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Hayer C, Burton M, Ferrazzini V, Esse B, Di Muro A. Unusually high SO 2 emissions and plume height from Piton de la Fournaise volcano during the April 2020 eruption. Bull Volcanol 2023; 85:21. [PMID: 36908764 PMCID: PMC9993386 DOI: 10.1007/s00445-023-01628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Piton de la Fournaise volcano, La Réunion, France, erupted between the 2 and 6 April 2020, one of a series of eruptive phases which occur typically two or three times per year. Here, we use back trajectory analysis of satellite data from the TROPOMI instrument to determine that gas emissions during the June 2020 eruption were of unusually high intensity and altitude, producing 34.9 ± 17.4 kt of SO2 and plume heights up to 5 km a.s.l. The early stages of the eruption (2-4 April 2020) were characterised by relatively low SO2 emission rates despite strong low frequency tremor (LFT); the latter phase followed an increase in intensity and explosivity in the early hours of 5 April 2020. This period included lava fountaining, significantly increased SO2 emission rates, increased high frequency tremor (HFT) and decreased LFT. Using the PlumeTraj back trajectory analysis toolkit, we found the peak SO2 emission rate was 284 ± 130 kg/s on the 6 April. The plume altitude peaked at ~ 5 km a.s.l. on 5 April, in the hours following a sudden increase in explosivity, producing one of the tallest eruption columns recorded at Piton de la Fournaise. PlumeTraj allowed us to discriminate each day's SO2, which otherwise would have led to a mass overestimate due to the plumes remaining visible for more than 24 h. The eruption exhibited a remarkable decoupling and anti-correlation between the intensity of the LFT signal and that of the magma and gas emission rates. LFT intensity peaked during the first phase with low magma and SO2 emissions, but quickly decreased during the second phase, replaced by unusually strong HFT. We conclude that the observation of strong HFT is associated with higher intensity of eruption, degassing, and greater height of neutral buoyancy of the plume, which may provide an alert to the presence of greater hazards produced by higher intensity eruptive activity. This might be particularly useful when direct visual observation is prevented by meteorological conditions. This eruption shows the importance of combining multiple data sets when monitoring volcanoes. Combining gas and seismic data sets allowed for a much more accurate assessment of the eruption than either could have done alone. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s00445-023-01628-1.
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Affiliation(s)
- C. Hayer
- COMET, Department of Earth and Environmental Sciences, The University of Manchester, Manchester, M13 9PL UK
| | - M. Burton
- COMET, Department of Earth and Environmental Sciences, The University of Manchester, Manchester, M13 9PL UK
| | - V. Ferrazzini
- Institut de Physique du Globe de Paris, Université de Paris, CNRS, 75005 Paris, France
- Institut de Physique du Globe de Paris, Observatoire Volcanologique du Piton de La Fournaise, 97418 La Plaine Des Cafres, France
| | - B. Esse
- COMET, Department of Earth and Environmental Sciences, The University of Manchester, Manchester, M13 9PL UK
| | - A. Di Muro
- Institut de Physique du Globe de Paris, Université de Paris, CNRS, 75005 Paris, France
- Institut de Physique du Globe de Paris, Observatoire Volcanologique du Piton de La Fournaise, 97418 La Plaine Des Cafres, France
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Canullo L, Rakic M, Corvino E, Burton M, Krumbeck JA, Chittoor Prem A, Ravidà A, Ignjatović N, Sculean A, Menini M, Pesce P. Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study. BMC Oral Health 2023; 23:27. [PMID: 36650477 PMCID: PMC9843976 DOI: 10.1186/s12903-023-02729-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration. MATERIAL AND METHODS Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing. RESULTS PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP. CONCLUSIONS PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.
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Affiliation(s)
- Luigi Canullo
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Mia Rakic
- grid.4795.f0000 0001 2157 7667ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense of Madrid, Madrid, Spain
| | - Emilio Corvino
- grid.8404.80000 0004 1757 2304University of Florence, Florence, Italy
| | - Maria Burton
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA
| | - Janina A. Krumbeck
- Zymo Research Corporation, 17062 Murphy Ave, Irvine, CA 92614 USA ,Pangea Laboratory, 14762 Bentley Cir., Tustin, CA 92780 USA
| | | | | | - Nenad Ignjatović
- grid.419857.60000 0001 2221 9722Institute of Technical Science of the Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - Anton Sculean
- grid.5734.50000 0001 0726 5157Department of Periodontology, University of Bern, Bern, Switzerland
| | - Maria Menini
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pesce
- grid.5606.50000 0001 2151 3065Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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Martin C, Burton M, Wyld L. Caregiver experiences of making treatment decisions for older women with breast cancer and dementia. Health Soc Care Community 2022; 30:e2058-e2068. [PMID: 34761449 DOI: 10.1111/hsc.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/06/2020] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
Family caregivers are an important source of support for older people living with dementia, especially when faced with a new diagnosis of cancer. Little is currently known about the caregiver role in facilitating treatment discussions, and the factors that underpin breast cancer treatment decision-making in older patients. This study used a sequential explanatory mixed method approach to explore the role of family caregivers in making cancer treatment decisions for older women (aged over 70 years) with pre-existing dementia and primary operable breast cancer. Thirteen caregivers participated in the study (13 completed a postal questionnaire; eight questionnaire respondents participated in a semi-structured interview). Quantitative data were analysed descriptively, and the Framework Approach was used to analyse qualitative findings and identify themes. Three themes were generated: (a) Clinical interactions, information and support; (b) Treatment decision-making processes and (c) Influences on treatment choice. These findings highlight the complexities that caregivers face when navigating cancer treatment options and their role in facilitating treatment decisions.
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Affiliation(s)
- Charlene Martin
- Department of Oncology and Metabolism, The University of Sheffield, The Medical School, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, The University of Sheffield, The Medical School, Sheffield, UK
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, Vijay Sukhnani M, Brown L, Desai B, Elzanati H, Godhaniya J, Kavanagh E, Kent J, Kishor A, Liu A, Norwood M, Shaari N, Wood C, Wood M, Brown A, Chellapuri A, Ferriman A, Ghosh I, Kulkarni N, Noton T, Pinto A, Rajesh S, Varghese B, Wenban C, Aly R, Barciela C, Brookes T, Corrin E, Goldsworthy M, Mohamed Azhar MS, Moore J, Nakhuda S, Ng D, Pillay S, Port S, Abdullah M, Akinyemi J, Islam S, Kale A, Lewis A, Manjunath T, McCabe H, Misra S, Stubley T, Tam JP, Waraich N, Chaora T, Ford C, Osinkolu I, Pong G, Rai J, Risquet R, Ainsworth J, Ayandokun P, Barham E, Barrett G, Barry J, Bisson E, Bridges I, Burke D, Cann J, Cloney M, Coates S, Cripps P, Davies C, Francis N, Green S, Handley G, Hathaway D, Hurt L, Jenkins S, Johnston C, Khadka A, McGee U, Morris D, Murray R, Norbury C, Pierrepont Z, Richards C, Ross O, Ruddy A, Salmon C, Shield M, Soanes K, Spencer N, Taverner S, Williams C, Wills-Wood W, Woodward S, Chow J, Fan J, Guest O, Hunter I, Moon WY, Arthur-Quarm S, Edwards P, Hamlyn V, McEneaney L, N D G, Pranoy S, Ting M, Abada S, Alawattegama LH, Ashok A, Carey C, Gogna A, Haglund C, Hurley P, Leelo N, Liu B, Mannan F, Paramjothy K, Ramlogan K, Raymond-Hayling O, Shanmugarajah A, Solichan D, Wilkinson B, Ahmad NA, Allan D, Amin A, Bakina C, Burns F, Cameron F, Campbell A, Cavanagh S, Chan SMZ, Chapman S, Chong V, Edelsten E, Ekpete O, El Sheikh M, Ghose R, Hassane A, Henderson C, Hilton-Christie S, Husain M, Hussain H, Javid Z, Johnson-Ogbuneke J, Johnston A, Khalil M, Leung TCC, Makin I, Muralidharan V, Naeem M, Patil P, Ravichandran S, Saraeva D, Shankey-Smith W, Sharma N, Swan R, Waudby-West R, Wilkinson A, Wright K, Balasubramanian A, Bhatti S, Chalkley M, Chou WK, Dixon M, Evans L, Fisher K, Gandhi P, Ho S, Lau YB, Lowe S, Meechan C, Murali N, Musonda C, Njoku P, Ochieng L, Pervez MU, Seebah K, Shaikh I, Sikder MA, Vanker R, Alom J, Bajaj V, Coleman O, Finch G, Goss J, Jenkins C, Kontothanassis A, Liew MS, Ng K, Outram M, Shakeel MM, Tawn J, Zuhairy S, Chapple K, Cinnamond A, Coleman S, George HA, Goulder L, Hare N, Hawksley J, Kret A, Luesley A, Mecia L, Porter H, Puddy E, Richardson G, Sohail B, Srikaran V, Tadross D, Tobin J, Tokidis E, Young L, Ashdown T, Bratsos S, Koomson A, Kufuor A, Lim MQ, Shah S, Thorne EPC, Warusavitarne J, Xu S, Abigail S, Ahmed A, Ahmed J, Akmal A, Al-Khafaji M, Amini B, Arshad M, Bogie E, Brazkiewicz M, Carroll M, Chandegra A, Cirelli C, Deng A, Fairclough S, Fung YJ, Gornell C, Green RL, Green SV, Gulamhussein AHM, Isaac AG, Jan R, Jegatheeswaran L, Knee M, Kotecha J, Kotecha S, Maxwell-Armstrong C, McIntyre C, Mendis N, Naing TKP, Oberman J, Ong ZX, Ramalingam A, Saeed Adam A, Tan LL, Towell S, Yadav J, Anandampillai R, Chung S, Hounat A, Ibrahim B, Jeyakumar G, Khalil A, Khan UA, Nair G, Owusu-Ayim M, Wilson M, Kanani A, Kilkelly B, Ogunmwonyi I, Ong L, Samra B, Schomerus L, Shea J, Turner O, Yang Y, Amin M, Blott N, Clark A, Feather A, Forrest M, Hague S, Hamilton K, Higginbotham G, Hope E, Karimian S, 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Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, 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Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Wyld L, Reed MWR, Collins K, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Burton M, Lifford K, Edwards A, Brain K, Ring A, Herbert E, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Richards P, Brennan A, Cheung KL, Todd A, Harder H, Audisio R, Battisti NML, Wright J, Simcock R, Murray C, Thompson AM, Gosney M, Hatton M, Armitage F, Patnick J, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R. Improving outcomes for women aged 70 years or above with early breast cancer: research programme including a cluster RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/xzoe2552] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In breast cancer management, age-related practice variation is widespread, with older women having lower rates of surgery and chemotherapy than younger women, based on the premise of reduced treatment tolerance and benefit. This may contribute to inferior outcomes. There are currently no age- and fitness-stratified guidelines on which to base treatment recommendations.
