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Vasiliadou I, Grose D, Wilson C, Thapa A, Donnelly O, Lee E, Leslie I, Karim M, Hartley A, Partridge S, Medlow K, De Boisanger J, Metcalf R, Williamson A, Haridass A, Noble D, Mactier K, Walter H, Ma N, De Winton E, Cohen J, Rayner L, Geropantas K, Jankowska P, Mason J, Moleron R, Laws K, Ulahannan D, Nallathambi C, Michaelidou A, Nallamilli S, Raouf S, Palmer K, Bienz M, Karet T, Khalique S, Paterson C, Harrington K, Bhide S, Kong A. The use of pembrolizumab monotherapy for the management of head and neck squamous cell carcinoma (HNSCC) in the UK. Int J Cancer 2024. [PMID: 38685816 DOI: 10.1002/ijc.34963] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 05/02/2024]
Abstract
Pembrolizumab has received approval in the UK as first-line monotherapy for recurrent and/or metastatic HNSCC (R/M HNSCC) following the results of the KEYNOTE-048 trial, which demonstrated a longer overall survival (OS) in comparison to the EXTREME chemotherapy regimen in patients with a combined positive score (CPS) ≥1. In this article, we provide retrospective real-world data on the role of pembrolizumab monotherapy as first-line systemic therapy for HNSCC across 18 centers in the UK from March 20, 2020 to May 31, 2021. 211 patients were included, and in the efficacy analysis, the objective response rate (ORR) was 24.7%, the median progression-free survival (PFS) was 4.8 months (95% confidence interval [CI]: 3.6-6.1), and the median OS was 10.8 months (95% CI 9.0-12.5). Pembrolizumab monotherapy was well tolerated, with 18 patients having to stop treatment owing to immune-related adverse events (irAEs). 53 patients proceeded to second-line treatment with a median PFS2 of 10.2 months (95% CI: 8.8-11.5). Moreover, patients with documented irAEs had a statistically significant longer median PFS (11.3 vs. 3.3 months; log-rank p value = <.001) and median OS (18.8 vs. 8.9 months; log-rank p value <.001). The efficacy and safety of pembrolizumab first-line monotherapy for HNSCC has been validated using real-world data.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Alekh Thapa
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Olly Donnelly
- Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK
| | - Elsa Lee
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Isla Leslie
- Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Sarah Partridge
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - Katharine Medlow
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - James De Boisanger
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | | | | | | | | | | | | | - Ning Ma
- University Hospitals of Leicester, Leicester, UK
| | - Emma De Winton
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Jennifer Cohen
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Lindsay Rayner
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | | | - Petra Jankowska
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Jessica Mason
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - Kirsten Laws
- Aberdeen Royal Infirmary-NHS Grampian, Aberdeen, UK
| | | | | | | | - Susanna Nallamilli
- Maidstone Hospital-Tunbridge Wells Hospital-NHS Trust, Tunbridge Wells, UK
| | - Sherif Raouf
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Kieran Palmer
- King's College London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | | | | | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Shreerang Bhide
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Anthony Kong
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
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Korolewicz JA, Scheiner B, Fulgenzi CAM, D'Alessio A, Cortellini A, Pascual C, Mehan A, Partridge S, Gujral DM, Mohammed W, Mohammed O, Grzesiak A, Booker L, Cleator S, Pokrovska T, Saleem W, Rackie J, Needham Y, Krell J, McNeish I, Tookman L, Park WHE, Asif M, Evans JS, Pinato DJ. The Hammersmith Score optimises patient selection and predicts for overall survival in early-phase cancer trial participants independent of tumour burden. Chemotherapy 2024:000539109. [PMID: 38679017 DOI: 10.1159/000539109] [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] [Received: 01/21/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION As tumour response rates are increasingly demonstrated in early-phase cancer trials (EPCT), optimal patient selection and accurate prognostication is paramount. Hammersmith Score (HS), a simple prognostic index derived on routine biochemical measures (Albumin <35g/L, Lactate Dehydrogenase (LDH) >450 IU/L, Sodium <135mmol/L) is a validated predictor of response and survival in EPCT participants. HS has not been validated in the cancer immunotherapy era. METHODS We retrospectively analysed characteristics and outcomes of unselected referrals to our early-phase unit (12/2019-12/2022). Independent predictors for overall survival (OS) were identified from univariable and multivariable models. HS was calculated for 66 eligible trial participants and compared with the Royal Marsden Score (RMS) to predict OS. Multivariable logistic regression and c-index was used to compare predictive ability of prognostic models. RESULTS Of 212 referrals, 147 patients were screened and 82 patients treated in EPCT. Prognostic stratification by HS identifies significant difference in median OS and HS was confirmed as a multivariable predictor for OS (HR: HS 1 vs. 0 2.51, 95%CI: 1.01-6.24, p=0.049; HS 2/3 vs. 0: 10.32, 95%CI: 2.15-49.62, p=0.004; C-index 0.771) with superior multivariable predictive ability than RMS (HR: RMS 2 vs. 0/1 5.46, 95%CI: 1.12-26.57, p=0.036; RMS 3 vs. 0/1 6.83, 95%CI: 1.15-40.53, p<0.001; C-index 0.743). CONCLUSIONS HS is a validated prognostic index for patients with advanced cancer treated in the context of modern EPCTs, independent of tumour burden. HS is a simple, inexpensive prognostic tool to optimise referral for EPCT.
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Lewis P, George J, Kapil V, Poulter NR, Partridge S, Goodman J, Faconti L, McCormack T, Wilkinson IB. Adult hypertension referral pathway and therapeutic management: British and Irish Hypertension Society position statement. J Hum Hypertens 2024; 38:3-7. [PMID: 38196000 PMCID: PMC10803252 DOI: 10.1038/s41371-023-00882-2] [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: 11/13/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 01/11/2024]
Abstract
In the UK, most adults with hypertension are managed in Primary Care. Referrals to Secondary Care Hypertension Specialists are targeted to patients in whom further investigations are likely to change management decisions. In this position statement the British and Irish Hypertension Society provide clinicians with a framework for referring patients to Hypertension Specialists. Additional therapeutic advice is provided to optimise patient management whilst awaiting specialist review. Our aim is to ensure that referral criteria to Hypertension Specialists are consistent across the UK and Ireland to ensure equitable access for all patients.
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Affiliation(s)
- Philip Lewis
- Stockport NHS Foundation Trust, Stockport, SK2 7JE, UK
| | - Jacob George
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, Queen Mary University London, London, EC1M 6BQ, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, W12 7RH, UK
| | - Sarah Partridge
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK.
| | - James Goodman
- Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Luca Faconti
- King's College London British Heart Foundation Centre, Department of Clinical Pharmacology, 4th Floor, North Wing, St. Thomas' Hospital, Westminster Bridge, London, SE17EH, UK
| | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, HU6 7RX, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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Kulkarni S, Glover M, Kapil V, Abrams SML, Partridge S, McCormack T, Sever P, Delles C, Wilkinson IB. Management of hypertensive crisis: British and Irish Hypertension Society Position document. J Hum Hypertens 2023; 37:863-879. [PMID: 36418425 PMCID: PMC10539169 DOI: 10.1038/s41371-022-00776-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022]
Abstract
Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by British and Irish Hypertension Society, aims to provide clinicians a framework for diagnosing, evaluating, and managing patients with hypertensive crisis, based on the critical appraisal of available evidence and expert opinion.
