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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [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: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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2
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Ford AC, Wright-Hughes A, Alderson SL, Ow PL, Ridd MJ, Foy R, Bianco G, Bishop FL, Chaddock M, Cook H, Cooper D, Fernandez C, Guthrie EA, Hartley S, Herbert A, Howdon D, Muir DP, Nath T, Newman S, Smith T, Taylor CA, Teasdale EJ, Thornton R, Farrin AJ, Everitt HA. Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2023; 402:1773-1785. [PMID: 37858323 DOI: 10.1016/s0140-6736(23)01523-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. METHODS This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. FINDINGS Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (-27·0, 95% CI -46·9 to -7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. INTERPRETATION To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. FUNDING National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).
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Affiliation(s)
- Alexander C Ford
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.
| | - Alexandra Wright-Hughes
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah L Alderson
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Pei-Loo Ow
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Gina Bianco
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | | | - Heather Cook
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah Cooper
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Catherine Fernandez
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Elspeth A Guthrie
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amy Herbert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daniel Howdon
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Delia P Muir
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Taposhi Nath
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sonia Newman
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Smith
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Christopher A Taylor
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma J Teasdale
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Ruth Thornton
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda J Farrin
- Clinical Trial Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Hazel A Everitt
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
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Russell F, Herbert A, Lobo D, Ferre R, Kaine J, Pallansch J, Soriano P, Adame J. 154 Gamification of Point-of-Care Ultrasound: Are Students Learning? Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.178] [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: 11/01/2022]
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Herbert A, Winters S, McPhail S, Elliss-Brookes L, Lyratzopoulos G, Abel GA. Population trends in emergency cancer diagnoses: The role of changing patient case-mix. Cancer Epidemiol 2019; 63:101574. [PMID: 31655434 PMCID: PMC6905147 DOI: 10.1016/j.canep.2019.101574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diagnosis of cancer through an emergency presentation is associated with worse clinical and patient experience outcomes. The proportion of patients with cancer who are diagnosed through emergency presentations has consequently been introduced as a routine cancer surveillance measure in England. Welcome reductions in this metric have been reported over more than a decade but whether reductions reflect true changes in how patients are diagnosed rather than the changing case-mix of incident cohorts in unknown. METHODS We analysed 'Routes to Diagnosis' data on cancer patients (2006-2015) and used logistic regression modelling to determine the contribution of changes in four case-mix variables (sex, age, deprivation, cancer site) to time-trends in emergency presentations. RESULTS Between 2006 and 2015 there was an absolute 4.7 percentage point reduction in emergency presentations (23.8%-19.2%). Changing distributions of the four case-mix variables explained 19.0% of this reduction, leaving 81.0% unexplained. Changes in cancer site case-mix alone explained 16.0% of the total reduction. CONCLUSION Changes in case-mix (particularly that of cancer sites) account for about a fifth of the overall reduction in emergency presentations. This would support the use of adjustment/standardisation of reported statistics to support their interpretation and help appreciate the influence of case-mix, particularly regarding cancer sites with changing incidence. However, most of the reduction in emergency presentations remains unaccounted for, and likely reflects genuine changes during the study period in how patients were being diagnosed.
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Affiliation(s)
- A Herbert
- MRC Integrative Epidemiology Unit Bristol Medical School University of Bristol Bristol UK; Epidemiology of Cancer and Healthcare Outcomes (ECHO) Group, Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK
| | - S Winters
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK
| | - S McPhail
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK
| | - L Elliss-Brookes
- National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK
| | - G Lyratzopoulos
- Epidemiology of Cancer and Healthcare Outcomes (ECHO) Group, Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, UK; National Cancer Registration and Analysis Service (NCRAS), Public Health England, 6th Floor, Wellington House, 135-155 Waterloo Road, London, UK; Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK.
| | - G A Abel
- University of Exeter Medical School, Exeter, UK
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5
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Chakravarthi R, Herbert A. Two's company, three's a crowd: Individuation is necessary for object recognition. Cognition 2018; 184:69-82. [PMID: 30576886 DOI: 10.1016/j.cognition.2018.12.008] [Citation(s) in RCA: 3] [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] [Received: 10/16/2017] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
Abstract
Object recognition is essential for navigating the real world. Despite decades of research on this topic, the processing steps necessary for recognition remain unclear. In this study, we examined the necessity and role of individuation, the ability to select a small number of spatially distinct objects irrespective of their identity, in the recognition process. More specifically, we tested if the ability to rapidly individuate and enumerate a small number of objects (subitizing) can be impaired by crowding. Crowding is flanker-induced interference that specifically impedes the recognition process. We found that subitizing is impaired when objects are close to each other (Experiment 1), and if the target objects are surrounded by irrelevant but perceptually similar flankers (Experiments 2-4). This impairment cannot be attributed to confusion between targets and flankers, wherein flankers are inadvertently included in or targets are excluded from enumeration (Experiments 3-4). Importantly, the flanker induced interference was comparable in both subitizing and crowding tasks (Experiment 4), suggesting that individuation and identification share a common processing pathway. We conclude that individuation is an essential stage in the object recognition pipeline and argue for a cohesive proposal that both crowding and subitizing are due to limitations of selective attention.