Aim
We aimed to optimise treatment choice and outcomes for older women (aged ≥ 70 years) with operable breast cancer.
Objectives
Our objectives were to (1) determine the age, comorbidity, frailty, disease stage and biology thresholds for endocrine therapy alone versus surgery plus adjuvant endocrine therapy, or adjuvant chemotherapy versus no chemotherapy, for older women with breast cancer; (2) optimise survival outcomes for older women by improving the quality of treatment decision-making; (3) develop and evaluate a decision support intervention to enhance shared decision-making; and (4) determine the degree and causes of treatment variation between UK breast units.
Design
A prospective cohort study was used to determine age and fitness thresholds for treatment allocation. Mixed-methods research was used to determine the information needs of older women to develop a decision support intervention. A cluster-randomised trial was used to evaluate the impact of this decision support intervention on treatment choices and outcomes. Health economic analysis was used to evaluate the cost–benefit ratio of different treatment strategies according to age and fitness criteria. A mixed-methods study was used to determine the degree and causes of variation in treatment allocation.
Main outcome measures
The main outcome measures were enhanced age- and fitness-specific decision support leading to improved quality-of-life outcomes in older women (aged ≥ 70 years) with early breast cancer.
Results
(1) Cohort study: the study recruited 3416 UK women aged ≥ 70 years (median age 77 years). Follow-up was 52 months. (a) The surgery plus adjuvant endocrine therapy versus endocrine therapy alone comparison: 2854 out of 3416 (88%) women had oestrogen-receptor-positive breast cancer, 2354 of whom received surgery plus adjuvant endocrine therapy and 500 received endocrine therapy alone. Patients treated with endocrine therapy alone were older and frailer than patients treated with surgery plus adjuvant endocrine therapy. Unmatched overall survival and breast-cancer-specific survival were higher in the surgery plus adjuvant endocrine therapy group (overall survival: hazard ratio 0.27, 95% confidence interval 0.23 to 0.33; p < 0.001; breast-cancer-specific survival: hazard ratio 0.41, 95% confidence interval 0.29 to 0.58; p < 0.001) than in the endocrine therapy alone group. In matched analysis, surgery plus adjuvant endocrine therapy was still associated with better overall survival (hazard ratio 0.72, 95% confidence interval 0.53 to 0.98; p = 0.04) than endocrine therapy alone, but not with better breast-cancer-specific survival (hazard ratio 0.74, 95% confidence interval 0.40 to 1.37; p = 0.34) or progression-free-survival (hazard ratio 1.11, 95% confidence interval 0.55 to 2.26; p = 0.78). (b) The adjuvant chemotherapy versus no chemotherapy comparison: 2811 out of 3416 (82%) women received surgery plus adjuvant endocrine therapy, of whom 1520 (54%) had high-recurrence-risk breast cancer [grade 3, node positive, oestrogen receptor negative or human epidermal growth factor receptor-2 positive, or a high Oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA) score of > 25]. In this high-risk population, there were no differences according to adjuvant chemotherapy use in overall survival or breast-cancer-specific survival after propensity matching. Adjuvant chemotherapy was associated with a lower risk of metastatic recurrence than no chemotherapy in the unmatched (adjusted hazard ratio 0.36, 95% confidence interval 0.19 to 0.68; p = 0.002) and propensity-matched patients (adjusted hazard ratio 0.43, 95% confidence interval 0.20 to 0.92; p = 0.03). Adjuvant chemotherapy improved the overall survival and breast-cancer-specific survival of patients with oestrogen-receptor-negative disease. (2) Mixed-methods research to develop a decision support intervention: an iterative process was used to develop two decision support interventions (each comprising a brief decision aid, a booklet and an online tool) specifically for older women facing treatment choices (endocrine therapy alone or surgery plus adjuvant endocrine therapy, and adjuvant chemotherapy or no chemotherapy) using several evidence sources (expert opinion, literature and patient interviews). The online tool was based on models developed using registry data from 23,842 patients and validated on an external data set of 14,526 patients. Mortality rates at 2 and 5 years differed by < 1% between predicted and observed values. (3) Cluster-randomised clinical trial of decision support tools: 46 UK breast units were randomised (intervention, n = 21; usual care, n = 25), recruiting 1339 women (intervention, n = 670; usual care, n = 669). There was no significant difference in global quality of life at 6 months post baseline (difference –0.20, 95% confidence interval –2.7 to 2.3; p = 0.90). In women offered a choice of endocrine therapy alone or surgery plus adjuvant endocrine therapy, knowledge about treatments was greater in the intervention arm than the usual care arm (94% vs. 74%; p = 0.003). Treatment choice was altered, with higher rates of endocrine therapy alone than of surgery in the intervention arm. Similarly, chemotherapy rates were lower in the intervention arm (endocrine therapy alone rate: intervention sites 21% vs. usual-care sites 15%, difference 5.5%, 95% confidence interval 1.1% to 10.0%; p = 0.02; adjuvant chemotherapy rate: intervention sites 10% vs. usual-care site 15%, difference 4.5%, 95% confidence interval 0.0% to 8.0%; p = 0.013). Survival was similar in both arms. (4) Health economic analysis: a probabilistic economic model was developed using registry and cohort study data. For most health and fitness strata, surgery plus adjuvant endocrine therapy had lower costs and returned more quality-adjusted life-years than endocrine therapy alone. However, for some women aged > 90 years, surgery plus adjuvant endocrine therapy was no longer cost-effective and generated fewer quality-adjusted life-years than endocrine therapy alone. The incremental benefit of surgery plus adjuvant endocrine therapy reduced with age and comorbidities. (5) Variation in practice: analysis of rates of surgery plus adjuvant endocrine therapy or endocrine therapy alone between the 56 breast units in the cohort study demonstrated significant variation in rates of endocrine therapy alone that persisted after adjustment for age, fitness and stage. Clinician preference was an important determinant of treatment choice.
Conclusions
This study demonstrates that, for older women with oestrogen-receptor-positive breast cancer, there is a cohort of women with a life expectancy of < 4 years for whom surgery plus adjuvant endocrine therapy may offer little benefit and simply have a negative impact on quality of life. The Age Gap decision tool may help make this shared decision. Similarly, although adjuvant chemotherapy offers little benefit and has a negative impact on quality of life for the majority of older women with oestrogen-receptor-positive breast cancer, for women with oestrogen-receptor-negative breast cancer, adjuvant chemotherapy is beneficial. The negative impacts of adjuvant chemotherapy on quality of life, although significant, are transient. This implies that, for the majority of fitter women aged ≥ 70 years, standard care should be offered.
Limitations
As with any observational study, despite detailed propensity score matching, residual bias cannot be excluded. Follow-up was at median 52 months for the cohort analysis. Longer-term follow-up will be required to validate these findings owing to the slow time course of oestrogen-receptor-positive breast cancer.
Future work
The online algorithm is now available (URL: https://agegap.shef.ac.uk/; accessed May 2022). There are plans to validate the tool and incorprate quality-of-life and 10-year survival outcomes.
