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Johnstone P, Charlton P, Ajzensztejn D, Higgins G, Stuart R, Panakis N. Survival Outcomes Following Concomitant Chemoradiation (CRT) for Stage III Non-small Cell Lung Cancer (NSCLC) at Oxford University. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stenman M, Benmakhlouf H, Wersäll P, Johnstone P, Hatiboglu MA, Mayer-da-Silva J, Harmenberg U, Lindskog M, Sinclair G. Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery. Acta Neurochir (Wien) 2021; 163:333-342. [PMID: 32902689 DOI: 10.1007/s00701-020-04537-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The effects of single-fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA) and immune checkpoint inhibitors (ICI) are insufficiently studied. METHODS AND MATERIALS Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n = 43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60 to 100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE). RESULTS One hundred and ninety-four targets were irradiated. The median number of targets at first sf-GKRS was two. The median prescription dose was 22.0 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC rates at 12 and 18 months were 97% and 90%. Median OS from the first sf-GKRS was 15.7 months. Low serum albumin (HR for death 5.3), corticosteroid use pre-sf-GKRS (HR for death 5.8) and KPS < 80 (HR for death 9.1) were independently associated with worse OS. No further prognostic information was gleaned from MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases. Other prognostic scores for BM radiosurgery, including DS-GPA, renal-GPA, LLV-SIR and CITV-SIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sf-GKRS. CONCLUSIONS We identified albumin, corticosteroid use and KPS as independent prognostic factors for sf-GKRS of clear cell RCC BM. Studies focusing on the prognostic significance of albumin in sf-GKRS are rare. Further studies with a larger number of patients are warranted to confirm the above analytical outcome. Also, in keeping with previous studies, our data showed optimal rates of local tumour control and limited toxicity post radiosurgery, rendering GKRS the tool of choice in the management of RCC BM.
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Affiliation(s)
- M Stenman
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - H Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - P Wersäll
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - P Johnstone
- Department of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - M A Hatiboglu
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - J Mayer-da-Silva
- Centro Gamma Knife, CUF Infante Santo Hospital, Lisbon, Portugal
| | - U Harmenberg
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Lindskog
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - G Sinclair
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Oncology, North Middlesex University Hospital NHS Trust, London, UK.
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Necchi A, Bandini M, Ross J, Zhu Y, Ding-Wei Y, Ornellas A, Watkin N, Ayres B, Hakenberg O, Heidenreich A, Raggi D, Giannatempo P, Marandino L, Chipollini J, Azizi M, Brouwer O, Grass D, Johnstone P, Albersen M, Spiess P. 706MO Association between human papillomavirus (HPV) infection and outcome of perioperative nodal radiotherapy for penile carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.778] [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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Johnstone P, Regan M. Gambling harm is everybody's business: A public health approach and call to action. Public Health 2020; 184:63-66. [PMID: 32684349 PMCID: PMC7366099 DOI: 10.1016/j.puhe.2020.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/11/2019] [Revised: 05/12/2020] [Accepted: 06/08/2020] [Indexed: 01/31/2023]
Abstract
There is a growing consensus that gambling is a public health issue and that preventing gambling related harms requires a broad response. Although many policy decisions regarding gambling are made at a national level in the UK, there are clear opportunities to take action at local and regional levels to prevent the negative impacts on individuals, families and local communities. This response goes beyond the statutory roles of licencing authorities to include amongst others the National Health Service (NHS), the third sector, mental health services, homelessness and housing services, financial inclusion support. As evidence continues to emerge to strengthen the link between gambling and a wide range of risk factors and negative consequences, there is also a strong correlation with health inequalities. Because the North of England experiences increasing health inequalities, it offers an opportunity as a specific case study to share learning on reducing gambling-related harms within a geographic area. This article describes an approach to gambling as a public health issue identifying it as needing a cross-cutting, systemwide multisectoral approach to be taken at local and regional levels. Challenges at national and local levels require policy makers to adopt a ‘health in all policy’ approach and use the best evidence in their future decisions to prevent harm. A whole systems approach which aims to reduce poverty and health inequalities needs to incorporate gambling harm within place-based planning and draws on the innovative opportunities that exist to engage local stakeholders, builds local leadership and takes a collaborative approach to tackling gambling-related harms. This whole systems approach includes the following: (1) understanding the prevalence of gambling related harms with insights into the consequences and how individuals, their family and friends and wider community are affected; (2) ensuring tackling gambling harms is a key public health commitment at all levels by including it in strategic plans, with meaningful outcome measures, and communicating this to partners; (3) understanding the assets and resources available in the public, private and voluntary sectors and identifying what actions are underway; (4) raising awareness and sharing data, developing a compelling narrative and involving people who have been harmed and are willing to share their experience; (5) ensuring all regulatory authorities help tackle gambling-related harms under a ‘whole council’ approach. This piece presents the case for why gambling is a particularly unique public health issue which requires a cross-cutting, systemwide multisectoral approach. It explores opportunities for action at national and local level, using examples of work underway. It concludes with a call to action using lesson learnt from managing harms from similar public health threats.