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Affiliation(s)
| | - Amy Herbert
- School of Psychology, University of Aberdeen, Kings College, Aberdeen AB24 3FX, UK
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6
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Herbert A. Dulcie Coleman: A pioneer of cytology in the UK and Europe. Cytopathology 2018; 29:222-223. [PMID: 29723428 DOI: 10.1111/cyt.12564] [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] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- A Herbert
- Cellular Pathology, St. Thomas' Hospital, London, UK
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7
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Ilyas C, Herbert A, Jones J, Cartledge J. Effect of perioperative epidural insertion on disease recurrence following renal cancer surgery. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.051] [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] Open
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Patel JJ, Gartell PC, Guyer PB, Herbert A, Taylor I. Use of Ultrasound Localization to Improve Results of Fine Needle Aspiration Cytology of Breast Masses. J R Soc Med 2018; 81:10-2. [PMID: 3278115 PMCID: PMC1291418 DOI: 10.1177/014107688808100106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of ‘blind’ aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P=0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P=0.036). The results were influenced by the number of needle manoeuvres performed, < 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when > 10 manoeuvres were performed (P= <0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization. It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.
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Affiliation(s)
- J J Patel
- University Surgical Unit, University of Southampton
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Herbert A. Brexit should not mean Brexit for cytopathology. Cytopathology 2017; 28:337-338. [DOI: 10.1111/cyt.12439] [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] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Herbert
- Guy's & St Thomas' NHS Foundation Trust; London UK
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Richardso J, Tchuisseu Y, Omar D, Conn C, Browne A, King S, Crawford-Johnson M, Swaby N, Wills A, Herbert A, O'Connor M, Mills G. Assessing diabetes knowledge and prevalence in Nevis, WI: A type 2
diabetes surveillance initiative. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.488] [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] Open
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Affiliation(s)
- A Herbert
- Guy's & St Thomas' NHS Foundation Trust, London, UK
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Herbert A. Primary HPV testing: a proposal for co-testing in initial rounds of screening to optimise sensitivity of cervical cancer screening. Cytopathology 2016; 28:9-15. [PMID: 27005867 DOI: 10.1111/cyt.12334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
As explained by Kitchener in a previous issue of Cytopathology (2015;26:4-6), primary human papillomavirus (HPV) testing is likely to be introduced in the UK for all women aged 25-64 years following pilot site studies already in place. This will be necessary when the prevalence of cervical cancer and its precursors declines when vaccination takes effect but there is a risk in abandoning cytology as a primary test: a risk that would be most apparent in the present unvaccinated population in which the prevalence of cervical cancer and its precursors is exceptionally high. HPV testing is more sensitive than cytology but has a significant false-negative rate that could be detrimental to a successful screening programme if introduced without cytology backup. Accurate cytology would be needed for triage and could be compromised if HPV-negative tests were excluded from examination. This article proposes a compromise: cytology and HPV co-testing for the first two screening tests to optimise the sensitivity of the test as a whole. Registrations of invasive and in situ carcinoma of the uterine cervix in England indicate that the prevalence of the disease is highest in young women in the early rounds of screening. Calculations of the likely impact on the workload of this proposal have been based on a service evaluation of 295 cytology tests received at St Thomas' Hospital, which suggests that the volume of cytology tests would be reduced by approximately 60% compared with 80% for primary HPV testing alone. This proposal should be debated openly before irrevocable changes are made to a skilled workforce.
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Affiliation(s)
- A Herbert
- Cellular Pathology, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Abstract
Dr Oliver Anthony Nasseem Husain, who died on 22 September 2014, aged 90 years, was one of the great names of European cytology, a pioneer of automated cervical screening and a founding member of both the British Society for Clinical Cytology (BSCC) and the European Federation of Cytology Societies (EFCS). The life of this one remarkable man involved much of the pioneering work, which is reviewed in this article, that has brought conventional cytology to the complex multimodal discipline it is today.
