1
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Jensen GL, Cederholm T, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Gautier JBO, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Compher C, Barazzoni R. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. JPEN J Parenter Enteral Nutr 2024; 48:145-154. [PMID: 38221842 DOI: 10.1002/jpen.2590] [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: 11/11/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Uppsala, Sweden
- Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Isabel T D Correia
- Food Science Post Graduation Program; Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka
| | - Heather Keller
- Department of Kinesiology and Health Sciences, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, Ohio, USA
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | | | - Matthias Pirlich
- Departments of Endocrinology, Gastroenterology, and Clinical Nutrition, Imperial Oak Outpatient Clinic, Berlin, Germany
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Marian de van der Schueren
- School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Alison Steiber
- Academy of Nutrition and Dietetics, Cleveland, Ohio, USA
| | - Marion F Winkler
- Surgical Nutrition Service, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Phillips W, Somner J. A Case of Idiopathic Intracranial Hypertension/Pseudotumor Cerebri Syndrome Cured by Myomectomy. J Neuroophthalmol 2023; 43:e156-e158. [PMID: 35439233 DOI: 10.1097/wno.0000000000001588] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wendy Phillips
- Department of Neurology, Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
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3
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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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4
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Cederholm T, Jensen GL, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Ochoa Gautier JB, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Barazzoni R, Compher C. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. Clin Nutr 2023:S0261-5614(23)00390-4. [PMID: 38238189 DOI: 10.1016/j.clnu.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable with 99 % overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Sweden; Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden.
| | - Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Isabel T D Correia
- Food Science Post Graduation Program, Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, OH, USA.
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo Japan.
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium.
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia.
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka.
| | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada.
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, OH, USA.
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA.
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico.
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Japan.
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University, Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.
| | | | - Matthias Pirlich
- Praxis Kaisereiche - Imperial Oak Outpatient Clinic, Berlin Germany; Endocrinology, Gastroenterology, Clinical Nutrition, Berlin, Germany.
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Thailand.
| | | | - Marian de van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Wageningen University, Division of Human Nutrition and Health, the Netherlands.
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, China.
| | | | - Marion F Winkler
- Alpert Medical School of Brown University, Rhode Island Hospital, Surgical Nutrition Service, Providence, RI, USA.
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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5
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McLoughlin C, Hoeritzauer I, Cabreira V, Aybek S, Adams C, Alty J, Ball HA, Baker J, Bullock K, Burness C, Dworetzky BA, Finkelstein S, Garcin B, Gelauff J, Goldstein LH, Jordbru A, Huys ACM, Laffan A, Lidstone SC, Linden SC, Ludwig L, Maggio J, Morgante F, Mallam E, Nicholson C, O'Neal M, O'Sullivan S, Pareés I, Petrochilos P, Pick S, Phillips W, Roelofs K, Newby R, Stanton B, Gray C, Joyce EM, Tijssen MA, Chalder T, McCormick M, Gardiner P, Bègue I, Tuttle MC, Williams I, McRae S, Voon V, McWhirter L. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:855-862. [PMID: 36977553 PMCID: PMC10511956 DOI: 10.1136/jnnp-2022-330192] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland
- Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - Caitlin Adams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Alty
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Baker
- Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | | | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anika Jordbru
- Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Catherine Ml Huys
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aoife Laffan
- Neurology, St. James's Hospital, Dublin, Ireland
| | - Sarah C Lidstone
- University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lea Ludwig
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Julie Maggio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Elizabeth Mallam
- The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Nicholson
- Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary O'Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isabel Pareés
- Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Rachel Newby
- Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Cordelia Gray
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | - Eileen M Joyce
- Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Marina Aj Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Maxanne McCormick
- Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA
| | - Paula Gardiner
- Psychological Therapy in Primary Care, University of Dundee, Dundee, UK
- enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK
| | - Indrit Bègue
- Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland
| | - Margaret C Tuttle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isobel Williams
- Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Sarah McRae
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Valerie Voon
- Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Guenter P, Blackmer A, Malone A, Phillips W, Mogensen KM, Becker P. Current nutrition assessment practice: A 2022 survey. Nutr Clin Pract 2023; 38:998-1008. [PMID: 37060155 DOI: 10.1002/ncp.10998] [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: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Malnutrition remains a significant problem in patients with acute or chronic illnesses. Nutrition assessment is an important component in detecting malnutrition; but not always performed using a standardized tool. This survey on nutrition assessment evaluates current clinical practices on the assessment, diagnosis, and treatment of malnutrition. METHODS This 2022 survey of US-based nutrition clinicians collected data on assessment parameters used in hospitals, long-term care facilities, and the home care setting. RESULTS A total of 686 surveys were available for analysis. Ninety-seven percent of adult and 91% of pediatric responding clinicians indicated that a dietitian completed the assessment. Parameters used most frequently among adult clinician respondents included nutrient intake, current weight, and weight history, those used by pediatric clinician respondents included nutrient intake, weight-for-age z score, and weight-for-length/height z score. Eighty-nine percent of adult clinicians in all care settings and 85% of pediatric clinicians use the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM). Respondents reported malnutrition rates of 32%-40% for adults and 4%-30% for pediatric patients, depending on the setting. Appropriate interventions for those with malnutrition (as perceived by the survey respondents) were ordered 70% of the time. CONCLUSION This survey demonstrated significant use of the AAIM by both adult and pediatric clinicians across care settings. Reported malnutrition rates are consistent with others published in the literature. The authors suggest that quality improvement efforts should focus on the 30% of patients with malnutrition but without a reported appropriate nutrition intervention.
