1
|
Annels NE, Denyer M, Nicol D, Hazell S, Silvanto A, Crockett M, Hussain M, Moller-Levet C, Pandha H. The dysfunctional immune response in renal cell carcinoma correlates with changes in the metabolic landscape of ccRCC during disease progression. Cancer Immunol Immunother 2023; 72:4221-4234. [PMID: 37940720 DOI: 10.1007/s00262-023-03558-5] [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: 11/28/2022] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
Renal cell carcinoma is an immunogenic tumour with a prominent dysfunctional immune cell infiltrate, unable to control tumour growth. Although tyrosine kinase inhibitors and immunotherapy have improved the outlook for some patients, many individuals are non-responders or relapse despite treatment. The hostile metabolic environment in RCC affects the ability of T-cells to maintain their own metabolic programme constraining T-cell immunity in RCC. We investigated the phenotype, function and metabolic capability of RCC TILs correlating this with clinicopathological features of the tumour and metabolic environment at the different disease stages. Flow cytometric analysis of freshly isolated TILs showed the emergence of exhausted T-cells in advanced disease based on their PD-1high and CD39 expression and reduced production of inflammatory cytokines upon in vitro stimulation. Exhausted T-cells from advanced stage disease also displayed an overall phenotype of metabolic insufficiency, characterized by mitochondrial alterations and defects in glucose uptake. Nanostring nCounter cancer metabolism assay on RNA obtained from 30 ccRCC cases revealed significant over-expression of metabolic genes even at early stage disease (pT1-2), while at pT3-4 and the locally advanced thrombi stages, there was an overall decrease in differentially expressed metabolic genes. Notably, the gene PPARGC1A was the most significantly down-regulated gene from pT1-2 to pT3-4 RCC which correlated with loss of mitochondrial function in tumour-infiltrating T-cells evident at this tumour stage. Down-regulation of PPARGC1A into stage pT3-4 may be the 'tipping-point' in RCC disease progression, modulating immune activity in ccRCC and potentially reducing the efficacy of immunotherapies in RCC and poorer patient outcomes.
Collapse
Affiliation(s)
- Nicola E Annels
- Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - M Denyer
- Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - D Nicol
- Royal Marsden Hospital, Fulham Road, London, UK
| | - S Hazell
- Royal Marsden Hospital, Fulham Road, London, UK
| | - A Silvanto
- Frimley Park Hospital, Frimley, Camberley, UK
| | - M Crockett
- Frimley Park Hospital, Frimley, Camberley, UK
| | - M Hussain
- Frimley Park Hospital, Frimley, Camberley, UK
| | | | - Hardev Pandha
- Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK.
| |
Collapse
|
2
|
Fung A, Hamilton E, Du Plessis E, Askin N, Avery L, Crockett M. Training programs to improve identification of sick newborns and care-seeking from a health facility in low- and middle-income countries: a scoping review. BMC Pregnancy Childbirth 2021; 21:831. [PMID: 34906109 PMCID: PMC8670028 DOI: 10.1186/s12884-021-04240-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most neonatal deaths occur in low- and middle-income countries (LMICs). Limited recommendations are available on the optimal personnel and training required to improve identification of sick newborns and care-seeking from a health facility. We conducted a scoping review to map the key components required to design an effective newborn care training program for community-based health workers (CBHWs) to improve identification of sick newborns and care-seeking from a health facility in LMICs. METHODS We searched multiple databases from 1990 to March 2020. Employing iterative scoping review methodology, we narrowed our inclusion criteria as we became more familiar with the evidence base. We initially included any manuscripts that captured the concepts of "postnatal care providers," "neonates" and "LMICs." We subsequently included articles that investigated the effectiveness of newborn care provision by CBHWs, defined as non-professional paid or volunteer health workers based in communities, and their training programs in improving identification of newborns with serious illness and care-seeking from a health facility in LMICs. RESULTS Of 11,647 articles identified, 635 met initial inclusion criteria. Among these initial results, 35 studies met the revised inclusion criteria. Studies represented 11 different types of newborn care providers in 11 countries. The most commonly studied providers were community health workers. Key outcomes to be measured when designing a training program and intervention to increase appropriate assessment of sick newborns at a health facility include high newborn care provider and caregiver knowledge of newborn danger signs, accurate provider and caregiver identification of sick newborns and appropriate care-seeking from a health facility either through caregiver referral compliance or caregivers seeking care themselves. Key components to consider to achieve these outcomes include facilitators: sufficient duration of training, refresher training, supervision and community engagement; barriers: context-specific perceptions of newborn illness and gender roles that may deter care-seeking; and components with unclear benefit: qualifications prior to training and incentives and remuneration. CONCLUSION Evidence regarding key components and outcomes of newborn care training programs to improve CBHW identification of sick newborns and care-seeking can inform future newborn care training design in LMICs. These training components must be adapted to country-specific contexts.
Collapse
Affiliation(s)
- Alastair Fung
- Hospital for Sick Children, Division of Paediatric Medicine, University of Toronto, 555 University Ave., Rm 10402, Black Wing, Toronto, Ontario, M5G 1X8, Canada.
| | - Elisabeth Hamilton
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Elsabé Du Plessis
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, Rady Faculty of Health Sciences, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Lisa Avery
- Institute for Global Public Health, Department Of Obstetrics, Gynecology and Reproductive Sciences, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Maryanne Crockett
- Institute for Global Public Health, Department of Pediatrics and Child Health, Medical Microbiology and Infectious Diseases, Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| |
Collapse
|
3
|
Srivastava K, Yadav R, Pelly L, Hamilton E, Kapoor G, Mishra AM, Anis P, Crockett M. Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff. BMC Public Health 2021; 21:2027. [PMID: 34742283 PMCID: PMC8572490 DOI: 10.1186/s12889-021-12047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children. METHODS This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death. RESULTS There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff. CONCLUSION The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.
