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Sara G, Hamer J, Gould P, Curtis J, Ramanuj P, O’Brien TA, Burgess P. Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users. Epidemiol Psychiatr Sci 2024; 33:e12. [PMID: 38494985 PMCID: PMC10951789 DOI: 10.1017/s2045796024000131] [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] [Received: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS Timely access to surgery is an essential part of healthcare. People living with mental health (MH) conditions may have higher rates of chronic illness requiring surgical care but also face barriers to care. There is limited evidence about whether unequal surgical access contributes to health inequalities in this group. METHODS We examined 1.22 million surgical procedures in public and private hospitals in New South Wales (NSW), Australia, in 2019. In a cross-sectional study of 76,320 MH service users aged 18 and over, surgical procedure rates per 1,000 population were compared to rates for 6.23 million other NSW residents after direct standardisation for age, sex and socio-economic disadvantage. Rates were calculated for planned and emergency surgery, for major specialty groups, for the top 10 procedure blocks in each specialty group and for 13 access-sensitive procedures. Subgroup analyses were conducted for hospital and insurance type and for people with severe or persistent MH conditions. RESULTS MH service users had higher rates of surgical procedures (adjusted incidence rate ratio [aIRR]: 1.53, 95% CI: 1.51-1.56), due to slightly higher planned procedure rates (aIRR: 1.22, 95% CI: 1.19-1.24) and substantially higher emergency procedure rates (aIRR: 3.60, 95% CI: 3.51-3.70). Emergency procedure rates were increased in all block groups with sufficient numbers for standardisation. MH service users had very high rates (aIRR > 4.5) of emergency cardiovascular, skin and plastics and respiratory procedures, higher rates of planned coronary artery bypass grafting, coronary angiography and cholecystectomy but lower rates of planned ophthalmic surgery, cataract repair, shoulder reconstruction, knee replacement and some plastic surgery procedures. CONCLUSIONS Higher rates of surgery in MH service users may reflect a higher prevalence of conditions requiring surgical care, including cardiac, metabolic, alcohol-related or smoking-related conditions. The striking increase in emergency surgery rates suggests that this need may not be being met, particularly for chronic and disabling conditions which are often treated by planned surgery in private hospital settings in the Australian health system. A higher proportion of emergency surgery may have serious personal and health system consequences.
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Affiliation(s)
- G. Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Hamer
- Mid North Coast Local Health District, Coffs Harbour, NSW, Australia
| | - P. Gould
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Curtis
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - P. Ramanuj
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK
- RAND Europe, London, UK
| | - T. A. O’Brien
- Cancer Institute NSW, Sydney, NSW, Australia
- Medicine & Science, University of New South Wales, Sydney, NSW, Australia
| | - P. Burgess
- School of Public Health, University of Queensland, Brisbane, NSW, Australia
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Unnikrishnan R, Zhao Y, Chondur R, Burgess P. Alcohol-Attributable Death and Burden of Illness among Aboriginal and Non-Aboriginal Populations in Remote Australia, 2014-2018. Int J Environ Res Public Health 2023; 20:7066. [PMID: 37998297 PMCID: PMC10671330 DOI: 10.3390/ijerph20227066] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
Harmful use of alcohol is a problem in the Northern Territory (NT), Australia. The aim of this study was to assess and compare alcohol-attributable deaths and the contribution of alcohol to the burden of disease and injury (BOD) among the Aboriginal and non-Aboriginal populations in the NT between 2014 and 2018. The alcohol-use data for adults aged 15+ years old in the NT population was taken from the 2016 National Drug Strategy Household Survey. BOD was measured in disability-adjusted life years (DALY) as part of the NT BOD study. Population-attributable fractions were derived to analyse deaths and BOD. Between 2014 and 2018, 673 Aboriginal and 392 non-Aboriginal people died of harmful use of alcohol, accounting for 26.3% and 12.9% of the total deaths in the Aboriginal and non-Aboriginal population, respectively. Alcohol caused 38,596 and 15,433 DALY (19.9% and 10.2% of the total), respectively, in the NT Aboriginal and non-Aboriginal population for the same period. The alcohol-attributable DALY rate in the Aboriginal population was 10,444.6 per 100,000 persons, six times the non-Aboriginal rate. This study highlights the urgent need to reduce harmful alcohol use in the NT, which disproportionately affects Aboriginal peoples in rural and remote areas.
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Affiliation(s)
| | - Yuejen Zhao
- Health Statistics & Informatics, Department of Health, Darwin, NT 0800, Australia
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Goddard L, Field E, Moran J, Franzon J, Zhao Y, Burgess P. External validation of the Health Care Homes hospital admission risk stratification tool in the Aboriginal Australian population of the Northern Territory. AUST HEALTH REV 2023; 47:521-534. [PMID: 37696752 DOI: 10.1071/ah23017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
Objective This study aimed to externally validate the Commonwealth's Health Care Homes (HCH) algorithm for Aboriginal Australians living in the Northern Territory (NT). Methods A retrospective cohort study design using linked primary health care (PHC) and hospital data was used to analyse the performance of the HCH algorithm in predicting the risk of hospitalisation for the NT study population. The study population consisted of Aboriginal Australians residing in the NT who have visited a PHC clinic at one of the 54 NT Government clinics at least once between 1 January 2013 and 31 December 2017. Predictors of hospitalisation included demographics, patient observations, medications, diagnoses, pathology results and previous hospitalisation. Results There were a total of 3256 (28.5%) emergency attendances or preventable hospitalisations during the study period. The HCH algorithm had an area under the receiver operating characteristic curve (AUC) of 0.58 for the NT remote Aboriginal population, compared with 0.66 in the Victorian cohort. A refitted model including 'previous hospitalisation' had an AUC of 0.72, demonstrating better discrimination than the HCH algorithm. Calibration was also improved in the refitted model, with an intercept of 0.00 and a slope of 1.00, compared with an intercept of 1.29 and a slope of 0.55 in the HCH algorithm. Conclusion The HCH algorithm performed poorly on the NT cohort compared with the Victorian cohort, due to differences in population demographics and burden of disease. A population-specific hospitalisation risk algorithm is required for the NT.
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Affiliation(s)
- Laura Goddard
- Northern Territory Primary Health Network, Darwin, NT, Australia; and National Centre for Epidemiology and Population Health, Australia National University, Canberra, ACT, Australia
| | - Emma Field
- National Centre for Epidemiology and Population Health, Australia National University, Canberra, ACT, Australia
| | - Judy Moran
- Health Statistics and Informatics, Northern Territory Department of Health, Darwin, NT, Australia
| | - Julie Franzon
- Northern Territory Primary Health Network, Darwin, NT, Australia
| | - Yuejen Zhao
- Health Statistics and Informatics, Northern Territory Department of Health, Darwin, NT, Australia
| | - Paul Burgess
- Health Statistics and Informatics, Northern Territory Department of Health, Darwin, NT, Australia
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Zhao Y, Raymond K, Chondur R, Sharp W, Gadd E, Bailie R, Skinner J, Burgess P. Costs and benefits of community water fluoridation in remote Aboriginal communities of the Northern Territory. Aust J Rural Health 2023; 31:1017-1026. [PMID: 37706591 DOI: 10.1111/ajr.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). DESIGN Dental caries experiences were compared between CWF and non-CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. SETTING AND PARTICIPANTS Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. INTERVENTION CWF. MAIN OUTCOME MEASURES Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. RESULTS Given the total 20-year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300-499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long-term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). CONCLUSIONS The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more.
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Affiliation(s)
- Yuejen Zhao
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Kate Raymond
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Ramakrishna Chondur
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
| | - Wayne Sharp
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Elizabeth Gadd
- Power and Water Corporation, Northern Territory, Darwin, Northern Territory, Australia
| | - Ross Bailie
- The University of Sydney, Sydney, New South Wales, Australia
| | - John Skinner
- Macquarie University, Sydney, New South Wales, Australia
| | - Paul Burgess
- Department of Health, Northern Territory, Casuarina, Northern Territory, Australia
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Kreitman RJ, Moreau P, Ravandi F, Hutchings M, Gazzah A, Michallet AS, Wainberg ZA, Stein A, Dietrich S, de Jonge MJA, Willenbacher W, De Grève J, Arons E, Ilankumaran P, Burgess P, Gasal E, Subbiah V. Dabrafenib plus trametinib in patients with relapsed/refractory BRAF V600E mutation-positive hairy cell leukemia. Blood 2023; 141:996-1006. [PMID: 36108341 PMCID: PMC10163281 DOI: 10.1182/blood.2021013658] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 08/09/2021] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
BRAF V600E is the key oncogenic driver mutation in hairy cell leukemia (HCL). We report the efficacy and safety of dabrafenib plus trametinib in patients with relapsed/refractory BRAF V600E mutation-positive HCL. This open-label, phase 2 study enrolled patients with BRAF V600E mutation-positive HCL refractory to first-line treatment with a purine analog or relapsed after ≥2 prior lines of treatment. Patients received dabrafenib 150 mg twice daily plus trametinib 2 mg once daily until disease progression, unacceptable toxicity, or death. The primary endpoint was investigator-assessed objective response rate (ORR) per criteria adapted from National Comprehensive Cancer Network-Consensus Resolution guidelines. Secondary endpoints included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Fifty-five patients with BRAF V600E mutation-positive HCL were enrolled. The investigator-assessed ORR was 89.0% (95% confidence interval, 77.8%-95.9%); 65.5% of patients had a complete response (without minimal residual disease [MRD]: 9.1% [negative immunohistochemistry of bone marrow {BM} biopsy], 12.7% [negative BM aspirate flow cytometry {FC}], 16.4% [negative immunohistochemistry and/or FC results]; with MRD, 49.1%), and 23.6% had a partial response. The 24-month DOR was 97.7% with 24-month PFS and OS rates of 94.4% and 94.5%, respectively. The most common treatment-related adverse events were pyrexia (58.2%), chills (47.3%), and hyperglycemia (40.0%). Dabrafenib plus trametinib demonstrated durable responses with a manageable safety profile consistent with previous observations in other indications and should be considered as a rituximab-free therapeutic option for patients with relapsed/refractory BRAF V600E mutation-positive HCL. This trial is registered at www.clinicaltrials.gov as #NCT02034110.
