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Macpherson I, Sanagustín E, Roqué MV, Giner-Tarrida L. Evaluation of relational factor in patient satisfaction with the treatment received by dental students. Eur J Dent Educ 2024; 28:548-558. [PMID: 37986272 DOI: 10.1111/eje.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The study focused on the importance of the relational factor and empathy in the general satisfaction of patients for the treatment received by university dental students. To achieve this objective, a tool capable of evaluating the most humanistic dimensions (empathy, kindness, trust) in the development of dental treatment has been designed. MATERIALS AND METHODS A review of the literature was carried out and, based on its findings, a questionnaire was designed to assess patient satisfaction with the dental student's empathy. It consisted of 20 questions and was completed by 80 patients. The questionnaire was subjected to a validation process using the Delphi method (content validity) and psychometric analysis (construct validity), through a principal components analysis (PCA). RESULTS The results of the PCA showed the existence of four components that suggest grouping the 20 questions into three blocks with a sequential structure, in which the questions would describe the patient's satisfaction throughout their treatment: reception and explanation of the treatment; development and progress of treatment; and expectations and completion of treatment. In each of these blocks, satisfaction was determined by a specific humanistic dimension: communication, trust and benevolence. CONCLUSION The validated questionnaire is an effective tool to analyse the relational factors that determine patient satisfaction in a treatment. Furthermore, the analysis of the questionnaire suggests that communication, trust and benevolence are elements that acquire singular importance throughout the care process. This analysis is essential for the acquisition of humanistic skills by future professionals and to optimize the dentist-patient relationship.
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Affiliation(s)
- Ignacio Macpherson
- Bioethics Unit, Department of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elisa Sanagustín
- Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - María Victoria Roqué
- Bioethics Unit, Department of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lluís Giner-Tarrida
- Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
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Macpherson I, Roqué MV, Martín-Sánchez JC, Segarra I. Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning. Eur J Dent Educ 2022; 26:277-287. [PMID: 34085360 DOI: 10.1111/eje.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes. MATERIALS AND METHODS A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge. RESULTS Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women. CONCLUSION Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.
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Affiliation(s)
- Ignacio Macpherson
- Bioethics Unit, Department of Humanities, International University of Catalonia, Sant Cugat del Vallés, Spain
| | - María Victoria Roqué
- Bioethics Unit, Department of Humanities, International University of Catalonia, Sant Cugat del Vallés, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, International University of Catalonia, Sant Cugat del Vallés, Spain
| | - Ignacio Segarra
- Department of Pharmacy, Faculty of Health Sciences, Catholic University of Murcia, Murcia, Spain
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Sobolewska V, Duff H, Craighead F, Macpherson I, Veiraiah A, Dummer S, Lockman KA. Improving care for patients in the outlying wards: Lessons from patients' care experience. Acute Med 2022; 21:80-85. [PMID: 35681181 DOI: 10.52964/amja.0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
IMPORTANCE Overcrowding in hospitals and lack of capacity in general medical wards can result in a medical patient being transferred to other specialty wards often referred as 'outlying' or 'boarding' wards. OBJECTIVES We explored the experiences of our outlying patients to identify local factors that affect their care experience and inform interventions that could improve their care deliveries and outcomes. DESIGN, SETTING, AND PARTICIPANTS Qualitative interviews using semi-structured questions were conducted in 21 medical patients from a mixture of specialty wards in a large tertiary NHS hospital. MAIN OUTCOMES AND MEASURES Perceptions of the factors contributing to the experience of being a patient on a boarding ward, and potential solutions. RESULTS Almost all participants reported experiences of good care in an outlying ward. Positive comments highlighted good nursing care, restful environment and a strong focus on patient-centred care. However, none of the participants could identify the team or consultant responsible for their care and this was linked to multiple doctors being involved in the patient's care. Participants also perceived that the frequency of review was reduced and occurred much later in the day than that experienced in the medical ward. Most felt indifferent about the care ownership, timing and frequency of review but in some cases, this led to confusion and the perception of poor progress. Further, participants felt that they had to actively seek information relating to clinical progress. Negative experience of discharge planning was also reported. The associated themes included conflicting information and delays in social care provision. This led to anxiety, frustration and the perception of being a barrier to patient flow. CONCLUSIONS AND RELEVANCE Patient experience of the outlying ward is positive, and this can provide a foundation for improvement. Our findings suggest that better care processes and improved communication are needed to promote equity and quality of care. However, this should be complemented with efforts to overcome wider challenges that affect the entire continuum of flow within the healthcare system.