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Affiliation(s)
- G Kocjan
- Department of Cellular Pathology, University College London Hospitals, London, UK
| | - A Herbert
- Cellular Pathology, St. Thomas' Hospital, London, UK
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Yung CM, Vereen MK, Herbert A, Davis KM, Yang J, Kantorowska A, Ward CS, Wernegreen JJ, Johnson ZI, Hunt DE. Thermally adaptive tradeoffs in closely related marine bacterial strains. Environ Microbiol 2015; 17:2421-9. [DOI: 10.1111/1462-2920.12714] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Cheuk-Man Yung
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Marissa K. Vereen
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Amy Herbert
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Katherine M. Davis
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Jiayu Yang
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Agata Kantorowska
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
| | - Christopher S. Ward
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
- Integrated Toxicology and Environmental Health Program; Duke University; Durham NC 27708 USA
| | | | - Zackary I. Johnson
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
- Biology Department; Duke University; Durham NC 27708 USA
| | - Dana E. Hunt
- Nicholas School of the Environment; Duke University; Durham NC 27708 USA
- Biology Department; Duke University; Durham NC 27708 USA
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Affiliation(s)
- A Herbert
- Cellular Pathology Department, Second Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - G Holdsworth
- Department of Public Health, Southwark Council, 160 Tooley Street, London SE1 2TZ, UK
| | - A A Kubba
- Colposcopy Unit, McNair Unit, Guy's Hospital, London SE1 9RT, UK
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Herbert A. Cell blocks are not a substitute for cytology: why pathologists should understand cytopathology particularly in their chosen speciality. Cytopathology 2014; 25:351-5. [PMID: 25424154 DOI: 10.1111/cyt.12222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Herbert
- Department of Cellular Pathology, St Thomas's Hospital, London, UK.
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Herbert A, Anic V, Cochand-Priollet B, Dina R, Ehya H, Eide ML, Fabre M, Field A, Kapila K, Kardum-Skelin I, Oliveira MH, Olszewski W, Önal B, Nasioutziki M, Nayar R, Nielsen K, Shabalova I, Schmitt F, Tötsch M, Wilson A, Vass L, Zeppa P. Training and practice of cytotechnologists: a discussion forum focused on Europe. Cytopathology 2014; 25:307-15. [DOI: 10.1111/cyt.12201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 12/28/2022]
Affiliation(s)
- A. Herbert
- Cellular Pathology Department; St Thomas’ Hospital; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - V. Anic
- Department of Clinical Cytology and Cytogenetics; Merkur University Hospital; Zagreb Croatia
| | | | - R. Dina
- Histopathology Department; Imperial College NHS Trust; Hammersmith Hospital; London UK
| | - H. Ehya
- Department of Pathology; Fox Chase Cancer Center; Philadelphia PA USA
| | - M.-L. Eide
- Department of Pathology and Medical Genetics; Trondheim University Hospital; Trondheim Norway
| | - M. Fabre
- Department of Pathology; Gustave Roussy; Cancer Campus Grand Paris; Villejuif France
| | - A. Field
- Department of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - K. Kapila
- Cytopathology Unit; Department of Pathology; Faculty of Medicine; Kuwait University; Kuwait Kuwait
| | - I. Kardum-Skelin
- Department of Clinical Cytology and Cytogenetics; Merkur University Hospital and School of Medicine; University of Zagreb; Zagreb Croatia
| | - M. H. Oliveira
- Laboratório de Anatomia Patológica; Hospital Beatriz Angelo; Loures Portugal
| | - W. Olszewski
- Department of Pathology; Institute of Oncology; Warsaw Poland
| | - B. Önal
- Department of Pathology and Cytology; Ankara Diskapi Teaching and Research Hospital; Ankara Turkey
| | - M. Nasioutziki
- Molecular Cytopathology Laboratory; Faculty of Medicine; AUTH; Hippokration Hospital; Thessaloniki Greece
| | - R. Nayar
- Cytopathology Laboratory; Northwestern Memorial Hospital; Chicago IL USA
| | - K. Nielsen
- Institute of Pathology; Aahus University Hospital; Aarhus Denmark
| | - I. Shabalova
- Russian Medical Academy of Postgraduate Education; Moscow Russia
| | - F. Schmitt
- Institute of Molecular Pathology and Immunology of the University of Porto; Porto Portugal
- Department of Laboratory Medicine and Pathobiology; Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - M. Tötsch
- Institute of Cytology; University Hospital of Graz; Medical University of Graz; Graz Austria
| | - A. Wilson
- Department of Histopathology; Monklands Hospital; Airdrie UK
| | - L. Vass
- Department of Pathology/Cytology; University Hospital of Pest County; Kistarcsa Hungary
| | - P. Zeppa
- Anatomia Patologica; University of Salerno; Salerno Italy
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Bona S, Herbert A, Toneatto C, Silvanto J, Cattaneo Z. P 151. The right (but not the left) lateral occipital complex is causally implicated in visual mirror symmetry detection: An fMRI-guided TMS study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Crowe L, Herbert A, Mattke A. IS IT APPROPRIATE TO INITIATE PALLIATIVE CARE IN A PAEDIATRIC INTENSIVE CARE UNIT (PICU)? BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.100] [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: 11/04/2022]