Collapse
Affiliation(s)
- Kanchan Srivastava
- India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India
| | - Ranjana Yadav
- India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India
| | - Lorine Pelly
- University of Manitoba, Institute for Global Public Health, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Elisabeth Hamilton
- University of Manitoba, Institute for Global Public Health, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Gaurav Kapoor
- India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India
| | - Aman Mohan Mishra
- India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India
| | - Parwez Anis
- India Health Action Trust, 404 - 4th Floor, 20-A Ratan Square, Vidhan Sabha Marg, Lucknow, Uttar Pradesh, 226001, India
| | - Maryanne Crockett
- University of Manitoba, Institute for Global Public Health, R070 Med Rehab Building, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.,Departments of Pediatrics and Child Health, Medical Microbiology and Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
4
|
Rajvanshi D, Anthony J, Namasivayam V, Dehury B, Banadakoppa Manjappa R, Prakash R, Chintada DR, Khare S, Avery L, Crockett M, Isac S, Becker M, Blanchard J, Halli S. Association of identification of facility and transportation for childbirth with institutional delivery in high priority districts of Uttar Pradesh, India. BMC Pregnancy Childbirth 2021; 21:724. [PMID: 34706676 PMCID: PMC8549204 DOI: 10.1186/s12884-021-04187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. Hence, understanding the factors associated with birth preparedness and its significance for safe delivery is essential. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India. Methods A community-based cross-sectional survey was conducted between June–October 2018 in the rural areas of 25 high priority districts of Uttar Pradesh, India. Simple random sampling was used to select 40 blocks among 294 blocks in 25 districts and 2646 primary sampling units within the selected blocks. The survey interviewed 9458 women who had a delivery 2 months prior to the survey. Descriptive statistics were included to characterize the study population. Multivariable logistic regression analyses were performed to identify the determinants of birth preparedness and to examine the association of birth preparedness with institutional delivery. Results Among the 9458 respondents, 61.8% had birth preparedness (both facility and transportation identified) and 79.1% delivered in a health facility. Women in other caste category (aOR = 1.24, CI 1.06–1.45) and those with 10 or more years of education (aOR = 1.68, CI 1.46–1.92) were more likely to have birth preparedness. Antenatal care (ANC) service uptake related factors like early registration for ANC (aOR = 1.14, CI 1.04–1.25) and three or more front line worker contacts (aOR = 1.61, CI 1.46–1.79) were also found to be significantly associated with birth preparedness. The adjusted multivariate model showed that those who identified both facility and transport were seven times more likely to undergo delivery in a health facility (aOR = 7.00, CI 6.07–8.08). Conclusion The results indicate the need for focussing on marginalized groups for improving birth preparedness. Increasing ANC registration in the first trimester of pregnancy, improving frontline worker contact, and optimum utilization of antenatal care check-ups for effective counselling on birth preparedness along with system level improvements could improve birth preparedness and consequently institutional delivery rates in Uttar Pradesh, India. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04187-5.
Collapse
Affiliation(s)
- Divya Rajvanshi
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.
| | - John Anthony
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Bidyadhar Dehury
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India
| | | | - Ravi Prakash
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Dhanunjaya Rao Chintada
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shagun Khare
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India
| | - Lisa Avery
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Maryanne Crockett
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Marissa Becker
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shiva Halli
- India Health Action Trust, Lucknow, Uttar Pradesh/ New Delhi, India.,Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
5
|
Pelly L, Srivastava K, Singh D, Anis P, Mhadeshwar VB, Kumar R, Crockett M. Readiness to provide child health services in rural Uttar Pradesh, India: mapping, monitoring and ongoing supportive supervision. BMC Health Serv Res 2021; 21:914. [PMID: 34479540 PMCID: PMC8417968 DOI: 10.1186/s12913-021-06909-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak. METHODS Secondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed. RESULTS The median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016. CONCLUSIONS Facility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.
Collapse
Affiliation(s)
- Lorine Pelly
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
| | - Kanchan Srivastava
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Dinesh Singh
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Parwez Anis
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Vishal Babu Mhadeshwar
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Rashmi Kumar
- Department of Pediatrics, King George’s Medical University, King George’s Medical University Chowk, 226003 Lucknow, Uttar Pradesh India
| | - Maryanne Crockett
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
- Departments of Pediatrics and Child Health, Medical Microbiology and Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
6
|
Banadakoppa Manjappa R, Kar A, Jayanna K, Hallad JS, Cunningham T, Potty R, Mohan HL, Crockett M, Bradley J, Fischer E, Sudarshan H, Blanchard JF, Moses S, Avery L. Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys. BMC Pregnancy Childbirth 2020; 20:242. [PMID: 32326902 PMCID: PMC7181530 DOI: 10.1186/s12884-020-02942-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India. METHODS From 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n = 5240) and endline (n = 5154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2-7 and 8-28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility. RESULTS Overall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3-38.4) and 21.6 (95% CI 16.3-28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1-47.5) vs. 9.3 (95% CI 3.9-22.3) (p = 0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06-0.82, p = 0.02). CONCLUSION The nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings.
Collapse
Affiliation(s)
- Ramesh Banadakoppa Manjappa
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - H L Mohan
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Janet Bradley
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Lisa Avery
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| |
Collapse
|
7
|
Ray Saraswati L, Baker M, Mishra A, Bhandari P, Rai A, Mishra P, Chandan A, Crockett M, Pelly L, Anthony J, Shetye M, Krotki K, Kraemer J. 'Know-Can' gap: gap between knowledge and skills related to childhood diarrhoea and pneumonia among frontline workers in rural Uttar Pradesh, India. Trop Med Int Health 2019; 25:454-466. [PMID: 31863613 DOI: 10.1111/tmi.13365] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In India, frontline workers (FLWs) - public accredited social health activists (ASHAs) and private rural medical providers (RMPs) - are important for early detection and treatment of childhood diarrhoea and pneumonia. This cross-sectional study aims to measure knowledge and skills, and the gap between the two ('know-can' gap), regarding assessment of childhood diarrhoea with dehydration and pneumonia among FLWs, and to explore factors associated with them. METHODS We surveyed 473 ASHAs and 447 RMPs in six districts of Uttar Pradesh. We assessed knowledge and skills using face-to-face interviews and video vignettes, respectively, about key signs of both conditions. The 'know-can' gap corresponds to absent skills among FLWs with correct knowledge. We used logistic regression to identify the correlates of knowledge and skills. RESULTS FLWs' correct knowledge ranged from 23% to 48% for dehydration signs and 27% to 37% for pneumonia signs. Their skills ranged from 3% to 42% for dehydration and 3% to 18% for pneumonia. There was a significant 'know-can' gap in all the signs, except 'sunken eyes'. Training and supervisory support was associated with better knowledge and skills for diarrhoea with dehydration, but only better knowledge for pneumonia. CONCLUSIONS FLWs are crucial to the Indian health system, and high-quality FLW services are necessary for continued progress against under-five deaths. The gap between FLWs' knowledge and skills warrants immediate attention. In particular, our results suggest that knowledge-focused trainings are insufficient for FLWs to convert knowledge into appropriate assessment skills.
Collapse
|
8
|
Tien-Estrada J, Vieira A, Percy V, Millar K, Tam H, Russell K, Crockett M, Dart A, McGavock J. Determinants of scholarly project completion in a paediatric resident program in Canada. Paediatr Child Health 2018; 24:e98-e103. [PMID: 30996614 DOI: 10.1093/pch/pxy089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The primary aims of this study were to: 1) assess barriers and facilitators of completing scholarly projects from residents and faculty mentor perspectives, 2) determine the perceived value of new initiatives designed to support resident scholarly projects and 3) determine if these initiatives led to changes in resident publications. Design and Methods Between June and September 2014, we surveyed 18 paediatric residents and 41 faculty mentors regarding barriers to resident scholarly project completion and the value of new initiatives to support scholarly activity. We also tracked scientific publications by residents before and after implementation of these initiatives. Results The primary perceived barriers to research for residents and faculty were lack of protected time (64.3% versus 68.6%, respectively), lack of resident interest in scholarly activity (50.0% versus 60.0%, respectively) and lack of mentor motivation. Mentors and residents did not agree that lack of proper training in research (29% versus 54%, respectively) and faculty motivation (29% versus 17%, respectively) were barriers to completing a project. A dedicated research coordinator (71.4% versus 70.6%, respectively), a revised research curriculum (71.4% versus 41.2%, respectively) and works in progress sessions (50.0% versus 61.8%, respectively) were perceived as valuable initiatives to the program. These initiatives were not associated with changes in annual resident publication rates. Conclusions Lack of time and competing clinical training are primary barriers to scholarly project completion for residents in addition to a lack of motivation on the part of faculty members. Improving program support was perceived as positive changes to address these barriers but did not increase resident publication rates. The information provided here could be used to tailor future resident research programs and highlight the value of gathering input from resident and faculty when designing initiatives to enhance resident research productivity.