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Affiliation(s)
- V Sobolewska
- MBChB, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - H Duff
- MBChB, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - F Craighead
- MBChB, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - I Macpherson
- MBChB, Gut Group, University of Dundee, Dundee, UK. ORCID ID https://orcid.org/0000-0003-0443-2073, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - A Veiraiah
- MBBS, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - S Dummer
- MBChB, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
| | - K A Lockman
- MB Bch MD FRCP, NHS Lothian, Department of Acute and General Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, United Kingdom
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Macpherson I, Arregui M, Marchini L, Giner-Tarrida L. Analysis of moral reasoning in dentistry students through case-based learning (CBL). J Dent Educ 2021; 86:416-424. [PMID: 34796479 DOI: 10.1002/jdd.12830] [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: 06/27/2021] [Revised: 10/11/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this study was to develop a tool to analyze the ethical dimensions during dental students' decision making, by using case-based learning (CBL). METHODS Five clinical scenarios involving ethical aspects addressing different moral dilemmas were selected. The cases were then administered to students during a course on ethics, and the students responded using a narrative technique. To analyze the responses, a criterion inspired by Kohlberg's theory of moral development was used. Subsequently, the data were analyzed statistically, and possible associations between the answers and other variables, such as the student's gender and theoretical knowledge of ethics, were evaluated. RESULTS A total of 260 students participated (182 women and 78 men), and 1300 narratives were analyzed. The reliability of the construct, as tested by the Cronbach's alpha and the homogeneity index, was acceptable (0.7). The validity of the construct was also assessed, suggesting a component analysis. The descriptive analysis suggests a certain tendency to solve moral problems by referring to established norms and laws. Furthermore, the correlation anaylysis suggests the interrelation between dimensions linked to patient integrity and respect for the truth, even though this conclusion is not reflected in the component analysis, which only detects a generic component of moral sensitivity. No significant differences by gender were found in the narratives, nor a strong correlation of the responses with theoretical knowledge on ethics. CONCLUSION CBL through the narrative method on ethical dilemmas is an effective tool for assessing dental students' moral competencies and their possible interactions with other variables.
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Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, Faculty of Humanities, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - María Arregui
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Leonardo Marchini
- Department of Preventive and Community Dentistry, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa, USA
| | - Luís Giner-Tarrida
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
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Earl HM, Hiller L, Dunn J, Macpherson I, Rea D, Hughes-Davies L, McAdam K, Hall P, Mansi J, Wheatley D, Abraham JE, Caldas C, Gasson S, O'Riordan E, Wilcox M, Miles D, Cameron DA, Wardley A. Optimising the Duration of Adjuvant Trastuzumab in Early Breast Cancer in the UK. Clin Oncol (R Coll Radiol) 2021; 33:15-19. [PMID: 32723485 PMCID: PMC7382576 DOI: 10.1016/j.clon.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022]
Affiliation(s)
- H M Earl
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - I Macpherson
- University of Glasgow, Institute of Cancer Sciences, Glasgow, UK
| | - D Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - L Hughes-Davies
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K McAdam
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - P Hall
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - J Mansi
- Department of Medical Oncology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust and King's College Medical School, London, UK
| | - D Wheatley
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J E Abraham
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - C Caldas
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Gasson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - E O'Riordan
- Independent Cancer Patients' Voice, London, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, London, UK
| | - D Miles
- Mount Vernon Cancer Centre, Northwood, UK
| | - D A Cameron
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - A Wardley
- The NIHR Manchester Clinical Research Facility at The Christie, Manchester, UK; University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
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Conefrey C, Donovan JL, Stein RC, Paramasivan S, Marshall A, Bartlett J, Cameron D, Campbell A, Dunn J, Earl H, Hall P, Harmer V, Hughes-Davies L, Macpherson I, Makris A, Morgan A, Pinder S, Poole C, Rea D, Rooshenas L. Strategies to Improve Recruitment to a De-escalation Trial: A Mixed-Methods Study of the OPTIMA Prelim Trial in Early Breast Cancer. Clin Oncol (R Coll Radiol) 2020; 32:382-389. [PMID: 32089356 PMCID: PMC7246331 DOI: 10.1016/j.clon.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
AIMS De-escalation trials are challenging and sometimes may fail due to poor recruitment. The OPTIMA Prelim randomised controlled trial (ISRCTN42400492) randomised patients with early stage breast cancer to chemotherapy versus 'test-directed' chemotherapy, with a possible outcome of no chemotherapy, which could confer less treatment relative to routine practice. Despite encountering challenges, OPTIMA Prelim reached its recruitment target ahead of schedule. This study reports the root causes of recruitment challenges and the strategies used to successfully overcome them. MATERIALS AND METHODS A mixed-methods recruitment intervention (QuinteT Recruitment Intervention) was used to investigate the recruitment difficulties and feedback findings to inform interventions and optimise ongoing recruitment. Quantitative site-level recruitment data, audio-recorded recruitment appointments (n = 46), qualitative interviews (n = 22) with trialists/recruiting staff (oncologists/nurses) and patient-facing documentation were analysed using descriptive, thematic and conversation analyses. Findings were triangulated to inform a 'plan of action' to optimise recruitment. RESULTS Despite best intentions, oncologists' routine practices complicated recruitment. Discomfort about deviating from the usual practice of recommending chemotherapy according to tumour clinicopathological features meant that not all eligible patients were approached. Audio-recorded recruitment appointments revealed how routine practices undermined recruitment. A tendency to justify chemotherapy provision before presenting the randomised controlled trial and subtly indicating that chemotherapy would be more/less beneficial undermined equipoise and made it difficult for patients to engage with OPTIMA Prelim. To tackle these challenges, individual and group recruiter feedback focussed on communication issues and vignettes of eligible patients were discussed to address discomforts around approaching patients. 'Tips' documents concerning structuring discussions and conveying equipoise were disseminated across sites, together with revisions to the Patient Information Sheet. CONCLUSIONS This is the first study illuminating the tension between oncologists' routine practices and recruitment to de-escalation trials. Although time and resources are required, these challenges can be addressed through specific feedback and training as the trial is underway.