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Herbert A, Irving H. PRACTICALITIES AND SENSITIVITIES AROUND DISCUSSING RESUSCITATION AT THE END OF LIFE: A CLINICAL TOOL. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.87] [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: 11/04/2022]
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Kelly J, Herbert A, Ritchie J. AUDIT OF RESUSCITATION PLANNING AND DOCUMENTATION AT A TERTIARY CHILDREN'S HOSPITAL OVER A 12 MONTH PERIOD. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pase MP, Herbert A, Grima NA, Pipingas A, O'Rourke MF. Arterial stiffness as a cause of cognitive decline and dementia: a systematic review and meta-analysis. Intern Med J 2013; 42:808-15. [PMID: 22151013 DOI: 10.1111/j.1445-5994.2011.02645.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although arterial stiffness has recently been confirmed as a predictor of cardiovascular disease, the association between arterial stiffness and cognitive decline is less clear. AIM We performed a systematic review and meta-analysis to examine the evidence for large artery stiffness as a cause of cognitive decline and dementia. METHOD Electronic databases were systematically searched until September 2011 for studies reporting on the longitudinal relationship between any validated measure of large artery stiffness and cognitive decline or dementia. Meta-analysis was performed on four studies investigating the association between aortic pulse wave velocity and a decline in Mini-Mental State Examination scores. RESULTS Six relevant longitudinal studies were located, conducted over an average of 5 years follow up. Arterial stiffness was predictive of cognitive decline in five/six studies. In meta-analysis, higher aortic stiffness predicted lower Mini-Mental State Examination scores within the sample (β=-0.03, 95% confidence interval (CI): -0.06 to 0.01, n= 3947), although studies were not all homogeneous, and statistical heterogeneity was present (I(2) = 71.9%, P= 0.01). Removal of one study with a relatively younger cohort and lower median aortic stiffness found higher aortic stiffness to significantly predict cognitive decline (β=-0.04, 95% CI: -0.07 to -0.01, n= 3687) without evidence of heterogeneity (I(2) = 9.5%, P= 0.33). There was little research investigating the effects of aortic stiffness on the development of dementia. CONCLUSION Aortic stiffness was found to predict cognitive decline in both qualitative review and quantitative analysis.
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Affiliation(s)
- M P Pase
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia.
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Affiliation(s)
- A. Herbert
- Department of Cellular Pathology; St Thomas's Hospital; London; UK
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Herbert A. Leopold G. Koss: a tribute to his life and work. Cytopathology 2013; 24:3-4. [PMID: 23336992 DOI: 10.1111/cyt.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Umana A, Dunsmore H, Herbert A, Jokhan A, Kubba A. Are significant numbers of abnormal cells lost on the discarded ThinPrep® broom when used for cervical cytology? Cytopathology 2012; 24:228-34. [PMID: 23171273 DOI: 10.1111/cyt.12029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Are significant numbers of abnormal cells lost on the discarded ThinPrep® broom when used for cervical cytology? BACKGROUND In view of a study with SurePath® showing that cells were lost on the broom if it was discarded, we decided to investigate whether cells were lost on the ThinPrep® (TP) broom, which is discarded according to the manufacturer's protocol. AIM To determine whether significant amounts of cellular material are lost on the discarded TP broom, and whether the loss is operator dependent. METHODS Three hundred and six women attending the Guy's Hospital Colposcopy Unit gave their consent for TP liquid-based cytology samples to be taken and the broom immersed in a second vial instead of being discarded. The cellularity of the first and second vials was compared by counting cells in 10 ×40 high-power fields (HPFs). The significance of cell loss was ascertained by correlating the likelihood of abnormal cells and transformation zone (TZ) material being present with the degree of cellularity of the two vials. RESULTS More than 10 cells per HPF were seen in 3.2%, 19.4% and 35.8% of slides from the second vial taken by three experienced colposcopists, which was significantly different between them (P < 0.001); cellularity of the first vial was not significantly different between colposcopists but the one with highest cellularity in the first vial discarded most in the second. Abnormal cells were more likely to be seen in slides with more than 10 cells per HPF (P < 0.001) and with evidence of TZ sampling (P < 0.001), but there was no preferential loss of TZ material in the second vial. Of 126 slides with abnormal cells on the slides from the second vial, 113 (89.7%) were also present on the significantly more cellular first vial (P < 0.001). CONCLUSION Abnormal cells were potentially lost on the broom, but were usually represented in the first vial. The likelihood of abnormal cells being discarded was operator dependent in this small study, but this did not affect the quality of the initial preparation. The likelihood of abnormal cells being seen on TP slides was dependent on their cellularity, which provided our laboratory with a criterion for the assessment of sample adequacy.
