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Herzog C, Jones A, Evans I, Reisel D, Olaitan A, Doufekas K, MacDonald N, Rådestad AF, Gemzell-Danielsson K, Zikan M, Cibula D, Dostálek L, Paprotka T, Leimbach A, Schmitt M, Ryan A, Gentry-Maharaj A, Apostolidou S, Rosenthal AN, Menon U, Widschwendter M. Plasma cell-free DNA methylation analysis for ovarian cancer detection: Analysis of samples from a case-control study and an ovarian cancer screening trial. Int J Cancer 2024; 154:679-691. [PMID: 37861205 DOI: 10.1002/ijc.34757] [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: 05/22/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
Analysis of cell-free DNA methylation (cfDNAme), alone or combined with CA125, could help to detect ovarian cancers earlier and may reduce mortality. We assessed cfDNAme in regions of ZNF154, C2CD4D and WNT6 via targeted bisulfite sequencing in diagnostic and early detection (preceding diagnosis) settings. Diagnostic samples were obtained via prospective blood collection in cell-free DNA tubes in a convenience series of patients with a pelvic mass. Early detection samples were matched case-control samples derived from the UK Familial Ovarian Cancer Screening Study (UKFOCSS). In the diagnostic set (ncases = 27, ncontrols = 41), the specificity of cfDNAme was 97.6% (95% CI: 87.1%-99.9%). High-risk cancers were detected with a sensitivity of 80% (56.3%-94.3%). Combination of cfDNAme and CA125 resulted in a sensitivity of 94.4% (72.7%-99.9%) for high-risk cancers. Despite technical issues in the early detection set (ncases = 29, ncontrols = 29), the specificity of cfDNAme was 100% (88.1%-100.0%). We detected 27.3% (6.0%-61.0%) of high-risk cases with relatively lower genomic DNA (gDNA) contamination. The sensitivity rose to 33.3% (7.5%-70.1%) in samples taken <1 year before diagnosis. We detected ovarian cancer in several patients up to 1 year before diagnosis despite technical limitations associated with archival samples (UKFOCSS). Combined cfDNAme and CA125 assessment may improve ovarian cancer screening in high-risk populations, but future large-scale prospective studies will be required to validate current findings.
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Affiliation(s)
- Chiara Herzog
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Allison Jones
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Iona Evans
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Daniel Reisel
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Adeola Olaitan
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Konstantinos Doufekas
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Nicola MacDonald
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Michal Zikan
- Department of Gynecology and Obstetrics, Charles University in Prague, First Faculty of Medicine and Hospital, Na Bulovce, Czech Republic
| | - David Cibula
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, Prague and, General University Hospital, Prague, Czech Republic
| | - Lukáš Dostálek
- Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, Prague and, General University Hospital, Prague, Czech Republic
| | | | | | - Markus Schmitt
- Eurofins Genomics Europe Sequencing GmbH, Konstanz, Germany
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Adam N Rosenthal
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Martin Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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2
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Barrett JE, Jones A, Evans I, Herzog C, Reisel D, Olaitan A, Mould T, MacDonald N, Doufekas K, Newton C, Crosbie EJ, Bjørge L, Colombo N, Dostalek L, Costas L, Peremiquel-Trillas P, Ponce J, Matias-Guiu X, Zikan M, Cibula D, Wang J, Sundström K, Dillner J, Widschwendter M. The WID-EC test for the detection and risk prediction of endometrial cancer. Int J Cancer 2023; 152:1977-1988. [PMID: 36533702 DOI: 10.1002/ijc.34406] [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: 10/16/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
The incidence of endometrial cancer is rising. Measures to identify women at risk and to detect endometrial cancer earlier are required to reduce the morbidity triggered by the aggressive treatment required for advanced endometrial cancer. We developed the WID-EC (Women's cancer risk IDentification-Endometrial Cancer) test, which is based on DNA methylation at 500 CpG sites, in a discovery set of cervical liquid-based cytology samples from 1086 women with and without an endometrial cancer (217 cancer cases and 869 healthy controls) with a worse prognosis (grade 3 or ≥stage IB). We validated the WID-EC test in an independent external validation set of 64 endometrial cancer cases and 225 controls. We further validated the test in 150 healthy women (prospective set) who provided a cervical sample as part of the routine Swedish cervical screening programme, 54 of whom developed endometrial cancer within 3 years of sample collection. The WID-EC test identified women with endometrial cancer with a receiver operator characteristic area under the curve (AUC) of 0.92 (95% CI: 0.88-0.97) in the external set and of 0.82 (95% CI: 0.74-0.89) in the prospective validation set. Using an optimal cutoff, cancer cases were detected with a sensitivity of 86% and a specificity of 90% in the external validation set, and a sensitivity and specificity of 52% and 98% respectively in the prospective validation set. The WID-EC test can identify women with or at risk of endometrial cancer.
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Affiliation(s)
- James E Barrett
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria.,Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK.,Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Allison Jones
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Iona Evans
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Chiara Herzog
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria
| | - Daniel Reisel
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Adeola Olaitan
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Tim Mould
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Nicola MacDonald
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Konstantinos Doufekas
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Claire Newton
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,University of Bristol, Bristol, UK
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Line Bjørge
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nicoletta Colombo
- Istituto Europeo di Oncologia, Milan, Italy.,University of Milano-Bicocca, Milan, Italy
| | - Lukas Dostalek
- Hospital Na Bulovce, Prague, Czech Republic.,Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Laura Costas
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Unit of Molecular Epidemiology and Genetics in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, CIBERONC. Hospitalet de Llobregat, Barcelona, Spain
| | - Michal Zikan
- Hospital Na Bulovce, Prague, Czech Republic.,Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiangrong Wang
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria.,Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK.,Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
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Marshall D, Krupp S, Khoury R, MacDonald N, Tokarski G, Makowski C, Miller J, Manteuffel J. 16 The Impact of an Emergency Department Alternatives to Opiates (ALTO) Program on Opiate Administration. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.038] [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: 11/29/2022]
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Wong M, Eaton PK, Zanichelli C, Moore C, Hegarty C, MacDonald N. The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients. Eur J Surg Oncol 2021; 48:1167-1172. [PMID: 34980543 DOI: 10.1016/j.ejso.2021.12.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/13/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors. MATERIALS AND METHODS This was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation. RESULTS Among 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3-11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL. CONCLUSIONS Undiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.
