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Lim E, Waller D, Lau K, Steele J, Pope A, Ali C, Bilancia R, Keni M, Popat S, O'Brien M, Tokaca N, Maskell N, Stadon L, Fennell D, Nelson L, Edwards J, Tenconi S, Socci L, Rintoul RC, Wood K, Stone A, Muthukumar D, Ingle C, Taylor P, Cove-Smith L, Califano R, Summers Y, Tasigiannopoulos Z, Bille A, Shah R, Fuller E, Macnair A, Shamash J, Mansy T, Milton R, Koh P, Ionescu AA, Treece S, Roy A, Middleton G, Kirk A, Harris RA, Ashton K, Warnes B, Bridgeman E, Joyce K, Mills N, Elliott D, Farrar N, Stokes E, Hughes V, Nicholson AG, Rogers CA. Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): a phase 3 randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00119-X. [PMID: 38740044 DOI: 10.1016/s2213-2600(24)00119-x] [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] [Received: 11/17/2023] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Extended pleurectomy decortication for complete macroscopic resection for pleural mesothelioma has never been evaluated in a randomised trial. The aim of this study was to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. METHODS MARS 2 was a phase 3, national, multicentre, open-label, parallel two-group, pragmatic, superiority randomised controlled trial conducted in the UK. The trial took place across 26 hospitals (21 recruiting only, one surgical only, and four recruiting and surgical). Following two cycles of chemotherapy, eligible participants with pleural mesothelioma were randomly assigned (1:1) to surgery and chemotherapy or chemotherapy alone using a secure web-based system. Individuals aged 16 years or older with resectable pleural mesothelioma and adequate organ and lung function were eligible for inclusion. Participants in the chemotherapy only group received two to four further cycles of chemotherapy, and participants in the surgery and chemotherapy group received pleurectomy decortication or extended pleurectomy decortication, followed by two to four further cycles of chemotherapy. It was not possible to mask allocation because the intervention was a major surgical procedure. The primary outcome was overall survival, defined as time from randomisation to death from any cause. Analyses were done on the intention-to-treat population for all outcomes, unless specified. This study is registered with ClinicalTrials.gov, NCT02040272, and is closed to new participants. FINDINGS Between June 19, 2015, and Jan 21, 2021, of 1030 assessed for eligibility, 335 participants were randomly assigned (169 to surgery and chemotherapy, and 166 to chemotherapy alone). 291 (87%) participants were men and 44 (13%) women, and 288 (86%) were diagnosed with epithelioid mesothelioma. At a median follow-up of 22·4 months (IQR 11·3-30·8), median survival was shorter in the surgery and chemotherapy group (19·3 months [IQR 10·0-33·7]) than in the chemotherapy alone group (24·8 months [IQR 12·6-37·4]), and the difference in restricted mean survival time at 2 years was -1·9 months (95% CI -3·4 to -0·3, p=0·019). There were 318 serious adverse events (grade ≥3) in the surgery group and 169 in the chemotherapy group (incidence rate ratio 3·6 [95% CI 2·3 to 5·5], p<0·0001), with increased incidence of cardiac (30 vs 12; 3·01 [1·13 to 8·02]) and respiratory (84 vs 34; 2·62 [1·58 to 4·33]) disorders, infection (124 vs 53; 2·13 [1·36 to 3·33]), and additional surgical or medical procedures (15 vs eight; 2·41 [1·04 to 5·57]) in the surgery group. INTERPRETATION Extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable pleural mesothelioma, compared with chemotherapy alone. FUNDING National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (15/188/31), Cancer Research UK Feasibility Studies Project Grant (A15895).
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Affiliation(s)
- Eric Lim
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK.
| | | | | | | | | | - Clinton Ali
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Sanjay Popat
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Mary O'Brien
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - Nadza Tokaca
- The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | | | - John Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sara Tenconi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Laura Socci
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert C Rintoul
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Kelly Wood
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Amanda Stone
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Charlotte Ingle
- East Sussex and North Essex NHS Foundation Trust, Colchester, UK
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Raffaele Califano
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Yvonne Summers
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Andrea Bille
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Riyaz Shah
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Elizabeth Fuller
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Andrew Macnair
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Jonathan Shamash
- Queen's Hospital, Barking Havering and Redbridge NHS Trust, Barking, UK
| | - Talal Mansy
- South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | | | - Pek Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Sarah Treece
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Alan Kirk
- Golden Jubilee National Hospital, Clydebank, UK
| | - Rosie A Harris
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Ashton
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Warnes
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Bridgeman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Joyce
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicola Farrar
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Stokes
- University of Oxford Health Economics Research Centre, Oxford, UK
| | - Vikki Hughes
- Papworth Trials Unit Collaboration, Royal Papworth Hospital, Cambridge, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; Imperial College London, London, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Beynel L, Gura H, Rezaee Z, Ekpo EC, Deng ZD, Joseph JO, Taylor P, Luber B, Lisanby SH. Lessons learned from an fMRI-guided rTMS study on performance in a numerical Stroop task. PLoS One 2024; 19:e0302660. [PMID: 38709724 PMCID: PMC11073721 DOI: 10.1371/journal.pone.0302660] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
The Stroop task is a well-established tool to investigate the influence of competing visual categories on decision making. Neuroimaging as well as rTMS studies have demonstrated the involvement of parietal structures, particularly the intraparietal sulcus (IPS), in this task. Given its reliability, the numerical Stroop task was used to compare the effects of different TMS targeting approaches by Sack and colleagues (Sack AT 2009), who elegantly demonstrated the superiority of individualized fMRI targeting. We performed the present study to test whether fMRI-guided rTMS effects on numerical Stroop task performance could still be observed while using more advanced techniques that have emerged in the last decade (e.g., electrical sham, robotic coil holder system, etc.). To do so we used a traditional reaction time analysis and we performed, post-hoc, a more advanced comprehensive drift diffusion modeling approach. Fifteen participants performed the numerical Stroop task while active or sham 10 Hz rTMS was applied over the region of the right intraparietal sulcus (IPS) showing the strongest functional activation in the Incongruent > Congruent contrast. This target was determined based on individualized fMRI data collected during a separate session. Contrary to our assumption, the classical reaction time analysis did not show any superiority of active rTMS over sham, probably due to confounds such as potential cumulative rTMS effects, and the effect of practice. However, the modeling approach revealed a robust effect of rTMS on the drift rate variable, suggesting differential processing of congruent and incongruent properties in perceptual decision-making, and more generally, illustrating that more advanced computational analysis of performance can elucidate the effects of rTMS on the brain where simpler methods may not.
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Affiliation(s)
- Lysianne Beynel
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Hannah Gura
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
- Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States Of America
| | - Zeynab Rezaee
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Ekaete C. Ekpo
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Janet O. Joseph
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
- Pathobiology Graduate Program, Division of Biology and Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Paul Taylor
- Scientific and Statistical Computing Core, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
| | - Sarah H. Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, United States of America
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Chang KY, Tik M, Mizutani-Tiebel Y, Schuler AL, Taylor P, Campana M, Vogelmann U, Huber B, Dechantsreiter E, Thielscher A, Bulubas L, Padberg F, Keeser D. Neural response during prefrontal theta burst stimulation: Interleaved TMS-fMRI of full iTBS protocols. Neuroimage 2024; 291:120596. [PMID: 38554783 DOI: 10.1016/j.neuroimage.2024.120596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Left prefrontal intermittent theta-burst stimulation (iTBS) has emerged as a safe and effective transcranial magnetic stimulation (TMS) treatment protocol in depression. Though network effects after iTBS have been widely studied, the deeper mechanistic understanding of target engagement is still at its beginning. Here, we investigate the feasibility of a novel integrated TMS-fMRI setup and accelerated echo planar imaging protocol to directly observe the immediate effects of full iTBS treatment sessions. OBJECTIVE/HYPOTHESIS In our effort to explore interleaved iTBS-fMRI feasibility, we hypothesize that TMS will induce acute BOLD signal changes in both the stimulated area and interconnected neural regions. METHODS Concurrent TMS-fMRI with full sessions of neuronavigated iTBS (i.e. 600 pulses) of the left dorsolateral prefrontal cortex (DLPFC) was investigated in 18 healthy participants. In addition, we conducted four TMS-fMRI sessions in a single patient on long-term maintenance iTBS for bipolar depression to test the transfer to clinical cases. RESULTS Concurrent TMS-fMRI was feasible for iTBS sequences with 600 pulses. During interleaved iTBS-fMRI, an increase of the BOLD signal was observed in a network including bilateral DLPFC regions. In the clinical case, a reduced BOLD response was found in the left DLPFC and the subgenual anterior cingulate cortex, with high variability across individual sessions. CONCLUSIONS Full iTBS sessions as applied for the treatment of depressive disorders can be established in the interleaved iTBS-fMRI paradigm. In the future, this experimental approach could be valuable in clinical samples, for demonstrating target engagement by iTBS protocols and investigating their mechanisms of therapeutic action.
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Affiliation(s)
- Kai-Yen Chang
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Martin Tik
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Brain Stimulation Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA.
| | - Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Anna-Lisa Schuler
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Paul Taylor
- Department of Psychology, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Ulrike Vogelmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Barbara Huber
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Axel Thielscher
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Denmark
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich - NICUM, University Hospital, LMU Munich, Munich, Germany.