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Affiliation(s)
- Robert J. Kreitman
- Laboratory of Molecular Biology, National Institutes of Health, Bethesda, MD
| | | | - Farhad Ravandi
- Division of Cancer Medicine, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Martin Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet, Copenhagen, Denmark
| | - Anas Gazzah
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | | | - Alexander Stein
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Maja J. A. de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wolfgang Willenbacher
- Internal Medicine V: Hematology & Oncology, Medical University Innsbruck, Innsbruck, Austria
- Oncotyrol–Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Jacques De Grève
- University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Evgeny Arons
- Laboratory of Molecular Biology, National Institutes of Health, Bethesda, MD
| | - Palanichamy Ilankumaran
- Global Drug Development, Oncology Development Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Paul Burgess
- Global Drug Development, Oncology Development Unit, Novartis Pharma AG, Basel, Switzerland
| | - Eduard Gasal
- Global Drug Development, Oncology Development Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Chakraborty A, Walke E, Bainbridge R, Bailie R, Matthews V, Larkins S, Burgess P, Askew D, Langham E, Smorgon S, Swaminathan G, Cameron D, Piccoli T, Passey M. VOICE-Validating Outcomes by Including Consumer Experience: A Study Protocol to Develop a Patient Reported Experience Measure for Aboriginal and Torres Strait Islander Peoples Accessing Primary Health Care. Int J Environ Res Public Health 2022; 20:357. [PMID: 36612678 PMCID: PMC9819546 DOI: 10.3390/ijerph20010357] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Aboriginal and Torres Strait Islander peoples' (hereafter respectfully referred to as Indigenous Australians) experiences of health care are shaped by historical, social and cultural factors, with cultural security critical to effective care provision and engagement between services and community. Positive patient experiences are associated with better health outcomes. Consequently, it is an accreditation requirement that primary health care (PHC) services must formally gather and respond to patient feedback. However, currently available patient feedback tools were not developed with Indigenous Australians, and do not reflect their values and world views. Existing tools do not capture important experiences of care of Indigenous Australians in PHC settings, nor return information that assists services to improve care. Consistent with the principles of Indigenous Data Sovereignty, we will co-design and validate an Indigenous-specific Patient Reported Experience Measure (PREM) that produces data by and for community, suitable for use in quality improvement in comprehensive PHC services. This paper presents the protocol of the study, outlining the rationale, methodologies and associated activities that are being applied in developing the PREM. Briefly, guided by an Aboriginal and Torres Strait Islander Advisory Group, our team of Indigenous and non-Indigenous researchers, service providers and policy makers will use a combination of Indigenous methodologies, participatory, and traditional western techniques for scale development. We will engage PHC service staff and communities in eight selected sites across remote, regional, and metropolitan communities in Australia for iterative cycles of data collection and feedback throughout the research process. Yarning Circles with community members will identify core concepts to develop an "Experience of Care Framework", which will be used to develop items for the PREM. Staff members will be interviewed regarding desirable characteristics and feasibility considerations for the PREM. The PREM will undergo cognitive and psychometric testing.
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Affiliation(s)
- Amal Chakraborty
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Emma Walke
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Roxanne Bainbridge
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Paul Burgess
- NT Health, Northern Territory Government, Casuarina, NT 0811, Australia
| | - Deborah Askew
- School of Medicine, Faculty of Medicine, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Erika Langham
- Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, QLD 4067, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, QLD 4067, Australia
| | - Samantha Smorgon
- The Royal Australian College of General Practitioners (RACGP), East Melbourne, VIC 3002, Australia
| | - Girish Swaminathan
- Australian Commission on Safety and Quality in Health Care (ACSQHC), Sydney, NSW 2000, Australia
| | - Danielle Cameron
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Tracey Piccoli
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
| | - Megan Passey
- University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia
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Houchen-Wolloff L, Poinasamy K, Holmes K, Tarpey M, Hastie C, Raihani K, Rogers N, Smith N, Adams D, Burgess P, Clark J, Cranage C, Desai M, Geary N, Gill R, Mangwani J, Staunton L, Berry C, Bolton CE, Chalder T, Chalmers J, De Soyza A, Elneima O, Geddes J, Heller S, Ho LP, Jacob J, McAuley H, Parmar A, Quint JK, Raman B, Rowland M, Singapuri A, Singh SJ, Thomas D, Toshner MR, Wain LV, Horsley AR, Marks M, Brightling CE, Evans RA. Joint patient and clinician priority setting to identify 10 key research questions regarding the long-term sequelae of COVID-19. Thorax 2022; 77:717-720. [PMID: 35354642 PMCID: PMC9209667 DOI: 10.1136/thoraxjnl-2021-218582] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
Given the large numbers of people infected and high rates of ongoing morbidity, research is clearly required to address the needs of adult survivors of COVID-19 living with ongoing symptoms (long COVID). To help direct resource and research efforts, we completed a research prioritisation process incorporating views from adults with ongoing symptoms of COVID-19, carers, clinicians and clinical researchers. The final top 10 research questions were agreed at an independently mediated workshop and included: identifying underlying mechanisms of long COVID, establishing diagnostic tools, understanding trajectory of recovery and evaluating the role of interventions both during the acute and persistent phases of the illness.
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Affiliation(s)
- Linzy Houchen-Wolloff
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | | | - Kate Holmes
- Office for Clinical Research Infrastructure (NOCRI), National Institute for Health Research, London, UK
| | - Maryrose Tarpey
- James Lind Alliance, University of Southampton, Southampton, UK
| | - Claire Hastie
- Long Covid Support, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Kelly Raihani
- Long Covid Support, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Natalie Rogers
- Long Covid Support, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Nikki Smith
- Long Covid Support, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Dawn Adams
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Paul Burgess
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Jean Clark
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Clare Cranage
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Mahadev Desai
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Nicola Geary
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Rhyan Gill
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Jitendra Mangwani
- Leicester Orthopaedic Research Network, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lily Staunton
- Patient and Public Involvement Group, NIHR Leicester Biomedical Research Centre - Respiratory, Leicester, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Charlotte E Bolton
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Trudie Chalder
- Pyschological Medicine, King's College London, London, UK
| | - James Chalmers
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Anthony De Soyza
- Lung Biology and Transplantation Group, Newcastle University, Newcastle upon Tyne, UK
| | - Omer Elneima
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Simon Heller
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Ling-Pei Ho
- Medical Research Council Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Joseph Jacob
- Centre for Medical Imaging and Computing, University College London, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Hamish McAuley
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - Aarti Parmar
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Rowland
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amisha Singapuri
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - Sally J Singh
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - David Thomas
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Mark R Toshner
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Louise V Wain
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
- Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex Robert Horsley
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher E Brightling
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre - Respiratory, University of Leicester, Leicester, UK
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8
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Hare MJL, Zhao Y, Guthridge S, Burgess P, Barr ELM, Ellis E, Butler D, Rosser A, Falhammar H, Maple-Brown LJ. Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study. BMJ Open 2022; 12:e059716. [PMID: 35569825 PMCID: PMC9125760 DOI: 10.1136/bmjopen-2021-059716] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the prevalence and incidence of diabetes among Aboriginal peoples in remote communities of the Northern Territory (NT), Australia. DESIGN Retrospective cohort analysis of linked clinical and administrative data sets from 1 July 2012 to 30 June 2019. SETTING Remote health centres using the NT Government Primary Care Information System (51 out of a total of 84 remote health centres in the NT). PARTICIPANTS All Aboriginal clients residing in remote communities serviced by these health centres (N=21 267). PRIMARY OUTCOME MEASURES Diabetes diagnoses were established using hospital and primary care coding, biochemistry and prescription data. RESULTS Diabetes prevalence across all ages increased from 14.4% (95% CI: 13.9% to 14.9%) to 17.0% (95% CI: 16.5% to 17.5%) over 7 years. Among adults (≥20 years), the 2018/2019 diabetes prevalence was 28.6% (95% CI: 27.8% to 29.4%), being higher in Central Australia (39.5%, 95% CI: 37.8% to 41.1%) compared with the Top End region (24.2%, 95% CI: 23.3% to 25.1%, p<0.001). Between 2016/2017 and 2018/2019, diabetes incidence across all ages was 7.9 per 1000 person-years (95% CI: 7.3 to 8.7 per 1000 person-years). The adult incidence of diabetes was 12.6 per 1000 person-years (95% CI: 11.5 to 13.8 per 1000 person-years). CONCLUSIONS The burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.
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Affiliation(s)
- Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Paul Burgess
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
- Primary Health Care Division, Top End Region, NT Health, Darwin, Northern Territory, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Deborah Butler
- Sector and System Leadership Division, NT Health, Darwin, Northern Territory, Australia
| | - Amy Rosser
- Primary Health Care Division, Central Australia Region, NT Health, Alice Springs, Northern Territory, Australia
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Zhao Y, Wakerman J, Zhang X, Wright J, VanBruggen M, Nasir R, Duckett S, Burgess P. Remoteness, models of primary care and inequity: Medicare under-expenditure in the Northern Territory. AUST HEALTH REV 2022; 46:302-308. [PMID: 35508434 DOI: 10.1071/ah21276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory.MethodsAnalytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models.ResultsIn per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age-sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality.ConclusionsThe current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model.
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Affiliation(s)
- Yuejen Zhao
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia; and Menzies School of Health Research, NT, Australia
| | | | - Xiaohua Zhang
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia
| | - Jo Wright
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia
| | - Maja VanBruggen
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia
| | - Rus Nasir
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia
| | | | - Paul Burgess
- Department of Health, Manunda Place, 38 Cavenagh Street, Darwin, NT 0811, Australia
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Hakim U, Pinti P, Noah AJ, Zhang X, Burgess P, Hamilton A, Hirsch J, Tachtsidis I. Investigation of functional near-infrared spectroscopy signal quality and development of the hemodynamic phase correlation signal. Neurophotonics 2022; 9:025001. [PMID: 35599691 PMCID: PMC9116886 DOI: 10.1117/1.nph.9.2.025001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Significance: There is a longstanding recommendation within the field of fNIRS to use oxygenated (HbO 2 ) and deoxygenated (HHb) hemoglobin when analyzing and interpreting results. Despite this, many fNIRS studies do focus onHbO 2 only. Previous work has shown thatHbO 2 on its own is susceptible to systemic interference and results may mostly reflect that rather than functional activation. Studies using bothHbO 2 and HHb to draw their conclusions do so with varying methods and can lead to discrepancies between studies. The combination ofHbO 2 and HHb has been recommended as a method to utilize both signals in analysis. Aim: We present the development of the hemodynamic phase correlation (HPC) signal to combineHbO 2 and HHb as recommended to utilize both signals in the analysis. We use synthetic and experimental data to evaluate how the HPC and current signals used for fNIRS analysis compare. Approach: About 18 synthetic datasets were formed using resting-state fNIRS data acquired from 16 channels over the frontal lobe. To simulate fNIRS data for a block-design task, we superimposed a synthetic task-related hemodynamic response to the resting state data. This data was used to develop an HPC-general linear model (GLM) framework. Experiments were conducted to investigate the performance of each signal at different SNR and to investigate the effect of false positives on the data. Performance was based on each signal's mean T -value across channels. Experimental data recorded from 128 participants across 134 channels during a finger-tapping task were used to investigate the performance of multiple signals [HbO 2 , HHb, HbT, HbD, correlation-based signal improvement (CBSI), and HPC] on real data. Signal performance was evaluated on its ability to localize activation to a specific region of interest. Results: Results from varying the SNR show that the HPC signal has the highest performance for high SNRs. The CBSI performed the best for medium-low SNR. The next analysis evaluated how false positives affect the signals. The analyses evaluating the effect of false positives showed that the HPC and CBSI signals reflect the effect of false positives onHbO 2 and HHb. The analysis of real experimental data revealed that the HPC and HHb signals provide localization to the primary motor cortex with the highest accuracy. Conclusions: We developed a new hemodynamic signal (HPC) with the potential to overcome the current limitations of usingHbO 2 and HHb separately. Our results suggest that the HPC signal provides comparable accuracy to HHb to localize functional activation while at the same time being more robust against false positives.