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South J, Connolly AM, Stansfield JA, Johnstone P, Henderson G, Fenton KA. Putting the public (back) into public health: leadership, evidence and action. J Public Health (Oxf) 2020; 41:10-17. [PMID: 29546426 DOI: 10.1093/pubmed/fdy041] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/09/2018] [Indexed: 11/14/2022] Open
Abstract
There is a strong evidence-based rationale for community capacity building and community empowerment as part of a strategic response to reduce health inequalities. Within the current UK policy context, there are calls for increased public engagement in prevention and local decision-making in order to give people greater control over the conditions that determine health. With reference to the challenges and opportunities within the English public health system, this essay seeks to open debate about what is required to mainstream community-centred approaches and ensure that the public is central to public health. The essay sets out the case for a reorientation of public health practice in order to build impactful action with communities at scale leading to a reduction in the health gap. National frameworks that support local practice are described. Four areas of challenge that could potentially drive an implementation gap are discussed: (i) achieving integration and scale, (ii) effective community mobilization, (iii) evidencing impact and (iv) achieving a shift in power. The essay concludes with a call to action for developing a contemporary public health practice that is rooted in communities and offers local leadership to strengthen local assets, increase community control and reduce health inequalities.
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Affiliation(s)
- J South
- Public Health England, London, UK
- Leeds Beckett University, Leeds, UK
| | | | - J A Stansfield
- Public Health England, London, UK
- Leeds Beckett University, Leeds, UK
| | - P Johnstone
- Public Health England, London, UK
- Leeds Beckett University, Leeds, UK
| | | | - K A Fenton
- Public Health England, London, UK
- Health and Wellbeing, Southwark Council, London, UK
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Sinclair G, Stenman M, Benmakhlouf H, Johnstone P, Wersäll P, Lindskog M, Hatiboglu MA, Harmenberg U. Adaptive radiosurgery based on two simultaneous dose prescriptions in the management of large renal cell carcinoma brain metastases in critical areas: Towards customization. Surg Neurol Int 2020; 11:21. [PMID: 32123609 PMCID: PMC7049890 DOI: 10.25259/sni_275_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/13/2019] [Indexed: 12/23/2022] Open
Abstract
Background: The long-term benefits of local therapy in metastatic renal cell carcinoma (mRCC) have been widely documented. In this context, single fraction gamma knife radiosurgery (SF-GKRS) is routinely used in the management of brain metastases. However, SF-GKRS is not always feasible due to volumetric and regional constraints. We intend to illustrate how a dose-volume adaptive hypofractionated GKRS technique based on two concurrent dose prescriptions termed rapid rescue radiosurgery (RRR) can be utilized in this particular scenario. Case Description: A 56-year-old man presented with left-sided hemiparesis; the imaging showed a 13.1 cc brain metastasis in the right central sulcus (Met 1). Further investigation confirmed the histology to be a metastatic clear cell RCC. Met 1 was treated with upfront RRR. Follow-up magnetic resonance imaging (MRI) at 10 months showed further volume regression of Met 1; however, concurrently, a new 17.3 cc lesion was reported in the boundaries of the left frontotemporal region (Met 2) as well as a small metastasis (<1 cc) in the left temporal lobe (Met 3). Met 2 and Met 3 underwent RRR and SF-GKRS, respectively. Results: Gradual and sustained tumor ablation of Met 1 and Met 2 was demonstrated on a 20 months long follow- up. The patient succumbed to extracranial disease 21 months after the treatment of Met 1 without evidence of neurological impairment post-RRR. Conclusion: Despite poor prognosis and precluding clinical factors (failing systemic treatment, eloquent location, and radioresistant histology), RRR provided optimal tumor ablation and salvage of neurofunction with limited toxicity throughout follow-up.
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Affiliation(s)
- Georges Sinclair
- Departments of Neurosurgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.,Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - M Stenman
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - H Benmakhlouf
- Departments of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Johnstone
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - P Wersäll
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Lindskog
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M A Hatiboglu
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - U Harmenberg
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Addison M, Kaner E, Johnstone P, Hillier-Brown F, Moffatt S, Russell S, Barr B, Holland P, Salway S, Whitehead M, Bambra C. Equal North: how can we reduce health inequalities in the North of England? A prioritization exercise with researchers, policymakers and practitioners. J Public Health (Oxf) 2019; 41:652-664. [PMID: 30346563 PMCID: PMC6995035 DOI: 10.1093/pubmed/fdy170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England. METHODS Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data. RESULTS In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1. CONCLUSIONS Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.