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Affiliation(s)
- Michael Wong
- Department of Gynecological Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Patricia Kay Eaton
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carla Zanichelli
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Christina Moore
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catherine Hegarty
- Lymphedema Service, Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nicola MacDonald
- Department of Gynecological Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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5
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Worrall M, MacDonald N, Gillen R, Hince A, Hampson L, Duguid R, McCallum S, Gentle D. The optimisation of paediatric CT examinations in Scotland: phase one; benchmarking current performance. J Radiol Prot 2021; 41:902-919. [PMID: 33862611 DOI: 10.1088/1361-6498/abf901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
To benchmark the dose from paediatric head and chest examinations on computed tomography (CT) scanners throughout Scotland, to identify scanners that may require optimisation and to provide optimisation advice based on the protocols from better performing scanners. Anthropomorphic phantoms corresponding to 1, 5 and 10 year olds were sent to 50 CT scanners around Scotland. Head and chest examinations were undertaken by local staff using local techniques on each scanner with each phantom, and details of the protocols used were recorded. Computed tomography dose index (CTDI)voland dose length product (DLP) were recorded post-scan. There is a significant variation in performance throughout Scotland. For head examinations, the highest DLP is 13 times the lowest for an equivalent sized phantom. For chest examinations, the highest is 128 times the lowest for an equivalent sized phantom. The wide range of CT dose measurements indicates the potential for variation in image quality across Scotland. Feedback has been provided to all participating sites on their individual results compared to the national data set. Specific feedback was provided where relevant on potential considerations for optimisation. Scanners that may be undertaking paediatric CT head and chest examinations in a sub-optimal manner throughout Scotland have been identified along with those aspects of a scan protocol that are most likely to lead to sub-optimal performance.
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Affiliation(s)
- Mark Worrall
- Department of Medical Physics, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee, DD1 9SY, United Kingdom
| | - Nicola MacDonald
- Department of Medical Physics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Rebecca Gillen
- Department of Clinical Physics and Bioengineering, Gartnavel Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom
| | - Andrew Hince
- Department of Medical Physics and Bioengineering, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ, United Kingdom
| | - Lee Hampson
- Department of Medical Physics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom
| | - Rebecca Duguid
- Department of Medical Physics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom
| | - Stephen McCallum
- Department of Medical Physics, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom
| | - David Gentle
- Department of Clinical Physics and Bioengineering, Gartnavel Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom
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6
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Lewin J, Egbe A, Ellery P, Wilkinson N, MacDonald N, Kotsopoulos IC, Olaitan A. Female Genital Tract Melanoma: 10 Years of Experience at a Single Tertiary Center. J Low Genit Tract Dis 2021; 25:142-145. [PMID: 33587530 DOI: 10.1097/lgt.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
OBJECTIVE Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade. METHODS Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist. RESULTS We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026). CONCLUSIONS Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
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Affiliation(s)
- Jonathan Lewin
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Azelle Egbe
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Peter Ellery
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nafisa Wilkinson
- Department of Cellular Pathology, University College London Hospital, London, United Kingdom
| | - Nicola MacDonald
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Ioannis C Kotsopoulos
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
| | - Adeola Olaitan
- Gynaecological Oncology Department, University College London Hospital, London, United Kingdom
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Dutton J, Zardab M, De Braal VJF, Hariharan D, MacDonald N, Hallworth S, Hutchins R, Bhattacharya S, Abraham A, Kocher HM, Yip VS. The accuracy of pre-operative (P)-POSSUM scoring and cardiopulmonary exercise testing in predicting morbidity and mortality after pancreatic and liver surgery: A systematic review. Ann Med Surg (Lond) 2020; 62:1-9. [PMID: 33489107 PMCID: PMC7804364 DOI: 10.1016/j.amsu.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiopulmonary exercise-testing (CPET) and the (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity ((P)-POSSUM) are used as pre-operative risk stratification and audit tools in general surgery, however, both have been demonstrated to have limitations in major hepatopancreatobiliary (HPB) surgery. Materials and methods The aim of this review is to determine if CPET and (P)-POSSUM scoring systems accurately predict morbidity and mortality. Eligible articles were identified with an electronic database search. Analysis according to surgery type and tool used was performed. Results Twenty-five studies were included in the final review. POSSUM predicted morbidity demonstrated weighted O/E ratios of 0.75(95%CI0.57–0.97) in hepatic surgery and 0.85(95%CI0.8–0.9) in pancreatic surgery. P-POSSUM predicted mortality in pancreatic surgery demonstrated an O/E ratio of 0.75(95%CI0.27–2.13) and 0.94(95%CI0.57–1.55) in hepatic surgery. In both pancreatic and hepatic surgery an anaerobic threshold(AT) of between 9 0.5–11.5 ml/kg/min was predictive of post-operative complications, and in pancreatic surgery ventilatory equivalence of carbon dioxide(˙VE/˙VCO2) was predictive of 30-day mortality. Conclusion POSSUM demonstrates an overall lack of predictive fit for morbidity, whilst CPET variables provide some predictive power for post-operative outcomes. Development of a new HPB specific risk prediction tool would be beneficial; the combination of parameters from POSSUM and CPET, alongside HPB specific markers could overcome current limitations. Current pre-operative scoring for pancreatic and liver surgery is inaccurate. In pancreatic and liver surgery anaerobic threshold scores were predictive of complications. In pancreatic surgery ventilatory equivalence of carbon dioxide was predictive of mortality. P-POSSUM is inaccurate for predicting mortality and morbidity in pancreatic surgery.
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Affiliation(s)
| | | | | | | | - N MacDonald
- Department of Anaesthesia, The Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1BB, UK
| | - S Hallworth
- Department of Anaesthesia, The Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1BB, UK
| | | | | | | | | | - V S Yip
- Barts and London HPB Centre, UK
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Kasivisvanathan V, Lindsay J, Rakshani-Moghadam S, Elhamshary A, Kapriniotis K, Kazantzis G, Syed B, Hines J, Bex A, Ho DH, Hayward M, Bhan C, MacDonald N, Clarke S, Walker D, Bellingan G, Moore J, Rohn J, Muneer A, Roberts L, Haddad F, Kelly JD. A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site. Int J Surg 2020; 84:57-65. [PMID: 33122153 PMCID: PMC7584883 DOI: 10.1016/j.ijsu.2020.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022]
Abstract
Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration. Priority surgeries are being cancelled every week due to the COVID-19 pandemic. A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.
