1
|
Carter LM, Wigston Z, Laws P, Vital E. POS0719 RAPID EFFICACY OF ANIFROLUMAB IN MULTIPLE SUBTYPES OF RECALCITRANT CUTANEOUS LUPUS PARALLELS DISCRETE CHANGES IN TRANSCRIPTOMIC AND CELLULAR BIOMARKERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCutaneous lupus eyrthematosus (CLE) is frequently refractory to immunosuppressive therapies including B-cell depletion, but this varies by morphology with the chronic discoid (DLE) subtype being particularly resistant. Local production and response to type-I interferon (IFN-I) is implicated in all subtypes of CLE. Therapeutic blockade of the IFN-I receptor with anifrolumab has direct effects on IFN-I signaling, and subsequent more widespread effects on other immune functions regulated by IFN-I[1].Response to anifrolumab by lesion subtype have not been described, and it is unclear which effects of IFN-blockade are responsible for cutaneous response. We hypothesise that the efficacy of anifrolumab will differ dependent on the relative contribution of direct IFN-I effects vs. the downstream immunostimulatory effects of IFN-I on other immune functions.ObjectivesTo evaluate the effect of anifrolumab on (i) rituximab-refractory CLE; (ii) on DLE; (iii) to compare clinical responses with IFN-specific biomarkers and transcriptomic evaluation of broader immune responses; (iv) to compare early and late immunophenotypic and clinical responses.MethodsSLE patients with active recalcitrant CLE were treated with anifrolumab 300 mg IV every 4 weeks and evaluated using the cutaneous lupus erythematosus disease area and severity index (CLASI) and dermatology life quality index (DLQI). Fluorescence intensity of tetherin (CD317), a cell surface interferon biomarker, was evaluated on major cell subsets by multiparameter flow cytometry of peripheral blood mononuclear cells (PBMCs). Previously validated IFN-Scores-A and B [2], in addition to gene expression scores annotated to inflammation, myeloid lineage and plasmablasts modules [3], were measured in PBMCs using customised Taqman array at baseline, 1 month and 3 months into treatment.Results8 patients (DLE n=5, chillblain / nodular vasculitis n=2, subacute CLE n=1) have enrolled to date. One month clinical and biomarker data are now available for 5. Median number of previously failed standard therapies is 6, including rituximab in 6/8 patients, belimumab in 3/8 and thalidomide in 4/8. Four patients required long-term oral prednisolone >10 mg daily. Median baseline CLASI activity score was 16 and DLQI was 16/30.Rapid clinical responses were evident at 1 month in 4/5 patients, being greatest in magnitude in patients with SCLE and DLE compared with chillblain lesions. Median fall in CLASI activity score at 1 month was 6 points with a median percentage change from baseline of 31%. In all patients, a rapid and marked suppression of IFN-Score-A (mean difference 2.92, p<0.01) and plasmablast tetherin (p=0.01), was evident by 1 month. Small and variable downward trends were observed in inflammation- and IFN-Score-B (p=0.06), myeloid (p=0.27) and plasmablast (p=0.15) -annotated gene expression scores. Major cell population numbers were proportionally unaltered in flow cytometry.ConclusionThese preliminary results suggest that anifrolumab: (i) may be effective in rituximab-resistant CLE, (ii) is effective in DLE; (iii) rapidly suppresses IFN-I response, but with lesser effects on non-IFN immune biomarkers and (iv) early direct effects on IFN-I are associated with rapid clinical response.References[1]Morand et al., Engl J Med 2020; 382:211-221[2]Banchereau et al., Cell 2016;165: 551-65[3]El-Sherbiny et al., Sci. Rep. 2018; 8: 5793Disclosure of InterestsLucy Marie Carter: None declared, Zoe Wigston: None declared, Philip Laws Speakers bureau: AbbVie, Actelion, BMS, Consultant of: Amgen, Celgene, Janssen, Leo, Lilly, Sanofi, Grant/research support from: UCB, Almirall, and Novartis, Edward Vital Consultant of: AstraZeneca, Genentech, Aurinia, Lilly, ILTOO and Modus Therapeutics., Grant/research support from: AstraZeneca and Sandoz
Collapse
|
2
|
