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Gidlow CJ, Sams L, Buckless K, Ellis NJ, Duffy HC, Lambley-Burke R, Campbell P, Cooke A, Dziedzic K, Brookes M, Chockalingam N, Devall P, Mallen C. "We have to change our mindsets": a qualitative study of barriers and facilitators in research collaboration across integrated care system organisations. BMC Health Serv Res 2024; 24:264. [PMID: 38429760 PMCID: PMC10908113 DOI: 10.1186/s12913-024-10760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challenging given that organisations span health, local authority, voluntary and community sector, and research. This study aimed to explore the appetite for collaborative Research and Innovation (R&I) across ICSs, potential barriers and solutions. This qualitative study involved semi-structured interviews with 24 stakeholders who held senior positions within organisations across two ICS areas (Staffordshire and Stoke-on-Trent; Shropshire, Telford and Wrekin). Interview transcripts were analysed using inductive and deductive analysis, first mapping to the Theoretical Domains Framework (TDF), then considering key influences on organisational behaviour in terms of Capability, Opportunity and Motivation from the COM-B Behaviour Change Wheel. There were fundamental limitations on organisational opportunities for collaborative R&I: a historical culture of competition (rather than collaboration), a lack of research culture and prioritisation, compounded by a challenging adverse economic environment. However, organisations were motivated to undertake collaborative R&I. They recognised the potential benefits (e.g., skill-sharing, staff development, attracting large studies and funding), the need for collaborative research that mirrors integrated care, and subsequent benefits for care recipients. Related barriers included negative experiences of collaboration, fear of failing and low confidence. Capability varied across organisations in terms of research skills and confidence, which reflected the range of partners (from local authorities to NHS Trusts, primary care, and academic institutions). These findings indicate a need to shift from a culture of competition to collaboration, and to help organisations across ICS to prioritise research, and share resources and skills to mitigate the limiting effects of a constrained economic environment. This could be further explored using a systems change approach, to develop the collaborative research efforts alongside the overarching move towards integrated care.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Lorna Sams
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Kim Buckless
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen C Duffy
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Ruth Lambley-Burke
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Paul Campbell
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
- Keele University, ST5 5BG, Keele, Staffordshire, UK
| | - Alison Cooke
- Keele University, ST5 5BG, Keele, Staffordshire, UK
- University Hospitals of North Midlands NHS Trust, Newcastle Road, ST4 6QG, Stoke-on-Trent, UK
| | | | - Matthew Brookes
- University of Wolverhampton, Wolverhampton, UK
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Nachiappan Chockalingam
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Pam Devall
- NIHR Clinical Research Network West Midlands, New Cross Hospital, WV10 0QP, Wolverhampton, UK
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Feys O, Ferez M, Corvilain P, Schuind S, Rikir E, Legros B, Gaspard N, Holmes N, Brookes M, Wens V, De Tiège X. On-Scalp Magnetoencephalography Based On Optically Pumped Magnetometers Can Detect Mesial Temporal Lobe Epileptiform Discharges. Ann Neurol 2024; 95:620-622. [PMID: 38050959 DOI: 10.1002/ana.26844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Odile Feys
- Department of Neurology, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
| | - Maxime Ferez
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
| | - Pierre Corvilain
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Estelle Rikir
- Department of Neurology, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Benjamin Legros
- Department of Neurology, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Niall Holmes
- School of Physics and Astronomy, Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Matthew Brookes
- School of Physics and Astronomy, Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Vincent Wens
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
- Department of Translational Neuroimaging, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Xavier De Tiège
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Brussels, Belgium
- Department of Translational Neuroimaging, Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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Feys O, Wens V, Corvilain P, Ferez M, Holmes N, Brookes M, De Tiège X. Where do we stand exactly with on-scalp magnetoencephalography in the presurgical evaluation of refractory focal epilepsy? Epilepsia 2023; 64:3414-3417. [PMID: 37863642 DOI: 10.1111/epi.17806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Odile Feys
- Department of Neurology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), ULB Neuroscience Institute (UNI), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent Wens
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), ULB Neuroscience Institute (UNI), Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Translational Neuroimaging, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
| | - Pierre Corvilain
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), ULB Neuroscience Institute (UNI), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Maxime Ferez
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), ULB Neuroscience Institute (UNI), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Niall Holmes
- School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Cerca Magnetics Ltd, Nottingham, UK
| | - Matthew Brookes
- School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
- Cerca Magnetics Ltd, Nottingham, UK
| | - Xavier De Tiège
- Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), ULB Neuroscience Institute (UNI), Université libre de Bruxelles (ULB), Brussels, Belgium
- Department of Translational Neuroimaging, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Erasme, Brussels, Belgium
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Feys O, Corvilain P, Bertels J, Sculier C, Holmes N, Brookes M, Wens V, De Tiège X. On-scalp magnetoencephalography for the diagnostic evaluation of epilepsy during infancy. Clin Neurophysiol 2023; 155:29-31. [PMID: 37673016 DOI: 10.1016/j.clinph.2023.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Odile Feys
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium; Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN(2)T), Brussels, Belgium.
| | - Pierre Corvilain
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN(2)T), Brussels, Belgium
| | - Julie Bertels
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN(2)T), Brussels, Belgium
| | - Claudine Sculier
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatric Neurology, Brussels, Belgium
| | - Niall Holmes
- University of Nottingham, School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
| | - Matthew Brookes
- University of Nottingham, School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
| | - Vincent Wens
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN(2)T), Brussels, Belgium; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
| | - Xavier De Tiège
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN(2)T), Brussels, Belgium; Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
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Selinger CP, Laube R, Steed H, Brookes M, BioResource NIHR, Leong RWL. Planning to conceive within a year is associated with better pregnancy-specific disease-related patient knowledge and better medication adherence in women of childbearing age with inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231193211. [PMID: 37667806 PMCID: PMC10475232 DOI: 10.1177/17562848231193211] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 09/06/2023] Open
Abstract
Background Adherence to inflammatory bowel disease (IBD) medication is crucial to maintain remission, especially during pregnancy. Objective To examine the influence of family planning and pregnancy-related patient knowledge regarding IBD and pregnancy on adherence. Design Cross-sectional survey study. Methods We surveyed female patients with IBD aged 18-35 years, who at recruitment to the UK IBD BioResource had not had children. We elicited disease and treatment history, demographics and family planning status via an online questionnaire. Patient knowledge as assessed by the validated Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow) and adherence by visual analogue scale (VAS). Results In 326 responders (13.8% response rate), good adherence (VAS ⩾ 80) was found in only 38.35%. Disease- and treatment-related factors were not significantly associated with good adherence, except for methotrexate (70.0% adherent of 10 exposed patients versus 37.2% non-exposed; p = 0.036). Patients planning pregnancy for the next year were more often adherent (59.0% versus 35.5%; p = 0.019) and knowledgeable (median CCPKnow 8 versus 7; p = 0.035) compared to those in other family planning categories. Pregnancy-related patient knowledge was significantly associated with adherence (Pearson correlation 0.141; p = 0.015). Adherent patients had significantly higher CCPKnow scores than non-adherent patients (median 8 versus 6; p = 0.009). On binary regression analysis, only planning to conceive within 12 months was independently associated with better adherence (p = 0.016), but not methotrexate exposure (p = 0.076) and CCPKnow (p = 0.056). Conclusions In a cohort of women of childbearing age with IBD overall medication, adherence was low. Planning to conceive within the next year was associated with better adherence and greater patient knowledge.