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Sinyor M, Ekstein D, Prabaharan N, Fiksenbaum L, Vandermeer C, Schaffer A, Pirkis J, Heisel MJ, Goldstein BI, Redelmeier DA, Taylor P, Niederkrotenthaler T. Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l'engagement des médias nationaux à la déclaration responsable du suicide au Canada. Can J Psychiatry 2024; 69:358-368. [PMID: 38174363 PMCID: PMC11032096 DOI: 10.1177/07067437231223334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown. METHOD This pre-post observational study examined changes in reporting characteristics in a random sample of suicide-related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n = 900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data. RESULTS Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone's death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω = -5.41, SE = 3.43, t = 1.58, p = 0.12). CONCLUSIONS We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniella Ekstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nivetha Prabaharan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Caroline Vandermeer
- Viterbi School of Engineering, University of Southern California, Los Angeles, USA
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marnin J. Heisel
- Department of Psychiatry, The University of Western Ontario, London, Canada
| | - Benjamin I. Goldstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, Canada
| | - Donald A. Redelmeier
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
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Schoeberl F, Dowsett J, Pradhan C, Grabova D, Köhler A, Taylor P, Zwergal A. TMS of the left primary motor cortex improves tremor intensity and postural control in primary orthostatic tremor. J Neurol 2024:10.1007/s00415-024-12376-3. [PMID: 38625401 DOI: 10.1007/s00415-024-12376-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
A ponto-cerebello-thalamo-cortical network is the pathophysiological correlate of primary orthostatic tremor. Affected patients often do not respond satisfactorily to pharmacological treatment. Consequently, the objective of the current study was to examine the effects of a non-invasive neuromodulation by theta burst repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex (M1) and dorsal medial frontal cortex (dMFC) on tremor frequency, intensity, sway path and subjective postural stability in primary orthostatic tremor. In a cross-over design, eight patients (mean age 70.2 ± 5.4 years, 4 female) with a primary orthostatic tremor received either rTMS of the left M1 leg area or the dMFC at the first study session, followed by the other condition (dMFC or M1 respectively) at the second study session 30 days later. Tremor frequency and intensity were quantified by surface electromyography of lower leg muscles and total sway path by posturography (foam rubber with eyes open) before and after each rTMS session. Patients subjectively rated postural stability on the posturography platform following each rTMS treatment. We found that tremor frequency did not change significantly with M1- or dMFC-stimulation. However, tremor intensity was lower after M1- but not dMFC-stimulation (p = 0.033/ p = 0.339). The sway path decreased markedly after M1-stimulation (p = 0.0005) and dMFC-stimulation (p = 0.023) compared to baseline. Accordingly, patients indicated a better subjective feeling of postural stability both with M1-rTMS (p = 0.007) and dMFC-rTMS (p = 0.01). In conclusion, non-invasive neuromodulation particularly of the M1 area can improve postural control and tremor intensity in primary orthostatic tremor by interference with the tremor network.
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Affiliation(s)
- Florian Schoeberl
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - James Dowsett
- Division of Psychology, University of Stirling, Stirling, UK
| | - Cauchy Pradhan
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Denis Grabova
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Angelina Köhler
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany
| | - Paul Taylor
- Faculty of Philosophy, Philosophy of Science and the Study of Religion, LMU Munich, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology and German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, LMU Munich, Munich, Germany.
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Jordan T, Nuamek T, Fornacon-Wood I, Califano R, Coote J, Harris M, Mistry H, Taylor P, Woolf D, Faivre-Finn C. A study demonstrating users' preference for the adapted-REQUITE patient-reported outcome questionnaire over PRO-CTCAE ® in patients with lung cancer. Front Oncol 2024; 14:1328871. [PMID: 38660130 PMCID: PMC11039780 DOI: 10.3389/fonc.2024.1328871] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The use of patient-reported outcomes (PROs) has been shown to enhance the accuracy of symptom collection and improve overall survival and quality of life. This is the first study comparing concordance and patient preference for two PRO tools: Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) and the adapted-REQUITE Lung Questionnaire. Materials and Methods Patients with lung cancer were recruited to the study while attending outpatient clinics at a tertiary cancer centre. Clinician-reported outcomes were generated through initial patient assessment with CTCAE v4.03. Participants then completed the PRO-CTCAE® and adapted-REQUITE questionnaires. Concordance between the 2 questionnaires was assessed by calculating Pearson correlation coefficient. PRO-CTCAE® and CTCAE concordance was demonstrated by calculating Pearson correlation coefficient from the linear predictors of an ordinal logistic regression. P-values were also calculated. Results Out of 74 patients approached, 65 provided written informed consent to participate in the study. 63 (96.9%) patients completed both PRO-CTCAE® and adapted-REQUITE questionnaires. Pearson correlation coefficient between PRO tools was 0.8-0.83 (p <.001). Correlation between CTCAE and PRO-CTCAE® ranged between 0.66-0.82 (p <.001). Adapted-REQUITE and CTCAE correlation was higher for all symptoms ranging between 0.79-0.91 (p <.001). Acceptable discrepancies within one grade were present in 96.8%-100% of symptom domains for REQUITE and in 92.1%-96.8% for all domains in the PRO-CTCAE®. 54% of the total participant cohort favored the adapted-REQUITE questionnaire due to reduced subjectivity in the questions and ease of use. Conclusion The adapted-REQUITE questionnaire has shown a superior correlation to clinician-reported outcomes and higher patient preference than the PRO-CTCAE®. The results of this study suggest the use of the REQUITE questionnaire for patients with lung cancer in routine clinical practice.
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Affiliation(s)
- Thomas Jordan
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom
| | | | - Isabella Fornacon-Wood
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Raffaele Califano
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Paul Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Pierpaoli C, Nayak A, Hafiz R, Irfanoglu MO, Chen G, Taylor P, Hallett M, Hoa M, Pham D, Chou YY, Moses AD, van der Merwe AJ, Lippa SM, Brewer CC, Zalewski CK, Zampieri C, Turtzo LC, Shahim P, Chan L. Neuroimaging Findings in US Government Personnel and Their Family Members Involved in Anomalous Health Incidents. JAMA 2024; 331:1122-1134. [PMID: 38497822 PMCID: PMC10949155 DOI: 10.1001/jama.2024.2424] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024]
Abstract
Importance US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms. Objective To assess the potential presence of magnetic resonance imaging (MRI)-detectable brain lesions in participants with AHIs, with respect to a well-matched control group. Design, Setting, and Participants This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit. Exposure AHIs. Main Outcomes and Measures Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)-wise; (2) diffusion MRI-derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling. Results Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P < .05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ = 0.10). The study did not replicate the results of a previously published investigation of AHIs. Conclusions and Relevance In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.
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Affiliation(s)
- Carlo Pierpaoli
- Laboratory on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - Amritha Nayak
- Laboratory on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
- Scientific and Statistical Computing Core, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Rakibul Hafiz
- Laboratory on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - M. Okan Irfanoglu
- Laboratory on Quantitative Medical Imaging, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland
| | - Gang Chen
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Paul Taylor
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Mark Hallett
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Michael Hoa
- Military Traumatic Brain Injury Initiative (MTBI2—formerly known as the Center for Neuroscience and Regenerative Medicine [CNRM])
| | - Dzung Pham
- The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Yi-Yu Chou
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Anita D. Moses
- Scientific and Statistical Computing Core, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - André J. van der Merwe
- Scientific and Statistical Computing Core, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Sara M. Lippa
- National Intrepid Center of Excellence Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Carmen C. Brewer
- Military Traumatic Brain Injury Initiative (MTBI2—formerly known as the Center for Neuroscience and Regenerative Medicine [CNRM])
| | - Chris K. Zalewski
- Military Traumatic Brain Injury Initiative (MTBI2—formerly known as the Center for Neuroscience and Regenerative Medicine [CNRM])
| | - Cris Zampieri
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - L. Christine Turtzo
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Pashtun Shahim
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Leighton Chan
- Scientific and Statistical Computing Core, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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8
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Szlosarek PW, Creelan BC, Sarkodie T, Nolan L, Taylor P, Olevsky O, Grosso F, Cortinovis D, Chitnis M, Roy A, Gilligan D, Kindler H, Papadatos-Pastos D, Ceresoli GL, Mansfield AS, Tsao A, O’Byrne KJ, Nowak AK, Steele J, Sheaff M, Shiu CF, Kuo CL, Johnston A, Bomalaski J, Zauderer MG, Fennell DA. Pegargiminase Plus First-Line Chemotherapy in Patients With Nonepithelioid Pleural Mesothelioma: The ATOMIC-Meso Randomized Clinical Trial. JAMA Oncol 2024; 10:475-483. [PMID: 38358753 PMCID: PMC10870227 DOI: 10.1001/jamaoncol.2023.6789] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 02/16/2024]
Abstract
Importance Arginine deprivation using ADI-PEG20 (pegargiminase) combined with chemotherapy is untested in a randomized study among patients with cancer. ATOMIC-Meso (ADI-PEG20 Targeting of Malignancies Induces Cytotoxicity-Mesothelioma) is a pivotal trial comparing standard first-line chemotherapy plus pegargiminase or placebo in patients with nonepithelioid pleural mesothelioma. Objective To determine the effect of pegargiminase-based chemotherapy on survival in nonepithelioid pleural mesothelioma, an arginine-auxotrophic tumor. Design, Setting, and Participants This was a phase 2-3, double-blind randomized clinical trial conducted at 43 centers in 5 countries that included patients with chemotherapy-naive nonepithelioid pleural mesothelioma from August 1, 2017, to August 15, 2021, with at least 12 months' follow-up. Final follow-up was on August 15, 2022. Data analysis was performed from March 2018 to June 2023. Intervention Patients were randomly assigned (1:1) to receive weekly intramuscular pegargiminase (36.8 mg/m2) or placebo. All patients received intravenous pemetrexed (500 mg/m2) and platinum (75-mg/m2 cisplatin or carboplatin area under the curve 5) chemotherapy every 3 weeks up to 6 cycles. Pegargiminase or placebo was continued until progression, toxicity, or 24 months. Main Outcomes and Measures The primary end point was overall survival, and secondary end points were progression-free survival and safety. Response rate by blinded independent central review was assessed in the phase 2 portion only. Results Among 249 randomized patients (mean [SD] age, 69.5 [7.9] years; 43 female individuals [17.3%] and 206 male individuals [82.7%]), all were included in the analysis. The median overall survival was 9.3 months (95% CI, 7.9-11.8 months) with pegargiminase-chemotherapy as compared with 7.7 months (95% CI, 6.1-9.5 months) with placebo-chemotherapy (hazard ratio [HR] for death, 0.71; 95% CI, 0.55-0.93; P = .02). The median progression-free survival was 6.2 months (95% CI, 5.8-7.4 months) with pegargiminase-chemotherapy as compared with 5.6 months (95% CI, 4.1-5.9 months) with placebo-chemotherapy (HR, 0.65; 95% CI, 0.46-0.90; P = .02). Grade 3 to 4 adverse events with pegargiminase occurred in 36 patients (28.8%) and with placebo in 21 patients (16.9%); drug hypersensitivity and skin reactions occurred in the experimental arm in 3 patients (2.4%) and 2 patients (1.6%), respectively, and none in the placebo arm. Rates of poststudy treatments were comparable in both arms (57 patients [45.6%] with pegargiminase vs 58 patients [46.8%] with placebo). Conclusions and Relevance In this randomized clinical trial of arginine depletion with pegargiminase plus chemotherapy, survival was extended beyond standard chemotherapy with a favorable safety profile in patients with nonepithelioid pleural mesothelioma. Pegargiminase-based chemotherapy as a novel antimetabolite strategy for mesothelioma validates wider clinical testing in oncology. Trial Registration ClinicalTrials.gov Identifier: NCT02709512.