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Affiliation(s)
- M Addison
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - E Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - P Johnstone
- Public Health England, North of England, Blenheim House, West One, Leeds LS1 4PL, UK
| | - F Hillier-Brown
- Department of Sport and Exercise, Durham University, 42 Old Elvet, Durham DH1 3HN, UK
| | - S Moffatt
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - S Russell
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - B Barr
- Institute of Psychology, Health and Society, Department of Public Health and Policy, University of Liverpool, Whelan Building, The Quadrangle, Liverpool L69 3GB, UK
| | - P Holland
- Lecturer in Public Health, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness Building, Lancaster LA1 4YG, UK
| | - S Salway
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield S10 2TU, UK
| | - M Whitehead
- Institute of Psychology, Health and Society, Department of Public Health and Policy, University of Liverpool, Whelan Building, The Quadrangle, Liverpool L69 3GB, UK
| | - C Bambra
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
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McCoard S, Heiser A, Lowe K, Molenaar A, MacLean P, Johnstone P, Leath S, Hoskin SO, Khan MA. Effect of weaning age on growth, mammary gland development, and immune function in Holstein Friesian calves fed conserved alfalfa (FiberStart). J Dairy Sci 2019; 102:6076-6087. [PMID: 31079903 DOI: 10.3168/jds.2018-15615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/29/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
This study aimed to evaluate intake, body growth, and the development of the rumen, mammary gland, and immune system in Holstein Friesian calves reared for 100 d on the commercially available feed FiberStart (conserved alfalfa, Medicago sativa; Fiber Fresh Feeds Ltd., Reporoa, New Zealand) and fed calf milk replacer (CMR) for either 56 or 91 d. Eighty calves (40 bulls and 40 heifer calves) were reared indoors in groups (n = 5 of the same sex/pen). All calves were fed 4 L of CMR/d (175 g/L of CMR) in 2 feeds/d for the first 10 d and then 1 feed/d until d 49 or 84. The calves were gradually weaned by d 56 (earlier weaned; n = 8 pens) and d 91 (later weaned; n = 8 pens). All calves were fed FiberStart ad libitum as the only solid feed source from d 1 to 100 of the study. Irrespective of treatment, all calves had similar body weights at d 0 (40.9 ± 3.0 kg) and d 49 (74.2 ± 5.1 kg) of the study. Calf sex had no effect on intake, growth, blood, and immune system parameters. Earlier-weaned calves consumed 18% more solid feed dry matter but had 16% lower body weight gain (28.9 vs. 38.5 kg, respectively) from d 56 to 100 relative to later-weaned calves, resulting in different body weight at 100 d (104 vs. 121 ± 1.3 kg). Although earlier-weaned calves could compensate for the loss of CMR dry matter and crude protein intake from d 56 to 100 by increasing forage intake, they were unable to compensate for the loss of energy from the CMR by increasing solid feed consumption. Plasma β-hydroxybutyrate concentrations were 52% greater in earlier-weaned calves than in later-weaned calves at d 84, indicating greater metabolic activity of the rumen wall. The duration of CMR feeding had no influence on humoral or cell-mediated immune functions of the calves, as evidenced by a lack of effect on antivaccine antibody responses as well as on immune gene expression. Earlier- versus later-weaned heifer calves had 5% lower mammary gland mass, indicating that greater energy supply increased mammary mass. The results of this experiment demonstrate the ability to artificially rear dairy calves on a conserved alfalfa as the only solid feed. Furthermore, earlier weaning off CMR promotes solid feed intake and an associated increase in blood β-hydroxybutyrate, an indicator of rumen development, but increasing the duration of CMR feeding improves growth and mammary gland mass by d 100. The implications of these findings on lifetime growth, health, and milk production in dairy heifers warrant further investigation.
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Affiliation(s)
- S McCoard
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - A Heiser
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - K Lowe
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - A Molenaar
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand
| | - P MacLean
- AgResearch Ltd., Lincoln Research Centre, Private Bag 4749, Christchurch 8140, New Zealand
| | - P Johnstone
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand; AgResearch Ltd., Ruakura Research Centre, Private Bag 3123, Hamilton 3240, New Zealand
| | - S Leath
- AgResearch Ltd., Lincoln Research Centre, Private Bag 4749, Christchurch 8140, New Zealand
| | - S O Hoskin
- Fiber Fresh Feeds Ltd, RD2, Reporoa, New Zealand
| | - M A Khan
- AgResearch Ltd., Grasslands Research Centre, Private Bag 11008, Palmerston North 4474, New Zealand.