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Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Allison Blackmer
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Bajaj JS, Peña-Rodriguez M, La Reau A, Phillips W, Fuchs M, Davis BC, Sterling RK, Sikaroodi M, Fagan A, Shamsaddini A, Henseler Z, Ward T, Puri P, Lee H, Gillevet PM. Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis. Gut 2023; 72:759-771. [PMID: 36343978 PMCID: PMC9998342 DOI: 10.1136/gutjnl-2022-328403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE First decompensation development is a critical milestone that needs to be predicted. Transkingdom gut microbial interactions, including archaeal methanogens, may be important targets and predictors but a longitudinal approach is needed. DESIGN Cirrhosis outpatients who provided stool twice were included. Group 1: compensated, group 2: 1 decompensation (decomp), group 3: >1 decompensationwere followed and divided into those who remained stable or decompensated. Bacteria, viral and archaeal presence, α/β diversity and taxa changes over time adjusted for clinical variables were analysed. Correlation networks between kingdoms were analysed. RESULTS 157 outpatients (72 group 1, 33 group 2 and 52 group 3) were followed and 28%-47% developed outcomes. Baseline between those who remained stable/developed outcome: While no α/β diversity differences were seen, commensals were lower and pathobionts were higher in those who decompensated. After decompensation: those experiencing their first decompensation showed greater decrease in α/β-diversity, bacterial change (↑Lactobacillus spp, Streptococcus parasanguinis and ↓ beneficial Lachnospiraceae and Eubacterium hallii) and viral change (↑Siphoviridae, ↓ Myoviridae) versus those with further decompensation. Archaea: 19% had Methanobacter brevii, which was similar between/within groups. Correlation networks: Baseline archaeal-viral-bacterial networks were denser and more homogeneous in those who decompensated versus the rest. Archaea-bacterial correlations collapsed post first decompensation. Lactobacillus phage Lc Nu and C2-like viruses were negatively linked with beneficial bacteria. CONCLUSION In this longitudinal study of cirrhosis outpatients, the greatest transkingdom gut microbial changes were seen in those reaching the first decompensation, compared with subsequent decompensating events. A transkingdom approach may refine prediction and provide therapeutic targets to prevent cirrhosis progression.
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Affiliation(s)
- Jasmohan S Bajaj
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | | | | | | | - Michael Fuchs
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Brian C Davis
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Richard K Sterling
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Masoumeh Sikaroodi
- Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA
| | - Andrew Fagan
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | | | | | - Tonya Ward
- Diversigen Inc, New Brighton, Minnesota, USA
| | - Puneet Puri
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Hannah Lee
- Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA
- GI Section, Central Virginia Veterans Healthcare System, Richmond, Virginia, USA
| | - Patrick M Gillevet
- Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA
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Carvalho-Salemi J, Phillips W, Wong Vega M, Swanson J, Becker PJ, Salemi JL. Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends. J Acad Nutr Diet 2023; 123:109-116. [PMID: 35659540 DOI: 10.1016/j.jand.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/24/2022] [Accepted: 12/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. OBJECTIVE The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. DESIGN Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. PARTICIPANTS/SETTING Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. MAIN OUTCOME MEASURE CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. STATISTICAL ANALYSES Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. RESULTS CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. CONCLUSIONS Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.
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Affiliation(s)
| | | | | | - Justin Swanson
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, Florida
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9
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Phillips W, Janowski M. Standardizing Malnutrition Benchmarking Programs to Support Effective Quality Improvement Efforts. J Acad Nutr Diet 2022; 122:2001-2005. [PMID: 35953027 DOI: 10.1016/j.jand.2022.08.115] [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] [Received: 04/02/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 10/31/2022]
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10
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Hayne DP, Phillips W, Cosh SM, Price I. Examining personality trait patterns in transdiagnostic dimensions of psychopathology. Curr Psychol 2022. [DOI: 10.1007/s12144-022-03028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Guenter P, Blackmer A, Malone A, Mirtallo JM, Phillips W, Tyler R, Barrocas A, Resnick HE, Anthony P, Abdelhadi R. Update on use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition in the United States. Nutr Clin Pract 2022; 37:94-101. [PMID: 35025121 DOI: 10.1002/ncp.10827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition continues to be associated with outcomes in hospitalized patients. METHODS An updated review of national data in patients with a coded diagnosis of malnutrition (CDM) and the use of nutrition support (enteral nutrition [EN] and parenteral nutrition [PN]) was conducted using the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and Medicare Claims data. RESULTS Results demonstrated a growing trend in CDM accompanied by continued low utilization of PN and EN. CONCLUSION Underutilization of nutrition support may be due to product shortages, reluctance of clinicians to use these therapies, undercoding of nutrition support, strict adherence to published guidelines, and other factors.
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Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Allison Blackmer
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Jay M Mirtallo
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | | | - Renay Tyler
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | - Pat Anthony
- American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA
| | - Ruba Abdelhadi
- University of Kansas School of Medicine, Kansas City, MO, USA
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12
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Arensberg MB, Saal-Ridpath K, Kerr K, Phillips W. Opportunities to Improve Quality Outcomes: Integrating Nutrition Care Into Medicare Advantage to Address Malnutrition and Support Social Determinants of Health. INQUIRY 2022; 59:469580221081431. [PMID: 35255728 PMCID: PMC8908402 DOI: 10.1177/00469580221081431] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medicare Advantage (MA) is a public–private healthcare program for older adults and individuals with disabilities in the United States (US). MA enrollees receive their benefits from private health plans and the percentage of Medicare beneficiaries in MA plans continues to increase. MA plan enrollees typically have more socioeconomic risk factors compared to traditional Medicare enrollees. The COVID-19 pandemic has highlighted the importance of MA plans’ flexibilities to address socioeconomic risk factors, or social determinants of health (SDOH), and to tailor benefits and services to meet individual MA enrollee needs. Poor nutrition—often termed malnutrition or protein calorie malnutrition—is a problem for many Medicare beneficiaries. Malnutrition can prolong recovery and increase medical complications and readmissions. Up to half of older Americans are at risk for malnutrition or are malnourished. Nutrition-related supplemental benefits offered by MA plans can most effectively help address malnutrition and impact SDOH and quality outcomes as part of multi-modal interventions. Multi-modal interventions integrate quality nutrition care throughout the MA care process. This Editorial explores the issue of older adult malnutrition and SDOH and the nutrition-related supplemental benefits currently offered by MA plans. It also identifies opportunities for further nutrition benefit development and impact, including through integration in MA outcome measurements and quality frameworks.