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Affiliation(s)
- Veeru Kasivisvanathan
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Jamie Lindsay
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Sara Rakshani-Moghadam
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ahmed Elhamshary
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Georgios Kazantzis
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Bilal Syed
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Axel Bex
- Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Chetan Bhan
- Department of General Surgery, Whittington Health NHS Trust, London, UK
| | - Nicola MacDonald
- Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon Clarke
- Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK
| | - David Walker
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - Geoff Bellingan
- Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - James Moore
- NHS England and NHS Improvement, England, UK
| | - Jennifer Rohn
- Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK
| | - Lois Roberts
- Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Fares Haddad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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Ammari T, Fernandes Ferreira CD, Jordan DJ, MacDonald N, Rust PA. Establishing local diagnostic reference levels for mini C-arm use in upper limb surgery - A step towards national audit. Surgeon 2020; 19:e338-e343. [PMID: 32994124 DOI: 10.1016/j.surge.2020.08.007] [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: 06/02/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
Abstract
AIMS Under the Ionising Radiation Medical Exposure Regulations, hospitals using fluoroscopy and image intensifiers should monitor doses from exposures using ionising radiation. There is a need for national diagnostic reference levels to advise Orthopaedic and Plastic surgeons on safe screening times and radiation doses for patients having upper limb surgical procedures. METHODS Retrospective study of all patients who underwent upper limb surgical procedures requiring intra-operative mini C-arm image intensifier use at our hospital between 2013 and 2019. This included results from three machines in different rooms. Procedures were classified as closed and open procedures. RESULTS Information on a total of 2910 procedures over 6 years (June 2013 to June 2019) were obtained. 133 procedures with incomplete data and 4 cases of lower extremities were excluded. 1719 closed procedures had a median dose area product of 0.48 cGycm2 and median screening time of 7 s, compared to 1054 open procedures, with a median dose area product of 1.88 cGycm2 and median screening time of 28 s. National diagnostic reference levels are set at the third quartile and indicate the difference between good and poor practice. For diagnostic reference levels, we suggest a dose area product of 0.82 cGycm2 and a screening time of 11 s for closed procedures and a dose area product of 3.07 cGycm2 and screening time of 40 s for open procedures. Public Health England state that national diagnostic reference levels should be derived from multiple patients, radiology rooms and hospitals. Our data meets the first two criteria and is an initial step in establishing national diagnostic reference levels for upper limb mini C-arm use. CONCLUSIONS This large audit reports results, which, with further work across multiple hospital sites, should lead to establishing national diagnostic reference levels for mini C-arm fluoroscopy for upper limb Orthopaedic procedures.
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Affiliation(s)
- Tareq Ammari
- Hooper Hand Unit, St John's Hospital, NHS Lothian, Livingston, United Kingdom.
| | | | - Daniel J Jordan
- Hooper Hand Unit, St John's Hospital, NHS Lothian, Livingston, United Kingdom
| | - Nicola MacDonald
- Department of Medical Physics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Philippa A Rust
- Hooper Hand Unit, St John's Hospital, NHS Lothian, Livingston, United Kingdom
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MacDonald N, Harmon SHE, Faour D, Graham J, Steffen C, Henaff L, Shendale S. Mandatory immunization: Empirical examination of governance instruments in 28 Global NITAG Network (GNN) countries. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the Global Vaccine Action Plan 2017 Assessment Report, WHO's SAGE noted need to understand ways in which legislation and regulation are used to advance or undermine immunization. The NITAG Environmental Scan Project sought to address this in a pilot study.
Methods
Data was collected via a secure online survey of GNN members (40 countries Sept 2018). Respondents reporting a mandatory element were asked: (1) what vaccinations were required by law; and (2) what population groups were subject to mandates; (3) what grounds, if any, were available for requesting exemptions.
Results
28 (70%) countries responded, representing every WHO region and World Bank income level. While mandatory immunization programs / elements within broader NIPs were relatively common, jurisdictions varied with respect to immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We observed some loose associations with geography and income level. Children were the most common population group subject to mandates at some stage of childhood development (28/28); healthcare workers were second (8/15 (53%)). Sanctions for failure to immunize varied broadly, ranging from no penalty, to loss of access to social services e.g. admission to school, monetary fines, and incarceration. A variance between countries as to how strictly immunization mandates are enforced was noted.
Conclusions
A variety of approaches existed ranging from Narrow/Permissive to Broad/ Inclusive in scope with enforcement mapping loosely to this continuum from Loose/Permissive to Tight/Coercive. Jurisdictions with few/no vaccines mandated, and few/no target groups identified, Loose approach is expected; for those closer to Broad approach, Tighter controls expected. Coercive measures may be 'positive' (vaccination as a gateway to public services, with possible work-arounds), or 'negative' (failure to vaccinate = penalties).
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Affiliation(s)
- N MacDonald
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - S H E Harmon
- Faculty of Law and Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - D Faour
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - J Graham
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - C Steffen
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - L Henaff
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - S Shendale
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
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11
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Gessler S, King M, Lemma A, Barber J, Jones L, Dunning S, Madden V, Pilling S, Hunter R, Fonagy P, Summerville K, MacDonald N, Olaitan A, Lanceley A. Stepped approach to improving sexual function after gynaecological cancer: the SAFFRON feasibility RCT. Health Technol Assess 2020; 23:1-92. [PMID: 30798790 DOI: 10.3310/hta23060] [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: 11/22/2022] Open
Abstract
BACKGROUND Women affected by gynaecological cancer are often unaware of the sexual consequences of both the cancer and its treatment. Most do not receive appropriate advice or help to recover sexual function, and the effect on their sexuality may be profound, both physically and emotionally. However, several potential therapies can be effective in helping recover some sexual engagement and change self-perception around sex. A major initial challenge is informing and involving patients in an appropriate and sensitive manner, and a further issue is delivering therapies in busy gynaelogical oncology clinics. This study was conceived in response to a National Institute for Health Research (NIHR) Health Technology Assessment (HTA) call asking for proposals to improve sexual functioning in women treated for gynaecological cancer while taking into account associated issues of mood. Existing evidence-based therapies for improving sexual function after cancer treatment were adapted and placed within a 'stepped care' model for delivering these in the NHS setting. An assessment and treatment stepping algorithm was developed in parallel, both to assign women to a treatment level at assessment and to follow their progress session by session to advise on changing intervention level. The assessment tool was applied to all participants on the principle that the problem was sexual difficulty, not the cancer of origin. PARTICIPANTS Women aged > 18 years (with partners at their choice) treated for any gynaecological malignancy with surgery and/or chemotherapy and/or radiation at University