Collapse
Affiliation(s)
- Joan Tien-Estrada
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Anajara Vieira
- Resident Scholarly Activity Committee, Department: Resident Scholarly Activity Committee, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba
| | - Vanessa Percy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Kyle Millar
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Herman Tam
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Kelly Russell
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.,Resident Scholarly Activity Committee, Department: Resident Scholarly Activity Committee, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba
| | - Maryanne Crockett
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.,Resident Scholarly Activity Committee, Department: Resident Scholarly Activity Committee, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba
| | - Allison Dart
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.,Resident Scholarly Activity Committee, Department: Resident Scholarly Activity Committee, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba
| | - Jonathan McGavock
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba.,Resident Scholarly Activity Committee, Department: Resident Scholarly Activity Committee, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
9
|
Avery LS, Du Plessis E, Shaw SY, Sankaran D, Njoroge P, Kayima R, Makau N, Munga J, Kadzo M, Blanchard J, Crockett M. Enhancing the capacity and effectiveness of community health volunteers to improve maternal, newborn and child health: Experience from Kenya. Can J Public Health 2017; 108:e427-e434. [PMID: 29120317 DOI: 10.17269/cjph.108.5578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/19/2017] [Accepted: 04/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether a simple monitoring and tracking tool, Mwanzo Mwema Monitoring and Tracking Tool (MMATT), would enable community health volunteers (CHVs) in Kenya to 1) plan their workloads and activities, 2) identify the women, newborns and children most in need of accessing critical maternal, newborn and child health (MNCH) interventions and 3) improve key MNCH indicators. METHODS A mixed methods approach was used. Household surveys at baseline (n = 912) and endline (n = 1143) collected data on key MNCH indicators in the four subcounties of Taita Taveta County, Kenya. Eight focus group discussions were held with 40 CHVs to ascertain their perspectives on using the tool. RESULTS Qualitative findings revealed that the CHVs found the MMATT to be useful in planning their activities and prioritizing beneficiaries requiring more support to access MNCH services. They also identified potential barriers to care at both the community and health system levels. At endline, previously pregnant women were more likely to have received four or more antenatal care visits, facility delivery, postnatal care within two weeks of delivery and a complete package of care than baseline respondents. Among women with children under 24 months, those at endline were more likely to report early breastfeeding and exclusive breastfeeding for the first six months. These results remained after adjustment for age, subcounty, gravida, mother's education and asset index. CONCLUSION Our results demonstrate that simple tools enable CHVs to identify disparities in service delivery and health outcomes, and to identify barriers to MNCH care. Tools that enhance CHVs' ability to plan and prioritize the women and children most in need increase CHVs' potential impact.
Collapse
Affiliation(s)
- Lisa S Avery
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Woodgate RL, Busolo DS, Crockett M, Dean RA, Amaladas MR, Plourde PJ. A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy! Int J Equity Health 2017; 16:5. [PMID: 28068998 PMCID: PMC5223444 DOI: 10.1186/s12939-016-0510-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Methods Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. Results African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let’s buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let’s buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. Conclusions African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.
Collapse
Affiliation(s)
- Roberta Lynn Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
| | - David Shiyokha Busolo
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Maryanne Crockett
- Departments of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
| | - Ruth Anne Dean
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Miriam R Amaladas
- Nor-West Co-op Access Center, 785 Keewatin Street, Winnipeg, MB, Canada
| | - Pierre J Plourde
- Medical Officer of Health, Winnipeg Regional Health Authority, 490 Hargrave Street, Winnipeg, MB, R3A 0X7, Canada
| |
Collapse
|
11
|
Bradley J, Jayanna K, Shaw S, Cunningham T, Fischer E, Mony P, Ramesh BM, Moses S, Avery L, Crockett M, Blanchard JF. Improving the knowledge of labour and delivery nurses in India: a randomized controlled trial of mentoring and case sheets in primary care centres. BMC Health Serv Res 2017; 17:14. [PMID: 28061783 PMCID: PMC5219705 DOI: 10.1186/s12913-016-1933-1] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Birthing in health facilities in India has increased over the last few years, yet maternal and neonatal mortality rates remain high. Clinical mentoring with case sheets or checklists for nurses is viewed as essential for on-going knowledge transfer, particularly where basic training is inadequate. This paper summarizes a study of the effect of such a programme on staff knowledge and skills in a randomized trial of 295 nurses working in 108 Primary Health Centres (PHCs) in Karnataka, India. METHODS Stratifying by district, half of the PHCs were randomly assigned to be intervention sites and provided with regular mentoring visits where case sheet/checklists were a central job and teaching aid, and half to be control sites, where no support was provided except provision of case sheets. Nurses' knowledge and skills around normal labour, labour complications and neonate issues were tested before the intervention began and again one year later. Univariate and multivariate analyses were conducted to examine the effect of mentoring and case sheets. RESULTS Overall, on none of the 3 measures, did case sheet use without mentoring add anything to the basic nursing training when controlling for other factors. Only individuals who used both case-sheets and received mentoring scored significantly higher on the normal labour and neonate indices, scoring almost twice as high as those who only used case-sheets. This group was also associated with significantly higher scores on the complications of labour index, with their scores 2.3 times higher on average than the case sheet only control group. Individuals from facilities with 21 or more deliveries in a month tended to fare worse on all 3 indices. There were no differences in outcomes according to district or years of experience. CONCLUSIONS This study demonstrates that provision of case sheets or checklists alone is insufficient to improve knowledge and practices. However, on-site mentoring in combination with case sheets can have a demonstrable effect on improving nurse knowledge and skills around essential obstetric and neonatal care in remote rural areas of India. We recommend scaling up of this mentoring model in order to improve staff knowledge and skills and reduce maternal and neonatal mortality in India. TRIAL REGISTRATION This study is registered at clinicaltrials.gov, Identifier No. NCT02004912 , November 27, 2013.