Trial registration
This trial is registered as ISRCTN46099296.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Karen Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Sue Ward
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Geoff Holmes
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Collegiate Cresent Campus, Sheffield Hallam University, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Paul Richards
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Department of Health and Social Care Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Jasmine Breast Centre, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Riccardo Audisio
- Sahlgrenska Universitetssjukhuset, University of Gothenburg, Göteborg, Sweden
| | | | | | | | | | | | - Margot Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tracy Green
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Deirdre Revill
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humber Research Network Consumer Research Panel, Sheffield, UK
| | | | - Chris Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Matt Winter
- Breast Unit, Weston Park Hospital, Sheffield, UK
| | - Jay Naik
- Breast Unit, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Rishi Parmeshwar
- Breast Unit, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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Burton M, Krumbeck JA, Wu G, Tang S, Prem A, Gupta AK, Dawson TL. The adult microbiome of healthy and otitis patients: Definition of the core healthy and diseased ear microbiomes. PLoS One 2022; 17:e0262806. [PMID: 35073343 PMCID: PMC8786117 DOI: 10.1371/journal.pone.0262806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022] Open
Abstract
Otitis media (OM) and externa (OE) are painful, recurrent ear conditions. As most otitis publications focus on the bacterial content of childhood ears, there remains a dearth of information regarding the adult ear microbiome including both bacteria and fungi. This study compares the outer ear microbiome of healthy adults to adults affected by OE and OM using both intergenic-transcribed-spacer (ITS) and 16S-rDNA sequencing. The adult ear core microbiome consists of the prokaryote Cutibacterium acnes and the eukaryotic Malassezia arunalokei, M. globosa, and M. restricta. The healthy ear mycobiome is dominated by Malassezia and can be divided into two groups, one dominated by M. arunalokei, the other by M. restricta. Microbiome diversity and biomass varied significantly between healthy and diseased ears, and analyses reveal the presence of a potential mutualistic, protective effect of Malassezia species and C. acnes. The healthy ear core microbiome includes the bacteria Staphylococcus capitis and S. capitis/caprae, while the diseased ear core is composed of known bacterial and fungal pathogens including Aspergillus sp., Candida sp., Pseudomonas aeruginosa, S. aureus, and Corynebacterium jeikeium. The data presented highlight the need for early detection of the cause of otitis to direct more appropriate, efficient treatments. This will improve patient outcomes and promote improved antimicrobial stewardship.
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Affiliation(s)
- Maria Burton
- Zymo Research Corporation, Irvine, CA, United States of America
| | | | - Guangxi Wu
- Zymo Research Corporation, Irvine, CA, United States of America
| | - Shuiquan Tang
- Zymo Research Corporation, Irvine, CA, United States of America
| | - Aishani Prem
- Zymo Research Corporation, Irvine, CA, United States of America
| | - Aditya K. Gupta
- Mediprobe Research Inc., London, ON, Canada and University of Toronto, Toronto, ON, Canada
| | - Thomas L. Dawson
- Skin Research Institute, Singapore, Singapore
- Dept of Drug Discovery, College of Pharmacy, Medical University of South Carolina, Charleston, SC, United States of America
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7
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Daniels SL, Burton M, Lee MJ, Moug SJ, Kerr K, Wilson TR, Brown SR, Wyld L. Healthcare professional preferences in the health and fitness assessment and optimization of older patients facing colorectal cancer surgery. Colorectal Dis 2021; 23:2331-2340. [PMID: 34046988 DOI: 10.1111/codi.15758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
AIM There are few age- and fitness-specific, evidence-based guidelines for colorectal cancer surgery. The uptake of different assessment and optimization strategies is variable. The aim of this study was to explore healthcare professional opinion about these issues using a mixed methods design. METHODS Semi-structured qualitative interviews were undertaken with healthcare professionals from a single UK region involved in the treatment, assessment and optimization of colorectal surgery patients. Interviews were analysed using the framework approach. An online questionnaire survey was subsequently designed and disseminated to UK surgeons to quantitatively assess the importance of interview themes. Descriptive statistics were used to analyse questionnaire data. RESULTS Thirty-seven healthcare professionals out of 42 approached (response rate 88%) were interviewed across five hospitals in the south Yorkshire region. Three broad themes were developed: attitudes towards treatment of the older patient, methods of assessment of suitability and optimization strategies. The questionnaire was completed by 103 out of an estimated 256 surgeons (estimated response rate 40.2%). There was a difference in opinion regarding the role of major surgery in older patients, particularly when there is coexisting dementia. Assessment was not standardized. Access to optimization strategies was limited, particularly in the emergency setting. CONCLUSION There is wide variation in the process of assessment and provision of optimization strategies in UK practice. Lack of evidence-based guidelines, cost and time constraints restrict the development of services and pathways. Differences in opinion between surgeons towards patients with frailty or dementia may account for some of the variation in colorectal cancer outcomes.
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Affiliation(s)
- Sarah L Daniels
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Susan J Moug
- Royal Alexandra Hospital, Paisley, UK.,University of Glasgow, Glasgow, UK
| | - Karen Kerr
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tim R Wilson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
| | - Steven R Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
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8
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Morgan JL, Shrestha A, Reed MWR, Herbert E, Bradburn M, Walters SJ, Martin C, Collins K, Ward S, Holmes G, Burton M, Lifford K, Edwards A, Ring A, Robinson T, Chater T, Pemberton K, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Thomson AM, Gosney M, Hatton M, Green T, Revill D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeschwar R, Wyld L. Bridging the age gap in breast cancer: impact of omission of breast cancer surgery in older women with oestrogen receptor-positive early breast cancer on quality-of-life outcomes. Br J Surg 2021; 108:315-325. [PMID: 33760065 PMCID: PMC10364859 DOI: 10.1093/bjs/znaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary endocrine therapy may be an alternative treatment for less fit women with oestrogen receptor (ER)-positive breast cancer. This study compared quality-of-life (QoL) outcomes in older women treated with surgery or primary endocrine therapy. METHODS This was a multicentre, prospective, observational cohort study of surgery or primary endocrine therapy in women aged over 70 years with operable breast cancer. QoL was assessed using European Organisation for Research and Treatment of cancer QoL questionnaires QLQ-C30, -BR23, and -ELD14, and the EuroQol Five Dimensions 5L score at baseline, 6 weeks, and 6, 12, 18, and 24 months. Propensity score matching was used to adjust for baseline variation in health, fitness, and tumour stage. RESULTS The study recruited 3416 women (median age 77 (range 69-102) years) from 56 breast units. Of these, 2979 (87.2 per cent) had ER-positive breast cancer; 2354 women had surgery and 500 received primary endocrine therapy (125 were excluded from analysis due to inadequate data or non-standard therapy). Median follow-up was 52 months. The primary endocrine therapy group was older and less fit. Baseline QoL differed between the groups; the mean(s.d.) QLQ-C30 global health status score was 66.2(21.1) in patients who received primary endocrine therapy versus 77.1(17.8) among those who had surgery plus endocrine therapy. In the unmatched analysis, changes in QoL between 6 weeks and baseline were noted in several domains, but by 24 months most scores had returned to baseline levels. In the matched analysis, major surgery (mastectomy or axillary clearance) had a more pronounced adverse impact than primary endocrine therapy in several domains. CONCLUSION Adverse effects on QoL are seen in the first few months after surgery, but by 24 months these have largely resolved. Women considering surgery should be informed of these effects.
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Affiliation(s)
- J L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - E Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - K Collins
- Faculty of Health and Wellbeing, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - M Burton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Ring
- Department of Medical Oncology, Royal Marsden Hospital, London, UK
| | - T Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - R Audisio
- Department of Surgery, University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Brighton, UK
| | - A M Thomson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - M Gosney
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - M Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - T Green
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - D Revill
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - J Gath
- North Trent Cancer Research Network Consumer Research Panel, Sheffield, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Department of Breast Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - J Naik
- Department of General Surgery, Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeschwar
- Department of Breast Surgery, University Hospitals of Morecambe Bay, Lancaster, UK
| | - L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Burton M, Lifford KJ, Wyld L, Armitage F, Ring A, Nettleship A, Collins K, Morgan J, Reed MWR, Holmes GR, Bradburn M, Gath J, Green T, Revell D, Brain K, Edwards A. Process evaluation of the Bridging the Age Gap in Breast Cancer decision support intervention cluster randomised trial. Trials 2021; 22:447. [PMID: 34256828 PMCID: PMC8278730 DOI: 10.1186/s13063-021-05360-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Bridging the Age Gap in Breast Cancer research programme sought to improve treatment decision-making for older women with breast cancer by developing and testing, in a cluster randomised trial (n = 1339 patients), two decision support interventions (DESIs). Both DESIs were used in the intervention arm and each comprised an online risk prediction model, brief decision aid and information booklet. One DESI supported the decision to have either primary endocrine therapy (PET) or surgery with adjuvant therapies and the second supported the decision to have adjuvant chemotherapy after surgery or not. Methods Sixteen sites were randomly selected to take part in the process evaluation. Multiple methods of data collection were used. Medical Research Council (MRC) guidelines for the evaluation of complex interventions were used. Results Eighty-two patients, mean age 75.5 (range 70–93), provided data for the process evaluation. Seventy-three interviews were completed with patients. Ten clinicians from six intervention sites took part in telephone interviews. Dose: Ninety-one members of staff in the intervention arm received intervention training. Reach: The online tool was accessed on 324 occasions by 27 clinicians. Reasons for non-use of the online tool were commonly that the patient had already made a decision or that there was no online access in the clinic. Of the 32 women for whom there were data available, fifteen from the intervention arm and six from the usual care arm were offered a choice of treatment. Fidelity: Clinicians used the online tool in different ways, with some using it during the consultation and others checking the online survival estimates before the consultation. Adaptation: There was evidence of adaptation when using the DESIs. A lack of infrastructure, e.g. internet access, was a barrier to the use of the online tool. The brief decision aid was rarely used. Mediators: Shared decision-making: Most patients felt able to contribute to decision-making and expressed high levels of satisfaction with the process. Participants’ responses to intervention: Six patients reported the DESIs to be very useful, one somewhat useful and two moderately useful. Conclusions Clinicians who participated were mainly supportive of the interventions and had attempted some adaptations to make the interventions applicable, but there were practical and engagement barriers that led to sub-optimal adoption in routine practice. Trial registration ISRCTN46099296. Registered on 11 August 2016—retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05360-z.
