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Jaumdally S, Tomasicchio M, Pooran A, Esmail A, Kotze A, Meier S, Wilson L, Oelofse S, van der Merwe C, Roomaney A, Davids M, Suliman T, Joseph R, Perumal T, Scott A, Shaw M, Preiser W, Williamson C, Goga A, Mayne E, Gray G, Moore P, Sigal A, Limberis J, Metcalfe J, Dheda K. Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants. Nat Commun 2024; 15:2003. [PMID: 38443359 PMCID: PMC10914788 DOI: 10.1038/s41467-024-45400-1] [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: 10/04/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Airborne transmission of SARS-CoV-2 aerosol remains contentious. Importantly, whether cough or breath-generated bioaerosols can harbor viable and replicating virus remains largely unclarified. We performed size-fractionated aerosol sampling (Andersen cascade impactor) and evaluated viral culturability in human cell lines (infectiousness), viral genetics, and host immunity in ambulatory participants with COVID-19. Sixty-one percent (27/44) and 50% (22/44) of participants emitted variant-specific culture-positive aerosols <10μm and <5μm, respectively, for up to 9 days after symptom onset. Aerosol culturability is significantly associated with lower neutralizing antibody titers, and suppression of transcriptomic pathways related to innate immunity and the humoral response. A nasopharyngeal Ct <17 rules-in ~40% of aerosol culture-positives and identifies those who are probably highly infectious. A parsimonious three transcript blood-based biosignature is highly predictive of infectious aerosol generation (PPV > 95%). There is considerable heterogeneity in potential infectiousness i.e., only 29% of participants were probably highly infectious (produced culture-positive aerosols <5μm at ~6 days after symptom onset). These data, which comprehensively confirm variant-specific culturable SARS-CoV-2 in aerosol, inform the targeting of transmission-related interventions and public health containment strategies emphasizing improved ventilation.
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Affiliation(s)
- S Jaumdally
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Tomasicchio
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Pooran
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Esmail
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Kotze
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - S Meier
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - L Wilson
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - S Oelofse
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - C van der Merwe
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Roomaney
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Davids
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - T Suliman
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa
| | - R Joseph
- Division of Medical Virology, Wellcome Centre for Infectious Diseases in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - T Perumal
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - A Scott
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa
| | - M Shaw
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa
| | - W Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch Tygerberg Campus; Medical Virology, National Health Laboratory Service Tygerberg, Parow, Cape Town, South Africa
| | - C Williamson
- Division of Medical Virology, Wellcome Centre for Infectious Diseases in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Health Laboratory Service (NHLS), Cape Town, South Africa
| | - A Goga
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - E Mayne
- Department of Immunology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Gray
- South African Medical Research Council, Cape Town, South Africa
| | - P Moore
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- SA MRC Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Sigal
- Africa Health Research Institute, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - J Limberis
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California, San Francisco, San Francisco, CA, USA
| | - J Metcalfe
- Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Centre, University of California, San Francisco, San Francisco, CA, USA
| | - K Dheda
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town Lung Institute, Cape Town, South Africa.
- Centre for the Study of Antimicrobial Resistance, South African Medical Research Council, Cape Town, South Africa.
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Marzan MB, Johnson E, Moore P, Jiang H, Hui L. Changes in the numbers of hospital-based abortions and outpatient early medical abortions in Victoria, 2012-22: a retrospective cohort study. Med J Aust 2024; 220:145-153. [PMID: 38305486 DOI: 10.5694/mja2.52203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 - March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. SETTING, PARTICIPANTS All admitted care episodes in Victoria during 1 January 2012 - 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone-misoprostol (MS-2 Step) during 1 January 2015 (date of listing) - 31 March 2022. MAIN OUTCOME MEASURES Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 - March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 - March 2022). RESULTS The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, -2.92 [95% CI, -3.45 to -2.38] per month); the rate of decline was greater during the pandemic period (slope, -5.74 [95% CI, -10.5 to -0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34-6.34] per month); it declined during the first month of the pandemic (slope, -26.4 [95% CI, -70.1 to -17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 - March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). CONCLUSIONS The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone-misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.
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Affiliation(s)
- Melvin B Marzan
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
| | - Eleanor Johnson
- Northern Centre for Health Education Research, Northern Health, Melbourne, VIC
| | - Patricia Moore
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Royal Women's Hospital, Melbourne, VIC
| | - Heng Jiang
- La Trobe University, Melbourne, VIC
- Centre for Health Equity, the University of Melbourne, Melbourne, VIC
| | - Lisa Hui
- Melbourne Medical School, the University of Melbourne, Melbourne, VIC
- Murdoch Children's Research Institute, Melbourne, VIC
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3
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O'Leary N, Wynne F, Moore P. An exploration of staff experience and participation in a perinatal and infant mental health network group. Ir J Psychol Med 2023; 40:554-560. [PMID: 35357295 DOI: 10.1017/ipm.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Infant mental health (IMH), an area which focuses on the social and emotional development of infants in the context of the parent-infant relationship, has become an increasingly prominent field of both research and clinical practice worldwide. IMH network groups are initiatives which aim to facilitate continuous learning in the IMH approach, provide an opportunity for case discussion and encourage reflective practice. This study aimed to explore the experiences of staff working within an adult mental health (AMH) service and their participation in a perinatal IMH network group (PIMH-NG). METHODS This study had a qualitative research design and the data were collected using a focus group methodology. Participants were recruited from a PIMH-NG which aimed to provide staff working within an AMH setting with the opportunity for continuous development of IMH knowledge. The data were analysed using thematic analysis. RESULTS The data gathered from the focus group indicated that staff participating in a PIMH-NG enhanced their clinical skill, reflective practice and supported the dissemination of IMH knowledge throughout their respective teams. The PIMH-NG facilitated this work by providing the opportunity for continuous learning, reflective group discussion and ongoing peer support. CONCLUSIONS The findings of this study indicate that incorporating elements of an IMH model into AMH services can be beneficial for staff, service users and overall service delivery and development. These findings may be used to develop the structure and content of future network groups of this nature.
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Affiliation(s)
- N O'Leary
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - F Wynne
- Cork Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - P Moore
- School of Applied Psychology, University College Cork, Cork, Ireland
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4
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Aiyegbusi OL, McMullan C, Hughes SE, Turner GM, Subramanian A, Hotham R, Davies EH, Frost C, Alder Y, Agyen L, Buckland L, Camaradou J, Chong A, Jeyes F, Kumar S, Matthews KL, Moore P, Ormerod J, Price G, Saint-Cricq M, Stanton D, Walker A, Haroon S, Denniston AK, Calvert MJ. Considerations for patient and public involvement and engagement in health research. Nat Med 2023; 29:1922-1929. [PMID: 37474660 DOI: 10.1038/s41591-023-02445-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
Patient and public involvement and engagement (PPIE) can provide valuable insights into the experiences of those living with and affected by a disease or health condition. Inclusive collaboration between patients, the public and researchers can lead to productive relationships, ensuring that health research addresses patient needs. Guidelines are available to support effective PPIE; however, evaluation of the impact of PPIE strategies in health research is limited. In this Review, we evaluate the impact of PPIE in the 'Therapies for Long COVID in non-hospitalised individuals' (TLC) Study, using a combination of group discussions and interviews with patient partners and researchers. We identify areas of good practice and reflect on areas for improvement. Using these insights and the results of a survey, we synthesize two checklists of considerations for PPIE, and we propose that research teams use these checklists to optimize the impact of PPIE for both patients and researchers in future studies.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK.
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK.
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Grace M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
| | | | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Lisa Agyen
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | - Amy Chong
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - Gary Price
- CPROR, University of Birmingham, Birmingham, UK
| | | | | | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Centre for Trauma Science Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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5
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Mahtani K, Parker M, Maclean E, Vyas R, Bo Wang R, Roelas M, Zemrak F, Muthumala A, Moore P, Sporton S, Chow A, Monkhouse C. Emergency pacemaker implantation in nonagenarians with complete heart block: is single chamber pacing sufficient? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In ambulatory patients with complete heart block and preserved sinus node activity (CHBs), dual chamber pacing confers well-established physiological benefits versus single chamber pacing. There is limited evidence as to whether these benefits extend to very frail patients, especially those over 90 years of age.