Collapse
Affiliation(s)
- Janet Bradley
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Souradet Shaw
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Troy Cunningham
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Elizabeth Fischer
- IntraHealth, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517 USA
| | - Prem Mony
- St. John’s National Academy of Health Sciences, Sarjapur Road, Bangalore, Karnataka State 560 034 India
| | - B. M. Ramesh
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Stephen Moses
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Lisa Avery
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - James F. Blanchard
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| |
Collapse
|
12
|
Jayanna K, Bradley J, Mony P, Cunningham T, Washington M, Bhat S, Rao S, Thomas A, S R, Kar A, N S, B M R, H L M, Fischer E, Crockett M, Blanchard J, Moses S, Avery L. Effectiveness of Onsite Nurse Mentoring in Improving Quality of Institutional Births in the Primary Health Centres of High Priority Districts of Karnataka, South India: A Cluster Randomized Trial. PLoS One 2016; 11:e0161957. [PMID: 27658215 PMCID: PMC5033379 DOI: 10.1371/journal.pone.0161957] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 01/24/2023] Open
Abstract
Background In India, although the proportion of institutional births is increasing, there are concerns regarding quality of care. We assessed the effectiveness of a nurse-led onsite mentoring program in improving quality of care of institutional births in 24/7 primary health centres (PHCs that are open 24 hours a day, 7 days a week) of two high priority districts in Karnataka state, South India. Primary outcomes were improved facility readiness and provider preparedness in managing institutional births and associated complications during child birth. Methods All functional 24/7 PHCs in the two districts were included in the study. We used a parallel, cluster randomized trial design in which 54 of 108 facilities received six onsite mentoring visits, along with an initial training update and specially designed case sheets for providers; the control arm received just the initial training update and the case sheets. Pre- and post-intervention surveys were administered in April-2012 and August-2013 using facility audits, provider interviews and case sheet audits. The provider interviews were administered to all staff nurses available at the PHCs and audits were done of all the filled case sheets during the month prior to data collection. In addition, a cost analysis of the intervention was undertaken. Results Between the surveys, we achieved coverage of 100% of facilities and 91.2% of staff nurse interviews. Since the case sheets were newly designed, case-sheet audit data were available only from the end line survey for about 80.2% of all women in the intervention facilities and 57.3% in the control facilities. A higher number of facilities in the intervention arm had all appropriate drugs, equipment and supplies to deal with gestational hypertension (19 vs.3, OR (odds ratio) 9.2, 95% C.I 2.5 to33.6), postpartum haemorrhage (29 vs. 12, OR 3.7, 95% C.I 1.6 to8.3); and obstructed labour (25 vs.9, OR 3.4, 95% CI 1.6 to8.3). The providers in the intervention arm had better knowledge of active management of the third stage of labour (82.4% vs.35.8%, AOR (adjusted odds ratio) 10, 95% C.I 5.5 to 18.2); management of maternal sepsis (73.5% vs. 10.9%, AOR 36.1, 95% C.I 13.6 to 95.9); neonatal resuscitation (48.5% vs.11.7%, AOR 10.7, 95% C.I 4.6 to 25.0) and low birth weight newborn care (58.1% vs. 40.9%, AOR 2.4, 95% C.I 1.2 to 4.7). The case sheet audits revealed that providers in the intervention arm showed greater compliance with the protocols during labour monitoring (77.3% vs. 32.1%, AOR 25.8, 95% C.I 9.6 to 69.4); delivery and immediate post-partum care for mothers (78.6% vs. 31.8%, AOR 22.1, 95% C.I 8.0 to 61.4) and for newborns (73.9% vs. 32.8%, AOR 24.1, 95% C.I 8.1 to 72.0). The cost analysis showed that the intervention cost an additional $5.60 overall per delivery. Conclusions The mentoring program successfully improved provider preparedness and facility readiness to deal with institutional births and associated complications. It is feasible to improve the quality of institutional births at a large operational scale, without substantial incremental costs. Trial Registration ClinicalTrials.gov NCT02004912
Collapse
Affiliation(s)
- Krishnamurthy Jayanna
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
- * E-mail:
| | - Janet Bradley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Prem Mony
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Troy Cunningham
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Maryann Washington
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Swarnarekha Bhat
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Suman Rao
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Annamma Thomas
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Rajaram S
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Swaroop N
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Ramesh B M
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Mohan H L
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Elizabeth Fischer
- IntraHealth International, Chapel Hill, North Carolina, United States of America
| | - Maryanne Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Avery
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
13
|
Affiliation(s)
- Maryanne Crockett
- Departments of Pediatrics and Child Health, Medical Microbiology, Community Health Sciences, and Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Avery
- Departments of Medical Microbiology, Community Health Sciences, Obstetrics, Gynecology and Reproductive Sciences, and Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Departments of Community Health Sciences and Centre for Global Public Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
14
|
Ramesh B, Ghosh AK, Prakash V, Sharma M, Rajaram S, Kar A, Gaikwad A, Pradhan NK, Krishnamurthy J, Crockett M, Avery L, Moses S, Blanchard J. Facility mapping: A tool for effective planning for MNCH services. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.692] [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] Open
|
15
|
Boggild A, Brophy J, Charlebois P, Crockett M, Geduld J, Ghesquiere W, McDonald P, Plourde P, Teitelbaum P, Tepper M, Schofield S, McCarthy A. Summary of recommendations for the diagnosis and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT). Can Commun Dis Rep 2014; 40:133-143. [PMID: 29769894 PMCID: PMC5864436 DOI: 10.14745/ccdr.v40i07a02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND On behalf of the Public Health Agency of Canada, the Committee to Advise on Tropical Medicine and Travel (CATMAT) developed the Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers for Canadian health care providers who are preparing patients for travel to malaria-endemic areas and treating travellers who have returned ill. These recommendations aim to achieve appropriate diagnosis and management of malaria, a disease that is still uncommon in Canada. OBJECTIVE To provide recommendations on the appropriate diagnosis and treatment of malaria. METHODS CATMAT reviewed all major sources of information on malaria diagnosis and treatment, as well as recent research and national and international epidemiological data, to tailor guidelines to the Canadian context. The evidence-based medicine recommendations were developed with associated rating scales for the strength and quality of the evidence. RECOMMENDATIONS Malarial management depends on rapid identification of the disease, as well as identification of the malaria species and level of parasitemia. Microscopic identification of blood samples is both rapid and accurate but can be done only by trained laboratory technicians. Rapid diagnostic tests are widely available, are simple to use and do not require specialized laboratory equipment or training; however, they do not provide the level of parasitemia and do require verification. Polymerase chain reaction (PCR), although still limited in availability, is emerging as the gold standard for high sensitivity and specificity in identifying the species.