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Affiliation(s)
- Peter W. Szlosarek
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | - Thomas Sarkodie
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
| | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Olga Olevsky
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Meenali Chitnis
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Hedy Kindler
- University of Chicago Medicine, Chicago, Illinois
| | | | | | | | - Anne Tsao
- The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth J. O’Byrne
- Princess Alexandra Hospital and Queensland University of Technology, Brisbane, Australia
| | - Anna K. Nowak
- Medical School, The University of Western Australia and Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Jeremy Steele
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Michael Sheaff
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | | | | | - Marjorie G. Zauderer
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Dean A. Fennell
- University of Leicester & University Hospitals of Leicester NHS, United Kingdom
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Cheong RCT, Jawad S, Adams A, Campion T, Lim ZH, Papachristou N, Unadkat S, Randhawa P, Joseph J, Andrews P, Taylor P, Kunz H. Enhancing paranasal sinus disease detection with AutoML: efficient AI development and evaluation via magnetic resonance imaging. Eur Arch Otorhinolaryngol 2024; 281:2153-2158. [PMID: 38197934 PMCID: PMC10942883 DOI: 10.1007/s00405-023-08424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Artificial intelligence (AI) in the form of automated machine learning (AutoML) offers a new potential breakthrough to overcome the barrier of entry for non-technically trained physicians. A Clinical Decision Support System (CDSS) for screening purposes using AutoML could be beneficial to ease the clinical burden in the radiological workflow for paranasal sinus diseases. METHODS The main target of this work was the usage of automated evaluation of model performance and the feasibility of the Vertex AI image classification model on the Google Cloud AutoML platform to be trained to automatically classify the presence or absence of sinonasal disease. The dataset is a consensus labelled Open Access Series of Imaging Studies (OASIS-3) MRI head dataset by three specialised head and neck consultant radiologists. A total of 1313 unique non-TSE T2w MRI head sessions were used from the OASIS-3 repository. RESULTS The best-performing image classification model achieved a precision of 0.928. Demonstrating the feasibility and high performance of the Vertex AI image classification model to automatically detect the presence or absence of sinonasal disease on MRI. CONCLUSION AutoML allows for potential deployment to optimise diagnostic radiology workflows and lay the foundation for further AI research in radiology and otolaryngology. The usage of AutoML could serve as a formal requirement for a feasibility study.
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Affiliation(s)
- Ryan Chin Taw Cheong
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Susan Jawad
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | | | | | | | - Nikolaos Papachristou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samit Unadkat
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Premjit Randhawa
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Jonathan Joseph
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Peter Andrews
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | | | - Holger Kunz
- University College London, London, UK.
- School of Public Health, Imperial College London, London, UK.
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10
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Shipman LA, Price J, Abdulwahid D, Bayman N, Blackhall F, Califano R, Chan C, Coote J, Eaton M, Fenemore J, Gomes F, Harris M, Halkyard E, Lindsay C, Neal H, McEntee D, Sheikh H, Summers Y, Taylor P, Woolf D, Yorke J, Faivre-Finn C. Service Evaluation of MyChristie-MyHealth, an Electronic Patient-Reported Outcome Measure Integrated Into Clinical Cancer Care. JCO Clin Cancer Inform 2024; 8:e2300162. [PMID: 38574311 DOI: 10.1200/cci.23.00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/14/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Electronic patient-reported outcome measures (ePROMs) are digitalized health questionnaires used to gauge patients' subjective experience of health and disease. They are becoming prevalent in cancer care and have been linked to a host of benefits including improved survival. MyChristie-MyHealth is the ePROM established at the Christie NHS Foundation Trust in 2019. We conducted an evaluation of this service to understand user experiences, as well as strategies to improve its functioning. METHODS Data collection: Patients who had opted never to complete MyChristie-MyHealth (n = 87), and those who had completed at least one (n = 87) were identified. Demographic data included age, sex, ethnicity, postcode, diagnosis, treatment intent, and trial status. Semistructured interviews were held with noncompleters (n = 30) and completers (n = 31) of MyChristie-MyHealth, as well as clinician users (n = 6), covering themes such as accessibility, acceptability and usefulness, and open discourse on ways in which the service could be improved. RESULTS Noncompleters of MyChristie-MyHealth were older (median age 72 v 66 years, P = .005), receiving treatment with curative rather than palliative intent (odds ratio [OR], 1.45; P = .045), and less likely to be enrolled on a clinical trial (OR, 0.531; P = .011). They were less likely to own a smartphone (33% v 97%) or have reliable Internet access (45% v 100%). Satisfaction with MyChristie-MyHealth was high in both groups: 93% (n = 29) of completers and 87% (n = 26) noncompleters felt generally happy to complete. Completers of MyChristie-MyHealth wanted their results to be acknowledged by their clinicians. Clinicians wanted results to be displayed in a more user-friendly way. CONCLUSION We have broadly characterized noncompleters of the Christie ePROM to identify those in need of extra support or encouragement in the clinic. An action plan resulting from this review has been compiled and will inform the future development of MyChristie-MyHealth.
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Affiliation(s)
- Lee A Shipman
- Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - James Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Raffaele Califano
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Clara Chan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marie Eaton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Emma Halkyard
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Colin Lindsay
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hilary Neal
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Delyth McEntee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hamid Sheikh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Yvonne Summers
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Christie Patient-Centred Research, Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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11
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Forward C, Bayley Z, Walker L, Krygier J, White C, Mwaba K, Elliott-Button H, Taylor P, Johnson MJ. Needs and experiences of homecare workers when supporting people to live at home at the end of life: a rapid review. BMJ Support Palliat Care 2024:spcare-2023-004737. [PMID: 38490719 DOI: 10.1136/spcare-2023-004737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group. AIM To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care. METHODS We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool. DATA SOURCES CINAHL and Medline databases (2011-2023; English language). RESULTS 19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant. CONCLUSIONS Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.
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Affiliation(s)
- Catherine Forward
- Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Liz Walker
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Justine Krygier
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Caroline White
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Kasonde Mwaba
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Helene Elliott-Button
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Paul Taylor
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
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12
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Häckel S, Gaff J, Pabbruwe M, Celenza A, Kern M, Taylor P, Miles A, Cunningham G. Heterotopic ossification, osteolysis and implant failure following cervical total disc replacement with the M6-C™ artificial disc. Eur Spine J 2024; 33:1292-1299. [PMID: 38363365 DOI: 10.1007/s00586-024-08129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION A recent study reported a 34% mid-term revision rate after M6-C™ cervical total disc replacement (CTDR) for wear-related osteolysis. Here, we aim to investigate the prevalence, risk factors, and radiographic characteristics of periprosthetic bony changes and implant failure of the M6-C™ artificial disc. METHODS We retrospectively analysed radiographic (conventional X-ray, CT scan) and clinical outcomes (EQ-5D-5L, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck and arm pain) data collected during routine follow-up of patients who underwent CTDR with the M6-C™ between 2011 and 2015. RESULTS In total, 85 patients underwent CTDR with the M6-C™. Follow-up data were available for 43 patients (54% female, mean age 44 years) with 50 implants and a mean follow-up of 8.1 years (6.5-11 years). Implant failure with the presence of severe osteolysis was identified in 5 (12%) patients who were all male (p = 0.016) and implanted at the C5/6 level (p = 0.11). All failed implants required revision surgery. The overall prevalence of osteolysis was 44% (22/50 implants) and 34% (17/50 implants) for significant heterotopic ossification. Patients with high-grade osteolysis showed higher VAS arm pain (p = 0.05) and lower EQ-5D-VAS health VAS (p = 0.03). CONCLUSION We report a lower reoperation rate for failed M6-C™ implants than previously published, but confirmed that osteolysis and heterotopic ossification are common following CTDR with the M6-C™ and may be asymptomatic. Therefore, we strongly recommend ongoing clinical and radiographic monitoring after CTDR with the M6-C™, particularly for male patients implanted at the C5/6 level.
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Affiliation(s)
- Sonja Häckel
- Neurospine Institute, Murdoch, Australia
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
| | - Jessica Gaff
- Neurospine Institute, Murdoch, Australia.
