods: We performed a retrospective review of clinical outcomes in patients diagnosed with LAPC and receiving between June 2010 and July 2015, with at least one year of follow up from diagnosis, at University of Alabama at Birmingham. Results: Total of 41 patients with ECOG performance scale of 0 or 1, who underwent neoadjuvant chemotherapy with FOLFIRINOX were assessed for clinical and pathological characteristics. Median age was 61 years (range 38-81) with 23 (56.1%) males, 28 (68.3%) Caucasians and 16 (39.0%) underwent surgery (whipple operation) post-neoadjuvant. Median OS (time of diagnosis to last follow up/death) is 83.5 months for whole cohort, survival rates are 94.9% at 1 year, 58.4% at 2 year, and 33.3% at 5 year.Median OS for those who underwent surgical resection following the chemotherapy is 38.6 months; 100% at one year, 85.1% at 2 year, 55.3% at 5 year; while median OS for those who did not undergo surgery is 21.8 months; 91.7% at one year, 41.5% at 2 year, 20.7% at 5 years. Among those who underwent surgery, the median recurrence free survival (time from surgery to relapse/progression) is 19.9 months with liver being common recurrence site (81%). There was no post-operative mortality in 30 days. Grade 3-4 toxicity occurred in 46% ( vomiting (12%), fatigue (28%) and neutropenia (54%), febrile neutropenia (9%)). There is a significant difference between surgery and non-surgery groups (p = 0.012) for improved OS by log-rank test. Conclusions: Neoadjuvant FOLFIRINOX treatment associated with high response rates leading to surgical resection in our cohort. Patients who underwent neoadjuvant chemotherapy followed by resection for LAPC have statistically significant improved OS compared to those who did not.
Collapse
Affiliation(s)
- Ashish Manne
- University of Alabama at Birmingham, Montgomery, AL
| | | | | | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | - Peng Li
- University of Alabama at Birmingham, Birmingham, AL
| | - James Posey
- Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | |
Collapse
|
18
|
Manne A, Reddy S, Li P, Contreras CM, Christein J, Vickers SM, Heslin M, Jacob R, Wang TN, Kasi A, Posey J, Paluri RK. Clinical outcomes of early-stage ampullary carcinoma: A single institutional experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
456 Background: Ampullary carcinoma [AC] is a rare malignancy associated with favorable prognosis among pancreatobiliary tumors. Pancreaticoduodenectomy [PDY] is considered to be curative for early stage cancers. The role of adjuvant chemotherapy [CT] or combination chemoradiation [CRT] remains uncertain for stage I/II. In this analysis we reviewed our institution’s experience with AC. Methods: From 2005 to 2015, 62 patients with stage 1 and 2 AC with at least one year follow up after PDY were reviewed. Clinical and pathologic factors and disease status were obtained from chart review. The patients’ demographical and oncological characteristics are summarized. The univariate Cox proportional hazard model was conducted for evaluating the parameters associated with overall survival. Kaplan-Meier method and log-rank was used to compare the time-to-events. Results: Adjuvant treatment was administered in 61%: CT (32%), CRT (29%) 39% surgical alone. The median overall survival [OS] for the study cohort is 60 months with 3 yr OS at 58% and 5 yr OS at 50%. Recurrence noted in 21% of patients. About half of patients surviving five years were alive at 10 years. Lymph node [LN] metastases (57%) predicted worse PFS (HR 2.29, 95% CI (1.13-4.61), p = 0.021) but did not significantly affect OS (HR 1.2, 95% CI (0.84-3.61);p = 0.13). There were no postoperative deaths following surgery.Peri- pancreatic extension [PPE] (20%) and peri-neural invasion [PNI] (16%) was also found to be determinants for poor OS. Current data did not suggest lympho-vascular invasion (24%) predict OS (HR 1.20, 95% CI (0.49, 2.96);p = 0.63 or PFS(HR 1.45 (0.65, 3.20),p = 0.36). When compared to surgery alone adjuvant CT or CRT had no statistically significant difference in terms of PFS (p = 0.53) or OS (p = 0.96). Conclusions: The use of adjuvant treatment may be most useful at improving long-term disease control in patients with high-risk features; however, no significant difference between CT and CRT was demonstrated in our series. This could be due to small sample size and needs further validation in larger cohort. PDY with regional lymphadenectomy is appropriate for early-stage AC, but worst outcomes seen in patients with PPE, PNI and LN involvement.