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Affiliation(s)
- C Conefrey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - J L Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - R C Stein
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - S Paramasivan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - A Marshall
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - D Cameron
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - A Campbell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Earl
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P Hall
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - V Harmer
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - I Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Makris
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - A Morgan
- Independent Cancer Patients' Voice, London, UK
| | - S Pinder
- King's College London, Comprehensive Cancer Centre at Guy's Hospital, London, UK
| | - C Poole
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Rea
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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Abstract
BACKGROUND Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant. OBJECTIVE The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency. RESEARCH DESIGN The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies. ETHICAL CONSIDERATIONS No significant ethical considerations as this is a discussion paper. FINDINGS The model was structured from the anthropology's concepts and decision-making process, applied to real situations. The structure of the three domains theoretical-practical-communicative is present in each session. DISCUSSION It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students' resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied. CONCLUSION We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.
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Macpherson I, Roqué MV, Segarra I. Moral enhancement, at the peak of pharmacology and at the limit of ethics. Bioethics 2019; 33:992-1001. [PMID: 31264244 DOI: 10.1111/bioe.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 11/12/2018] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
The debate over the improvement of moral capacity or moral enhancement through pharmacology has gained momentum in the last decade as a result of advances in neuroscience. These advances have led to the discovery and allowed the alteration of patterns of human behavior, and have permitted direct interventions on the neuronal structure of behavior. In recent years, this analysis has deepened regarding the anthropological foundations of morality and the reasons that would justify the acceptance or rejection of such technology. We present a review of proposals for pharmacological interventions directed directly towards moral enhancement. In addition, we identify the ethical dilemmas that such interventions may generate, as well as the moral assessment of the authors of these studies. There is a moderate consensus on the risks of any intervention on the intimate structure of the human condition, its autonomy and identity, but there are large differences in explaining the reasons for this concern and especially in justifying such interventions. These findings show that it is necessary to investigate the moral assessment of authors and the ethical dimension within the field of pharmacology in order to identify future trends.
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Affiliation(s)
- Ignacio Macpherson
- Faculty of Humanities, International University of Catalonia, Sant Cugat del Valles, Barcelona, Spain
| | - María Victoria Roqué
- Faculty of Humanities, International University of Catalonia, Sant Cugat del Valles, Barcelona, Spain
| | - Ignacio Segarra
- Department of Pharmacy, Faculty of Health Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
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Awada A, Cortés J, Slater S, Macpherson I, Csoszi T, Bertrand JB, Clermont AS, Pollard R, Chrestia-Blanchine R, Biswas-Baldwin N, Youssoufian H, El-Hariry I. TRYbeCA-2: A randomized phase II/III study of eryaspase in combination with gemcitabine and carboplatin chemotherapy versus chemotherapy alone as first-line treatment in patients with metastatic or locally recurrent triple-negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.076] [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] [Indexed: 11/14/2022] Open
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Llombart Cussac A, Medioni J, Colleoni M, Ettl J, Schmid P, Macpherson I, Gligorov J, Albanell J, Bellet Ezquerra M, Fernández A, Ruiz Borrego M, Gavilá-Gregori J, Wheatley D, Zamora P, Martínez E, Sampayo M, Riva F, Malfettone A, Pérez-García J, Cortés J. Palbociclib rechallenge in hormone receptor (HR)[+]/HER2[-] advanced breast cancer (ABC). PALMIRA trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The new reproductive technologies have opened the door to different processes of germline genetic enhancement by which the characteristics of an individual according to the interests of the agents involved could be selected during its gestation. Although the initiative is apparently oriented towards developing individuals that would excel in society, critical voices raise the concerns about that this approach would generate and need for a reflection on the ethical, social and legal implications of these techniques and their implementation in society. We reviewed the literature about these issues throughout their historical records to date, focusing on the moral arguments and non-clinical aspects that affect the legal and social environment. We have observed various trends of thought with divergent positions (proactive, preventive, and regulatory) as well as a large number of articles that try to reconcile the different approaches. This review illustrates a series of concepts from the ethics and philosophy fields which are frequently used in studies that evaluate the ethical implications of germline genetic enhancement, such as dignity, benefit, autonomy, and identity. In addition, amongst the many unresolved controversies surrounding genetic enhancement, we identify procreative beneficence, genetic disassociation, gender selection, the value of disability, embryo chimerization, and the psychosocial inequality of potentially enhanced individuals as crucial. We also develop possible scenarios for future debate. We consider especially important the definition and specification of three aspects which are essential for the deployment of new reproductive technologies: the moral status of the embryo undergoing enhancement, the legal status of the enhanced individual, and the responsibility of the agents executing the enhancement. Finally, we propose the precautionary principle as a means to navigate ethical uncertainties.