Purpose
In nonagenarians presenting with emergent CHBs from 2016–2019, we compared the clinical characteristics of patients selected for single versus dual chamber pacemakers (PPM), and evaluated the symptomatic and prognostic implications of these devices.
Methods
Baseline characteristics were discerned from electronic records, and physiological data extracted from serial PPM interrogations. Frailty was quantified according to the Rockwood clinical frailty scale (1–9). Cause of death was provided by the patients' General Practitioner. Cox proportional hazards analysis (HR, 95% CI) examined associations with all-cause mortality and death from congestive cardiac failure (CCF).
Results
168 consecutive patients were included (44.3% Male, Median age: 91 (2) years) and followed-up for 26.9±14.6 months. 22 patients (13.1%) were implanted with single chamber pacemakers (all programmed VVIR); when compared with patients receiving dual chamber devices, these patients had similar median age (93 (3) versus 91 (2) years, p=0.15) and LV systolic function (LVEF: 49.2% ±9.7 versus 50.7% ±10.1, p=0.71), but were more frail (Rockwood scale: 5.2±1.8 versus 4.3±1.1, p=0.004) and more likely to have severe cognitive impairment (27.3% versus 9.2%, p=0.018). Post implant, patients who received single chamber devices had higher average respiratory rates (21.3±2.4 breaths per minute versus 17.5±2.6 breaths per minute, p=0.002), lower average heart rates (65.5±10.1 bpm versus 71.9±8.6 bpm, p=0.002), and lower daily activity levels (0.57±0.3 hours of activity versus 1.5±1.1 hours of activity, p=0.016) than those with dual chamber devices. Death from CCF was more common in patients receiving single chamber devices (40.9% versus 6.2%, log rank p<0.0001); this association persisted when adjusting for age, frailty and cognitive impairment (adjusted HR: 6.2 (2.2–17.3, p=0.0005). However, in this age group, single chamber pacing was not independently associated with all-cause mortality when compared with dual chamber pacing (adjusted HR: 1.9 (0.95–3.6, p=0.07).
Conclusions
In nonagenarians with CHBs, dual chamber pacing was associated with improved symptomatic outcomes and a reduced risk of death from CCF, but did not affect all-cause mortality when compared with single chamber pacing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahtani
- St Bartholomew's Hospital , London , United Kingdom
| | - M Parker
- St Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- St Bartholomew's Hospital , London , United Kingdom
| | - R Vyas
- St Bartholomew's Hospital , London , United Kingdom
| | - R Bo Wang
- St Bartholomew's Hospital , London , United Kingdom
| | - M Roelas
- St Bartholomew's Hospital , London , United Kingdom
| | - F Zemrak
- St Bartholomew's Hospital , London , United Kingdom
| | - A Muthumala
- St Bartholomew's Hospital , London , United Kingdom
| | - P Moore
- St Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- St Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- St Bartholomew's Hospital , London , United Kingdom
| | - C Monkhouse
- St Bartholomew's Hospital , London , United Kingdom
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6
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Mahtani K, Maclean E, Honarbakhsh S, Bhuva A, Finlay M, Creta A, Earley MJ, Zemrak F, Moore P, Muthumala A, Sporton S, Schilling RJ, Hunter RJ, Monkhouse C, Chow A. Cardiac implantable electronic device infections: prognostic value of the PADIT score and its cost-utility implications for antimicrobial envelope use in the United Kingdom. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence of cardiac implantable electronic device (CIED) infections is rising.
Purpose
We examined the factors associated with CIED infection, assessed the prognostic power of the PADIT risk score, and modelled the cost-utility of selective TYRX antimicrobial envelope use for preventing CIED infections.
Methods
Data were extracted from 2016 to 2019, and included all de novo implants, generator changes and lead interventions for transvenous CIEDs at a high-volume UK centre. CIED infection was defined as hospitalisation for device infection within 12 months of a procedure. Cost-utility analysis was informed by standardised tariffs, and quality adjusted life year (QALY) and efficacy data was extrapolated from analysis of the WRAP-IT trial.
Results
6,035 patients underwent 7,383 procedures; CIED infection occurred in 59 individuals (0.8%). In addition to the constituents of the PADIT score, lead extraction (HR 3.3 (1.9–6.1), p<0.0001), C-reactive protein >50mg/l (HR 3.0 (1.4–6.4), p=0.005), re-intervention within two years (HR 10.1 (5.6–17.9), p<0.0001), and procedure duration over two hours (HR 2.6 (1.6–4.1), p=0.001) were independent predictors of infection. Increased PADIT score was strongly associated with infection (AUC: 0.82, HR per point increase: 1.36 (1.27–1.47), p<0.0001). A cost-utility model assigning TYRX envelopes to patients with PADIT scores ≥6 predicted a reduction in infections (number needed to treat: 72) and a cost per QALY gained within the UK's (NICE) cost-effectiveness threshold (£25,107).
Conclusions
The PADIT score was a powerful predictor of CIED infections in a heterogeneous population,and may facilitate cost-effective TYRX envelope allocation in selected high-risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahtani
- St Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- St Bartholomew's Hospital , London , United Kingdom
| | | | - A Bhuva
- St Bartholomew's Hospital , London , United Kingdom
| | - M Finlay
- St Bartholomew's Hospital , London , United Kingdom
| | - A Creta
- St Bartholomew's Hospital , London , United Kingdom
| | - M J Earley
- St Bartholomew's Hospital , London , United Kingdom
| | - F Zemrak
- St Bartholomew's Hospital , London , United Kingdom
| | - P Moore
- St Bartholomew's Hospital , London , United Kingdom
| | - A Muthumala
- St Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- St Bartholomew's Hospital , London , United Kingdom
| | | | - R J Hunter
- St Bartholomew's Hospital , London , United Kingdom
| | - C Monkhouse
- St Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- St Bartholomew's Hospital , London , United Kingdom
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7
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Woolner B, Moore P, Parker S. 81 An Audit of Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis Implementation. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
VTE is considered one of the most common preventable causes of death and significant co-morbidity in inpatients and is responsible for approximately 60,000 deaths occur per annum in the UK. The NHS Standard Contract requires all inpatients to undergo a VTE risk assessment, with a 95% patient assessment threshold. In January 2020 we identified that 72% of patients within our trust had a risk assessment completed, and 15% of these were accurate. We subsequently implemented mandatory VTE prescribing training for all junior doctors joining the trust.
Aim
Review the impact of mandatory training module on VTE risk assessment and prescribing, in compliance with NICE Guidelines.
Method
All inpatient medical notes, VTE risk assessments, and VTE prescriptions were reviewed to assess accurate risk assessment completion and subsequent appropriate prophylaxis prescribing. The standards were as set out in the NICE guidelines [NG89]. Paediatric, Obstetric and ITU patients were excluded.
Results
Our VTE risk assessment completion rates increased from 72.1% to 94.2%, and the accuracy of these assessments from 15.4% to 34.5%. Our prescription rate increased from 84.6% to 90.6%, and prescribing accuracy from 41.2% to 79.5%.
Conclusions
By implementing mandatory VTE prophylaxis training for all junior doctors joining a new NHS trust, we can see increased compliance with appropriate risk assessment and prophylaxis prescribing. This will reduce the risk of unnecessary death from VTE in hospital inpatients.