Collapse
Affiliation(s)
- Ashish Manne
- University of Alabama, Birmingham at Montgomery, Montgomery, AL
| | | | - Peng Li
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | - James Posey
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | | |
Collapse
|
19
|
Heslin M, Lappin J, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones P, Murray R, Fearon P, Doody G, Dazzan P, Craig T, Morgan C. Ten-year outcomes in first episode psychotic major depression patients compared with schizophrenia and bipolar patients. Schizophr Res 2016; 176:417-422. [PMID: 27236408 PMCID: PMC5147459 DOI: 10.1016/j.schres.2016.04.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 11/06/2022]
Abstract
We aimed to investigate long-term outcomes in psychotic major depression patients compared to schizophrenia and bipolar/manic psychosis patients, in an incidence sample, while accounting for diagnostic change. Based on Aetiology and Ethnicity in Schizophrenia and Other Psychoses (ÆSOP and ÆSOP-10), a first episode psychosis cohort was followed-up 10years after first presentation. The Schedules for Clinical Assessment in Neuropsychiatry, WHO Life Chart and Global Assessment of Functioning were used to assess clinical, social and service use outcomes. Seventy-two PMD patients, 218 schizophrenia patients and 70 psychotic bipolar disorder/mania patients were identified at baseline. Differences in outcome between PMD and bipolar patients based on baseline and lifetime diagnosis were minimal. Differences in clinical, social and service use outcomes between PMD and schizophrenia were more substantial with PMD patients showing better outcomes on most variables. However, there was some weak evidence (albeit not quite statistically significant at p<0.05) based on lifetime diagnoses that PMD patients were more likely to attempt suicide (OR 2.31, CI 0.98-5.42, p0.055) and self-harm (OR 2.34, CI 0.97-5.68, p0.060). PMD patients have better social and service use outcomes compared to people with schizophrenia, but may be more likely to attempt suicide or self-harm. This unique profile is important for clinicians to consider in any risk assessment.
Collapse
Affiliation(s)
- M. Heslin
- King's College London, London, UK,Corresponding author at: King's Health Economics, Institute of Psychiatry at King's College London, Box 024, The David Goldberg Centre, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.King's Health EconomicsInstitute of Psychiatry at King's College LondonThe David Goldberg CentreBox 02416 De Crespigny ParkDenmark HillLondonSE5 8AFUK
| | - J.M. Lappin
- University of New South Wales, Sydney, Australia
| | | | - B. Lomas
- Nottinghamshire Healthcare NHS trust, UK
| | - U. Reininghaus
- King's College London, London, UK,Maastricht University, The Netherlands
| | | | | | - P.B. Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | | | - G.A. Doody
- University of Nottingham, Nottingham, UK
| | - P. Dazzan
- King's College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, UK
| | | | | |
Collapse
|
20
|
Heslin M, Desai R, Lappin JM, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P, Fisher HL, Demjaha A, Craig T, Morgan C. Biological and psychosocial risk factors for psychotic major depression. Soc Psychiatry Psychiatr Epidemiol 2016; 51:233-45. [PMID: 26520449 PMCID: PMC4748002 DOI: 10.1007/s00127-015-1131-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
Abstract
AIMS Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. METHODS Based on the aetiology and ethnicity in schizophrenia and other psychoses (ÆSOP) study, we used a case-control study to identify and recruit, at baseline and 10-year follow-up, all first episode cases of psychosis, presenting for the first time to specialist mental health services in defined catchment areas in the UK. Population-based controls were recruited from the same areas. Data were collected on: sociodemographics; social isolation; childhood adversity; life events; minor physical anomalies; and neurological soft signs. RESULTS Living alone (aOR = 2.26, CI = 1.21-4.23), basic level qualification (aOR = 2.89, CI = 1.08-7.74), being unemployed (aOR = 2.12, CI = 1.13-3.96), having contact with friends less than monthly (aOR = 4.24, CI = 1.62-11.14), having no close confidants (aOR = 4.71, CI = 2.08-10.68), having experienced childhood adversity (aOR = 2.57, CI = 1.02-6.44), family history of mental illness (aOR = 10.68, CI = 5.06-22.52), family history of psychosis (aOR = 12.85, CI = 5.24-31.51), and having more neurological soft signs (aOR = 1.15, CI = 1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia. Few variables associated with PMD were also associated with a diagnosis of bipolar disorder. Minor physical anomalies were associated with a follow-up diagnosis of schizophrenia and bipolar disorder, but not PMD. CONCLUSIONS Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the 'specifier' between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change.