Zhao C, Choi C, Laws P, Gourley M, Dobson A, Driscoll T, Kirkland L, Moon L, Juckes R. Value of a national burden-of-disease study: a comparison of estimates between the Australian Burden of Disease Study 2015 and the Global Burden of Disease Study 2017. Int J Epidemiol 2021; 51:668-678. [PMID: 34058000 DOI: 10.1093/ije/dyab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 04/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Estimates of burden of disease are important for monitoring population health, informing policy and service planning. Burden estimates for the same population can be reported differently by national studies [e.g. the Australian Burden of Disease Study (ABDS) and the Global Burden of Disease Study (GBDS)]. METHODS Australian ABDS 2015 and GBDS 2017 burden estimates and methods for 2015 were compared. Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life Years (DALY) measures were compared for overall burden and 'top 50' causes. Disease-category definitions (based on ICD-10), redistribution algorithms, data sources, disability weights, modelling methods and assumptions were reviewed. RESULTS GBDS 2017 estimated higher totals than ABDS 2015 for YLL, YLD and DALY for Australia. YLL differences were mainly driven by differences in the allocation of deaths to disease categories and the redistribution of implausible causes of death. For YLD, the main drivers were data sources, severity distributions and modelling strategies. Most top-50 diseases for DALY had a similar YLL:YLD composition reported. CONCLUSIONS Differences in the ABDS and GBDS estimates reflect the different purposes of local and international studies and differences in data and modelling strategies. The GBDS uses all available evidence and is useful for international comparisons. National studies such as the ABDS have the flexibility to meet local needs and often the advantage of access to unpublished data. It is important that all data sources, inputs and models be assessed for quality and appropriateness. As studies evolve, differences should be accounted for through increased transparency of data and methods.
Collapse
Affiliation(s)
- Chenkun Zhao
- Australian Institute of Health and Welfare, Canberra, Australia
| | - Ching Choi
- University of New South Wales, Sydney, Australia
| | - Paula Laws
- Australian Institute of Health and Welfare, Canberra, Australia
| | | | | | | | - Laura Kirkland
- Department of Health Western Australia, Perth, Australia
| | - Lynelle Moon
- Australian Institute of Health and Welfare, Canberra, Australia
| | - Richard Juckes
- Australian Institute of Health and Welfare, Canberra, Australia
| |
Collapse
|
3
|
O’Kane D, Davis L, Ardern-Jones M, Laws P, Shaw L, Cork M, Velangi S, Cooper HL, Hudson R, Smith AB, Rout R. Treatment outcomes of patients with Atopic Dermatitis (AD) treated with dupilumab through the Early Access to Medicines Scheme (EAMS) in the UK. Ulster Med J 2021; 90:70-76. [PMID: 34276083 PMCID: PMC8278937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dupilumab, a monoclonal antibody against interleukin (IL)-4 receptor alpha that inhibits IL-4/IL-13 signalling is indicated in dermatology for the treatment of moderate-to-severe atopic dermatitis (AD) in adult and adolescent patients 12 years and older and severe AD in children 6-11 years, who are candidates for systemic therapy. Dupilumab received Early Access to Medicines Scheme (EAMS) approval for adults in March 2017. OBJECTIVES The purpose of this study was to assess the efficacy outcomes of treatment with dupilumab in EAMS. METHODS A retrospective analysis of adult patients enrolled in the dupilumab EAMS in the UK. Scores were assessed at baseline and follow up, including the Eczema Area and Severity Index (EASI), Investigator's Global Assessment Score (IGA) and Dermatology Life Quality Index (DLQI). RESULTS Data were available for 57 adult patients treated with dupilumab for at least 12 weeks; 73.6% of patients had received prior treatment with 3 or 4 immunosuppressants. Baseline scores for the EASI and DLQI were 27.93 (standard deviation, SD 13.09) and 18.26 (SD 6.18) respectively. AD severity scores showed statistically significant improvement at week 16±4 weeks (p <0.001 for all). The mean change in EASI was 14.13 points with 66.7% and 36.7% achieving a 50% (EASI-50) and 75% (EASI-75) improvement in EASI, respectively at 16+/- 4 weeks. IGA scores improved by at least two categories for 75% patients. DLQI scores decreased by a mean of 9.0 points, with 80% patients demonstrating a MCID 4-point improvement. For 85% patients, clinicians rated the treatment response as being either 'better' (19%) or 'much better' (65%). CONCLUSIONS Dupilumab is associated with a significant and clinically relevant improvements in AD as measured by patient- and physician-reported outcome measures. Importantly, the clinical efficacy, despite the refractory disease of this EAMS cohort, is comparable to that previously reported in clinical trials.