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Affiliation(s)
- B. Woolner
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - P. Moore
- Imperial College NHS Healthcare Trust, London, United Kingdom
| | - S. Parker
- Isle of Wight NHS Trust, Newport, United Kingdom
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Camuglia A, Cole C, Boyne N, Hayman S, Cox S, Moore P, Lau J, Delacroix S, Williamson A, Duong M, Schwarz N, Montarello J, Worthley S. 30-Day Outcomes With the Portico™ Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aprile G, Dermedgoglou A, Jhaveri U, Singbal Y, Moore P, Kyranis S, Cox S. Safety and Feasibility of Day Case PCI in a Cardiac Catheter Laboratory in a Queensland Tertiary Hospital. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Moore P, Wiggen T, Kent L, Arif S, Lucas S, O’Grady S, Hunter R. 414: Anaerobic microbiota facilitate Pseudomonas aeruginosa access to the airway epithelium in a novel co-culture model of colonization. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Mark N, Papageorgiou N, Ramplin J, Monkhouse C, Moore P, Chow A, Hunter R, Sporton S, Providencia R, Earley M, Elliott J, Muthumala A. Feasibility of using his bundle pacing with boston scientific generators. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
His bundle pacing (HBP) aims to deliver physiological activation of the ventricles via the native His-Purkinje conduction system. A challenge of HBP is the limited market of implantation tools, pacing leads and specifically designed pacing algorithms.
Purpose
Over the last three years both Medtronic (MDT) and Boston Scientific (BSC) generators have been used for HBP in a large tertiary centre. We examined whether there was any difference between lead parameters and battery longevity depending on the type of manufacturer used.
Methods
Patients implanted with a MDT Select Secure model 3830 lead were included in this retrospective study. Data collected included HBP thresholds (analysed at 1ms pulse width) at implant and at the most recent device check, HBP percentages and battery longevity (months). Battery longevity were calculated by adding duration of follow up and estimated battery life at last follow up.
Results
A total of 31 patients were included for data analysis (58% male and mean age 72 years). 18 patients had MDT generators of which 3 were PPMs, 5 were CRT-Ps and 10 were CRT-Ds. 13 patients had BSC generators of which 5 were PPMs, 5 were CRT-Ps and 3 were CRT-Ds. Mean follow up of the cohort was 12.7±9.02 months.
Mean HBP percentages were 77±37% and 72.2±42.1% for MDT and BSC, respectively (p=0.430). Mean HBP threshold (Volts) at implant was significantly lower with BSC vs MDT (0.85±0.58 vs 1.84±1.06, p=0.01), and similar after follow up (1.01±0.91 vs 1.32±0.73, p=NS). There were no statistically significant differences between mean HBP threshold at implant compared to follow up for both manufacturers.
Interestingly, mean battery longevity for BSC vs MDT generators was significantly higher (136±29.3 vs 90.5±29.1, p<0.001). Longevity was also compared for PPM/CRT-P and CRT-D separately. For PPM/CRT-P, BSC generators had significantly higher longevity as compared to MDT (141.6±33.1 vs 91.6±34.5, p=0.009). This difference was not observed for CRT-Ds between the 2 manufacturers (p=0.068).
Conclusion
Our results suggest HBP with MDT Select Secure 3830 lead is feasible with BSC generators. There is potentially greater battery longevity with BSC compared to MDT generators. Further studies are needed with greater numbers and longer follow up to confirm this finding.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Mark
- Barts Health NHS Trust, London, United Kingdom
| | | | - J Ramplin
- Barts Health NHS Trust, London, United Kingdom
| | - C Monkhouse
- Barts Health NHS Trust, London, United Kingdom
| | - P Moore
- Barts Health NHS Trust, London, United Kingdom
| | - A Chow
- Barts Health NHS Trust, London, United Kingdom
| | - R Hunter
- Barts Health NHS Trust, London, United Kingdom
| | - S Sporton
- Barts Health NHS Trust, London, United Kingdom
| | | | - M Earley
- Barts Health NHS Trust, London, United Kingdom
| | - J Elliott
- Barts Health NHS Trust, London, United Kingdom
| | - A Muthumala
- Barts Health NHS Trust, London, United Kingdom
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Shenderov E, De Marzo A, Lotan T, Wang H, Allaf M, Boudadi K, Chapman C, O'Neal T, Chen F, Moore P, Muth J, Sorg K, White A, Church S, Bivalacqua T, Ross A, Pavlovich C, Drake C, Pardoll D, Antonarakis E. 627P Phase II neoadjuvant trial of the anti–B7-H3 antibody, enoblituzumab, in men with localized prostate cancer: Safety, efficacy and immune correlates. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1140] [Citation(s) in RCA: 1] [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: 10/20/2022] Open
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13
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Keogh LA, Gurrin LC, Moore P. Estimating the abortion rate in Australia from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215:375-376. [PMID: 34365649 DOI: 10.5694/mja2.51217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Louise A Keogh
- Centre for Health Equity, University of Melbourne, Melbourne, VIC
| | - Lyle C Gurrin
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
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Moore P, Pickering O, Cook E. 1025 Readmission & Mortality Rates Following Enhanced Recovery After Surgery (ERAS) For Colorectal Procedures at An Island DGH. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Colorectal surgery under ERAS reduces postoperative morbidity by 40-50% and shortens length of hospital stay by 2-3 days. The 2018 National Bowel Cancer Audit reported a 30-day readmission rate of 10.5% for colorectal surgery under ERAS and a 90-day mortality rate of 2% nationally. Evidence shows readmission rates increase with discharge C-reactive protein (CRP); 16.5% when CRP >100 mg/L and 6% when CRP <100 mg/L.
Method
Data was collected prospectively at a small island DGH on 89 patients from September 2018 - March 2020.
Results
The 30-day readmission rate was 7.9% and the 90-day mortality rate was 0% locally. Six (86%) of the readmitted patients had a left-sided colorectal disease (potentially due to increased risk with a colo-colonic anastomosis). Five (71%) patients required return to theatre; four due to anastomotic leaks and one due to a wound collection. 43% of readmitted patients had upward white cell count/c-reactive protein (WCC/CRP) trends on discharge. Readmitted patients had a mean discharge CRP result of 150 (range 15.9 - 311).
Conclusions
Colorectal surgery under ERAS at our institution is at a high standard stemming from effective staff education and post-operative patient counselling. This study provides evidence that WCC/CRP trend is related to postoperative prognosis.