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Affiliation(s)
- Spoorthy Kulkarni
- Department of Clinical Pharmacology and Therapeutics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB20QQ, UK.
| | - Mark Glover
- Division of Therapeutics and Molecular Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, Queen Mary University London, London, EC1M 6BQ, UK
- Barts BP Centre of Excellence, Barts Heart Centre, London, EC1A 7BE, UK
| | - S M L Abrams
- Clinical Pharmacology and Therapeutics, Homerton Healthcare NHS Foundation Trust, London, E9 6SR, UK
| | - Sarah Partridge
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, BN1 9PH, UK
| | - Terry McCormack
- Institute of Clinical and Applied Health Research, Hull York Medical School, Hull, HU6 7RX, UK
| | - Peter Sever
- Imperial College School of Medicine, London, SW7 1LY, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, CB2 0QQ, UK
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Partridge S, Quadt L, Bolton M, Eccles J, Thompson C, Colasanti A, Bremner S, Jones CI, Bruun KD, Van Marwijk H. A systematic literature review on the clinical efficacy of low dose naltrexone and its effect on putative pathophysiological mechanisms among patients diagnosed with fibromyalgia. Heliyon 2023; 9:e15638. [PMID: 37206027 PMCID: PMC10189400 DOI: 10.1016/j.heliyon.2023.e15638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Background Low dose naltrexone (LDN) is used off-label by many individuals with fibromyalgia to help manage their pain. There is no current systematic literature review summarising the evidence to support this use of LDN. The objectives of this study were to evaluate if patients with fibromyalgia prescribed LDN have reduced pain scores and greater quality of life compared with those allocated to placebo in randomized controlled trials. Secondly to determine if changes in inflammatory markers and brain structure and function are observed among patients with fibromyalgia taking LDN. Methods Systematic literature searches were conducted in MEDLINE, Embase Classic + Embase, APA PsychInfo, and The Cochrane Library from inception to May 2022. Reference lists from the selected papers were cross-checked with database search results. Results Three studies met our inclusion criteria for the assessment of efficacy, and two studies on potential LDN mechanisms. Results indicated some evidence to suggest LDN reduces pain and increases quality of life. One study reported baseline erythrocyte sedimentation rate (ESR) predicted LDN response (≥30% reduction in fibromyalgia symptoms) and a second study showed plasma concentrations of inflammatory biomarkers were lower after LDN treatment. To our knowledge, there are no brain imaging studies reporting the effect of LDN in patients with fibromyalgia. All studies were based on small sample sizes, were restricted to women and the risk of bias was assessed to be high. There is also some evidence of publication bias. Conclusion The strength of evidence from randomized controlled trials to support the use of LDN among patients with fibromyalgia is low. Two small studies suggest ESR and cytokines may be involved in the mechanism by which LDN exerts its effects. Two trials (INNOVA and FINAL) are currently in progress, but further work is needed among men and different ethnic groups.
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Affiliation(s)
- Sarah Partridge
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Lisa Quadt
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Monica Bolton
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Jessica Eccles
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | | | - Alessandro Colasanti
- Brighton and Sussex Medical School, University of Sussex, UK
- Sussex Partnership NHS Foundation Trust, UK
| | - Stephen Bremner
- Brighton and Sussex Medical School, University of Sussex, UK
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Lee SP, Bonczyk A, Dimapilis MK, Partridge S, Ruiz S, Chien LC, Sawers A. Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. PLoS One 2022; 17:e0262977. [PMID: 35797362 PMCID: PMC9262185 DOI: 10.1371/journal.pone.0262977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting. Methods Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 years, range = 4–21 years) during prosthetic training were recorded. Recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. We also explored whether LLP users’ age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received. Results We recorded a total of 20 training sessions, yielding 904 statements of instruction from 338 minutes of training. Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 64% were internal, 9% external, 3% mixed, and 25% unfocused. Regression analysis revealed that female, older, and higher functioning LLP users were significantly more likely to receive internally-focused instructions (p = 0.006, 0.035, and 0.024, respectively). Conclusions Our results demonstrated that verbal instructions and feedback are frequently provided to LLP users during prosthetic training. Most verbal interactions are focused internally on the LLP users’ body movements and not externally on the movement effects. Impact statement While more research is needed to explore how motor learning principles may be applied to improve LLP user outcomes, clinicians should consider adopting the best available scientific evidence during treatment. Overreliance on internally-focused instructions as observed in the current study may hinder prosthetic skill learning.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
- * E-mail:
| | - Alexander Bonczyk
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Maria Katrina Dimapilis
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Sarah Partridge
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Samantha Ruiz
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Nevada, United States of America
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Raeside R, Redfern J, Partridge S. Co-Designing the Health4Me Text Message Intervention to Support and Improve Adolescent’s Physical and Mental Health Outcomes: An Active Research Partnership With Adolescents. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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8
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Malik A, Devabalan Y, Bernstein J, Awad Z, Gujral D, Partridge S, Madani G, Clarke P, Weir J, Mace A. Malignant salivary gland tumours: Single-centre experience of 108 patients. Clin Otolaryngol 2021; 46:1310-1314. [PMID: 34260814 DOI: 10.1111/coa.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 03/14/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Akshat Malik
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Yadsan Devabalan
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Bernstein
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Zaid Awad
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Dorothy Gujral
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Partridge
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Gitta Madani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Clarke
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Weir
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Alasdair Mace
- Department of Otolaryngology - Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
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Pinato DJ, Howlett S, Ottaviani D, Urus H, Patel A, Mineo T, Brock C, Power D, Hatcher O, Falconer A, Ingle M, Brown A, Gujral D, Partridge S, Sarwar N, Gonzalez M, Bendle M, Lewanski C, Newsom-Davis T, Allara E, Bower M. Association of Prior Antibiotic Treatment With Survival and Response to Immune Checkpoint Inhibitor Therapy in Patients With Cancer. JAMA Oncol 2021; 5:1774-1778. [PMID: 31513236 DOI: 10.1001/jamaoncol.2019.2785] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Gut dysbiosis impairs response to immune checkpoint inhibitors (ICIs) and can be caused by broad-spectrum antibiotic (ATB) therapy. Objective To evaluate whether there is an association between ATB therapy administered concurrently (cATB) or prior (pATB) to ICI therapy and overall survival (OS) and treatment response to ICI therapy in patients with cancer treated with ICIs in routine clinical practice. Design, Setting, and Participants This prospective, multicenter, cohort study conducted at 2 tertiary academic referral centers recruited 196 patients with cancer who received ICI therapy between January 1, 2015, and April 1, 2018, in routine clinical practice rather than clinical trials. Main Outcomes and Measures Overall survival calculated from the time of ICI therapy commencement and radiologic response to ICI treatment defined using the Response Evaluation Criteria in Solid Tumors (version 1.1), with disease refractory to ICI therapy defined as progressive disease 6 to 8 weeks after the first ICI dose without evidence of pseudoprogression. Results Among 196 patients (137 men and 59 women; median [range] age, 68 [27-93] years) with non-small cell lung cancer (n = 119), melanoma (n = 38), and other tumor types (n = 39), pATB therapy (HR, 7.4; 95% CI, 4.3-12.8; P < .001), but not cATB therapy (HR, 0.9; 95% CI, 0.5-1.4; P = .76), was associated with worse OS (2 vs 26 months for pATB therapy vs no pATB therapy, respectively) (hazard ratio [HR], 7.4; 95% CI, 4.2-12.9) and a higher likelihood of primary disease refractory to ICI therapy (21 of 26 [81%] vs 66 of 151 [44%], P < .001). Overall survival in patients with non-small cell lung cancer (2.5 vs 26 months, P < .001), melanoma (3.9 vs 14 months, P < .001), and other tumor types (1.1 vs 11, P < .001) was consistently worse in those who received pATBs vs those who did not. Multivariate analyses confirmed that pATB therapy (HR, 3.4; 95% CI, 1.9-6.1; P < .001) and response to ICI therapy (HR, 8.2; 95% CI, 4.0-16.9; P < .001) were associated with OS independent of tumor site, disease burden, and performance status. Conclusions and Relevance Despite being limited by sample size, geographic origin, and the lack of correlative analyses on patients' gut microbiota, this study suggests that pATB therapy but not cATB therapy is associated with a worse treatment response and OS in unselected patients treated with ICIs in routine clinical practice. Mechanistic studies are urgently required to investigate ATB-mediated alterations of gut microbiota as a determinant of poorer outcome following ICI treatment.