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Affiliation(s)
- Uzair Hakim
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
| | - Paola Pinti
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
- University of London, Birkbeck College, Centre for Brain and Cognitive Development, London, United Kingdom
| | - Adam J. Noah
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Xian Zhang
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Paul Burgess
- University College London, Institute of Cognitive Neuroscience, London, United Kingdom
| | - Antonia Hamilton
- University College London, Institute of Cognitive Neuroscience, London, United Kingdom
| | - Joy Hirsch
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
- Yale University, Department of Neuroscience and Comparative Medicine, Yale School of Medicine, United States
| | - Ilias Tachtsidis
- University College London, Department of Medical Physics and Biomedical Engineering, London, United Kingdom
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Subbiah V, Kreitman RJ, Wainberg ZA, Cho JY, Schellens JHM, Soria JC, Wen PY, Zielinski CC, Cabanillas ME, Boran A, Ilankumaran P, Burgess P, Romero Salas T, Keam B. Dabrafenib plus trametinib in patients with BRAF V600E–mutant anaplastic thyroid cancer: updated analysis from the phase II ROAR basket study. Ann Oncol 2022; 33:406-415. [PMID: 35026411 PMCID: PMC9338780 DOI: 10.1016/j.annonc.2021.12.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Combined therapy with dabrafenib plus trametinib was approved in several countries for treatment of BRAF V600E-mutant anaplastic thyroid cancer (ATC) based on an earlier interim analysis of 23 response-assessable patients in the ATC cohort of the phase II Rare Oncology Agnostic Research (ROAR) basket study. We report an updated analysis describing the efficacy and safety of dabrafenib plus trametinib in the full ROAR ATC cohort of 36 patients with ~4 years of additional study follow-up. Patients and methods: ROAR (NCT02034110) is an open-label, nonrandomized, phase II basket study evaluating dabrafenib plus trametinib in BRAF V600E-mutant rare cancers. The ATC cohort comprised 36 patients with unresectable or metastatic ATC who received dabrafenib 150 mg twice daily plus trametinib 2 mg once daily orally until disease progression, unacceptable toxicity, or death. The primary endpoint was investigator-assessed overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints were duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Results: At data cutoff (14 September 2020), median follow-up was 11.1 months (range, 0.9–76.6 months). The investigator-assessed ORR was 56% (95% confidence interval, 38.1% to 72.1%), including three complete responses; the 12-month DOR rate was 50%. Median PFS and OS were 6.7 and 14.5 months, respectively. The respective 12-month PFS and OS rates were 43.2% and 51.7%, and the 24-month OS rate was 31.5%. No new safety signals were identified with additional follow-up, and adverse events were consistent with the established tolerability of dabrafenib plus trametinib. Conclusions: These updated results confirm the substantial clinical benefit and manageable toxicity of dabrafenib plus trametinib in BRAF V600E-mutant ATC. Dabrafenib plus trametinib notably improved long-term survival and represents a meaningful treatment option for this rare, aggressive cancer.
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Affiliation(s)
- V Subbiah
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - J Y Cho
- Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | | | - J C Soria
- Institut Gustave Roussy, University of Paris-Sud, and University of Paris-Saclay, Villejuif, France
| | - P Y Wen
- Dana-Farber Cancer Institute, Boston, USA
| | | | - M E Cabanillas
- The University of Texas MD Anderson Cancer Center, Houston
| | - A Boran
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P Ilankumaran
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P Burgess
- Novartis Pharma AG, Basel, Switzerland
| | | | - B Keam
- Seoul National University Hospital, Seoul, Republic of Korea.
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Wen PY, Stein A, van den Bent M, De Greve J, Wick A, de Vos FYFL, von Bubnoff N, van Linde ME, Lai A, Prager GW, Campone M, Fasolo A, Lopez-Martin JA, Kim TM, Mason WP, Hofheinz RD, Blay JY, Cho DC, Gazzah A, Pouessel D, Yachnin J, Boran A, Burgess P, Ilankumaran P, Gasal E, Subbiah V. Dabrafenib plus trametinib in patients with BRAF V600E-mutant low-grade and high-grade glioma (ROAR): a multicentre, open-label, single-arm, phase 2, basket trial. Lancet Oncol 2021; 23:53-64. [PMID: 34838156 DOI: 10.1016/s1470-2045(21)00578-7] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Effective treatments are needed to improve outcomes for high-grade glioma and low-grade glioma. The activity and safety of dabrafenib plus trametinib were evaluated in adult patients with recurrent or progressive BRAFV600E mutation-positive high-grade glioma and low-grade glioma. METHODS This study is part of an ongoing open-label, single-arm, phase 2 Rare Oncology Agnostic Research (ROAR) basket trial at 27 community and academic cancer centres in 13 countries (Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Norway, South Korea, Spain, Sweden, and the USA). The study enrolled patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0, 1, or 2. Patients with BRAFV600E mutation-positive high-grade glioma and low-grade glioma received dabrafenib 150 mg twice daily plus trametinib 2 mg once daily orally until unacceptable toxicity, disease progression, or death. In the high-grade glioma cohort, patients were required to have measurable disease at baseline using the Response Assessment in Neuro-Oncology high-grade glioma response criteria and have been treated previously with radiotherapy and first-line chemotherapy or concurrent chemoradiotherapy. Patients with low-grade glioma were required to have measurable non-enhancing disease (except pilocytic astrocytoma) at baseline using the Response Assessment in Neuro-Oncology low-grade glioma criteria. The primary endpoint, in the evaluable intention-to-treat population, was investigator-assessed objective response rate (complete response plus partial response for high-grade glioma and complete response plus partial response plus minor response for low-grade glioma). This trial is ongoing, but is closed for enrolment, NCT02034110. FINDINGS Between April 17, 2014, and July 25, 2018, 45 patients (31 with glioblastoma) were enrolled into the high-grade glioma cohort and 13 patients were enrolled into the low-grade glioma cohort. The results presented here are based on interim analysis 16 (data cutoff Sept 14, 2020). In the high-grade glioma cohort, median follow-up was 12·7 months (IQR 5·4-32·3) and 15 (33%; 95% CI 20-49) of 45 patients had an objective response by investigator assessment, including three complete responses and 12 partial responses. In the low-grade glioma cohort, median follow-up was 32·2 months (IQR 25·1-47·8). Nine (69%; 95% CI 39-91) of 13 patients had an objective response by investigator assessment, including one complete response, six partial responses, and two minor responses. Grade 3 or worse adverse events were reported in 31 (53%) patients, the most common being fatigue (five [9%]), decreased neutrophil count (five [9%]), headache (three [5%]), and neutropenia (three [5%]). INTERPRETATION Dabrafenib plus trametinib showed clinically meaningful activity in patients with BRAFV600E mutation-positive recurrent or refractory high-grade glioma and low-grade glioma, with a safety profile consistent with that in other indications. BRAFV600E testing could potentially be adopted in clinical practice for patients with glioma. FUNDING Novartis.
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Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Alexander Stein
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin van den Bent
- Brain Tumor Center and Department of Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jacques De Greve
- University Hospital Vrije Universiteit Brussel, Brussels, Belgium
| | - Antje Wick
- Department of Neurology, University of Heidelberg, National Center for Tumor Diseases, Heidelberg, Germany
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - Nikolas von Bubnoff
- University Medical Center Freiburg, Freiburg, Germany; Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Lübeck, Germany
| | - Myra E van Linde
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Albert Lai
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Gerald W Prager
- Department of Medicine I, AKH Wien, Medical University of Vienna, Vienna, Austria
| | - Mario Campone
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Angelica Fasolo
- Department of Medical Oncology, Ospedale San Raffaele IRCCS, Milan, Italy
| | | | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Warren P Mason
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Jean-Yves Blay
- Center Leon Berard & University Claude Bernard Lyon I, Lyon, France
| | - Daniel C Cho
- New York Medical College, Valhalla, New York, NY, USA
| | - Anas Gazzah
- Gustave Roussy Cancer Institute, Villejuif, France
| | - Damien Pouessel
- Department of Medical Oncology & Clinical Research Unit, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jeffrey Yachnin
- Karolinska University Hospital, Theme Cancer, Center for Clinical Cancer Studies, Solna, Sweden
| | - Aislyn Boran
- Global Drug Development, Oncology Development Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Paul Burgess
- Global Drug Development, Oncology Development Unit, Novartis Pharma AG, Basel, Switzerland
| | - Palanichamy Ilankumaran
- Global Drug Development, Oncology Development Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Eduard Gasal
- Global Drug Development, Oncology Development Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ronca F, Crum J, Jones I, Hirsch J, Hamilton A, Tachtsidis I, Burgess P. Extensive Prefrontal Cortex Haemodynamic Changes Provoked By Intense Aerobic Exercise, Measured Via FNIRS. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000762824.50531.db] [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: 11/21/2022]
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14
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Kanagasabai S, Sharma L, Burgess P, Ronca F. Investigating The Impact Of Sleep And Fitness Level On Source Memory In Law Enforcement Officers. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000762840.57990.40] [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: 11/21/2022]
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15
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Subbiah V, Stein A, van den Bent M, Wick A, de Vos FY, von Bubnoff N, van Linde ME, Lai A, Prager GW, Campone M, Fasolo A, Lopez-Martin JA, Kim TM, Hofheinz RD, Blay JY, Cho DC, Gazzah A, Pouessel D, Yachnin J, Boran A, Burgess P, Ilankumaran P, Gasal E, Wen PY. Abstract CT025: Dabrafenib plus trametinib in BRAF V600E-mutant high-grade (HGG) and low-grade glioma (LGG). Clin Trials 2021. [DOI: 10.1158/1538-7445.am2021-ct025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Sara G, Chen W, Large M, Ramanuj P, Curtis J, McMillan F, Mulder C, Currow D, Burgess P. Potentially preventable hospitalisations for physical health conditions in community mental health service users: a population-wide linkage study. Epidemiol Psychiatr Sci 2021; 30:e22. [PMID: 33750482 PMCID: PMC8061153 DOI: 10.1017/s204579602100007x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/13/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
AIMS Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions. METHODS A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016-2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR). RESULTS MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5-3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2-5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5-5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6-3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5-6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1-5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20-29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage. CONCLUSIONS PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.