Collapse
Affiliation(s)
- A Boggild
- University Health Network, Toronto General Hospital (Toronto, ON)
| | - J Brophy
- Division of Infectious Diseases, Children’s Hospital of Eastern Ontario (Ottawa, ON)
| | - P Charlebois
- Internal Medicine, Canadian Forces Health Services Centre (Atlantic) (Halifax, NS)
| | - M Crockett
- Paediatrics and Child Health, University of Manitoba (Winnipeg, MB)
| | - J Geduld
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada (Ottawa, ON)
| | - W Ghesquiere
- Infectious Diseases and Internal Medicine, University of British Columbia (Victoria, BC)
| | - P McDonald
- Therapeutic Products Directorate, Health Canada (Ottawa, ON)
| | - P Plourde
- Faculty of Medicine, University of Manitoba (Winnipeg, MB)
| | | | - M Tepper
- Communicable Disease Control Program, Directorate of Force Health Protection (Ottawa, ON)
| | - S Schofield
- Pest Management Entomology, Directorate of Forces Health Protection (Ottawa, ON)
| | - A McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Disease, Ottawa Hospital General Campus (Ottawa, ON)
| |
Collapse
|
16
|
O'Shaughnessy J, Koeppen H, Crockett M, Lackner M, Spoerke JM, Wilson T, Levin MK, Pippen J, Paul D, Stokoe C, Blum J, Holmes FA, Lindquist DL, Krekow L, Vukelja SJ, Sedlacek S, Rivera R, Brooks RJ, McIntyre KJ, Schwartz JE, Jones S. Abstract P6-09-01: Central Ki67 analysis as a predictor for adjuvant capecitabine efficacy in early breast cancer (EBC) subtypes in US oncology trial 01062. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-09-01] [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
Background: USON 01062 (O’Shaughnessy J, et al. Proc SABCS, 2010, abst S4-2) showed no improvement in the primary endpoint of disease-free survival (DFS) (median FU 5 yrs: HR 0.84, 95% CI: 0.67-1.05; p = 0.125) with the addition of capecitabine (X) to standard adjuvant chemotherapy, but showed improvement in OS (HR 0.68, 95% CI: 0.51-0.92; p = 0.011). Exploratory analysis of local pathology-assessed Ki67 suggested benefit from adjuvant X in pts with more highly proliferative cancers with Ki67 ≥ 10% (Pippen J et al. Proc ASCO, 2011, abst 500). The objective of this study is to determine whether centrally-performed Ki67 IHC results corroborate or refute this finding.
Methods: 2610 pts with resected high risk EBC were randomized to receive 4 cycles of AC (doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2) IV every 3 wks for 4 cycles followed by either docetaxel 100mg/m2 IV or docetaxel 75mg/m2 IV plus X 825mg/m2 PO bid for 14 days every 3 wks for 4 cycles. Archival primary breast cancer tissue was collected on 2000 pts for predictive biomarker analyses. Central Ki67 IHC was performed using the anti-Ki67 monoclonal antibody SP6 and was read by one pathologist (HK) according to published recommendations (Dowsett M, et al. JNCI 103:1-9, 2011).
Results: Central Ki67 IHC has been performed on 1440 pts who had centrally-validated informed consents. The distribution of% Ki67-positive cells by locally-assessed ER/HER2 subtype is shown below. 45% of HR+ HER2- BCs had a Ki67 ≤ 10%, while 24% had a Ki67 11% to 20%, and 31% had a Ki67 > 20%. The concordance between the local vs central Ki67 results was low at 46% for Ki67 <10%, 49% for Ki67 10%-20%, and 76% for Ki67 > 20%. The central Ki67 results tended to be higher than the local testing results. Central mRNA classifiers were developed for ER, PR, HER2 and Ki67 using Fluidigm Microfluidics Dynamic Arrays and correlate highly with central IHC assessment of these markers.
Conclusions: HR+ HER2- EBC is enriched for cancers with a low proliferative rate, a group of pts unlikely to benefit from the cell cycle-specific cytotoxic agent, capecitabine. Analyses of the impact of adjuvant X added to AC/T in EBC pts according to ER status, and according to Ki67 (analyzed as a binary and continuous variable) will be performed prior to SABCS, 2013.
Number of Patients% Ki67 Pos CellsTotal *HR+TNHER2+/HR+HER2+/ HR-0-104163622222711-151391066151016-20126871615821-3018411539201031-1005751403423555Total144081042510790*Totals do not equal sum of subtype categories due to missing HER2 information
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-09-01.
Collapse
Affiliation(s)
- J O'Shaughnessy
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - H Koeppen
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - M Crockett
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - M Lackner
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - JM Spoerke
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - T Wilson
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - MK Levin
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - J Pippen
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - D Paul
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - C Stokoe
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - J Blum
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - FA Holmes
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - DL Lindquist
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - L Krekow
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - SJ Vukelja
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - S Sedlacek
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - R Rivera
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - RJ Brooks
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - KJ McIntyre
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - JE Schwartz
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| | - S Jones
- US Oncology, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center', Dallas, TX; Genetech, South San Francisco, CA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - Houston Memorial City, Houston, TX; Arizona Oncology Associates, Sedona, AZ; Texas Oncology - The Breast Care Center of North Texas, Bedford, TX; Texas Oncology - Tyler, Tyler, TX; Rocky Mountain Cancer Centers, Denver, CO; Texas Oncology - El Paso West, El Paso, TX; Arizona Oncology Associates, Tucson, AZ; Texas Oncology - Dallas Presbyterian Hospital, Dallas, TX
| |
Collapse
|
17
|
Audcent TA, Macdonnell HM, Moreau KA, Hawkes M, Sauve LJ, Crockett M, Fisher JA, Goldfarb DM, Hunter AJ, McCarthy AE, Pernica JM, Liu J, Luong TN, Sandhu AK, Rashed S, Levy A, Brenner JL. Development and evaluation of global child health educational modules. Pediatrics 2013; 132:e1570-6. [PMID: 24218464 DOI: 10.1542/peds.2013-1534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if a standardized global child health (GCH) modular course for pediatric residents leads to satisfaction, learning, and behavior change. METHODS Four 1-hour interactive GCH modules were developed addressing priority GCH topics. "Site champions" from 4 Canadian institutions delivered modules to pediatric residents from their respective programs during academic half-days. A pre-post, mixed methods evaluation incorporated satisfaction surveys, multiple-choice knowledge tests, and focus group discussions involving residents and satisfaction surveys from program directors. RESULTS A total of 125 trainees participated in ≥1 module. Satisfaction levels were high. Focus group participants reported high satisfaction with the concepts taught and the dynamic, participatory approach used, which incorporated multimedia resources. Mean scores on knowledge tests increased significantly postintervention for 3 of the 4 modules (P < .001), and residents cited increases in their practical knowledge, global health awareness, and motivation to learn about global health. Program directors unanimously agreed that the modules were relevant, interesting, and could be integrated within existing formal training time. CONCLUSIONS A relatively short, participatory, foundational GCH modular curriculum facilitated knowledge acquisition and attitude change. It could be scaled up and serve as a model for other standardized North American curricula.
Collapse
Affiliation(s)
- Tobey A Audcent
- Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Jones S, Collea R, Paul D, Sedlacek S, Favret A, Gore I, Lindquist DL, Holmes FA, Allison MAK, Steinberg MS, Stokoe C, Portillo RM, Crockett M, Wang Y, Lina A, Robert NJ, O'Shaughnessy J. Abstract P3-06-12: Effect of TOP2A and cMYC gene copy number on outcome in a Phase II trial of adjuvant TC (Docetaxel/Cyclophosphamide) plus trastuzumab (HER TC) in HER2-positive early stage breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-06-12] [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
Introduction: Approximately one-third of HER2+ early stage breast cancer (ESBC) patients have TOP2A-amplified breast cancer, the subpopulation known to benefit from anthracycline use (Press et al, JCO 2011). Data are needed to evaluate whether outcomes in ESBC patients treated with nonanthracycline-based regimens like docetaxel and cyclophosphamide + trastuzumab (HER TC) are affected by TOP2A or cMYC gene copy number.