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Affiliation(s)
- David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Sarah Howlett
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Diego Ottaviani
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Heather Urus
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Aisha Patel
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Takashi Mineo
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Tokyo Medical and Dental University, Tokyo, Japan
| | - Cathryn Brock
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Danielle Power
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Olivia Hatcher
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Alison Falconer
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Manasi Ingle
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Anna Brown
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Dorothy Gujral
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Sarah Partridge
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Naveed Sarwar
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Michael Gonzalez
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Maggie Bendle
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Conrad Lewanski
- Department of Oncology, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Thomas Newsom-Davis
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
| | - Elias Allara
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
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Raeside R, Jia S, Redfern J, Gibson A, Partridge S. Home is Where the Heart (Risk) is: How has the COVID-19 Pandemic Influenced Social Media Promotion of Food and Beverages From Popular Online Food Delivery Platforms? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Raeside R, Halim N, Partridge S, Redfern J. 713 A Review of Mobile Apps for Prevention of Chronic Disease in Adolescents Across a Range of Behaviours. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Partridge S, Raeside R, Singleton A, Mandoh M, Todd A, Latham Z, Hyun K, Gibson A, Redfern J. 726 Discretionary Food on Demand: Is the Emerging Trend of Online Food Delivery Contributing to Overconsumption of Discretionary Foods? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Todd A, Mandoh M, Redfern J, Partridge S. 736 Mapping Obesity Prevention and Management Approaches for Adolescents Within New South Wales. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.743] [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: 11/26/2022]
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14
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Singleton A, Raeside R, Partridge S, Hyun K, Sherman K, Elder E, Redfern J. 715 Are Women Managing Cardiovascular Risk Factors 12-Months After Active Breast Cancer Treatment? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pinato DJ, Howlett S, Ottaviani D, Urus H, Patel A, Mineo T, Brock C, Power D, Hatcher O, Falconer A, Ingle M, Brown A, Gujral DM, Partridge S, Sarwar N, Gonzalez M, Bendle M, Lewanski CR, Newsom-Davis T, Bower M. Antibiotic treatment prior to immune checkpoint inhibitor therapy as a tumor-agnostic predictive correlate of response in routine clinical practice. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
147 Background: Antibiotic therapy (ATB) may impair efficacy of immune checkpoint inhibitors (ICPI) through modulation of gut microbiota. Evidence is however limited to trial participants with non-small cell (NSCLC) and renal cell carcinoma (RCC). In this multi-centre study, we validated the impact of ATB in patients (pts) treated with ICPI in routine practice, irrespective of tumour site. Methods: We analysed a prospective dataset of pts treated with ICPI in 2 centres. We documented timing and duration of ATB administered within 1 month prior to ICPI treatment (pATB) or concurrently (cATB) until ICPI cessation. We evaluated response and overall survival (OS) across ATB+/-. Results: We enrolled 196 pts with NSCLC (n=119), Melanoma (n=38) and other histotypes (n=39). Most pts were male (n=137, 70%) with performance status 0-1 (n=159, 84%) and a median number of 2 metastatic sites (range 0-7). Pts received mostly anti-PD-1/PD-L1 ICPI (n=189, 96%) as first-line metastatic therapy (n=120, 62%). Twenty-nine patients (15%) received pATB with penicillins (n=22, 75%) for ≤7 days (n=26, 89%). Sixty-eight pts (35%) received penicillin-based (n=49, 72%) cATB for ≤7 days (n=39, 88%). Respiratory infections were the commonest indication for both pATB (n=16, 55%) and cATB (n=38, 85%). pATB (p<0.001) but not cATB (p=0.76) was associated with worse OS (26 vs. 2 months, Hazard Ratio 7.4, 95% CI 4.2-12.9) and increased likelihood of primary refractoriness to ICPI (44% vs 81%, p<0.001). pATB consistently worsened OS in NSCLC (26 vs. 2.5 months, p<0.001), melanoma (14 vs 3.9 months, p<0.001) and other tumours (11 vs 1.1 months, p<0.001). In multi-variable analyses pATB (p<0.001, HR 3.4, 95% CI 1.9-6.1) and response to ICPI (p<0.001, HR 8.2, 95% CI 4.0-16.9) predicted for OS independent of histotype, tumour burden, PS. Conclusions: This study suggests pATB to exert an independent detrimental effect on response and survival in unselected pts treated with ICPI in routine clinical practice. Mechanistic studies are urgently required to investigate ATB-mediated alterations of gut microbiota as a determinant of poorer outcome following ICPI treatment.
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Affiliation(s)
| | | | | | | | - Aisha Patel
- Imperial College NHS Trust, London, United Kingdom
| | | | - Cathryn Brock
- Chelsea and Westminster NHS Trust, London, United Kingdom
| | | | | | | | - Manasi Ingle
- Imperial College NHS Trust, London, United Kingdom
| | - Anna Brown
- Imperial College NHS Trust, London, United Kingdom
| | | | | | - Naveed Sarwar
- Charing Cross Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Michael Gonzalez
- Charing Cross Hospital, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Maggie Bendle
- Chelsea and Westminster NHS Trust, London, United Kingdom
| | | | - Thomas Newsom-Davis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Bower
- Chelsea and Westminster Hosp, London, United Kingdom
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Vedam S, Stoll K, McRae DN, Korchinski M, Velasquez R, Wang J, Partridge S, McRae L, Martin RE, Jolicoeur G. Patient-led decision making: Measuring autonomy and respect in Canadian maternity care. Patient Educ Couns 2019; 102:586-594. [PMID: 30448044 DOI: 10.1016/j.pec.2018.10.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 02/09/2018] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The Changing Childbirth in British Columbia study explored women's preferences and experiences of maternity care, including women's role in decision-making. METHODS Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers. RESULTS A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores. CONCLUSION Women's autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women's ability for self-determination. PRACTICE IMPLICATIONS If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada; School of Medicine, University of Sydney, Australia.