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Johnstone P, Grass G, Azizi M, Ahmed K, Yoder G, Welsh E, Fulp W, Dhillon J, Torres-Roca J, Giuliano A, Yuan Z, Spiess P. OC-0268 Intrinsic radiosensitivity, genomic-adjusted radiation dose and patterns of failure of penile cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30688-7] [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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Johnstone P, Scott J, Eschrich S, Torres-Roca J. RSI: A genomic signature of radiosensitivity. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mackintosh C, Johnstone P, Shaw R. Observations on the phenotypic relationships between anti-CarLA salivary IgA antibody response, nematode infection levels and growth rates in farmed red (Cervus elaphus) and wapiti hybrid deer (Cervus elaphus canadensis). Vet Parasitol 2014; 203:160-6. [DOI: 10.1016/j.vetpar.2014.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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Johnstone P, Matheson AS. An invisible enemy: Panton-Valentine leukocidin Staphylococcus aureus on deployed troops. J R Nav Med Serv 2013; 99:9-12. [PMID: 23691856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Over the last seven years Primary Care establishments in the Royal Navy and Royal Marines have dealt with a number of severe and fatal infections caused by Panton-Valentine leukocidin (PVL) producing Staphylococcus aureus, and appear to be seeing these infections more commonly than their civilian colleagues. This retrospective study looked at the levels of PVL S. aureus isolated in deployed personnel during Op HERRICK 14 to determine if the levels seen in British military troops are higher than the national average. We found that the percentage of PVL positive S. aureus isolates sent to the UK HPA reference laboratory from the Camp Bastion laboratory during OP Herrick 14 was 41%, considerably higher rate than the UK civilian rate. Future research, including a larger study into the carriage levels of PVL S. aureus in the military will hopefully shed more light on the spread and transmission of this potentially deadly bacterium.
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Affiliation(s)
- P Johnstone
- Pathology Department, MDHU Portsmouth, Hants, UK
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Newman ENC, Johnstone P, Hatch R, Hayward-Karlsson J, Green AD, Hewson R. Undifferentiated febrile illnesses amongst British troops in Helmand, Afghanistan. J ROY ARMY MED CORPS 2012; 158:143-145. [PMID: 22860509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Cheng C, Allgower C, Simmons J, Conley T, Das I, Zhao L, Zhao Q, Johnstone P, Buchsbaum J. SU-C-BRCD-05: A Failure Mode and Effects Analysis (FMEA) Approach for Craniospinal Irradiation (CSI) with Proton Therapy (PT). Med Phys 2012. [DOI: 10.1118/1.4734616] [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: 11/07/2022] Open
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Johnstone P. 26 DOSE FALLOFF IN PROTON CRANIOSPINAL IRRADIATION: WHERE AND WHY? Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fakiris A, Forquer J, Henderson M, Barriger R, Shapiro R, Brabham J, Johnstone P. Stereotactic Body Radiotherapy for Non-small Cell Lung Carcinoma: The Indiana University Experience. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Srivastava S, Das I, Cheng C, Kumar A, Johnstone P. TH-E-BRB-08: Effect of Rectal Balloon Fillings on Doses to Prostate, PTV and Rectum: An IMRT Planning Study. Med Phys 2011. [DOI: 10.1118/1.3613565] [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: 11/07/2022] Open
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Cheng C, Srivastava S, Buchsbaum J, Zhao L, Wolanski M, Simmons J, Johnstone P, Das I. SU-E-T-496: Dosimetric Comparison between Protons and Photons in the Field Junction in Craniospinal Irradiation (CSI). Med Phys 2011. [DOI: 10.1118/1.3612449] [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: 11/07/2022] Open
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Srivastava S, Das I, Cheng C, Kumar A, Johnstone P. Optimum Margin for Target Expansion in Head and Neck IMRT with Daily IGRT. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1721] [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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Cheng C, Zhao L, Wolanski M, Allgower C, Zhao Q, James J, Dikeman K, Mills M, Li M, Frye D, Lu X, Srivastava S, Das I, Johnstone P. SU-GG-I-03: Implications for Proton Therapy Treatment Planning of Tissue Characterization Curves from Different CT Scanners. Med Phys 2010. [DOI: 10.1118/1.3468036] [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: 11/07/2022] Open
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Das I, Cao M, Srivastava S, Cheng C, Li M, Gautam A, DesRosiers C, Johnstone P. SU-GG-T-581: Volume Variability in Treatment Planning Systems. Med Phys 2010. [DOI: 10.1118/1.3468982] [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: 11/07/2022] Open
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Moskvin V, Das I, Cheng C, Zhao L, Wolanski M, Andrews J, Johnstone P. SU-GG-T-385: Dose Perturbation by a Steel Magnetic Injection Port in a Breast Tissue Expander in Proton Radiotherapy: A Monte Carlo Study. Med Phys 2010. [DOI: 10.1118/1.3468782] [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: 11/07/2022] Open
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Srivastava S, Das I, Andrews J, Kumar A, Cheng C, Johnstone P. SU-GG-T-322: Dose Perturbation Due to Metallic Breast Tissue Expander in Electron Treatment of Breast Cancer. Med Phys 2010. [DOI: 10.1118/1.3468718] [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: 11/07/2022] Open
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Moskvin V, Das I, Cheng C, Zhao L, Johnstone P. SU-GG-T-396: Secondary Neutron Production by a Scanning Proton Beam. Med Phys 2010. [DOI: 10.1118/1.3468793] [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: 11/07/2022] Open