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Affiliation(s)
- P Moore
- Isle of Wight NHS Trust, Newport, United Kingdom
| | - O Pickering
- Isle of Wight NHS Trust, Newport, United Kingdom
| | - E Cook
- Isle of Wight NHS Trust, Newport, United Kingdom
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Anand E, Moore P, Cook E. Comment on: Resuming elective operations after COVID-19 pandemic. Br J Surg 2021; 108:e84. [PMID: 33711125 PMCID: PMC7799264 DOI: 10.1093/bjs/znaa035] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/12/2022]
Affiliation(s)
- E Anand
- Department of General Surgery, St Mary's Hospital, Newport, UK
| | - P Moore
- Department of General Surgery, St Mary's Hospital, Newport, UK
| | - E Cook
- Department of General Surgery, St Mary's Hospital, Newport, UK
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Kremer JM, Winkler A, Anatale-Tardiff L, Mclean R, Shan Y, Moore P, Tundia N, Suboticki J, Tesser J. FRI0100 COMPARISON OF PATIENTS (PTS) WITH RHEUMATOID ARTHRITIS (RA) AMONG DISEASE ACTIVITY CATEGORIES AFTER 6 MONTHS OF TREATMENT WITH A TUMOUR NECROSIS FACTOR INHIBITOR (TNFI): RESULTS FROM THE CORRONA® RA REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Targeting remission (REM) or low disease activity (LDA) is a widely accepted treatment strategy for RA. However, there are limited data on the proportion of pts who achieve these targets, or remain in moderate (MDA) or high disease activity (HDA) following advanced therapy.Objectives:To estimate the proportion of RA pts in disease activity states (REM, LDA, MDA, and HDA) who were biologic-naïve at initiation and had continuous treatment with a TNFi for 6–12 months in the Corrona RA registry.Methods:Eligible pts were aged ≥18 years, biologic-naïve, initiated TNFi treatment between January 1, 2010 and July 31, 2019, and had continuous use of a TNFi for 6–12 months. Disease activity was defined based on Clinical Disease Activity Index (CDAI) at the visit closest to 6-month follow-up: REM, ≤2.8; LDA, >2.8–10; MDA, >10–22; and HDA, >22. Disease characteristics, disease activity measures, and pt-reported outcomes (PROs) were reported at TNFi initiation and at the 6-month follow-up visit.Results:2586 biologic-naïve pts who initiated a TNFi and had continuous use for 6–12 months were included. At TNFi initiation, 167 (6%) were in REM, 479 (19%) had LDA, 907 (35%) had MDA, and 1033 (40%) had HDA. After 6–12 months of treatment, 563 (21.8%) were in REM, 923 (35.7%) had LDA, 674 (26.1%) had MDA, and 426 (16.5%) had HDA. Pts with HDA/MDA at 6–12 months were more likely to have a history of hypertension (32.7% HDA; 34.0% MDA; vs 23.6% REM) and had higher mean body mass index (BMI) (30.9 HDA; 31.1 MDA; vs 29.0 REM) at baseline compared with pts in REM. Disease activity measures and PROs were worse in pts with MDA and HDA vs LDA and REM after 6–12 months (Table). Pt Global Assessment was higher than Physician Global Assessment across all groups.Conclusion:While 57.4% of pts who initiated a TNFi experienced a favorable outcome, >40% required additional or alternative intervention to achieve REM/LDA. Pts who remained in MDA/HDA continued to have an inadequate response to TNFi (as measured by disease activity measures and PROs) after 6–12 months of treatment compared with those who achieved REM/LDA.TableSummary of disease activity measures and PROs in previously biologic-naïve pts at the 6–12-month follow-up visit, stratified by disease activity category at the 6–12-month follow-up visitCharacteristics at 6–12 months, mean (standard deviation)Disease activity category at 6–12 monthsREM (n=563)LDA (n=923)MDA (n=674)HDA (n=426)CDAI1.2 (0.8)6.2 (2.1)15.4 (3.4)32.7 (9.2)Tender joint count (28)0.1 (0.3)1.0 (1.3)4.3 (3.3)13.4 (7.0)Swollen joint count (28)0.1 (0.3)1.1 (1.6)4.0 (3.6)9.1 (5.9)C-reactive protein6.4 (22.7)7.0 (10.6)11.1 (19.9)12.6 (22.1)Modified health assessment questionnaire0.1 (0.2)0.3 (0.4)0.5 (0.5)0.8 (0.5)Pt global assessment6.6 (6.8)28.6 (20.9)43.7 (25.7)58.0 (22.7)Physician global assessment3.6 (4.3)12.1 (10.4)27.4 (15.9)44.9 (19.8)Pt pain assessment8.7 (11.0)30.3 (23.5)46.1 (27.0)59.9 (24.4)Pt fatigue assessment15.7 (19.2)34.5 (26.6)48.3 (28.0)59.4 (27.5)Morning stiffness (min)16.5 (36.5)55.4 (146.3)96.9 (197.5)143.6 (260.0)Disclosure of Interests:Joel M Kremer Shareholder of: May own stocks and opinions, Grant/research support from: Research and consulting fees from AbbVie Inc., Consultant of: AbbVie, Amgen, BMS, Genentech, Inc., Gilead, GSK, Lilly, Pfizer, Regeneron and Sanofi, Employee of: Corrona, LLC employee, Anne Winkler Consultant of: AbbVie, Pfizer, and Novratis, Speakers bureau: AbbVie, Janssen, Sanofi, Genentech, Celgene, Eli Lilly, and Novartis., Laura Anatale-Tardiff Employee of: Corrona, LLC employee, Robert McLean Employee of: Corrona, LLC, Ying Shan Employee of: Corrona, LLC employee, Page Moore Employee of: Corrona, LLC employee, Namita Tundia Shareholder of: May own stocks and options, Employee of: AbbVie employee, Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., John Tesser Consultant of: Sanofi/Regeneron, Speakers bureau: Sanofi/Regeneron
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Yeong C, Conners G, Cox S, Garrahy P, Kyranis S, Lim R, McCann A, Moore P, Singbal Y, Camuglia A. 902 Time to First Device Time in ST Elevation Myocardial Infarction (STEMI) at a High-Volume STEMI Centre Stratified by Access Site Approach. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Affiliation(s)
- Mary E. Maloney
- Department of Dermatology, University of Massachusetts Medical School, Hahnemann Campus, Worcester, MA, United States
- Corresponding author.
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Naderi H, L"heureux C, Keenan N, Moore P, Sehmi J. P111Double chambered left ventricle. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Naderi
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C L"heureux
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - N Keenan
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - P Moore
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sehmi
- Watford General Hospital, Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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Im SA, Bang YJ, Oh DY, Giaccone G, Bauer T, Nordstrom J, Li H, Moore P, Hong S, Baughman J, Rock E, Burris H. Abstract P6-18-11: Long-term responders to single-agent margetuximab, an Fc-modified anti-HER2 monoclonal antibody, in metastatic HER2+ breast cancer patients with prior anti-HER2 therapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Margetuximab is an Fc-optimized anti-HER2 antibody that recognizes the same epitope as trastuzumab. Margetuximab has increased affinity for the activating CD16A Fc-receptor on NK cells and macrophages as well as decreased affinity for the inhibitory CD32B receptor compared to trastuzumab. In a Phase 1 study (NCT01148849) of 66 patients with relapsed or metastatic HER2+ cancer across multiple indications, margetuximab was well tolerated at all doses. Among 60 response-evaluable patients, confirmed partial response (PR) and stable disease (SD) were seen in 7 (12%) and 30 (50%) patients, respectively. Tumor reductions occurred in 18/23 (78%) evaluable breast cancer patients. Ex-vivo analyses of patient peripheral blood mononuclear cell samples confirmed margetuximab's ability to enhance antibody dependent cell-mediated cytotoxicity over that from trastuzumab. We report on 3 breast cancer patients with prior anti-HER2 therapy failure with durable (≥ 3.5 years) SD (1) or PR (2).
Methods
Enrolled patients had histologically/cytologically-confirmed carcinoma with documented HER2 overexpression by immunohistochemistry (2+ or 3+) and disease progression during/following last therapy. Eligibility included life expectancy ≥3 months; performance status ≤1; measurable disease by Response Criteria for Solid Tumors 1.1; adequate bone marrow, renal, hepatic function; and left ventricular ejection fraction ≥50%. Margetuximab was given by intravenous infusion at 0.1 – 6.0 mg/kg for 3 of every 4 weeks or once every 3 weeks (10 – 18 mg/kg).
Results
Three of 17 HER2 3+ metastatic breast cancer patients received long-term margetuximab. Patient 35 had 3 prior regimens (adjuvant doxorubicin+cyclophosphamide followed by docetaxol+trastuzumab; gemcitabine+vinorelbine; lapatinib+capecitabine) and received margetuximab at 10 mg/kg q3wk, 88 cycles to date, with PR achieved Cycle 1 Day 43, maintained 4.4 years. Patient 44 had 3 prior regimens for metastatic disease (docetaxel+trastuzumab+pertuzumab; doxorubicin+cyclophosphamide; lapatinib+capecitabine) and received margetuximab at 15 mg/kg q3wk, 79 cycles to date with SD for 4.3 years. Patient 50 had 4 prior regimens for recurrent/metastatic disease (tamoxifen; anastrozole; capecitabine+trastuzumab; lapatinib+capecitabine) and received margetuximab dose of 18 mg/kg q3wk with PR achieved Cycle 1 Day 43, maintained 3.5 years. Progression was noted at Cycle 57, and margetuximab continues at 63 cycles to date. No cardiac toxicities were found during long-term follow-up for these 3 patients and there were no treatment-related adverse events ≥Grade 3.