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Affiliation(s)
| | | | - Kirk Kerr
- Abbott Nutrition Division of Abbott, Columbus, OH, USA
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13
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Floyd J, Bao A, Phillips W, Patel T, Stein G, Hedrick M, Rice C, Brenner A. Image-Guided Rhenium-186 NanoLiposome (186RNL) Brachytherapy in the Treatment of Recurrent Glioblastoma: Technique, Image Analysis, Dosimetry, and Monitoring. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1578] [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: 11/28/2022]
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14
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Jooya A, Qureshi D, Leigh J, Webber C, Phillips W, Tanuseputro P, Ong M, Bourque J. Barriers to Access Palliative Radiotherapy in Prostate Cancer ― A Population-Based Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.995] [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: 11/16/2022]
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Fosso Wamba S, Queiroz MM, Roscoe S, Phillips W, Kapletia D, Azadegan A. Guest editorialEmerging technologies in emergency situations. IJOPM 2021. [DOI: 10.1108/ijopm-09-2021-904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Guenter P, Abdelhadi R, Anthony P, Blackmer A, Malone A, Mirtallo JM, Phillips W, Resnick HE. Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018. Nutr Clin Pract 2021; 36:957-969. [PMID: 34486169 DOI: 10.1002/ncp.10771] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 06/01/2021] [Accepted: 07/31/2021] [Indexed: 11/07/2022] Open
Abstract
In the US, malnutrition is prevalent among hospitalized patients and is associated with higher morbidity, mortality, and healthcare costs when compared with those without malnutrition. Over time, national data have indicated the rate of coded malnutrition diagnoses among hospital discharges rising over time, and more current data on demographic and clinical characteristics of these patients are needed. Data on malnutrition discharges from the 2018 Healthcare Cost and Utilization Project (HCUP)-the most recent nationally representative data-were examined and compared with earlier HCUP findings. Based on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, 8.9% of all US non-maternal, non-neonatal hospital discharges in 2018 had a coded diagnosis of malnutrition (CDM). From this 2018 data, those with a CDM were older, had longer lengths of stay, and incurred higher costs, as compared with those without a CDM. Higher readmission rates and higher inpatient mortality were also observed in this group. These findings provide more recent demographic and clinical evidence for standardized malnutrition diagnostic and interventional programs to treat and/or prevent this condition.
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Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Ruba Abdelhadi
- Pediatrics, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas, Missouri, USA
- Education and Staff Development, Nutrition Support, Children's Mercy Hospital, Kansas, Missouri, USA
| | - Pat Anthony
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Allison Blackmer
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Jay M Mirtallo
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Abstract
Clinical hypnosis is an important therapeutic tool with an increasingly understood cognitive and neurobiological basis, and evidence for efficacy. Hypnosis involves controlled modulation of components of cognition-such as awareness, volition, perception and belief-by an external agent (the hypnotist) or by oneself (self-hypnosis) employing suggestion. In this article, we describe what hypnosis is, how it can be used in clinical settings, and how it is done.
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Affiliation(s)
- Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Jason Price
- Department of Neuropsychology, James Cook University Hospital, Middlesbrough, UK
| | - Paul D Molyneux
- Department of Neurology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Quinton Deeley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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18
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Affiliation(s)
- Wendy Phillips
- Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Bitar R, Ortiz C, Garza L, Parker M, Lopera J, Walker J, Phillips W. Abstract No. 36 A novel method for loading Tc-99m and R-186 into alginate microspheres for radioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Huynh M, Kempson I, Bezak E, Phillips W. Predictive modeling of hypoxic head and neck cancers during fractionated radiotherapy with gold nanoparticle radiosensitization. Med Phys 2021; 48:3120-3133. [PMID: 33818799 DOI: 10.1002/mp.14872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Intrinsic radioresistance and increased proliferation rates in head and neck cancers (HNCs) are associated with negative radiotherapy (RT) treatment responses. The use of gold nanoparticles (AuNPs) as radiosensitizers could enable total radiation dose reduction and lowered radiation toxicity. AuNP radiosensitization may overcome hypoxia-induced radioresistance and treatment-induced accelerated repopulation of cancer cells in HNCs, improving radiotherapy outcomes. METHODS Tumor control was determined by considering individual cancer cell responses in probabilistic computational simulations using HYP-RT software for clinical radiotherapy doses and fractionation schedules along with three different nanoparticle administration schedules. Antagonistic tumor hypoxia and rapid tumor regrowth due to accelerated repopulation of cancers cells were taken into consideration. RESULTS Simulations indicate that tumors that are conventionally uncontrollable can be controlled with AuNP radiosensitization. In simulations where the absence of AuNPs required radiotherapy doses above standard clinical prescriptions, reoccurring AuNP administration allowed for radiation dose reductions below standard clinical dose prescriptions. For example, considering a 2 Gy per fraction radiotherapy schedule, tumor control was achieved with 57.2 ± 5.1 Gy (P = <0.0001) for weekly AuNP administration and 53.0 ± 4.0 Gy (P = <0.0001) for biweekly AuNP administration compared to 69.9 ± 5.8 Gy with no radiosensitization. CONCLUSIONS AuNPs decreased the predicted RT total doses required to achieve tumor control via total stem cell elimination, offering an optimistic prediction and method for which hypoxia-induced and rapidly growing radioresistant tumors are treated more effectively. Outcomes are also shown to be sensitive to the RT schedule with data for hyperfractionated RT indicating the greatest benefits from radiosensitization.
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Affiliation(s)
- Myxuan Huynh
- Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Ivan Kempson
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, 5095, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, SA, Australia.,Department of Physics, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Wendy Phillips
- Department of Physics, University of Adelaide, North Terrace, Adelaide, SA, Australia.,Department of Medical Physics, Royal Adelaide Hospital, Adelaide, SA, Australia
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Huynh M, Kempson I, Bezak E, Phillips W. In silico modeling of cellular probabilistic nanoparticle radiosensitization in head and neck cancers. Nanomedicine (Lond) 2020; 15:2837-2850. [DOI: 10.2217/nnm-2020-0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The use of gold nanoparticles (AuNPs) as radiosensitizers may offer a new approach in the treatment of head and neck cancers; minimizing treatment-associated toxicities and improving patient outcomes. AuNPs promote localized dose deposition; permitting improved local control and/or dose reduction. Aim: This work aimed to address the theoretical optimization of radiation doses, fractionation and nanoparticle injection schedules to maximize therapeutic benefits. Materials & methods: Probabilistic nanoparticle sensitization factors were incorporated into the individual cell-based HYP-RT computer model of tumor growth and radiotherapy. Results: Total dose outcomes across all radiation therapy treatment regimens were found to be significantly reduced with the presence of AuNPs, with bi-weekly injections showing the most decrease. Conclusion: Outcomes suggest the need for regular AuNP administration to permit effective radiosensitization.