| | - Kathrin Stoll
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daphne N McRae
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mo Korchinski
- Women In 2 Healing, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raquel Velasquez
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessie Wang
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Partridge
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorna McRae
- Access Midwifery and Family Care, Victoria, British Columbia, Canada
| | - Ruth Elwood Martin
- Women In 2 Healing, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
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Partridge S, Singleton A, Cohen P, Allman-Farinelli M, Mihrshahi S, Chau J, Bauman A, Phongsavan P, Redfern J. PO544 Development of a Bank of Text Messages Targeting Healthy Eating, Physical Activity, and Social Wellbeing In Adolescents At Risk of Obesity. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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18
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Vedam S, Stoll K, Martin K, Rubashkin N, Partridge S, Thordarson D, Jolicoeur G. The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLoS One 2017; 12:e0171804. [PMID: 28231285 PMCID: PMC5322919 DOI: 10.1371/journal.pone.0171804] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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: 03/15/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. DESIGN Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. SETTING AND PARTICIPANTS Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. MAIN OUTCOME MEASURES We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. RESULTS The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. DISCUSSION The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. CONCLUSION The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person's ability to lead decision-making over the course of maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- * E-mail:
| | - Kathrin Stoll
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah Partridge
- Residency Program, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dana Thordarson
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
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Zecchin R, Waldner L, Parker H, Partridge S, Gallagher R. Waist Circumference is the Best Measure of Visceral Fat in Cardiac Rehabilitation Patients Across Time. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.714] [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: 10/19/2022]
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20
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Partridge S, Grunseit A, O’Hara B, Neubeck L, Ding D, Gallagher P, Freeman B, Bauman A, Phongsavan P, Gallagher R. Development of a Social Media Intervention for the Secondary Prevention of Cardiovascular Disease. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.702] [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: 10/19/2022]
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21
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Specht JM, Partridge S, Chai X, Novakova A, Peterson L, Shields A, Guenthoer J, Linden HM, Gralow JR, Gadi V, Korde L, Hills D, Hsu L, Hockenbery DM, Kinahan P, Mankoff DA, Porter PL. Abstract P5-01-02: Multimodality molecular imaging with dynamic 18F-fluorodeoxyglucose positron emission tomography (FDG PET) and MRI to evaluate response and resistance to neoadjuvant chemotherapy (NAC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-01-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Using quantitative FDG PET to measure glucose metabolism and perfusion, and dynamic contrast-enhanced (DCE) MRI to measure perfusion, we previously identified a metabolic signature for breast cancer resistant to NAC. This imaging signature is (1) persistent or increased tumor perfusion despite treatment, (2) an altered pattern of glucose kinetics in response to therapy, and (3) pre-therapy mismatch between tumor metabolism (MRFDG) and glucose delivery (K1) (high ratio of MRFDG/K1). These patterns predict poor response, early relapse and death independent of established prognostic factors, including pathologic response. Identification of factors associated with resistance or response to therapy is the translational goal of "Quantitative Dynamic PET and MRI in Breast Cancer Therapy," part of the Seattle Breast SPORE (1P50CA138293).
Methods: Patients (Pts) undergoing NAC for histologically confirmed breast cancer (stage II-III) were approached for this trial (CCIRB# 7587). FDG PET and DCE-MRI were obtained pre-therapy, 2-12 weeks after start of NAC (mid-therapy) and after completion of NAC. Breast biopsies were obtained pre-therapy and post-NAC. FDG PET included a dynamic scan with kinetic analysis. PET measures included SUVmax, MRFDG, K1, Ki, and Patlak. 3T DCE-MRI measurements included semi-quantitative vascular parameters of peak enhancement (PE), signal enhancement ratio (SER), washout fraction, functional tumor volume, and apparent diffusion coefficient (ADC) from diffusion-weighted MRI (DWI). Breast biopsies were assayed by immunohistochemistry and gene expression profiling. NAC was per physician's choice with most pts receiving weekly paclitaxel (with trastuzumab if HER2+) followed by doxorubicin/cyclophosphamide.
Results: 32 pts have completed the study. Pathologic complete response (pCR), defined as absence of invasive cancer in the breast, was observed in 9 (28%); near pCR defined as only microscopic residual invasive cancer in 3 (9%) more pts. Mid-therapy decline in SUVmax and K1 was associated with near pCR; (p-value 0.06, 0.04, respectively). Pre-therapy PET measures of MRFDG and K1 were not predictive of pCR. On MRI, pre-therapy PE (p=0.009), SER (p=0.01), washout fraction (p=0.02), ADC (p=0.08, trend) and mid-therapy change in volume (p=0.05) were each predictive of pCR. Gene profiling of pre-therapy biopsies showed correlation between high MRFDG/K1 ratio in basal and luminal B tumors.
Conclusions: Assessment of serial changes in tumor metabolism and perfusion by FDG PET and DCE-MRI is feasible in the clinic. Mid-therapy decline in metabolism and glucose delivery was predictive of pCR; consistent with prior retrospective series. Baseline DCE-MRI and DWI measures show promise to predict response, and associations of mid-therapy change in MR functional tumor volume with pCR agree with findings of another multisite clinical trial (ISPY). These imaging parameters may serve as useful biomarkers to inform future neoadjuvant trials. Integration of imaging data with gene expression profiling revealed that the pattern of metabolism in luminal B tumors was closer to that of the basal subtype compared to other ER-positive tumors.
Citation Format: Specht JM, Partridge S, Chai X, Novakova A, Peterson L, Shields A, Guenthoer J, Linden HM, Gralow JR, Gadi V, Korde L, Hills D, Hsu L, Hockenbery DM, Kinahan P, Mankoff DA, Porter PL. Multimodality molecular imaging with dynamic 18F-fluorodeoxyglucose positron emission tomography (FDG PET) and MRI to evaluate response and resistance to neoadjuvant chemotherapy (NAC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-01-02.
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Affiliation(s)
- JM Specht
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - S Partridge
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - X Chai
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - A Novakova
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - L Peterson
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - A Shields
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - J Guenthoer
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - HM Linden
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - JR Gralow
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - V Gadi
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - L Korde
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - D Hills
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - L Hsu
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - DM Hockenbery
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - P Kinahan
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - DA Mankoff
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
| | - PL Porter
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA; Bassett Cancer Institute, Cooperstown, NY; University of Pennsylvania, Philadelphia, PA
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Partridge S, Balayla J, Holcroft CA, Abenhaim HA. Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years. Am J Perinatol 2012; 29:787-93. [PMID: 22836820 DOI: 10.1055/s-0032-1316439] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between adequacy of prenatal care utilization and risk of fetal and neonatal mortality and adverse outcomes. METHODS We conducted a population-based cohort study using the Center for Disease Control and Prevention's Linked Birth-Infant Death and Fetal Death data on all deliveries in the United States between 1995 and 2002. Inclusion criteria were singleton births ≥22 weeks of gestation with no known congenital malformation. Inadequate prenatal care was defined according to the Adequacy of Prenatal Care Utilization Index, and its effect on fetal and neonatal death was estimated using unconditional logistic regression analysis adjusting for maternal age, race, education, and other confounding variables. RESULTS During our 8-year study period, 32,206,417 births occurred, 28,729,765 (89.2%) of which met inclusion criteria. Inadequate prenatal care utilization occurred in 11.2% of expectant mothers, more commonly among women ≤20 years, black non-Hispanic and Hispanic women, and those without high school education. Relative to adequate care, inadequate care was associated with increased risk of prematurity 3.75 (3.73 to 3.77), stillbirth 1.94 (1.89 to 1.99), early neonatal dearth 2.03 (1.97 to 2.09), late neonatal death 1.67 (1.59 to 1.76), and infant death 1.79 (1.76 to 1.82). CONCLUSION Risk of prematurity, stillbirth, early and late neonatal death, and infant death increased linearly with decreasing care. Given the population effect of this association, public health initiatives should target program expansion to ensure timely and adequate access, particularly for women ≤20 years, Black non-Hispanic and Hispanic women, and those without high school education.