Collapse
Affiliation(s)
- M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - R Desai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - J M Lappin
- University of New South Wales, Sydney, Australia
| | - K Donoghue
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - B Lomas
- University of Nottingham, Nottingham, UK
| | - U Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Maastricht University, Maastrict, The Netherlands
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | | | - P B Jones
- University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - P Fearon
- Trinity College, Dublin, Ireland
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - H L Fisher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
Heslin M, Lomas B, Lappin JM, Donoghue K, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Dazzan P, Morgan C, Doody GA. Diagnostic change 10 years after a first episode of psychosis. Psychol Med 2015; 45:2757-2769. [PMID: 25936425 PMCID: PMC4595854 DOI: 10.1017/s0033291715000720] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/19/2015] [Accepted: 03/24/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND A lack of an aetiologically based nosology classification has contributed to instability in psychiatric diagnoses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an incidence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change. METHOD Data were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables associated with change were examined using logistic regression and likelihood ratio tests. RESULTS Slightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years. Many variables were associated with change to schizophrenia but few with overall change in diagnosis. CONCLUSIONS Diagnoses other than schizophrenia should to be regarded as potentially provisional.
Collapse
Affiliation(s)
- M. Heslin
- Centre for Economics of Mental and Physical
Health, King's College London,
London, UK
| | - B. Lomas
- Division of Psychiatry,
University of Nottingham, Nottingham,
UK
| | - J. M. Lappin
- Department of Psychiatry,
University of New South Wales, Sydney,
Australia
- Psychosis Studies Department,
King's College London, London,
UK
| | - K. Donoghue
- Addictions Department,
King's College London, London,
UK
| | - U. Reininghaus
- Centre for Epidemiology and Public
Health, King's College London,
London, UK
- Department of Psychiatry and Psychology,
School for Mental Health and Neuroscience, Maastricht
University, Maastricht, The
Netherlands
- NIHR Collaboration for Leadership in Applied
Health Research & Care, Cambridge,
UK
| | - A. Onyejiaka
- Department of Psychology,
King's College London, London,
UK
| | - T. Croudace
- School of Nursing and Midwifery,
College of Medicine, Dentistry and Nursing, University
of Dundee, Dundee, UK
| | - P. B. Jones
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - R. M. Murray
- Psychosis Studies Department,
King's College London, London,
UK
| | - P. Fearon
- Department of Psychiatry,
Trinity College, Dublin,
Republic of Ireland
| | - P. Dazzan
- Psychosis Studies Department,
King's College London, London,
UK
| | - C. Morgan
- Centre for Epidemiology and Public
Health, King's College London,
London, UK
| | - G. A. Doody
- Division of Psychiatry,
University of Nottingham, Nottingham,
UK
| |
Collapse
|
22
|
Lappin JM, Morgan C, Chalavi S, Morgan KD, Reinders AATS, Fearon P, Heslin M, Zanelli J, Jones PB, Murray RM, Dazzan P. Bilateral hippocampal increase following first-episode psychosis is associated with good clinical, functional and cognitive outcomes. Psychol Med 2014; 44:1279-1291. [PMID: 23866084 DOI: 10.1017/s0033291713001712] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hippocampal pathology has been proposed to underlie clinical, functional and cognitive impairments in schizophrenia. The hippocampus is a highly plastic brain region; examining change in volume, or change bilaterally, over time, can advance understanding of the substrate of recovery in psychosis. METHOD Magnetic resonance imaging and outcome data were collected at baseline and 6-year follow-up in 42 first-episode psychosis subjects and 32 matched controls, to investigate whether poorer outcomes are associated with loss of global matter and hippocampal volumes. Bilateral hippocampal increase (BHI) over time, as a marker of hippocampal plasticity was hypothesized to be associated with better outcomes. Regression analyses were performed on: (i) clinical and functional outcomes with grey matter volume change and BHI as predictor variables; and (ii) cognitive outcome with BHI as predictor. RESULTS BHI was present in 29% of psychosis participants. There was no significant grey matter loss over time in either patient or control groups. Less severe illness course and lesser symptom severity were associated with BHI, but not with grey matter change. Employment and global function were associated with BHI and with less grey matter loss. Superior delayed verbal recall was also associated with BHI. CONCLUSIONS BHI occurs in a minority of patients following their first psychotic episode and is associated with good outcome across clinical, functional and cognitive domains.