- Curtin Medical School, Curtin University, Bentley, Australia.
| | - Moreica Pabbruwe
- Department of Medical Engineering and Physics, Centre for Implant Technology and Retrieval Analysis, Royal Perth Hospital, Perth, Australia
| | | | - Michael Kern
- Neurospine Institute, Murdoch, Australia
- Department of Neurosurgery, St. John of God Hospital, Murdoch, Australia
| | - Paul Taylor
- Neurospine Institute, Murdoch, Australia
- Department of Orthopaedic Surgery, St. John of God Hospital, Murdoch, Australia
- Department of Orthopaedic Surgery, Mount Hospital, Perth, Australia
| | - Andrew Miles
- Neurospine Institute, Murdoch, Australia
- Department of Neurosurgery, St. John of God Hospital, Murdoch, Australia
| | - Greg Cunningham
- Neurospine Institute, Murdoch, Australia
- Curtin Medical School, Curtin University, Bentley, Australia
- Department of Orthopaedic Surgery, St. John of God Hospital, Murdoch, Australia
- Department of Orthopaedic Surgery, Mount Hospital, Perth, Australia
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13
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Burdon J, Fingas S, Parry R, Pitsillides C, Taylor P. Sedation from analgesics: patient preference survey. BMJ Support Palliat Care 2024:spcare-2023-004759. [PMID: 38388209 DOI: 10.1136/spcare-2023-004759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The propensity for certain analgesics to cause sedation is well documented, yet physician-patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect. OBJECTIVES To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making. METHODS Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion. RESULTS Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis. CONCLUSIONS Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.
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Affiliation(s)
- Joseph Burdon
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
| | - Samuel Fingas
- Palliative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Parry
- Palliative Medicine, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | | | - Paul Taylor
- Palliative Medicine, St Luke's Hospice, Sheffield, UK
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
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14
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Noetel M, Sanders T, Gallardo-Gómez D, Taylor P, Del Pozo Cruz B, van den Hoek D, Smith JJ, Mahoney J, Spathis J, Moresi M, Pagano R, Pagano L, Vasconcellos R, Arnott H, Varley B, Parker P, Biddle S, Lonsdale C. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 2024; 384:e075847. [PMID: 38355154 PMCID: PMC10870815 DOI: 10.1136/bmj-2023-075847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN Systematic review and network meta-analysis. METHODS Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018118040.
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Affiliation(s)
- Michael Noetel
- School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | | | - Paul Taylor
- School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia
| | - Borja Del Pozo Cruz
- Department of Clinical Biomechanics and Sports Science, University of Southern Denmark, Odense, Denmark
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, University of Cádiz, Spain
| | - Daniel van den Hoek
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD, Australia
| | - Jordan J Smith
- School of Education, University of Newcastle, Callaghan, NSW, Australia
| | - John Mahoney
- School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia
| | - Jemima Spathis
- School of Health and Behavioural Sciences, Australian Catholic University, Banyo, QLD, Australia
| | - Mark Moresi
- School of Health and Behavioural Sciences, Australian Catholic University, Strathfield, NSW, Australia
| | - Rebecca Pagano
- School of Education, Australian Catholic University, Strathfield, NSW, Australia
| | - Lisa Pagano
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Roberta Vasconcellos
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Hugh Arnott
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW, Australia
| | - Benjamin Varley
- Children's Hospital Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Philip Parker
- Australian Catholic University, North Sydney, NSW, Australia
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
- Faculty of Sport and Health Science, University of Jyvaskyla, Jyvaskyla, Finland
| | - Chris Lonsdale
- Australian Catholic University, North Sydney, NSW, Australia
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Bayley Z, Bothma J, Bravington A, Forward C, Hussain J, Manthorpe J, Pearson M, Roberts H, Taylor P, Walker L, White C, Wray J, Johnson MJ. Correction: Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol. PLoS One 2024; 19:e0298925. [PMID: 38346048 PMCID: PMC10861030 DOI: 10.1371/journal.pone.0298925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0291525.].
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16
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Bayley Z, Bothma J, Bravington A, Forward C, Hussain J, Manthorpe J, Pearson M, Roberts H, Taylor P, Walker L, White C, Wray J, Johnson MJ. Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol. PLoS One 2023; 18:e0291525. [PMID: 38091299 PMCID: PMC10718427 DOI: 10.1371/journal.pone.0291525] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. AIM To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. METHODS In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner's Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). CONTRIBUTION We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers.
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Affiliation(s)
- Zana Bayley
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Alison Bravington
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Cat Forward
- King’s College London, London, United Kingdom
| | - Jamilla Hussain
- Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | | | - Mark Pearson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Helen Roberts
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- St Luke’s Hospice, Sheffield, United Kingdom
| | - Liz Walker
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Caroline White
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jane Wray
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
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17
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Fennell D, Griffiths D, Eminton Z, Morgan-Fox A, Hill K, Ewings S, Stuart C, Johnson L, Mallard K, Nye M, Darlison L, Dulloo S, Cave J, Luo JL, Taylor P, Spicer J, Poile C, Bzura A, Griffiths G. Evaluating niraparib versus active symptom control in patients with previously treated mesothelioma (NERO): a study protocol for a multicentre, randomised, two-arm, open-label phase II trial in UK secondary care centres. BMJ Open 2023; 13:e073120. [PMID: 37993149 PMCID: PMC10668324 DOI: 10.1136/bmjopen-2023-073120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Malignant mesothelioma is a rapidly lethal cancer that has been increasing at an epidemic rate over the last three decades. Targeted therapies for mesothelioma have been lacking. A previous study called MiST1 (NCT03654833), evaluated the efficacy of Poly (ADP-ribose) polymerase (PARP) inhibition in mesothelioma. This study met its primary endpoint with 15% of patients having durable responses exceeding 1 year. Therefore, there is a need to evaluate PARP inhibitors in relapsed mesothelioma patients, where options are limited. Niraparib is the PARP inhibitor used in NERO. METHODS NERO is a multicentre, two-arm, open-label UK randomised phase II trial designed to evaluate the efficacy of PARP inhibition in relapsed mesothelioma. 84 patients are being recruited. NERO is not restricted by line of therapy; however, eligible participants must have been treated with an approved platinum based systemic therapy. Participants will be randomised 2:1, stratified according to histology and response to prior platinum-based chemotherapy, to receive either active symptom control (ASC) and niraparib or ASC alone, for up to 24 weeks. Participants will be treated until disease progression, withdrawal, death or development of significant treatment limiting toxicity. Participants randomised to niraparib will receive 200 or 300 mg daily in a 3-weekly cycle. The primary endpoint is progression-free survival, where progression is determined by modified Response Evaluation Criteria in Solid Tumors (mRECIST) or RECIST 1.1; investigator reported progression; or death from any cause, whichever comes first. Secondary endpoints include overall survival, best overall response, 12-week and 24 week disease control, duration of response, treatment compliance and safety/tolerability. If NERO shows niraparib to be safe and biologically effective, it may lead to future late phase randomised controlled trials in relapsed mesothelioma. ETHICS AND DISSEMINATION The study received ethical approval from London-Hampstead Research Ethics Committee on 06-May-2022 (22/LO/0281). Data from all centres will be analysed together and published as soon as possible. TRIAL REGISTRATION NUMBER ISCRTN16171129; NCT05455424.
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Affiliation(s)
- Dean Fennell
- Mesothelioma Research Programme, Department of Genetics and Genome Biology, University of Leicester & University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Abigail Morgan-Fox
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kayleigh Hill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Charlotte Stuart
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Lucy Johnson
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kim Mallard
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Mavis Nye
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Liz Darlison
- Mesothelioma Research Programme, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sean Dulloo
- Department of Genetics and Genome Biology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Judith Cave
- Department of Oncology, Wessex NET group ENETS Centre of Excellence, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jin-Li Luo
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Paul Taylor
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jake Spicer
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Charlotte Poile
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Aleksandra Bzura
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
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18
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d'Andrea F, Taylor P, Yang K, Heller B. Can inertial measurement unit sensors evaluate foot kinematics in drop foot patients using functional electrical stimulation? Front Hum Neurosci 2023; 17:1225086. [PMID: 38021225 PMCID: PMC10666752 DOI: 10.3389/fnhum.2023.1225086] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
The accuracy of inertial measurement units (IMUs) in measuring foot motion in the sagittal plane has been previously compared to motion capture systems for healthy and impaired participants. Studies analyzing the accuracy of IMUs in measuring foot motion in the frontal plane are lacking. Drop foot patients use functional electrical stimulation (FES) to improve walking and reduce the risk of tripping and falling by improving foot dorsiflexion and inversion-eversion. Therefore, this study aims to evaluate if IMUs can estimate foot angles in the frontal and sagittal planes to help understand the effects of FES on drop foot patients in clinical settings. Two Gait Up sensors were used to estimate foot dorsi-plantar flexion and inversion-eversion angles in 13 unimpaired participants and 9 participants affected by drop foot while walking 6 m in a straight line. Unimpaired participants were asked to walk normally at three self-selected speeds and to simulate drop foot. Impaired participants walked with and without FES assistance. Foot angles estimated by the IMUs were compared with those measured from a motion capture system using curve RMSE and Bland Altman limits of agreement. Between participant groups, overall errors of 7.95° ± 3.98°, -1.12° ± 4.20°, and 1.38° ± 5.05° were obtained for the dorsi-plantar flexion range of motion, dorsi-plantar flexion at heel strike, and inversion-eversion at heel strike, respectively. The between-system comparison of their ability to detect dorsi-plantar flexion and inversion-eversion differences associated with FES use on drop foot patients provided limits of agreement too large for IMUs to be able to accurately detect the changes in foot kinematics following FES intervention. To the best of the authors' knowledge, this is the first study to evaluate IMU accuracy in the estimation of foot inversion-eversion and analyze the potential of using IMUs in clinical settings to assess gait for drop foot patients and evaluate the effects of FES. From the results, it can be concluded that IMUs do not currently represent an alternative to motion capture to evaluate foot kinematics in drop foot patients using FES.