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Affiliation(s)
- A Umana
- Cellular Pathology Department, St Thomas' Hospital and Colposcopy Unit, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Heard T, Chandra A, Culora G, Gupta SS, Herbert A, Morgan M. Use of the ThinPrep Imaging System for internal quality control of cervical cytology. Cytopathology 2012; 24:246-53. [DOI: 10.1111/cyt.12010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
More HIV-positive patients are living longer and presenting to non-infection specialties with non-HIV-related issues (eg diabetes, heart disease). National recommendations advise routinely offering HIV testing to all new registrants to primary care and all general medical admissions where community prevalence exceeds 2:1000. It is, therefore, imperative that all physicians are educated and competent in HIV infection, counselling and testing. This study aimed to establish regional medical registrars' opinions on teaching provision, and confidence in, HIV medicine. The results indicated a lack of confidence in HIV medicine and, in those without postgraduate rotations in HIV medicine or infectious diseases, a perception that HIV and infection-related teaching provision is inadequate.
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Affiliation(s)
- T Wingfield
- The Monsall Unit, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester.
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Herbert A. The challenge of cervical screening: to find and treat high-grade cervical intraepithelial neoplasia at risk of progression in women of childbearing age. Cytopathology 2012; 23:3-5. [PMID: 22243287 DOI: 10.1111/j.1365-2303.2011.00956.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tavakoli M, Kallinikos P, Iqbal A, Herbert A, Fadavi H, Efron N, Boulton AJM, A Malik R. Corneal confocal microscopy detects improvement in corneal nerve morphology with an improvement in risk factors for diabetic neuropathy. Diabet Med 2011; 28:1261-7. [PMID: 21699561 PMCID: PMC3181044 DOI: 10.1111/j.1464-5491.2011.03372.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [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] [Indexed: 02/06/2023]
Abstract
AIM We have assessed whether corneal confocal microscopy can be used to detect alterations in nerve morphology following an improvement in risk factors associated with diabetic neuropathy. METHODS Twenty-five patients with diabetes with mild to moderate neuropathy and 18 control subjects underwent corneal confocal microscopy to quantify corneal nerve fibre (density, branch density, length and tortuosity) at baseline and after 24 months from first visit. This was not planned as an intervention trial and was simply an observational follow-up. RESULTS At baseline, nerve fibre density (18.8 ± 2.1 vs. 46.0 ± 3.8 number/mm(2), P = 0.001), nerve branch density (6.9 ± 1.5 vs. 35.6 ± 6.7 number/mm(2), P < 0.0001), nerve fibre length (8.3 ± 0.9 vs. 13.5 ± 0.8 mm/mm(2), P < 0.0001) and nerve fibre tortuosity (19.8 ± 1.6 vs. 22.7 ± 2.2, P < 0.05) were significantly lower in patients with diabetes than in control subjects. At follow-up, glycaemic control (HbA(1c) 64 ± 3 to 58 ± 2 mmol/mol, P = 0.08), total cholesterol (4.9 ± 0.2 to 4.2 ± 0.2 mmol/l, P = 0.01), systolic blood pressure (145.8 ± 4.9 to 135.9 ± 3.7 mmHg, P = 0.09) and diastolic blood pressure (77.8 ± 2.7 to 70.8 ± 2.5, P = 0.03) improved. Nerve fibre density (24.1 ± 2.0, P = 0.05), nerve branch density (11.1 ± 1.3, P < 0.01) and nerve fibre tortuosity (22.6 ± 1.5, P = 0.05) increased significantly, with no change in nerve fibre length (8.4 ± 0.5). Improvement in nerve fibre density correlated significantly with the improvement in HbA(1c) (r = -0.51, P = 0.008). Via four multifactorial regressions, this confirms the negative association between HbA(1c) and nerve fibre density (P = 0.02). CONCLUSIONS This study shows that corneal confocal microscopy may be employed in longitudinal studies to assess progression of human diabetic neuropathy and also supports the hypothesis that improvements in risk factors for diabetic neuropathy, in particular HbA(1c) , may lead to morphological repair of nerve fibres.