Methods: This was an open-label, phase II study of HER TC in HER2+ breast cancer patients. Outcome data have been previously reported (Jones et al, SABCS 2011, PD07-03). Tissue was collected to review HER2, cMYC, and TOP2A gene copy number at a central reference laboratory. HER2, cMYC, and TOP2A amplification was defined as FISH ratio >2, and deletion was defined as FISH ratio <1. Every 21 days, patients received T 75mg/m2 IV and C 600mg/m2 IV, plus weekly H 4mg/kg IV (loading dose) and 2mg/kg IV thereafter for a total of 4 cycles. After 4 cycles of TC+H, patients continued on H for 1 year on a 3-week schedule. The primary endpoint was disease-free survival (DFS) at 2 years with continued follow-up for 3 years. Secondary endpoints were overall survival (OS) and safety.
Results: 493 patients with HER2+ ESBC were enrolled. From the 493 patients, 438 (89%) tissue samples were available and analyzed at Caris Diagnostics (Phoenix, AZ) to test for TOP2A, cMYC, and HER2 gene copy number by FISH. HER2 status was confirmed as positive in 87% of samples. Results for TOP2A, cMYC, and HER2 were generated in 438, 436, and 438 samples, respectively. TOP2A was classified as amplified in 43%, normal in 30%, deleted in 27%. cMYC was classified as amplified in 99(23%), normal in 246(56%), and deleted in 91(21%). Three-year DFS and OS in TOP2A and cMYC status as well as ER and Nodal status are depicted in Table 1. Multivariate analyses of age, nodal status, ER status, and gene expression shown below in Table 2 indicate that neither cMYC nor TOP2A status had an effect on outcome. Only nodal and ER status affected outcome.
Conclusion: Outcome (DFS + OS) in a phase II study of a nonanthracycline regimen (TC) coupled with H was unaffected by cMYC or TOP2A gene copy number status. Only ER and nodal status showed an effect in a multivariate analysis.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-12.
Collapse
Affiliation(s)
- S Jones
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - R Collea
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - D Paul
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - S Sedlacek
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - A Favret
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - I Gore
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - DL Lindquist
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - FA Holmes
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - MAK Allison
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - MS Steinberg
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - C Stokoe
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - RM Portillo
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - M Crockett
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - Y Wang
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - A Lina
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - NJ Robert
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| | - J O'Shaughnessy
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Baylor-Sammons Cancer Center, Dallas, TX; New York Oncology Hematology, Albany, NY; Rocky Mountain Cancer Center, Denver, CO; Virginia Cancer Specialists, Fairfax, VA; Birmingham Hematology and Oncology, Birmingham, AL; Arizona Oncology Associates, Sedona, AZ; Texas Oncology-Texas Memorial City, Houston, TX; Comprehensive Cancer Center, Henderson, NV; Virginia Oncology Associates, Virginia Beach, VA; Texas Oncology - Plano East, Plano, TX; Texas Oncology - El Paso West, El Paso, TX
| |
Collapse
|
19
|
Al-Juaid A, Walkty A, Embil J, Crockett M, Karlowsky J. Differential time to positivity: Vascular catheter drawn cultures for the determination of catheter-related bloodstream infection. ACTA ACUST UNITED AC 2012; 44:721-5. [DOI: 10.3109/00365548.2012.678883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Crockett M, Hui C, Kuhn S, Ford-Jones L, Grondin D, Keystone J. Travel-Related Illnesses in Paediatric Travellers who Visit Friends and Relatives Abroad (TRIP-VFR). Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.16a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Hawkes M, Li X, Crockett M, Diassiti A, Finney C, Min-Oo G, Liles WC, Liu J, Kain KC. CD36 deficiency attenuates experimental mycobacterial infection. BMC Infect Dis 2010; 10:299. [PMID: 20950462 PMCID: PMC2965149 DOI: 10.1186/1471-2334-10-299] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/15/2010] [Indexed: 01/27/2023] Open
Abstract
Background Members of the CD36 scavenger receptor family have been implicated as sensors of microbial products that mediate phagocytosis and inflammation in response to a broad range of pathogens. We investigated the role of CD36 in host response to mycobacterial infection. Methods Experimental Mycobacterium bovis Bacillus Calmette-Guérin (BCG) infection in Cd36+/+ and Cd36-/- mice, and in vitro co-cultivation of M. tuberculosis, BCG and M. marinum with Cd36+/+ and Cd36-/-murine macrophages. Results Using an in vivo model of BCG infection in Cd36+/+ and Cd36-/- mice, we found that mycobacterial burden in liver and spleen is reduced (83% lower peak splenic colony forming units, p < 0.001), as well as the density of granulomas, and circulating tumor necrosis factor (TNF) levels in Cd36-/- animals. Intracellular growth of all three mycobacterial species was reduced in Cd36-/- relative to wild type Cd36+/+ macrophages in vitro. This difference was not attributable to alterations in mycobacterial uptake, macrophage viability, rate of macrophage apoptosis, production of reactive oxygen and/or nitrogen species, TNF or interleukin-10. Using an in vitro model designed to recapitulate cellular events implicated in mycobacterial infection and dissemination in vivo (i.e., phagocytosis of apoptotic macrophages containing mycobacteria), we demonstrated reduced recovery of viable mycobacteria within Cd36-/- macrophages. Conclusions Together, these data indicate that CD36 deficiency confers resistance to mycobacterial infection. This observation is best explained by reduced intracellular survival of mycobacteria in the Cd36-/- macrophage and a role for CD36 in the cellular events involved in granuloma formation that promote early bacterial expansion and dissemination.
Collapse
Affiliation(s)
- Michael Hawkes
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Goode S, Chowdhury A, Crockett M, Beech A, Simpson R, Richards T, Braithwaite B. Laser and Radiofrequency Ablation Study (LARA study): A Randomised Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810nm). J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.06.097] [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]
|
23
|
Hawkes M, Li X, Crockett M, Diassiti A, Liles WC, Liu J, Kain KC. Malaria exacerbates experimental mycobacterial infection in vitro and in vivo. Microbes Infect 2010; 12:864-74. [PMID: 20542132 DOI: 10.1016/j.micinf.2010.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/20/2010] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
Abstract
Tuberculosis (Mtb) and malaria are among the most important infectious causes of morbidity and mortality worldwide, causing an estimated 1.5 million and 1 million deaths every year, respectively. Here we demonstrate a biological interaction between malaria and mycobacteria in vitro and in vivo. Murine macrophages co-incubated with Plasmodium falciparum parasitized erythrocytes demonstrated impaired control of intracellular Mtb replication, and reduced production of reactive nitrogen species in response to mycobacteria. Infection of C57BL/6 mice with Plasmodium species exacerbated the course of acute mycobacterial infection (57% increase in peak splenic CFU, p = 0.043 for difference over time course of infection), induced disruption of the structural integrity of established granulomas, and caused reactivation of latent mycobacterial infection (2.6-fold increase in peak splenic CFU, p = 0.016 for difference over time course of reactivation). Malaria pigment deposition within the granulomas of co-infected mice suggested that the influx of dysfunctional hemozoin-laden monocytes into the locus of mycobacterial control may contribute to impaired containment of mycobacteria. Collectively, these results point to malaria-induced dysregulation of innate and adaptive anti-mycobacterial defences, and suggest that the interaction of these globally important pathogens may potentiate Mtb infection and transmission.