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Affiliation(s)
- Francesca d'Andrea
- Sports EngineeringResearch Group, Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, United Kingdom
| | - Paul Taylor
- The National Clinical FES Centre, Department of Clinical Science and Engineering, Salisbury District Hospital, Salisbury, United Kingdom
- Faculty of Health and Social Science, Bournemouth University, Poole, United Kingdom
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, United Kingdom
| | - Kai Yang
- Etexsense, Southampton, United Kingdom
- Winchester School of Art, University of Southampton, Southampton, United Kingdom
| | - Ben Heller
- Sports EngineeringResearch Group, Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, United Kingdom
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19
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Winter L, Taylor P, Bellenger C, Grimshaw P, Crowther RG. The application of the Lyapunov Exponent to analyse human performance: A systematic review. J Sports Sci 2023; 41:1994-2013. [PMID: 38326239 DOI: 10.1080/02640414.2024.2308441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
Variability is a normal component of human movement, allowing one to adapt to environmental perturbations. It can be analysed from linear or non-linear perspectives. The Lyapunov Exponent (LyE) is a commonly used non-linear technique, which quantifies local dynamic stability. It has been applied primarily to walking gait and appears to be limited application in other movements. Therefore, this systematic review aims to summarise research methodologies applying the LyE to movements, excluding walking gait. Four databases were searched using keywords related to movement variability, dynamic stability, LyE and divergence exponent. Articles written in English, using the LyE to analyse movements, excluding walking gait were included for analysis. 31 papers were included for data extraction. Quality appraisal was conducted and information related to the movement, data capture method, data type, apparatus, sampling rate, body segment/joint, number of strides/steps, state space reconstruction, algorithm, filtering, surrogation and time normalisation were extracted. LyE values were reported in supplementary materials (Appendix 2). Running was the most prevalent non-walking gait movement assessed. Methodologies to calculate the LyE differed in various aspects resulting in different LyE values being generated. Additionally, test-retest reliability, was only conducted in one study, which should be addressed in future.
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Affiliation(s)
- Lachlan Winter
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Paul Taylor
- School of Behavioural and Health Sciences, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Clint Bellenger
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Paul Grimshaw
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Faculty of Sciences, Engineering and Technology, Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert G Crowther
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
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20
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Rangelov B, Young A, Lilaonitkul W, Aslani S, Taylor P, Guðmundsson E, Yang Q, Hu Y, Hurst JR, Hawkes DJ, Jacob J. Author Correction: Delineating COVID-19 subgroups using routine clinical data identifies distinct in-hospital outcomes. Sci Rep 2023; 13:18376. [PMID: 37884602 PMCID: PMC10603162 DOI: 10.1038/s41598-023-45343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Bojidar Rangelov
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK.
| | - Alexandra Young
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
- Department of Neuroimaging, King's College London, London, UK
| | | | - Shahab Aslani
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Eyjólfur Guðmundsson
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Qianye Yang
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Yipeng Hu
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - David J Hawkes
- Centre for Medical Image Computing, University College London, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
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21
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Taylor P, Meyer RE. Veterinary clinical research or experiments on pets. Vet Anaesth Analg 2023; 50:383-385. [PMID: 37634935 DOI: 10.1016/j.vaa.2023.07.006] [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: 08/29/2023]
Affiliation(s)
- P Taylor
- Taylor Monroe, Gravel Head Farm, Ely, Cambridgeshire, UK.
| | - R E Meyer
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, MS, USA
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22
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Tache I, Warmelink L, Taylor P, Hope L. Cultural differences in the efficacy of unexpected questions, sketching, and timeline methods in eliciting cues to deception. Front Psychol 2023; 14:1175333. [PMID: 37720643 PMCID: PMC10500155 DOI: 10.3389/fpsyg.2023.1175333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Asking unexpected questions, asking the interviewee to sketch the room, and asking the interviewee to make a timeline are techniques that have been shown to help an interviewer detect deceit. However, evidence of the efficacy of these techniques comes from studies of North American and North-West European participants, who are on average more individualistic (i.e., value individual achievements and uniqueness over group achievements) than people from other parts of the world. In two experiments involving participants with individualistic and collectivistic cultural backgrounds, we provide a more culturally diverse test of these techniques. Specifically, this study describes two experiments that investigated these interviewing techniques with people who are recent migrants to the UK. Experiment 1 used the LIWC categories "I," "we," "cognitive processes," and "social processes" as the dependent variables; Experiment 2 measured details provided in a sketch and a timeline. The results show no effects of veracity in either of these experiments, although various effects of cultural differences in the outcome variables were observed. This suggests that cues to deception may not necessarily generalize to people from different cultural backgrounds. These results highlight the importance of conducting lie detection research across different countries and cultures.
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Affiliation(s)
- Irina Tache
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Lara Warmelink
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Paul Taylor
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Lorraine Hope
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
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23
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Taylor P, Swan M, Sitters H, Smith A, Di Stefano J. Small mammals reduce activity during high moon illumination under risk of predation by introduced predators. Sci Rep 2023; 13:10532. [PMID: 37386037 PMCID: PMC10310734 DOI: 10.1038/s41598-023-37166-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
Predation influences prey survival and drives evolution of anti-predator behaviour. Anti-predator strategies by prey are stimulated by direct encounters with predators, but also by exposure to indicators of risk such as moonlight illumination and vegetation cover. Many prey species will suffer increased risk on moonlit nights, but risk may be reduced by the presence of dense vegetation. Determining the role of vegetation in reducing perceived risk is important, especially given predictions of increased global wildfire, which consumes vegetation and increases predation. We used remote cameras in southeastern Australia to compare support for the predation risk and habitat-mediated predation risk hypotheses. We examined the influence of moonlight and understorey cover on seven 20-2500 g mammalian prey species and two introduced predators, red foxes and feral cats. Activity of all prey species reduced by 40-70% with increasing moonlight, while one species (bush rat) reduced activity in response to increasing moonlight more sharply in low compared to high understorey cover. Neither predator responded to moonlight. Our findings supported the predation risk hypothesis and provided limited support for the habitat-mediated predation risk hypothesis. For prey, perceived costs of increased predation risk on moonlit nights outweighed any benefits of a brighter foraging environment.
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Affiliation(s)
- P Taylor
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, 4 Water Street, Creswick, VIC, 3363, Australia
- NSW Department of Primary Industries, Vertebrate Pest Research Unit, 1447 Forest Road, Orange, NSW, 2800, Australia
| | - M Swan
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, 4 Water Street, Creswick, VIC, 3363, Australia.
| | - H Sitters
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, 4 Water Street, Creswick, VIC, 3363, Australia
| | - A Smith
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, 4 Water Street, Creswick, VIC, 3363, Australia
| | - J Di Stefano
- School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, 4 Water Street, Creswick, VIC, 3363, Australia
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24
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Rangelov B, Young A, Lilaonitkul W, Aslani S, Taylor P, Guðmundsson E, Yang Q, Hu Y, Hurst JR, Hawkes DJ, Jacob J. Delineating COVID-19 subgroups using routine clinical data identifies distinct in-hospital outcomes. Sci Rep 2023; 13:9986. [PMID: 37339958 PMCID: PMC10282086 DOI: 10.1038/s41598-023-32469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/28/2023] [Indexed: 06/22/2023] Open
Abstract
The COVID-19 pandemic has been a great challenge to healthcare systems worldwide. It highlighted the need for robust predictive models which can be readily deployed to uncover heterogeneities in disease course, aid decision-making and prioritise treatment. We adapted an unsupervised data-driven model-SuStaIn, to be utilised for short-term infectious disease like COVID-19, based on 11 commonly recorded clinical measures. We used 1344 patients from the National COVID-19 Chest Imaging Database (NCCID), hospitalised for RT-PCR confirmed COVID-19 disease, splitting them equally into a training and an independent validation cohort. We discovered three COVID-19 subtypes (General Haemodynamic, Renal and Immunological) and introduced disease severity stages, both of which were predictive of distinct risks of in-hospital mortality or escalation of treatment, when analysed using Cox Proportional Hazards models. A low-risk Normal-appearing subtype was also discovered. The model and our full pipeline are available online and can be adapted for future outbreaks of COVID-19 or other infectious disease.
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Affiliation(s)
- Bojidar Rangelov
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK.
| | - Alexandra Young
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
- Department of Neuroimaging, King's College London, London, UK
| | | | - Shahab Aslani
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Eyjólfur Guðmundsson
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Qianye Yang
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Yipeng Hu
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - David J Hawkes
- Centre for Medical Image Computing, University College London, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing (CMIC), University College London, London, UK
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Jhaveri S, Battersby E, Stern KWD, Cohen J, Yang Y, Price A, Hughes E, Poston L, Pasupathy D, Taylor P, Vieira MC, Groves A. Normative ranges of biventricular volumes and function in healthy term newborns. J Cardiovasc Magn Reson 2023; 25:26. [PMID: 37095534 PMCID: PMC10127416 DOI: 10.1186/s12968-023-00932-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is increasingly used in newborns with congenital heart disease. However, reporting on ventricular volumes and mass is hindered by an absence of normative data in this population. DESIGN/METHODS Healthy term (37-41 weeks gestation) newborns underwent non-sedated, free-breathing CMR within the first week of life using the 'feed and wrap' technique. End-diastolic volume (EDV), end-systolic volume (ESV) stroke volume (SV) and ejection fraction (EF) were calculated for both left ventricle (LV) and right ventricle (RV). Papillary muscles were separately contoured and included in the myocardial volume. Myocardial mass was calculated by multiplying myocardial volume by 1.05 g/ml. All data were indexed to weight and body surface area (BSA). Inter-observer variability (IOV) was performed on data from 10 randomly chosen infants. RESULTS Twenty healthy newborns (65% male) with a mean (SD) birth weight of 3.54 (0.46) kg and BSA of 0.23 (0.02) m2 were included. Normative LV parameters were indexed EDV 39.0 (4.1) ml/m2, ESV 14.5 (2.5) ml/m2 and ejection fraction (EF) 63.2 (3.4)%. Normative RV indexed EDV, ESV and EF were 47.4 (4.5) ml/m2, 22.6 (2.9) ml/m2 and 52.5 (3.3)% respectively. Mean LV and RV indexed mass were 26.4 (2.8) g/m2 and 12.5 (2.0) g/m2, respectively. There was no difference in ventricular volumes by gender. IOV was excellent with an intra-class coefficient > 0.95 except for RV mass (0.94). CONCLUSION This study provides normative data on LV and RV parameters in healthy newborns, providing a novel resource for comparison with newborns with structural and functional heart disease.