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Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, International University of Catalonia, Barcelona, Spain
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
| | - María Victoria Roqué
- Department of Humanities, International University of Catalonia, Barcelona, Spain
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Ignacio Segarra
- Pharmacokinetics, Patient Care and Translational Bioethics Research Group, Catholic University of Murcia (UCAM), Murcia, Spain
- Department of Pharmacy, Faculty of Health Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
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Macpherson I, Roqué-Sánchez MV. [Ethical analysis of the principle of health vulnerability]. Cuad Bioet 2019; 30:253-262. [PMID: 31618588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
The concept of vulnerability has determined multiple actions in the health field. In recent years, this concept has originated various holistic models that oscillate between considering vulnerability as a descriptive element of an accidental situation until it is considered a guiding principle of medical practice. The need to deepen this phenomenon from the point of view of moral philosophy is perceived. The moral reflection reveals an imbalance in the binomial autonomy-dependence, generating opposite solutions in decision-making. Although autonomy has so far supported much of the medical action, the dependency raises a new perspective on vulnerability, rooted in the ethics of care. This perspective allows us to overcome the consideration of vulnerability as a characteristic, an accident or a principle. Vulnerability appears as an intrinsic dimension of the human being that, far from altering its dignity or autonomy, makes it posible to demonstrate the need of others to reach their fullness.
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Affiliation(s)
- Ignacio Macpherson
- Departament d'Humanitats, Àrea Bioética. Universitat Internacional de Catalunya, Barcelona.
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13
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Macpherson I. Ethical reflections about the anonymity in gamete donation. Hum Reprod 2019; 34:1847-1848. [DOI: 10.1093/humrep/dez142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
- I Macpherson
- Department of Humanities, International University of Catalonia, Barcelona, Spain
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Turner N, Bye H, Kernaghan S, Proszek P, Fribbens C, Moretti L, Morden J, Snowdon C, Macpherson I, Wardley A, Roylance R, Baird R, Bliss J, Ring A. Abstract OT1-06-03: The plasmaMATCH trial: A multiple parallel cohort, open-label, multi-centre phase II clinical trial of ctDNA screening to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Circulating tumour DNA (ctDNA) is found in the plasma of over 90% of patients with advanced breast cancer (BC). Screening for the presence of mutations in ctDNA provides a current assessment of the genetic profile of the patient's recurrent BC. The plasmaMATCH trial is designed to assess the potential of ctDNA screening to direct targeted therapies in patients with advanced breast cancer.
Methods
plasmaMATCH is a multi-centre phase IIa umbrella trial platform of ctDNA screening and a therapeutic trial. The study will screen 1000 women with advanced breast cancer, who have received prior systemic treatment in the advanced setting, with digital PCR ctDNA assays for hotspot mutations in ESR1, HER2, AKT1, and PIK3CA, with HER2 copy number assessment, in a central laboratory. The study will recruit from up to 50 sites in the UK. Patients with mutations identified will enter the matching treatment cohort, ESR1 – extended dose fulvestrant 500mg every two weeks, HER2 – neratinib +/- fulvestrant, AKT1 – AZD5363 +/- fulvestrant.
Mutation prevalence is presented with corresponding exact 95% confidence intervals (CIs) both overall and excluding 14 patients who were known to have mutations from a prior screening program. Patients with more than one mutation are included once in each relevant row.
Results
We report the results of prospective ctDNA mutation testing in the first 92 patients. plasmaMATCH opened to recruitment on 15/12/2016. As of 08/06/2017, 120 patients have been registered for ctDNA screening from 7 UK centres, of which 92 have ctDNA screening results available:
plasmaMATCH ctDNA screening resultsMutationPrevalence (95% CI)Prevalence excluding 14 patients with known mutations (95% CI)ESR134/92: 37% (27%-48%)26/78: 33% (23%-45%)HER25/90: 6% (2%-12%)2/76: 3% (0%-9%)AKT17/92: 8% (3%-15%)4/78: 5% (1%-13%)PIK3CA*22/92: 24% (16%-34%)21/78: 27% (18%-38%)*No corresponding plasmaMATCH treatment cohort
14 patients had more than one mutation detected (10 ESR1+PIK3CA, 3 ESR1+AKT1, 1 ESR1+ +HER2+AKT1). ctDNA results were reported in a median of 8 working days.