Collapse
Affiliation(s)
- Michael Hawkes
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
24
|
Crockett M, Hui C, Kuhn S, Ford-Jones L, Keystone J. Travel-Related Illnesses in Canadian Children (Trip Study). Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.36a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
25
|
Affiliation(s)
- Maryanne Crockett
- Section of Pediatric Infectious Diseases, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
26
|
Jones S, Jones S, Collea R, Collea R, Oratz R, Oratz R, Paul D, Paul D, Sedlacek S, Sedlacek S, Holmes F, Holmes F, Portillo R, Portillo R, Crockett M, Wang Y, Asmar L, O'Shaughnessy J, O'Shaughnessy J, Robert N. Cardiac Safety Results of a Phase II Trial of Adjuvant Docetaxel/Cyclophosphamide Plus Trastuzumab (Her TC) in HER2+ Early Stage Breast Cancer Patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5082] [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: 11/16/2022]
Abstract
Abstract
Background: Docetaxel/cyclophosphamide (TC) has superior activity to doxorubicin/cyclophosphamide (AC) in the adjuvant treatment of patients (pts) with early breast cancer and is devoid of known cardiac toxicity (Jones et al, JCO 27:1177-1183, 2009). Although the addition of trastuzumab (H) to anthracycline-based adjuvant regimens is effective, it is associated with increased cardiac toxicity. Therefore, a short course of the nonanthracycline TC regimen coupled with H appeared to be a logical combination for women with lower risk HER2+ breast cancer. We report the cardiac safety of the TC+H regimen for the first group of women to complete 1 year of treatment.Patients and Methods: 263 pts were registered to the study and stratified by nodal status (positive/negative). Pts must have had baseline left ventricular ejection fraction (LVEF) ≥50% by MUGA or ECHO. On Day 1 of each 21-day cycle for a total of 4 cycles, pts received: (T) 75 mg/m2 IV, followed by (C) 600 mg/m2 IV. Weekly (H) was also given at 4 mg/kg IV (loading dose, over 90 minutes Day 1, Cycle 1 only) and 2 mg/kg IV Days 1, 8, 15 thereafter throughout chemotherapy. After completion of chemotherapy, H was administered at 6 mg/kg IV every 3 weeks to complete 12 months of therapy with H. Decreased LVEF was defined as a decrease from baseline (start of treatment) to completion of TC+H, or when assessed at 3-month intervals until the completion of H treatment. H was withheld if there was a 15% or more decline in LVEF (absolute %). Treatment was discontinued after 2 or 3 treatment delays at investigator's discretion (same rules as prior studies). This report focuses on cardiac safety occurring during the 3 months of chemotherapy plus 1 year of H therapy.Results: To date, 260 pts completed 1 year of treatment and comprised the cardiac safety population; median age was 55 yrs (30-76); 90% of pts had ECOG 0; 64% were ER+, 47% were PR+, and 77% had no lymph node involvement. 184 pts (70%) completed planned treatment and 23 pts (9%) discontinued treatment due to adverse events. A total of 61 pts (23.5%) had declines of ≥10% LVEF; 8 pts (3.1%) had 2 or more LVEF declines ≥10% and were taken off treatment before 1 year of H was completed, and 16 pts (6.1%) had declines of LVEF below 50% during treatment. No patient had clinical CHF.Scheduled MUGA/ECHO ResultsMonthPatients, no.Median LVEF, % (range)Patients with decrease LVEF ≥10%, no.Patients with LVEF <50%, no.Baseline26064 (49,89)––1-324163 (40,85)154-623062 (40,85)2157-921763 (36,89)265≥1018763 (48,80)131Conclusions: H combined with 4 cycles of the nonanthracycline TC regimen produced a low rate of cardiac events, mainly asymptomatic drops in LVEF, but no reported cases of CHF.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5082.
Collapse
Affiliation(s)
- S. Jones
- 1US Oncology Research, Inc., TX,
| | - S. Jones
- 2Baylor-Charles A. Sammons Cancer Center, TX,
| | | | - R. Collea
- 3New York Oncology Hematology Center, NY,
| | - R. Oratz
- 1US Oncology Research, Inc., TX,
| | - R. Oratz
- 4New York University School of Medicine, NY,
| | - D. Paul
- 1US Oncology Research, Inc., TX,
| | - D. Paul
- 5Rocky Mountain Cancer Centers, CO,
| | | | | | | | | | | | | | | | - Y. Wang
- 1US Oncology Research, Inc., TX,
| | - L. Asmar
- 1US Oncology Research, Inc., TX,
| | | | | | - N. Robert
- 8Northern Virginia Hematology-Oncology, VA,
| |
Collapse
|
27
|
Abstract
Malaria that is caused by Plasmodium falciparum is a significant global health problem. Genetic characteristics of the host influence the severity of disease and the ultimate outcome of infection, and there is evidence of coevolution of the plasmodium parasite with its host. In humans, pyruvate kinase deficiency is the second most common erythrocyte enzyme disorder. Here, we show that pyruvate kinase deficiency provides protection against infection and replication of P. falciparum in human erythrocytes, raising the possibility that mutant pyruvate kinase alleles may confer a protective advantage against malaria in human populations in areas where the disease is endemic.
Collapse
Affiliation(s)
- Kodjo Ayi
- McLaughlin-Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Malaria remains an important cause of global morbidity and mortality. As antimalarial drug resistance escalates, new safe and effective medications are necessary to prevent and treat malarial infection. Tafenoquine is an 8-aminoquinoline antimalarial that is presently under development. It has a long half-life of approximately 14 days and is generally safe and well tolerated, although it cannot be used in pregnant women and individuals who are deficient in the enzyme glucose-6-phosphate dehydrogenase. In well-designed studies, tafenoquine was highly effective in both the radical cure of relapsing malaria and causal prophylaxis of Plasmodium vivax and P. falciparum infections with protective efficacies of > or = 90%. Given its causal activity and safety profile, tafenoquine represents a potentially exciting alternative to standard agents for the prevention and radical cure of malaria.