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Affiliation(s)
- Maria Burton
- College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Kate J Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Fiona Armitage
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Alistair Ring
- Breast Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Karen Collins
- College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Malcolm W R Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, University of Sheffield, ScHARR, 30 Regent Street, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel UK, Sheffield, UK
| | - Tracy Green
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel UK, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel UK, Sheffield, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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10
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Battisti NML, Hatton MQ, Reed MWR, Herbert E, Morgan JL, Bradburn M, Simcock R, Walters SJ, Collins KA, Ward SE, Holmes GR, Burton M, Lifford KJ, Edwards A, Robinson TG, Martin C, Chater T, Pemberton KJ, Brennan A, Leung Cheung K, Todd A, Audisio RA, Wright J, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeshwar R, Gosney MA, Thompson AM, Wyld L, Ring A. Observational cohort study in older women with early breast cancer: Use of radiation therapy and impact on health-related quality of life and mortality. Radiother Oncol 2021; 161:166-176. [PMID: 34146616 DOI: 10.1016/j.radonc.2021.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy reduces in-breast recurrence risk in early breast cancer (EBC) in older women. This benefit may be small and should be balanced against treatment effect and holistic patient assessment. This study described treatment patterns according to fitness and impact on health-related quality-of-life (HRQoL). METHODS A multicentre, observational study of EBC patients aged ≥ 70 years, undergoing breast-conserving surgery (BCS) or mastectomy, was undertaken. Associations between radiotherapy use, surgery, clinico-pathological parameters, fitness based on geriatric parameters and treatment centre were determined. HRQoL was measured using the European Organisation for the Research and Treatment of Cancer (EORTC) questionnaires. RESULTS In 2013-2018 2811 women in 56 UK study centres underwent surgery with a median follow-up of 52 months. On multivariable analysis, age and tumour risk predicted radiotherapy use. Among healthier patients (based on geriatric assessments) with high-risk tumours, 534/613 (87.1%) having BCS and 185/341 (54.2%) having mastectomy received radiotherapy. In less fit individuals with low-risk tumours undergoing BCS, 149/207 (72.0%) received radiotherapy. Radiotherapy effects on HRQoL domains, including breast symptoms and fatigue were seen, resolving by 18 months. CONCLUSION Radiotherapy use in EBC patients ≥ 70 years is affected by age and recurrence risk, whereas geriatric parameters have limited impact regardless of type of surgery. There was geographical variation in treatment, with some fit older women with high-risk tumours not receiving radiotherapy, and some older, low-risk, EBC patients receiving radiotherapy after BCS despite evidence of limited benefit. The impact on HRQoL is transient.
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Matthew Q Hatton
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Richard Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Karen A Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Sue E Ward
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kirsty J Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, Sheffield, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Matthew C Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, UK
| | | | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
| | - Alistair Ring
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
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11
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Daniels SL, Lee MJ, Moug S, Wilson TR, Burton M, George J, Brown SR, Wyld L. Protocol for a multi-centre observational and mixed methods pilot study to identify factors predictive of poor functional recovery after major gastrointestinal surgery and strategies to enhance uptake of perioperative optimization: Optimizing the care and treatment pathways for older patients facing major gastrointestinal surgery (OCTAGON). Colorectal Dis 2021; 23:1552-1561. [PMID: 33638249 DOI: 10.1111/codi.15603] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/21/2021] [Accepted: 02/21/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION National datasets report large variations in outcomes from older people (≥65 years) between different UK surgical units. This implies that not all patients receive the same level of care or access to resources, such as rehabilitation or allied health professional input. This might impact functional decline. AIMS Our aim is to evaluate the baseline status of older patients facing major gastrointestinal surgery and the impact of variation in perioperative assessment and provision of perioperative support on functional outcomes. Patients' experiences and views of assessment and optimization will be explored via integrated qualitative semi-structured interviews. METHODS AND ANALYSIS This multi-centre, pilot cohort study will include patients ≥65 years presenting via both elective and emergency pathways at three to five South Yorkshire NHS hospitals (Clinical Trials registration NCT04545125). The primary outcome is functional recovery measured using the World Health Organization Disability Assessment Schedule 2.0 at 6 weeks post-operation. Secondary outcomes include feasibility, quality of life, length of stay and complication rate. An opportunistic sample size of 120 has been estimated and will inform the design of a future, adequately powered study. For the qualitative study, 20-30 semi-structured patient interviews will be undertaken with patients from the cohort study to explore experiences of assessment and optimization. Interviews will be digitally recorded, transcribed verbatim and analysed according to the framework approach. ETHICS AND DISSEMINATION This study has been approved by the National Health Service Research Ethics Committee and is registered centrally with Health Research Authority. It has been adopted by the National Institute for Health Research Portfolio scheme. Dissemination will be via international and national surgical and geriatric conferences.
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Affiliation(s)
- Sarah L Daniels
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Susan Moug
- Royal Alexandra Hospital, NHS Greater Glasgow and the Clyde, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Tim R Wilson
- University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw, NHS Foundation Trust, Doncaster, UK
| | | | - Jayan George
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven R Brown
- General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
| | - Lynda Wyld
- University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw, NHS Foundation Trust, Doncaster, UK
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Ring A, Battisti NML, Reed MWR, Herbert E, Morgan JL, Bradburn M, Walters SJ, Collins KA, Ward SE, Holmes GR, Burton M, Lifford K, Edwards A, Robinson TG, Martin C, Chater T, Pemberton KJ, Brennan A, Cheung KL, Todd A, Audisio RA, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeshwar R, Gosney MA, Hatton MQ, Thompson AM, Wyld L. Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer. Br J Cancer 2021; 125:209-219. [PMID: 33972747 PMCID: PMC8292504 DOI: 10.1038/s41416-021-01388-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/20/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. METHODS A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage. RESULTS Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19-0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20-0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08-0.49];BCSS: HR 0.12 [95% CI 0.03-0.44]).Transient negative quality-of-life impacts were observed. CONCLUSIONS Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient. TRIAL REGISTRATION ISRCTN 46099296.
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Affiliation(s)
- Alistair Ring
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK & Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Karen A Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Sue E Ward
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty J Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | | | - Richard Simcock
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - Tracey Green
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Deirdre Revell
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, Lancashire, UK
| | | | | | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK.
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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MacDonald C, Burton M, Carachi R, O'Toole S. Why adolescents delay with presentation to hospital with acute testicular pain: A qualitative study. J Pediatr Surg 2021; 56:614-619. [PMID: 32828543 DOI: 10.1016/j.jpedsurg.2020.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE Adolescents have poor outcomes following testicular torsion directly attributable to delay from onset of symptoms to presentation to hospital. The aim of this study was to investigate the barriers to urgent presentation in young men. METHODS Semistructured interviews were undertaken with young men (11-19 years), using a topic guide exploring issues surrounding testicular pain and health. Thematic analysis was undertaken using a framework approach. RESULTS Twenty-seven adolescents were recruited, data saturation was reached at sixteen participants, and median age was 13.5 years (range 11-18). The process by which an adolescent gets to hospital with testicular pain is slow. They must recognize the problem and alert their parents, who then use a 'watch and wait' policy to assess need for medical review, often leaving it 'a day' or overnight. Adolescent males do not engage with healthcare services independently of their parents. Additional factors preventing early presentation include: absence of knowledge about testicular pathology from adolescents and their parents; concern from the young people about raising a false alarm and family concerns about burdening healthcare services. CONCLUSIONS Recommendations include designing a testicular health education campaign for young men and educating parents regarding the medical conditions where a 'watch and wait' policy may be harmful to their child. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Caroline MacDonald
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland; Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 4TF, Scotland.
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, S1 1WB, UK
| | - Robert Carachi
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
| | - Stuart O'Toole
- School of MVLS, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland; Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 4TF, Scotland
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Battisti NML, Reed MWR, Herbert E, Morgan JL, Collins KA, Ward SE, Holmes GR, Bradburn M, Walters SJ, Burton M, Lifford K, Edwards A, Robinson TG, Martin C, Chater T, Pemberton KJ, Shrestha A, Brennan A, Cheung KL, Todd A, Audisio RA, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter MC, Naik J, Parmeshwar R, Gosney MA, Hatton MQ, Thompson AM, Wyld L, Ring A. Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer. Eur J Cancer 2021; 144:269-280. [PMID: 33373871 PMCID: PMC7896040 DOI: 10.1016/j.ejca.2020.11.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. MATERIALS AND METHODS A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. RESULTS Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts. CONCLUSIONS The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy. TRIAL REGISTRATION NUMBER ISRCTN 46099296.