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Affiliation(s)
- Myxuan Huynh
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Ivan Kempson
- Future Industries Institute, University of South Australia, Mawson Lakes 5095, South Australia, Australia
| | - Eva Bezak
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Wendy Phillips
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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22
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Phillips W, Becker PJ, Wong Vega M, Smith E, Konek S, Bailer J, Carvalho-Salemi J. Comprehensive Application of the Malnutrition Quality Improvement Initiative (MQII) Toolkit to Pediatric Malnutrition Care. J Acad Nutr Diet 2020; 121:1021-1034. [PMID: 33187924 DOI: 10.1016/j.jand.2020.08.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 01/04/2023]
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23
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Phillips W. La Envidia: An Illness Manifest at the Level of the Community Body. Anthropol Conscious 2020. [DOI: 10.1111/anoc.12126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wendy Phillips
- Goddard College and California Institute of Integral Studies
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Abstract
PurposeThe emergence of distributed manufacturing (DM) is examined as a new form of localised production, distinct from previous manifestations of multi-domestic and indigenous production.Design/methodology/approachSupply network (SN) configuration and infrastructural provisioning perspectives were used to examine the literature on established localised production models as well as DM. A multiple case study was then undertaken to describe and explore the DM model further. A maximum variation sampling procedure was used to select five exemplar cases.FindingsThree main contributions emerge from this study. First, the research uniquely brings together two bodies of literature, namely SN configuration and infrastructure provisioning to explore the DM context. Second, the research applies these theoretical lenses to establish the distinctive nature of DM across seven dimensions of analysis. Third, emerging DM design rules are identified and compared with the more established models of localised production, drawing on both literature and DM case evidence.Practical implicationsThis study provides a rich SN configuration and infrastructural provisioning view on DM leading to a set of design rules for DM adoption, thus supporting practitioners in their efforts to develop viable DM implementation plans.Originality/valueThe authors contribute to the intra- and inter-organisational requirements for the emerging DM context by providing new perspectives through the combined lenses of SN configuration and infrastructural provisioning approaches.
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Barker J, Moule P, Evans D, Phillips W, Leggett N. Developing a typology of the roles public contributors undertake to establish legitimacy: a longitudinal case study of patient and public involvement in a health network. BMJ Open 2020; 10:e033370. [PMID: 32430448 PMCID: PMC7239550 DOI: 10.1136/bmjopen-2019-033370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify how public contributors established their legitimacy in the functioning of a patient and public involvement programme at a health network. DESIGN A longitudinal case study with three embedded units (projects) involving public contributors. Interviews (n=24), observations (n=27) and documentary data collection occurred over 16 months. SETTING The West of England Academic Health Science Network (WEAHSN), 1 of 15 regional AHSNs in England. PARTICIPANTS Interviews were conducted with public contributors (n=5) and professionals (n=19) who were staff from the WEAHSN, its member organisations and its partners. RESULTS Public contributors established their legitimacy by using nine distinct roles: (1) lived experience, as a patient or carer; (2) occupational knowledge, offering job-related expertise; (3) occupational skills, offering aptitude developed through employment; (4) patient advocate, promoting the interests of patients; (5) keeper of the public purse, encouraging wise spending; (6) intuitive public, piloting materials suitable for the general public; (7) fresh-eyed reviewer, critiquing materials; (8) critical friend, critiquing progress and proposing new initiatives and (9) boundary spanner, urging professionals to work across organisations. Individual public contributors occupied many, but not all, of the roles. CONCLUSIONS Lived experience is only one of nine distinct public contributor roles. The WEAHSN provided a benign context for the study because in a health network public contributors are one of many parties seeking to establish legitimacy through finding valuable roles. The nine roles can be organised into a typology according to whether the basis for legitimacy lies in: the public contributor's knowledge, skills and experience; citizenship through the aspiration to achieve a broad public good; or being an outsider. The typology shows how public contributors can be involved in work where lived experience appears to lack relevance: strategic decision making; research unconnected to particular conditions; or acute service delivery.
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Affiliation(s)
- Jacqueline Barker
- Faculty of Business and Law, University of the West of England Bristol, Bristol, UK
| | - Pam Moule
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - David Evans
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Wendy Phillips
- Faculty of Business and Law, University of the West of England Bristol, Bristol, UK
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Peterson S, Dobak S, Phillips W, Malone A, Ireton-Jones C, Haney A, Rybicki M, Guenter P. Enteral and Parenteral Order Writing Survey-A Collaborative Evaluation Between the Academy of Nutrition and Dietetics' Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutrition (ASPEN) Dietetics Practice Section. Nutr Clin Pract 2020; 35:377-385. [PMID: 32215972 DOI: 10.1002/ncp.10467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States. METHODS A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges. RESULTS Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n = 558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting. CONCLUSION PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This paper has been approved by the Academy's Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in the Journal of the Academy of Nutrition and Dietetics. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
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Affiliation(s)
- Sarah Peterson
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephanie Dobak
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.,Mt. Carmel East Hospital, Columbus, Ohio, USA
| | | | - Amanda Haney
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Mary Rybicki
- Mary Immaculate Nursing/Restorative Center, Lawrence, Massachusetts.,Academy of Nutrition and Dietetics, Chicago, IL
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Phillips W, Tuma PA. Consumer Protection Through Professional Regulation. J Acad Nutr Diet 2019; 119:1561-1563. [DOI: 10.1016/j.jand.2019.05.028] [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] [Received: 05/28/2019] [Indexed: 10/26/2022]
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Phillips W, Janowski M, Brennan H, Leger-LeBlanc G. Nutrition Focused Physical Exam Improves Accuracy of Malnutrition Diagnosis. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Phillips W, Janowski M, Brennan H, Leger G. Analyzing Registered Dietitian Nutritionist Productivity Benchmarks for Acute Care Hospitals. J Acad Nutr Diet 2019; 119:1985-1991. [PMID: 31262693 DOI: 10.1016/j.jand.2019.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Indexed: 01/04/2023]
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Abstract
Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract.