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Affiliation(s)
- Simone Jhaveri
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
| | - Ellie Battersby
- Center for the Developing Brain, Kings College London, London, UK
| | - Kenan W D Stern
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Cohen
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yang Yang
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Price
- Center for the Developing Brain, Kings College London, London, UK
| | - Emer Hughes
- Center for the Developing Brain, Kings College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Syndey, NSW, Australia
| | - Paul Taylor
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Matias C Vieira
- Department of Women and Children's Health, School of Life Course and Population Sciences, Kings College London, London, UK
| | - Alan Groves
- Department of Pediatrics, Dell Medical School at the University of Austin, Austin, TX, USA
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26
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Norvilaite O, Lindsay C, Taylor P, Armes SP. Silica-Coated Micrometer-Sized Latex Particles. Langmuir 2023; 39:5169-5178. [PMID: 37001132 PMCID: PMC10100546 DOI: 10.1021/acs.langmuir.3c00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/14/2023] [Indexed: 06/19/2023]
Abstract
A series of silica-coated micrometer-sized poly(methyl methacrylate) latex particles are prepared using a Stöber silica deposition protocol that employs tetraethyl orthosilicate (TEOS) as a soluble silica precursor. Given the relatively low specific surface area of the latex particles, silica deposition is best conducted at relatively high solids to ensure a sufficiently high surface area. Such conditions aid process intensification. Importantly, physical adsorption of chitosan onto the latex particles prior to silica deposition minimizes secondary nucleation and promotes the formation of silica shells: in the absence of chitosan, well-defined silica overlayers cannot be obtained. Thermogravimetry studies indicate that silica formation is complete within a few hours at 20 °C regardless of the presence or absence of chitosan. Kinetic data obtained using this technique suggest that the adsorbed chitosan chains promote surface deposition of silica onto the latex particles but do not catalyze its formation. Systematic variation of the TEOS/latex mass ratio enables the mean silica shell thickness to be tuned from 45 to 144 nm. Scanning electron microscopy (SEM) studies of silica-coated latex particles after calcination at 400 °C confirm the presence of hollow silica particles, which indicates the formation of relatively smooth (albeit brittle) silica shells under optimized conditions. Aqueous electrophoresis and X-ray photoelectron spectroscopy studies are also consistent with latex particles coated in a uniform silica overlayer. The silica deposition formulation reported herein is expected to be a useful generic strategy for the efficient coating of micrometer-sized particles at relatively high solids.
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Affiliation(s)
- O. Norvilaite
- Dainton
Building, Department of Chemistry, University
of Sheffield, Brook Hill, Sheffield, South
Yorkshire S3 7HF, UK
| | - C. Lindsay
- Syngenta, Jealott’s Hill International
Research Centre, Bracknell, Berkshire RG42 6EY, UK
| | - P. Taylor
- Syngenta, Jealott’s Hill International
Research Centre, Bracknell, Berkshire RG42 6EY, UK
| | - S. P. Armes
- Dainton
Building, Department of Chemistry, University
of Sheffield, Brook Hill, Sheffield, South
Yorkshire S3 7HF, UK
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Lee GC, Kyeremateng S, Taylor P, Jones C, Hammond P, McTague L. Palliative care teaching in the new internal medicine curriculum: Project ECHO-an innovative approach to postgraduate education. BMJ Support Palliat Care 2023; 13:247-254. [PMID: 37028918 DOI: 10.1136/spcare-2022-004008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/15/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The Internal Medicine Training (IMT) Programme is an evolution of Core Medical Training introduced in 2019. The IMT curriculum places an increased emphasis on palliative care; however, access to palliative care training is variable. Project ECHO (Extension of Community Healthcare Outcomes) develops communities of practice and is a valuable tool for medical education. We report on an evaluation of Project ECHO to deliver palliative medicine training across a geographically large deanery in the North of England. METHODS The Project ECHO training programme involved multipoint video technology, telementoring, expert talks and case-based discussions over six sessions, and was fully mapped to the palliative care component of the IMT curriculum. We collected data particularly around attendance and self-reported confidence and knowledge. RESULTS By creating a community of practice, we provided virtual placements and over 9 hours of virtual direct contact with palliative medicine consultants; and in total, 921 individual attendances occurred, with 62% attending all six sessions. The course was associated with an increase in self-reported confidence and high satisfaction. DISCUSSION Project ECHO is an effective method of delivering teaching to trainees across a large geographical area. Course evaluation shows outstanding results in trainee satisfaction, confidence, knowledge, patient care, clinical skills and reduction in fear when managing death and dying.
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Affiliation(s)
- Gemma Claire Lee
- Intensive Care, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, FY3 8NR, UK
- School of Medicine, Health Education England, Leeds, UK
| | - Sam Kyeremateng
- Palliative Care, St Luke's Hospice, Sheffield, UK
- Palliative Care, Health Education England, Leeds, UK
| | - Paul Taylor
- Palliative Care, St Luke's Hospice, Sheffield, UK
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Colin Jones
- School of Medicine, Health Education England, Leeds, UK
- Renal Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Peter Hammond
- School of Medicine, Health Education England, Leeds, UK
- Endocrine Medicine, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Laura McTague
- Palliative Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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28
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Crockett C, Price J, Pham M, Abdulwahid D, Bayman N, Blackhall F, Bostock L, Califano R, Chan C, Coote J, Cove-Smith L, Eaton M, Fenemore J, Gomes F, Harris M, Halkyard E, Hughes S, Lindsay C, Neal H, McEntee D, Pemberton L, Sheikh H, Summers Y, Taylor P, Woolf D, Yorke J, Faivre-Finn C. Experience With the Routine Use of Electronic Patient-Reported Outcome Measures for Patients With Lung Cancer. JCO Clin Cancer Inform 2023; 7:e2200150. [PMID: 37071029 PMCID: PMC10281443 DOI: 10.1200/cci.22.00150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/27/2022] [Accepted: 02/27/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE The Christie NHS Foundation Trust launched their electronic patient-reported outcome measures (ePROMs) service in January 2019 in the routine clinical setting. The lung cancer questionnaires consist of 14 symptom items, adapted from the Common Terminology Criteria for Adverse Events (version 5.0) and the EuroQol EQ-5D-5L quality-of-life (QoL) tool. Patients with lung cancer are invited to complete questionnaires assessing their symptoms and QoL using an online platform. METHODS The ePROM responses and clinical, pathologic, and treatment data for patients who completed the questionnaires between January 2019 and December 2020 were extracted from electronic medical records. The symptom and QoL scores of patients who completed baseline pretreatment ePROMs and also those who completed ePROMs pre- and postpalliative lung systemic anticancer therapy (SACT) or radical thoracic radiotherapy were evaluated. Pretreatment questionnaires were analyzed according to age, Eastern Cooperative Oncology Group performance status (ECOG PS), and Adult Comorbidity Evaluation-27 (ACE-27) comorbidity score. RESULTS One thousand four hundred eighty patients with lung cancer were included. There were no statistically significant differences in symptoms and QoL scores between age groups. Cough (P = .006) and EQ-5D-5L mobility scores (P = .006) were significantly worse for patients with an ECOG PS of 0-1. Dyspnea (P = .035), hemoptysis (P = .023), nausea (P = .041), mobility (P = .004), and self-care (P = .0420) were significantly worse for those with higher ACE-27 scores (2-3 v 0-1). Palliative SACT was associated with a significant improvement in cough (P < .001) and hemoptysis (P = .025), but significantly negatively affected mobility (P = .013). Patients receiving radical thoracic radiotherapy reported a significant improvement in hemoptysis (P = .042) but worse pain (P = .002) and fatigue (P = .01). Other changes in symptom and QoL scores were not significant. CONCLUSION The symptoms and QoL reported at baseline and before and after both palliative SACT and radical thoracic radiotherapy are clinically relevant and meaningful. We have demonstrated that routine implementation of ePROMs into clinical practice is feasible and can inform clinical practice and future research.