Conclusions
Margetuximab is well-tolerated without cardiac toxicities in long-term responders, with single-agent activity including durable responses in heavily pre-treated metastatic breast cancer. A Phase 3, randomized, multi-center clinical trial (SOPHIA; NCT02492711) is enrolling patients with metastatic breast cancer, comparing margetuximab plus chemotherapy to trastuzumab plus chemotherapy in patients who have received 1 to 3 lines of therapy for advanced disease.
Citation Format: Im S-A, Bang Y-J, Oh D-Y, Giaccone G, Bauer T, Nordstrom J, Li H, Moore P, Hong S, Baughman J, Rock E, Burris H. Long-term responders to single-agent margetuximab, an Fc-modified anti-HER2 monoclonal antibody, in metastatic HER2+ breast cancer patients with prior anti-HER2 therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-11.
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Affiliation(s)
- S-A Im
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - Y-J Bang
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - D-Y Oh
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - G Giaccone
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - T Bauer
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - J Nordstrom
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - H Li
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - P Moore
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - S Hong
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - J Baughman
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - E Rock
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
| | - H Burris
- Seoul National University Hospital, Seoul, Republic of Korea; Georgetown University, Washington, DC; Sarah Cannon Research Institute, Nashville, TN; MacroGenics, Inc., Rockville, MD
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Moore P. Book Review: Textbook of Hyperbaric Medicine—4th Edition. Anaesth Intensive Care 2019. [DOI: 10.1177/0310057x0603400629] [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: 11/16/2022]
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22
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Palter J, Roy C, Aceves J, Moore P. 298 Interactions With Immigration Officers in the Emergency Department: A Needs Assessment Survey. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Henning Buehring J, Moore P. Emotional and Social Intelligence as ‘Magic Key’ in Innovation: A Designer’s call toward inclusivity for all. jim 2018. [DOI: 10.24840/2183-0606_006.002_0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper draws attention to the emotional and social intelligence of individuals - encompassing self- and social awareness, empathy and social skills; when applied to innovation, it can boost employee creativity, diversity, risk taking, learning, adapting, and strategic decision making which is deemed as critical in meeting the challenges of the 21stCentury. Meanwhile, Design in business and innovation have become increasingly synonymous in both meaning (e.g. design and futures thinking) and reach (e.g. products, services, business models, and systems), placing renewed focus on creative human capital as the organizations’ greatest asset. Expanding the conversation of Design in business as a strategic role to develop user-centered innovations through ‘inclusivity for all’, it is proposed that an organization’s emotional and social intelligence may well bear the 'magic key' toward competitive resilience and long-term survival.
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Affiliation(s)
- D Lanz
- Women's Health Research Unit, Queen Mary University of London, London, UK
| | - P Moore
- Anaesthetics, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - J Daru
- Women's Health Research Unit, Queen Mary University of London, London, UK
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Karim N, Jacob A, Shaukat M, Hua Y, Chiu H, Mehta A, Moore P, Chow A. 59Can high volume tertiary centres with 24/7 device implanting service provide improved efficacy and outcomes compared to a large district general hospital model? Europace 2017. [DOI: 10.1093/europace/eux283.054] [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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Moore P, Streeton C. Oral hormonal contraception in special circumstances. Aust Fam Physician 2017; 46:728-732. [PMID: 29036771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite the general consensus that long-acting reversible contraceptives (LARCs) are the most appropriate choice of contraception for most women, there are special circumstances when the contraceptive and non-contraceptive needs of the patient are met by oral methods. OBJECTIVE By using case histories, we seek to demonstrate the medical and practical complexities in managing contraceptive needs that may result in oral contraception being the most appropriate choice. The cases also illustrate the resources available to enable evidence-based management. DISCUSSION Concurrent medical conditions and non-contraceptive benefits of oral contraceptive methods will see the continued use of these medications for a significant minority of women. A comprehensive knowledge of the rapidly developing evidence regarding medical eligibility and indications for usage is required. Reference to the already highly developed and easily accessible evidence bases ensures best practice for the women and families who seek advice.
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Moore P, Janssen C, Murphy A, Nadra I, Della Siega A, Robinson S. CORONARY ANGIOGRAPHY AND REVASCULARISATION AFTER CABG IN BRITISH COLUMBIA: INCIDENCE, PREDICTORS AND OUTCOMES. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gillette D, Fisher J, Yeh J, Moore P, Gladstone C, Fishman D. NAVIGATING THE HUMAN PATH IN AN INTERGENERATIONAL DESIGN STUDIO. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2599] [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: 11/13/2022] Open
Affiliation(s)
- D. Gillette
- Training for Development of Innovative Control Technologies (TDICT) Project, San Francisco, California,
- MooreDesign Associates, Phoenix, Arizona,
| | - J. Fisher
- Aging 2.0, San Francisco, California,
- Public Health Institute, Oakland, California,
| | - J.C. Yeh
- University of California, Berkeley, Berkley, California
| | - P. Moore
- University of California, San Francisco, Institute for Health & Aging, San Francisco, California,
| | - C. Gladstone
- University of California, Berkeley, Berkley, California
| | - D. Fishman
- University of California, Berkeley, Berkley, California
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Capoferri A, Ramos J, Xu D, Rosenbloom D, Siliciano J, Siliciano R, Noy A, Moore P, Ambinder R, Durand C. OA1-1 Impact of vorinostat treatment of non-Hodgkin‘s lymphoma on HIV-1 latent reservoir. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sohaib SMA, Shun-Shin M, Wright I, Lim E, Moore P, Lim PB, Koa Wing M, Lefroy D, Linton N, Davies DW, Peters NS, Kanagaratnam P, Francis D, Whinnett ZI. P1538Using high precision haemodynamic measurements to assess differences in AV optimum between different left ventricular lead positions in biventricular pacing. Europace 2017. [DOI: 10.1093/ehjci/eux158.164] [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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Varanasi S, Wright I, Hussain W, Bowers R, Slater T, Sengupta A, Porter B, Hussein A, Chu G, Siddiqui M, Man S, Somani R, Sandilands A, Stafford P, Ng G, Luther V, Young Kim M, Benfield A, Tanner M, Lefroy D, Koa-Wing M, Lim P, Linton N, Davies D, Peters N, Kanagaratnam P, Moore P, Whinnett Z, Thakrar D, Iacovides S, Paisey J, Balasubramaniam R, Sopher SM, Saunderson C, Moyles C, Blackburn Y, Morley C, Jamil H, Schlosshan D, Kearney M, Witte K, Lambden C, Woodcock T, Matthew D, Hashmy S, Kaur M, Kaba A, Grant R, Unger-Graeber B, Khan S, Das M, Wynn G, Morgan M, Waktare J, Hall M, Modi S, Snowdon R, Todd D, Gupta D. MODERATED POSTERS (1)43P WAVE DURATION & SPECTRAL ANALYSIS OF SIGNAL AVERAGED P WAVE: CAN THIS PREDICT RECURRENCE OF PARAOXYSMAL ATRIAL FIBRILLATION AFTER PULMONARY VEIN SIOLATION? A PROSPECTIVE STUDY44ATP INDUCED SLOW VF - A MECHANISM TO EXPLAIN THE ASSOCIATION BETWEEN ATP AND INCREASED MORTALITY45THE USE OF A HANDHELD DEVICE IN IDENTIFYING ATRIAL FIBRILLATION PATIENTS DURING FLU VACCINATION CLINICS46DELIVERY OF A FULL EP SERVICE FROM A DISTRICT GENERAL HOSPITAL SETTING: OUTCOMES FROM A SINGLE CENTRE47THE PREVALENCE OF SODIUM AND FLUID DEPLETION IN PATIENTS WITH RECURRENT SYNCOPE OF PRESUMED HYPOTENSIVE ORIGIN: A SINGLE CENTRE EXPERIENCE48ECHOCARDIOGRAPHY AND RISK STRATIFICATION FOR ICD IMPLANTATION AFTER ST-ELEVATION MYOCARDIAL INFARCTION:OPPORTUNITIES FOR IMPROVEMENT49THE QUALITY AND OUTCOMES FRAMEWORK DATA UNDERESTIMATES AF PREVALENCE AND