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Zook J, Sandrasegaran K, Saxena R, Price T, Maluccio M, Kwo P, Johnstone P, Cardenes H. Orthotopic Liver Transplant (OLT) following Stereotactic Body Radiation Therapy (SBRT) in Patients with Hepatocellular Carcinoma (HCC): Radiologic and Pathologic Correlation. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kang T, Ahn M, Johnstone P, Kao C, Ko S, Gardner T. MP-15.06: Enhancement of FCYttk-Armed Prostate-Restricted Replicative Adenovirus Effect with Prodrugs Gancyclovir and 5-FC In Prostate Cancer. Urology 2009. [DOI: 10.1016/j.urology.2009.07.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Das I, Nichiporov D, Moskvin V, Shahnazi K, Fanelli L, Fitzek M, Johnstone P. SU-FF-T-328: Dose Perturbation and Range Shift with High-Z Medium in Proton Beam. Med Phys 2009. [DOI: 10.1118/1.3181808] [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: 11/07/2022] Open
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Das I, Srivastava S, Cheng C, Chopra K, Jones A, Mihailidis D, Pai S, Sarkar A, Taylor M, Wuu C, Johnstone P. SU-FF-T-506: Patterns of Care in the Era of ICRU-50 for 3D Conformal Radiation Therapy: A Multi-Institutional Study. Med Phys 2009. [DOI: 10.1118/1.3182004] [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: 11/07/2022] Open
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Srivastava S, Das I, Kumar A, Johnstone P. SU-FF-T-165: Dosmietric Comparison of Fixed Beam Geometry with Optimized Beam Geometry IMRT Plans:. Med Phys 2009. [DOI: 10.1118/1.3181639] [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: 11/07/2022] Open
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Ko S, Cao M, Slessinger E, Johnstone P, Das I. SU-FF-T-56: A Simple Method for Dose Fusion From Multi-Modality Treatment: Brachytherapy to External Beam Therapy. Med Phys 2009. [DOI: 10.1118/1.3181528] [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: 11/07/2022] Open
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McGuire S, Hoogeveen J, Bacchia P, Johnstone P, Khew C, Lee B, Marchant H, Morris K, Riley C, Smith K, Kruger E, Tennant M. The presenting complaints of low income adults for emergency dental care: an analysis of 35,000 episodes in Victoria, Australia. Community Dent Health 2008; 25:143-147. [PMID: 18839719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study examined the mix of presenting problems faced by a large diverse dental service treating low-income Australian adults and provides a basis for communities to understand and manage demand for dental services. DESIGN A retrospective analysis in a state-wide multi-centre dental health service. Data for all patients (in all public adult dental clinics in the state of Victoria during May-Aug 2005) who used the emergency services in a 12 week period were recorded and analysed. A triage question tree was developed and embedded into a neural network based computer triage tool. RESULTS Approximately 52% of low income adults presenting for emergency treatment required treatment on the day of triage. The main problem was with natural teeth (89.6%). Of those with natural teeth problems, 41.3% had pain disturbing their sleep patterns and 14.7% had experienced a swelling. Metropolitan patients accessed the services 2.3 times more than rural patients. CONCLUSION These data clearly highlight that there is significant opportunity to reduce nearly 48% of on-day demand for emergency dental care through the application of appropriately clinical based triage.
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Cardenes H, Price T, Perkins S, Maluccio M, Kwo P, Breen T, Henderson M, Tudor K, DeLuca J, Johnstone P. Phase I Trial of Stereotactic Body Radiation Therapy for Primary Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.432] [Citation(s) in RCA: 2] [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: 10/21/2022]
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Abstract
BACKGROUND In high income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically. Some argue that this reduction has led to revolving door admissions and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful by institutionalising people to hospital care. OBJECTIVES To determine the clinical and service outcomes of planned short stay admission policies versus a long or standard stay for people with serious mental illnesses. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group's register of trials (July 2007). SELECTION CRITERIA We included all randomised trials comparing planned short with long/standard hospital stays for people with serious mental illnesses. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated fixed effects weighted mean differences (WMD). MAIN RESULTS We included six relevant trials. We found no significant difference in hospital readmissions between planned short stays and standard care at one year (n=651, 4 RCTs, RR 1.26 CI 1.0 to 1.6). Short hospital stay did not confer any benefit in terms of 'loss to follow up compared with standard care (n=453, 3 RCTs, RR 0.87 CI 0.7 to 1.1). There were no significant differences for the outcome of 'leaving hospital prematurely' (n=229, 2 RCTs, RR 0.77 CI 0.3 to 1.8). More post-discharge day care was given to participants in the short stay group (n=247, 1 RCT, RR 4.52 CI 2.7 to 7.5, NNH 3 CI 2 to 6) and people from the short stay groups were more likely to be employed at two years (n=330, 2 RCTs, RR 0.61 CI 0.5 to 0.8, NNT 5 CI 4 to 8). Economic data were few but, once discharged, costs may be more for those allocated to an initial short stay. AUTHORS' CONCLUSIONS The effects of hospital care and the length of stay is important for mental health policy. We found limited data, although outcomes do suggest that a planned short stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified.