Collapse
|
4
|
King N, Elshimy N, Laws P. Maculopapular rash and acute breathlessness in a young man. Clin Exp Dermatol 2020; 46:591-594. [PMID: 33249598 DOI: 10.1111/ced.14496] [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] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N King
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Elshimy
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
5
|
Moon L, Gourley M, Goss J, Lum On M, Laws P, Reynolds A, Juckes R. History and development of national burden of disease assessment in Australia. Arch Public Health 2020; 78:88. [PMID: 33005402 PMCID: PMC7523303 DOI: 10.1186/s13690-020-00467-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/04/2020] [Indexed: 01/15/2023] Open
Abstract
Australia's 1996 national burden of disease (BoD) study was one of the first in the world and updates have continued over the following two decades with the fifth study now underway. The studies adapt the global framework most recently implemented by the Global Burden of Disease Study and the World Health Organization to suit Australia's specific needs, producing estimates of fatal and non-fatal burden via the Disability Adjusted Life Year (DALY) metric, as well as attribution of the burden to many risk factors. Detailed Australian data are used with minimal reliance on modelling to fill data gaps. Comprehensive estimates are produced, including for the Indigenous population, for each of the eight states and territories, the five remoteness areas and five socioeconomic quintiles. A number of method developments have been made as part of these studies, including redistribution of deaths data and a detailed quality framework for describing the robustness of the underlying data and methods. Data and methods continue to be refined as part of the studies, and developments in global studies and other national studies are incorporated where appropriate.
Collapse
Affiliation(s)
- Lynelle Moon
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Michelle Gourley
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - John Goss
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Miriam Lum On
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Paula Laws
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Anna Reynolds
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| | - Richard Juckes
- Health Group, Australian Institute of Health and Welfare, GPO Box 570, Canberra, ACT 2601 Australia
| |
Collapse
|
6
|
Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, Bradford N, Cohn R, Birdsall M, Barr R, Suzuki N, Takae S, Marinho R, Xiao S, Chen QH, Mahajan N, Patil M, Gunasheela D, Smith K, Sender L, Melo C, Almeida-Santos T, Salama M, Appiah L, Su I, Lane S, Woodruff TK, Pacey A, Anderson RA, Shenfield F, Sullivan E, Ledger W. The Development of an International Oncofertility Competency Framework: A Model to Increase Oncofertility Implementation. Oncologist 2019; 24:e1450-e1459. [PMID: 31147490 PMCID: PMC6975957 DOI: 10.1634/theoncologist.2019-0043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/15/2019] [Accepted: 04/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. Currently, oncofertility competencies do not exist. The aim of this study was to develop an oncofertility competency framework that defines the key components of oncofertility care, develops a model for prioritizing service development, and defines the roles that health care professionals (HCPs) play. MATERIALS AND METHOD A quantitative modified Delphi methodology was used to conduct two rounds of an electronic survey, querying and synthesizing opinions about statements regarding oncofertility care with HCPs and patient and family advocacy groups (PFAs) from 16 countries (12 high and 4 middle income). Statements included the roles of HCPs and priorities for service development care across ten domains (communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, oncofertility training, reproductive survivorship care and fertility-related psychosocial support, supportive care, and ethical frameworks) that represent 33 different elements of care. RESULTS The first questionnaire was completed by 457 participants (332 HCPs and 125 PFAs). One hundred and thirty-eight participants completed the second questionnaire (122 HCPs and 16 PFAs). Consensus was agreed on 108 oncofertility competencies and the roles HCPs should play in oncofertility care. A three-tier service development model is proposed, with gradual implementation of different components of care. A total of 92.8% of the 108 agreed competencies also had agreement between high and middle income participants. CONCLUSION FP guidelines establish best practice but do not consider the skills and requirements to implement these guidelines. The competency framework gives HCPs and services a structure for the training of HCPs and implementation of care, as well as defining a model for prioritizing oncofertility service development. IMPLICATIONS FOR PRACTICE Despite international evidence about fertility preservation (FP), several barriers still prevent the implementation of equitable FP practice. The competency framework gives 108 competencies that will allow health care professionals (HCPs) and services a structure for the development of oncofertility care, as well as define the role HCPs play to provide care and support. The framework also proposes a three-tier oncofertility service development model which prioritizes the development of components of oncofertility care into essential, enhanced, and expert services, giving clear recommendations for service development. The competency framework will enhance the implementation of FP guidelines, improving the equitable access to medical and psychological oncofertility care.