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Affiliation(s)
- M Tavakoli
- Division of Cardiovascular Medicine, University of Manchester and Manchester Royal Infirmary, Manchester, UK
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Paisley AN, Banerjee M, Rezai M, Schofield RE, Balakrishnannair S, Herbert A, Lawrance JAL, Trainer PJ, Cruickshank JK. Changes in arterial stiffness but not carotid intimal thickness in acromegaly. J Clin Endocrinol Metab 2011; 96:1486-92. [PMID: 21346071 DOI: 10.1210/jc.2010-2225] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Acromegaly increases cardiovascular morbidity. We tested the hypothesis that increased arterial stiffness together with left ventricular hypertrophy may be a contributory factor. PATIENTS AND DESIGN Fifty-six patients (40 males, 54 ± 13 yr; 25 active disease, 31 in remission) and 46 healthy controls (30 males, 52 ± 13 yr) underwent measurements of aortic pulse wave velocity (PWV), carotid Doppler (IMT), echocardiography, and cardiovascular risk factors. RESULTS Mean serum IGF-I was 323 ± 286 ng/ml (sd score 1.8 ± 1.9) in all patients. Age, body mass index, diastolic blood pressure (BP), and lipid levels were similar comparing patients and controls. Systolic BP (130.8 ± 19.9 vs. 122 ± 14 mm Hg controls, P < 0.01) and PWV (11.7 ± 3.8 vs. 9.7 ± 2.8 m/sec, 95% confidence interval -3.4 to -0.7, P <0.01) were higher in patients than controls. Regression analysis revealed age, presence of acromegaly, systolic BP, and body mass index, inversely, as significantly and independently associated with PWV. No difference in carotid IMT was seen (0.8 ± 0.2 patients vs. 0.7 ± 0.2 mm controls, P = 0.5) or between active/controlled disease. In the subset of participants with echocardiography (n = 32), left ventricular mass was higher by a mean of 38.2 g (95% confidence interval -80.9 to +4.6, P = 0.08). CONCLUSION In summary, patients with acromegaly had independently and significantly increased aortic PWV as evidence of arterial stiffening but unaltered carotid IMT compared with controls, also influenced by age and systolic BP. Premature cardiovascular disease in patients with acromegaly is likely related to pressure-related arterial and left ventricular stiffening rather than atherosclerotic disease.
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Affiliation(s)
- A N Paisley
- Department of Endocrinology, The Christie National Health Service Foundation Trust, Manchester M20 4BX, United Kingdom.
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Ramos E, Chen G, Shriner D, Doumatey A, Gerry NP, Herbert A, Huang H, Zhou J, Christman MF, Adeyemo A, Rotimi C. Replication of genome-wide association studies (GWAS) loci for fasting plasma glucose in African-Americans. Diabetologia 2011; 54:783-8. [PMID: 21188353 PMCID: PMC3052446 DOI: 10.1007/s00125-010-2002-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/08/2010] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Chronically elevated blood glucose (hyperglycaemia) is the primary indicator of type 2 diabetes, which has a prevalence that varies considerably by ethnicity in the USA, with African-Americans disproportionately affected. Genome-wide association studies (GWASs) have significantly enhanced our understanding of the genetic basis of diabetes and related traits, including fasting plasma glucose (FPG). However, the majority of GWASs have been conducted in populations of European ancestry. Thus, it is important to conduct replication analyses in populations with non-European ancestry to identify shared loci associated with FPG across populations. METHODS We used data collected from non-diabetic unrelated African-American individuals (n = 927) who participated in the Howard University Family Study to attempt to replicate previously published GWASs of FPG. Of the 29 single nucleotide polymorphisms (SNPs) previously reported, we directly tested 20 in this study. In addition to the direct test, we queried a 500 kb window centred on all 29 reported SNPs for local replication of additional markers in linkage disequilibrium (LD). RESULTS Using direct SNP and LD-based comparisons, we replicated multiple SNPs previously associated with FPG and strongly associated with type 2 diabetes in populations with European ancestry. The replicated SNPs included those in or near TCF7L2, SLC30A8, G6PC2, MTNR1B, DGKB-TMEM195 and GCKR. We also replicated additional variants in LD with the reported SNPs in ZMAT4 and adjacent to IRS1. CONCLUSIONS/INTERPRETATION We identified multiple GWAS variants for FPG in our cohort of African-Americans. Using an LD-based strategy we also identified SNPs not previously reported, demonstrating the utility of using diverse populations for replication analysis.