Collapse
Affiliation(s)
- Maryanne Crockett
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, M5G 1X8, Canada.
| | | |
Collapse
|
29
|
Reynolds DL, Gillis F, Kitai I, Deamond SL, Silverman M, King SM, Matlow AG, Crockett M. Transmission of Mycobacterium tuberculosis from an infant. Int J Tuberc Lung Dis 2006; 10:1051-6. [PMID: 16964800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
SETTING This report investigates the unusual transmission of Mycobacterium tuberculosis from a 12-week-old infant with nosocomially acquired tuberculosis (TB). Compliance with recommendations on the post-exposure management of young children is described. DESIGN Contacts of an infant case of TB were identified and recommended to undergo baseline and post-exposure tuberculin skin tests (TST) as per Canadian TB standards. TST conversion was measured at least 8 weeks post exposure. Children aged <6 years were recommended to initiate preventive treatment with isoniazid (INH) until their post-exposure TST. Information on TST results and adherence to therapy were analysed from existing medical records. RESULTS Overall, 17 TST conversions were documented among 732 contacts: both parents, two health care workers (HCWs) who provided close care, and several patients, visitors and one staff member without obvious close contact. Of 65 eligible children, 46% completed post-exposure therapy as recommended. The most common reasons for treatment failure were concern about side effects, perception of low risk and lack of physician support. CONCLUSION This investigation suggests that all children, including infants, with cough and numerous bacilli or extensive pulmonary disease should be considered infectious. Health care provider education is necessary to resolve the observed low compliance with current post-exposure management guidelines.
Collapse
Affiliation(s)
- D L Reynolds
- Durham Region Health Department, Whitby, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
In self-rotation reproduction tasks, subjects appear to estimate the displacement angle and then reproduce this angle without necessarily replicating the entire temporal velocity profile. In contrast, subjects appear to reproduce the entire temporal velocity profile during linear motion stimulating the otoliths. To investigate what happens during combined rotation and translation, we investigated in darkness the central processing of vestibular cues during eccentric rotation. Controlling a centrifuge with a joystick, nine healthy subjects were asked to reproduce the angle of the previously imposed rotation. Rotations were either ON-center, or 50 cm OFF-center with inter-aural centripetal acceleration. Rotation duration was either variable (proportional to the traveled angle), or constant. We examined whether the stimulation of the otoliths during OFF-center rotation changes self-rotation reproduction, and whether rotation duration is processed differently by the nervous system with and without otolith stimulation. As postulated, the subjects indeed reproduced more closely the stimulus velocity profile when OFF-center. But the primary result is that the additional supra-threshold linear acceleration cues, measured by the otoliths, did not improve performance. More specifically, to our surprise, the ability to reproduce rotation angle degraded slightly in the presence of additional information from the otolith organs, with the linear acceleration cues appearing to interfere with the reproduction of movement duration.
Collapse
Affiliation(s)
- I Israël
- Collège de France-CNRS, LPPA, 11 place Marcelin Berthelot, 75005 Paris, France.
| | | | | | | |
Collapse
|
31
|
Crockett M. New faces from faraway places: Immigrant child health in Canada. Paediatr Child Health 2005; 10:277-81. [PMID: 19668632 PMCID: PMC2722545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
For the past several years, more than 50,000 children have immigrated to Canada annually. These children are particularly vulnerable in terms of their health. Although the Immigration Medical Examination provides the required medical screening, a number of additional recommendations for the medical evaluation of immigrant children can optimize their health care as they transition to life in Canada. Furthermore, a number of other issues must be specifically addressed in the care of immigrant children, such as consideration of their culture, nutritional issues and growth, psychosocial issues and immunizations. Certain groups of immigrant children, such as internationally adopted children and refugees, may be even more vulnerable and have special needs. However, despite the numerous challenges in addressing the health issues of immigrant children, there are many resources available to help paediatricians provide these children with optimal care.
Collapse
Affiliation(s)
- Maryanne Crockett
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario
| |
Collapse
|
32
|
Abstract
Travel vaccines comprise an essential component of pretravel health advice; however, many travelers do not take advantage of this preventive health strategy to decrease their risk of travel-related illness. Factors that impact on a traveler's decision on whether or not to be vaccinated are related to the knowledge, attitudes and beliefs of the traveler regarding travel vaccines, vaccine-preventable diseases, and other factors. Further research is required to increase travelers' awareness of the need for pretravel vaccination and then to translate that awareness into positive attitudes leading to increased travel vaccine uptake.
Collapse
Affiliation(s)
- Maryanne Crockett
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
33
|
Crockett M, King SM, Kitai I, Jamieson F, Richardson S, Malloy P, Yaffe B, Reynolds D, Hellmann J, Cutz E, Matlow A. Nosocomial Transmission of Congenital Tuberculosis in a Neonatal Intensive Care Unit. Clin Infect Dis 2004; 39:1719-23. [PMID: 15578377 DOI: 10.1086/425740] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 07/23/2004] [Indexed: 11/03/2022] Open
Abstract
Congenital tuberculosis is uncommon, and nosocomial transmission from a congenitally infected infant to another infant has not been reported in the English literature. We report an investigation of 2 infants with tuberculosis who were cared for in the same neonatal intensive care unit. Isolates from both infants were genetically indistinguishable. Transmission between the 2 infants was likely due to contaminated respiratory equipment.
Collapse
Affiliation(s)
- Maryanne Crockett
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kao L, Leikin JB, Crockett M, Burda A. Methemoglobinemia from artificial fingernail solution. JAMA 1997; 278:549-50. [PMID: 9268273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
35
|
Abstract
Essential to a neonate's survival is an ability to respond effectively to hostile environmental forces. The developing neonate's immune system has functional, albeit limited, defensive, homeostatic and surveillance capabilities. The development of the cellular components of the neonatal immune system and their physiologic interrelationships and limitations are discussed.
Collapse
Affiliation(s)
- M Crockett
- Sutter Center for Women's Health, Sutter Memorial Hospital, Sacramento, CA, USA
| |
Collapse
|
36
|
Crockett M, Tappero E. Dopamine and dobutamine: neonatal indications and implications. Neonatal Netw 1989; 7:13-20. [PMID: 2649781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
37
|
Lincoln J, Crockett M, Haven AJ, Burnstock G. Rat bladder in the early stages of streptozotocin-induced diabetes: adrenergic and cholinergic innervation. Diabetologia 1984; 26:81-7. [PMID: 6231206 DOI: 10.1007/bf00252269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The adrenergic and cholinergic innervation of the bladder was studied in streptozotocin-diabetic rats. The presence of hypertrophy and distension in the 'diabetic' bladders necessitates care in assessing changes occurring in the nerves, factors which are also relevant to clinical histochemical studies. Biochemical assays of cholinergic enzymes revealed decreased activities per g wet weight tissue. However, the total activities of choline acetyltransferase and acetylcholinesterase per whole bladder were significantly increased after 2 weeks of diabetes with greater changes by 8 weeks. Total dopamine levels per bladder were significantly higher than in control rats in the 2-week but not the 8-week group of animals; this may indicate an initial increase in adrenergic nerve activity. There was no impairment in the ability of the detrusor muscle to respond to noradrenaline, acetylcholine or to cholinergic nerve stimulation. Shortly after induction of diabetes streptozotocin-treated rats display polyuria. It is proposed that the activity of the bladder is therefore stimulated to allow greater volumes of urine to be passed. The results are discussed in relation to human diabetes mellitus where clinical studies have implicated a neuropathic origin to bladder dysfunction.
Collapse
|
38
|
|