OVERESTIMATES RATES OF APPROPRIATE THROMBOEMBOLIC PROPHYLAXIS50THE RELATIONSHIP BETWEEN THE EFFECTIVE REFRACTORY PERIOD OF RECONNECTED PULMONARY VEINS AT REPEAT ELECTROPHYSIOLOGY STUDY AND RECURRENCE OF ATRIAL TACHYCARRHYTHMIA BEYOND ONE MONTH AFTER PULMONARY VEIN ISOLATION. Europace 2016. [DOI: 10.1093/europace/euw268] [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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Moore P, Jackson C, Mutch K, Methley A, Pollard C, Hamid S, Jacob A. Patient-reported outcome measure for neuromyelitis optica: pretesting of preliminary instrument and protocol for further development in accordance with international guidelines. BMJ Open 2016; 6:e011142. [PMID: 27694484 PMCID: PMC5051334 DOI: 10.1136/bmjopen-2016-011142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/24/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study outlines the development of a patient-reported outcome measure (PROM), an instrument to obtain self-reported health status for neuromyeltis optica (NMO), a disabling neurological condition. DESIGN Development was conducted in accordance with international guidance for PROMs including systematic review of existing literature, item generation guided by qualitative interviews, health-related quality of life conceptual framework and clinical expert panel and cognitive interviews with NMO patients. SETTING Participants were identified through a national NMO clinic in a tertiary NHS neurosciences service. PARTICIPANTS 15 individuals with NMO participated in cognitive interviews requiring review and ranking of proposed PROM items and qualitative feedback on content, layout and response options. RESULTS Participants endorsed the draft instrument as reflecting their experience of the condition and as being easy to understand. Rating and ranking of item relevance and importance reduced the draft instrument from 106 to 48 items. Participant feedback on overlapping items eliminated a further 2 items and resulted in a preliminary instrument of 46 items. As a direct result of participant feedback ordering of the 10 domains was revised, a 4 option Likert scale was employed and a 4-week recall period for impact of symptoms was selected. CONCLUSIONS A 46-item instrument developed in accordance with international PROM development guidelines through literature review, developed by subject matter experts and refined through pretesting examining content validity provides a preliminary measure for assessing patient-report of health status in NMO. Further evaluation is proposed including sensitivity to clinical change, and international contributions to evaluating the measure are encouraged.
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Affiliation(s)
- P Moore
- Department of Clinical Neuropsychology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - C Jackson
- Department of Clinical Neuropsychology, The Walton Centre NHS Foundation Trust, Liverpool, UK Department of Clinical Psychology, University of Liverpool, Liverpool, UK
| | - K Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A Methley
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - C Pollard
- Department of Clinical Neuropsychology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - S Hamid
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - A Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Rowe M, Moore P, Pratap J, Coucher J, Gould P, Kaye G. Surface ECG Criteria During Pacemaker Implantation are Not Predictive of Right Ventricular Septal Pacing Lead Position when Compared to Cardiac CT. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Austrom MG, Hartwell C, Moore P, Perkins AJ, Damush T, Unverzagt FW, Boustani M, Hendrie HC, Callahan CM. An integrated model of comprehensive care for people with Alzheimer's disease and their caregivers in a primary care setting. Dementia 2016. [DOI: 10.1177/1471301206067108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most people with Alzheimer's disease and their families receive care in primary care. This article describes an integrated model of Alzheimer's disease care in a primary care setting serving a predominantly ethnic minority population. This model included: a comprehensive screening and diagnosis process; a multidisciplinary team approach to care, coordinated by a geriatric advanced practice nurse; and a proactive, longitudinal tracking system. The psychosocial intervention included specific responses to the treatment and management of behavioral and psychological symptoms of dementia, including caregiver directed interventions and pharmacological treatment if needed. Results suggest that this type of model can be implemented in primary care, particularly with the involvement of geriatric advanced practice nurses who can effectively manage the complex nature of Alzheimer's disease.
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Chen X, Haddish-Berhane N, Moore P, Clark T, Yang Y, Li H, Xuan D, Barton HA, Betts AM, Barletta F. Mechanistic Projection of First-in-Human Dose for Bispecific Immunomodulatory P-Cadherin LP-DART: An Integrated PK/PD Modeling Approach. Clin Pharmacol Ther 2016; 100:232-41. [DOI: 10.1002/cpt.393] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- X Chen
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Cambridge Massachusetts USA
| | - N Haddish-Berhane
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
- Current Address: Clinical Pharmacology and Pharmacometrics; Quantitative Sciences Janssen Pharmaceuticals, Spring House, Pennsylvania USA
| | - P Moore
- MacroGenics; Rockville; Maryland USA
| | - T Clark
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - Y Yang
- MacroGenics; Rockville; Maryland USA
| | - H Li
- MacroGenics; Rockville; Maryland USA
| | - D Xuan
- Clinical Pharmacology; Pfizer; San Diego California USA
| | - HA Barton
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - AM Betts
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Groton Connecticut USA
| | - F Barletta
- Pharmacokinetics, Dynamics and Metabolism; Pfizer; Pearl River New York USA
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Pandya N, Chen W, Lohr J, Yao XT, Burns R, Li H, Li H, Muth J, Goldwater R, Bonvini E, Johnson S, Moore P, Wigginton J. OP0201 Safety, Tolerability, and Functional Activity of MGD010, A Dart® Molecule Targeting CD32B and CD79B, Following A Single Dose Administration in Healthy Volunteers. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Landslides are hazardous events with often disastrous consequences. Monitoring landslides with observations of high spatio-temporal resolution can help mitigate such hazards. Mini unmanned aerial vehicles (UAVs) complemented by structure-from-motion (SfM) photogrammetry and modern per-pixel image matching algorithms can deliver a time-series of landslide elevation models in an automated and inexpensive way. This research investigates the potential of a mini UAV, equipped with a Panasonic Lumix DMC-LX5 compact camera, to provide surface deformations at acceptable levels of accuracy for landslide assessment. The study adopts a self-calibrating bundle adjustment-SfM pipeline using ground control points (GCPs). It evaluates misalignment biases and unresolved systematic errors that are transferred through the SfM process into the derived elevation models. To cross-validate the research outputs, results are compared to benchmark observations obtained by standard surveying techniques. The data is collected with 6 cm ground sample distance (GSD) and is shown to achieve planimetric and vertical accuracy of a few centimetres at independent check points (ICPs). The co-registration error of the generated elevation models is also examined in areas of stable terrain. Through this error assessment, the study estimates that the vertical sensitivity to real terrain change of the tested landslide is equal to 9 cm.
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Jansen VM, Bhola NE, Bauer JA, Formisano L, Moore P, Koch J, Arteaga CL. Abstract PD2-06: Inhibition of 3-phosphoinositide dependent protein kinase 1 (PDK1) synergizes with CDK4/6 inhibitors against ER-positive breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd2-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Dysregulation in cell cycle checkpoints is common in cancer. Small molecule inhibitors that target the CDK4/6/cyclinD1 pathway of the cell cycle are in clinical development. Recently the combination of the CDK4/6 inhibitor palbociclib and the aromatase inhibitor letrozole was approved for the treatment of post-menopausal women with ER+/HER2- advanced breast cancer. However, not all patients benefit from CDK4/6 inhibitors and a significant fraction of them eventually progress on these agents, underscoring the need to develop potent therapeutic strategies to circumvent drug resistance.