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Affiliation(s)
- Christian P. Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Bexley Wing, Leeds, LS9 7TF, UK
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Helen Steed
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton, UK
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton, UK
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - NIHR BioResource
- Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, UK
| | - Rupert W. L. Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
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Chibanda Y, Brookes M, Churchill D, Al-Hassi H. The Ferritin, Hepcidin and Cytokines Link in the Diagnoses of Iron Deficiency Anaemia during Pregnancy: A Review. Int J Mol Sci 2023; 24:13323. [PMID: 37686128 PMCID: PMC10488244 DOI: 10.3390/ijms241713323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Following a diagnosis of iron deficiency anaemia in pregnancy, iron supplements are prescribed using UK guidelines; however, despite this, the condition remains highly prevalent, affecting up to 30% of pregnant women in the UK. According to the World Health Organisation, it globally accounts for 45% in the most vulnerable groups of pregnant women and infants (<5 years old). Recently, the efficacy of iron replacement therapy and the effectiveness of current standard testing of iron parameters have been reviewed in order to evaluate whether a more accurate diagnosis can be made using alternative and/or supplementary markers. Furthermore, many questions remain about the mechanisms involved in iron metabolism during pregnancy. The most recent studies have shed more light on serum hepcidin and raised questions on the significance of pregnancy related inflammatory markers including cytokines in iron deficiency anaemia. However, research into this is still scarce, and this review aims to contribute to further understanding and elucidating these areas.
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Affiliation(s)
- Yvonne Chibanda
- Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Matthew Brookes
- Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - David Churchill
- Obstetrics, The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Hafid Al-Hassi
- Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton WV1 1LY, UK
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Selinger CP, Steed H, Purewal S, Homer R, Brookes M. Factors Associated with Family Planning Status and Voluntary Childlessness in Women of Childbearing Age with Inflammatory Bowel Diseases. J Clin Med 2023; 12:4267. [PMID: 37445302 DOI: 10.3390/jcm12134267] [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: 05/26/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Women with Inflammatory Bowel Diseases (IBD) have fewer children and stay childless more often. The decision-making process around family planning choices remains incompletely understood. METHODS We examined family status in women who at recruitment to the UK IBD Bioresource had not had children yet via an electronic survey. The primary outcome was the proportion of women with voluntary childlessness. Secondary outcomes were factors associated with family planning status. RESULTS Of 326 responders, 10.7% had either given birth, were currently pregnant or were currently trying to conceive; 12.6% were planning to conceive within 12 months; 54.4% were contemplating conception in the distant future (vague plans); and 22.3% were voluntarily childless. Factors associated with family planning status fell into three areas: general background (age, household income, perceived support to raise a child), relationship status (sexual orientation, being single, not cohabiting, perception of being 'in the right relationship to raise a child', perception of a good sex life) and the expression of having a child as a goal in life. On binary logistics regression analysis with voluntary childlessness versus vague family plans as the outcomes of choice, having a household income of <£30,000 (p = 0.046), not seeing a child as a life goal (p < 0.0001) and identifying as lesbian or bisexual (p = 0.047) were independent predictors of voluntary childlessness. CONCLUSIONS Clinicians should consider sexual orientation, income, younger age, current relationship and lack of expression of having a child as a life goal as important factors for family planning when providing care. Pre-pregnancy advice should be made widely available for women with IBD.
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Affiliation(s)
- Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals, Leeds LS9 7TF, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS9 7TF, UK
| | - Helen Steed
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Satvinder Purewal
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Rebecca Homer
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
| | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK
- Gastroenterology, University of Wolverhampton, Wolverhampton WV1 1SG, UK
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Kirk J, Reynolds F, Adey E, Boazman M, Brookes M, Brocklehurst P. Developing paediatric chief investigators within the NHS: the Clinical Trials Scholars programme. Arch Dis Child Educ Pract Ed 2023; 108:139-141. [PMID: 35193887 DOI: 10.1136/archdischild-2021-322186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Jeremy Kirk
- Research and Development, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Fiona Reynolds
- Chief Medical Office, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Adey
- Research and Development, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Matthew Boazman
- Research and Development, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Peter Brocklehurst
- Institute of Applied Health Research, Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Feys O, Corvilain P, Van Hecke A, Sculier C, Rikir E, Legros B, Gaspard N, Leurquin-Sterk G, Holmes N, Brookes M, Goldman S, Wens V, De Tiège X. Recording of Ictal Epileptic Activity Using on-Scalp Magnetoencephalography. Ann Neurol 2023; 93:419-421. [PMID: 36480016 DOI: 10.1002/ana.26562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Odile Feys
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium.,Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium
| | - Pierre Corvilain
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium
| | - Audrey Van Hecke
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Department of Pediatric Neurology, Brussels, Belgium
| | - Claudine Sculier
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Pediatric Neurology, Brussels, Belgium
| | - Estelle Rikir
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium
| | - Benjamin Legros
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium
| | - Nicolas Gaspard
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Neurology, Brussels, Belgium
| | - Gil Leurquin-Sterk
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium.,University of Nottingham, School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
| | - Niall Holmes
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Nuclear Medicine, Brussels, Belgium
| | - Matthew Brookes
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Nuclear Medicine, Brussels, Belgium
| | - Serge Goldman
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium.,University of Nottingham, School of Physics and Astronomy, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
| | - Vincent Wens
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium.,Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
| | - Xavier De Tiège
- Université libre de Bruxelles (ULB), ULB Neuroscience Institute (UNI), Laboratoire de Neuroimagerie et Neuroanatomie translationnelles (LN2T), Brussels, Belgium.,Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Translational Neuroimaging, Brussels, Belgium
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Hussain Y, Bannaga A, Fisher N, Krishnamoorthy A, Kimani P, Malik A, Truslove M, Joshi S, Hitchins M, Abbasi A, Corbett C, Brookes M, Than NN, Arasaradnam R. THE FATTY LIVER, CIRRHOSIS & LIVER CANCER STUDY - TENDENCY (PROTOCOL) (Preprint). JMIR Res Protoc 2022; 12:e44264. [DOI: 10.2196/44264] [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] [Received: 11/22/2022] [Revised: 02/02/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
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Allen C, Rier L, Gascoyne L, Dineen R, DasNair R, Brookes M, Evangelou N. 164 The role of MEG in assessment and diagnosis in mTBI. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionThis MRC Confidence in Concept funded study (Clinical Trials reference:NCT03867513) combined magnetoencephalography (MEG) with ultrahigh field 7T MRI, to look for functional and struc- tural abnormalities in mild traumatic brain injury (mTBI).ObjectivesCan those with mTBI be differentiated from non-head injured orthopaedic trauma controls by measuring brain wave activity.MethodsWe scanned 40 participants within two weeks of an emergency department visit and they underwent resting state and task specific MEG followed by 7T MRI including structural, susceptibility, and diffusion sequences. Questionnaire assessment was completed at baseline, three, and six months.ResultsWhilst most individuals with mTBI recover a significant proportion have persistent difficulties. Using a Hidden Markov Model in the mTBI cohort, we were able to demonstrate reduced beta band connec- tivity results from a loss in the temporal coincidence of bursts of activity in spatially distinct regions. This replicates our findings in a distinct sub-acute mTBI cohort. Susceptibility weight imaging revealed only two mTBI participants with microhaemorrhages, their clinical care, markers of injury severity, and recovery did not differentiate them from others in the mTBI cohort.ConclusionsOur results suggests that mTBI may impair the dynamic coordination of neural network activity and this requires further exploration.
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Udegbune M, Sharrod-Cole H, Townsend S, Allen B, Brookes M, Ford C, Gama R. Diagnostic performance of serum calprotectin in discriminating active from inactive ulcerative colitis in an outpatient setting. Ann Clin Biochem 2022; 59:404-409. [PMID: 35850604 DOI: 10.1177/00045632221116830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are limited and conflicting data on the value of serum calprotectin (sCp) in discriminating active from inactive disease activity in ulcerative colitis (UC). METHODS Faecal calprotectin (fCp), sCp, serum C-reactive protein (sCRP) and platelets were compared in patients with UC who had clinically active (n=29) and clinically inactive (n=42) disease. sCp was measured with Bühlmann® (BMN sCp) and ImmunodiagnostikTM (IDK sCp) assays. RESULTS Median (interquartile range) fCp was higher in active than inactive disease [1004 (466 - 1922) vs 151 (55 - 280) µg/g; p < 0.0001). BMN sCp [4534 (3387 - 6416) vs 4031 (2401 - 5414) ng/mL; p = 0.1825], IDK sCp [4531 (2920 - 6433) vs 3307 (2104 - 4789) ng/mL; p = 0.1065], sCRP [ 4 (2 - 8) vs 2 (1 - 4) mg/L; p = 0.0638) and platelets [269 (233 - 331) vs 280 (227 - 325) x10-9/L; p = 0.8055] were similar in active and inactive disease respectively. The area under the receiver operator characteristics curves with 95% confidence limits were 0.85 (0.76 - 0.94) for fCp, 0.61 (0.47 - 0.74) for BMN sCp, 0.61 (0.48 - 0.75) for IDK sCp, 0.69 (0.56 - 0.81) for sCRP, and 0.52 (0.38 - 0.66) for blood platelets. CONCLUSIONS FCp is the optimum biomarker for discriminating between active and inactive UC. The diagnostic performance of sCp, irrespective of assay, and systemic biomarkers was poor; of these sCRP performed best.