Collapse
Affiliation(s)
- J M Lappin
- Institute of Psychiatry, King's College London, London, UK
| | - C Morgan
- Institute of Psychiatry, King's College London, London, UK
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Morgan
- Department of Psychology, University of Westminster, London, UK
| | | | - P Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Republic of Ireland
| | - M Heslin
- Institute of Psychiatry, King's College London, London, UK
| | - J Zanelli
- Institute of Psychiatry, King's College London, London, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, King's College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
23
|
Jadhav T, Chen D, Putcha BDK, Samuel T, Posey J, Heslin M, Manne U. Abstract 4031: Distinct gene expression profile of recurrent stage II colorectal cancers in African American and Caucasian American patients. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: To determine gene expression profile of Stage II colorectal cancers (CRCs) based on disease recurrence and patient race/ethnicity.
Background: About 25-35% of Stage II CRCs recur after potentially curative surgery. Furthermore, the incidence, recurrence, and mortality rates for CRC are higher in African Americans (AAs) relative to Caucasian Americans (CAs), even when they are diagnosed with early stage disease. Differences in tumor biology may contribute to this race-based disparity. Thus, identification of these ‘high-risk’ patients is an unmet medical need.
Methods: Using GeneChip microarray technology, we obtained gene expression profiles for Stage II CRCs from 16 AA and 30 CA patients. Samples from recurrent disease, within 5 years post-surgery (n=5 in AA, n= 9 in CA) were compared against non-recurrent, within 10 years post-surgery, (n=11 in AA, and n=21 in CA) samples. The data were analyzed for expression differences at the gene level comparing AA with CA patients and further analyzed for functions and pathways.
Results: In the samples of recurrent CRCs, a significant number of genes (n=561) were differentially expressed, with a false-discovery rate of ≤5%. Further analyses showed 253 genes differentially expressed within the AA recurrent subgroup and 317 genes in CA recurrent subgroup. In recurrent CRCs, there were 9 genes common to AA and CA patients, suggesting a common gene signature specific for Stage II disease. Canonical pathway analyses and interaction network analyses for these differentially expressed genes revealed that ERK/MAPK, protein kinase A, and CDK5 signaling were the top three affected signaling pathways in recurrent samples from AAs. In contrast, RhoA, integrin, and cell cycle control signaling were the top three affected pathways in Stage II CRCs of CAs. This suggests, for samples from CAs and AAs, a distinct race-based gene expression and downstream effects on pathways.
Conclusion: A common gene expression signature, specific for stage II, together with a race-specific expression profile may have therapeutic implications for AA and CA patients.
Citation Format: Trafina Jadhav, Dongquan Chen, Balananda-Dhurjati Kumar Putcha, Temesgen Samuel, James Posey, Martin Heslin, Upender Manne. Distinct gene expression profile of recurrent stage II colorectal cancers in African American and Caucasian American patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4031. doi:10.1158/1538-7445.AM2013-4031
Collapse
|
24
|
Abstract
e17522 Background: An exceptional survivor of cancer is an individual who has outlived actuarial predictions for his/her particular form of cancer or experienced a complete regression. This pilot study was designed to determine if there were any biological, psychosocial, cultural or lifestyle characteristics exceptional survivors of cancer that can be measured and transferred through interventions to other cancer patients. Methods: The sample consisted of 21 survivors of cancer who were identified by oncologists at UAB as exceptional survivors. The study gathered qualitative data through semi-structured interviews and two validated scales measuring resilience, sense of coherence. A new cancer ‘catastrophizing’ scale based on the pain catastrophizing scale (PCS) was tested for its concordance with the two validated scales. The diagnosis and treatment information on these patients was collected through a questionnaire completed by the patient's oncologist. Results: Eight oncologists referred twenty-five patients to the study. Twenty-one patients agreed to participate. A unifying theme across all patient interviews was a deep spiritual connection with a supreme being. Praying for healing, intercessory prayer, and seeking guidance through faith with respect to best treatment options were common. The patients verbalized faith in physicians and were willing to seek more experimental treatments largely due to their spirituality. In general, the survivors were highly resilient as measured by the resilience scale and had a high sense of coherence as measured by the sense of coherence scale. They were also unlikely to conceptualize the diagnosis as a ‘catastrophe’ as measured by the new cancer catastrophizing scale. Conclusions: This study provides preliminary evidence of a relationship between spirituality and exceptional survivorship. Findings suggest exceptional survivors may be more willing to participate in clinical trials than other populations of cancer patients. Future studies should prospectively follow cancer patients to ascertain the temporal nature of the association between spirituality and exceptional survivorship. No significant financial relationships to disclose.