Collapse
Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Paula Laws
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Shanna Logan
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Carla Saunders
- Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| | - Jo Travaglia
- Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Natalie Bradford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | | | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nao Suzuki
- St. Marianna University School of Medicine, Kawasaki Kanagawa Prefecture, Japan
| | - Seido Takae
- St. Marianna University School of Medicine, Kawasaki Kanagawa Prefecture, Japan
| | | | - Shuo Xiao
- Reproductive Health and Toxicology Lab, Department of Environmental Health Sciences Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Qiong-Hua Chen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xiamen University, Siming Qu, Xiamen Shi, People's Republic of China
| | | | - Madhuri Patil
- Dr. Patil's Fertility and Endoscopy Clinic, Center for Assisted Reproductive Technology, Endoscopic Surgery and Andrology, Bangalore, India
| | - Devika Gunasheela
- Gunasheela Surgical and Maternity Hospital, Basavanagudi, Bengaluru, Karnataka, India
| | - Kristen Smith
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Leonard Sender
- Children's Hospital Orange County, Orange, California, USA
| | - Cláudia Melo
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mahmoud Salama
- Reproductive Medicine Department, National Research Center, Cairo, Egypt
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Leslie Appiah
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, Ohio, USA
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
- Nationwide Children's Hospital, Department of Paediatric Surgery, Columbus, Ohio, USA
| | - Irene Su
- University of California San Diego, San Diego, California, USA
| | - Sheila Lane
- Children's Hospital Oxford Headley Way, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Allan Pacey
- Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire, United Kingdom
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh University, Edinburgh, United Kingdom
| | - Francoise Shenfield
- Reproductive Medicine Unit, Elizabeth Garrett Anderson, University College London Hospital, London, United Kingdom
| | | | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Fertility and Research Centre, Royal Hospital for Women, Randwick, Sydney, Australia
| |
Collapse
|
7
|
Moon L, Garcia J, Laws P, Dunford M, On ML, Bishop K, Prescott V, Gourley M. Measuring Health Loss in Australia: the Australian Burden of Disease Study. J Korean Med Sci 2019; 34:e61. [PMID: 30923485 PMCID: PMC6434150 DOI: 10.3346/jkms.2019.34.e61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lynelle Moon
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Julianne Garcia
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Paula Laws
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Melanie Dunford
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Miriam Lum On
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Karen Bishop
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Vanessa Prescott
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Michelle Gourley
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| |
Collapse
|
8
|
Anazodo A, Laws P, Logan S, Saunders C, Travaglia J, Gerstl B, Bradford N, Cohn R, Birdsall M, Barr R, Suzuki N, Takae S, Marinho R, Xiao S, Qiong-Hua C, Mahajan N, Patil M, Gunasheela D, Smith K, Sender L, Melo C, Almeida-Santos T, Salama M, Appiah L, Su I, Lane S, Woodruff TK, Pacey A, Anderson RA, Shenfield F, Ledger W, Sullivan E. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod Update 2019; 25:159-179. [PMID: 30462263 PMCID: PMC6390168 DOI: 10.1093/humupd/dmy038] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/15/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fertility preservation (FP) is an important quality of life issue for cancer survivors of reproductive age. Despite the existence of broad international guidelines, the delivery of oncofertility care, particularly amongst paediatric, adolescent and young adult patients, remains a challenge for healthcare professionals (HCPs). The quality of oncofertility care is variable and the uptake and utilization of FP remains low. Available guidelines fall short in providing adequate detail on how oncofertility models of care (MOC) allow for the real-world application of guidelines by HCPs. OBJECTIVE AND RATIONALE The aim of this study was to systematically review the literature on the components of oncofertility care as defined by patient and clinician representatives, and identify the barriers, facilitators and challenges, so as to improve the implementation of oncofertility services. SEARCH METHODS A systematic scoping review was conducted on oncofertility MOC literature published in English between 2007 and 2016, relating to 10 domains of care identified through consumer research: communication, oncofertility decision aids, age-appropriate care, referral pathways, documentation, training, supportive care during treatment, reproductive care after cancer treatment, psychosocial support and ethical practice of oncofertility care. A wide range of electronic databases (CINAHL, Embase, PsycINFO, PubMed, AEIPT, Education Research Complete, ProQuest