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Affiliation(s)
| | | | | | | | - Matthew Brookes
- Department of Gastroenterology8692Royal Wolverhampton Hospitals NHS Trust
| | - Clare Ford
- Clinical Chemistry156543New Cross Hospital
| | - Rousseau Gama
- Blood Sciences8692Royal Wolverhampton Hospitals NHS Trust
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Allen CM, Rier L, Halsey L, Gascoyne L, Dineen R, DasNair R, Brookes M, Evangelou N. 124 MEGAbIT – the role of OPM MEG in assessment and diagnosis In mTBI. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Can those with mild traumatic brain injury (mTBI) be differentiated from non-head injured orthopaedic trauma controls by measuring brain wave activity? These are the preliminary data from MEGAbIT, a MRC Confidence in Concept funded study. Clinical Trials reference:NCT03867513Whilst most individuals with mTBI recover, a significant proportion have persistent difficulties. These patients have normal routine scans, and consequently a biomarker to understand the neuropathology underly- ing these symptoms is lacking. We have combined ultrahigh field 7T MRI with magnetoencephalography (MEG), to look for structural and functional abnormalities in acute mTBI. Following a systematic review of the MEG mTBI literature, we established that the most robust finding is increased power in the delta frequency band following mTBI. So far, in our study, 10 of the 13 mTBI participants have shown this abnormality.Comparisons of spectral power between the mTBI cohort and controls in other frequency bands were less sensitive biomarkers of mTBI. Full analysis to be presented will include assessment of whole-brain con- nectivity using amplitude envelope correlation, structural damage using high-resolution susceptibility weighted imaging and structural connectivity using diffusion tensor imaging. Our results are in keeping with publications suggesting that MEG can detect mTBI abnormalities when structural imaging is normal.christopher.allen@nottingham.ac.uk
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Feys O, Corvilain P, Aeby A, Sculier C, Holmes N, Brookes M, Goldman S, Wens V, De Tiège X. On-Scalp Optically Pumped Magnetometers versus Cryogenic Magnetoencephalography for Diagnostic Evaluation of Epilepsy in School-aged Children. Radiology 2022; 304:429-434. [PMID: 35503013 DOI: 10.1148/radiol.212453] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Magnetoencephalography (MEG) is an established method used to detect and localize focal interictal epileptiform discharges (IEDs). Current MEG systems house hundreds of cryogenic sensors in a rigid, one-size-fits-all helmet, which results in several limitations, particularly in children. Purpose To determine if on-scalp MEG based on optically pumped magnetometers (OPMs) alleviates the main limitations of cryogenic MEG. Materials and Methods In this prospective single-center study conducted in a tertiary university teaching hospital, participants underwent cryogenic (102 magnetometers, 204 planar gradiometers) and on-scalp (32 OPMs) MEG. The two modalities for the detection and localization of IEDs were compared. The t test was used to compare IED amplitude and signal-to-noise ratio (SNR). Distributed source modeling was performed on OPM-based and cryogenic MEG data. Results Five children (median age, 9.4 years [range, 5-11 years]; four girls) with self-limited idiopathic (n = 3) or refractory (n = 2) focal epilepsy were included. IEDs were identified in all five children with comparable sensor topographies for both MEG devices. IED amplitudes were 2.3 (7.2 of 3.1) to 4.6 (3.2 of 0.7) times higher (P < .001) with on-scalp MEG, and the SNR was 27% (16.7 of 13.2) to 60% (12.8 of 8.0) higher (P value range: .001-.009) with on-scalp MEG in all but one participant (P = .93), whose head movements created pronounced motion artifacts. The neural source of averaged IEDs was located at approximately 5 mm (n = 3) or higher (8.3 mm, n = 1; 15.6 mm, n = 1) between on-scalp and cryogenic MEG. Conclusion Despite the limited number of sensors and scalp coverage, on-scalp magnetoencephalography (MEG) based on optically pumped magnetometers helped detect interictal epileptiform discharges in school-aged children with epilepsy with a higher amplitude, higher signal-to-noise ratio, and similar localization value compared with conventional cryogenic MEG. Online supplemental material is available for this article. © RSNA, 2022 See also the editorial by Widjaja in this issue.
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Affiliation(s)
- Odile Feys
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Pierre Corvilain
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Alec Aeby
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Claudine Sculier
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Niall Holmes
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Matthew Brookes
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Serge Goldman
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Vincent Wens
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
| | - Xavier De Tiège
- From the Departments of Neurology (O.F.), Pediatric Neurology (C.S., F.C.), Nuclear Medicine (S.G.), and Translational Neuroimaging (V.W., X.D.T.), CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Translational Neuroimaging and Neuroanatomy (Laboratoire de Neuroimagerie et Neuroanatomie translationnelles) (LNT), ULB Neuroscience Institute, Université Libre de Bruxelles, 808 Lennik St, Brussels, Belgium (O.F., P.C., S.G., V.W., X.D.T.); Department of Pediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium (A.A.); and Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom (N.H., M.B.)
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Kirk J, Willcocks J, Boyle P, Brocklehurst P, Morris K, Kearney R, Holden M, Brookes M. Developing chief investigators within the NHS: the West Midlands clinical trials scholars programme. Clin Med (Lond) 2022; 22:149-152. [PMID: 38589177 DOI: 10.7861/clinmed.2021-0606] [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] [Indexed: 11/27/2022]
Abstract
Consecutive Royal College of Physicians' Research for all surveys have highlighted the challenges for doctors becoming involved in research. Local issues included under-representation of chief investigators (CIs) and reduction in dedicated research time. The West Midlands National Institute for Health Research (NIHR) Clinical Research Network (CRN) established a clinical trials scholarship (CTS) initiative in 2019 to develop research-active consultants in smaller trusts, with a dedicated day per week embedded in a local clinical trials unit. In the initial round of 41 applications from 13 partner organisations, 17 CTSs were appointed, including nine consultant physicians, with one subsequently deferring. After 2 years, the remaining 16 CTSs have been awarded 40 grants totalling £18.35 million as CI or co-CI, including 10 NIHR grants, plus >200 publications. These scholarships are a proven cost-effective way to develop CIs, provide academic leadership and promote a research culture, even in small, previously less research-active trusts.