Of the 40 patients with one or more actionable mutation, 15 have entered a cohort, 16 are being screened for entry into a cohort, 5 are currently receiving further systemic treatment prior to cohort entry and 4 will not enter a cohort. One additional patient has entered a treatment cohort on the basis of a mutation detected in an alternative tumour sequencing initiative.
Conclusions
plasmaMATCH ctDNA demonstrates the feasibility and accuracy of ctDNA testing as a screening tool for patients with advanced BC, with a high rate of subsequent recruitment into matching therapeutic trials.
Citation Format: Turner N, Bye H, Kernaghan S, Proszek P, Fribbens C, Moretti L, Morden J, Snowdon C, Macpherson I, Wardley A, Roylance R, Baird R, Bliss J, Ring A. The plasmaMATCH trial: A multiple parallel cohort, open-label, multi-centre phase II clinical trial of ctDNA screening to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-03.
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Affiliation(s)
- N Turner
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - H Bye
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - S Kernaghan
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - P Proszek
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - C Fribbens
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - L Moretti
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - J Morden
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - C Snowdon
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - I Macpherson
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - A Wardley
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - R Roylance
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - R Baird
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - J Bliss
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - A Ring
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, International University of Catalonia, Barcelona, Spain
| | - Ignacio Segarra
- School of Pharmacy, University of Barcelona, Barcelona, Spain
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16
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Rafii S, Macpherson I, Baird R, Saggese M, Spiliopoulou P, Kumar S, Italiano A, Bonneterre J, Campone M, Cresti N, Posner J, Takeda Y, Arimura A, Spicer J. Abstract P4-21-08: A phase I/II of S-222611, a reversible EGFR and HER2 inhibitor, combined with trastuzumab +/- chemotherapy in patients with HER2-positive metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: S-222611, an oral, reversible EGFR and HER2 inhibitor, has been shown to be well-tolerated as monotherapy at a dose of 800mg daily with good anti-tumor activity in patients previously treated with other anti-HER2-based regimens. This study evaluated the tolerability and safety of daily oral administration of S-222611 (S) in combination with trastuzumab (T), trastuzumab + vinorelbine (T+V) and trastzumab + capecitabine (T+C) in HER2-positive (HER2+) metastatic breast cancer (MBC) with or without brain metastases.
Methods: This study was performed as a 3+3 dose escalation followed by expansion to examine the tolerability and safety of S in combination with T, T+V and T+C in Arms A, B and C, respectively. S was administered orally once daily, starting at a dose of 400mg in Arm A, and 200mg in Arms B and C. The dosing of T was 8mg/kg loading followed by 6mg/kg or fixed dose of 600mg subcutaneously every 21 days as recommended. V was administered at 60mg/m2 orally on Day 1 and 8 of a 21-day cycle, and C 1000mg/m2 orally daily for 14 days followed by a 7-day rest period. All patients had HER2+ MBC and were required to have progressed following at least one prior line of anti-HER2 therapy. Prior treatments with V and C were permitted. Anti-diarrhea prophylaxis with loperamide was not required.
Results: A total of 45 patients were enrolled. All patients had received prior anti-tumor regimens including T (n=45), T-DM1 (n=26), pertuzumab (n=9) and lapatinib (n=12). The clinically recommended doses of S at which most adverse events were manageable,were determined as:600mg in Arm A, 200mg in Arm B and 400mg in Arm C. Dose limiting toxicities included Grade 3 diarrhea for Arm A; and Grade 4 neutropenia, Grade 3 Hypokalemia and Hypophosphatemia for Arm B. As of 13 May 2016, treatment is ongoing in 2 patients. No other Grade 4 AEs related to S-222611 have been observed. Grade 3 bilirubin elevation was observed in 5/45 patients, probably due to transporter (UGT1A1) inhibition, while no G3/4 liver dysfunction was reported. RECIST partial responses (PR) were observed in 6 of 9 patients in Arm A and 5 of 9 patients in Arm C, at respective clinically recommended doses. Nine of 45 patients had brain metastases; 4 of these patients showed RECIST PR including an intracranial tumor response in one patient (400mg in Arm C) who had prior treatments with paclitaxel, T+C, T-DM1 and V after diagnosis of BM.
Conclusions: The clinically recommended doses of S-222611 combined with T, T +V and T+C were determined for further clinical studies. Clinical benefit (PR and SD >6 month) was seen with each combination even in heavily pre-treated HER2+ MBC patients.