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Doley J, Phillips W, Talaber J, Leger-LeBlanc G. Early Implementation of Malnutrition Clinical Quality Metrics to Identify Institutional Performance Improvement Needs. J Acad Nutr Diet 2019; 119:547-552. [DOI: 10.1016/j.jand.2018.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Indexed: 01/04/2023]
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Flores E, Yélamos O, Cordova M, Kose K, Phillips W, Lee EH, Rossi A, Nehal K, Rajadhyaksha M. Peri-operative delineation of non-melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video-mosaicking. J Eur Acad Dermatol Venereol 2019; 33:1084-1091. [PMID: 30811707 DOI: 10.1111/jdv.15491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The surgical removal of non-melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour-intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re-excisions. Reflectance confocal microscopy (RCM) with a new video-mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real-time, augmenting the traditional approaches of histopathology. OBJECTIVE To assess a new peri-operative RCM video-mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. METHODS Thirty-five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video-mosaics. Two RCM evaluators read and assessed video-mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. RESULTS Reflectance confocal microscopy videos and video-mosaics displayed acceptable imaging quality (resolution and contrast), pre-operatively in 32/35 (91%) NMSC lesions and intra-operatively in 29/35 lesions (83%). Pre-operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra-operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video-mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter-evaluator agreement (k = 0.59, P ≤ 0.0002). CONCLUSIONS Peri-operative RCM video-mosaicking of NMSC margins directly on patients may potentially guide surgery in real-time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re-excisions. Further testing in larger studies is needed.
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Affiliation(s)
- E Flores
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Public Health Science Department, Penn State College of Medicine, Hershey, PA, USA
| | - O Yélamos
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Kose
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Phillips
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Doley J, Phillips W. Accurate Coding Impacts the Geometric Length of Stay for Malnourished Inpatients. J Acad Nutr Diet 2019; 119:193-198. [DOI: 10.1016/j.jand.2017.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 01/04/2023]
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Rojas-Bracho L, Gulland FMD, Smith CR, Taylor B, Wells RS, Thomas PO, Bauer B, Heide-Jørgensen MP, Teilmann J, Dietz R, Balle JD, Jensen MV, Sinding MHS, Jaramillo-Legorreta A, Abel G, Read AJ, Westgate AJ, Colegrove K, Gomez F, Martz K, Rebolledo R, Ridgway S, Rowles T, van Elk CE, Boehm J, Cardenas-Hinojosa G, Constandse R, Nieto-Garcia E, Phillips W, Sabio D, Sanchez R, Sweeney J, Townsend F, Vivanco J, Vivanco JC, Walker S. A field effort to capture critically endangered vaquitas Phocoena sinus for protection from entanglement in illegal gillnets. ENDANGER SPECIES RES 2019. [DOI: 10.3354/esr00931] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kong JC, Guerra GR, Warrier SK, Lynch AC, Michael M, Ngan SY, Phillips W, Ramsay G, Heriot AG. Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis. Colorectal Dis 2018; 20:574-585. [PMID: 29582537 DOI: 10.1111/codi.14106] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/01/2018] [Indexed: 02/08/2023]
Abstract
AIM The current standard of care for locally advanced rectal cancer involves neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision. There is a spectrum of response to neoadjuvant therapy; however, the prognostic value of tumour regression grade (TRG) in predicting disease-free survival (DFS) or overall survival (OS) is inconsistent in the literature. METHOD This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was undertaken using Ovid MEDLINE, Embase and Google Scholar. Inclusion criteria were Stage II and III locally advanced rectal cancer treated with long-course CRT followed by radical surgery. The aim of the meta-analysis was to assess the prognostic implication of each TRG for rectal cancer following neoadjuvant CRT. Long-term prognosis was assessed. The main outcome measures were DFS and OS. A random effects model was performed to pool the hazard ratio (HR) from all included studies. RESULTS There were 4875 patients from 17 studies, with 775 (15.9%) attaining a pathological complete response (pCR) and 719 (29.9%) with no response. A significant association with OS was identified from a pooled-estimated HR for pCR (HR = 0.47, P = 0.002) and nonresponding tumours (HR = 2.97; P < 0.001). Previously known tumour characteristics, such as ypN, lymphovascular invasion and perineural invasion, were also significantly associated with DFS and OS, with estimated pooled HRs of 2.2, 1.4 and 2.3, respectively. CONCLUSION In conclusion, the degree of TRG was of prognostic value in predicting long-term outcomes. The current challenge is the development of a high-validity tests to predict pCR.
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Affiliation(s)
- J C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G R Guerra
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Craig Lynch
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - M Michael
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - S Y Ngan
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - W Phillips
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - G Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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Mantamadiotis T, Daniel P, Filiz G, Christie M, Waring P, Zhang Y, Pouton C, Flanagan D, Vincan E, Phillips W. PO-202 PI3K activation in neural stem cells drives tumourigenesis which can be ameliorated by targeting the cAMP response element binding (CREB) protein. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.720] [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: 11/03/2022] Open
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Phillips W, Janowski M. RDN Productivity Benchmarks for Long Term Care Facilities. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.131] [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: 11/28/2022]
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Morris LS, To B, Baek K, Chang-Webb YC, Mitchell S, Strelchuk D, Mikheenko Y, Phillips W, Zandi M, Jenaway A, Walsh C, Voon V. Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories. Neuroimage Clin 2017; 16:286-294. [PMID: 28856091 PMCID: PMC5562176 DOI: 10.1016/j.nicl.2017.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional neurological disorder (FND) is an elusive disorder characterized by unexplained neurological symptoms alongside aberrant cognitive processing and negative affect, often associated with amygdala reactivity. METHODS We examined the effect of negative conditioning on cognitive function and amygdala reactivity in 25 FND patients and 20 healthy volunteers (HV). Participants were first conditioned to stimuli paired with negative affective or neutral (CS +/CS -) information. During functional MRI, subjects then performed an instrumental associative learning task to avoid monetary losses in the context of the previously conditioned stimuli. We expected that FND patients would be better at learning to avoid losses when faced with negatively conditioned stimuli (increased harm avoidance). Multi-echo resting state fMRI was also collected from the same subjects and a robust denoising method was employed, important for removing motion and physiological artifacts. RESULTS FND subjects were more sensitive to the negative CS + compared to HV, demonstrated by a reinforcement learning model. Contrary to expectation, FND patients were generally more impaired at learning to avoid losses under both contexts (CS +/CS -), persisting to choose the option that resulted in a negative outcome demonstrated by both behavioural and computational analyses. FND patients showed enhanced amygdala but reduced dorsolateral prefrontal cortex responses when they received negative feedback. Patients also had increased resting state functional connectivity between these two regions. CONCLUSIONS FND patients had impaired instrumental avoidance learning, findings that parallel previous observations of impaired action-outcome binding. FND patients further show enhanced behavioural and neural sensitivity to negative information. However, this did not translate to improved avoidance learning. Put together, our findings do not support the theory of harm avoidance in FND. We highlight a potential mechanism by which negative contexts interfere with adaptive behaviours in this under-explored disorder.