College London Hospital or Bristol Gynaecological cancer centres, minimally 3 months post end of treatment, of any sexual orientation, with sexual function difficulties identified by three initial screening questions. DESIGN A feasibility two-arm, parallel-group randomised controlled pilot trial. SETTING Two NHS gynaecological cancer centres, one in London and one in Bristol. INTERVENTIONS A three-level stepped care intervention. OBJECTIVE To assess the feasibility of conducting a full-scale investigation of stepped therapy and indicate the potential benefits to patients and to the NHS generally. PRIMARY OUTCOME MEASURES Recruitment to study, proportion of women stepping up, number of usable data points of all measures and time points over length of trial, and retention of participants to end of trial. RESULTS Development of the intervention and accompanying algorithm was completed. The study was stopped before the recruitment stage and, hence, no randomisation, recruitment, numbers analysed, outcomes or harms were recorded. LIMITATIONS As the study did not proceed, the intervention and its accompanying algorithm have not been evaluated in practice, and the capacity of the NHS system to deliver it has not been examined. CONCLUSIONS None, as the study was halted. FUTURE WORK The intervention could be studied within a clinical setting; however, the experience of the study group points to the need for psychosocial studies in medical settings to establish pragmatic and innovative mechanisms to ensure adequate resource when extending staff clinical skills and time to deliver any new intervention for the duration of the trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN12010952 and ClinicalTrials.gov NCT02458001. FUNDING This project was funded by the NIHR HTA programme and will be published in full in Health Technology Assessment; Vol. 23, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sue Gessler
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Michael King
- PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Alessandra Lemma
- Psychological Therapies Development Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | | | - Stephen Pilling
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Karen Summerville
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Nicola MacDonald
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Adeola Olaitan
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
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Manteuffel J, Shayya S, Sabagha N, MacDonald N, Griebe K, Doyal M, Hedroug Y, France J, El-Khoury C, Theoharris T. 317 Sustainable Naloxone Education and Distribution From an Urban Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Abstract
The approach to i.v. fluid therapy for hypovolaemia may significantly influence outcomes for patients who experience a systemic inflammatory response after sepsis, trauma, or major surgery. Currently, there is no single i.v. fluid agent that meets all the criteria for the ideal treatment for hypovolaemia. The physician must choose the best available agent(s) for each patient, and then decide when and how much to administer. Findings from large randomized trials suggest that some colloid-based fluids, particularly starch-based colloids, may be harmful in some situations, but it is unclear whether they should be withdrawn from use completely. Meanwhile, crystalloid fluids, such as saline 0.9% and Ringer's lactate, are more frequently used, but debate continues over which preparation is preferable. Perhaps most importantly, it remains unclear how to select the optimal dose of fluid in different patients and different clinical scenarios. There is good reason to believe that both inadequate and excessive i.v. fluid administration may lead to poor outcomes, including increased risk of infection and organ dysfunction, for hypovolaemic patients. In this review, we summarize the current knowledge on this topic and identify some key pitfalls and some areas of agreed best practice.
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Affiliation(s)
- N MacDonald
- Department of Perioperative and Pain Medicine, Barts Health NHS Trust, London E1 1BB, UK
| | - R M Pearse
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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14
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Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth 2018; 118:424-429. [PMID: 28186223 DOI: 10.1093/bja/aew466] [Citation(s) in RCA: 427] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/16/2022] Open
Abstract
Background The 100 mm visual analog scale (VAS) score is widely used to measure pain intensity after surgery. Despite this widespread use, it is unclear what constitutes the minimal clinically important difference (MCID); that is, what minimal change in score would indicate a meaningful change in a patient's pain status. Methods We enrolled a sequential, unselected cohort of patients recovering from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS with a global rating-of-change questionnaire using an anchor-based method and three distribution-based methods (0.3 sd , standard error of the measurement, and 5% range). We then averaged the change estimates to determine the MCID for the pain VAS. The patient acceptable symptom state (PASS) was defined as the 25th centile of the VAS corresponding to a positive patient response to having made a good recovery from surgery. Results We enrolled 224 patients at the first postoperative visit, and 219 of these were available for a second interview. The VAS scores improved significantly between the first two interviews. Triangulation of distribution and anchor-based methods resulted in an MCID of 9.9 for the pain VAS, and a PASS of 33. Conclusions Analgesic interventions that provide a change of 10 for the 100 mm pain VAS signify a clinically important improvement or deterioration, and a VAS of 33 or less signifies acceptable pain control (i.e. a responder), after surgery.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D B Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - W Galagher
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - D Boyd
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - C Chew
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - N MacDonald
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A Dennis
- Department of Anaesthesia, Royal Women's Hospital, Parkville, Victoria, Australia
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15
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Abbott TEF, Gooneratne M, McNeill J, Lee A, Levett DZH, Grocott MPW, Swart M, MacDonald N. Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study. Br J Anaesth 2017; 120:475-483. [PMID: 29452804 DOI: 10.1016/j.bja.2017.11.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET. METHODS We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO2 peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement. RESULTS Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO2 peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO2 peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO2 peak was moderate [0.73 (0.64-0.80)]. CONCLUSIONS Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
| | | | | | - A Lee
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D Z H Levett
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M P W Grocott
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M Swart
- South Devon Healthcare NHS Trust, Torbay, UK
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16