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Affiliation(s)
- G. Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - W. Chen
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, Australia
| | - M. Large
- School of Psychiatry, University of NSW, Sydney, Australia
| | - P. Ramanuj
- Royal National Orthopaedic Hospital, London, England
- RAND Europe, London, England
| | - J. Curtis
- School of Psychiatry, University of NSW, Sydney, Australia
| | - F. McMillan
- School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Wagga Wagga, Australia
| | - C.L. Mulder
- Epidemiological and Social Research Institute, Erasmus University, Rotterdam, Netherlands
| | - D. Currow
- Cancer Institute NSW, Sydney, Australia
| | - P. Burgess
- School of Public Health, University of Queensland, Brisbane, Australia
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Subbiah V, Lassen U, Gasal E, Burgess P, Wainberg ZA. Dabrafenib plus trametinib in patients with BRAFV600E-mutated biliary tract cancer – Authors' reply. Lancet Oncol 2020; 21:e516. [DOI: 10.1016/s1470-2045(20)30625-2] [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] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
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18
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Alharbi MKM, Burgess P, Taggart MP, Sellin PJ. Retrofitting an environmental monitor with a silicon photomultiplier sensor. J Radiol Prot 2020; 40:N31-N38. [PMID: 32408280 DOI: 10.1088/1361-6498/ab9312] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report on the retrofitting of a standard DP2 environmental radiation monitor replacing the photomultiplier tube with a silicon photomultiplier (SiPM). The use of a SiPM has several advantages for a hand-held radiation monitor, including convenient low-voltage operation and physical robustness. We report the detection efficiency and alpha/beta discrimination performance of the modified probe compared with an unmodified version.
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Affiliation(s)
- M K M Alharbi
- Department of Physics, University of Surrey, Guildford, Surrey, United Kingdom. Department of Radiological Science, Taif University, Ta'if, Saudi Arabia
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19
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Subbiah V, Lassen U, Élez E, Italiano A, Curigliano G, Javle M, de Braud F, Prager GW, Greil R, Stein A, Fasolo A, Schellens JHM, Wen PY, Viele K, Boran AD, Gasal E, Burgess P, Ilankumaran P, Wainberg ZA. Dabrafenib plus trametinib in patients with BRAF V600E-mutated biliary tract cancer (ROAR): a phase 2, open-label, single-arm, multicentre basket trial. Lancet Oncol 2020; 21:1234-1243. [PMID: 32818466 DOI: 10.1016/s1470-2045(20)30321-1] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/20/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Effective treatments for patients with cholangiocarcinoma after progression on gemcitabine-based chemotherapy are urgently needed. Mutations in the BRAF gene have been found in 5% of biliary tract tumours. The combination of dabrafenib and trametinib has shown activity in several BRAFV600E-mutated cancers. We aimed to assess the activity and safety of dabrafenib and trametinib combination therapy in patients with BRAFV600E-mutated biliary tract cancer. METHODS This study is part of an ongoing, phase 2, open-label, single-arm, multicentre, Rare Oncology Agnostic Research (ROAR) basket trial in patients with BRAFV600E-mutated rare cancers. Patients were eligible for the biliary tract cancer cohort if they were aged 18 years or older, had BRAFV600E-mutated, unresectable, metastatic, locally advanced, or recurrent biliary tract cancer, an Eastern Cooperative Oncology Group performance status of 0-2, and had received previous systemic treatment. All patients were treated with oral dabrafenib 150 mg twice daily and oral trametinib 2 mg once daily until disease progression or intolerance of treatment. The primary endpoint was the overall response rate, which was determined by Response Evaluation Criteria in Solid Tumors version 1.1 in the intention-to-treat evaluable population, which comprised all enrolled patients regardless of receiving treatment who were evaluable (ie, had progression, began a new anticancer treatment, withdrew consent, died, had stable disease for 6 weeks or longer, or had two or more post-baseline assessments). The ROAR trial is registered with ClinicalTrials.gov, NCT02034110. These results are based on an interim analysis; the study is active but not recruiting. FINDINGS Between March 12, 2014, and July 18, 2018, 43 patients with BRAFV600E-mutated biliary tract cancer were enrolled to the study and were evaluable. Median follow-up was 10 months (IQR 6-15). An investigator-assessed overall response was achieved by 22 (51%, 95% CI 36-67) of 43 patients. An independent reviewer-assessed overall response was achieved by 20 (47%, 95% CI 31-62) of 43 patients. The most common grade 3 or worse adverse event was increased γ-glutamyltransferase in five (12%) patients. 17 (40%) patients had serious adverse events and nine (21%) had treatment-related serious adverse events, the most frequent of which was pyrexia (eight [19%]). No treatment-related deaths were reported. INTERPRETATION Dabrafenib plus trametinib combination treatment showed promising activity in patients with BRAFV600E-mutated biliary tract cancer, with a manageable safety profile. Routine testing for BRAFV600E mutations should be considered in patients with biliary tract cancer. FUNDING GlaxoSmithKline and Novartis.
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Affiliation(s)
- Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ulrik Lassen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elena Élez
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoine Italiano
- Early Phase Trials and Sarcoma Units, Institut Bergonié, Bordeaux, France
| | - Giuseppe Curigliano
- Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, and University of Milano, Milan, Italy
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filippo de Braud
- Dipartimento di Oncologia, Istituto Nazionale dei Tumori, Milan, Italy
| | - Gerald W Prager
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, CCS Salzburg, Salzburg, Austria
| | - Alexander Stein
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelica Fasolo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jan H M Schellens
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kert Viele
- Berry Consultants, Austin, TX, USA; Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Aislyn D Boran
- Precision Medicine, Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Eduard Gasal
- Global Drug Development, Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Paul Burgess
- Global Drug Development, Novartis Pharma, Basel, Switzerland
| | | | - Zev A Wainberg
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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20
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Barr ELM, Barzi F, Rohit A, Cunningham J, Tatipata S, McDermott R, Hoy WE, Wang Z, Bradshaw PJ, Dimer L, Thompson PL, Brimblecombe J, O'Dea K, Connors C, Burgess P, Guthridge S, Brown A, Cass A, Shaw JE, Maple-Brown L. Performance of cardiovascular risk prediction equations in Indigenous Australians. Heart 2020; 106:1252-1260. [PMID: 31949024 DOI: 10.1136/heartjnl-2019-315889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. METHODS We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals. RESULTS When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell. CONCLUSION The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.
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Affiliation(s)
- Elizabeth Laurel Mary Barr
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia .,Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Athira Rohit
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Shaun Tatipata
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, James Cook University - Cairns Campus, Cairns, Queensland, Australia
| | - Wendy E Hoy
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Zhiqiang Wang
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pamela June Bradshaw
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Lyn Dimer
- National Heart Foundation, Perth, Western Australia, Australia
| | - Peter L Thompson
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Julie Brimblecombe
- Nutrition Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Christine Connors
- Primary Health Care Top End Health Services, Northern Territory Department of Health, Casuarina, Northern Territory, Australia
| | - Paul Burgess
- Northern Territory Department of Health, Casuarina, Northern Territory, Australia
| | - Steven Guthridge
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Medicine - Aboriginal Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
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21
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Zhao Y, Jeyaraman K, Burgess P, Connors C, Guthridge S, Maple-Brown L, Falhammar H. All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study. BMJ Open 2020; 10:e030034. [PMID: 31900264 PMCID: PMC6955566 DOI: 10.1136/bmjopen-2019-030034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia. DESIGN Retrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk. SETTING The benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities. PARTICIPANTS None had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded. INTERVENTION Aspirin at a dose of 75-162 mg/day. OUTCOME MEASURES Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds. RESULTS 8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding. CONCLUSION Aspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Department of Health, Darwin, Northern Territory, Australia
| | - Kanakamani Jeyaraman
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Paul Burgess
- NT Medical School, Flinders University, Darwin, Northern Territory, Australia
| | - Christine Connors
- Top End Health Services, NT Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Grob J, Atkinson V, Robert C, Schadendorf D, Nathan P, Davies M, Kefford R, Dummer R, Kirkwood J, Flaherty K, Ribas A, Burgess P, Gasal E, Long G, Hauschild A. Adverse event (AE) kinetics in patients (pts) treated with dabrafenib + trametinib (D + T) in the metastatic and adjuvant setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Li SQ, Guthridge S, Lawton P, Burgess P. Does delay in planned diabetes care influence outcomes for aboriginal Australians? A study of quality in health care. BMC Health Serv Res 2019; 19:582. [PMID: 31426768 PMCID: PMC6699070 DOI: 10.1186/s12913-019-4404-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine the association between delay in planned diabetes care and quality of outcomes. METHODS A retrospective analysis of primary care and inpatient records for 2567 Aboriginal patients, with diabetes, living in 49 remote communities in the Northern Territory of Australia. Poisson regression was used to estimate the association between delay from diagnosis to documented diabetes care plan and three outcome measures: mean HbA1c level, most recent blood pressure and number of diabetes-related hospital admissions. RESULTS Compared with no delay (< 60 days), patients with delay had increased risk of elevated mean HbA1c: 60 days to < 2 years, incidence rate ratio (IRR), 1.2 (95% CI:1.07-1.39); 2 years to < 4 years, incidence rate ratio (IRR), 1.2 (95% CI:1.04-1.45); 4 years and over, incidence rate ratio (IRR), 1.3 (95% CI:1.12-1.52). There was no evidence of association between delay and optimal blood pressure control. Risk of diabetes-related admission increased with increased delay. Compared with no delay the IRRs for delay were: 60 days to < 2 years, 1.2 (95% CI:1.07-1.42); 2 to < 4 years, 1.3 (95% CI: 1.15-1.58): and 4 years and over, 2.6 (95% CI,2.28-3.08). CONCLUSION The study found that a timely diabetes care plan was associated with better short-term blood glucose control and fewer diabetes-related admissions but not with improved blood pressure control. Delays may be a result of both patient and service-related factors.