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/psychology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/psychology
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/psychology
- Female
- Follow-Up Studies
- Humans
- Prognosis
- Prospective Studies
- Quality of Life
- Surveys and Questionnaires
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Department of Medicine, Breast Unit the Royal Marsden Hospital NHS Foundation Trust, London, UK; Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | | | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Karen A Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, UK
| | - Sue E Ward
- Health Economics and Decision Science Section, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Geoffrey R Holmes
- Health Economics and Decision Science Section, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty J Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Alan Brennan
- Health Economics and Decision Science Section, School for Health and Related Research (ScHARR), University of Sheffield, UK
| | - Kwok L Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
| | - Juliet Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Richard Simcock
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - Tracey Green
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Deirdre Revell
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, Cottingham, UK
| | - Kieran Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, Lancashire, UK
| | | | | | | | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
| | - Alistair Ring
- Department of Medicine, Breast Unit the Royal Marsden Hospital NHS Foundation Trust, London, UK; Breast Cancer Research Division, The Institute of Cancer Research, London, UK
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Morgan JL, Holmes G, Ward S, Martin C, Burton M, Walters SJ, Cheung KL, Audisio RA, Reed MW, Wyld L. Observational cohort study to determine the degree and causes of variation in the rate of surgery or primary endocrine therapy in older women with operable breast cancer. Eur J Surg Oncol 2021; 47:261-268. [PMID: 33046279 PMCID: PMC7526638 DOI: 10.1016/j.ejso.2020.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the UK there is variation in the treatment of older women with breast cancer, with up to 40% receiving primary endocrine therapy (PET), which is associated with inferior survival. Case mix and patient choice may explain some variation in practice but clinician preference may also be important. METHODS A multicentre prospective cohort study of women aged >70 with operable breast cancer. Patient characteristics (health status, age, tumour characteristics, treatment allocation and decision-making preference) were analysed to identify whether treatment variation persisted following case-mix adjustment. Expected case-mix adjusted surgery rates were derived by logistic regression using the variables age, co-morbidity, tumour stage and grade. Concordance between patients' preferred and actual decision-making style was assessed and associations between age, treatment and decision-making style calculated. RESULTS Women (median age 77, range 70-102) were recruited from 56 UK breast units between 2013 and 2018. Of 2854/3369 eligible women with oestrogen receptor positive breast cancer, 2354 were treated with surgery and 500 with PET. Unadjusted surgery rates varied between hospitals, with 23/56 units falling outside the 95% confidence intervals on funnel plots. Adjusting for case mix reduced, but did not eliminate, this variation between hospitals (10/56 units had practice outside the 95% confidence intervals). Patients treated with PET had more patient-centred decisions compared to surgical patients (42.2% vs 28.4%, p < 0.001). CONCLUSIONS This study demonstrates variation in treatment selection thresholds for older women with breast cancer. Health stratified guidelines on thresholds for PET would help reduce variation, although patient preference should still be respected.
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Affiliation(s)
- Jenna L Morgan
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
| | - Geoff Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Stephen J Walters
- Clinical Trials Research Unit, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok Leung Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Riccardo A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345, Göteborg, Sweden
| | | | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
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Martin C, Shrestha A, Morgan J, Bradburn M, Herbert E, Burton M, Todd A, Walters S, Ward S, Holmes G, Reed M, Collins K, Robinson TG, Ring A, Cheung KL, Audisio R, Gath J, Revell D, Green T, Lifford K, Edwards A, Chater T, Pemberton K, Wyld L. Treatment choices for older women with primary operable breast cancer and cognitive impairment: Results from a prospective, multicentre cohort study. J Geriatr Oncol 2021; 12:705-713. [PMID: 33353856 DOI: 10.1016/j.jgo.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The presence of dementia co-existing with a diagnosis of breast cancer may render management more challenging and have a substantial impact on oncological outcomes. The aim of this study was to examine the treatment and outcomes of older women with co-existing cognitive impairment and primary breast cancer. MATERIALS AND METHODS A prospective, multicentre UK cohort study of women aged 70 years or over with primary operable breast cancer. Patients with and without cognitive impairment were compared to assess differences in treatment and survival outcomes. RESULTS In total, 3416 women were recruited between 2013 and 2018. Of these, 478 (14%) had a diagnosis of dementia or cognitive impairment, subcategorised as mild, moderate and severely impaired. Up to 85% of women with normal cognition underwent surgery compared to 74%, 61% and 40% with mild, moderate, and severe impairment (p = 0.001). Among women at higher risk of recurrence, the uptake of chemotherapy was 25% for cognitively normal women compared to 20%, 22% and 12% for mild, moderate and severe impairment groups (p = 0.222). Radiotherapy use was similar in the subgroups. Although patients with cognitive impairment had shorter overall survival (HR: 2.10, 95% CI: 1.77-2.50, p < 0.001), there were no statistically significant differences in breast cancer specific or progression-free survival. CONCLUSION Cognitive impairment appears to play a significant part in deciding how to treat older women with breast cancer. Standard treatment may be over-treatment for some women with severe dementia and careful consideration must be given to a more tailored approach in these women.
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Affiliation(s)
- Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | - Stephen Walters
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Geoffrey Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, The Glenfield Hospital, Leicester LE3 9QP, UK
| | - Alistair Ring
- Breast Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK
| | - Riccardo Audisio
- Department of Surgery, Institute of Clinical Sciences, Blå Stråket 5, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
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18
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Nightingale J, Burton M, Appleyard R, Sevens T, Campbell S. Retention of radiographers: A qualitative exploration of factors influencing decisions to leave or remain within the NHS. Radiography (Lond) 2021; 27:795-802. [PMID: 33423914 DOI: 10.1016/j.radi.2020.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In many countries a widening imbalance exists between radiographer workforce supply and demand. Improving retention is a rapid method of workforce expansion which is gaining importance with policy makers and providers. To better understand the current leaver profile, this study aimed to identify why radiographers leave the NHS early, and what incentives are important in their decision to stay. METHODS A qualitative framework methodology used semi-structured telephone interviews to explore the perspectives of radiography managers, radiographers who have left the NHS, and those considering leaving. Purposive sampling ensured representation across radiography professional groups, geographical and organisational diversity, and stages of career. RESULTS Three over-arching themes were identified across all radiographer professional groups (n = 44): 1) Challenging working patterns and the impact on employee health and wellbeing; 2) Lack of flexibility in working terms and conditions; 3) Lack of timely career progression and access to CPD, and the need to feel valued. Radiographers were keen to express how they 'loved being a radiographer'; small concessions and changes to workplace culture might be the incentive to remain in radiography that some were clearly searching for. Manager participants recognised the need to offer greater flexibility in working patterns but this was challenging within financial and service delivery constraints. CONCLUSIONS While some influencing factors varied between radiographer professional groups, the three themes were consistent across participants. Failure to address these concerns will exacerbate the loss of experienced and highly trained staff from the NHS at a time when demand for services continues to rise. IMPACT ON PRACTICE Recommendations are presented related to three primary themes which will be a catalyst for sharing of best practice between radiology and radiotherapy centres.
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Affiliation(s)
- J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK.