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Affiliation(s)
- Sarah Partridge
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
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Specht JM, Partridge S, Dunnwald L, Doot R, Schubert E, Kurland B, Gralow J, Linden H, Gadi V, Ellis G, Mankoff D. DCE-MRI and dynamic FDG PET to monitor breast cancer response to neoadjuvant sunitinib in patients with locally-advanced breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6006] [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
Abstract #6006
Background: We are enrolling patients with locally-advanced (LABC) or inflammatory breast cancer on a phase II trial of neoadjuvant sunitinib and metronomic chemotherapy. The addition of sunitinib is hypothesized to increase rate of pathologic complete response (pCR) via its effect on tumor vasculature. Measurement of FDG PET and MRI parameters of metabolism and blood flow (BF) after a one week run-in of sunitinib alone provides an opportunity to evaluate in vivo pharmacodynamics of sunitinib which may be predictive of response and provide insight into mechanism of sunitinib activity. Materials and Methods: Patients with HER2 negative LABC participated in an imaging trial with pre-therapy [18F]-FDG PET and DCE-MRI (T0) followed by a one-week run-in of sunitinib 37.5 mg orally daily with a second PET and MRI on day 7 (T1). FDG metabolic rate (MRFDG), transport (FDG K1) and MR indices of tumor perfusion (peak enhancement (PE), signal enhancement ratio (SER), and washout volume(WV)) were assessed. Results: Metabolism and perfusion parameters are available for the first 3 patients treated on this trial. All patients presented with grade 3, HER2 negative LABC. DCI-MRI (left) and PET images (right) pre-therapy (T0, top) and after one week sunitinib (T1, bottom) are illustrated in Figure 1. DCE-MRI studies show gray-scale images with color-coded regional perfusion (SER) superimposed; red indicates high levels of perfusion and blue lower levels. Three different responses were observed and expressed as percent change T0 to T1: patient 1 had no significant change in metabolism (MRFDG) or perfusion (K1,SER, PE); patient 2 showed a decline in perfusion with decreases in K1 (-55%), SER (-19%), PE (-10%), and WV (-56%), but minimal change in MRFDG (+ 5.9%); while patient 3 had marked declines in perfusion K1 (-41%), SER (-25%), WV (-78%) and MRFDG (-59%). Discussion: These early data demonstrate the ability to measure changes in tumor metabolism and blood flow by PET and MRI and illustrate heterogeneity in tumor response to sunitinib. As patients complete neoadjuvant chemotherapy (NC), metabolism and perfusion parameters from mid-therapy (T2) and end-therapy (T3) imaging will be evaluated in the context of pCR versus other with the goal of exploiting functional imaging parameters to predict response to NC and elucidate mechanism of response to sunitinib and metronomic chemotherapy. Supported by grant from NCCN, SI11.
 

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6006.
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Affiliation(s)
- JM Specht
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - S Partridge
- 2 Radiology, Univ. of Washington, Seattle, WA
| | - L Dunnwald
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
| | - R Doot
- 5 Bioengineering, Univ. of Washington, Seattle, WA
| | - E Schubert
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
| | - B Kurland
- 4 Clinical Statistics, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - J Gralow
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - H Linden
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - V Gadi
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - G Ellis
- 1 Medical Oncology, Univ. of Washington, Seattle, WA
| | - D Mankoff
- 3 Nuclear Medicine, Univ. of Washington, Seattle, WA
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Gill GV, Beeching NJ, Khoo S, Bailey JW, Partridge S, Blundell JW, Luksza AR. A British Second World War veteran with disseminated strongyloidiasis. Trans R Soc Trop Med Hyg 2004; 98:382-6. [PMID: 15099996 DOI: 10.1016/j.trstmh.2003.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 07/16/2003] [Revised: 11/14/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022] Open
Abstract
A case is described of a 78-year-old British veteran of the Second World War (1939-45) who was stationed in Southeast Asia and who developed a recurrent pneumonia with blood eosinophilia. He was treated with steroids, and eventually died with a severe Pseudomonas pneumonia. Just prior to death, larvae of Strongyloides stercoralis were identified in his sputum, and a specific serum ELISA test was later positive. At autopsy no other organs were involved, but bronchoalveolar carcinoma was found. Longstanding (57 years) chronic strongyloidiasis in a veteran who served in Southeast Asia but who was not a prisoner of war is very unusual. The pattern of dissemination was also not that of a true hyperinfection syndrome, and the case demonstrates the continued need for diagnostic vigilance amongst former soldiers who were based in the Far East.
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Affiliation(s)
- G V Gill
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
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Kudesia G, Partridge S, Farrington CP, Soltanpoor N. Changes in age related seroprevalence of antibody to varicella zoster virus: impact on vaccine strategy. J Clin Pathol 2002; 55:154-5. [PMID: 11865016 PMCID: PMC1769589 DOI: 10.1136/jcp.55.2.154] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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] [Indexed: 11/03/2022]
Abstract
AIM To study changes in the seroprevalence of varicella zoster virus (VZV) antibody over the past 25 years with a view to determining the target age group for any future vaccination strategy. METHODS Stored sera collected from different age groups over a period of 25 years were tested by a commercial VZV IgG enzyme immunoassay at a four year time interval. Data were analysed by logistic regression to investigate the evidence for changes in incidence and hence seroprevalence over that period. RESULTS There was a significant rise in VZV antibody prevalence in the 1-4 year age group during the study period. CONCLUSIONS A universal childhood VZV vaccination strategy will need to take account of the increase in incidence of VZV infection in children under the age of 4 years; hence, the suggested target age would be between 12 and 18 months---soon after the disappearance of maternal antibody.
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Affiliation(s)
- G Kudesia
- Public Health Laboratory, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
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Yeh SH, Ward JI, Partridge S, Marcy SM, Lee H, Jing J, Curry ES, Howe BJ. Safety and immunogenicity of a pentavalent diphtheria, tetanus, pertussis, hepatitis B and polio combination vaccine in infants. Pediatr Infect Dis J 2001; 20:973-80. [PMID: 11642632 DOI: 10.1097/00006454-200110000-00011] [Citation(s) in RCA: 49] [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: 11/26/2022]
Abstract
INTRODUCTION The objectives of this study were to evaluate the safety and immunogenicity of a new combination vaccine (DTaP-HB-IPV) containing diphtheria, tetanus, acellular pertussis and hepatitis B (HB) and a new inactivated poliovirus vaccine (IPV) manufactured by GlaxoSmithKline (GSK). This vaccine was given in an all IPV or sequential IPV and oral polio vaccine (OPV) schedule. Another combination vaccine, DTaP-HB (GSK), was similarly evaluated given with OPV or IPV. METHODS Four hundred infants were randomized into one of four study groups and immunized at 2, 4 and 6 months of age. Group A received three doses of DTaP-HB-IPV; Group B received DTaP-HB-IPV at 2 and 4 months and DTaP-HB with OPV (Orimune) at 6 months; Group C received three doses of DTaP-HB with licensed IPV (IPOL) administered separately; Group D received separate doses of OPV, DTaP (Infanrix; GSK) and HB (Engerix; GSK). All subjects received conjugate Haemophilus influenzae type b vaccine (Hib) (OmniHIB) at 2, 4 and 6 months of age given at a separate injection site. Subjects who returned at 12 to 18 months of age (229) received booster immunization with DTaP and Hib. Safety was evaluated after each vaccine dose. Blood was drawn before the first dose and one month after the third dose as well as before and after the booster dose. RESULTS There were no vaccine-related serious adverse events in any group after any vaccine dose. Minor systemic and local adverse events were also not significantly different among the four groups after any dose. There were no differences in the immune response rates for Hib, HB, polio (types 1, 2 and 3), diphtheria, tetanus or pertussis antigens (pertussis toxin, filamentous hemagglutinin, pertactin) among groups, although there were some quantitative differences in specific antibody titers among groups. DTaP-HB-IPV and DTaP-HB combination vaccines had safety and immunogenicity equivalent to those of standard individually administered vaccines. The new IPV was not inferior to IPOL. CONCLUSION Use of the pentavalent combination vaccine would greatly reduce the number of required injections during the first 2 years of life, thereby simplifying the immunization schedule, enhancing compliance and facilitating acceptance of additional injections engendered by introduction of newer vaccines.