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Marchetti C, Kristeleit R, McCormack M, Mould T, Olaitan A, Widschwendter M, MacDonald N, Ledermann JA. Outcome of Patients With Advanced Ovarian Cancer Who Do Not Undergo Debulking Surgery: A Single Institution Retrospective Review. Obstet Gynecol Surv 2017. [DOI: 10.1097/ogx.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Milani A, Kristeleit R, McCormack M, Raja F, Luvero D, Widschwendter M, MacDonald N, Mould T, Olatain A, Hackshaw A, Ledermann JA. Switching from standard to dose-dense chemotherapy in front-line treatment of advanced ovarian cancer: a retrospective study of feasibility and efficacy. ESMO Open 2017; 1:e000117. [PMID: 28848659 PMCID: PMC5548979 DOI: 10.1136/esmoopen-2016-000117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Current standard neoadjuvant treatment for advanced ovarian cancer is 3-weekly platinum-based chemotherapy (CP3w). Patients unable to have interval debulking surgery (IDS) or with significant residual disease have a poor outcome to CP3w treatment. We investigated the outcome in patients who were switched to dose-dense chemotherapy. METHODS We retrospectively analysed 30 patients treated at UCLH in 2009-2013, who switched to dose-dense chemotherapy after neoadjuvant CP3w, having achieved a poor response/progressed and unable to proceed to IDS (n=21), or had >1 cm residual disease after IDS (n=9). Treatment was 3-weekly carboplatin and weekly paclitaxel (n=23), or both drugs weekly (n=7). For comparison, we included 30 matched patients treated with CP3w followed by IDS (n=24, without or ≤1 cm residual disease; n=6, with >1 cm residual disease). Time to progression (TTP) and overall survival (OS) were measured from the date of diagnosis until progression (CT scan or CA-125) and death from any cause, respectively. RESULTS Baseline characteristics were similar in both groups. The response rate to dose-dense chemotherapy was 70% (Gynecological Cancer Intergroup criteria). In the dose-dense group, 24 patients had tumour progression and 16 died; the corresponding numbers in the control group were 24 and 11. Median TTP was 15.8 months with dose-dense therapy, higher than expected for this patient group, and the same as in the control group (15.7 months) undergoing IDS, p=0.27. Median TTP in patients with residual disease postsurgery was 16.5 months (dose-dense) and 10.8 months (controls), p=0.02. TTP in dose-dense patients who did not have surgery was 10.4 months. Median OS was 31.3 (dose-dense) and 59.6 months (controls), p=0.06. Dose-dense chemotherapy was well tolerated: only three patients interrupted treatment due to toxicity. CONCLUSION Switching to dose-dense chemotherapy in patients who failed to respond to CT3w neoadjuvant chemotherapy appears to be an effective strategy and requires further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Jonathan A Ledermann
- UCL Hospitals London, London, UK.,Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
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18
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Marchetti C, Kristeleit R, McCormack M, Mould T, Olaitan A, Widschwendter M, MacDonald N, Ledermann JA. Outcome of patients with advanced ovarian cancer who do not undergo debulking surgery: A single institution retrospective review. Gynecol Oncol 2017; 144:57-60. [PMID: 27825669 DOI: 10.1016/j.ygyno.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the outcome of patients with advanced ovarian cancer (OC) who were treated without surgery, having received upfront chemotherapy and no interval debulking surgery (IDS). METHODS Retrospective analysis of medical and chemotherapy records of consecutive patients with OC between 2005 and 2013 at UCL Hospitals London, UK who received neoadjuvant chemotherapy (NACT) was then found to be unsuitable for IDS following review by the multidisciplinary team. RESULTS Eighty-three patients (18%) out of 467 receiving NACT did not undergo IDS. Median age was 70years (range 33-88); out of these 83 patients, 43 (51.8%) presented with stage IV disease. Forty-three of these 83 patients received carboplatin and paclitaxel (CP) (51.8%) and 37 received carboplatin alone (C) (44.6%); 3 patients (3.6%) received other platinum-based combinations. Reasons for not proceeding to surgery were: poor response to chemotherapy after 3-4 cycles of NACT (61/83, 73.5%); comorbidities (12/83, 14.5%); patient decision (4/83, 4.8%). Six patients (7.2%) received <3 cycles of NACT due to a worsening clinical condition. The median overall survival (OS) for patients not undergoing IDS was 18months (95% CI 10-20months). Forty-four of 83 patients (53%) received >2 lines of chemotherapy. In a univariate analysis CP, age <70years, and absence of comorbidities were factors influencing OS. In a multivariate analysis only having received CP remained independently associated with OS (HR 0.49, 95% CI 0.29-0.84). CONCLUSIONS Chemotherapy alone can provide reasonable disease control in patients unsuitable for IDS and CP should be used if possible.
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Affiliation(s)
- Claudia Marchetti
- UCL Cancer Institute and UCL Hospitals, London, UK; Department of Gynecological and Obstetrical Sciences and Urological Sciences, University "Sapienza", Rome, Italy
| | | | - Mary McCormack
- Cancer Division, University College Hospital, UCL Hospitals, London, UK
| | - Tim Mould
- Department of Gynaecological Oncology, Women's Health University College Hospital, UCL Hospitals, London, UK
| | - Adeola Olaitan
- Department of Gynaecological Oncology, Women's Health University College Hospital, UCL Hospitals, London, UK
| | - Martin Widschwendter
- Department of Gynaecological Oncology, Women's Health University College Hospital, UCL Hospitals, London, UK
| | - Nicola MacDonald
- Department of Gynaecological Oncology, Women's Health University College Hospital, UCL Hospitals, London, UK
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19
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Lemech CR, Ensell L, Paterson JC, Eminowicz G, Lowe H, Arora R, Arkenau HT, Widschwendter M, MacDonald N, Olaitan A, Mould T, Meyer T, Hartley J, Mitra A, Ledermann JA, McCormack M, Kristeleit RS. Enumeration and Molecular Characterisation of Circulating Tumour Cells in Endometrial Cancer. Oncology 2016; 91:48-54. [PMID: 27256106 DOI: 10.1159/000445999] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND This is a feasibility study to determine whether circulating tumour cells (CTCs) are detectable and suitable for molecular profiling in advanced endometrial cancer (aEC). METHOD Between October 2012 and February 2014, 30 patients with aEC had baseline and up to 3 follow-up samples. CTCs and stathmin expression were evaluated using the CellSearch platform. Epithelial cell adhesion molecule (EpCAM) and stathmin immunohistochemistry were performed on FFPE tumour tissue. RESULTS Eighteen from 30 (60%) patients had detectable CTCs during study [1 CTC (n = 7), 2 (n = 4), 3 (n = 1), 4 (n = 2), 7 (n = 1), 8 (n = 1), 22 (n = 1), 172 (n = 1) in 7.5 ml blood]. Ten from 18 patients had between 50 and 100% of detectable CTCs that were stathmin positive. More CTC-positive than CTC-negative patients had non-endometrioid versus endometrioid histology, tumour size ≥5 versus <5 cm, higher-stage disease and worse survival [hazard ratio 3.3, p > 0.05, 95% confidence interval 0.7-16.2]. Twenty-one tumour blocks were tested for EpCAM and stathmin immunohistochemistry (IHC). Stathmin tumour immunostaining scores (TIS) on IHC were higher in CTC-positive patients. CONCLUSION CTC enumeration and molecular profiling with stathmin on the CellSearch platform is feasible in aEC. Stathmin TIS on IHC, a known prognostic marker in EC, was associated with CTC positivity.
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20
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MacDonald N, Ahmad T, Mohr O, Kirk-Bayley J, Moppett I, Hinds C, Pearse R. Dynamic preload markers to predict fluid responsiveness during and after major gastrointestinal surgery: an observational substudy of the OPTIMISE trial. Br J Anaesth 2015; 114:598-604. [DOI: 10.1093/bja/aeu398] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Sutton DG, McVey S, Gentle D, Hince AJ, MacDonald N, McCallum S. CT chest abdomen pelvis doses in Scotland: has the DRL had its day? Br J Radiol 2014; 87:20140157. [PMID: 24971617 DOI: 10.1259/bjr.20140157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This article reports on a pilot study designed to collect dose data representative of current CT chest abdomen pelvis (CAP) practice in Scotland, make any immediately obvious interventions and to identify if the current UK diagnostic reference level (DRL) of 940 mGy cm is still appropriate. The aims are to identify if a Scotland-wide picture archiving and communication system (PACS)-based dose audit of a number of CT examinations is likely to have value in terms of optimization of patient doses and to comment on the significance of the results in terms of future optimization strategies. METHODS Dose audit of CT CAP examinations at 32 different scanner sites across Scotland using accepted data collection and analysis methods. The minimum sample size was 30. RESULTS RESULTS indicate that CT CAP doses are lower than those previously reported (median, 800 mGy cm, 75th percentile 840 mGy cm) but follow a distribution that is not in keeping with the concept of DRLs as presently understood or implemented. CONCLUSION There is value in a PACS-based dose audit project to provide serial snapshots of patient doses as optimization efforts take place and to revise current knowledge about CT doses. In our opinion, the results call into question whether DRLs or the concept of "achievable dose" are suitable for devising optimization strategies once a certain degree of optimization has taken place. ADVANCES IN KNOWLEDGE The results reported here suggest that it may be time to take a different approach to optimization, concentrating on tools that are more refined than the DRL, which may have become more of a compliance tool than an aid to optimization.