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Affiliation(s)
- Laurel S. Morris
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Benjaman To
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Kwangyeol Baek
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Yee-Chien Chang-Webb
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Simon Mitchell
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Daniela Strelchuk
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Yevheniia Mikheenko
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Wendy Phillips
- Department of Molecular Neuroscience, UCL Institute of Neurology
| | - Michael Zandi
- Department of Molecular Neuroscience, UCL Institute of Neurology
| | - Allison Jenaway
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Cathy Walsh
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
- Department of Molecular Neuroscience, UCL Institute of Neurology
| | - Valerie Voon
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
- NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
- Corresponding author at: Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, United Kingdom.
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To B, Morris LS, Baek K, Chang-Webb YC, Mitchell S, Strelchuk D, Mitchell S, Strelchuk D, Mikheenko Y, Phillips W, Zandi M, Jenaway A, Walsh C, Voon V. 3 Disrupted avoidance learning in functional neurological disorder. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baek K, Doñamayor N, Morris LS, Strelchuk D, Mitchell S, Mikheenko Y, Yeoh SY, Phillips W, Zandi M, Jenaway A, Walsh C, Voon V. Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement. Psychol Med 2017; 47:1624-1636. [PMID: 28183377 PMCID: PMC5964459 DOI: 10.1017/s0033291717000071] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional neurological disorders (FNDs), also known as conversion disorder, are unexplained neurological symptoms unrelated to a neurological cause. The disorder is common, yet poorly understood. The symptoms are experienced as involuntary but have similarities to voluntary processes. Here we studied intention awareness in FND. METHOD A total of 26 FND patients and 25 healthy volunteers participated in this functional magnetic resonance study using Libet's clock. RESULTS FND is characterized by delayed awareness of the intention to move relative to the movement itself. The reporting of intention was more precise, suggesting that these findings are reliable and unrelated to non-specific attentional deficits. That these findings were more prominent with aberrant positive functional movement symptoms rather than negative symptoms may be relevant to impairments in timing for an inhibitory veto process. Attention towards intention relative to movement was associated with lower right inferior parietal cortex activity in FND, a region early in the processing of intention. During rest, aberrant functional connectivity was observed with the right inferior parietal cortex and other motor intention regions. CONCLUSIONS The results converge with observations of low inferior parietal activity comparing involuntary with voluntary movement in FND, emphasizing core deficiencies in intention. Heightened precision of this impaired intention is consistent with Bayesian theories of impaired top-down priors that might influence the sense of involuntariness. A primary impairment in voluntary motor intention at an early processing stage might explain clinical observations of slowed effortful voluntary movement, heightened self-directed attention and underlie functional movements. These findings further suggest novel therapeutic targets.
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Affiliation(s)
- K. Baek
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - N. Doñamayor
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - L. S. Morris
- Behavioural and Clinical Neurosciences
Institute, Cambridge, UK
| | - D. Strelchuk
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - S. Mitchell
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - Y. Mikheenko
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - S. Y. Yeoh
- School of Clinical Medicine, University of
Cambridge, Cambridge, UK
| | - W. Phillips
- Department of Clinical Neurosciences,
Addenbrooke's Hospital, Cambridge,
Cambridge, UK
| | - M. Zandi
- Department of Clinical Neurosciences,
Addenbrooke's Hospital, Cambridge,
Cambridge, UK
- Department of Molecular Neuroscience,
UCL Institute of Neurology, London,
UK
- National Hospital for Neurology and
Neurosurgery, UCLH NIHR Biomedical Research Centre,
London, UK
| | - A. Jenaway
- Cambridgeshire and Peterborough NHS Foundation
Trust, Cambridge, UK
| | - C. Walsh
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
- Department of Clinical Neurosciences,
Addenbrooke's Hospital, Cambridge,
Cambridge, UK
| | - V. Voon
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neurosciences
Institute, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation
Trust, Cambridge, UK
- NIHR Biomedical Research Council,
Cambridge, Cambridge, UK
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Zhao J, van Mierlo KMC, Gómez-Ramírez J, Kim H, Pilgrim CHC, Pessaux P, Rensen SS, van der Stok EP, Schaap FG, Soubrane O, Takamoto T, Viganò L, Winkens B, Dejong CHC, Olde Damink SWM, Martín Pérez E, Cho JY, Choi YR, Phillips W, Michael M, Panaro F, Chenard MP, Verhoef C, Grünhagen DJ, Vara J, Scatton O, Hashimoto T, Makuuchi M, De Rosa G, Ravarino N. Systematic review of the influence of chemotherapy-associated liver injury on outcome after partial hepatectomy for colorectal liver metastases. Br J Surg 2017; 104:990-1002. [PMID: 28542731 DOI: 10.1002/bjs.10572] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/07/2017] [Accepted: 03/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The impact of chemotherapy-associated liver injury (CALI) on postoperative outcome in patients undergoing partial hepatectomy for colorectal liver metastases (CRLM) remains controversial. The objective of this study was to clarify the effect of CALI (sinusoidal dilatation (SD), steatosis and steatohepatitis) on postoperative morbidity and mortality by investigating a large data set from multiple international centres. METHODS PubMed and Embase were searched for studies published between 1 January 2004 and 31 December 2013 with keywords 'chemotherapy', 'liver resection', 'outcome' and 'colorectal metastases' to identify potential collaborating centres. Univariable and multivariable analyses were performed using binary logistic regression models, with results presented as odds ratios (ORs) with 95 per cent confidence intervals. RESULTS A consolidated database comprising 788 patients who underwent hepatectomy for CRLM in eight centres was obtained. In multivariable analyses, severe SD was associated with increased major morbidity (Dindo-Clavien grade III-V; OR 1·73, 95 per cent c.i. 1·02 to 2·95; P = 0·043). Severe steatosis was associated with decreased liver surgery-specific complications (OR 0·52, 95 per cent c.i. 0·27 to 1·00; P = 0·049), whereas steatohepatitis was linked to an increase in these complications (OR 2·08, 1·18 to 3·66; P = 0·012). Subgroup analysis showed that lobular inflammation was the sole component associated with increased overall morbidity (OR 2·22, 1·48 to 3·34; P = 0·001) and liver surgery-specific complications (OR 3·35, 2·11 to 5·32; P < 0·001). Finally, oxaliplatin treatment was linked to severe SD (OR 2·74, 1·67 to 4·49; P < 0·001). CONCLUSION An increase in postoperative major morbidity and liver surgery-specific complications was observed after partial hepatectomy in patients with severe SD and steatohepatitis. Postoperative liver failure occurred more often in patients with severe SD.