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Affiliation(s)
- Jeremy Kirk
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK.
| | - Jane Willcocks
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK
| | - Pauline Boyle
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK
| | | | | | | | | | - Matthew Brookes
- National Institute for Health Research Clinical Research Network West Midlands, Birmingham, UK
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Rye E, Tam C, Nguyen H, Farrell M, McNatty D, Brookes M, Morris J, Sindone A, Tofler G. HEart Failure Dashboard Project (HEFD): An Innovative eMR Based Quality Improvement Project. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rosiou K, Ong Ming San E, Kumar A, Esquivel K, Almas S, Stokes D, Ng T, Jayasooriya N, Ranasinghe I, Pollok R, Brookes M, Selinger CP. Comparative Outcomes of Budesonide MMX versus Prednisolone for Ulcerative Colitis: Results from a British Retrospective Multi-Centre Real-World Study. J Clin Med 2021; 10:jcm10194329. [PMID: 34640345 PMCID: PMC8509767 DOI: 10.3390/jcm10194329] [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: 07/28/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic many IBD units chose Budesonide MMX (Cortiment) as the first-line treatment for flares of ulcerative colitis (UC) in outpatients for its favourable side effect profile. This retrospective study of all UC patients treated with oral steroids between 1 March 2019–30 June 2019 and 1 March 2020–30 June 2020 aimed to compare Cortiment with Prednisolone in routine clinical practice. Outcomes included the need for hospitalisation for acute severe ulcerative colitis, symptoms at four weeks and end of treatment, and the need for rescue Prednisolone. The 2019 and 2020 cohorts did not differ at the baseline. Cortiment prescriptions rose from 24.5% in 2019 to 70.1% in 2020 (p < 0.001). At week four there were significant differences between 2019 and 2020 in mean bowel frequency (3.49 vs. 5.85, p = 0.001), rectal bleeding <50% (89.7% vs. 73.1% of patients, p = 0.039), and physician global assessment (PGA) (39.2% vs. 19.8% in remission, p = 0.045). There was no significant difference in hospital admissions, rectal bleeding, and PGA at week eight. Rescue Prednisolone was required in 10% of Cortiment patients in 2019 vs. 31.3% in 2020 (p = 0.058). Active IBD is associated with worse COVID-19 outcomes prompting the careful evaluation of the choice of first-line steroid for UC, as Cortiment was associated with worse outcomes at four weeks.
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Affiliation(s)
- Konstantina Rosiou
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals, Leeds LS9 7TF, UK; (K.R.); (E.O.M.S.)
| | - Elaine Ong Ming San
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals, Leeds LS9 7TF, UK; (K.R.); (E.O.M.S.)
| | - Aditi Kumar
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK; (A.K.); (K.E.); (S.A.); (D.S.); (M.B.)
| | - Kim Esquivel
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK; (A.K.); (K.E.); (S.A.); (D.S.); (M.B.)
| | - Saima Almas
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK; (A.K.); (K.E.); (S.A.); (D.S.); (M.B.)
| | - Daniel Stokes
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK; (A.K.); (K.E.); (S.A.); (D.S.); (M.B.)
| | - Tze Ng
- Department of Gastroenterology, St Georges Hospital, London SW17 0QT, UK; (T.N.); (N.J.); (I.R.); (R.P.)
| | - Nishani Jayasooriya
- Department of Gastroenterology, St Georges Hospital, London SW17 0QT, UK; (T.N.); (N.J.); (I.R.); (R.P.)
| | - Ian Ranasinghe
- Department of Gastroenterology, St Georges Hospital, London SW17 0QT, UK; (T.N.); (N.J.); (I.R.); (R.P.)
| | - Richard Pollok
- Department of Gastroenterology, St Georges Hospital, London SW17 0QT, UK; (T.N.); (N.J.); (I.R.); (R.P.)
| | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK; (A.K.); (K.E.); (S.A.); (D.S.); (M.B.)
- Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton WV1 1LY, UK
| | - Christian P. Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals, Leeds LS9 7TF, UK; (K.R.); (E.O.M.S.)
- Correspondence: ; Tel.: +44-113-206-8768
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Pelitari S, Gautham A, Mistry P, Mohan S, Brookes M, McKaig B, Shah A, Jewes S, Fieldhouse G, Veitch A, Murugananthan A. Impact on healthcare resources of switch from fecal occult blood test to fecal immunochemical test within the English Bowel Cancer Screening Program: a single-center study. Gastrointest Endosc 2021; 94:598-606. [PMID: 33727015 DOI: 10.1016/j.gie.2021.03.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/05/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS In July 2019, the fecal immunochemistry test (FIT) replaced the fecal occult blood test (FOBT) in England as the Bowel Cancer Screening Program (BCSP) screening tool. We aimed to assess the impact of this on healthcare resources at our BCSP center. METHODS Two 6-month periods were initially analyzed for stool sample return and positivity rates. A subsequent comparative analysis of patient screening episodes assessed utilization of specialist screening practitioner (SSP) time, endoscopy, histology, radiology, surgical, and oncology service usage. RESULTS A total of 42,234 patients received FOBT and 42,545 patients received FIT stool kits, with FIT showing higher return (61.8% vs 58.58%, FIT vs FOBT, P < .001) and sample positivity rates (2.41% vs 1.45%, FIT vs FOBT, P < .001). Four hundred patients commenced FOBT and 616 FIT screening episodes, a 54% increase. The FIT group had of a lower mean age (67.5 vs 69.5 years, FIT vs FOBT, P = .0001) with a lower nonattendance rate (.16% vs 1.5%, FIT vs FOBT, P = .01). With higher patient numbers, the FIT group required 69% more endoscopic procedures, 58% increased SSP time, 40% more radiologic tests, and 68% higher surgical procedures. FIT also led to a 109% increase in endoscopy-derived histology samples from an increase in the proportion of patients with polyps with FIT (54.8% vs 47.2%, P = .020) and a greater number of polyps per patient in whom polyps were found (3.00 vs 2.50 polyps, P = .017). This additional service burden equated to additional financial costs of approximately $558,000 per annum. CONCLUSIONS The implementation of FIT led to notable increases in SSP time, endoscopy procedures, radiology tests, surgical procedures, and histopathology services, resulting in considerable ongoing financial implications on the organization. Findings can be used to aid workforce and service planning in National Health Service sites delivering BCSP and countries that have already adopted or are considering FIT within their national screening programs.
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Affiliation(s)
- Stavroula Pelitari
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Abhirami Gautham
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Pritesh Mistry
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Siddhartha Mohan
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Matthew Brookes
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK; Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Brian McKaig
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Ashit Shah
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Sarah Jewes
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Gemma Fieldhouse
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Andrew Veitch
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
| | - Aravinth Murugananthan
- The Royal Wolverhampton NHS Trust, Gastroenterology Department, Medical Division, Wolverhampton, UK
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Rutter MD, Brookes M, Lee TJ, Rogers P, Sharp L. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut 2021; 70:537-543. [PMID: 32690602 PMCID: PMC7385747 DOI: 10.1136/gutjnl-2020-322179] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK's National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis. DESIGN We developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16-22 March) and COVID-impacted (23 March-31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated. RESULTS A weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal). CONCLUSION This national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Brookes
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
- Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bloom J, Andrew E, Nehme Z, Dinh D, Shi W, Vriesendorp P, Nanayakarra S, Fernando H, Dawson L, Brennan A, Noaman S, Layland J, William J, Al-Fiadh A, Brookes M, Freeman M, Hutchinson A, McGaw D, Van GW, Wilson W, White A, Prakash R, Reid C, Lefkovits J, Duffy S, Chan W, Kaye D, Stephenson M, Bernard S, Smith K, Stub D. Pre-Hospital Heparin Use for ST-Elevation Myocardial Infarction is Safe and Improves Angiographic Outcomes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Hoffe S, Frakes JM, Aguilera TA, Czito B, Palta M, Brookes M, Schweizer C, Colbert L, Moningi S, Bhutani MS, Pant S, Tzeng CW, Tidwell RS, Thall P, Yuan Y, Moser EC, Holmlund J, Herman J, Taniguchi CM. Randomized, Double-Blinded, Placebo-controlled Multicenter Adaptive Phase 1-2 Trial of GC 4419, a Dismutase Mimetic, in Combination with High Dose Stereotactic Body Radiation Therapy (SBRT) in Locally Advanced Pancreatic Cancer (PC). Int J Radiat Oncol Biol Phys 2020; 108:1399-1400. [PMID: 33427657 DOI: 10.1016/j.ijrobp.2020.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Hoffe
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J M Frakes
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - T A Aguilera
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - B Czito
- Duke University Medical Center, Durham, NC
| | - M Palta
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | | | | | - L Colbert
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Moningi
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - S Pant
- (10)University of Oklahoma Health Science Center, Stephenson Cancer Center, Department of Hematology & Oncology, Oklahoma City, OK
| | - C W Tzeng
- (11)The Univ of Texas MD Anderson Cancer Center, Houston, TX
| | - R S Tidwell
- (12)MD Anderson Cancer Center, Department of Biostatistics, Houston, TX
| | - P Thall
- (13)Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y Yuan
- MD Anderson Cancer Center, Houston, TX
| | | | - J Holmlund
- (14)Galera Therapeutics Inc., Malvern, PA
| | - J Herman
- (15)Northwell Health Cancer Institute, Lake Success, NY
| | - C M Taniguchi
- (16)UT MD Anderson Cancer Center, Houston, TX; (17)Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Catlow J, Sharp L, Kasim A, Lu L, Brookes M, Lee T, McCarthy S, Gray J, Sniehotta F, Deane J, Rutter M. The National Endoscopy Database (NED) Automated Performance Reports to Improve Quality Outcomes Trial (APRIQOT) randomized controlled trial design. Endosc Int Open 2020; 8:E1545-E1552. [PMID: 33140009 PMCID: PMC7584467 DOI: 10.1055/a-1261-3151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Colonoscopists with low polyp detection have higher post colonoscopy colorectal cancer incidence and mortality rates. The United Kingdom's National Endoscopy Database (NED) automatically captures patient level data in real time and provides endoscopy key performance indicators (KPI) at a national, endoscopy center, and individual level. Using an electronic behavior change intervention, the primary objective of this study is to assess if automated feedback of endoscopist and endoscopy center-level optimal procedure-adjusted detection KPI (opadKPI) improves polyp detection performance. Methods This multicenter, prospective, cluster-randomized controlled trial is randomizing NHS endoscopy centres to either intervention or control. The intervention is targeted at independent colonoscopists and each center's endoscopy lead. The intervention reports are evidence-based from endoscopist qualitative interviews and informed by psychological theories of behavior. NED automatically creates monthly reports providing an opadKPI, using mean number of polyps, and an action plan. The primary outcome is opadKPI comparing endoscopists in intervention and control centers at 9 months. Secondary outcomes include other KPI and proximal detection measures at 9 and 12 months. A nested histological validation study will correlate opadKPI to adenoma detection rate at the center level. A cost-effectiveness and budget impact analysis will be undertaken. Conclusion If the intervention is efficacious and cost-effective, we will showcase the potential of this learning health system, which can be implemented at local and national levels to improve colonoscopy quality, and demonstrate that an automated system that collects, analyses, and disseminates real-time clinical data can deliver evidence- and theory-informed feedback.