Collapse
|
25
|
Howard JH, Frolov A, Tzeng CWD, Stewart A, Midzak A, Majmundar A, Godwin A, Heslin M, Bellacosa A, Arnoletti JP. Epigenetic downregulation of the DNA repair gene MED1/MBD4 in colorectal and ovarian cancer. Cancer Biol Ther 2009; 8:94-100. [PMID: 19127118 DOI: 10.4161/cbt.8.1.7469] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
MED1 is a base excision repair enzyme that interacts with the mismatch repair protein MLH1 and maintains genomic integrity by binding methylated DNA and repairing spontaneous deamination events. MED1 mutations have been associated with microsatellite instability and accelerated colorectal cancer (CRC) tumorigenesis. We propose that promoter methylation may serve as an alternative epigenetic mechanism for MED1 gene suppression during sporadic CRC tumorigenesis. Methylation status of the MED1 promoter was investigated in a panel of ovarian and colorectal cancer cell lines. The MED1 promoter region was sequenced following bisulfite treatment and sequence analysis identified a CpG island within the MED1 promoter which is frequently and preferentially methylated (> or =50%) in ovarian and colorectal cancer cell lines with low/reduced MED1 expression. In vitro reversal of methylation restored MED1 expression. In colorectal cancer patients, when MED1 methylation was present, both tumor and matched mucosa were affected equally (mean frequency of methylation 24%) and there was no correlation between methylation and tumor stage. Patients without history of CRC showed significantly lower frequency of methylation (mean 14%, p < 0.05). Decreased MED1 transcript levels were observed in matched normal mucosa when compared to controls (median fold difference 8.0). Additional decreased expression was seen between mucosa and matched tumor (median fold decrease 4.4). Thus, MED1 promoter methylation and gene silencing occur in sporadic CRC patients and represent an early event in CRC tumorigenesis. Detection of MED1 methylation and gene suppression in normal colon mucosa may contribute to identifying patients at higher risk of developing CRC during screening procedures.
Collapse
Affiliation(s)
- J Harrison Howard
- Department of Surgery at the University of Alabama at Birmingham, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Li JQ, Xu B, Shakhtour B, Deane N, Merchant N, Heslin M, Washington K, Coffey R, Beauchamp R, Shyr Y, Billheimer D. Variability of in situ proteomic profiling and implications for study design in colorectal tumors. Int J Oncol 2007. [DOI: 10.3892/ijo.31.1.103] [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: 11/06/2022] Open
|
27
|
Posey JA, Thornton J, Russo S, Cerfolio R, Heslin M, Eloubeidi M. A phase II study of irinotecan and docetaxel with concurrent radiotherapy as preoperative treatment in resectable esophageal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4245] [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: 11/20/2022] Open
Affiliation(s)
- J. A. Posey
- University of Alabama at Birmingham, Birmingham, AL
| | - J. Thornton
- University of Alabama at Birmingham, Birmingham, AL
| | - S. Russo
- University of Alabama at Birmingham, Birmingham, AL
| | - R. Cerfolio
- University of Alabama at Birmingham, Birmingham, AL
| | - M. Heslin
- University of Alabama at Birmingham, Birmingham, AL
| | - M. Eloubeidi
- University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
28
|
Lewis JJ, Leung D, Heslin M, Woodruff JM, Brennan MF. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997; 15:646-52. [PMID: 9053489 DOI: 10.1200/jco.1997.15.2.646] [Citation(s) in RCA: 191] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival. PATIENTS AND METHODS Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model. RESULTS We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors. DISCUSSION These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.
Collapse
Affiliation(s)
- J J Lewis
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | |
Collapse
|