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Affiliation(s)
- N A Alwan
- Goverment Office for Yorkshire & the Humber, New Station Street, Leeds, West Yorkshire, UK LS1 4US.
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Busch R, Johnstone P. Lymphadenectomy in Patients Undergoing Definitive Surgery for Bladder Cancer: Geographic Variability and Impact on Survival. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1444] [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: 11/27/2022]
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Abstract
BACKGROUND Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. Serious adverse effects have been reported for some drugs used to treat scabies. OBJECTIVES To evaluate topical and systemic drugs for treating scabies. SEARCH STRATEGY In February 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and INDMED. In March 2007, we also searched the grey literature and sources for registered trials. We also checked the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials of drug treatments for scabies. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Results were presented as relative risks with 95% confidence intervals and data combined where appropriate. MAIN RESULTS Twenty small trials involving 2392 people were included. One trial was placebo controlled, 16 compared two or more drug treatments, two compared treatment regimens, and one compared different drug vehicles.Fewer treatment failures occurred by day seven with oral ivermectin in one small trial (55 participants). Topical permethrin appeared more effective than oral ivermectin (85 participants, 1 trial), topical crotamiton (194 participants, 2 trials), and topical lindane (753 participants, 5 trials). Permethrin also appeared more effective in reducing itch persistence than either crotamiton (94 participants, 1 trial) or lindane (490 participants, 2 trials). One small trial did not detect a difference between permethrin (a synthetic pyrethroid) and a natural pyrethrin-based topical treatment (40 participants). No significant difference was detected in the number of treatment failures between crotamiton and lindane (100 participants, 1 trial), lindane and sulfur (68 participants, 1 trial), benzyl benzoate and sulfur (158 participants, 1 trial), and benzyl benzoate and natural synergized pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of malathion were identified. No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of headache, abdominal pain, diarrhoea, vomiting, and hypotension. AUTHORS' CONCLUSIONS Topical permethrin appears to be the most effective treatment for scabies. Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of malathion, particularly when compared to permethrin, and on the management of scabies in an institutional setting and at a community level.
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Affiliation(s)
- M Strong
- University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, UK, S1 4DA.
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Johnstone P, Sung S, Anderson C, Arbiser J, Chung L. 218 The natural product honokiol potentiates radiation sensitization induced by SiRNA ADAM9 knockdown in prostate cancer cells. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80695-x] [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: 12/01/2022]
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Pollard JC, Littlejohn RP, Johnstone P, Laas FJ, Corson ID, Suttie JM. Behavioural and heart rate responses to velvet antler removal in red deer. N Z Vet J 2005; 40:56-61. [PMID: 16031658 DOI: 10.1080/00480169.1992.35698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Heart rate and behaviour during and following velvet antler removal were monitored in yearling red deer stags to determine the extent to which this procedure was perceived by the deer to be aversive. Nine stags normally kept at pasture were habituated over 5 weeks to the following daily handling procedure. Each deer was fitted with a harness containing a heart rate monitor. It was then allowed to run through a fixed course in a deer yard, restrained for 40 s in a mechanical deer crush, and then confined for 3.5 h with the remainder of the group of stags in an indoor pen containing food and water. In Week 6, the deer were subjected to either restraint for 6 minutes (the control treatment) or removal of one velvet antler under local anaesthesia. Each velvet antler was removed on separate occasions, either on Days 1 and 2 (five deer) or Days 3 and 4 (four deer). The control treatment was applied to all deer when velvet antler was not being removed, and on Day 5. Heart rate and behaviour (time taken to enter the treatment area, and number of struggles made during restraint) were measured before and during treatment, and post-treatment activities were recorded at 0, 1 and 3 h (indoors), and at 6 and 9 h (at pasture). Heart rate was higher during the second velvet antler removal treatment than during the first, but lower during the second control treatment than the first (P<0.05). During velvet antler removal, stags struggled more, and after the treatment flicked their ears, shook their heads, and groomed themselves more than control stags (P<0.05). Stags whose velvet antler had been removed spent less time eating than control stags, and spent progressively more time sitting during the 3.5 h of confinement (P<0.05). However, during the paddock observation at 9 h post-treatment, stags which had had their velvet antler removed grazed more than control stags (P<0.05). The increase in heart rate over the two velvet antler removal treatments and the greater amount of struggling during velvet antler removal indicated that it was more aversive than the control treatment. Post-treatment differences in behaviour may have been due to pain following velvet antler removal.