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Affiliation(s)
- S H Yeh
- UCLA Center for Vaccine Research, Research and Education Institute, Torrance, CA, USA
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Zangwill KM, Droge J, Mendelman P, Marcy SM, Partridge S, Chiu CY, Jing J, Chang SJ, Cho I, Ward JI. Prospective, randomized, placebo-controlled evaluation of the safety and immunogenicity of three lots of intranasal trivalent influenza vaccine among young children. Pediatr Infect Dis J 2001; 20:740-6. [PMID: 11734734 DOI: 10.1097/00006454-200108000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
BACKGROUND Trivalent formulations of an experimental, cold-adapted, intranasal influenza (CAIV) vaccine have been shown to be safe, immunogenic and efficacious in young children. METHODS We evaluated the safety and immunogenicity of three consistency lots of CAIV in children 12 to 36 months of age randomized to one of five groups: Groups 1, 2 and 3 received separate lots containing A/Shenzhen/227/95 (H1N1), A/Wuhan/359/95(H3N2) and B/Harbin/7/94-like viral strains. Group 4 received an earlier efficacy trial lot which included a different H1N1 strain (A/Texas/36/91-like); and Group 5 received placebo. We performed strain-specific serum hemagglutination inhibition antibody levels against type A (H3N2 or H1N1) or type B as appropriate. RESULTS Overall 474 children received 2 doses, 2 months apart. Each lot was well-tolerated, and there were no significant group differences between consistency lots in the proportion of children with fever and local or systemic reactions after vaccination. The 3 consistency lots were not statistically different with regard to immunogenicity as measured by seroconversion or absolute geometric mean titer. Immune responses were more robust among initially seronegative children and for H3N2 and B strains than for H1N1 strains. After 2 doses of vaccine 97, 84 and 62% had hemagglutination inhibition titers > or = 1/32 against A/H3N2, B and H1N1 strains, respectively. For A/H3N2 only, immune responses after 1 dose of vaccine are similar to those seen after 2 doses. CONCLUSIONS Each consistency lot of CAIV is as or more immunogenic than a lot used in a large efficacy trial.
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Affiliation(s)
- K M Zangwill
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance, CA, USA
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Esserman L, Kaplan E, Partridge S, Tripathy D, Rugo H, Park J, Hwang S, Kuerer H, Sudilovsky D, Lu Y, Hylton N. MRI phenotype is associated with response to doxorubicin and cyclophosphamide neoadjuvant chemotherapy in stage III breast cancer. Ann Surg Oncol 2001; 8:549-59. [PMID: 11456056 DOI: 10.1007/s10434-001-0549-8] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The preferred management for women with stage II or locally advanced breast cancer (LABC) is neoadjuvant chemotherapy. Pathologic response to chemotherapy has been shown to be an excellent predictor of outcome. Surrogates that can predict pathologic response and outcome will fuel future changes in management. Magnetic resonance imaging (MRI) demonstrates that patients with LABC have distinct tumor patterns. We investigated whether or not these patterns predict response to therapy. METHODS Thirty-three women who received neoadjuvant doxorubicin and cyclophosphamide chemotherapy for 4 cycles and serial breast MRI scans before and after therapy were evaluated for this study. Response to therapy was measured by change in the longest diameter on the MRI. RESULTS Five distinct imaging patterns were identified: circumscribed mass, nodular tissue infiltration diffuse tissue infiltration, patchy enhancement, and septal spread. The likelihood of a partial or complete response as measured by change in longest diameter was 77%, 37.5%, 20%, and 25%, respectively. CONCLUSIONS MRI affords three-dimensional characterization of tumors and has revealed distinct patterns of tumor presentation that predict response. A multisite trial is being planned to combine imaging and genetic information in an effort to better understand and predict response and, ultimately, to tailor therapy and direct the use of novel agents.
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Affiliation(s)
- L Esserman
- Department of Surgery, University of California, San Francisco, USA.
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Partridge S, Hubble C. Is bringing back matron just a publicity stunt? Nurs Times 2001; 97:15. [PMID: 11957871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Partridge S. Meddling matrons are a mistake. Nurs Times 2001; 97:20. [PMID: 11957906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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31
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Rogstad KE, Bates SM, Partridge S, Kudesia G, Poll R, Osborne MA, Dixon S. The prevalence of Chlamydia trachomatis infection in male undergraduates: a postal survey. Sex Transm Infect 2001; 77:111-3. [PMID: 11287689 PMCID: PMC1744289 DOI: 10.1136/sti.77.2.111] [Citation(s) in RCA: 24] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the prevalence of Chlamydia trachomatis infection in male undergraduates and to investigate whether prevalence increases with time spent at university. To investigate the feasibility of screening men for C trachomatis by self sampling and posting of urine specimens. METHODS The study design was a postal survey undertaken by the Department of Genito-Urinary Medicine (GUM) and Student University Health Service (SUHS) in SHEFFIELD: 2607 male undergraduates from the SUHS patient list were invited to participate in the study by providing a first void urine specimen and posting it to the laboratory. The main outcome measure was the detection of C trachomatis infection. RESULTS 758 students participated in the study, a response rate of 29.1%. Nine students (1.2%) tested positive for C trachomatis. The prevalence of infection in the first, second, and third year of study was 0.7%, 1.5%, and 1.6% of participants respectively. There was no statistically significant difference in prevalence of infection between first and third year students (chi(2) test, p = 0.32). However, students with chlamydia had a higher median age (Mann-Whitney U test, p < or = 0.05). Contact tracing identified four further cases of C trachomatis infection. CONCLUSION Screening for C trachomatis infection by postal survey is feasible. However, the response rate in this study was poor and the estimated sample size was not reached. Therefore, it has not been possible to determine the true prevalence of infection in this population or to accurately assess changes in prevalence with time spent at university.
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Affiliation(s)
- K E Rogstad
- Department of Genito-Urinary Medicine, Royal Hallamshire Hospital, Sheffield, UK
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Greenberg DP, Wong VK, Partridge S, Chang SJ, Jing J, Howe BJ, Ward JI. Immunogenicity of a Haemophilus influenzae type b-tetanus toxoid conjugate vaccine when mixed with a diphtheria-tetanus-acellular pertussis-hepatitis B combination vaccine. Pediatr Infect Dis J 2000; 19:1135-40. [PMID: 11144372 DOI: 10.1097/00006454-200012000-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/25/2022]
Abstract
BACKGROUND Combination vaccines are urgently needed to reduce the number of injections given to young children. The aim of the study was to evaluate the safety and immunogenicity of a combination vaccine that contains diphtheria and tetanus toxoids and acellular pertussis antigens (DTaP), recombinant hepatitis B surface antigen (HepB) and Haemophilus influenzae type b (Hib) polysaccharide conjugated to tetanus toxoid (PRP-T). METHODS Four hundred five infants were randomized equally to three groups and immunized at 2, 4 and 6 months of age with: (1) DTaP/HepB vaccine used to reconstitute lyophilized PRP-T vaccine and administered as a single injection; (2) DTaP/HepB vaccine and PRP-T vaccine administered as two separate injections; or (3) DTaP, HepB and PRP-T vaccines administered as three separate injections. Safety was closely monitored, and blood specimens were obtained to assess antibody responses to each vaccine antigen. RESULTS All study vaccines were well-tolerated, and the rates of systemic and injection site reactions were similar between groups. After the third dose the geometric mean antibody concentrations to Hib were significantly lower in subjects in Group 1 (1.63 microg/ml) compared with subjects in Groups 2 and 3 (6.26 and 6.15 microg/ml, respectively; P < 0.0001). Subjects with antibody concentrations <1.0 microg/ml after the third dose responded well to a booster dose of Hib conjugate vaccine given at 11 to 15 months of age (41 of 44 with anti-PRP > or = 1.0 microg/ml). Differences between groups for antibody responses to the other vaccine components were not clinically significant. CONCLUSIONS Infants given a combined DTaP/ HepB/PRP-T vaccine experienced a significantly lower antibody response to the PRP-T component than infants given PRP-T vaccine as a separate injection. However, the immune response to a booster dose of Hib conjugate vaccine indicated the presence of immunologic memory.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance, CA, USA.