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Affiliation(s)
| | - James Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mai Pham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Layla Bostock
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Raffaele Califano
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Clara Chan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Marie Eaton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Emma Halkyard
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Hughes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Colin Lindsay
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hilary Neal
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Delyth McEntee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Laura Pemberton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hamid Sheikh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Yvonne Summers
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Christie Patient-Centred Research, Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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29
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Veroniki AA, Tricco AC, Watt J, Tsokani S, Khan PA, Soobiah C, Negm A, Doherty-Kirby A, Taylor P, Lunny C, McGowan J, Little J, Mallon P, Moher D, Wong S, Dinnes J, Takwoingi Y, Saxinger L, Chan A, Isaranuwatchai W, Lander B, Meyers A, Poliquin G, Straus SE. Rapid antigen-based and rapid molecular tests for the detection of SARS-CoV-2: a rapid review with network meta-analysis of diagnostic test accuracy studies. BMC Med 2023; 21:110. [PMID: 36978074 PMCID: PMC10049780 DOI: 10.1186/s12916-023-02810-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The global spread of COVID-19 created an explosion in rapid tests with results in < 1 hour, but their relative performance characteristics are not fully understood yet. Our aim was to determine the most sensitive and specific rapid test for the diagnosis of SARS-CoV-2. METHODS Design: Rapid review and diagnostic test accuracy network meta-analysis (DTA-NMA). ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) and observational studies assessing rapid antigen and/or rapid molecular test(s) to detect SARS-CoV-2 in participants of any age, suspected or not with SARS-CoV-2 infection. INFORMATION SOURCES Embase, MEDLINE, and Cochrane Central Register of Controlled Trials, up to September 12, 2021. OUTCOME MEASURES Sensitivity and specificity of rapid antigen and molecular tests suitable for detecting SARS-CoV-2. Data extraction and risk of bias assessment: Screening of literature search results was conducted by one reviewer; data abstraction was completed by one reviewer and independently verified by a second reviewer. Risk of bias was not assessed in the included studies. DATA SYNTHESIS Random-effects meta-analysis and DTA-NMA. RESULTS We included 93 studies (reported in 88 articles) relating to 36 rapid antigen tests in 104,961 participants and 23 rapid molecular tests in 10,449 participants. Overall, rapid antigen tests had a sensitivity of 0.75 (95% confidence interval 0.70-0.79) and specificity of 0.99 (0.98-0.99). Rapid antigen test sensitivity was higher when nasal or combined samples (e.g., combinations of nose, throat, mouth, or saliva samples) were used, but lower when nasopharyngeal samples were used, and in those classified as asymptomatic at the time of testing. Rapid molecular tests may result in fewer false negatives than rapid antigen tests (sensitivity: 0.93, 0.88-0.96; specificity: 0.98, 0.97-0.99). The tests with the highest sensitivity and specificity estimates were the Xpert Xpress rapid molecular test by Cepheid (sensitivity: 0.99, 0.83-1.00; specificity: 0.97, 0.69-1.00) among the 23 commercial rapid molecular tests and the COVID-VIRO test by AAZ-LMB (sensitivity: 0.93, 0.48-0.99; specificity: 0.98, 0.44-1.00) among the 36 rapid antigen tests we examined. CONCLUSIONS Rapid molecular tests were associated with both high sensitivity and specificity, while rapid antigen tests were mainly associated with high specificity, according to the minimum performance requirements by WHO and Health Canada. Our rapid review was limited to English, peer-reviewed published results of commercial tests, and study risk of bias was not assessed. A full systematic review is required. REVIEW REGISTRATION PROSPERO CRD42021289712.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Sofia Tsokani
- School of Education, University of Ioannina, Ioannina, Greece
| | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ahmed Negm
- University of Alberta, Edmonton, AB, Canada
| | - Amanda Doherty-Kirby
- Patient Partner, Strategy for Patient Oriented-Research Evidence Alliance (SPOR EA), Toronto, Canada
| | - Paul Taylor
- Patient Partner, Strategy for Patient Oriented-Research Evidence Alliance (SPOR EA), Toronto, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Jessie McGowan
- University of Ottawa/Université d'Ottawa, Ottawa, ON, Canada
| | - Julian Little
- University of Ottawa/Université d'Ottawa, Ottawa, ON, Canada
| | | | - David Moher
- Ottawa Hospital Research Institute/Institut de Recherche de L'Hôpital d'Ottawa, Ottawa, ON, Canada
| | - Sabrina Wong
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | - Bryn Lander
- Health Canada (Ottawa)/Santé Canada (Ottawa), Ottawa, ON, Canada
| | - Adrienne Meyers
- Public Health Agency of Canada/Agence de La Santé Publique du Canada, Ottawa, ON, Canada
| | - Guillaume Poliquin
- Public Health Agency of Canada/Agence de La Santé Publique du Canada, Ottawa, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
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30
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Albertella L, Kirkham R, Adler AB, Crampton J, Drummond SPA, Fogarty GJ, Gross JJ, Zaichkowsky L, Andersen JP, Bartone PT, Boga D, Bond JW, Brunyé TT, Campbell MJ, Ciobanu LG, Clark SR, Crane MF, Dietrich A, Doty TJ, Driskell JE, Fahsing I, Fiore SM, Flin R, Funke J, Gatt JM, Hancock PA, Harper C, Heathcote A, Heatown KJ, Helsen WF, Hussey EK, Jackson RC, Khemlani S, Killgore WDS, Kleitman S, Lane AM, Loft S, MacMahon C, Marcora SM, McKenna FP, Meijen C, Moulton V, Moyle GM, Nalivaiko E, O'Connor D, O’Conor D, Patton D, Piccolo MD, Ruiz C, Schücker L, Smith RA, Smith SJR, Sobrino C, Stetz M, Stewart D, Taylor P, Tucker AJ, van Stralen H, Vickers JN, Visser TAW, Walker R, Wiggins MW, Williams AM, Wong L, Aidman E, Yücel M. Building a transdisciplinary expert consensus on the cognitive drivers of performance under pressure: An international multi-panel Delphi study. Front Psychol 2023; 13:1017675. [PMID: 36755983 PMCID: PMC9901503 DOI: 10.3389/fpsyg.2022.1017675] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/02/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction The ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure. Methods International experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance. Results Sixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control-Performance Monitoring; (3) Arousal and Regulatory Systems-Arousal; (4) Cognitive Control-Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control-Response Selection and Inhibition/Suppression; (6) Working memory-Flexible Updating; (7) Working memory-Active Maintenance; (8) Perception and Understanding of Self-Self-knowledge; (9) Working memory-Interference Control, and (10) Expert-suggested-Shifting. Discussion Our results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization.
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Affiliation(s)
- Lucy Albertella
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia,*Correspondence: Lucy Albertella,
| | - Rebecca Kirkham
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - John Crampton
- APS College of Sport and Exercise Psychologists, Melbourne, VIC, Australia
| | - Sean P. A. Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Gerard J. Fogarty
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, QLD, Australia
| | | | - Leonard Zaichkowsky
- Wheelock College of Education and Human Development, Boston University, Boston, MA, United States
| | | | | | - Danny Boga
- Australian Army Psychology Corps, Canberra, ACT, Australia
| | - Jeffrey W. Bond
- APS College of Sport and Exercise Psychologists, Melbourne, VIC, Australia
| | - Tad T. Brunyé
- U.S. Army DEVCOM Analysis Center, Natick, MA, United States
| | - Mark J. Campbell
- Physical Education & Sport Sciences Department, University of Limerick, Limerick, Ireland
| | - Liliana G. Ciobanu
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Scott R. Clark
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Monique F. Crane
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Arne Dietrich
- Department of Psychology, American University of Beirut, Beirut, Lebanon
| | - Tracy J. Doty
- Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | | | - Ivar Fahsing
- Norwegian Police University College, Oslo, Norway
| | - Stephen M. Fiore
- Department of Psychology, and Institute of Simulation and Training, University of Central Florida, Orlando, FL, United States
| | - Rhona Flin
- Aberdeen Business School, Robert Gordon University, Aberdeen, United Kingdom
| | - Joachim Funke
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Justine M. Gatt
- School of Psychology, University of New South Wales, Kensington, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia
| | - P. A. Hancock
- Department of Psychology, and Institute of Simulation and Training, University of Central Florida, Orlando, FL, United States
| | - Craig Harper
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Andrew Heathcote
- The University of Newcastle, Callaghan, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Kristin J. Heatown
- US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, United States
| | | | | | - Robin C. Jackson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sangeet Khemlani
- United States Naval Research Laboratory, Washington, DC, United States
| | | | - Sabina Kleitman
- School of Psychology, The University of Sydney, Darlington, NSW, Australia
| | - Andrew M. Lane
- Sport, Physical Activity Research Centre (SPARC), School of Sport, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Shayne Loft
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Clare MacMahon
- School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Samuele M. Marcora
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Frank P. McKenna
- Department of Psychology, University of Reading, Reading, United Kingdom
| | - Carla Meijen
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, Twickenham, United Kingdom
| | | | - Gene M. Moyle
- Faculty of Creative Industries, Education and Social Justice, Queensland University of Technology, Brisbane, QLD, Australia
| | - Eugene Nalivaiko
- The University of Newcastle, Callaghan, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Donna O'Connor
- Sydney School of Education and Social Work, The University of Sydney, Darlington, NSW, Australia
| | | | - Debra Patton
- United States Department of Defense, Washington DC, United States
| | | | - Coleman Ruiz
- Mission Critical Team Institute, Annapolis, MD, United States
| | - Linda Schücker
- Department of Sport Psychology, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | | | - Sarah J. R. Smith
- Defense Science and Technology Laboratory, Salisbury, United Kingdom
| | - Chava Sobrino
- NSW Institute of Sport and Diving, Sydney, NSW, Australia
| | - Melba Stetz
- Independent Practitioner, Grand Ledge, MI, United States
| | | | - Paul Taylor
- The University of Newcastle, Callaghan, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew J. Tucker
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Joan N. Vickers
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Troy A. W Visser
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Rohan Walker
- The University of Newcastle, Callaghan, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia
| | - Mark W. Wiggins
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Leonard Wong
- United States Army War College, Carlisle, PA, United States
| | - Eugene Aidman
- The University of Newcastle, Callaghan, NSW, Australia,Decision Sciences Division, Defense Science and Technology Group, Adelaide, SA, Australia
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Mirhadi S, Zhang W, Pham NA, Karimzadeh F, Pintilie M, Tong J, Taylor P, Krieger J, Pitcher B, Sykes J, Wybenga-Groot L, Fladd C, Xu J, Wang T, Cabanero M, Li M, Weiss J, Sakashita S, Zaslaver O, Yu M, Caudy AA, St-Pierre J, Hawkins C, Kislinger T, Liu G, Shepherd FA, Tsao MS, Moran MF. Mitochondrial Aconitase ACO2 Links Iron Homeostasis with Tumorigenicity in Non-Small Cell Lung Cancer. Mol Cancer Res 2023; 21:36-50. [PMID: 36214668 PMCID: PMC9808373 DOI: 10.1158/1541-7786.mcr-22-0163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/01/2022] [Revised: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 02/03/2023]
Abstract
The ability of a patient tumor to engraft an immunodeficient mouse is the strongest known independent indicator of poor prognosis in early-stage non-small cell lung cancer (NSCLC). Analysis of primary NSCLC proteomes revealed low-level expression of mitochondrial aconitase (ACO2) in the more aggressive, engrafting tumors. Knockdown of ACO2 protein expression transformed immortalized lung epithelial cells, whereas upregulation of ACO2 in transformed NSCLC cells inhibited cell proliferation in vitro and tumor growth in vivo. High level ACO2 increased iron response element binding protein 1 (IRP1) and the intracellular labile iron pool. Impaired cellular proliferation associated with high level ACO2 was reversed by treatment of cells with an iron chelator, whereas increased cell proliferation associated with low level ACO2 was suppressed by treatment of cells with iron. Expression of CDGSH iron-sulfur (FeS) domain-containing protein 1 [CISD1; also known as mitoNEET (mNT)] was modulated by ACO2 expression level and inhibition of mNT by RNA interference or by treatment of cells with pioglitazone also increased iron and cell death. Hence, ACO2 is identified as a regulator of iron homeostasis and mNT is implicated as a target in aggressive NSCLC. IMPLICATIONS FeS cluster-associated proteins including ACO2, mNT (encoded by CISD1), and IRP1 (encoded by ACO1) are part of an "ACO2-Iron Axis" that regulates iron homeostasis and is a determinant of a particularly aggressive subset of NSCLC.