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Affiliation(s)
- J C Pollard
- MAF Technology, Invermay Agricultural Centre, Private Bag, Mosgiel, New Zealand
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Davis Q, Sutter A, Whitaker D, Johnstone P. Incorporating simultaneous in-field boost (SIB) with inverse-planned IMRT using dynamic multi-leaf collimation (DMLC) to the intact breast after lumpectomy. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.063] [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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Moore H, Summerbell C, Hooper L, Cruickshank K, Vyas A, Johnstone P, Ashton V, Kopelman P. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2004:CD004097. [PMID: 15266517 DOI: 10.1002/14651858.cd004097.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES To assess the effect of type and frequency of different types of dietary advice to all adults with type 2 diabetes on weight, measures of diabetic control, morbidity, total mortality and quality of life. SEARCH STRATEGY We carried out a comprehensive search of The Cochrane Library (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to October Week 1, 2003), EMBASE (1980 to Week 40, 2003), CINAHL (1982 to October Week 1, 2003), AMED (1985 to October 2003), bibliographies and contacted relevant experts. SELECTION CRITERIA All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention in adults with type 2 diabetes mellitus. DATA COLLECTION AND ANALYSIS The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. For continuous outcomes, endpoint data were preferred to change data. MAIN RESULTS Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. REVIEWERS' CONCLUSIONS There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.
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Affiliation(s)
- H Moore
- Postgraduate Institute, University of Teesside, Parkside West Offices, School of Health and Social Care, University of Teesside, Middlesbrough, UK, TS1 3BA
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Moore H, Summerbell C, Hooper L, Cruickshank K, Vyas A, Johnstone P, Ashton V, Kopelman P. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2004:CD004097. [PMID: 15106237 DOI: 10.1002/14651858.cd004097.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES To assess the effect of type and frequency of different types of dietary advice to all adults with type 2 diabetes on weight, measures of diabetic control, morbidity, total mortality and quality of life. SEARCH STRATEGY We carried out a comprehensive search of The Cochrane Library (The Cochrane Library Issue 3, 2003), MEDLINE (1966 to October Week 1, 2003), EMBASE (1980 to Week 40, 2003), CINAHL (1982 to October Week 1, 2003), AMED (1985 to October 2003), bibliographies and contacted relevant experts. SELECTION CRITERIA All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention in adults with type 2 diabetes mellitus. DATA COLLECTION AND ANALYSIS The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. For continuous outcomes, endpoint data were preferred to change data. MAIN RESULTS Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. REVIEWERS' CONCLUSIONS There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.
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Affiliation(s)
- H Moore
- Postgraduate Institute, University of Teesside, Parkside West Offices, School of Health and Social Care, University of Teesside, Middlesbrough, UK, TS1 3BA
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Moore H, Summerbell C, Hooper L, Cruickshank K, Vyas A, Johnstone P, Ashton V, Kopelman P. Dietary advice for treatment of type 2 diabetes mellitus in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Whitby JE, Heaton PR, Black EM, Wooldridge M, McElhinney LM, Johnstone P. First isolation of a rabies-related virus from a Daubenton's bat in the United Kingdom. Vet Rec 2000; 147:385-8. [PMID: 11073000 DOI: 10.1136/vr.147.14.385] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
On May 30, 1996, a sick Daubenton's bat (Myotis daubentonii) was recovered from the cellar of a public house in Newhaven, East Sussex. Its condition deteriorated rapidly, and it was euthanased and examined. Positive results, establishing the presence of a rabies or rabies-related virus in its brain, were obtained from the fluorescent antibody test, the rabies tissue culture isolation test, and a hemi-nested reverse-transcription PCR. The complete sequence of the nucleoprotein gene was determined and a phylogenetic analysis, based on the 470 nucleotide bases of the amino terminus of the nucleoprotein, established the genotype of the virus as European bat lyssavirus 2. Bat rabies had not previously been recorded in the UK but does occur in mainland Europe. A study of the back-trajectories of the wind on May 29 and 30, established that the infected bat possibly came from near the Franco-Swiss border.
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Black EM, McElhinney LM, Lowings JP, Smith J, Johnstone P, Heaton PR. Molecular methods to distinguish between classical rabies and the rabies-related European bat lyssaviruses. J Virol Methods 2000; 87:123-31. [PMID: 10856759 DOI: 10.1016/s0166-0934(00)00159-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A rapid and sensitive reverse transcriptase-polymerase chain reaction (RT-PCR) assay for the detection of classical rabies virus (genotype 1) and the rabies related European bat lyssaviruses (EBLs) (genotypes 5 and 6) was developed. When combined with specific oligonucleotide probes and a PCR-enzyme linked immunosorbent assay (PCR-ELISA), genotype 5 and 6 viruses can be distinguished from each other and from genotype 1 viruses. Ninety-two isolates from the six established genotypes of rabies and rabies-related viruses were screened by RT-PCR and PCR-ELISA to determine the specificity of the assays. All genotype 1, 5 and 6 viruses were detected by RT-PCR while none of the genotype 2, 3 and 4 viruses were detected. All the genotype 5 and 6 viruses were detected by the two PCR-ELISA probes when used in combination while none of the genotype 1-4 viruses were detected. When used individually, the PCR-ELISA probes also distinguished between the genotype 5 and 6 viruses. This new discriminatory test should allow the rapid genotyping of all lyssaviruses likely to be encountered in Europe and as such could provide useful epidemiological information in the event of an outbreak.