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Affiliation(s)
- Shu Qin Li
- Northern Territory Department of Health, PO Box 40596, Casuarina, NT 0811 Australia
| | - Steven Guthridge
- Northern Territory Department of Health, PO Box 40596, Casuarina, NT 0811 Australia
- Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Paul Lawton
- Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Paul Burgess
- Northern Territory Department of Health, PO Box 40596, Casuarina, NT 0811 Australia
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24
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Robert C, Grob JJ, Stroyakovskiy D, Karaszewska B, Hauschild A, Levchenko E, Chiarion Sileni V, Schachter J, Garbe C, Bondarenko I, Gogas H, Mandalá M, Haanen JBAG, Lebbé C, Mackiewicz A, Rutkowski P, Nathan PD, Ribas A, Davies MA, Flaherty KT, Burgess P, Tan M, Gasal E, Voi M, Schadendorf D, Long GV. Five-Year Outcomes with Dabrafenib plus Trametinib in Metastatic Melanoma. N Engl J Med 2019; 381:626-636. [PMID: 31166680 DOI: 10.1056/nejmoa1904059] [Citation(s) in RCA: 760] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients who have unresectable or metastatic melanoma with a BRAF V600E or V600K mutation have prolonged progression-free survival and overall survival when receiving treatment with BRAF inhibitors plus MEK inhibitors. However, long-term clinical outcomes in these patients remain undefined. To determine 5-year survival rates and clinical characteristics of the patients with durable benefit, we sought to review long-term data from randomized trials of combination therapy with BRAF and MEK inhibitors. METHODS We analyzed pooled extended-survival data from two trials involving previously untreated patients who had received BRAF inhibitor dabrafenib (at a dose of 150 mg twice daily) plus MEK inhibitor trametinib (2 mg once daily) in the COMBI-d and COMBI-v trials. The median duration of follow-up was 22 months (range, 0 to 76). The primary end points in the COMBI-d and COMBI-v trials were progression-free survival and overall survival, respectively. RESULTS A total of 563 patients were randomly assigned to receive dabrafenib plus trametinib (211 in the COMBI-d trial and 352 in the COMBI-v trial). The progression-free survival rates were 21% (95% confidence interval [CI], 17 to 24) at 4 years and 19% (95% CI, 15 to 22) at 5 years. The overall survival rates were 37% (95% CI, 33 to 42) at 4 years and 34% (95% CI, 30 to 38) at 5 years. In multivariate analysis, several baseline factors (e.g., performance status, age, sex, number of organ sites with metastasis, and lactate dehydrogenase level) were significantly associated with both progression-free survival and overall survival. A complete response occurred in 109 patients (19%) and was associated with an improved long-term outcome, with an overall survival rate of 71% (95% CI, 62 to 79) at 5 years. CONCLUSIONS First-line treatment with dabrafenib plus trametinib led to long-term benefit in approximately one third of the patients who had unresectable or metastatic melanoma with a BRAF V600E or V600K mutation. (Funded by GlaxoSmithKline and Novartis; COMBI-d ClinicalTrials.gov number, NCT01584648; COMBI-v ClinicalTrials.gov number, NCT01597908.).
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Affiliation(s)
- Caroline Robert
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Jean J Grob
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Daniil Stroyakovskiy
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Boguslawa Karaszewska
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Axel Hauschild
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Evgeny Levchenko
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Vanna Chiarion Sileni
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Jacob Schachter
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Claus Garbe
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Igor Bondarenko
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Helen Gogas
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Mario Mandalá
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - John B A G Haanen
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Celeste Lebbé
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Andrzej Mackiewicz
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Piotr Rutkowski
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Paul D Nathan
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Antoni Ribas
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Michael A Davies
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Keith T Flaherty
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Paul Burgess
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Monique Tan
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Eduard Gasal
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Maurizio Voi
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Dirk Schadendorf
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
| | - Georgina V Long
- From Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris (C.L.) - all in France; Moscow City Oncology Hospital, Moscow (D. Stroyakovskiy), and the Petrov Research Institute of Oncology, St. Petersburg (E.L.) - both in Russia; Przychodnia Lekarska Komed, Konin (B.K.), the University of Medical Sciences, Poznań (A.M.), and the Maria Skłodowska-Curie Institute-Oncology Center, Warsaw (P.R.) - all in Poland; the University Hospital Schleswig-Holstein, Kiel (A.H.), the Department of Dermatology, University of Tübingen, Tübingen (C.G.), University Hospital Essen, Essen (D. Schadendorf), and the German Cancer Consortium, Heidelberg (D. Schadendorf) - all in Germany; the Veneto Institute of Oncology, Padua (V.C.S.), and Papa Giovanni XXIII Hospital, Bergamo (M.M.) - both in Italy; the Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel Hashomer (J.S.), and Sackler Medical School, Tel Aviv University, Tel Aviv (J.S.) - both in Israel; Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine (I.B.); Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens (H.G.); the Netherlands Cancer Institute, Amsterdam (J.B.A.G.H.); Mount Vernon Cancer Centre, Northwood, United Kingdom (P.D.N.); the University of California, Los Angeles, Los Angeles (A.R.); the University of Texas M.D. Anderson Cancer Center, Houston (M.A.D.); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston (K.T.F.); Novartis Pharma, Basel, Switzerland (P.B.); Novartis Pharmaceuticals, East Hanover, NJ (M.T., E.G., M.V.); and the Melanoma Institute Australia, the University of Sydney, and Royal North Shore and Mater Hospitals, Sydney (G.V.L.)
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Nathan PD, Robert C, Grob JJ, Stroyakovskiy D, Karaszewska B, Hauschild A, Levchenko E, Chiarion Sileni V, Schachter J, Garbe C, Bondarenko I, Davies MA, Ribas A, Flaherty K, Burgess P, Tan M, Gasal E, Schadendorf D, Long GV. Five-year analysis on the long-term effects of dabrafenib plus trametinib (D + T) in patients with BRAF V600–mutant unresectable or metastatic melanoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9507 Background: First-line treatment with D+T demonstrated prolonged progression-free survival (PFS) and overall survival (OS) in patients with BRAF V600–mutant unresectable or metastatic melanoma. With 5 years of follow-up, we report survival and describe characteristics of patients in the phase 3 COMBI-d and COMBI-v trials with long-term benefit. Methods: Pooled 5-year landmark data for patients treated with D+T in the phase 3 COMBI-d (NCT01584648) and COMBI-v (NCT01597908) trials were analyzed. The trials enrolled patients with previously untreated BRAF V600E/K–mutant unresectable or metastatic melanoma. Patients received D 150 mg twice daily plus T 2 mg once daily vs either D + placebo (COMBI-d) or vemurafenib (COMBI-v). The primary endpoints were PFS in COMBI-d and OS in COMBI-v. Results: The pooled population included 563 patients who received D+T (COMBI-d, n = 211; COMBI-v, n = 352). Four- and 5-year PFS and OS rates were similar, suggesting a stabilization (4- and 5-year PFS, 21% [95% CI, 17%-24%] and 19% [95% CI, 15%-22%, respectively]; 4- and 5-year OS, 37% [95% CI, 33%-42%] and 34% [95% CI, 30%-38%], respectively). In patients with normal baseline lactate dehydrogenase (LDH) levels the 5-year PFS rate was 25% vs 8% in patients with elevated baseline LDH levels. Similarly, the 5-year OS rate was considerably higher in patients with normal baseline LDH levels vs those with elevated LDH levels at baseline (43% vs 16%). Among patients with normal baseline LDH levels and < 3 organ sites with metastases, the 5-year PFS and OS rates were 31% and 55%, respectively. In addition, exploratory analyses will be performed to characterize subgroup(s) of patients most likely to experience long-term benefit. Of 299 patients who received subsequent anticancer therapy following treatment with D+T, 151 (51%) received an anti–CTLA-4 therapy and 102 (34%) received an anti–PD-1 therapy. The safety profile of D+T was as previously reported, and no new safety signals were observed. No treatment-related deaths were reported. Conclusions: First-line treatment with D+T leads to durable long-term benefit in many patients with BRAF V600–mutant unresectable or metastatic melanoma. Clinical trial information: NCT01584648; NCT01597908.
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Affiliation(s)
| | - Caroline Robert
- Paris-Sud University, Gustave Roussy, Villejuif Cedex, France
| | | | | | | | | | | | | | - Jacob Schachter
- Ella Lemelbaum Institute for Immuno-Oncology and Melanoma, Sheba Medical Center, Tel-Hashomer, and Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Claus Garbe
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Igor Bondarenko
- Dnepropetrovsk State Medical Academy, Dnepropetrovsk, Ukraine
| | | | - Antoni Ribas
- University of California, Los Angeles, Los Angeles, CA
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Monique Tan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Eduard Gasal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Georgina V. Long
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, Australia
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Wainberg ZA, Lassen UN, Elez E, Italiano A, Curigliano G, De Braud FG, Prager G, Greil R, Stein A, Fasolo A, Schellens JHM, Wen PY, Boran AD, Burgess P, Gasal E, Ilankumaran P, Subbiah V. Efficacy and safety of dabrafenib (D) and trametinib (T) in patients (pts) with BRAF V600E–mutated biliary tract cancer (BTC): A cohort of the ROAR basket trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.187] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
187 Background: BTCs are rare, aggressive malignancies with poor prognoses. Treatment options and outcomes after first-line therapy are not well defined. Median progression-free survival (PFS) in second-line BTC is < 5 mo. Combined BRAF + MEK inhibition is efficacious in BRAF V600–mutated anaplastic thyroid cancer, melanoma, and lung cancer, but less so in BRAF V600E-mutated colorectal cancer. Activating BRAF V600E mutations have been reported in 0% to 20% of BTCs; thus, D (BRAF inhibitor) + T (MEK inhibitor) was evaluated as a treatment for pts with BRAF V600E–mutated BTC in the ROAR basket trial. Methods: In this phase II, open-label trial, pts with BRAF V600E mutations in 9 rare tumor types, including BTC, received D (150 mg BID) + T (2 mg QD) until unacceptable toxicity, disease progression, or death. Eligible pts had advanced or metastatic cancer and had been treated with ≥ 1 prior systemic therapy. The primary endpoint was investigator-assessed overall response rate (ORR). Secondary endpoints included duration of response (DOR), PFS, overall survival (OS), biomarker correlates, and safety. Results: Thirty-three pts with BTC had enrolled at data cutoff (January 3, 2018). BRAF V600E mutations were centrally confirmed in 30 of 33 pts with BTC (91%). Median age was 58 y, and 78% had received ≥ 2 prior lines of systemic therapy. 32 of 33 pts with BTC were evaluable. Investigator-assessed ORR was 41% (13/32; 95% CI, 24%-59%), with 6 of 13 responses ongoing at data cutoff, 7 of 13 pts (54%) had a DOR ≥ 6 mo. Median PFS was 7.2 mo (95% CI, 4.6-10.1 mo), and median OS was 11.3 mo (95% CI, 7.3-17.6 mo). Grade 3/4 adverse events in ≥ 3 pts were increased γ-glutamyltransferase (n = 3 [9%]) and decreased white blood cell count (n = 3 pts [9%]). Biomarker analyses demonstrate a heterogeneous genetic landscape, and suggest a higher baseline expression of MAPK pathway genes in the pts who did not respond to D + T. Conclusions: D + T demonstrated promising efficacy in pts with BTC, with a favorable safety profile. These pts should be considered for BRAF mutation analysis, and D + T should be considered for pts with BRAF V600E-mutated BTC. Clinical trial information: NCT02034110.