and VOCED) were searched in order to synthesize the evidence around delivery of oncofertility care. Related citations and reference lists were searched. The review was undertaken following registration (International prospective register of systematic reviews (PROSPERO) registration number CRD42017055837) and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). OUTCOMES A total of 846 potentially relevant studies were identified after the removal of duplicates. All titles and abstracts were screened by a single reviewer and the final 147 papers were screened by two reviewers. Ten papers on established MOC were identified amongst the included papers. Data were extracted from each paper and quality scores were then summarized in the oncofertility MOC summary matrix. The results identified a number of themes for improving MOC in each domain, which included: the importance of patients receiving communication that is of a higher quality and in different formats on their fertility risk and FP options; improving provision of oncofertility care in a timely manner; improving access to age-appropriate care; defining the role and scope of practice of all HCPs; and improving communication between different HCPs. Different forms of decision aids were found useful for assisting patients to understand FP options and weigh up choices. WIDER IMPLICATIONS This analysis identifies core components for delivery of oncofertility MOC. The provision of oncofertility services requires planning to ensure services have safe and reliable referral pathways and that they are age-appropriate and include medical and psychological oncofertility care into the survivorship period. In order for this to happen, collaboration needs to occur between clinicians, allied HCPs and executives within paediatric and adult hospitals, as well as fertility clinics across both public and private services. Training of both cancer and non-cancer HCPs is needed to improve the knowledge of HCPs, the quality of care provided and the confidence of HCPs with these consultations.
Collapse
Affiliation(s)
- Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Paula Laws
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
| | - Shanna Logan
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Carla Saunders
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Jo Travaglia
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- Nelune Cancer Centre, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, Australia
| | - Natalie Bradford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, Australia
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children’s Hospital, High Street Randwick, Randwick, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
| | - Mary Birdsall
- Fertility Associates, 7 Ellerslie Racecourse Drive, Auckland City, New Zealand
| | - Ronald Barr
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Nao Suzuki
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Seido Takae
- St. Marianna University School of Medicine, 2-16-1 Sugao, Kawasaki Kanagawa Prefecture, Japan
| | - Ricardo Marinho
- Pro Criar Medicina Reprodutiva, Rua Bernardo Guimarães 2063, Belo Horizonte, Brazil
| | - Shuo Xiao
- Reproductive Health and Toxicology Lab, Dept. Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Discovery I, 915 Greene St, Rm 327, Columbia, SC, USA
| | - Chen Qiong-Hua
- Obstetrics and Gynecology Department, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Siming Qu, Xiamen Shi 35, China
| | - Nalini Mahajan
- Mother and Child Hospital, D-59 Defence Colony, New Delhi, India
| | - Madhuri Patil
- Dr. Patil’s Fertility and Endoscopy Center, Center for Assisted Reproductive Technology, Endoscopic Surgery and Andrology, Bangalore, India
| | - Devika Gunasheela
- Gunasheela Surgical & Maternity Hospital, No. 1, Dewan Madhava Road, Opp. M. N. Krishna Rao Park, Basavanagudi, Bengaluru, Karnataka, India
| | - Kristen Smith
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Leonard Sender
- Children’s Hospital Orange County, 1201 W La Veta Avenue, Orange, CA, USA
| | - Cláudia Melo
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Teresa Almeida-Santos
- Centro de Preservação da Fertilidade, Serviço de Medicina da Reprodução, Centro Hospitalar e Universitário de Coimbra, Edifício de São Jerónimo, Piso 2, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mahmoud Salama
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
- Reproductive Medicine Department, National Research Center, Buhouth Street 33, Cairo, Egypt
| | - Leslie Appiah
- The Ohio State University College of Medicine, Department of Obstetrics and Gynecology, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
- Nationwide Children’s Hospital, Department of Paediatric Surgery, 700 Children’s Drive, Columbus, OH, USA
| | - Irene Su
- University of California San Diego, 355 Dickinson St # 315, San Diego, CA, USA
| | - Sheila Lane
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, 420 E Superior Street, Chicago, IL, USA
| | - Allan Pacey
- Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Level 4, The Jessop Wing, Tree Root Walk, Sheffield, South Yorkshire, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen’s Medical Research Institute, Edinburgh University, 47 Little France Crescent, Scotland, UK
| | - Francoise Shenfield
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, 25 Grafton Way, London, UK