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Affiliation(s)
- E. Ramos
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - G. Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - D. Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - A. Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - N. P. Gerry
- Coriell Institute for Medical Research, Camden, NJ USA
| | - A. Herbert
- Department of Genetics and Genomics, Boston University School of Medicine, Boston, MA USA
| | - H. Huang
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - J. Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | | | - A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - C. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
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Herbert A, Ng H, Jessup W, Kockx M, Cartland S, Thomas S, Hogg P, Wargon O. Hypoxia regulates the production and activity of glucose transporter-1 and indoleamine 2,3-dioxygenase in monocyte-derived endothelial-like cells: possible relevance to infantile haemangioma pathogenesis. Br J Dermatol 2011; 164:308-15. [DOI: 10.1111/j.1365-2133.2010.10086.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Alivon M, Bozec E, Herbert A, Laurent S, Boutouyrie P. P6.18 COMPARISON OF ARTERIAL STIFFNESS ASSESSED BY ARTERIOGRAPH WITH ARTERIAL STIFFNESS ASSESSED BY APPLANATION TONOMETRY AND ECHOTRACKING: A CLINICAL STUDY. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener H, Herbert A, von Karsa L. European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition--summary document. Ann Oncol 2010; 21:448-458. [PMID: 20176693 PMCID: PMC2826099 DOI: 10.1093/annonc/mdp471] [Citation(s) in RCA: 325] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
European Guidelines for Quality Assurance in Cervical Cancer Screening have been initiated in the Europe Against Cancer Programme. The first edition established the principles of organised population-based screening and stimulated numerous pilot projects. The second multidisciplinary edition was published in 2008 and comprises ∼250 pages divided into seven chapters prepared by 48 authors and contributors. Considerable attention has been devoted to organised, population-based programme policies which minimise adverse effects and maximise benefits of screening. It is hoped that this expanded guidelines edition will have a greater impact on countries in which screening programmes are still lacking and in which opportunistic screening has been preferred in the past. Other methodological aspects such as future prospects of human papillomavirus testing and vaccination in cervical cancer control have also been examined in the second edition; recommendations for integration of the latter technologies into European guidelines are currently under development in a related project supported by the European Union Health Programme. An overview of the fundamental points and principles that should support any quality-assured screening programme and key performance indicators are presented here in a summary document of the second guidelines edition in order to make these principles and standards known to a wider scientific community.
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Affiliation(s)
- M Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Center, Scientific Institute of Public Health, Brussels, Belgium
| | - A Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - J Jordan
- Birmingham Women's Hospital, Birmingham, UK
| | - G Ronco
- Cancer Epidemiology Unit, Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - U Schenck
- Institute of Pathology, Technical University, Munich, Germany
| | - N Segnan
- Cancer Epidemiology Unit, Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - H Wiener
- Department of Clinical Pathology and Histopathology, Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - A Herbert
- Histopathology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L von Karsa
- Quality Assurance Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
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Armerding W, Herbert A, Schindler T, Spiekermann M, Comes FJ. In Situ Measurements of Tropospheric OH Radicals - A Challenge for the Experimentalist. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19900940711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Comes FJ, Armerding W, Grigonis R, Herbert A, Spiekermann M, Walter J. Tropospheric OH: Local Measurements and Their Interpretations. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19920960311] [Citation(s) in RCA: 7] [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] [Indexed: 11/12/2022]
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Armerding W, Spiekermann M, Grigonis R, Walter J, Herbert A, Comes FJ. Fast Scanning Laser DOAS for Local Monitoring of Trace Gases, in Particular Tropospheric OH Radicals. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19920960317] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Anshu, Herbert A, Cochand-Priollet B, Cross P, Desai M, Dina R, Duskova J, Evered A, Farnsworth A, Gray W, Gupta SS, Kapila K, Kardum-Skelin I, Kloboves-Prevodnik V, Kobayashi TK, Koutselini H, Olszewski W, Onal B, Pitman MB, Marinsek Z, Sauer T, Schenck U, Schmitt F, Shabalova I, Smith JHF, Tani E, Vass L, Vielh P, Wiener H. Survey of medical training in cytopathology carried out by the journal Cytopathology. Cytopathology 2010; 21:147-56. [PMID: 20482722 DOI: 10.1111/j.1365-2303.2010.00761.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This report of the Editorial Advisory Board of Cytopathology gives the results of a survey of medical practitioners in cytopathology, which aimed to find out their views on the current situation in undergraduate and postgraduate training in their institutions and countries. The results show that training in cytopathology and histopathology are largely carried out at postgraduate level and tend to be organized nationally rather than locally. Histopathology was regarded as essential for training in cytopathology by 89.5% of respondents and was mandatory according to 83.1%. Mandatory cytopathology sections of histopathology were reported by 67.3% and specific examinations in cytopathology by 55.4%. The main deficiencies in training were due to its variability; there were insufficient numbers of pathologists interested in cytology and a consequent lack of training to a high level of competence. Pathologists without specific training in cytopathology signed out cytology reports according to 54.7% of responses, more often in centres where training was 3-6 months or less duration. Although 92.2% of respondents thought that specialist cytology should not be reported by pathologists without experience in general cytopathology, that practice was reported by 30.9%, more often in centres with small workloads. The survey report recommends that 6-12 months should be dedicated to cytopathology during histopathology training, with optional additional training for those wanting to carry out independent practice in cytopathology. Formal accreditation should be mandatory for independent practice in cytopathology. When necessary, temporary placements to centres of good practice should be available for trainees intending to practise independently in cytopathology. There should be adequate numbers of pathologists trained in cytopathology to a high level of competence; some of their time could be released by training cytotechnologists and trainee pathologists to prescreen cytology slides and assess adequacy of fine-needle aspiration samples when immediate diagnosis was not required. The survey demonstrated a clear need for European and international guidelines for training in cytopathology.