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Affiliation(s)
- Jamie Catlow
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland,North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
| | - Linda Sharp
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Adetayo Kasim
- Durham University, Wolfson Research Institute of Health and Wellbeing, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Liya Lu
- Newcastle University Centre for Cancer – Populations Health Sciences Institute, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Brookes
- Royal Wolverhampton Hospitals NHS Trust, Gastroenterology, Wolverhamptonm
| | - Tom Lee
- Northumbria Healthcare NHS Foundation Trust, Gastroenterology, North Shields, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
| | - Stephen McCarthy
- Northumbria University, Department of Nursing, Midwifery & Health, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Joanne Gray
- Northumbria University, Department of Nursing, Midwifery & Health, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Falko Sniehotta
- Newcastle University, Population and Health Sciences Institute, Newcastle Upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
| | - Jill Deane
- North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland
| | - Matt Rutter
- North Tees and Hartlepool NHL Foundation Trust – Gastroenterology, Stockton on Tees, United Kingdom of Great Britain and Northern Ireland,Newcastle University, Centre for Cancer, Newcastle Upon Tyne, Tyne and Wear, United Kingdom of Great Britain and Northern Ireland
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23
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1147] [Impact Index Per Article: 229.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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24
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Misra R, Limdi J, Cooney R, Sakuma S, Brookes M, Fogden E, Pattni S, Sharma N, Iqbal T, Munkholm P, Burisch J, Arebi N. Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study. World J Gastroenterol 2019; 25:6145-6157. [PMID: 31686769 PMCID: PMC6824277 DOI: 10.3748/wjg.v25.i40.6145] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/01/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The current epidemiology of inflammatory bowel disease (IBD) in the multi-ethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago.
AIM To describe the incidence and phenotype of IBD and distribution within ethnic groups.
METHODS Adult patients (> 16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype (Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database.
RESULTS Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis (UC, 64.3%), 115 with Crohn's disease (CD, 33.9%) and 6 with IBD unclassified (1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group (25.2/100000 and 20.5/100000) compared to White European (14.9/100000, P = 0.009 and 8.2/100000, P < 0.001) and Pakistani groups (14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans (52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment.
CONCLUSION This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC (20.5/100000). Further studies on dietary, microbial and metabolic factors that might explain these findings in UC are underway.
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Affiliation(s)
- Ravi Misra
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
| | - Jimmy Limdi
- The Pennine Acute Hospitals NHS Trust, Institute of Inflammation and Repair, University of Manchester, Manchester BL9 7TD, United Kingdom
| | - Rachel Cooney
- Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
| | - Samia Sakuma
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
| | - Matthew Brookes
- Gastroenterology, Royal Wolverhampton NHS Trust, London WV10 0QP, United Kingdom
| | - Edward Fogden
- Gastroenterology, Sandwell and West Birmingham Hospitals, Birmingham B71 4HJ, United Kingdom
| | - Sanjeev Pattni
- Gastroenterology, University Leicester Hospitals, Leicester LE1 5WW, United Kingdom
| | - Naveen Sharma
- Gastroenterology, Heartlands Hospital, Birmingham B9 5SS, United Kingdom
| | - Tariq Iqbal
- Gastroenterology, University Hospitals Birmingham, Birmingham B12 2TH, United Kingdom
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund 3600, Denmark
| | - Naila Arebi
- Gastroenterology, St. Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
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Witton C, Sergeyev SV, Turitsyna EG, Furlong PL, Seri S, Brookes M, Turitsyn SK. Rogue bioelectrical waves in the brain: the Hurst exponent as a potential measure for presurgical mapping in epilepsy. J Neural Eng 2019; 16:056019. [DOI: 10.1088/1741-2552/ab225e] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Ng O, Keeler B, Simpson JA, Madhusudan S, Brookes M, Acheson A. Feasibility of Intravenous Iron Isomaltoside to Improve Anemia and Quality of Life During Palliative Chemotherapy for Esophagogastric Adenocarcinoma. Nutr Cancer 2018; 70:1106-1117. [DOI: 10.1080/01635581.2018.1504090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Oliver Ng
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Barrie Keeler
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - John Alastair Simpson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Srinivasan Madhusudan
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - Austin Acheson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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27
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Siau K, Yew AC, Ishaq S, Jewes S, Shetty S, Brookes M, Veitch A, McKaig B, Murugananthan A. Colonoscopy conversion after flexible sigmoidoscopy screening: results from the UK Bowel Scope Screening Programme. Colorectal Dis 2018; 20:502-508. [PMID: 29205835 DOI: 10.1111/codi.13982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/12/2017] [Indexed: 12/11/2022]
Abstract
AIM In the UK Bowel Scope Screening Programme (BSSP), patients progress to colonoscopy based on high-risk features on flexible sigmoidoscopy (FS). We aim to assess the practice of colonoscopy conversion and predictors of detection of additional adenomas on colonoscopy. METHOD The Bowel Cancer Screening database was interrogated and collated with endoscopic and histological findings from patients undergoing colonoscopy following FS between August 2013 and August 2016. Multivariate analysis was performed to identify predictors of new adenomas. RESULTS FS was performed on 11 711 patients, with an adenoma detection rate (ADR) of 8.5% and conversion to colonoscopy in 421 (3.6%). The additional ADR at colonoscopy was 35.2%, with one additional malignant diagnosis (0.26%). The adenoma miss rate was 3.6%. On multivariate analysis, a polyp ≥ 10 mm was the only high-risk indication associated with additional ADR at colonoscopy (OR 3.68, 95% CI 1.51-3.65, P < 0.001), in addition to male gender (OR 2.36, 95% CI 1.46-3.83, P < 0.001). Predictors of detection of a new adenoma ≥ 10 mm included: villous adenoma (P = 0.002), polyp ≥ 10 mm (P = 0.007) and male gender (P = 0.039). The presence of any conversion criterion was associated with the detection of any proximal adenoma (P < 0.001) and adenoma ≥ 10 mm (P = 0.031). CONCLUSION Male gender, polyps ≥ 10 mm and villous-preponderant histology at FS were predictors of adenomas < 10 mm and ≥ 10 mm at colonoscopy. Further data are required to assess the role for gender-based stratification of conversion criteria.