Summary of the safety and efficacy of S-222611 (S) combination. Dose (mg)nDLT (1st cycle)G3 Diarrhea during study (N of patients)RECIST tumor response, PR n/ SD ≥6M nORR n (%)CBR n (%)Arm A: S + T4005010/10/5 (0%)1/5 (20%)Arm A: S + T6009036/06/9 (67%)6/9 (67%)Arm A: S + T8007141/11/7 (14%)2/7 (29%)Arm B: S + T + V2005020/40/5 (0%)4/5 (80%)Arm B: S + T + V4002211/01/2 (50%)1/2 (50%)Arm C: S + T + C2004010/10/4 (0%)1/4 (25%)Arm C: S + T + C4009025/05/9 (56%)5/9 (56%)Arm C: S + T + C6004022/12/4 (50%)3/4 (75%)
Citation Format: Rafii S, Macpherson I, Baird R, Saggese M, Spiliopoulou P, Kumar S, Italiano A, Bonneterre J, Campone M, Cresti N, Posner J, Takeda Y, Arimura A, Spicer J. A phase I/II of S-222611, a reversible EGFR and HER2 inhibitor, combined with trastuzumab +/- chemotherapy in patients with HER2-positive metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-08.
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Affiliation(s)
- S Rafii
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - I Macpherson
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - R Baird
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - M Saggese
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - P Spiliopoulou
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - S Kumar
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - A Italiano
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Bonneterre
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - M Campone
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - N Cresti
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Posner
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - Y Takeda
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - A Arimura
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Spicer
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
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Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. Abstract OT3-02-12: OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive HER2-negative node-negative early breast cancer. These uses of MPAs have not yet been prospectively validated. OPTIMA aims to validate the use of MPA testing to predict chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The preliminary phase (OPTIMA prelim) evaluated the performance of MPAs to identify a suitable test(s) to be used in the main efficacy trial and assessed the feasibility and acceptability of a large UK trial. Eligible patients are men or women aged 40 years or older who have surgically resected early stage breast cancer, which is ER-positive and HER2-negative and who have either 1-9 involved axillary lymph nodes or tumors of at least 30mm diameter. Randomization is to standard management (chemotherapy followed by endocrine therapy) or to MPA-directed treatment. Those with a tumor categorized as "high-risk" by the test will be assigned to standard management whilst those at "low-risk" will be treated with endocrine therapy alone. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50). The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy compared to standard practice. Secondary outcomes include IDFS in "low-risk" patients, distant disease free survival, breast cancer specific survival, overall survival and quality of life. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients over 4 years will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites. It confirmed the acceptability of randomization to patients with a 47% acceptance rate, and to clinicians and hence the feasibility of a large prospective trial of test-directed treatment running in 100-plus UK sites. It showed that investment into research on test-directed therapy, especially with Prosigna, should be of substantial value to the NHS.
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy in node-positive hormone-sensitive early breast cancer will have a global impact on patient treatment. Recruitment into the main efficacy trial will commence in October 2015.
Funding: Project funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-12.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - D Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - I Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Francis
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - J Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
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Roqué MV, Macpherson I, Gonzalvo Cirac M. El principio de precaución y los límites en biomedicina. pers bioet 2015. [DOI: 10.5294/pebi.2015.19.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Los actuales avances en tecnología biomédica han alcanzado resultados hasta ahora inimaginables, tanto en la terapia de enfermedades como en el perfeccionamiento de la especie humana. Es necesario plantearse si el deseo de perfección posee límites precisos, y si es necesario aplicar un principio limitador que garantice el respeto de la naturaleza humana e impida la asunción de riesgos que puedan afectar a generaciones futuras. El principio de precaución se presenta como elemento racionalizador frente a cualquier intento de un progreso ciego o despótico. Pero dicho principio puede derivar hacia concepciones confusas cuando se desliga de su componente constitutivo: la virtud de la prudencia.
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Macpherson I, Stewart K, Chick J, Brock K, Poondru S, Gedrich R, Stephens AW, Evans TR. A dose escalation (DE), pharmacokinetic (PK), and pharmacodynamic (PD) study of OSI-930 and erlotinib (E) in patients (pts) with advanced solid tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3550 Background: EGFR and VEGFR are important targets in a number of human cancers with common downstream signalling pathways. Combined blockade of EGFR-VEGFR with E and OSI-930 has shown additional antitumor activity compared to either agent alone with long-term remissions in multiple xenograft models. Methods: Sequential cohorts of pts with advanced refractory solid tumors were treated with OSI-930 BID with addition of E QD from Day 8 and beyond to determine the maximum tolerated dose (MTD) and to evaluate safety, PK and efficacy of the combination. Escalation followed a standard 3+3 design until dose-limiting toxicity (DLT) was observed in ≥ 