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Partridge S, Timothy A, O'Doherty MJ, Hain SF, Rankin S, Mikhaeel G. 2-Fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin's disease: influence on patient management in a single institution. Ann Oncol 2000; 11:1273-9. [PMID: 11106116 DOI: 10.1023/a:1008368330519] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Optimum therapy for patients with Hodgkin's disease (HD) is determined by a number of prognostic factors, one of which is an accurate definition of extent of disease (stage). Computerised tomography is widely used in staging but cannot reliably evaluate normal sized lymph nodes and some extranodal sites, e.g., liver, spleen and bone marrow. 2-Fluorine-18-fluoro-2-deoxy-D glucose (FDG) has been shown to concentrate preferentially in lymphoma sites (whether in nodal or extranodal tissue) and therefore may have a useful role in staging patients with HD. This study compares concurrent computerized tomography (CT) and FDG positron emission tomography (PET) in the staging of Hodgkin's disease and assesses the frequency of stage migration and possible changes in therapy related to the use of PET scanning. PATIENTS AND METHODS This was a single centre retrospective study of 44 patients with Hodgkin's disease who underwent both staging CT and PET prior to treatment between September 1993 and August 1998 at St. Thomas' Hospital. The number and sites of disease were assessed for each patient, documenting any stage and therapy modification prompted by PET findings. RESULTS One hundred fifty-nine sites of disease were demonstrated in forty-four patients by FDG-PET compared with eighty-four by CT. As a result, 18 (40.9%) patients were upstaged, nine of these by FDG-uptake in splenic or extranodal sites not visualised on CT. Only three patients were downstaged by PET results. Eleven patients (25%) had treatment modified by PET scan findings. CONCLUSIONS Significantly more sites of disease were identified by PET than CT resulting in stage changes and a modification of therapy in 25% of patients. This has important implications not only for current patient management but also for the design of future clinical trials.
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Affiliation(s)
- S Partridge
- Department of Clinical Oncology, St. Thomas' Hospital, London, UK
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34
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Partridge S, Leslie M, Irvine A. Infusional 5-fluorouracil can be a pain in the neck: A case for repositioning displaced Hickman lines. Clin Oncol (R Coll Radiol) 2000; 11:274-6. [PMID: 10473727 DOI: 10.1053/clon.1999.9063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Increasing numbers of patients receive infusional chemotherapy or total parenteral nutrition via Hickman or Grochong lines. Although the insertion of these indwelling catheters is generally performed under radiological guidance and their positions verified by chest radiography, it is still feasible for them to become displaced at a later date. This possibility should be excluded in patients who develop unusual symptoms during the course of their infusional therapy. We review the reported complications associated with Hickman lines, and present a case history demonstrating that interventional radiology has a valuable role in displaced line repositioning, after the exclusion of thrombosis and infection.
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Partridge S, Timothy A, O'Doherty MJ, Hain SF, Rankin S, Mikhaeel G. 2-Fluorine-18-fluoro-2-deoxy-D-glucose Positron Emission Tomography in the Pretreatment Staging of Hodgkin's Disease. ACTA ACUST UNITED AC 1999; 2:323. [PMID: 14516620 DOI: 10.1016/s1095-0397(99)00083-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Partridge S. Nursing in Academia. Nurse Educ Today 1996; 16:385. [PMID: 9025531 DOI: 10.1016/s0260-6917(96)80015-3] [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: 05/22/2023]
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38
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39
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Greenberg DP, Vadheim CM, Wong VK, Marcy SM, Partridge S, Greene T, Chiu CY, Margolis HS, Ward JI. Comparative safety and immunogenicity of two recombinant hepatitis B vaccines given to infants at two, four and six months of age. Pediatr Infect Dis J 1996; 15:590-6. [PMID: 8823852 DOI: 10.1097/00006454-199607000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the relative safety and immunogenicity of the two recombinant hepatitis B vaccines licensed in the United States with doses recommended for routine immunization of low risk infants and a schedule that corresponds with routine pediatric visits. METHODS Healthy infants were immunized at 2, 4 and 6 months of age with hepatitis B vaccine manufactured by either SmithKline Beecham (Engerix-B, 10 micrograms/dose, n = 228) or Merck and Co. (Recombivax HB, 2.5 micrograms/dose, n = 200). Adverse reactions were ascertained by parental reports and interviews and by review of medical records. Antibody concentrations to hepatitis B surface antigen (anti-HBs) were measured in sequential serum specimens by enzyme immunoassay. RESULTS Adverse reactions were mild and the rates were not significantly different between the two groups. After the first and second doses the rates of seropositivity (> or = 10 mIU/ml) and seroprotection (> or = 10 mIU/ml) were significantly higher in infants given SmithKline Beecham vaccine (P < 0.01). After the second and third doses infants given SmithKline Beecham vaccine also had significantly higher geometric mean anti-HBs concentrations compared with those given Merck vaccine (348.0 mIU/ml vs. 66.9 and 1914.8 mIU/ml vs. 514.8 mIU/ml, respectively, P < 0.001). Nevertheless after the third dose 99% of infants in both vaccine groups achieved seroprotective antibody concentrations. CONCLUSIONS Both recombinant hepatitis B vaccines were safe and immunogenic when administered concurrently with other pediatric vaccines at 2, 4 and 6 months of age, but earlier protective responses were observed with the SmithKline Beecham vaccine than with the Merck vaccine.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA, Medical Center, Torrance, USA.
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40
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Greenberg DP, Vadheim CM, Marcy SM, Partridge S, Jing J, Chiu CY, Greene T, Margolis HS, Ward JI. Safety and immunogenicity of a recombinant hepatitis B vaccine administered to infants at 2, 4 and 6 months of age. The Kaiser-UCLA Vaccine Study Group. Vaccine 1996; 14:811-6. [PMID: 8817829 DOI: 10.1016/0264-410x(95)00228-s] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A recombinant hepatitis B vaccine was administered to over 5000 infants in a prospective, randomized and blinded study. Infants were given either recombinant hepatitis B vaccine (Engerix-B, SmithKline Beecham Pharmaceuticals, 10 micrograms dose-1) or a Haemophilus influenzae type b (Hib) conjugate vaccine at 2, 4 and 6 months of age simultaneously with diphtheria-tetanus-pertussis and oral polio vaccines. Adverse reactions were ascertained by parental reports and interviews, and review of medical records. Blood specimens collected from 269 infants given hepatitis B vaccine were assayed for antibody to hepatitis B surface antigen (anti-HBs) by enzyme immunoassay. Infants given hepatitis B vaccine experienced low rates of adverse reactions that were similar or lower than the rates in infants given Hib conjugate vaccine. The geometric mean anti-HBs concentrations were 9.6 mIU ml-1 after one dose, 333 mIU ml-1 after two doses and 1812 mIU ml-1 after three doses (99% had levels > or = 10 mIU ml-1). Antibody responses to diphtheria and tetanus toxoids were unaffected by simultaneous administration of hepatitis B or Hib conjugate vaccine. Engerix-B vaccine was safe and immunogenic when given with other routine childhood immunizations at 2, 4 and 6 months of age, and should provide long-term protection against hepatitis B virus infection.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance 90502, USA
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Lieberman JM, Greenberg DP, Wong VK, Partridge S, Chang SJ, Chiu CY, Ward JI. Effect of neonatal immunization with diphtheria and tetanus toxoids on antibody responses to Haemophilus influenzae type b conjugate vaccines. J Pediatr 1995; 126:198-205. [PMID: 7844665 DOI: 10.1016/s0022-3476(95)70545-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We randomly assigned 150 newborn infants to receive diphtheria and tetanus toxoids (DT) or Hib oligosaccharide conjugate (HbOC) at birth to determine whether exposure to the Haemophilus influenzae type b (Hib) conjugate vaccines' carrier proteins would enhance immune responses to subsequent administrations of HbOC or PRP-tetanus toxoid conjugate (PRP-T) at 2, 4, and 6 months of age. Their antibody responses were compared with those of 100 children immunized with HbOC or PRP-T beginning at 2 months of age. No serious adverse reactions were associated with neonatal vaccination. Administration of HbOC at birth did not lead to earlier or higher antibody levels. Newborn immunization with DT did not prime children for enhanced antibody responses. Moreover, Hib antibody levels were lower in DT-primed children than in children immunized beginning at 2 months of age. Diphtheria antibody levels, but not tetanus antibody levels, were also lower in children immunized with DT at birth. We conclude that neonatal immunization with Hib conjugate vaccines is not a means to provide earlier protection against invasive Hib disease. Newborn DT administration does not enhance subsequent antibody responses to Hib conjugate vaccines, and may lead to suppression of Hib and diphtheria antibody responses.