| | - M Burton
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - R Appleyard
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - T Sevens
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - S Campbell
- Breast Imaging Department, Yeovil District Hospital NHS Foundation Trust, UK
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19
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Wyld L, Reed MWR, Morgan J, Collins K, Ward S, Holmes GR, Bradburn M, Walters S, Burton M, Herbert E, Lifford K, Edwards A, Ring A, Robinson T, Martin C, Chater T, Pemberton K, Shrestha A, Brennan A, Cheung KL, Todd A, Audisio R, Wright J, Simcock R, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Patnick J, Gosney M, Hatton M, Thomson AM. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer 2020; 142:48-62. [PMID: 33220653 PMCID: PMC7789991 DOI: 10.1016/j.ejca.2020.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
Background Age-related breast cancer treatment variance is widespread with many older women having primary endocrine therapy (PET), which may contribute to inferior survival and local control. This propensity-matched study determined if a subgroup of older women may safely be offered PET. Methods Multicentre, prospective, UK, observational cohort study with propensity-matched analysis to determine optimal allocation of surgery plus ET (S+ET) or PET in women aged ≥70 with breast cancer. Data on fitness, frailty, cancer stage, grade, biotype, treatment and quality of life were collected. Propensity-matching (based on age, health status and cancer stage) adjusted for allocation bias when comparing S+ET with PET. Findings A total of 3416 women (median age 77, range 69–102) were recruited from 56 breast units—2854 (88%) had ER+ breast cancer: 2354 had S+ET and 500 PET. Median follow-up was 52 months. Patients treated with PET were older and frailer than patients treated with S+ET. Unmatched overall survival was inferior in the PET group (hazard ratio, (HR) 0.27, 95% confidence interval (CI) 0.23–0.33, P < 0.001). Unmatched breast cancer–specific survival (BCSS) was also inferior in patients treated with PET (HR: 0.41, CI: 0.29–0.58, P < 0.001 for BCSS). In the matched analysis, PET was still associated with an inferior overall survival (HR = 0.72, 95% CI: 0.53–0.98, P = 0.04) but not BCSS (HR = 0.74, 95% CI: 0.40–1.37, P = 0.34) although at 4–5 years subtle divergence of the curves commenced in favor of surgery. Global health status diverged at certain time points between groups but over 24 months was similar when adjusted for baseline variance. Interpretation For the majority of older women with early ER+ breast cancer, surgery is oncologically superior to PET. In less fit, older women, with characteristics similar to the matched cohort of this study (median age 81 with higher comorbidity and functional impairment burdens, the BCSS survival differential disappears at least out to 4–5 year follow-up, suggesting that for those with less than 5-year predicted life-expectancy (>90 years or >85 with comorbidities or frailty) individualised decision making regarding PET versus S+ET may be appropriate and safe to offer. The Age Gap online decision tool may support this decision-making process (https://agegap.shef.ac.uk/). Trial registration number ISRCTN: 46099296. Propensity matched study of women >70 with breast cancer comparing surgery or PET Unmatched analysis found surgery improves overall & disease-specific survival. Matched analysis (stage, age, health, frailty) found similar disease-specific survival Surgery led to adverse events in 19% & negative impacts on QoL and physical function Less fit women >85 may be offered PET to reduce morbidity, without survival detriment
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Affiliation(s)
- Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | | | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Karen Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Sue Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Geoffrey R Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Maria Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Cresent Campus, Sheffield, UK
| | - Esther Herbert
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kate Lifford
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Alistair Ring
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, UK
| | - Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Alan Brennan
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, UK
| | - Kwok L Cheung
- University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Annaliza Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Riccardo Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, 41345 Göteborg, Sweden
| | - Juliet Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - Tracy Green
- Yorkshire and Humber Consumer Research Panel, UK
| | | | - Jacqui Gath
- Yorkshire and Humber Consumer Research Panel, UK
| | - Kieran Horgan
- Dept of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Prescott Street, Liverpool L7 8 XP, UK
| | - Matt Winter
- Weston Park Hospital, Whitham Rd, Sheffield S10 2SJ, UK
| | - Jay Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Aberford Rd, Wakefield, UK
| | - Rishi Parmeshwar
- University Hospitals of Morecambe Bay, Royal Lancashire Infirmary Ashton Road, Lancaster, Lancashire, LA1 4RP, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Margot Gosney
- Royal Berkshire NHS Foundation Trust, Reading, RG1 5AN, UK
| | | | - Alastair M Thomson
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
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Wyld L, Reed M, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Ring A, Martin C, Shrestha A, Nettleship A, Brown M, Richards P, Todd A, Harder H, Brain K. Cluster randomised trial to evaluate the clinical benefits of decision support interventions for older women with operable breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30545-1] [Citation(s) in RCA: 1] [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: 11/30/2022]
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21
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Petersen JK, Boldt HB, Sørensen MD, Blach S, Dahlrot RH, Hansen S, Burton M, Thomassen M, Kruse T, Poulsen FR, Andreasen L, Hager H, Ulhøi BP, Lukacova S, Reifenberger G, Kristensen BW. Targeted next-generation sequencing of adult gliomas for retrospective prognostic evaluation and up-front diagnostics. Neuropathol Appl Neurobiol 2020; 47:108-126. [PMID: 32696543 DOI: 10.1111/nan.12645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 01/03/2023]
Abstract
AIMS We aimed to reclassify a population-based cohort of 529 adult glioma patients to evaluate the prognostic impact of the 2016 World Health Organization (WHO) central nervous system tumour classification. Moreover, we evaluated the feasibility of gene panel next-generation sequencing (NGS) in daily diagnostics of 225 prospective glioma patients. METHODS The retrospective cohort was reclassified according to WHO 2016 criteria by immunohistochemistry for IDH-R132H, fluorescence in situ hybridization for 1p/19q-codeletion and gene panel NGS. All tumours of the prospective cohort were subjected to NGS analysis up-front. RESULTS The entire population-based cohort was successfully reclassified according to WHO 2016 criteria. NGS results were obtained for 98% of the prospective patients. Survival analyses in the population-based cohort confirmed three major prognostic subgroups, that is, isocitrate dehydrogenase (IDH)-mutant and 1p/19q-codeleted oligodendrogliomas, IDH-mutant astrocytomas and IDH-wildtype glioblastomas. The distinction between WHO grade II and III was prognostic in patients with IDH-mutant astrocytoma. The survival of patients with IDH-wildtype diffuse astrocytomas carrying TERT promoter mutation and/or EGFR amplification overlapped with the poor survival of IDH-wildtype glioblastoma patients. CONCLUSIONS Gene panel NGS proved feasible in daily diagnostics. In addition, our study confirms the prognostic role of glioma classification according to WHO 2016 in a large population-based cohort. Molecular features of glioblastoma in IDH-wildtype diffuse glioma were linked to poor survival corresponding to IDH-wildtype glioblastoma patients. The distinction between WHO grade II and III retained prognostic significance in patients with IDH-mutant diffuse astrocytic gliomas.
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Affiliation(s)
- J K Petersen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H B Boldt
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M D Sørensen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Blach
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - R H Dahlrot
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - S Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark
| | - M Burton
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - M Thomassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - T Kruse
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - F R Poulsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - L Andreasen
- Department of Pathology, Vejle Hospital, Vejle, Denmark
| | - H Hager
- Department of Pathology, Vejle Hospital, Vejle, Denmark
| | - B P Ulhøi
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - S Lukacova
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - G Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - B W Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Morgan J, Holmes G, Ward S, Martin C, Burton M, Audisio R, Leung-Cheung K, Ring A, Reed M, Wyld L. P065: "Bridging the age gap in breast cancer": An analysis of the decision-making preferences of older women with operable breast cancer in the UK. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2020.03.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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George J, Morgan J, Martin C, Shrestha A, Sue W, Holmes G, Bradburn M, Burton M, Chater T, Pemberton K, Nettleship A, Walters S, Ring A, Robinson T, Cheung KL, Audisio R, Reed M, Wyld L, Bridging the Age Gap Trial Management Group. Bridging the Age Gap in Breast Cancer - Analysis of the Complication Rates of Surgery in Older Women. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Probst H, Barry J, Clough H, Lindley M, Mather R, Newton H, Rosbottom K, Ulman J, Willis J, Yates S, Burton M. Resource to prepare patients for deep inspiration breath hold: the RESPIRE project. Radiography (Lond) 2020. [DOI: 10.1016/j.radi.2019.11.027] [Citation(s) in RCA: 1] [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: 10/25/2022]
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25
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Chen HW, Von Euw E, Millan P, Fresco R, Carrez S, Afenjar K, Fung H, Burton M, Santiago A, Guzman R, Villalobos I, Press M, Eiermann W, Slamon D. Results from TRIO030, a pre-surgical tissue-acquisition study to evaluate molecular alterations in human breast cancer tissue following short-term exposure to the androgen receptor antagonist darolutamide. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Shrestha A, Martin C, Burton M, Walters S, Collins K, Wyld L. Quality of life versus length of life considerations in cancer patients: A systematic literature review. Psychooncology 2019. [PMID: 30838697 DOI: 10.1002/pon.505416] [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] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Patients with cancer face difficult decisions regarding treatment and the possibility of trading quality of life (QoL) for length of life (LoL). Little information is available regarding patients' preferences and attitudes toward their cancer treatment and the personal costs they are prepared to exchange to extend their life. The aim of this review is to determine the complex trade-offs and underpinning factors that make patients with cancer choose quality over quantity of life. METHODS A systematic review of the literature was conducted using MeSH terms: cancer, longevity or LoL, QoL, decision making, trade-off, and health utility. Articles retrieved were published between 1942 and October 2018. RESULTS Out of 4393 articles, 30 were included in this review. Older age, which may be linked to declining physical status, was associated with a preference for QoL over LoL. Younger patients were more likely to undergo aggressive treatment to increase survival years. Preference for QoL and LoL was not influenced by gender, education, religion, having children, marital status, or type of cancer. Patients with better health valued LoL and inversely those with poorer physical status preferred QoL. CONCLUSION Baseline QoL and future expectations of life seem to be key determinants of preference for QoL versus LoL in cancer patients. In-depth studies are required to understand these trade-offs and the compromises patients are willing to make regarding QoL or LoL, especially in older patients with naturally limited life expectancy.
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Affiliation(s)
- Anne Shrestha
- Department of Oncology and Metabolism, University of Sheffield, Sheffield
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield
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27
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Shrestha A, Martin C, Burton M, Walters S, Collins K, Wyld L. Quality of life versus length of life considerations in cancer patients: A systematic literature review. Psychooncology 2019; 28:1367-1380. [PMID: 30838697 PMCID: PMC6619389 DOI: 10.1002/pon.5054] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Patients with cancer face difficult decisions regarding treatment and the possibility of trading quality of life (QoL) for length of life (LoL). Little information is available regarding patients' preferences and attitudes toward their cancer treatment and the personal costs they are prepared to exchange to extend their life. The aim of this review is to determine the complex trade-offs and underpinning factors that make patients with cancer choose quality over quantity of life. METHODS A systematic review of the literature was conducted using MeSH terms: cancer, longevity or LoL, QoL, decision making, trade-off, and health utility. Articles retrieved were published between 1942 and October 2018. RESULTS Out of 4393 articles, 30 were included in this review. Older age, which may be linked to declining physical status, was associated with a preference for QoL over LoL. Younger patients were more likely to undergo aggressive treatment to increase survival years. Preference for QoL and LoL was not influenced by gender, education, religion, having children, marital status, or type of cancer. Patients with better health valued LoL and inversely those with poorer physical status preferred QoL. CONCLUSION Baseline QoL and future expectations of life seem to be key determinants of preference for QoL versus LoL in cancer patients. In-depth studies are required to understand these trade-offs and the compromises patients are willing to make regarding QoL or LoL, especially in older patients with naturally limited life expectancy.