2/6 pts. PK of OSI-930, E and its metabolite OSI-420 were determined. Levels of soluble VEGFR2 (sVEGFR2) in plasma were also measured. Results: 16 pts have been entered (13M/3F); median age 63 years (range 41–78), PS ≤2 and 38% pts with mCRC. OSI-930/E were administered at 3 levels [mg(pts entered/evaluable)]; 200 BID/100 QD (7/6), 200 BID/150 QD (4/3), and 300 BID/150 QD (5/5). Median duration of therapy was 8 weeks (range 1–22). DLT was seen in 1/6 pts at 200 BID/100 QD (>5 day interruption due to G4 neutropenia); and 1/5 at 300 BID/150 QD (G3 Asthenia/lethargy). Other common related toxicities (% all grades:% g3/4) were: skin-related (rash, HFS etc) (85:23), Asthenia/lethargy/fatigue (69:15), diarrhea (77:8), anorexia (92:0), and transaminitis (31:15). Reduction and/or interruptions of one or both study drugs during or beyond the initial 28 days were required in 8/14 pts. Six of 11 pts evaluable for response achieved SD ≥12 weeks. Median plasma Cmax (and AUCTau) of OSI -930 for Cohort 3 (300 BID/150 QD) were: 0.826 (6.08), 0.947 (5.57), and 1.66 (14.3) μg/mL (μg.hr/mL) on Days 7, 8 and 22, respectively. Exposure of OSI-930 increased approximately 2-fold upon co-administration with E at steady-state. OSI-930 appeared not to alter the PK properties of E or the ratio of OSI-420 to E. Decreases in plasma sVEGFR2 were observed, indicating a PD effect of OSI-930. Conclusions: Additional patients are being added to confirm the MTD of the combination. PK data indicate a drug-drug interaction with doubling of the OSI-930 exposure on co-administration with E. [Table: see text]
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Affiliation(s)
- I. Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - K. Stewart
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - J. Chick
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - K. Brock
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - S. Poondru
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - R. Gedrich
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - A. W. Stephens
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
| | - T. R. Evans
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals, Boulder, CO
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Abstract
Serological testing of turkey flocks in Great Britain was undertaken as a result of the isolation of an avian paramyxovirus of serotype PMV-3 from turkeys in 1981 (Macpherson et al., 1983). Turkeys on two of four farms with egg production problems examined for PMV-3 haemagglutination inhibition (HI) antibodies in 1981 were positive. Turkeys on 34 farms were tested for PMV-3 antibodies in 1982. Seven of 16 flocks showing egg production problems and/or respiratory disease were considered positive for PMV-3 (mean log(2) HI titre >/= 2.5), but five of 18 flocks with no reported disease were also positive for PMV-3 antibodies. On one turkey farm the appearance of PMV-3 antibodies and an isolation of a PMV-3 virus coincided with egg production problems. Analysis of HI titres in turkeys vaccinated against Newcastle disease virus (NDV) and unvaccinated birds suggested that significant NDV HI titres are unlikely to be recorded as a result of PMV-3 virus infections of unvaccinated birds. However, while NDV vaccination prior to PMV-3 infection apparently caused slight suppression of the PMV-3 immune response, the HI titres to NDV were boosted considerably in direct relationship to the PMV-3 titre.
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Affiliation(s)
- D J Alexander
- Poultry Department, Central Veterinary Laboratory, New Haw, Weybridge, Surrey, England
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Macpherson I, Feest A. Some observations on the value of the infectious bronchitis haemagglutination inhibition test in the field. Avian Pathol 2007; 7:337-47. [DOI: 10.1080/03079457808418288] [Citation(s) in RCA: 12] [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] [Indexed: 10/22/2022]
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Simpson IN, Gisby J, Hemingway CP, Durodie J, Macpherson I. Evaluation of mupirocin E-test for determination of isolate susceptibility: comparison with standard agar dilution techniques. J Clin Microbiol 1995; 33:2254-9. [PMID: 7494011 PMCID: PMC228389 DOI: 10.1128/jcm.33.9.2254-2259.1995] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Mupirocin E-test strips have been evaluated for their ease of use and accuracy in determining the susceptibilities of 171 strains of Staphylococcus spp., Streptococcus spp., Haemophilus influenzae, and Moraxella catarrhalis. The susceptibility of each strain was determined on two occasions, using parallel E-test and agar dilution methodologies each time. To ensure similar precisions for statistical analyses, E-test MICs were rounded up to a standard twofold agar dilution scale. Clear, elliptical zones were obtained against Staphylococcus spp. M. catarrhalis also gave clear zones, but the scale intercept was often difficult to interpret because of the irregular shape of the inhibition zone. Poor growth sometimes resulted in less-distinct zones of inhibition against Streptococcus spp. and H. influenzae. Excellent correlation was observed between the the E-test and agar dilution against Staphylococcus spp. and H. influenzae, with > 95% of the E-test values falling within one log2 dilution of the corresponding agar MIC. The correlation was lower for Streptococcus spp. and M. catarrhalis, with 86 and 83%, respectively, of E-test results falling within one log2 dilution of the agar MIC. When E-test MICs did not agree exactly with the corresponding agar MIC against Staphylococcus spp. or Streptococcus spp., there was a tendency for the E-test to give a lower MIC. This bias has little effect upon individual MICs in staphylococci or in the generation of susceptibility interpretation errors ( < 1.5% overall), but it could reduce population geometric mean MICs by factors of 0.78 to 0.83. This effect was more marked for Streptococcus spp., reducing the population mean by a factor of 0.73 and resulting in 0.7% major and 8% very major errors. In contrast, the E-test tended to give higher MICs against M. catarrhalis, resulting in 7.3% major errors and increasing the population geometric mean MIC by a factor of 1.60.