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Affiliation(s)
- D G Sutton
- 1 Department of Medical Physics, Ninewells Hospital, NHS Tayside, Dundee, UK
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22
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Taddio A, Ipp M, Apppleton M, Chambers C, Halperin S, Lockett D, MacDonald N, Mousmanis P, Ridell RP, Rieder M, Scott J, Shah V. 197: Implementing Best Practices for Vaccination Pain Management. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-192] [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: 11/13/2022] Open
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Bortolussi R, MacDonald N, Moraca S, Grant E. 9: Assessing Healthcare Needs and Research Barriers for Community Focused Interdisciplinary Health Research Capacity Building Using a Microresearch Model in East Africa. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lemech CR, Ensell L, Paterson J, Eminowicz G, Lowe H, Griffin N, Arora R, Arkenau HT, Widschwendter M, MacDonald N, Olaitan A, Mould T, Meyer T, Hartley JA, Mitra A, Ledermann JA, McCormack M, Kristeleit RS. Feasibility of circulating tumour cell (CTC) enumeration and molecular profiling (MP) as a biomarker in advanced endometrial cancer (aEC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Leah Ensell
- University College London Cancer Institute, London, United Kingdom
| | - Jennifer Paterson
- University College London Advanced Diagnostics, London, United Kingdom
| | | | - Helen Lowe
- University College London Cancer Institute, London, United Kingdom
| | - Natalie Griffin
- University College London Cancer Institute, London, United Kingdom
| | - Rupali Arora
- Universiy College London Hospital, London, United Kingdom
| | | | | | | | - Adeola Olaitan
- University College London Hospital, London, United Kingdom
| | - Tim Mould
- University College London Hospital, London, United Kingdom
| | - Tim Meyer
- University College London Cancer Institute, London, United Kingdom
| | | | - Anita Mitra
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | - Rebecca Sophie Kristeleit
- University College London Cancer Institute, University College London Cancer Hospital, London, United Kingdom
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Gagnon B, Agulnik JS, Gioulbasanis I, Kasymjanova G, Morris D, MacDonald N. Montreal prognostic score: estimating survival of patients with non-small cell lung cancer using clinical biomarkers. Br J Cancer 2013; 109:2066-71. [PMID: 24064979 PMCID: PMC3798950 DOI: 10.1038/bjc.2013.515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 03/21/2013] [Revised: 08/06/2013] [Accepted: 08/09/2013] [Indexed: 01/03/2023] Open
Abstract
Background: For evidence-based medical practice, well-defined risk scoring systems are essential to identify patients with a poor prognosis. The objective of this study was to develop a prognostic score, the Montreal prognostic score (MPS), to improve prognostication of patients with incurable non-small cell lung cancer (NSCLC) in everyday practice. Methods: A training cohort (TC) and a confirmatory cohort (CC) of newly diagnosed patients with NSCLC planning to receive chemotherapy were used to develop the MPS. Stage and clinically available biomarkers were entered into a Cox model and risk weights were estimated. C-statistics were used to test the accuracy. Results: The TC consisted of 258 patients and the CC consisted of 433 patients. Montreal prognostic score classified patients into three distinct groups with median survivals of 2.5 months (95% confidence interval (CI): 1.8, 4.2), 8.2 months (95% CI: 7.0, 9.4) and 18.2 months (95% CI: 14.0, 27.5), respectively (log-rank, P<0.001). Overall, the C-statistics were 0.691 (95% CI: 0.685, 0.697) for the TC and 0.665 (95% CI: 0.661, 0.670) for the CC. Conclusion: The MPS, by classifying patients into three well-defined prognostic groups, provides valuable information, which physicians could use to better inform their patients about treatment options, especially the best timing to involve palliative care teams.
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Affiliation(s)
- B Gagnon
- Department of Family Medicine and Emergency Medicine, Université Laval, Centre de Recherché du Le Centre Hospitalier Universitaire de Québec, 9 rue McMahon, Local 1899-6, Quebec, Quebec City, Quebec QC G1R 2J6, Canada
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Hersheson J, Mencacci NE, Davis M, MacDonald N, Trabzuni D, Ryten M, Pittman A, Paudel R, Kara E, Fawcett K, Plagnol V, Bhatia KP, Medlar AJ, Stanescu HC, Hardy J, Kleta R, Wood NW, Houlden H. Mutations in the autoregulatory domain of β-tubulin 4a cause hereditary dystonia. Ann Neurol 2013; 73:546-53. [PMID: 23424103 PMCID: PMC3698699 DOI: 10.1002/ana.23832] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [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: 08/05/2012] [Revised: 10/23/2012] [Accepted: 11/05/2012] [Indexed: 12/24/2022]
Abstract
Dystonia type 4 (DYT4) was first described in a large family from Heacham in Norfolk with an autosomal dominantly inherited whispering dysphonia, generalized dystonia, and a characteristic hobby horse ataxic gait. We carried out a genetic linkage analysis in the extended DYT4 family that spanned 7 generations from England and Australia, revealing a single LOD score peak of 6.33 on chromosome 19p13.12-13. Exome sequencing in 2 cousins identified a single cosegregating mutation (p.R2G) in the β-tubulin 4a (TUBB4a) gene that was absent in a large number of controls. The mutation is highly conserved in the β-tubulin autoregulatory MREI (methionine-arginine-glutamic acid-isoleucine) domain, highly expressed in the central nervous system, and extensive in vitro work has previously demonstrated that substitutions at residue 2, specifically R2G, disrupt the autoregulatory capability of the wild-type β-tubulin peptide, affirming the role of the cytoskeleton in dystonia pathogenesis.