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Affiliation(s)
- K Siau
- Joint Advisory Group on Gastrointestinal Endoscopy (JAG), Royal College of Physicians, London, UK.,Dudley Group NHS Foundation Trust, Dudley, UK
| | - A C Yew
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK
| | - S Ishaq
- Dudley Group NHS Foundation Trust, Dudley, UK.,Department of Medicine, Birmingham City University, Birmingham, UK
| | - S Jewes
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK
| | - S Shetty
- Dudley Group NHS Foundation Trust, Dudley, UK
| | - M Brookes
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK
| | - A Veitch
- Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK
| | - B McKaig
- Joint Advisory Group on Gastrointestinal Endoscopy (JAG), Royal College of Physicians, London, UK.,Royal Wolverhampton NHS Foundation Trust, Wolverhampton, UK
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28
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González-Méndez R, Watts P, Reich DF, Mullock SJ, Cairns S, Hickey P, Brookes M, Mayhew CA. Use of Rapid Reduced Electric Field Switching to Enhance Compound Specificity for Proton Transfer Reaction-Mass Spectrometry. Anal Chem 2018; 90:5664-5670. [DOI: 10.1021/acs.analchem.7b05211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ramón González-Méndez
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, U.K
| | - Peter Watts
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, U.K
| | - D. Fraser Reich
- Kore Technology, Ltd., Cambridgeshire Business Park, Ely, Cambridgeshire, CB7 4EA, U.K
| | - Stephen J. Mullock
- Kore Technology, Ltd., Cambridgeshire Business Park, Ely, Cambridgeshire, CB7 4EA, U.K
| | - Stuart Cairns
- Defence Science and Technology Laboratory, Fort Halstead, Sevenoaks, Kent, TN14 7BP, U.K
| | - Peter Hickey
- Defence Science and Technology Laboratory, Fort Halstead, Sevenoaks, Kent, TN14 7BP, U.K
| | - Matthew Brookes
- Defence Science and Technology Laboratory, Porton Down, Salisbury, Wilshire SP4 0JQ, U.K
| | - Chris A. Mayhew
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, U.K
- Institut für Atemgasanalytik, Leopold-Franzens-Universität Innsbruck, Rathausplatz 4, 6850, Dornbirn, Austria
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Affiliation(s)
- Hafid Omar Al-Hassi
- Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, UK
| | - Oliver Ng
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Matthew Brookes
- Gastroenterology Unit, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Meyer SS, Bonaiuto J, Lim M, Rossiter H, Waters S, Bradbury D, Bestmann S, Brookes M, Callaghan MF, Weiskopf N, Barnes GR. Flexible head-casts for high spatial precision MEG. J Neurosci Methods 2017; 276:38-45. [PMID: 27887969 PMCID: PMC5260820 DOI: 10.1016/j.jneumeth.2016.11.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 09/21/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND In combination with magnetoencephalographic (MEG) data, accurate knowledge of the brain's structure and location provide a principled way of reconstructing neural activity with high temporal resolution. However, measuring the brain's location is compromised by head movement during scanning, and by fiducial-based co-registration with magnetic resonance imaging (MRI) data. The uncertainty from these two factors introduces errors into the forward model and limit the spatial resolution of the data. NEW METHOD We present a method for stabilizing and reliably repositioning the head during scanning, and for co-registering MRI and MEG data with low error. RESULTS Using this new flexible and comfortable subject-specific head-cast prototype, we find within-session movements of <0.25mm and between-session repositioning errors around 1mm. COMPARISON WITH EXISTING METHOD(S) This method is an improvement over existing methods for stabilizing the head or correcting for location shifts on- or off-line, which still introduce approximately 5mm of uncertainty at best (Adjamian et al., 2004; Stolk et al., 2013; Whalen et al., 2008). Further, the head-cast design presented here is more comfortable, safer, and easier to use than the earlier 3D printed prototype, and give slightly lower co-registration errors (Troebinger et al., 2014b). CONCLUSIONS We provide an empirical example of how these head-casts impact on source level reproducibility. Employment of the individual flexible head-casts for MEG recordings provide a reliable method of safely stabilizing the head during MEG recordings, and for co-registering MRI anatomical images to MEG functional data.
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Affiliation(s)
- Sofie S Meyer
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK.
| | - James Bonaiuto
- Sobell Department for Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Mark Lim
- Chalk Studios Ltd, 14 Windsor St., N1 8QG, London, UK
| | - Holly Rossiter
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Sheena Waters
- Sobell Department for Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - David Bradbury
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Sven Bestmann
- Sobell Department for Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Matthew Brookes
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Martina F Callaghan
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1a, 04103 Leipzig, Germany
| | - Gareth R Barnes
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
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31
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Sharpe L, Brookes M, Jones E, Gittins C, Wufong E, Nicholas M. Threat and fear of pain induces attentional bias to pain words: An eye‐tracking study. Eur J Pain 2016; 21:385-396. [DOI: 10.1002/ejp.936] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- L. Sharpe
- School of Psychology The University of Sydney NSW Australia
| | - M. Brookes
- School of Psychology The University of Sydney NSW Australia
| | - E. Jones
- School of Psychology The University of Sydney NSW Australia
| | - C. Gittins
- School of Psychology The University of Sydney NSW Australia
| | - E. Wufong
- University of Western Sydney NSW Australia
| | - M.K. Nicholas
- Pain Management Research Unit University of Sydney NSW Australia
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González-Méndez R, Watts P, Olivenza-León D, Reich DF, Mullock SJ, Corlett CA, Cairns S, Hickey P, Brookes M, Mayhew CA. Enhancement of Compound Selectivity Using a Radio Frequency Ion-Funnel Proton Transfer Reaction Mass Spectrometer: Improved Specificity for Explosive Compounds. Anal Chem 2016; 88:10624-10630. [PMID: 27715015 DOI: 10.1021/acs.analchem.6b02982] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A key issue with any analytical system based on mass spectrometry with no initial separation of compounds is to have a high level of confidence in chemical assignment. This is particularly true for areas of security, such as airports, and recent terrorist attacks have highlighted the need for reliable analytical instrumentation. Proton transfer reaction mass spectrometry is a useful technology for these purposes because the chances of false positives are small owing to the use of a mass spectrometric analysis. However, the detection of an ion at a given m/z for an explosive does not guarantee that that explosive is present. There is still some ambiguity associated with any chemical assignment owing to the presence of isobaric compounds and, depending on mass resolution, ions with the same nominal m/z. In this article we describe how for the first time the use of a radio frequency ion-funnel (RFIF) in the reaction region (drift tube) of a proton transfer reaction-time-of-flight-mass spectrometer (PTR-ToF-MS) can be used to enhance specificity by manipulating the ion-molecule chemistry through collisional induced processes. Results for trinitrotoluene, dinitrotoluenes, and nitrotoluenes are presented to demonstrate the advantages of this new RFIF-PTR-ToF-MS for analytical chemical purposes.