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Affiliation(s)
- I N Simpson
- SmithKline Beecham, Betchworth, Surrey, United Kingdom
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Macpherson I. Construction management. Health Estate J 1993; 47:18. [PMID: 10125452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Construction Management is fundamentally different from other forms of building procurement, including management contracting and should be seen as a 'professional management' service, recognising management as a skill in its own right, aside from contracting. It does expose the client to greater risk, of course, but a value judgement has to be made as to the benefit a client obtains from the system versus the risk profile of the system.
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Greenwood NN, Kennedy JD, Macpherson I, Thornton-Pett M. Polyhedral Molybdenaborane Chemistry:nido-6-molybdenadecaboranes including the molecular structure of [6,6,6,6-(CO)2(PMe2Ph)2-nido-6-MoB9H12-5-Cl] Some Structural Intercomparisons. Z Anorg Allg Chem 1986. [DOI: 10.1002/zaac.19865400908] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Macpherson I, Watt RG, Alexander DJ. Isolation of avian paramyxovirus other than Newcastle disease virus from commercial poultry in Great Britain. Vet Rec 1983; 112:479-80. [PMID: 6868324 DOI: 10.1136/vr.112.20.479] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Keenan RA, Morrice JJ, Macpherson I, Hopkinson JM. Non-hormonal adrenocortical tumours (carcinomas). J R Coll Surg Edinb 1983; 28:63-65. [PMID: 6834320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Hebb M, Macpherson I, Cudmore D, Scott K, Weldon L, Smart M, Ley E. Nova scotia fetal risk project. Can Fam Physician 1980; 26:1664-1673. [PMID: 20469319 PMCID: PMC2383653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Family physicians delivering obstetrical care in Nova Scotia were invited to participate in a fetal risk project, conducted from 1971 to 1975. Thirty percent of the physicians participated, and data were collected on 17,270 patients, using the Goodwin, Dunne and Thomas(4) fetal risk scoring system. Patients scoring four to ten on the entire system accounted for 60% of stillbirths and 68% of neonatal deaths; when the 68% of neonatal deaths; when the non-gestational portion alone was used, patients scoring three to six accounted for 52% of stillbirths and 57% of neonatal deaths. When the scoring system was altered, patients scoring three to six accounted for 61% of stillbirths and 62% of neonatal deaths. Patients of participants did not appear to fare better than those of non-participants.
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Watt RG, Macpherson I. Freeze-dried infectious bronchitis haemagglutinating antigen. Vet Rec 1980; 106:467. [PMID: 6254230 DOI: 10.1136/vr.106.22.467-a] [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: 01/19/2023]
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Macpherson I. EDS 76 in broiler breeder flocks. Vet Rec 1980; 106:160. [PMID: 7368539 DOI: 10.1136/vr.106.7.160] [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: 01/24/2023]
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Gardas A, Macpherson I. Microinjection of ricin entrapped in unilamellar liposomes into a ricin-resistant mutant of baby hamster kidney cells. Biochim Biophys Acta 1979; 584:538-41. [PMID: 454680 DOI: 10.1016/0304-4165(79)90126-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fluorescein-labelled Ricin was entrapped in unilamellar liposomes; 14 microgram of protein was entrapped by 1 mg of lipids. Liposomes added to cells in culture in low serum medium can deliver entrapped Ricin to a Ricin-resistant mutant of baby hamster kidney(BHK)cells. Ricin entrapped in unilamellar liposomes inhibits protein biosynthesis at a concentration of 1.75 microgram/ml in Ricin-resistant cells. Ricin dissolved in medium at 50 microgram/ml does not affect protein synthesis in these cells.
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Macpherson I, Melero JA, Salas M, Salas J. DNA-binding proteins and the G1 leads to S transition in normal and virus-transformed cells. Bibl Haematol 1975:50-2. [PMID: 1232986 DOI: 10.1159/000399094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Macpherson I, Feest A. Newcastle disease haemagglutination inhibition titres found on routine sampling of poultry in 1974. Vet Rec 1975; 97:169-70. [PMID: 1166592 DOI: 10.1136/vr.97.9.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Macpherson I. Hospital accreditation. Can Med Assoc J 1974; 111:1301. [PMID: 20312595 PMCID: PMC1955982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Deng CT, Boettiger D, Macpherson I, Varmus HE. The persistence and expression of virus-specific DNA in revertants of Rous sarcoma virus-transformed BHK-21 cells. Virology 1974; 62:512-21. [PMID: 4372788 DOI: 10.1016/0042-6822(74)90411-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Warren L, Critchley D, Macpherson I. Surface glycoproteins and glycolipids of chicken embryo cells transformed by a temperature-sensitive mutant of Rous sarcoma virus. Nature 1972; 235:275-8. [PMID: 4334032 DOI: 10.1038/235275a0] [Citation(s) in RCA: 118] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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