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Affiliation(s)
- Anshu
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
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Pelz J, Purington J, Herbert A. Travel gaze? Re-examining gaze behavior during locomotion. J Vis 2010. [DOI: 10.1167/9.8.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Herbert A, Anshu, Culora G, Dunsmore H, Gupta SS, Holdsworth G, Kubba AA, McLean E, Sim J, Raju KS. Invasive cervical cancer audit: why cancers developed in a high-risk population with an organised screening programme. BJOG 2010; 117:736-45. [DOI: 10.1111/j.1471-0528.2010.02511.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kocjan G, Chandra A, Cross P, Denton K, Giles T, Herbert A, Smith P, Remedios D, Wilson P. BSCC Code of Practice--fine needle aspiration cytology. Cytopathology 2009; 20:283-96. [PMID: 19754835 DOI: 10.1111/j.1365-2303.2009.00709.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue (Cytopathology 2009;20:211-23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.
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Affiliation(s)
- G Kocjan
- Department of Histopathology, University College Hospital, London, UK
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Affiliation(s)
- G Sasseigne
- Service de gastroentérologie, centre hospitalier de Chartres, BP 30407, 28018 Chartres cedex, France
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Abstract
We have examined the contribution of hysterectomy, compared with less invasive surgery, for dysfunctional uterine bleeding (DUB) on the prevalence of bladder problems five years after surgery. We report a prospective cohort study of over 25,000 women treated for benign cause menorrhagia by three types of surgery - transcervical endometrial resection/ablation and hysterectomy with or without bilateral oophorectomy. Postal questionnaires were sent five years after surgery investigating satisfaction with surgery and bladder function. When adjusted for confounders the odds of severe urinary incontinence (OR = 1.59, CI 95%, 1.35 - 1.87), urinary frequency (1.23 (1.04 - 1.45)), and nocturia (1.19, (1.03 - 1.38)) - were increased for women who had a hysterectomy compared with endometrial ablation. Hysterectomy with bilateral oophorectomy was not as strongly associated with severe bladder problems. Women who had the LAVH were most likely to report severe urinary incontinence (2.02, CI 95% 1.32 - 3.07), but not severe frequency or nocturia.
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Affiliation(s)
- K McPherson
- Nuffield Department of Obstetrics and Gynaecology, Oxford, UK.
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Herbert A, Gregory M, Gupta SS, Singh N. Invasive cervical cancer audit: a relative increase in interval cancers while coverage increased and incidence declined. BJOG 2009; 116:845-53. [DOI: 10.1111/j.1471-0528.2008.01990.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Herbert A, Gregory M, Gupta SS, Singh N. Screen-detected invasive cervical carcinoma and its clinical significance during the introduction of organized screening. BJOG 2009; 116:854-9. [DOI: 10.1111/j.1471-0528.2008.01989.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herbert A, Gray W, Cross P. Terminology of the BSCC, European Community and the Bethesda system: the boundary between low-grade and high-grade cytology. Cytopathology 2009; 20:3-4. [PMID: 19133066 DOI: 10.1111/j.1365-2303.2008.00637.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kocjan G, Bourgain C, Fassina A, Hagmar B, Herbert A, Kapila K, Kardum-Skelin I, Kloboves-Prevodnik V, Krishnamurthy S, Koutselini H, Majak B, Olszewski W, Onal B, Pohar-Marinšek Ž, Shabalova I, Smith J, Tani E, Vielh P, Wiener H, Schenck U, Schmitt F. The role of breast FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology 2008; 19:271-8. [DOI: 10.1111/j.1365-2303.2008.00610.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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