Methods: We performed a high-throughput RNA interference (RNAi) kinome screen targeting 720 kinases to identify targetable molecules whose inhibition, in combination with the CDK4/6 inhibitor LEE011 (ribociclib), induced synthetic lethality in MCF7 ER+ breast cancer cells. PDK1 RNAi oligonucleotides and the PDK1 inhibitor GSK2334470 in combination with each of the CDK4/6 inhibitors, palbociclib and LEE011, were tested against ER+ breast cancer cells. In vivo anti-tumor efficacy of LEE011 and GSK2334470 was assessed in ovariectomized athymic nude mice bearing MCF7 xenografts.
Results: A siRNA kinome screen identified PDK1 as the top RNA whose downregulation sensitized MCF7 cells to CDK4/6 inhibitors. This was confirmed with independent siRNAs in ER+ MCF7, T47D, HCC1428 and HCC1500 breast cancer cells. Pharmacological inhibition of PDK1 with the ATP-competitive, small molecule inhibitor GSK2334470 in combination with each of the CDK4/6 inhibitors, LEE011 and palbociclib, synergistically inhibited proliferation and increased apoptosis of MCF7 and T47D cells (combination index 0.19-0.89). LEE011-resistant MCF7 and T47D cells were generated by chronic treatment with doses of LEE011 up to 1 µM. Drug-resistant cells displayed increased levels of PDK1, phosphorylated Rb, and phosphorylated S6 ribosomal protein (pS6), an effector of the PDK1 substrate p70S6K, compared to parental drug-sensitive cells. Inhibition of PDK1 with siRNA or GSK2334470 re-sensitized the LEE011-resistant cells to the CDK4/6 inhibitors. Genetic (RNAi) and pharmacological inhibition of PDK1 (with GSK2334470) abrogated pS6 levels whereas inhibition of AKT with the small molecule inhibitor MK2206 did not affect pS6 levels, suggesting PDK1 can induce resistance to CDK4/6 inhibitors via p70S6K/pS6 signaling in an AKT-independent manner. The effects observed in cell lines in culture were recapitulated in vivo using MCF7 xenografts established in ovariectomized nude mice in the absence of estrogen supplementation. Treatment with GSK2334470 and LEE011 induced tumor regressions (8/8 tumors by RECIST criteria) more potently than either drug alone.
Conclusions: These data support a critical role of PDK1 in mediating acquired resistance to CDK4/6 inhibitors in ER+ breast cancer cells. Co-targeting of the PDK1 and CDK4/6 pathways may overcome resistance to CDK4/6 inhibitors and is worthy of further translational and clinical investigation in patients with ER+ breast cancer.
Citation Format: Jansen VM, Bhola NE, Bauer JA, Formisano L, Moore P, Koch J, Arteaga CL. Inhibition of 3-phosphoinositide dependent protein kinase 1 (PDK1) synergizes with CDK4/6 inhibitors against ER-positive breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD2-06.
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Affiliation(s)
- VM Jansen
- Vanderbilt University, Nashville, TN
| | - NE Bhola
- Vanderbilt University, Nashville, TN
| | - JA Bauer
- Vanderbilt University, Nashville, TN
| | | | - P Moore
- Vanderbilt University, Nashville, TN
| | - J Koch
- Vanderbilt University, Nashville, TN
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Taylor R, Sohaib S, Gamble J, Qureshi N, Chu G, Chubb H, Umar F, Stegemann B, Leyva F, Wright I, Lim E, Koawing M, Lim P, Moore P, Linton N, Lefroy D, Davies D, Peters N, Kanagaratnam P, Francis D, Whinnett Z, Khiani R, Herring N, Foley P, Ginks M, Rajappan K, Bashir Y, Betts T, Kim S, Cantwell C, Ali R, Roney C, Shun-Shin M, Ng F, Wright I, Lim E, Lefroy D, Whinnett Z, Linton N, Kanagaratnam P, Peters N, Lim P, Li X, Vanheusden F, Almeida T, Salinet J, Dastagir N, Varanasi S, Chin S, Siddiqui S, Man S, Stafford P, Sandilands A, Schlindwein F, Ng G, Harrison J, Williams S, Whitaker J, Weiss S, Krueger S, Stenzel G, Schaeffter T, Razavi R, O'Neill M. Young Investigators Competition1Left ventricular lead position, mechanical activation and myocardial scar in relation to the clinical outcome of cardiac resynchronisation therapy: the role of feature-tracking and contrast-enhanced cardiovascular magnetic resonance2Does the haemodynamic improvement of biventricular pacing truly arise from cardiac resynchronisation? quantifying the contribution of av and vv adjustment3Differential relationship of electrical delay with endocardial and epicardial left ventricular leads for cardiac resynchronisation therapy4Characterisation of the persistent af substrate through the assessment of electrophysiologic parameters in the organised vs. disorganised rhythm5Targeting cyclical highest dominant frequency in the ablation of persistent atrial fibrillation6Feasibility of fully mr-guided ablation with active tracking: from pre-clinical to clinical application. Europace 2015. [DOI: 10.1093/europace/euv324] [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: 11/12/2022] Open
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Abstract
The plant-parasitic nematode, Pratylenchus penetrans, is a major constraint to red raspberry (Rubus idaeus) production. To determine the impact of P. penetrans on the establishment and productivity of eight raspberry cultivars, R. niveus, and R. leucodermis, plants were grown in fumigated and nonfumigated soil. Then, soil and root populations of P. penetrans and plant productivity (vigor, cane height, biomass, and yield) were monitored over 2 years. In a separate experiment, the role that soil type plays in mediating P. penetrans populations and raspberry establishment was investigated. At 6 and 12 months after planting, population densities of P. penetrans were lower in fumigated than in nonfumigated soil; this trend continued 18 months after planting. All cultivars and R. leucodermis were found to be extremely susceptible to damage caused by P. penetrans. By the end of the experiment, yield was the most sensitive indicator of plant productivity among cultivars, with losses in nonfumigated soil ranging from 63 to 100% of those observed in fumigated soil. However, there was no difference in the productivity of R. niveus plants grown in nonfumigated versus fumigated soils. Results also indicated that the damage potential of P. penetrans was greater on sandy loam versus silt loam soils. The total plant biomass of 'Meeker' raspberry was 46% lower in a sandy loam soil containing P. penetrans compared with soil without P. penetrans; this trend was not observed consistently in a silt loam soil. Despite the fact that soil fumigation is increasingly more limited by regulations, this study shows the utility of fumigation in reducing P. penetrans populations for a sufficient period of time to ensure that newly planted raspberry seedlings can become successfully established.
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Affiliation(s)
- Inga A Zasada
- United States Department of Agriculture-Agricultural Research Service Horticultural Crops Research Laboratory, Corvallis, OR 97330
| | - Jerry E Weiland
- United States Department of Agriculture-Agricultural Research Service Horticultural Crops Research Laboratory, Corvallis, OR 97330
| | - Z Han
- Washington State University (WSU) Northwestern Washington Research and Extension Center, Mt. Vernon, WA 98273
| | - T W Walters
- Washington State University (WSU) Northwestern Washington Research and Extension Center, Mt. Vernon, WA 98273
| | - P Moore
- WSU-Puyallup, Puyallup 98371
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McArdle S, Meade MM, Moore P. Exploring attitudes toward eating disorders among elite athlete support personnel. Scand J Med Sci Sports 2015; 26:1117-27. [PMID: 26134346 DOI: 10.1111/sms.12515] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
To date, little is known about the beliefs, attitudes, and experiences of athlete support personnel (ASP) working in elite sport toward disordered eating (DE) and eating disorders (EDs). This study seeks to explore this area of mental health, employing an attribution model of stigma as a conceptual lens. Interviews were undertaken with 14 service providers (seven males and seven females) working in high-performance sport in Ireland. In contrast to previous research in the general population, findings revealed that sport-based personnel, in the main, did not hold the individual responsible for the development of their eating disorder. The predominant emotional response of those who had worked with an athlete with a known or suspected eating disorder was anxiety and worry. In line with the findings of previous studies with other health professionals, negative views on the prognosis of those with EDs were expressed by the ASP. Furthermore, confidentiality was found to be a significant barrier to bringing athletes' disclosure of problematic eating or exercise behavior to the fore. The findings of this study add to the limited research exploring attitudes toward EDs in sport and highlights the importance of greater education and openness toward this particular mental health problem.