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Affiliation(s)
- Ramón González-Méndez
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham , Edgbaston, Birmingham B15 2TT, U.K
| | - Peter Watts
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham , Edgbaston, Birmingham B15 2TT, U.K
| | - David Olivenza-León
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham , Edgbaston, Birmingham B15 2TT, U.K
| | - D Fraser Reich
- Kore Technology Ltd , Cambridgeshire Business Park, Ely, Cambridgeshire CB7 4EA, U.K
| | - Stephen J Mullock
- Kore Technology Ltd , Cambridgeshire Business Park, Ely, Cambridgeshire CB7 4EA, U.K
| | - Clive A Corlett
- Kore Technology Ltd , Cambridgeshire Business Park, Ely, Cambridgeshire CB7 4EA, U.K
| | - Stuart Cairns
- Defence Science and Technology Laboratory , Fort Halstead, Sevenoaks, Kent TN14 7BP, U.K
| | - Peter Hickey
- Defence Science and Technology Laboratory , Fort Halstead, Sevenoaks, Kent TN14 7BP, U.K
| | - Matthew Brookes
- Defence Science and Technology Laboratory , Porton Down, Salisbury, Wilshire SP4 0JQ, U.K
| | - Chris A Mayhew
- Molecular Physics Group, School of Physics and Astronomy, University of Birmingham , Edgbaston, Birmingham B15 2TT, U.K.,Institut für Atemgasanalytik, Leopold-Franzens-Universitaet Innsbruck , Innsbruck 6020, Austria
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Affiliation(s)
- D J Richards
- Arthritis Research Unit and Department of Anatomy, Guy's Hospital, London
| | - M Brookes
- Arthritis Research Unit and Department of Anatomy, Guy's Hospital, London
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Johnstone J, David A, Morgan A, Brookes M. 20: The importance of a well organised and appropriate referral pathway for the management of gastrointestinal incidental findings on PET-CT done for lung cancer. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Early F, Watts T, Homan K, Green A, Brookes M, Fuld J. P93 Supporting Patient Involvement In Service Development: Eliciting Patient-centred Information To Inform Commissioning Of Copd Services. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.234] [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: 11/03/2022]
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Stevenson C, Brookes M, López JD, Troebinger L, Mattout J, Penny W, Morris P, Hillebrand A, Henson R, Barnes G. Does function fit structure? A ground truth for non-invasive neuroimaging. Neuroimage 2014; 94:89-95. [PMID: 24636880 PMCID: PMC4073649 DOI: 10.1016/j.neuroimage.2014.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 11/25/2022] Open
Abstract
There are now a number of non-invasive methods to image human brain function in-vivo. However, the accuracy of these images remains unknown and can currently only be estimated through the use of invasive recordings to generate a functional ground truth. Neuronal activity follows grey matter structure and accurate estimates of neuronal activity will have stronger support from accurate generative models of anatomy. Here we introduce a general framework that, for the first time, enables the spatial distortion of a functional brain image to be estimated empirically. We use a spherical harmonic decomposition to modulate each cortical hemisphere from its original form towards progressively simpler structures, ending in an ellipsoid. Functional estimates that are not supported by the simpler cortical structures have less inherent spatial distortion. This method allows us to compare directly between magnetoencephalography (MEG) source reconstructions based upon different assumption sets without recourse to functional ground truth. We use spherical harmonics to create generative cortical surface models. Accurate functional estimates will be best supported by veridical cortical models. The method provides spatial confidence bounds for non-invasive functional images.
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Affiliation(s)
| | | | - José David López
- SISTEMIC, Engineering Faculty, Universidad de Antioquia, Medellín, Colombia
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Johnstone J, Fletcher R, Morgan A, Brookes M. 62 Gastrointestinal incidental findings of PET CT done for lung cancer and their follow up. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70062-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Woolrich MW, Baker A, Luckhoo H, Mohseni H, Barnes G, Brookes M, Rezek I. Dynamic state allocation for MEG source reconstruction. Neuroimage 2013; 77:77-92. [PMID: 23545283 PMCID: PMC3898887 DOI: 10.1016/j.neuroimage.2013.03.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 10/30/2012] [Revised: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 11/16/2022] Open
Abstract
Our understanding of the dynamics of neuronal activity in the human brain remains limited, due in part to a lack of adequate methods for reconstructing neuronal activity from noninvasive electrophysiological data. Here, we present a novel adaptive time-varying approach to source reconstruction that can be applied to magnetoencephalography (MEG) and electroencephalography (EEG) data. The method is underpinned by a Hidden Markov Model (HMM), which infers the points in time when particular states re-occur in the sensor space data. HMM inference finds short-lived states on the scale of 100ms. Intriguingly, this is on the same timescale as EEG microstates. The resulting state time courses can be used to intelligently pool data over these distinct and short-lived periods in time. This is used to compute time-varying data covariance matrices for use in beamforming, resulting in a source reconstruction approach that can tune its spatial filtering properties to those required at different points in time. Proof of principle is demonstrated with simulated data, and we demonstrate improvements when the method is applied to MEG.
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Affiliation(s)
- Mark W Woolrich
- Oxford Centre for Human Brain Activity (OHBA), University of Oxford, Warneford Hospital, Oxford, UK.
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Sonpavde G, Matveev V, Burke J, Caton J, Fleming M, Hutson T, Galsky M, Berry W, Karlov P, Holmlund J, Wood B, Brookes M, Leopold L. Randomized phase II trial of docetaxel plus prednisone in combination with placebo or AT-101, an oral small molecule Bcl-2 family antagonist, as first-line therapy for metastatic castration-resistant prostate cancer. Ann Oncol 2012; 23:1803-8. [DOI: 10.1093/annonc/mdr555] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dowswell G, Ryan A, Taylor A, Daley A, Freemantle N, Brookes M, Jones J, Haslop R, Grimmett C, Cheng KK, Sue W. Designing an intervention to help people with colorectal adenomas reduce their intake of red and processed meat and increase their levels of physical activity: a qualitative study. BMC Cancer 2012; 12:255. [PMID: 22708848 PMCID: PMC3532076 DOI: 10.1186/1471-2407-12-255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 05/09/2012] [Indexed: 01/19/2023] Open
Abstract
Background Most cases of colorectal cancer (CRC) arise from adenomatous polyps and malignant potential is greatest in high risk adenomas. There is convincing observational evidence that red and processed meat increase the risk of CRC and that higher levels of physical activity reduce the risk. However, no definitive randomised trial has demonstrated the benefit of behaviour change on reducing polyp recurrence and no consistent advice is currently offered to minimise patient risk. This qualitative study aimed to assess patients’ preferences for dietary and physical activity interventions and ensure their appropriate and acceptable delivery to inform a feasibility trial. Methods Patients aged 60–74 included in the National Health Service Bowel Cancer Screening Programme (NHSBCSP) were selected from a patient tracking database. After a positive faecal occult blood test (FOBt), all had been diagnosed with an intermediate or high risk adenoma (I/HRA) at colonoscopy between April 2008 and April 2010. Interested patients and their partners were invited to attend a focus group or interview in July 2010. A topic guide, informed by the objectives of the study, was used. A thematic analysis was conducted in which transcripts were examined to ensure that all occurrences of each theme had been accounted for and compared. Results Two main themes emerged from the focus groups: a) experiences of having polyps and b) changing behaviour. Participants had not associated polyp removal with colorectal cancer and most did not remember being given any information or advice relating to this at the time. Heterogeneity of existing diet and physical activity levels was noted. There was a lack of readiness to change behaviour in many people in the target population. Conclusions This study has confirmed and amplified recently published factors involved in developing interventions to change dietary and physical activity behaviour in this population. The need to tailor the intervention to individuals, the lack of knowledge about the aetiology of colon cancer and the lack of motivation to change behaviour are critical factors. Trial registration Current Controlled Trials ISRCTN03320951
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Affiliation(s)
- George Dowswell
- Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Bosanko NC, Chauhan A, Brookes M, Moss M, Wilson PG. Presentations of pyogenic liver abscess in one UK centre over a 15-year period. J R Coll Physicians Edinb 2011; 41:13-7. [PMID: 21365060 DOI: 10.4997/jrcpe.2011.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Pyogenic liver abscess (PLA) has been a condition of high mortality, improving over recent decades with combined antibiotic and percutaneous drainage. We aimed to identify the presenting features, diagnosis, microbiology, treatment and outcome for patients over a 15-year period at an inner-city hospital. METHODS Patients with an appropriate discharge diagnosis were identified and case records retrospectively analysed. RESULTS A total of 73 patient records were analysed. Common presenting features were anorexia, abdominal pain, fever, vomiting and weight loss with raised white cell count, C-reactive protein, alkaline phosphatase and hypoalbuminaemia. The delay following symptom onset to presentation was a mean of 17.3 days. The inclusion of PLA as a possible diagnosis on admission was only considered in 1% of cases. Positive blood or abscess culture was achieved in 63% of cases. We recorded a hospital mortality rate of 11%. CONCLUSIONS In this sample, PLA was rarely considered as a possible diagnosis at presentation. There are common presenting features, which should prompt early investigation. Our microbiological yield was lower than in some studies and may be due to the early empirical use of antibiotics, without microbiological guidance. Percutaneous drainage and antibiotic treatment remain the mainstay of management. The underlying cause for PLA is often not identified. Emerging septicaemia or underlying malignancy were strong predictors of mortality.