| | - William Ledger
- School of Women’s and Children’s Health, University of New South Wales, Botany Street, Sydney, NSW, Australia
- Fertility and Research Centre, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW, Australia
| | - Elizabeth Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, 15 Broadway, Ultimo, Sydney, NSW, Australia
| |
Collapse
|
9
|
Abignano G, Laws P, Del Galdo F, Marzo-Ortega H, McGonagle D. Three-dimensional nail imaging by optical coherence tomography: a novel biomarker of response to therapy for nail disease in psoriasis and psoriatic arthritis. Clin Exp Dermatol 2018; 44:462-465. [PMID: 30246363 DOI: 10.1111/ced.13786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- G Abignano
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK.,Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Via Potito Petrone snc, 85100, Potenza, Italy
| | - P Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - H Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - D McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| |
Collapse
|
10
|
Keszegpál A, Latzko A, Macleod T, Laws P, Goodfield M, Stacey M, Wittmann M. 425 Identification of the skin psoriatic inflammation profile by cytokine analysis from tape stripping. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Lecamwasam K, Mathew B, Gilson D, Burton C, Laws P. Correspondence article regarding CD68 as a marker of CD8+ lymphoid proliferation suggested by Wobseret al. Br J Dermatol 2016; 174:1158-9. [DOI: 10.1111/bjd.14420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. Mathew
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - D. Gilson
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - C. Burton
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| | - P. Laws
- Leeds Teaching Hospitals; NHS Trust; Leeds U.K
| |
Collapse
|
12
|
Delaney J, Laws P, Wille-Jørgensen P, Engel A. Inflammatory bowel disease meta-evidence and its challenges: is it time to restructure surgical research? Colorectal Dis 2015; 17:600-11. [PMID: 25546572 DOI: 10.1111/codi.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to compare the methodological quality and input paper characteristics of systematic reviews and meta-analyses reported in the medical and surgical literature by performing a systematic 'overview of reviews'. Ulcerative colitis (UC) and Crohn's disease (CD) were used as the framework for this comparison as they are relatively common serious conditions, with both medical and surgical options for therapy. METHOD Medline, Embase, CINHAL and the Cochrane Database were searched to November 2013. Eligible papers were systematic reviews or meta-analyses that considered a question of therapy in CD or UC. Two independent reviewers selected the papers, extracted the data and scored their methodology using the AMSTAR scoring system. The papers were categorized into medical therapy (M), surgical therapy (S) or medical and surgical therapy (MS) groups. Following retrieval of the sample of meta-evidence papers, the original input studies used in their creation were identified and a search of Medline, Embase, CINHAL and the Cochrane Database was performed. A team of researchers then examined the collection of papers for bibliographic and financial information. RESULTS Five hundred papers were identified in the meta-evidence search, of which 118 were deemed eligible. There was a difference in the AMSTAR-rated average quality of the papers between the S and M group (S 7.36 vs M 8.75, P = 0.01). On average S papers were published in journals with a lower impact factor (S 3.26, M 5.04, MS 5.30, P < 0.001). S papers also showed more heterogeneity (I(2) ; S 37%, M 24%, MS 10%, P < 0.001). Some 25% of S meta-analyses used data-sets with significant heterogeneity (I(2) > 75%), compared with 8% of M meta-analyses and 3% of the MS meta-analyses. Some 5% of S papers were done on data sets that had I(2) values > 90%. There was no difference in the average number of papers assessed in each group, the average number of patients per meta-paper, the average time covered by the reviews, the average number of papers considered within each meta-analysis, or the average number of patients considered within each meta-analysis. Considering the conclusions of each meta-analysis, S meta-evidence was 50% more likely than M meta-evidence to be unable to make recommendations for practice. A total of 1499 original input papers were identified, of which 283 were used in more than one review. Within the non-repeated papers (n = 1023) the average impact factor within the S group was lower than that of the M and the MS groups (3.720 vs 11.230 vs 7.563, respectively; ANOVAP < 0.001). M papers had higher rates of pharmaceutical sponsorship than S papers (M 56% vs S 1%) and twice the level of government support (M 16% vs S 8%). Of note, 21% of M papers had corporate sponsorship but did not list any conflict of interest. CONCLUSION Compared with M meta-analyses, S meta-analyses in the UC and CD domain are more likely to be of poorer methodological quality, are of a greater degree of heterogeneity and less often offer a positive conclusion. The papers used to generate meta-evidence in M papers have a greater degree of corporate and government sponsorship, and are more likely to come from journals with higher impact factors.