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Affiliation(s)
- J Zhao
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - K M C van Mierlo
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - J Gómez-Ramírez
- Hepatopancreaticobiliary Surgery Unit, Department of Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - H Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - C H C Pilgrim
- Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred Hospital, and Division of Cancer Surgery, Peter MacCallum Cancer Centre, Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - P Pessaux
- Digestive Surgery and Transplantation, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France
| | - S S Rensen
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - E P van der Stok
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - F G Schaap
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplant, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Université Denis Diderot, Paris, France
| | - T Takamoto
- Department of Hepatopancreaticobiliary Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - L Viganò
- Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy
| | - B Winkens
- Department of Methodology and Statistics, Maastricht University Medical Centre, and CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - C H C Dejong
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - S W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK
| | | | - E Martín Pérez
- Hepatopancreaticobiliary Surgery Unit, Department of Surgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - J Y Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - Y R Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea
| | - W Phillips
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Michael
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - F Panaro
- Digestive Surgery and Transplantation, Hôpital de Hautepierre, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - M-P Chenard
- Department of Pathology, Hôpital de Hautepierre, University hospital of Strasbourg, University of Strasbourg, Strasbourg, France
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J Vara
- Digestive Tumours Unit, Institut Bergonié, Bordeaux, France
| | - O Scatton
- Department of Digestive and Hepatobiliary Surgery, La Pitié Hospital, Université Pierre et Maris Curie, Paris, France
| | - T Hashimoto
- Department of Hepatopancreaticobiliary Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - M Makuuchi
- Department of Hepatopancreaticobiliary Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - G De Rosa
- Department of Pathology, Mauriziano Umberto I Hospital, Turin, Italy
| | - N Ravarino
- Department of Pathology, Mauriziano Umberto I Hospital, Turin, Italy
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Phillips W, Zechariah S. Minimizing False-Positive Nutrition Referrals Generated from the Malnutrition Screening Tool. J Acad Nutr Diet 2017; 117:665-669. [DOI: 10.1016/j.jand.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Indexed: 01/26/2023]
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Phillips W, Doley J. Granting Order-Writing Privileges to Registered Dietitian Nutritionists Can Decrease Costs in Acute Care Hospitals. J Acad Nutr Diet 2016; 117:840-847. [PMID: 27498360 DOI: 10.1016/j.jand.2016.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 11/28/2022]
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Eves-van den Akker S, Laetsch DR, Thorpe P, Lilley CJ, Danchin EGJ, Da Rocha M, Rancurel C, Holroyd NE, Cotton JA, Szitenberg A, Grenier E, Montarry J, Mimee B, Duceppe MO, Boyes I, Marvin JMC, Jones LM, Yusup HB, Lafond-Lapalme J, Esquibet M, Sabeh M, Rott M, Overmars H, Finkers-Tomczak A, Smant G, Koutsovoulos G, Blok V, Mantelin S, Cock PJA, Phillips W, Henrissat B, Urwin PE, Blaxter M, Jones JT. The genome of the yellow potato cyst nematode, Globodera rostochiensis, reveals insights into the basis of parasitism and virulence. Genome Biol 2016; 17:124. [PMID: 27286965 PMCID: PMC4901422 DOI: 10.1186/s13059-016-0985-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background The yellow potato cyst nematode, Globodera rostochiensis, is a devastating plant pathogen of global economic importance. This biotrophic parasite secretes effectors from pharyngeal glands, some of which were acquired by horizontal gene transfer, to manipulate host processes and promote parasitism. G. rostochiensis is classified into pathotypes with different plant resistance-breaking phenotypes. Results We generate a high quality genome assembly for G. rostochiensis pathotype Ro1, identify putative effectors and horizontal gene transfer events, map gene expression through the life cycle focusing on key parasitic transitions and sequence the genomes of eight populations including four additional pathotypes to identify variation. Horizontal gene transfer contributes 3.5 % of the predicted genes, of which approximately 8.5 % are deployed as effectors. Over one-third of all effector genes are clustered in 21 putative ‘effector islands’ in the genome. We identify a dorsal gland promoter element motif (termed DOG Box) present upstream in representatives from 26 out of 28 dorsal gland effector families, and predict a putative effector superset associated with this motif. We validate gland cell expression in two novel genes by in situ hybridisation and catalogue dorsal gland promoter element-containing effectors from available cyst nematode genomes. Comparison of effector diversity between pathotypes highlights correlation with plant resistance-breaking. Conclusions These G. rostochiensis genome resources will facilitate major advances in understanding nematode plant-parasitism. Dorsal gland promoter element-containing effectors are at the front line of the evolutionary arms race between plant and parasite and the ability to predict gland cell expression a priori promises rapid advances in understanding their roles and mechanisms of action. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-0985-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Dominik R Laetsch
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3FL, UK
| | - Peter Thorpe
- Cell and Molecular Sciences Group, Dundee Effector Consortium, James Hutton Institute, Dundee, DD2 5DA, UK
| | | | - Etienne G J Danchin
- INRA, University Nice Sophia Antipolis, CNRS, UMR 1355-7254 Institut Sophia Agrobiotech, 06900, Sophia Antipolis, France
| | - Martine Da Rocha
- INRA, University Nice Sophia Antipolis, CNRS, UMR 1355-7254 Institut Sophia Agrobiotech, 06900, Sophia Antipolis, France
| | - Corinne Rancurel
- INRA, University Nice Sophia Antipolis, CNRS, UMR 1355-7254 Institut Sophia Agrobiotech, 06900, Sophia Antipolis, France
| | - Nancy E Holroyd
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, CB10 1SA, UK
| | - James A Cotton
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, CB10 1SA, UK
| | - Amir Szitenberg
- School of Biological, Biomedical and Environmental Sciences, University of Hull, Hull, HU6 7RX, UK