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Affiliation(s)
- N C Bosanko
- Sandwell and West Birmingham NHS Trust, Birmingham, UK.
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Fleming MT, Pond GR, Armstrong AJ, Wood BA, Brookes M, Leopold LH, Matveev VB, Burke JM, Caton JR, Sonpavde G. Ability of serum alkaline phosphatase (ALP) changes to complement PSA changes and predict survival in men with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel and prednisone (DP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15019] [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: 11/20/2022] Open
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Sonpavde G, Matveev VB, Burke JM, Caton JR, Fleming MT, Karlov PA, Holmlund J, Wood BA, Brookes M, Leopold LH. A randomized, double-blind phase II trial of docetaxel plus prednisone (DP) combined with either AT-101 or placebo for the first-line therapy of metastatic castration-resistant prostate cancer (CRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pond GR, Armstrong AJ, Wood BA, Brookes M, Leopold LH, Berry WR, De Wit R, Eisenberger MA, Tannock I, Sonpavde G. Evaluating the value of continuing docetaxel and prednisone (DP) beyond 10 cycles in men with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pond GR, Armstrong AJ, Wood BA, Brookes M, Leopold LH, Burke JM, Caton JR, Fleming MT, Sonpavde G. Assessment of two prognostic risk group methods to predict outcomes with docetaxel-based therapy in men with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
185 Background: Threeprognosticrisk groups have been identified in men with mCRPC (good [GR]/intermediate [IR]/poor [PR]) based on 0-1, 2 or 3-4 factors (visceral disease, pain, anemia, bone scan progression). Prostate Cancer Working Group (PCWG)-2 defines clinical subtypes with visceral disease, bone metastases ± nodal metastases and nodal disease only. The prognostic ability of risk grouping or PCWG2 subtypes was evaluated in a large, independent phase II trial. Methods: A randomized phase IItrial of 221 men with mCRPC that received docetaxel-prednisone (DP) + AT-101 (Bcl-2 inhibitor) or DP + placebo was retrospectively analyzed using Cox regression and χ2 tests. Additional outcomes, tests and measures of discriminatory ability were assessed and will be presented. Patients from both groups were combined for analysis, as no significant differences in outcomes were observed. Results: 93, 81 and 38 men had GR, IR and PR disease. GR men were more likely than IR/PR men to be ECOG-PS 0 (48%, 27%, 21%) and had a lower median baseline PSA (63, 85, 193 ng/ml). Significant differences between risk groups were observed for progression-free survival (PFS, p=0.009) and overall survival (OS, p<0.001), while PCWG2 subtypes did not discriminate for these outcomes. Both risk groups and PCWG2 subtypes inconsistently predicted PSA declines (table). Conclusions: Prognostic risk groups significantly distinguished between outcomes in men with mCRPC receiving DP-based therapy, while PCWG2 subtypes did not. Risk groups may enhance stratification of patients in randomized trials and enable tailored drug development. Prognostic models that incorporate tumor molecular features may improve discriminatory ability. [Table: see text] [Table: see text]
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Affiliation(s)
- G. R. Pond
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - A. J. Armstrong
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - B. A. Wood
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - M. Brookes
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - L. H. Leopold
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - J. M. Burke
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - J. R. Caton
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - M. T. Fleming
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
| | - G. Sonpavde
- McMaster University, Hamilton, ON, Canada; Duke University Medical Center, Durham, NC; Ascenta Therapeutics, Malvern, PA; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; Texas Oncology, Baylor College of Medicine, Houston, TX
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Sonpavde G, Matveev VB, Burke JM, Caton JR, Fleming MT, Karlov PA, Holmlund J, Wood BA, Brookes M, Leopold LH. A randomized, double-blind phase II trial of docetaxel plus prednisone (DP) combined with either AT101 or placebo for the first-line therapy of metastatic castration-resistant prostate cancer (CRPC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
125 Background: AT-101 (A), a small molecule oral inhibitor of the Bcl-2 protein family has broad preclinical activity including synergy with docetaxel (D). AT-101 has demonstrated activity alone and in combination with D in D-refractory patients with metastatic CRPC. Methods: A randomized, double-blind, placebo-controlled phase II trial was conducted to compare the combination of DP with either A or placebo in chemo-naive men with progressive metastatic CRPC. A key requirement was progression (bone scan, RECIST or rising PSA ≥ 2 ng/mL) despite androgen deprivation. Stratification factors were pain and performance status. Patients received DP (75mg/m2 day 1; 5mg PO b.i.d.) Q 21 days (1 cycle) with either A (40 mg b.i.d.) or placebo PO on days 1–3. Radiological assessments were performed every 3 cycles. Primary endpoint was overall survival (OS) and 221 patients were planned for 110 events (80% power, HR 0.67, 1-sided alpha 0.1). Results: 221 patients were randomized to ADP or placebo-DP and baseline factors were balanced. Efficacy outcomes (OS, PFS, PSA declines, disease control) were not significantly different ( Table ). In a subgroup of patients with poor-risk CRPC (n=34), efficacy endpoints appeared to favor ADP with a median OS of 19 months vs.14 months for placebo-DP. Grade 3/4 AEs that occurred with higher incidence in the ADP arm compared to placebo-DP included cardiac AEs (5% vs. 2%), lymphopenia (23% vs. 16%), neutropenia (47% vs. 40%), ileus (2% vs. 0%) and pulmonary embolism (6% vs. 2%). Conclusions: The combination of AT-101 with DP in men with chemonaive metastatic CRPC was well tolerated but did not extend OS compared to placebo-DP. There was a potential benefit in a subset of high-risk patients. [Table: see text] [Table: see text]
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Affiliation(s)
- G. Sonpavde
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - V. B. Matveev
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - J. M. Burke
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - J. R. Caton
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - M. T. Fleming
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - P. A. Karlov
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - J. Holmlund
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - B. A. Wood
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - M. Brookes
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
| | - L. H. Leopold
- Texas Oncology, Baylor College of Medicine, Houston, TX; N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia; Rocky Mountain Cancer Centers, Aurora, CO; Willamette Valley Cancer Center, Eugene, OR; US Oncology Research, The Woodlands, TX; Virginia Oncology Associates, Hampton, VA; St. Petersburg City Clinical Oncology Center, St. Petersburg, Russia; Ascenta Therapeutics, Carlsbad, CA; Ascenta Therapeutics, Malvern, PA
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Fogden E, Brookes M. Is medical research in the U.K. in decline? Clin Med (Lond) 2009; 9:296-297. [PMID: 19634403] [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: 05/28/2023]
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Brookes M, Eldabe S. 320 CASE REPORT: EFFICACY OF ZICONOTIDE IN MIXED NEUROPATHIC AND NOCICEPTIVE PAIN. Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brookes M, MacVicar D, Husband J. Metastatic carcinoma of the breast: the appearances of metastatic spread to the abdomen and pelvis as demonstrated by CT. Br J Radiol 2007; 80:284-92. [PMID: 17038411 DOI: 10.1259/bjr/50066770] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This review illustrates some CT appearances of metastatic breast cancer in the subdiaphragmatic abdomen and pelvis. Such manifestations are not uncommon in advanced disease and familiarity will enable confident diagnosis in patients at risk for metastatic disease.
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Affiliation(s)
- M Brookes
- Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT
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