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Affiliation(s)
- Zev A. Wainberg
- Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA
| | | | - Elena Elez
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Antoine Italiano
- Early Phase Trials and Sarcoma Units, Institut Bergonié, Bordeaux, France
| | - Giuseppe Curigliano
- Division of Early Drug Development, University of Milano, Istituto Europeo di Oncologia (IRCCS) di Milano, Milano, Italy
| | | | | | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, CCS Salzburg, Salzburg, Austria
| | - Alexander Stein
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelica Fasolo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jan H. M. Schellens
- Department of Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Patrick Y. Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Aislyn D. Boran
- Oncology Precision Medicine, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Paul Burgess
- Oncology Global Development Unit, Novartis Pharma AG, Basel, Switzerland
| | - Eduard Gasal
- Global Clinical Precision Medicine, Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX
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Pinti P, Scholkmann F, Hamilton A, Burgess P, Tachtsidis I. Current Status and Issues Regarding Pre-processing of fNIRS Neuroimaging Data: An Investigation of Diverse Signal Filtering Methods Within a General Linear Model Framework. Front Hum Neurosci 2019; 12:505. [PMID: 30687038 PMCID: PMC6336925 DOI: 10.3389/fnhum.2018.00505] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Functional near-infrared spectroscopy (fNIRS) research articles show a large heterogeneity in the analysis approaches and pre-processing procedures. Additionally, there is often a lack of a complete description of the methods applied, necessary for study replication or for results comparison. The aims of this paper were (i) to review and investigate which information is generally included in published fNIRS papers, and (ii) to define a signal pre-processing procedure to set a common ground for standardization guidelines. To this goal, we have reviewed 110 fNIRS articles published in 2016 in the field of cognitive neuroscience, and performed a simulation analysis with synthetic fNIRS data to optimize the signal filtering step before applying the GLM method for statistical inference. Our results highlight the fact that many papers lack important information, and there is a large variability in the filtering methods used. Our simulations demonstrated that the optimal approach to remove noise and recover the hemodynamic response from fNIRS data in a GLM framework is to use a 1000th order band-pass Finite Impulse Response filter. Based on these results, we give preliminary recommendations as to the first step toward improving the analysis of fNIRS data and dissemination of the results.
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Affiliation(s)
- Paola Pinti
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Felix Scholkmann
- Department of Neonatology, Biomedical Optics Research Laboratory, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Paul Burgess
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Wen P, De Greve J, Mason W, Hofheinz RD, Dietrich S, de Vos F, van den Bent M, Mookerjee B, Boran A, Burgess P, Rangwala F, Gazzah A. RARE-11. EFFICACY AND SAFETY OF DABRAFENIB + TRAMETINIB IN PATIENTS WITH RECURRENT/REFRACTORY BRAF V600E–MUTATED LOW-GRADE GLIOMA (LGG). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.988] [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)
- Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Warren Mason
- University of Toronto University Health Network, Toronto, ON, Canada
| | | | | | | | | | - Bijoyesh Mookerjee
- Global Clinical Program, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Aislyn Boran
- Oncology Precision Medicine, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Paul Burgess
- Oncology Global Development Unit, Novartis Pharma AG, Basel, Switzerl
| | - Fatima Rangwala
- Global Clinical Program, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Anas Gazzah
- Gustave Roussy Cancer Institute, Villejuif, France
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Wen P, Alexander S, Yung-Jue B, van den Bent M, Gazzah A, Dietrich S, de Vos F, van Linde M, Lai A, Chi A, Prager G, Campone M, von Bubnoff N, Fasolo A, Lopez-Martin J, Mookerjee B, Boran A, Burgess P, Rangwala F, Subbiah V. RARE-09. EFFICACY AND SAFETY OF DABRAFENIB + TRAMETINIB IN PATIENTS WITH RECURRENT/REFRACTORY BRAF V600E–MUTATED HIGH-GRADE GLIOMA (HGG). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Patrick Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stein Alexander
- Department of Internal Medicine II (Oncology Center), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bang Yung-Jue
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Anas Gazzah
- Gustave Roussy Cancer Institute, Villejuif, France
| | | | | | | | - Albert Lai
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | | | - Mario Campone
- Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | | | - Angelica Fasolo
- Department of Medical Oncology, Ospedale San Raffaele IRCCS, Milano, Italy
| | | | - Bijoyesh Mookerjee
- Global Clinical Program, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Aislyn Boran
- Oncology Precision Medicine, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Paul Burgess
- Oncology Global Development Unit, Novartis Pharma AG, Basel, Switzerl
| | - Fatima Rangwala
- Global Clinical Program, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pinti P, Aichelburg C, Gilbert S, Hamilton A, Hirsch J, Burgess P, Tachtsidis I. A Review on the Use of Wearable Functional Near-Infrared Spectroscopy in Naturalistic Environments . Jpn Psychol Res 2018; 60:347-373. [PMID: 30643322 PMCID: PMC6329605 DOI: 10.1111/jpr.12206] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 05/07/2018] [Indexed: 02/05/2023]
Abstract
The development of novel miniaturized wireless and wearable functional Near-Infrared Spectroscopy (fNIRS) devices have paved the way to new functional brain imaging that can revolutionize the cognitive research fields. Over the past few decades, several studies have been conducted with conventional fNIRS systems that have demonstrated the suitability of this technology for a wide variety of populations and applications, to investigate both the healthy brain and the diseased brain. However, what makes wearable fNIRS even more appealing is its capability to allow measurements in everyday life scenarios that are not possible with other gold-standard neuroimaging modalities, such as functional Magnetic Resonance Imaging. This can have a huge impact on the way we explore the neural bases and mechanisms underpinning human brain functioning. The aim of this review is to provide an overview of studies conducted with wearable fNIRS in naturalistic settings in the field of cognitive neuroscience. In addition, we present the challenges associated with the use of wearable fNIRS in unrestrained contexts, discussing solutions that will allow accurate inference of functional brain activity. Finally, we provide an overview of the future perspectives in cognitive neuroscience that we believe would benefit the most by using wearable fNIRS.
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Affiliation(s)
- Paola Pinti
- Department of Medical Physics and Biomedical Engineering, University College London, UK
- Institute of Cognitive Neuroscience, University College London, UK
| | | | - Sam Gilbert
- Institute of Cognitive Neuroscience, University College London, UK
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, University College London, UK
| | - Joy Hirsch
- Department of Medical Physics and Biomedical Engineering, University College London, UK
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Paul Burgess
- Institute of Cognitive Neuroscience, University College London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, UK
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Abstract
Patients presenting with adenocarcinoma of the gallbladder within Newcastle upon Tyne over a 5 year period (1980–1985) were reviewed retrospectively. The mean age of patients on diagnosis was 74 years. Of the 29 patients diagnosed, two were detected after routine cholecystectomy. Laparotomy was performed in 21 patients (72%) of which only 14 patients had a cholecystectomy performed. Mean survival after surgery was 6.6 months with only one patient alive after 5 years. Metastatic disease was present in 72% of patients. The poor prognosis of carcinoma of the gallbladder reflects its late diagnosis and early metastasis to distant sites. Improvement in survival will depend upon early detection of in situ lesions and identification of at risk patients.
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Affiliation(s)
- P Burgess
- Department of Surgery, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE
| | - P D Murphy
- Department of Surgery, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE
| | - M B Clague
- Department of Surgery, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE
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Bailie R, Matthews V, Larkins S, Thompson S, Burgess P, Weeramanthri T, Bailie J, Cunningham F, Kwedza R, Clark L. Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study. BMJ Open 2017; 7:e016626. [PMID: 28982818 PMCID: PMC5639983 DOI: 10.1136/bmjopen-2017-016626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians. DESIGN Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care. SETTING Indigenous primary healthcare services across five states/territories of Australia. PARTICIPANTS 175 Indigenous primary healthcare services. INTERVENTIONS A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. PRIMARY AND SECONDARY OUTCOME MEASURES: (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines). RESULTS Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. CONCLUSIONS Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
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Affiliation(s)
- Ross Bailie
- University Centre for Rural Health–North Coast, School of Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Veronica Matthews
- University Centre for Rural Health–North Coast, School of Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Paul Burgess
- Northern Territory Department of Health and Families, Darwin, Australia
| | - Tarun Weeramanthri
- Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Jodie Bailie
- University Centre for Rural Health–North Coast, School of Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Frances Cunningham
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - Ru Kwedza
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Clark
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
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Horstkotte T, Utsi TA, Larsson-Blind Å, Burgess P, Johansen B, Käyhkö J, Oksanen L, Forbes BC. Human-animal agency in reindeer management: Sámi herders’ perspectives on vegetation dynamics under climate change. Ecosphere 2017. [DOI: 10.1002/ecs2.1931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- T. Horstkotte
- Arctic Centre; University of Lapland; Pohjoisranta 4 Rovaniemi FI-96101 Finland
- Department of Geography and Geology; University of Turku; Turku FI-20500 Finland
| | - T. Aa. Utsi
- Department of Arctic and Marine Biology; The Arctic University of Norway; Tromsø NO-9019 Norway
| | - Å. Larsson-Blind
- Arctic Centre; University of Lapland; Pohjoisranta 4 Rovaniemi FI-96101 Finland
| | - P. Burgess
- Arctic Centre; University of Lapland; Pohjoisranta 4 Rovaniemi FI-96101 Finland
| | - B. Johansen
- NORUT Northern Research Institute; Sykehusvegen 23 Tromsø NO-9019 Norway
| | - J. Käyhkö
- Department of Geography and Geology; University of Turku; Turku FI-20500 Finland
| | - L. Oksanen
- Department of Geography and Geology; University of Turku; Turku FI-20500 Finland
- Department of Arctic and Marine Biology; The Arctic University of Norway; Tromsø NO-9019 Norway
| | - B. C. Forbes
- Arctic Centre; University of Lapland; Pohjoisranta 4 Rovaniemi FI-96101 Finland
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Anstey M, Burgess P, Angus L. Realising the potential of health needs assessments. AUST HEALTH REV 2017; 42:370-373. [PMID: 28501047 DOI: 10.1071/ah16262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/28/2017] [Indexed: 11/23/2022]
Abstract
Population-level assessment and planning has traditionally been the role of public health departments but in establishing Primary Health Networks (PHNs), the Australian Government has instituted a new mechanism for identifying community needs and commissioning services to meet those needs. If PHNs are to achieve the vision of nimble organisations capable of identifying and addressing local health needs via integrated health and social services, several things need to occur. First, PHN funding schedules must become more flexible. Second, the Federal health department must maintain an open dialogue with PHNs, permit waivers in funding schedules to suit local conditions and be prepared to back innovations with seed investment. Third, health data exchange and linkage must be accelerated to better inform community needs assessments and commissioning. Finally, PHNs must be encouraged and supported to develop collaborations both within and outside the health sector in order to identify and address a broad set of health issues and determinants. By following these principles, PHNs may become leading change agents in the Australian healthcare system.