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Affiliation(s)
- Joshua Hersheson
- Department of Molecular Neuroscience, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Belton K, MacDonald N, Voaklander D. BUILDING OF A FRAMEWORK FOR THE IMPLEMENATION OF AN INJURY PREVENTION STRATEGY: AN ALBERTA, CANADA EXAMPLE. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.33] [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: 11/04/2022]
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Allen VM, Dodds L, Spencer A, Cummings EA, MacDonald N, Kephart G. Application of a national administrative case definition for the identification of pre-existing diabetes mellitus in pregnancy. Chronic Dis Inj Can 2012; 32:113-120. [PMID: 22762897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Accurate ascertainment of pregnant women with pre-existing diabetes allows for the comprehensive surveillance of maternal and neonatal outcomes associated with this chronic disease. METHOD To determine the accuracy of case definitions for pre-existing diabetes mellitus when applied to a pregnant population, a cohort of women who were pregnant in Nova Scotia, Canada, between 1991 and 2003 was obtained from a population-based provincial perinatal database, the Nova Scotia Atlee Perinatal Database (NSAPD). Person-level data from administrative databases using hospital discharge abstract data and outpatient physician services data were linked to this cohort. Various algorithms for defining diabetes mellitus from the administrative data, including the algorithm suggested by the National Diabetes Surveillance System (NDSS), were compared to a reference standard definition from the NSAPD. RESULTS Validation of the NDSS case definition applied to this pregnant population demonstrated a sensitivity of 87% and a positive predictive value (PPV) of 66.4%. Use of ICD-9 and ICD-10 diagnostic codes among hospitalizations with diabetes mellitus in pregnancy showed important increases in sensitivity and PPV, especially for those pregnancies delivered in tertiary centres. In this population, pregnancy-related administrative data from the hospitalization database alone appear to be a more accurate data source for identifying pre-existing diabetes than applying the NDSS case definition, particularly when pregnant women are delivered in a tertiary hospital. CONCLUSION Although the NDSS definition of diabetes performs reasonably well compared to a reference standard definition of diabetes, using this definition for evaluating maternal and perinatal outcomes associated with diabetes in pregnancy will result in a certain degree of misclassification and, therefore, biased estimates of outcomes.
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Affiliation(s)
- V M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Kasymjanova G, MacDonald N, Agulnik JS, Cohen V, Pepe C, Kreisman H, Sharma R, Small D. The predictive value of pre-treatment inflammatory markers in advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2011; 17:52-8. [PMID: 20697515 DOI: 10.3747/co.v17i4.567] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [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: 11/15/2022]
Abstract
BACKGROUND Accurate prediction of outcome in advanced non-small-cell lung cancer (NSCLC) remains challenging. Even within the same stage and treatment group, survival and response to treatment vary. We set out to determine the predictive value of inflammatory markers C-reactive protein (CRP) and white blood cells (WBCS) in patients with advanced NSCLC. PATIENTS AND METHODS Patients were assigned a prognostic index (PI): 0 for crp 10 mg/L or less and WBCS 11x10⁹/L or less, 1 if one of the two markers was elevated, and 2 if both markers were elevated. We then used chest computed tomography (CT) imaging to evaluate response after 2 cycles of chemotherapy treatment. RESULTS Of 134 patients, 46 had a PI of 0; 60, a PI of 1; and 28, a PI of 2. Disease progressed in 41 patients. Progression was significantly more frequent among patients with a PI of 2 (p = 0.008). Median survival was 20.0 months for the PI 0 group, 10.4 months for the PI 1 group, and 7.9 months for the PI 2 group (p < 0.001). The PI was the only significant prognostic factor for survival even after adjustment for performance status, smoking, and weight loss (hazard ratio: 1.57; 95% confidence interval: 1.2 to 2.14; p = 0.004). CONCLUSIONS Inflammatory state correlates significantly with both chemotherapy response and survival in stage IV NSCLC. The PI may provide additional guidance for therapeutic decision-making.
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Affiliation(s)
- G Kasymjanova
- Division of Pulmonary Diseases, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC.
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White P, Fox J, MacDonald N, Weber J, McClure M, Fidler S, Ward H. O1-S11.03 How many infections are averted by behaviour change after early HIV diagnosis & counselling of MSM? Estimates from a stochastic individual-based model. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.63] [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: 11/04/2022]
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MacDonald N, Hebert PC, Stanbrook MB. La tuberculose au Nunavut : un siecle d'echec. CMAJ 2011. [DOI: 10.1503/cmaj.110426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Brisbois TD, de Kock IH, Watanabe SM, Mirhosseini M, Lamoureux DC, Chasen M, MacDonald N, Baracos VE, Wismer WV. Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial. Ann Oncol 2011; 22:2086-2093. [PMID: 21343383 DOI: 10.1093/annonc/mdq727] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A pilot study (NCT00316563) to determine if delta-9-tetrahydrocannabinol (THC) can improve taste and smell (chemosensory) perception as well as appetite, caloric intake, and quality of life (QOL) for cancer patients with chemosensory alterations. PATIENTS AND METHODS Adult advanced cancer patients, with poor appetite and chemosensory alterations, were recruited from two sites and randomized in a double-blinded manner to receive either THC (2.5 mg, Marinol(®); Solvay Pharma Inc., n = 24) or placebo oral capsules (n = 22) twice daily for 18 days. Twenty-one patients completed the trial. At baseline and posttreatment, patients completed a panel of patient-reported outcomes: Taste and Smell Survey, 3-day food record, appetite and macronutrient preference assessments, QOL questionnaire, and an interview. RESULTS THC and placebo groups were comparable at baseline. Compared with placebo, THC-treated patients reported improved (P = 0.026) and enhanced (P < 0.001) chemosensory perception and food 'tasted better' (P = 0.04). Premeal appetite (P = 0.05) and proportion of calories consumed as protein increased compared with placebo (P = 0.008). THC-treated patients reported increased quality of sleep (P = 0.025) and relaxation (P = 0.045). QOL scores and total caloric intake were improved in both THC and placebo groups. CONCLUSIONS THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.
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Affiliation(s)
- T D Brisbois
- Department of Agricultural, Food & Nutritional Science
| | - I H de Kock
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton
| | - S M Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton
| | - M Mirhosseini
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton
| | - D C Lamoureux
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton
| | - M Chasen
- Division of Palliative Care Medicine, Department of Oncology, University of Ottawa, Ottawa
| | - N MacDonald
- Cancer Nutrition and Rehabilitation Program, Department of Oncology, McGill University, Montreal, Canada
| | - V E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton
| | - W V Wismer
- Department of Agricultural, Food & Nutritional Science.