| | - Eric Grenier
- INRA, UMR1349 IGEPP (Institute for Genetics, Environment and Plant Protection), 35653, Le Rheu, France
| | - Josselin Montarry
- INRA, UMR1349 IGEPP (Institute for Genetics, Environment and Plant Protection), 35653, Le Rheu, France
| | - Benjamin Mimee
- Agriculture and Agri-food Canada, Horticulture Research and Development Centre, 430 Bboul. Gouin, St-Jean-sur-Richelieu, Quebec, J3B 3E6, Canada
| | - Marc-Olivier Duceppe
- Agriculture and Agri-food Canada, Horticulture Research and Development Centre, 430 Bboul. Gouin, St-Jean-sur-Richelieu, Quebec, J3B 3E6, Canada
| | - Ian Boyes
- Sidney Laboratory, Canadian Food Inspection Agency (CFIA), 8801 East Saanich Rd, Sidney, BC, V8L 1H3, Canada
| | | | - Laura M Jones
- Centre for Plant Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Hazijah B Yusup
- Centre for Plant Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Joël Lafond-Lapalme
- Agriculture and Agri-food Canada, Horticulture Research and Development Centre, 430 Bboul. Gouin, St-Jean-sur-Richelieu, Quebec, J3B 3E6, Canada
| | - Magali Esquibet
- INRA, UMR1349 IGEPP (Institute for Genetics, Environment and Plant Protection), 35653, Le Rheu, France
| | - Michael Sabeh
- Agriculture and Agri-food Canada, Horticulture Research and Development Centre, 430 Bboul. Gouin, St-Jean-sur-Richelieu, Quebec, J3B 3E6, Canada
| | - Michael Rott
- Sidney Laboratory, Canadian Food Inspection Agency (CFIA), 8801 East Saanich Rd, Sidney, BC, V8L 1H3, Canada
| | - Hein Overmars
- Laboratory of Nematology, Department of Plant Sciences, Wageningen University, Droevendaalsesteeg 1, 6708, PB, Wageningen, The Netherlands
| | - Anna Finkers-Tomczak
- Laboratory of Nematology, Department of Plant Sciences, Wageningen University, Droevendaalsesteeg 1, 6708, PB, Wageningen, The Netherlands
| | - Geert Smant
- Laboratory of Nematology, Department of Plant Sciences, Wageningen University, Droevendaalsesteeg 1, 6708, PB, Wageningen, The Netherlands
| | | | - Vivian Blok
- Cell and Molecular Sciences Group, Dundee Effector Consortium, James Hutton Institute, Dundee, DD2 5DA, UK
| | - Sophie Mantelin
- Cell and Molecular Sciences Group, Dundee Effector Consortium, James Hutton Institute, Dundee, DD2 5DA, UK
| | - Peter J A Cock
- Information and Computational Sciences Group, James Hutton Institute, Dundee, UK
| | - Wendy Phillips
- USDA-ARS Horticultural Crops Research Laboratory, Corvallis, OR, USA
| | - Bernard Henrissat
- CNRS UMR 7257, INRA, USC 1408, Aix-Marseille University, AFMB, 13288, Marseille, France.,Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter E Urwin
- Centre for Plant Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Mark Blaxter
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, EH9 3FL, UK
| | - John T Jones
- Cell and Molecular Sciences Group, Dundee Effector Consortium, James Hutton Institute, Dundee, DD2 5DA, UK.,School of Biology, University of St Andrews, North Haugh, St Andrews, KY16 9TZ, UK
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Hibler BP, Sierra H, Cordova M, Phillips W, Rajadhyaksha M, Nehal KS, Rossi AM. Carbon dioxide laser ablation of basal cell carcinoma with visual guidance by reflectance confocal microscopy: a proof-of-principle pilot study. Br J Dermatol 2016; 174:1359-64. [PMID: 26800657 DOI: 10.1111/bjd.14414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laser ablation is an alternative, nonsurgical treatment modality for low-risk basal cell carcinoma (BCC). However, lack of confirmative tumour destruction or residual tumour presence has been a limiting factor to its adoption. Reflectance confocal microscopy (RCM) provides noninvasive, cellular-level resolution imaging of the skin and is capable of identifying tumour. OBJECTIVES To evaluate the use of RCM to guide carbon dioxide (CO2 ) laser ablation of BCC, confirm destruction and correlate findings with histology. METHODS RCM was used preablation to evaluate for features of BCC. Ablation was performed with a CO2 laser, and the response rapidly assessed using handheld RCM to evaluate for residual tumour. Confirmative pathology was used to verify confocal imaging. RESULTS Preablation RCM imaging identified tumour with features not identified on normal, surrounding skin. Postablation, RCM documented complete removal of tumour in six cases and residual tumour in two. Histological examination identified the ablated area and confirmed clearance of tumour in the six aforementioned cases and corroborated confocal findings for residual tumour in the other two cases. CONCLUSIONS We report successful treatment of superficial and nodular BCC using CO2 laser ablation augmented by RCM imaging for preablation guidance and verification of tumour removal postablation. Akin to complete circumferential and deep margin control techniques, using RCM helps to map peripheral and deep BCC margins to hone in on areas exhibiting persistent tumour after ablation. CO2 laser ablation visually guided by RCM can help circumvent previously cited limiting factors of laser ablation for tumour destruction by providing cellular-level resolution imaging of tumour and margin assessment in between each laser pass and postablation.
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Affiliation(s)
- B P Hibler
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - H Sierra
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - M Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - W Phillips
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - M Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - K S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
| | - A M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A
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Abstract
Corporate social responsibility (CSR) literature suggests CSR initiatives extend beyond meeting the immediate interests of stakeholders of for-profit enterprises, offering the potential to also enhance performance. Growing disillusionment of for-profit business models has drawn attention to social entrepreneurship and social innovation to ease social issues. Adopting a systematic review of relevant research, the article provides collective insights into research linking social innovation with social entrepreneurship, demonstrating growing interest in the area over the last decade. The past 5 years have seen a surge in attention with particular focus on the role of the entrepreneur, networks, systems, institutions, and cross-sectoral partnerships. Based on the findings of the review, the authors synthesize formerly dispersed fields of research into an analytical framework, signposting a “systems of innovation” approach for future studies of social innovation and social entrepreneurship.
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Affiliation(s)
| | - Hazel Lee
- University of the West of England, Bristol, UK
| | | | | | - Peter James
- University of the West of England, Bristol, UK
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