Collapse
Affiliation(s)
- J Delaney
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - P Laws
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - P Wille-Jørgensen
- Abdominal Disease Center K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Engel
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Vas A, Laws P, Marsland A, McQuillan O. Acute generalised exanthematous pustulosis induced by Pneumocystis jirovecii pneumonia prophylaxis with dapsone. Int J STD AIDS 2013; 24:745-7. [PMID: 24026795 DOI: 10.1177/0956462413482813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe the case of HIV-1 infected patient presenting to hospital with a severe cutaneous adverse drug reaction shortly after commencing dapsone therapy as Pneumocystis jirovecii pneumonia prophylaxis. To the best of our knowledge, acute generalised exanthematous pustulosis has not been reported as a reaction to dapsone in the setting of HIV.
Collapse
Affiliation(s)
- A Vas
- Manchester Centre for Sexual Health and HIV, Manchester Royal Infirmary, Manchester, UK
| | | | | | | |
Collapse
|
14
|
Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.010] [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: 10/27/2022]
|
15
|
Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. Eur J Vasc Endovasc Surg 2013; 45:373-80. [DOI: 10.1016/j.ejvs.2013.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
|
16
|
Cosgrove J, Nesbitt I, Laws P, Baruch M, Sawdon M, Green J, Fordy K, Kennedy D. Thomas the Tank Engine significantly improves the understanding of oxygen delivery and hypoxaemia. Med Teach 2012; 34:511. [PMID: 22489988 DOI: 10.3109/0142159x.2012.675097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
17
|
Marr R, Laws P. Visiting hours impact on medical care. Anaesthesia 2011; 66:229-30. [DOI: 10.1111/j.1365-2044.2011.06642.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
|
19
|
Robson SJ, Laws P, Sullivan EA. Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. Med J Aust 2009; 190:474-7. [PMID: 19413516 DOI: 10.5694/j.1326-5377.2009.tb02543.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 12/10/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. DESIGN, SETTING AND PARTICIPANTS A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. MAIN OUTCOME MEASURES Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. RESULTS 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17-2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45-1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78-2.29) were all higher in public hospitals. CONCLUSION For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.
Collapse
Affiliation(s)
- Stephen J Robson
- Department of Obstetrics and Gynaecology, Australian National University Medical School, Canberra, ACT, Australia.
| | | | | |
Collapse
|
20
|
Affiliation(s)
- Stephen J Robson
- Department of Obstetrics and Gynaecology, Australian National University Medical School, Canberra, ACT
| | - Paula Laws
- Perinatal and Reproductive Epidemiology Research Unit, University of New South Wales, Sydney, NSW
| | - Elizabeth A Sullivan
- Perinatal and Reproductive Epidemiology Research Unit, University of New South Wales, Sydney, NSW
| |
Collapse
|
21
|
|
22
|
Tracy SK, Dahlen H, Caplice S, Laws P, Wang YA, Tracy MB, Sullivan E. Birth centers in Australia: a national population-based study of perinatal mortality associated with giving birth in a birth center. Birth 2007; 34:194-201. [PMID: 17718869 DOI: 10.1111/j.1523-536x.2007.00171.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 11/30/2022]
Abstract
BACKGROUND Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. METHODS This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. RESULTS The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. CONCLUSIONS This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity.
Collapse
Affiliation(s)
- Sally K Tracy
- Australian Institute of Health and Welfare National Perinatal Statistics Unit, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | |
Collapse
|
23
|
Tracy SK, Tracy MB, Dean J, Laws P, Sullivan E. Spontaneous preterm birth of liveborn infants in women at low risk in Australia over 10 years: a population-based study. BJOG 2007; 114:731-5. [PMID: 17516965 DOI: 10.1111/j.1471-0528.2007.01323.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe a 10-year trend in preterm birth. DESIGN Population-based study. SETTING Australia. POPULATION All women who gave birth during 1994-03. METHODS The proportion of spontaneous preterm births (greater than or equal to 22 weeks of gestation and less than 37 completed weeks of gestation) was calculated by dividing the number of women who had a live spontaneous preterm birth (excluding elective caesarean section and induction of labour) by the total number of women who had a live birth after spontaneous onset of labour (excluding elective caesarean section and induction of labour). This method was repeated for the selected population of women at low risk. MAIN OUTCOME MEASURE Preterm birth rates among the overall population of women; preterm birth among all women with a spontaneous onset of labour; and preterm birth in a selected population of women who were either primiparous or multiparous, non-Indigenous; aged 20-40 years and who gave birth to a live singleton baby after the spontaneous onset of labour. RESULTS Over the 10-year study period, the proportion of all women having a live preterm birth in Australia increased by 12.1% (from 5.9% in 1994 to 6.6% in 2003). Among women with a spontaneous onset of labour, there was an increase of 18.3% (from 5.7 to 6.7%). Among the selected population of low-risk women after the spontaneous onset of labour, the rate increased by 10.7% (from 5.6 to 6.2%) among first time mothers and by 19.2% (4.4-5.2%) among selected multiparous women. CONCLUSIONS Over the 10-year period of 1994-03, the rate of spontaneous preterm birth among low-risk women having a live singleton birth has risen in Australia.