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Affiliation(s)
- J M Lieberman
- Division of Pediatric Infectious Diseases, University of California, Los Angeles
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Greenberg DP, Lieberman JM, Marcy SM, Wong VK, Partridge S, Chang SJ, Chiu CY, Ward JI. Enhanced antibody responses in infants given different sequences of heterogeneous Haemophilus influenzae type b conjugate vaccines. J Pediatr 1995; 126:206-11. [PMID: 7844666 DOI: 10.1016/s0022-3476(95)70546-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To evaluate the safety and immunogenicity of differing sequences of heterogeneous Haemophilus influenzae type b (Hib) conjugate vaccines, we randomly assigned 300 infants to one of six vaccination schedules. At 2, 4, and 6 months of age, subjects were given single or heterogeneous vaccines: Hib polysaccharide (PRP) conjugated to mutant diphtheria toxin (HbOC), PRP conjugated to outer-membrane protein of Neisseria meningitidis (PRP-OMP), or PRP conjugated to tetanus toxoid (PRP-T). No serious reactions were attributable to immunization with heterogeneous vaccines, and there were few significant differences in the rates of minor adverse reactions among groups. PRP-OMP was the only vaccine that induced an antibody response after the first dose, but significant booster responses were not seen after the second and third doses. Subjects given PRP-T vaccine responded well after two doses, but three doses of HbOC vaccine were needed for an equivalent antibody response. All the Hib vaccine schedules evaluated were immunogenic, and schedules initiated by PRP-OMP vaccine at 2 months of age, followed by two doses of either HbOC or PRP-T vaccine at 4 and 6 months of age, induced the highest antibody levels after each dose. Such schedules may be the best for protecting infants and children who are at greatest risk of having invasive Hib disease, such as American Indian children.
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Affiliation(s)
- D P Greenberg
- Division of Pediatric Infectious Diseases, Harbor-UCLA Medical Center, Torrance 90502
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46
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Greenberg DP, Vadheim CM, Partridge S, Chang SJ, Chiu CY, Ward JI. Immunogenicity of Haemophilus influenzae type b tetanus toxoid conjugate vaccine in young infants. The Kaiser-UCLA Vaccine Study Group. J Infect Dis 1994; 170:76-81. [PMID: 8014524 DOI: 10.1093/infdis/170.1.76] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [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: 01/28/2023] Open
Abstract
In a prospective, randomized, double-blind efficacy trial, the immunogenicity of 10 lots of Haemophilus influenzae type b capsular polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) was evaluated. More than 10,000 infants received PRP-T or hepatitis B vaccine at about 2, 4, and 6 months of age along with other childhood vaccines. In a subset of infants, geometric mean concentrations of total anticapsular antibody were 0.08, 0.79, and 5.29 micrograms/mL after the first, second, and third doses, respectively. Four lots of reconstituted lyophilized PRP-T vaccine were significantly more immunogenic than 6 lots of aqueous vaccine (P = .03). In a stepwise regression model, the most important additional factors affecting anticapsular antibody concentrations were the time between the third dose and the blood draw, race, and breast-feeding status at 6 months of age. Immune responses to diphtheria and tetanus toxoids were not significantly different for infants given PRP-T or hepatitis B vaccines along with diphtheria-tetanus toxoid-pertussis vaccine.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance 90502
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Vadheim CM, Greenberg DP, Partridge S, Jing J, Ward JI. Effectiveness and safety of an Haemophilus influenzae type b conjugate vaccine (PRP-T) in young infants. Kaiser-UCLA Vaccine Study Group. Pediatrics 1993; 92:272-9. [PMID: 8337029] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To study the safety, immunogenicity, and protective efficacy of the Haemophilus influenzae capsular polysaccharide tetanus conjugate vaccine (PRP-T). DESIGN Randomized, double-blind, controlled clinical trial. SETTING Southern California Kaiser-Permanente Health Plan. PARTICIPANTS 10,317 infants 6 to 15 weeks of age, with no known immune dysfunction, exposure to hepatitis B, or contraindication to diphtheria-tetanus-pertussis (DTP) vaccination were enrolled between August 1989 and September 1990. INTERVENTION Infants were randomized to receive either PRP-T or a recombinant hepatitis B control vaccine (in addition to DTP) at approximately 2, 4, and 6 months of age. OUTCOME MEASURES Adverse reactions occurring during the first 72 hours and between doses (including hospitalizations and outpatient visits) were measured using parental reporting/interviews and review of records. Invasive disease caused by H influenzae was ascertained from the time of enrollment until December 31, 1990. RESULTS In October 1990, the study was prematurely terminated because of licensure of other H influenzae vaccines recommended for routine infant use. The rates of systemic and local reactions occurring within 72 hours of each vaccine dose were generally similar for infants given PRP-T and hepatitis B, but some reaction rates (local reactions, fever > or = 102 degrees F, irritability, crying) were significantly higher in the PRP-T group. In the month following receipt of vaccine, PRP-T-vaccinated infants experienced five definite seizures compared with three in the hepatitis B control group. Within 48 hours of vaccination, three seizures (two definite and one possible), which were thought to be related to vaccination, occurred in the PRP-T group, compared with none in the control group (P < .13). Overall morbidity, mortality, and hospitalization rates were similar in the two vaccine groups. Three cases of invasive disease caused by H influenzae occurred in the control group; none occurred in the PRP-T group. CONCLUSIONS The PRP-T vaccine is safe and appears to be effective in preventing invasive disease caused by H influenzae type b.
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Affiliation(s)
- C M Vadheim
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance 90502
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Partridge S. Education: return of the robot tutors. Nurs Stand 1992; 6:46-7. [PMID: 1606012 DOI: 10.7748/ns.6.34.46.s59] [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: 12/27/2022]
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Partridge S. Lateral nursing: bring on the revolting nurses. Nurs Stand 1992; 6:46. [PMID: 1547098 DOI: 10.7748/ns.6.20.46.s62] [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: 12/27/2022]
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Partridge S. Downgrading of arts-centered education in state schools. Nurs Stand 1991; 6:43. [PMID: 1760348 DOI: 10.7748/ns.6.9.43.s45] [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: 12/28/2022]
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