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Affiliation(s)
- Anne Shrestha
- Department of Oncology and MetabolismUniversity of SheffieldSheffield
| | - Charlene Martin
- Department of Oncology and MetabolismUniversity of SheffieldSheffield
| | - Maria Burton
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffield
| | - Stephen Walters
- School of Health and Related ResearchUniversity of SheffieldSheffield
| | - Karen Collins
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffield
| | - Lynda Wyld
- Department of Oncology and MetabolismUniversity of SheffieldSheffield
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Morgan J, George J, Ward S, Holmes G, Burton M, Chater T, Bradburn M, Martin C, Shrestha A, Cheung KL, Audisio R, Reed M, Wyld L. 05. Bridging the Age Gap in Breast Cancer - analysis of the impact of Comorbidity, Dementia and Frailty on the rates of surgery in older women. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.01.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Martin C, Shrestha A, Burton M, Collins K, Wyld L. How are caregivers involved in treatment decision making for older people with dementia and a new diagnosis of cancer? Psychooncology 2019; 28:1197-1206. [PMID: 30908755 PMCID: PMC6563536 DOI: 10.1002/pon.5070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore how caregivers are involved in making treatment decisions for older people living with dementia and a new diagnosis of cancer. METHOD A systematic review of PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases was conducted. Studies recruiting formal or informal caregivers for older people with dementia and a diagnosis of cancer were considered for inclusion. RESULTS Of 1761 articles screened, 36 full texts were assessed for eligibility, and six were included in the review. This review has identified that health care professionals (HCPs) are often unaware of the coexistence or severity of dementia in cancer patients, and therefore fail to properly address care needs as a result. While caregivers are relied on to help make decisions, they have unmet information needs and feel excluded from decision-making. CONCLUSION Treatment decision making in the context of older adults with dementia and a new diagnosis of cancer needs further research. This will help HCPs to understand their needs and improve the experience of decision making for both caregivers and the people that they care for.
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Affiliation(s)
- Charlene Martin
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
| | - Anne Shrestha
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
| | - Maria Burton
- Department of Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - Karen Collins
- Department of Health and Social Care Research, Sheffield Hallam University, Sheffield
| | - Lynda Wyld
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield
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Burton M, Szabo-Pardi T, Garner K, Tierney J, Price T. Uncovering Cell-Specific Mechanisms in Sex Differences in TLR4-Dependent Pain. The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.016] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Watt S, Hasselbalch H, Skov V, Kjær L, Thomassen M, Kruse T, Burton M, Gögenur I. Whole blood gene expression profiling in patients undergoing colon cancer surgery identifies differential expression of genes involved in immune surveillance, inflammation and carcinogenesis. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Lifford KJ, Edwards A, Burton M, Harder H, Armitage F, Morgan JL, Caldon L, Balachandran K, Ring A, Collins K, Reed M, Wyld L, Brain K. Efficient development and usability testing of decision support interventions for older women with breast cancer. Patient Prefer Adherence 2019; 13:131-143. [PMID: 30679905 PMCID: PMC6338238 DOI: 10.2147/ppa.s178347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Around one-third of breast cancers diagnosed every year in the UK are in women aged ≥70 years. However, there are currently no decision support interventions (DESIs) for older women who have a choice between primary endocrine therapy and surgery followed by adjuvant endocrine therapy (surgery+endocrine therapy), or who can choose whether or not to have chemotherapy following surgery. There is also little evidence-based guidance specifically on the management of these older patients. A large UK cohort study is currently underway to address this lack of evidence and to develop two DESIs to facilitate shared decision-making with older women about breast cancer treatments. Here, we present the development and initial testing of these two DESIs. METHODS An initial prototype DESI was developed for the choice of primary endocrine therapy or surgery+endocrine therapy. Semi-structured interviews with healthy volunteers and patients explored DESI acceptability, usability, and utility. A framework approach was used for analysis. A second DESI for the choice of having chemotherapy or not was subsequently developed based on more focused development and testing. RESULTS Participants (n=22, aged 75-94 years, 64% healthy volunteers, 36% patients) found the primary endocrine therapy /surgery+endocrine therapy DESI acceptable, and contributed to improved wording and illustrations to address misunderstandings. The chemotherapy DESI (tested with 14 participants, aged 70-87 years, 57% healthy volunteers, 43% patients) was mostly understandable, however, suggestions for rewording sections were made. Most participants considered the DESIs helpful, but highlighted the importance of complementary discussions with clinicians. CONCLUSION It was possible to use a template DESI to efficiently create a second prototype for a different treatment option (chemotherapy). Both DESIs were acceptable and considered helpful to support/augment consultations. Development of acceptable additional DESIs for similar target populations using simplified methods may be an efficient way to develop future DESIs. Further research is needed to test the effectiveness of the DESIs.
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Affiliation(s)
- Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Helena Harder
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fiona Armitage
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lisa Caldon
- Department of General Surgery, The Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Alistair Ring
- Breast Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK,
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Gorbunov B, Burton M, Paling S. Zeptoampere electric current measurements with molecular tagging. Chem Phys 2018. [DOI: 10.1016/j.chemphys.2018.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kay SD, Carlsen AL, Voss A, Burton M, Diederichsen ACP, Poulsen MK, Heegaard NHH. Associations of circulating cell-free microRNA with vasculopathy and vascular events in systemic lupus erythematosus patients. Scand J Rheumatol 2018; 48:32-41. [DOI: 10.1080/03009742.2018.1450892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- SD Kay
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - AL Carlsen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - M Burton
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit and Human Genetics, University of Southern Denmark, Odense, Denmark
| | - ACP Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - MK Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - NHH Heegaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Swain F, Baidya S, Casey J, Francis R, Pahn G, Burton M, Hassell P, Havelberg K, Jones G, Mahon D, Holdsworth R. Thrombocytopenia secondary to passive transfer of anti-HPA 1a antibodies from male donor plasma. Transfus Med 2018; 28:398-399. [PMID: 29873421 DOI: 10.1111/tme.12542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/19/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- F Swain
- Pathology Queensland, Central Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - S Baidya
- Australian Red Cross Blood Service, Brisbane, Australia
| | - J Casey
- The Townsville Hospital, Douglas, Australia
| | - R Francis
- Princess Alexandra Hospital, Brisbane, Australia
| | - G Pahn
- Australian Red Cross Blood Service, Brisbane, Australia
| | - M Burton
- Australian Red Cross Blood Service, Brisbane, Australia
| | - P Hassell
- Australian Red Cross Blood Service, Brisbane, Australia
| | - K Havelberg
- Australian Red Cross Blood Service, Brisbane, Australia
| | - G Jones
- Australian Red Cross Blood Service, Brisbane, Australia
| | - D Mahon
- Australian Red Cross Blood Service, Brisbane, Australia
| | - R Holdsworth
- Australian Red Cross Blood Service, Brisbane, Australia
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Shrestha A, Martin C, Burton M, Collins K, Holmes G, Ward S, Audisio R, Chater T, Pemberton K, Robinson T, Cheung K, Ring A, Walters S, Reed M, Gath J, Green T, Revell D, Wyld L. Comparison of quality of life of older women treated with surgery or primary endocrine therapy for early breast cancer: propensity score matched analysis of a large prospective multicentre cohort study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30261-2] [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: 10/17/2022]
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Eby E, Johnson M, Bengtson L, Burton M, Hinnenthal J. 540Predictors of cardiac implantable electronic device infection from a large United States healthcare organisation. Europace 2018. [DOI: 10.1093/europace/euy015.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Eby
- Medtronic, plc, Mounds View, United States of America
| | - M Johnson
- Optum, Eden Prairie, United States of America
| | - L Bengtson
- Optum, Eden Prairie, United States of America
| | - M Burton
- Medtronic, plc, Mounds View, United States of America
| | - J Hinnenthal
- Medtronic, plc, Mounds View, United States of America
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O'Leary DP, Carter M, Wijewardene D, Burton M, Waldron D, Condon E, Coffey JC, Peirce C. The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial. Tech Coloproctol 2017; 21:863-868. [PMID: 29149428 DOI: 10.1007/s10151-017-1713-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ileostomy reversal is associated with surgical site infection (SSI) rates as high as 37%. Recent literature suggests that employing a purse-string approximation (PSA) of the reversal wound reduces this rate of SSI. Thus we wished to perform a randomised controlled trial to compare SSI rates in purse-string versus linear closure (PLC) wounds following ileostomy reversal. METHODS A randomised, controlled trial was conducted at University Hospital Limerick. Sixty-one patients undergoing ileostomy reversal were included. Thirty-four patients were randomised to PSA and 27 patients to linear closure. The primary endpoint was incidence of SSI and secondary endpoints measured were quality of life and satisfaction with cosmesis. Statistical analysis was performed on a per protocol basis using SPSS version 22.0. RESULTS Three patients in the PSA group developed an SSI compared to 8 in the PLC group at 30 days (8 vs 30%, p = 0.03). The mean time to SSI diagnosis was faster in the PSA group (3 vs 12.3 days, p = 0.08). Patients who developed SSI experienced a longer mean length of stay (6.8 vs 11.4 days, p = 0.012). On multivariate analysis, PLC was the only predictive factor of SSI formation (p < 0.001). There was no difference in patient satisfaction between the two study groups (p = 0.14). CONCLUSIONS PSA of wounds following ileostomy reversal significantly reduces SSI formation compared to linear approximation without any effect on patient satisfaction.