Collapse
Affiliation(s)
- S K Tracy
- Australian Institute of Health and Welfare National Perinatal Statistics Unit, University of New South Wales, Randwick, Australia.
| | | | | | | | | |
Collapse
|
24
|
Abstract
INTRODUCTION Hyperhomocysteinaemia has recently been identified as an important risk factor for atherosclerotic vascular disease. Screening for hyperhomocysteinaemia has been recommended, however, the incidence of hyperhomocysteinaemia in vascular patients is not known. AIMS To determine the incidence of hyperhomocysteinaemia in vascular patients, to determine the relation of hyperhomocysteinaemia with folate, vitamin B12 levels and lipid profiles in vascular patients. To examine if there is a relationship between the degree of vascular injury and homocysteine concentration. METHODS New vascular patients at The Queen Elizabeth Hospital were recruited and divided into peripheral, and aneurysmal presentations. Patients demographics were recorded, blood samples were taken for fasting lipid profile, and homocysteine concentration. Samples were also taken for vitamin B12, plasma and red cell folate levels. Sixty age and sex matched controls were included for comparison. RESULTS One hundred and twenty-six patients have been recruited, (95 men and 31 women) with a median age of 68 years (61-74 years). The incidence of elevated homocysteine, and cholesterol levels was 33, 47 and 24%. The levels of vitamin B12 and folate were normal in all patients. Homocysteine was elevated in 27% of claudicants, 50% of patients with rest pain and 53% of patients with an aortic aneurysm. CONCLUSION There is a high rate of hyperhomocysteinaemia in vascular patients with a higher incidence in patients with rest pain. There was also a high incidence of elevated homocysteine levels in patients with an abdominal aortic aneurysm. The rate of growth of these aneurysms is currently under review. Low folate or B12 concentrations is not the cause of raised homocysteine levels.
Collapse
Affiliation(s)
- J I Spark
- Department of Surgery, Queen Elizabeth Hospital, University of Adelaide, Woodville 5011, Adelaide, Australia
| | | | | |
Collapse
|
25
|
Williams DJ, Laws P, Imray C, Lambert AW, Horrocks M. Vascular surgical society of great britain and ireland: near-infrared spectroscopic monitoring of patients undergoing carotid endarterectomy under locoregional anaesthesia. Br J Surg 1999; 86:692. [PMID: 10361316 DOI: 10.1046/j.1365-2168.1999.0692b.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND: The level of cerebral desaturation, which is associated with a change in level of consciousness during carotid endarterectomy, was measured by near-infrared spectroscopy. METHODS: Patients were recruited in two centres over 24 months. Surgery was performed under deep and superficial cervical block using 0.5 per cent bupivacaine, with temazepam as a premedication. Cerebral oxygenation was measured by Critikon 2020 near-infrared spectrophotometers (Johnson and Johnson Medical, Newport, UK). RESULTS: Forty-nine procedures were performed on 45 patients (39 men; age range 52-84 (mean 68) years). Recordings were made from the ipsilateral frontal site in 38 patients, from the ipsilateral temporal site in 23 and bifrontally in eight patients. Monitoring failed in three subjects. Percentage changes in regional cerebral oxygen saturation are detailed below. CONCLUSION: Significantly different levels of cerebral desaturation occur in patients with neurological compromise during carotid endarterectomy compared with those who are unaffected.
Collapse
Affiliation(s)
- DJ Williams
- Walsgrave Hospital, Coventry and Royal United Hospital, Bath, UK
| | | | | | | | | |
Collapse
|
26
|
Laws P, Purser N, Williams D. The Stresst'er ergometer. Eur J Vasc Endovasc Surg 1998; 16:450-1. [PMID: 9854563 DOI: 10.1016/s1078-5884(98)80019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
27
|
|