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Affiliation(s)
- Matthew Anstey
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Paul Burgess
- NT Clinical School, Flinders University, Nightingdale Road, Royal Darwin Hospital Campus, Darwin, NT 0810, Australia. Email
| | - Lisa Angus
- Affiliation during preparation of manuscript: Centre for Health Economics Research & Evaluation (CHERE), University of Technology Sydney, PO Box 123, Haymarket, NSW 2007, Australia. Email
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Brynes RK, Wong RSM, Thein MM, Bakshi KK, Burgess P, Theodore D, Orazi A. A 2-Year, Longitudinal, Prospective Study of the Effects of Eltrombopag on Bone Marrow in Patients with Chronic Immune Thrombocytopenia. Acta Haematol 2016; 137:66-72. [PMID: 28006767 DOI: 10.1159/000452992] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The long-term effects of eltrombopag on bone marrow (BM) reticulin and/or collagen deposition in previously treated adults with chronic immune thrombocytopenia (ITP) were assessed. METHODS Three BM biopsies were collected at baseline and after 1 and 2 years of eltrombopag treatment. Specimens were centrally processed, stained for reticulin and collagen, independently reviewed by 2 hematopathologists, and rated according to the European Consensus 0-3 scale of marrow fibrosis (MF). RESULTS Of 162 patients enrolled, 93 completed all 3 protocol-specified BM biopsies. All patients with a baseline assessment were negative for collagen. Of 159 patients assessed at baseline, 150 (94%) had normal reticulin (MF-0) and 9 (6%) had minimally increased reticulin (MF-1). After 2 years, 83/93 patients (89%) with BM biopsies had MF-0, 10 (11%) had MF-1, and none had MF-2 or MF-3. Five out of 127 patients (4%) at 1 year and 1 out of 93 (1%) at 2 years had collagen deposition. None of the patients had clinical symptoms typical of BM dysfunction or abnormalities of clinical concern based on white blood cell count or peripheral blood smear. CONCLUSION For most patients with chronic ITP, eltrombopag is not associated with clinically relevant increases in BM reticulin or collagen formation.
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Affiliation(s)
- Russell K Brynes
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Abstract
Additional information on why adults participate in educational activities appears to be necessary if the field of adult education is to continue to improve educational offerings. Consequently, this study was designed and conducted to explore further the total framework of educational orientations as developed by Cyril O. Houle, Professor of Education at The University of Chicago. The results reported here were to test the hypothesis that reasons chosen by men and women for participating in educational activi ties will factor into eight groups. To test the hypothesis, 1,046 adult learners responded to an instrument developed by the author— Reasons for Educational Participation. The results were factor analyzed and seven groups of reasons were identified. Based on the nature of the items comprising each, the factors were named: The Desire to Know; The Desire to Reach a Personal Goal; The Desire to Reach a Social Goal; The Desire to Reach a Religious Goal; The Desire to Escape; The Desire to Take Part in an Activity; and The Desire to Comply with Formal Requirements.
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Affiliation(s)
- Paul Burgess
- Quality of Living Programs, University of Missouri Extension
Division, Columbia, Missouri
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Bailie C, Matthews V, Bailie J, Burgess P, Copley K, Kennedy C, Moore L, Larkins S, Thompson S, Bailie RS. Determinants and Gaps in Preventive Care Delivery for Indigenous Australians: A Cross-sectional Analysis. Front Public Health 2016; 4:34. [PMID: 27014672 PMCID: PMC4785185 DOI: 10.3389/fpubh.2016.00034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022] Open
Abstract
Background Potentially preventable chronic diseases are the greatest contributor to the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Preventive care is important for earlier detection and control of chronic disease, and a number of recent policy initiatives have aimed to enhance delivery of preventive care. We examined documented delivery of recommended preventive services for Indigenous peoples across Australia and investigated the influence of health center and client level factors on adherence to best practice guidelines. Methods Clinical audit data from 2012 to 2014 for 3,623 well adult clients (aged 15–54) of 101 health centers from four Australian states and territories were analyzed to determine adherence to delivery of 26 recommended preventive services classified into five different modes of care on the basis of the way in which they are delivered (e.g., basic measurement; laboratory tests and imaging; assessment and brief interventions, eye, ear, and oral checks; follow-up of abnormal findings). Summary statistics were used to describe the delivery of each service item across jurisdictions. Multilevel regression models were used to quantify the variation in service delivery attributable to health center and client level factors and to identify factors associated with higher quality care. Results Delivery of recommended preventive care varied widely between service items, with good delivery of most basic measurements but poor follow-up of abnormal findings. Health center characteristics were associated with most variation. Higher quality care was associated with Northern Territory location, urban services, and smaller service population size. Client factors associated with higher quality care included age between 25 and 34 years, female sex, and more regular attendance. Conclusion Wide variation in documented preventive care delivery, poor follow-up of abnormal findings, and system factors that influence quality of care should be addressed through continuous quality improvement approaches that engage stakeholders at multiple levels (including, for example, access to care in the community, appropriate decision support for practitioners, and financial incentives and context appropriate guidelines).
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Affiliation(s)
- Christopher Bailie
- School of Medicine, University of Queensland , Brisbane, QLD , Australia
| | - Veronica Matthews
- Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Jodie Bailie
- Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Paul Burgess
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Kerry Copley
- Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia
| | - Catherine Kennedy
- Maari Ma Health Aboriginal Corporation , Broken Hill, NSW , Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, School of Primary, Aboriginal and Rural Health Care, University of Western Australia , Geraldton, WA , Australia
| | - Ross Stewart Bailie
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Population Health, University of Queensland, Brisbane, QLD, Australia
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Chung-Hoon K, Tracy BL, Dibble LE, Marcus RL, Burgess P, LaStayo PC. The Association Between Knee Extensor Force Steadiness, Force Accuracy, and Mobility in Older Adults Who Have Fallen. J Geriatr Phys Ther 2016; 39:1-7. [PMID: 25695470 PMCID: PMC4540703 DOI: 10.1519/jpt.0000000000000044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older adults often experience limited mobility, lower extremity muscle weakness, and increased fall risk. Furthermore, when older adults perform tasks that require control of submaximal force, impairments in their ability to maintain steady and accurate force output have been reported. Such problems may be related to deteriorating levels of mobility, particularly in older adults who have fallen. PURPOSE The purpose of this study was to determine whether an association exists between muscle force steadiness (MFS) or muscle force accuracy (MFA) of the knee extensors and mobility in older adults who have fallen. METHODS Twenty older adults ((Equation is included in full-text article.)= 77.5 ± 7 years, 5 males and 15 females) with 2 or more comorbid conditions and who experienced a fall in the past year underwent assessment of maximal voluntary isometric contraction of the knee extensors. A submaximal target force of 50% of their maximal voluntary isometric contraction was used to determine concentric and eccentric (ECC) steadiness (the fluctuations in force production) and accuracy (the average distance of the mean force from the target force) measures. Mobility was indicated by the 6-minute walk test, the Timed Up and Go, stair ascent, and stair descent tests. Correlation analysis was used to assess the relationship between measures of muscle force control and mobility. RESULTS The correlations between muscle force steadiness and mobility were not significant (P > .05) for either contraction type. However, MFA during ECC contractions only was correlated significantly with all measures of mobility-6 minute walk test (r = -0.48; P = .03), Timed Up and Go (r = 0.68; P = .01), stair ascent (r = 0.60; P = .01), and stair descent (r = 0.75; P < .01). CONCLUSION The identification of the relationship between ECC MFA and mobility in older adults who have fallen is novel. Although the correlations are not causal, these relationships suggest that inaccurate force output during ECC contractions of the knee extensors is linked to impaired mobility.
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Affiliation(s)
- Kaiwi Chung-Hoon
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Brian L. Tracy
- Colorado State University, Department of Health and Exercise Science, 220 Moby-B Complex, Fort Collins, CO 80523
| | - Leland E. Dibble
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Robin L. Marcus
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Paul Burgess
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Paul C. LaStayo
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
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Pinti P, Aichelburg C, Lind F, Power S, Swingler E, Merla A, Hamilton A, Gilbert S, Burgess P, Tachtsidis I. Using Fiberless, Wearable fNIRS to Monitor Brain Activity in Real-world Cognitive Tasks. J Vis Exp 2015:53336. [PMID: 26651025 PMCID: PMC4692764 DOI: 10.3791/53336] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Functional Near Infrared Spectroscopy (fNIRS) is a neuroimaging technique that uses near-infrared light to monitor brain activity. Based on neurovascular coupling, fNIRS is able to measure the haemoglobin concentration changes secondary to neuronal activity. Compared to other neuroimaging techniques, fNIRS represents a good compromise in terms of spatial and temporal resolution. Moreover, it is portable, lightweight, less sensitive to motion artifacts and does not impose significant physical restraints. It is therefore appropriate to monitor a wide range of cognitive tasks (e.g., auditory, gait analysis, social interaction) and different age populations (e.g., new-borns, adults, elderly people). The recent development of fiberless fNIRS devices has opened the way to new applications in neuroscience research. This represents a unique opportunity to study functional activity during real-world tests, which can be more sensitive and accurate in assessing cognitive function and dysfunction than lab-based tests. This study explored the use of fiberless fNIRS to monitor brain activity during a real-world prospective memory task. This protocol is performed outside the lab and brain haemoglobin concentration changes are continuously measured over the prefrontal cortex while the subject walks around in order to accomplish several different tasks.