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Affiliation(s)
- S McArdle
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - M M Meade
- Ulster Sports Academy, University of Ulster, Jordanstown Campus, Newtownabbey, UK
| | - P Moore
- Irish Institute of Sport, National Sports Campus, Dublin, Ireland
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Heidecker B, Moore P, Bergsland EK, Merrick SH, Rao RK. Transcatheter pulmonic valve replacement in carcinoid heart disease. Eur Heart J Cardiovasc Imaging 2015; 16:1046. [PMID: 26003151 DOI: 10.1093/ehjci/jev121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Heidecker
- Division of Cardiology, University of California, 505 Parnassus Avenue, Room M1184, San Francisco, CA 94143-0124, USA
| | - P Moore
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - E K Bergsland
- Division of Hematology-Oncology, University of California, San Francisco, CA, USA
| | - S H Merrick
- Department of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - R K Rao
- Division of Cardiology, University of California, 505 Parnassus Avenue, Room M1184, San Francisco, CA 94143-0124, USA
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Geoghegan J, Middleton L, Moore P, Subseson G, Khan K, Daniels J. Routine cell salvage during elective caesarean section: a pilot randomised trial. Int J Obstet Anesth 2015; 24:86-7. [DOI: 10.1016/j.ijoa.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/05/2014] [Accepted: 08/19/2014] [Indexed: 11/26/2022]
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Moore P, Lollback N, Slater L, Gould P, Hill J, Kaye G. The safety of a nurse-led day case cardioversion service in the novel oral anticoagulant era: a single centre experience. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Savasi I, Jayasinghe K, Moore P, Jayasinghe Y, Grover SR. Complication rates associated with levonorgestrel intrauterine system use in adolescents with developmental disabilities. J Pediatr Adolesc Gynecol 2014; 27:25-8. [PMID: 24315712 DOI: 10.1016/j.jpag.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To assess the complication rates with the use of the levonorgestrel intrauterine system (LNG IUS) in adolescents with developmental disabilities. DESIGN Retrospective chart review of all adolescents with developmental disabilities taken to the operating room for LNG IUS insertion between January 2000 and July 2009 at the Royal Children's Hospital, Melbourne, Australia. Cases identified from the surgical database, and medical records reviewed. MAIN OUTCOME MEASURES Complication rates with LNG IUS use in adolescents with development disabilities: non-insertion, uterine perforation, infection, and expulsion. RESULTS Fifty-six adolescents with developmental disabilities had an attempted LNG IUS insertion. The average age at insertion was 15.6 years (range 10.5-21.5 y). The LNG IUS was used as first line therapy in 14 cases (25%). Pre-insertion ultrasonography was ordered in 48% of cases, out of which 5 cases had uterine lengths <6 cm. Despite this, 4 of these cases had successful insertions. Two insertion attempts were abandoned intra-operatively (3.6%); one due to inadequate uterine length of 4 cm, and the other due to anatomic distortion. One spontaneous expulsion occurred at approximately 5 months (1.9%). Four IUDs were removed prematurely (7.4% withdrawal rate); 1 for persistent abdominal pain, 1 for irregular bleeding, and 2 for suspected malpositions. There were no documented cases of infection, perforation, or pregnancy. CONCLUSION Our experience in this population has been very positive and confirms that complication rates are comparable to that in adults.
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Affiliation(s)
- Ingrid Savasi
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kokum Jayasinghe
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Patricia Moore
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yasmin Jayasinghe
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sonia R Grover
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
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Habib MJ, Risebrough N, Moore P, Kendall R, Li CM, Goeree R. Abstract P6-07-02: Pharmacoeconomic evaluation of denosumab for the treatment of bone metastases in patients with advanced breast cancer in Canada. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-07-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Skeletal-related events (SREs) occur in 80% of patients with advanced breast cancer (BC) and bone metastases. SREs are costly and can be painful and debilitating, impacting patients’ quality of life and morbidity. While intravenous bisphosphonates such as pamidronate (PAM) and zoledronic acid (ZA) have demonstrated clinical benefit in reducing SREs, skeletal metastases remain a problem as treatments that are more efficacious, well tolerated, more convenient and less costly to administer are needed. Denosumab (XGEVA™) is a novel subcutaneous human monoclonal antibody therapy that significantly reduces the risk of developing SREs in patients with bone metastases from BC.
Objective: The objective of this project is to estimate the incremental cost-effectiveness of denosumab relative to ZA and PAM in the treatment of advanced BC patients with bone metastases.
Methods: A lifetime Markov model with four-week cycle lengths was developed with three health states: on treatment; off treatment; and death. The model included the risk of an SRE for patients on and off treatment and adverse events during treatment. Efficacy was measured as reduction in SREs. Head-to-head efficacy data, transition probabilities, and risk of adverse events were obtained from the clinical trial of denosumab versus ZA. (Stopeck AT et al JCO 2010) Efficacy data compared to PAM was determined from a published network meta-analysis. (Ford JA et al Eur J Cancer 2012) The baseline SRE risk was derived from clinical trial data due to the absence of real-world Canadian data. Analyses were conducted from the Canadian healthcare system perspective and reported in 2011 $CAD. Resource use was determined from a Canadian retrospective chart review of oncology patients with SREs. Costs were based on the published literature, the Ontario Case Costing Initiative, and input from a physician panel. Utility inputs were based on a time trade-off study. (Matza LS et al. Eur J Health Econ 2013) Bisphosphonate administration costs were derived from a published time and motion study. (Dranitsaris G et al. J Oncol Pharm Pract 2001) Outcomes were measured as both SREs avoided and quality-adjusted life years (QALYs) gained. Dominance was assessed or incremental cost-effectiveness ratios calculated per SRE avoided and per QALY gained, for denosumab compared to ZA and PAM. Future costs and QALYs were discounted at 5% per annum. Sensitivity analyses were conducted to test the robustness of the results.
Results: Denosumab was dominant and resulted in $5,733 in cost savings compared to ZA and $2,566 in cost savings compared to PAM based on a probabilistic analysis. Cost savings was driven by differences in drug administration costs and reduction in SREs. SREs avoided were 0.27 and 0.57 compared to ZA and PAM respectively. Denosumab resulted in 0.012 QALYs gained and 0.025 QALYs gained per patient compared to ZA and PAM, respectively. Sensitivity analyses showed the results were robust but most sensitive to drug administration costs and the relative risk of SREs.
Conclusion: Compared to both ZA and PAM, denosumab is more efficacious and offers better value for money (i.e. dominant) in Canada for managing SREs in patients with advanced BC and bone metastases.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-02.
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Affiliation(s)
- MJ Habib
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - N Risebrough
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - P Moore
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - R Kendall
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - CM Li
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - R Goeree
- Amgen Canada, Mississauga, ON, Canada; Oxford Outcomes an ICON PLC Company, Toronto, ON, Canada; PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Gill T, Barua N, Woolley M, Bienemann A, Johnson D, S.O'Sullivan, Murray G, Fennelly C, Lewis O, Irving C, Wyatt M, Moore P, Gill S. In vitro and in vivo testing of a novel recessed-step catheter for reflux-free convection-enhanced drug delivery to the brain. J Neurosci Methods 2013; 219:1-9. [DOI: 10.1016/j.jneumeth.2013.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
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Kayani R, Botros S, Moore P. Beta-ketothiolase deficiency and pregnancy. Int J Obstet Anesth 2013; 22:260-1. [PMID: 23664791 DOI: 10.1016/j.ijoa.2013.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 02/08/2013] [Accepted: 03/11/2013] [Indexed: 12/29/2022]
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