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Hebert PC, Flegel K, Stanbrook MB, MacDonald N. No privacy of health information in Canada's Armed Forces. CMAJ 2011; 183:E167-8. [DOI: 10.1503/cmaj.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hebert PC, Flegel K, Stanbrook MB, MacDonald N, Barnhardt K. CMAJ at 100: our voice, our future. CMAJ 2011; 183:15. [DOI: 10.1503/cmaj.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kasapoglu I, Ata B, Ozerkan K, Uncu Y, Celik N, Uncu G, Ferrero S, Morotti M, Leone Roberti Maggiore U, Nicoletti AJ, Venturini PL, Remorgida V, Torok P, Jakab A, Major T, Lessey BA, Bushnell GA, Miller SE, Price TA, Azumaguchi A, Henmi H, Saito M, Itabashi E, Turkgeldi L, Turkgeldi E, Riris S, Cutner A, MacDonald N, Mould T, Olaitan A, Saridogan E. SELECTED ORAL COMMUNICATION SESSION SESSION 06: ENDOMETRIOSIS AND SURGERY Monday 4 July 2011 10:00 - 11:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kokaji AI, MacDonald N, Fairhurst M, Thomas T. Column-free methods for the fast and versatile isolation of highly purified, functional and expandable human regulatory T cell populations (LL3-3). Int Immunol 2010. [DOI: 10.1093/intimm/dxq203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bortolussi R, MacDonald N, Larson C, Brenner J, Kabakyenga J. “Micro-Research” for Developing Countries: Borrowing From the Microfinance Experience. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.56a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gagnon B, Abrahamowicz M, Xiao Y, Beauchamp ME, MacDonald N, Kasymjanova G, Kreisman H, Small D. Flexible modeling improves assessment of prognostic value of C-reactive protein in advanced non-small cell lung cancer. Br J Cancer 2010; 102:1113-22. [PMID: 20234363 PMCID: PMC2853092 DOI: 10.1038/sj.bjc.6605603] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [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] [Indexed: 11/23/2022] Open
Abstract
Background: C-reactive protein (CRP) is gaining credibility as a prognostic factor in different cancers. Cox's proportional hazard (PH) model is usually used to assess prognostic factors. However, this model imposes a priori assumptions, which are rarely tested, that (1) the hazard ratio associated with each prognostic factor remains constant across the follow-up (PH assumption) and (2) the relationship between a continuous predictor and the logarithm of the mortality hazard is linear (linearity assumption). Methods: We tested these two assumptions of the Cox's PH model for CRP, using a flexible statistical model, while adjusting for other known prognostic factors, in a cohort of 269 patients newly diagnosed with non-small cell lung cancer (NSCLC). Results: In the Cox's PH model, high CRP increased the risk of death (HR=1.11 per each doubling of CRP value, 95% CI: 1.03–1.20, P=0.008). However, both the PH assumption (P=0.033) and the linearity assumption (P=0.015) were rejected for CRP, measured at the initiation of chemotherapy, which kept its prognostic value for approximately 18 months. Conclusion: Our analysis shows that flexible modeling provides new insights regarding the value of CRP as a prognostic factor in NSCLC and that Cox's PH model underestimates early risks associated with high CRP.
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Affiliation(s)
- B Gagnon
- Department of Medicine and Oncology, McGill University, 687 Pine Avenue West, R4.29, Montreal, Quebec, H3A 1A1, Canada.
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Eggertson L, MacDonald N, Baldassi CL, Hebert PC, Flegel K, Ramsay J. Every child deserves a home. CMAJ 2009; 181:E265-6. [DOI: 10.1503/cmaj.091968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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MacDonald N, Pickering L. Le programme d'innocuité vaccinale canadien en huit étapes : des notions en matière de vaccination. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.9.608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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MacDonald N, Bortolussi R. Protéger les jeunes bébés contre la grippe. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.9.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hebert PC, MacDonald N. La course au vaccin H1N1: Reussira-t-on a devancer la pandemie? CMAJ 2009. [DOI: 10.1503/cmaj.091592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hebert PC, MacDonald N. Soins de sante pour les enfants en famille d'accueil: Reparer le systeme, sauver un enfant. CMAJ 2009. [DOI: 10.1503/cmaj.091679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hebert PC, MacDonald N. Se preparer a la pandemie de grippe A H1N1 2009. CMAJ 2009. [DOI: 10.1503/cmaj.091450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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MacDonald N. Le vaccin contre le virus H1N1: un acces mondial pour un enjeu mondial. CMAJ 2009. [DOI: 10.1503/cmaj.091202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Stanbrook MB, Flegel K, MacDonald N, Attaran A, Eggertson L, Sibbald B, Kelsall D, Fletcher J, Ramsay J, Kale R, Hebert PC. Revision de notre politique sur les interets concurrents des auteurs. CMAJ 2009. [DOI: 10.1503/cmaj.091102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Stanbrook MB, Flegel K, MacDonald N, Attaran A, Eggertson L, Sibbald B, Kelsall D, Fletcher J, Ramsay J, Kale R, Hebert PC. Competing interests of authors: We have revised our policy. CMAJ 2009. [DOI: 10.1503/cmaj.091042] [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: 11/01/2022] Open
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Abstract
e20631 Background: AVR118 represents a new class of cytoprotective drugs in managing symptoms associated with anorexia\/ cachexia. In a previous study in patients with advanced HIV-AIDS, an improvement in appetite, strength and alertness was noted. The precise mechanism of action is not understood, but activity may be related to AVR118's adenosine based components. Other active components include guanosine and branched chain amino acids leucine and valine. Objective: To determine the effect of AVR118 on appetite, early satiety and nutritional intake in patients with advanced cancer. Secondary endpoints include changes in performance status, lean muscle mass and quality of Life (QOL). Methods: Eligible adult patients received 4.0 ml of AVR118 subcutaneous daily injections. Patients underwent bi-monthly evaluations during the 28 day initial treatment (phase A) Evaluations included Karnofsky performance status, Edmonton Symptoms Assessment Scale (ESAS), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment, Dyspepsia Symptom Severity Index, Weight, Lean Body Mass, skin fold thickness and grip strength. Patients who benefited from phase A could elect to continue with therapy (phase B). Results: Currently, of 16 enrolled patients 7 have completed phase A. All 7 patients chose to continue with AVR118 treatment (phase B). Improvements in anorexia and PG-SGA scores were seen in 7/7 and 6/7 patients respectively. Weight stabilization or gain was observed in 5/7 patients. All other parameters showed no significant difference. There was AVR118 has been well tolerated and no serious side effects have been reported. Conclusions: Based on these positive results, the primary endpoints have been achieved and the study will be expanded from 14 to 30 patients. [Table: see text]
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Affiliation(s)
- J. T. D'Olimpio
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
| | - M. R. Chasen
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
| | - R. Sharma
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
| | - M. Diego
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
| | - V. Gullo
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
| | - N. MacDonald
- Monter Cancer Center, Lake Success, NY; McGill University, Montreal, QC, Canada; Advanced Viral Research Corp, Yonkers, NY
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