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Affiliation(s)
- Paola Pinti
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London; Infrared Imaging Lab, Institute for Advanced Biomedical Technology (ITAB), Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara
| | - Clarisse Aichelburg
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Frida Lind
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Sarah Power
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London
| | - Elizabeth Swingler
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Arcangelo Merla
- Infrared Imaging Lab, Institute for Advanced Biomedical Technology (ITAB), Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara
| | - Antonia Hamilton
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Sam Gilbert
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Paul Burgess
- Institute of Cognitive Neuroscience, Alexandra House, University College London
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, Malet Place Engineering Building, University College London;
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Brynes RK, Orazi A, Theodore D, Burgess P, Bailey CK, Thein MM, Bakshi KK. Evaluation of bone marrow reticulin in patients with chronic immune thrombocytopenia treated with eltrombopag: Data from the EXTEND study. Am J Hematol 2015; 90:598-601. [PMID: 25801698 DOI: 10.1002/ajh.24011] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/11/2015] [Accepted: 03/13/2015] [Indexed: 12/25/2022]
Abstract
Thrombopoietin receptor agonists, which raise platelet counts in patients with chronic immune thrombocytopenia, may be associated with increases in bone marrow (BM) reticulin. Patients with chronic immune thrombocytopenia participating in the Eltrombopag Extended Dosing (EXTEND) study underwent BM biopsies to identify clinically relevant BM fibrosis-related increases. Specimens were centrally reviewed by 2 hematopathologists. Two hundred thirty-two biopsy specimens were collected from 117 patients treated for ≤5.5 years. Moderate to marked reticulin fibrosis was found in 2 patients. After withdrawing from the study, the biopsy of 1 patient reverted to normal. There were no other pathologic changes identified among on-treatment specimens, and no pattern of abnormal reticulin deposition associated with eltrombopag treatment was evident.
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Affiliation(s)
- Russell K. Brynes
- Department of Pathology, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Attilio Orazi
- Department of Pathology; Weill Medical College of Cornell University; New York New York
| | | | | | | | - Maung M. Thein
- Department of Pathology, Keck School of Medicine; University of Southern California; Los Angeles California
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41
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Abstract
The motor skill required to decrease the variability in muscle force steadiness can be challenging. The purposes of this study were to determine whether muscle force steadiness improved following repeated trials and whether the number of trials varied for healthy younger adults, healthy older adults, and older adults who have fallen to obtain stable muscle force steadiness measures. Sixty participants performed 30 concentric and eccentric contractions of the knee extensors on an isokinetic dynamometer. Each group had significant improvements in muscle force steadiness and obtained stable measures within six to nine trials. Healthy younger and older adults, and older adults who have fallen, can improve muscle force steadiness. These findings provide a framework for methodological approaches when testing steadiness in varying populations.
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Castiel M, Alderman N, Jenkins K, Knight C, Burgess P. Use of the Multiple Errands Test-Simplified Version in the assessment of suboptimal effort. Neuropsychol Rehabil 2012; 22:734-51. [PMID: 22672068 DOI: 10.1080/09602011.2012.686884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Most measures of suboptimal effort focus on short-term learning; fewer studies have considered non-memory feigned cognitive impairment. This study investigated the utility of the Multiple Errands Test - Simplified Version (MET-SV) in the detection of feigned executive functioning impairment. Performance of simulating malingerers (N = 47) was compared to acquired brain injury (N = 46) and neurologically healthy control groups (N = 50). Although simulating malingerers were successful at feigning a realistic level of impairment compared to the brain injury group, there were significant differences regarding pattern of performance. A logistic regression model successfully classified 84% of simulating malingerers and 74.5% of brain injured individuals. Receiver Operating Characteristic (ROC) analysis supported the discriminatory power of the model. The current study is unique in yielding some understanding of the real-life observation of suspected malingerers compared to individuals with genuine cognitive difficulties. Results suggest the MET-SV can contribute to the clinical assessment of individuals suspected of suboptimal effort in the domain of executive functioning. Further research is needed to establish whether the MET-SV can be reliably used in medico-legal settings.
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Affiliation(s)
- Marcia Castiel
- Older People's Mental Health Services, Surrey and Borders Partnership NHS Foundation Trust, UK
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Coombes RC, Reise JA, Lau MR, Carme SC, Searle GE, Huiban M, Burgess P, Noibi S, Koch K, Sapunar F, Saleem A. OT2-05-01: An Open-Label Positron Emission Tomography Study To Investigate and Quantify Brain and Tumor Penetration of Carbon-11-Labeled Lapatinib in Patients with HER2−Overexpressing Advanced or Metastatic Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot2-05-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with HER2−overexpressing (HER2+) breast cancer tend to develop visceral metastases. About a third will develop brain metastases in the course of their disease. Several anticancer agents including trastuzumab are not believed to readily cross the blood-brain barrier (BBB); therefore, central nervous system (CNS) disease progression is emerging as an important clinical problem in this patient population. Although preclinical data indicate that lapatinib brain concentrations are low in healthy animals, probably due to the BBB efflux transporters, observations from clinical studies suggest lapatinib treatment might be associated with reduced CNS tumor growth. One hypothesis is that disruption of the BBB by tumors circumvents the usual protective function of transporters. Alternatively, inhibition of efflux transporters by lapatinib enhances its own accumulation with repeat dosing. The role of lapatinib in prevention of brain metastases is currently being explored in a phase III trial, EGF 111438 (CEREBEL).
Methods: To directly assess if lapatinib penetrates the brain and brain metastases, an open-label non-randomized study using carbon-11-labeled [11C] lapatinib is enrolling patients with HER2+ metastatic breast cancer. A minimum of 10 patients with an ECOG of <3 are grouped into 2 cohorts: with at least one 1-cm diameter brain metastasis or without brain metastases. Two positron emission tomography (PET) scans will be performed in each patient following intravenous administration of a microdose of [11C] lapatinib: in lapatinib-naïve patients and at steady-state lapatinib, after treatment with unlabelled oral lapatinib 1500 mg once daily for 8 days. [11C] lapatinib time-activity curves will be generated for normal brain and brain metastases, the PET volume of distribution in the brain calculated and penetration of [11C] lapatinib into the brain quantified. Analysis of brain PET data is explorative as [11C] lapatinib is a new tracer. Therefore, this study investigates both the difference in lapatinib brain penetration between patients with and without brain metastases, as well as the effect of low and high concentrations of lapatinib on the BBB efflux system.
The study is currently recruiting in one center in the United Kingdom.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-05-01.
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Affiliation(s)
- RC Coombes
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - JA Reise
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - MR Lau
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - SC Carme
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - GE Searle
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - M Huiban
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - P Burgess
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - S Noibi
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - K Koch
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - F Sapunar
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
| | - A Saleem
- 1Imperial College; GlaxoSmithKline Oncology; GlaxoSmithKline Clincial Imaging Centre
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Whisker L, Ledwidge S, Burgess P, Cox K, Baildam A. The Fleur-de-Lys Modification for Latissimus Dorsi (LD) Breast Reconstruction. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.093] [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] Open
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Monkhouse SJW, Court EL, Beard LA, Bunni J, Burgess P. A retrospective wound review of standard four-port laparoscopic cholecystectomy: is there need for single-port laparoscopic surgery? Surg Endosc 2011; 26:255-60. [PMID: 21858572 DOI: 10.1007/s00464-011-1863-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/18/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study was designed to assess the satisfaction or otherwise of a proportion of the U.K. population who have undergone standard four-port laparoscopic cholecystectomy within the past 18 months. The results should indicate whether there is potential demand for a new, improved approach to surgery. METHODS Patients who underwent laparoscopic cholecystectomy between October 2008 and October 2009 in two geographically separated general hospitals were identified from hospital databases. Notes were reviewed to confirm the technique and lack of conversion to an open procedure. Those who had immediate complications were excluded. A telephone questionnaire was conducted to answer questions related to long-term cosmetic and general satisfaction of the current procedure. RESULTS Of the patients surveyed, 93% were happy or extremely happy with the current procedure, 48% experienced some wound-related issues (pain, infection), and 65% of those were at the umbilicus (a possible reflection of location and retrieval site for gallbladder). Cosmesis was rated less important than hospital cleanliness and experience of the surgeon. CONCLUSIONS Overall satisfaction was high with the existing technique. The high rate of umbilical wound problems is an issue that will not be eradicated by introduction of single-port laparoscopic surgery.
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Affiliation(s)
- S J W Monkhouse
- Department of Upper GI Surgery, Gloucestershire Royal Hospital, Gloucester, GL1 3NN, UK.
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Coombes RC, Reise JA, Lau M, Carme SC, Searle GE, Huiban M, Burgess P, Koch K, Das-Gupta A, Saleem A. An open-label positron emission tomography (PET) study to investigate and quantify brain and tumor penetration of carbon-11 labeled lapatinib in patients with HER2-overexpressing (HER2+) advanced or metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cox K, Burgess P, Whisker L, Baildam A. Immediate Nipple Reconstruction with Skin-sparing Mastectomy and Sub-pectoral Tissue Expansion. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Burgess P, Hutt PB, Farokhzad OC, Langer R, Minick S, Zale S. On firm ground: IP protection of therapeutic nanoparticles. Nat Biotechnol 2010; 28:1267-70. [DOI: 10.1038/nbt.1725] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Burgess P, Mileran A, Bailie R. Beyond the mainstream - health gains in remote aboriginal communities. Aust Fam Physician 2008; 37:986-988. [PMID: 19142270] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have long asserted the health benefits of maintaining close links with the lands and seas to which they have ancestral connections. OBJECTIVE This article outlines the health findings of the 'Healthy country, healthy people' study conducted in central Arnhem Land between 2004-2007, which examined 'caring for country' practices in a remote Aboriginal community, and draws out the policy implications for health promotion and sustainable development. DISCUSSION At the request of, and in collaboration with, Aboriginal landowners in central Arnhem Land, the study investigated the ecological and human health outcomes associated with 'caring for country' practices. The study demonstrated significant and substantial health benefits associated with greater participation in caring for country, along with a healthier environment.
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Affiliation(s)
- Paul Burgess
- Menzies School of Health Research, Charles Darwin University, Northern Territory.
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