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Affiliation(s)
- D P O'Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M Carter
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Wijewardene
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M Burton
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Waldron
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - E Condon
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - C Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Sacco K, Helgeson S, Imam JS, Burton M. Penicillin Skin Testing in the ICU is Associated With a Greater Change to Narrow-Spectrum Antibiotics. Chest 2017. [DOI: 10.1016/j.chest.2017.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chobben J, Scheffer H, De Visser M, Van der Steege G, Verhey J, Osinga J, Burton M, Mensink R, Grootscholten P, Ten Kate L, Buys C. Prenatal Prediction of Spinal
Muscular Atrophy. Eur J Hum Genet 2017. [DOI: 10.1159/000472204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Collins K, Reed M, Lifford K, Burton M, Edwards A, Ring A, Brain K, Harder H, Robinson T, Cheung KL, Morgan J, Audisio R, Ward S, Richards P, Martin C, Chater T, Pemberton K, Nettleship A, Murray C, Walters S, Bortolami O, Armitage F, Leonard R, Gath J, Revell D, Green T, Wyld L. Bridging the age gap in breast cancer: evaluation of decision support interventions for older women with operable breast cancer: protocol for a cluster randomised controlled trial. BMJ Open 2017; 7:e015133. [PMID: 28760787 PMCID: PMC5642653 DOI: 10.1136/bmjopen-2016-015133] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION While breast cancer outcomes are improving steadily in younger women due to advances in screening and improved therapies, there has been little change in outcomes among the older age group. It is inevitable that comorbidities/frailty rates are higher, which may increase the risks of some breast cancer treatments such as surgery and chemotherapy, many older women are healthy and may benefit from their use. Adjusting treatment regimens appropriately for age/comorbidity/frailty is variable and largely non-evidence based, specifically with regard to rates of surgery for operable oestrogen receptor-positive disease and rates of chemotherapy for high-risk disease. METHODS AND ANALYSIS This multicentre, parallel group, pragmatic cluster randomised controlled trial (RCT) (2015-18) reported here is nested within a larger ongoing 'Age Gap Cohort Study' (2012-18RP-PG-1209-10071), aims to evaluate the effectiveness of a complex intervention of decision support interventions to assist in the treatment decision making for early breast cancer in older women. The interventions include two patient decision aids (primary endocrine therapy vs surgery/antioestrogen therapy and chemotherapy vs no chemotherapy) and a clinical treatment outcomes algorithm for clinicians. ETHICS AND DISSEMINATION National and local ethics committee approval was obtained for all UK participating sites. Results from the trial will be submitted for publication in international peer-reviewed scientific journals. IRAS REFERENCE 115550. TRIAL REGISTRATION NUMBER European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2015-004220-61;Pre-results. Sponsor's Protocol Code Number Sheffield Teaching Hospitals STH17086. ISRCTN 32447*.
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Affiliation(s)
- Karen Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Kate Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Thompson Robinson
- Department of Cardiovascular Sciences, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
| | - Kwok Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Nottingham, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Susan Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Tim Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anthony Nettleship
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher Murray
- Department of Epigenesys, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Oscar Bortolami
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Jacqui Gath
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Deirdre Revell
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Tracy Green
- Yorkshire and Humberside (formerly North Trent Cancer Network) Consumer Research Panel, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- University of Sheffield, Sheffield, UK
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Burton M, Kilner K, Wyld L, Lifford KJ, Gordon F, Allison A, Reed M, Collins KA. Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer. Psychooncology 2017; 26:2094-2100. [PMID: 28332254 DOI: 10.1002/pon.4429] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/12/2016] [Revised: 02/15/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. METHODS This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. RESULTS Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). CONCLUSIONS Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret.
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Affiliation(s)
- Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Karen Kilner
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Kate Joanna Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Frances Gordon
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Annabel Allison
- Biostatistics Unit, MRC, Cambridge Institute of Public Health, Cambridge, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - Karen Anna Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
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Chan WY, Clark A, Dernedde U, Roques T, Burton M, Kotecha J, Wilson A, Martin C. P80 Symptoms, delay to presentation and survival in lung cancer. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
This paper identifies the need for a shared definition of intellectual disability for health and social services. Intellectual disability is generally described in broad terms, i.e. a disability which started before adulthood; reduced ability to cope independently due to a reduced ability to understand new information and learn new skills. The first part of this paper reviews a range of definitions; each has advantages but also serious disadvantages. As a result, this paper concludes with a proposal for a composite definition. It is suggested that this presents a very practical way of defining the eligible population of those needing specialist services. This would enable resources to be focused on those most in need, but without neglecting those who would fall outside the scope of a more simplistic definition. Underpinning this discussion is the acknowledgement that learning disability services provide the support that people require by virtue of their learning (and associated) disabilities, and are not a substitute for the general services available to the rest of the population.
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Arnold C, Amescua M, Bulifant R, Burton M, Grotto D, Kazimi S, Parsons K, Smithson T. Barriers and Motivators to Mentoring Dietetic Internship Students. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.254] [Citation(s) in RCA: 2] [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: 10/21/2022]
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Collins K, Wyld L, Burton M, Lifford K, Armitage F. Breast Clinical Nurse Specialist perspective of decision support interventions. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lei C, Ryder K, Koukharenko E, Burton M, Nandhakumar IS. Electrochemical deposition of bismuth telluride thick layers onto nickel. Electrochem commun 2016. [DOI: 10.1016/j.elecom.2016.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Altobelli N, Postberg F, Fiege K, Trieloff M, Kimura H, Sterken VJ, Hsu HW, Hillier J, Khawaja N, Moragas-Klostermeyer G, Blum J, Burton M, Srama R, Kempf S, Gruen E. Flux and composition of interstellar dust at Saturn from Cassini's Cosmic Dust Analyzer. Science 2016; 352:312-8. [PMID: 27081064 DOI: 10.1126/science.aac6397] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 03/03/2016] [Indexed: 11/02/2022]
Abstract
Interstellar dust (ISD) is the condensed phase of the interstellar medium. In situ data from the Cosmic Dust Analyzer on board the Cassini spacecraft reveal that the Saturnian system is passed by ISD grains from our immediate interstellar neighborhood, the local interstellar cloud. We determine the mass distribution of 36 interstellar grains, their elemental composition, and a lower limit for the ISD flux at Saturn. Mass spectra and grain dynamics suggest the presence of magnesium-rich grains of silicate and oxide composition, partly with iron inclusions. Major rock-forming elements (magnesium, silicon, iron, and calcium) are present in cosmic abundances, with only small grain-to-grain variations, but sulfur and carbon are depleted. The ISD grains in the solar neighborhood appear to be homogenized, likely by repeated processing in the interstellar medium.
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Affiliation(s)
- N Altobelli
- European Space Agency, European Space Astronomy Centre, Madrid, Spain.
| | - F Postberg
- Institut für Geowissenschaften, University of Heidelberg, Heidelberg, Germany. Institut für Raumfahrtsysteme, University of Stuttgart, Stuttgart, Germany
| | - K Fiege
- Institut für Geowissenschaften, University of Heidelberg, Heidelberg, Germany. Georgia Institute of Technology, School of Chemistry and Biochemistry, Atlanta, GA, USA
| | - M Trieloff
- Institut für Geowissenschaften, University of Heidelberg, Heidelberg, Germany. Klaus-Tschira-Labor für Kosmochemie, University of Heidelberg, Heidelberg, Germany
| | - H Kimura
- Kobe University, Kobe, Hyōgo, Japan
| | - V J Sterken
- International Space Sciences Institute, Bern, Switzerland
| | - H-W Hsu
- University of Boulder, Boulder, CO, USA
| | | | - N Khawaja
- Institut für Raumfahrtsysteme, University of Stuttgart, Stuttgart, Germany
| | | | - J Blum
- Technische Universität Braunschweig, Institut für Geophysik und Extraterrestrische Physik, Braunschweig, Germany
| | - M Burton
- Jet Propulsion Laboratory, Pasadena, CA, USA
| | - R Srama
- Institut für Raumfahrtsysteme, University of Stuttgart, Stuttgart, Germany
| | - S Kempf
- University of Boulder, Boulder, CO, USA
| | - E Gruen
- Institut für Geowissenschaften, University of Heidelberg, Heidelberg, Germany. Institut für Raumfahrtsysteme, University of Stuttgart, Stuttgart, Germany. University of Boulder, Boulder, CO, USA
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Heinz S, Burton M, Braiding C, Brandt WN, Jonker PG, Sell P, Fender RP, Nowak MA, Schulz NS. LORD OF THE RINGS: A KINEMATIC DISTANCE TO CIRCINUS X-1 FROM A GIANT X-RAY LIGHT ECHO. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/2/265] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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