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Affiliation(s)
- E M Black
- D.E.R.A., Microbiology Department, Chemical and Biological Defence Sector, Porton Down, Wiltshire, SP4 0JQ, Salisbury, UK
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Reilly M, Johnstone P. Composite indicators may not be helpful in comparing health authorities. BMJ 2000; 320:252. [PMID: 10642249 PMCID: PMC1117448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
BACKGROUND Lengths for hospital stays for people with serious mental illness have reduced drastically over the last 30 years. Some argue that this reduction has led to revolving door admissions and worsening mental health outcomes despite apparent cost savings, whilst others suggest longer stays may be more harmful in the long term by institutionalising people to hospital care. This review attempts to answer which is the answer: whether short or long stays are effective. OBJECTIVES To determine the effect of planned short stay admission policies versus a long or standard stay for people with serious mental illnesses. SEARCH STRATEGY Biological Abstracts (1982-1995), Cochrane Schizophrenia Group's Register (December 1998), EMBASE (1980-1998), MEDLINE (1966-1998) and PsycLIT (1974-1995) were searched. Further references were sought from published trials and their authors. SELECTION CRITERIA All randomised trials of planned short versus long hospital stays for people with serious mental illness (however defined). DATA COLLECTION AND ANALYSIS Trials were reliably identified and data extracted. Analysis was on an intention-to-treat basis. People who dropped out or lost to follow-up were assumed to have no improvement. Peto odds ratios (OR) and 95% confidence intervals were calculated. MAIN RESULTS Five randomised controlled trials were included. For those receiving planned short stays, data suggested that this group experienced no more re-admissions (OR 1.1, CI 0.7-1.7), no more losses to follow up (OR 1.09, CI 0.6-1.9), and were more successfully discharged on time (OR 0.47, CI 0.3-0.9) compared to long stay or standard care. The data also suggested some evidence that planned short stay patients were no more likely to leave hospital prematurely and had a greater chance of being employed. Data on mental, social and family outcomes could not be summated and there was little or no data on user satisfaction, deaths, violence, criminal behaviour, and costs. REVIEWER'S CONCLUSIONS The effects of hospital care and the length of stay is important for mental health policy. This review suggests that a planned short stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified. It may be that the 'developing world', where, in some places, the long stay institutions are still functioning, will be able to provide good data that has failed to appear from research in the 'developed world'.
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Affiliation(s)
- P Johnstone
- Tees Health Authority, Poole House, Stokesley Road, Nunthorpe, Middlesbrough, UK, TS7 0NJ.
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Johnstone P. Kosovo: the challenge to public health. J Epidemiol Community Health 1999; 53:450. [PMID: 10562860 PMCID: PMC1756935 DOI: 10.1136/jech.53.8.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE To determine the effectiveness of planned short hospital stays versus standard care for people with serious mental illness. DESIGN Systematic review of all randomised controlled trials comparing planned short hospital stay versus long hospital stay or standard care for people with serious mental illness. SUBJECTS Four trials enrolled 628 patients. MAIN OUTCOMES MEASURES Relapse; readmission; death (suicides and all causes); violent incidents (self, others, property); lost to follow up; premature discharge; delayed discharge; mental state (not improved); social functioning; patient satisfaction, quality of life, self esteem, and psychological wellbeing; family burden; imprisonment; employment status; independent living; total cost of care; and average length of hospital stay. RESULTS Patients allocated to planned short hospital stays had no more readmissions (in four trials, odds ratio 0.93, 95% confidence interval 0.66 to 1.29 with no heterogeneity between trials), no more losses to follow up (in three trials of 404 patients, 1.09, 0.62 to 1.91 with no heterogeneity between trials), and more successful discharges on time (in three trials of 404 patients, 0.47, 0.27 to 0.85) than patients allocated long hospital stays or standard care. Some evidence showed that patients allocated planned short hospital stay were no more likely to leave hospital prematurely and had a greater chance of being employed than those allocated long hospital stay or standard care. Data on mental, social, and family outcomes could not be summated, and there were few or no data on patient satisfaction, deaths, violence, criminal behaviour, and costs. CONCLUSION The effectiveness of care in mental hospitals is important to patients, carers, and policy makers. Despite inadequacies in the data, this review suggests that planned short hospital stays do not encourage a "revolving door" pattern of care for people with serious mental illness and may be more effective than standard care. Further pragmatic trials are needed on the most effective organisation and delivery of care in mental hospitals.
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Affiliation(s)
- P Johnstone
- Berkshire Health Authority, Reading, Berkshire RG30 2BA.
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Johnstone P, Allot C. Modernising mental health services. Strategy does not seem to be based on systematic evidence. BMJ 1999; 318:806. [PMID: 10215388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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