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Affiliation(s)
- Shideh Mirhadi
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Wen Zhang
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Nhu-An Pham
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Melania Pintilie
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jiefei Tong
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Taylor
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Krieger
- SPARC BioCentre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bethany Pitcher
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jenna Sykes
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Christopher Fladd
- SPARC BioCentre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jing Xu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tao Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael Cabanero
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ming Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jessica Weiss
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Shingo Sakashita
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Olga Zaslaver
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Man Yu
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amy A. Caudy
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Julie St-Pierre
- Department of Biochemistry, Rosalind and Morris Goodman Cancer Centre, McGill University, Montreal, Québec, Canada.,Department of Biochemistry, Microbiology, and Immunology and Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Hawkins
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Kislinger
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Frances A. Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada.,Corresponding Authors: Michael F. Moran, Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada. Phone: 647-235-6435; E-mail: ; and Ming-Sound Tsao, Princess Margaret Cancer Research Tower, 101 College Street, Toronto, ON M5G 1L7, Canada. Phone: 416-340-4737; E-mail:
| | - Michael F. Moran
- Program in Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,SPARC BioCentre, Hospital for Sick Children, Toronto, Ontario, Canada.,Corresponding Authors: Michael F. Moran, Hospital for Sick Children, 686 Bay Street, Toronto, ON M5G 0A4, Canada. Phone: 647-235-6435; E-mail: ; and Ming-Sound Tsao, Princess Margaret Cancer Research Tower, 101 College Street, Toronto, ON M5G 1L7, Canada. Phone: 416-340-4737; E-mail:
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Hodge A, Manson J, McTague L, Kyeremateng S, Taylor P. Creating virtual communities of practice for ambulance paramedics: a qualitative evaluation of the use of Project ECHO in end-of-life care. Br Paramed J 2022; 7:51-58. [PMID: 36531799 PMCID: PMC9730191 DOI: 10.29045/14784726.2022.12.7.3.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Introduction Ambulance services play a key role in the recognition and care of patients nearing their end of life, yet are expected to recognise and manage these complex presentations often with limited education. Paramedics operate across large geographical areas, meaning education delivery is challenging. Yorkshire Ambulance Service implemented Project Extension for Community Healthcare Outcomes (ECHO), which is the creation of virtual communities of practice to address this problem and increase access to specialist supervision, education and sharing of practice. We undertook a service evaluation of the programme and interviewed paramedics about their experiences with ECHO. Methods Semi-structured interviews were conducted with eight ambulance clinicians who took part in the end-of-life care (EoLC) ECHO programme. Thematic analysis and coding was undertaken to identify and develop the emerging themes. Results This study identified three key themes: programme structure, factors influencing engagement and professional impact. The provision of a virtual community of practice through Project ECHO was a unique and highly valued experience, which was accessible and allowed for networking, peer support and sharing of practice. The concept of a ripple effect was reported in disseminating learning across the wider team. Conclusion The development of virtual communities of practice as a novel educational intervention has the potential to transform clinical supervision and ongoing education for ambulance clinicians who are often isolated by the nature of ambulance services that cover large regions.
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Affiliation(s)
- Andrew Hodge
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-2632-2249
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Nandakumar V, Swain I, Taylor P, Merson E, Budka M. SmartStim: A Recurrent Neural Network Assisted Adaptive Functional Electrical Stimulation for Walking. Current Directions in Biomedical Engineering 2022. [DOI: 10.1515/cdbme-2022-2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
According to the Neuro Patience report of the Neurological Alliance, 1 in 6 people in the UK has a neurological condition. With the growth in technology, rehabilitation for neurological problems is one of the fastgrowing fields. Functional Electrical Stimulation (FES) is one of those neuro-rehabilitation methods that uses electrical nerve stimulation to restore functional muscle movements that are lost due to neurological problems such as stroke and multiple sclerosis. This neuroprosthetic device is frequently used to assist walking by treating a condition called Drop Foot, a result of paralysis of the pretibial muscles. This study proposes a two-channel FES device called the SmartStim, which has the ability to modulate its stimulation levels according to various obstacles such as stairs and ramps. This system employs a sensor-based module with a Recurrent Neural Network to classify these different walking scenarios. The module is built with Inertial Measurement sensors embedded in a pair of shoes, and the Recurrent Neural Network uses data from these sensors to predict various obstacles as the user is walking. These predictions are then used by a Fuzzy Logic Controller to control and regulate the stimulation current in two channels of the SmartStim system. In the two channels of the system, one channel will help aid with drop foot, while the other will be used to stimulate another muscle group to help access stairs and ramps by the user. The Recurrent Neural Network module in this system has been trained and tested using the k-fold cross-validation. The evaluation of this trained model shows that it can predict obstacles from sensor data at 97 percent accuracy. Currently, further testing is being performed to assess the workings of the fuzzy logic controller in combination with the Recurrent Neural Network in healthy individuals. It is expected that the SmartStim system may aid users in accessing various walking scenarios more efficiently.
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Affiliation(s)
| | | | - Paul Taylor
- Odstock Medical Limited, Salisbury District Hospital, Salisbury , UK
| | - Earl Merson
- Odstock Medical Limited, Salisbury District Hospital, Salisbury , UK
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Mayland CR, Sunderland KA, Cooper M, Taylor P, Powell PA, Zeigler L, Cox V, Gilman C, Turner N, Flemming K, Fraser LK. Measuring quality of dying, death and end-of-life care for children and young people: A scoping review of available tools. Palliat Med 2022; 36:1186-1206. [PMID: 35915561 PMCID: PMC9446433 DOI: 10.1177/02692163221105599] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The circumstances and care provided at the end of a child's life have a profound impact on family members. Although assessing experiences and outcomes during this time is challenging, healthcare professionals have a responsibility to ensure high quality of care is provided. AIM To identify available tools which measure the quality of dying, death and end-of-life care for children and young people; describe the content, and data on validity and reliability of existing tools. DESIGN Scoping review was conducted following the Arksey and O'Malley methodological framework. DATA SOURCES Four electronic databases (MEDLINE, EMBASE, CINAHL and PsycINFO) and grey literature were searched for studies published in English (January 2000-June 2021). A review of reference lists and citation searching was also undertaken. Tools needed to include a focus on the 'dying' phase of illness (defined as the last month of life). RESULTS From 2078 articles, a total of 18 studies, reporting on 11 tools were identified. All tools were completed by primary caregivers or healthcare professionals as 'proxy' assessments; all except one was undertaken after death. Question items about quality of life and preparation for death were found in all tools; items relating to cultural aspects of care, grief and financial costs were less common. Only 6/11 had undergone psychometric testing within a paediatric palliative care setting. CONCLUSIONS Future research should include ways to adapt, refine and improve existing tools. Assessing their wider application in different clinical and cultural settings and conducting further psychometric assessment represent areas of focus.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Palliative Care Unit, University of Liverpool, Liverpool, UK
| | | | - Matthew Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,St Luke's Hospice, Sheffield, UK
| | - Philip A Powell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lucy Zeigler
- Academic Unit of Palliative Care, School of Medicine, University of Leeds, Leeds, UK
| | - Vicki Cox
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Constance Gilman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicola Turner
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Kate Flemming
- Department of Health Sciences, The University of York, York, UK
| | - Lorna K Fraser
- Department of Health Sciences, Martin House Research Centre, University of York, York, UK
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35
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Taylor P. S-09-01 Thyroid hormones, pregnancy and offspring development in humans and correlation to animals. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.092] [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: 11/30/2022]
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36
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Aidman E, Fogarty GJ, Crampton J, Bond J, Taylor P, Heathcote A, Zaichkowsky L. An app-enhanced cognitive fitness training program for athletes: The rationale and validation protocol. Front Psychol 2022; 13:957551. [PMID: 36110271 PMCID: PMC9469727 DOI: 10.3389/fpsyg.2022.957551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
The core dimensions of cognitive fitness, such as attention and cognitive control, are emerging through a transdisciplinary expert consensus on what has been termed the Cognitive Fitness Framework (CF2). These dimensions represent key drivers of cognitive performance under pressure across many occupations, from first responders to sport, performing arts and the military. The constructs forming the building blocks of CF2 come from the RDoC framework, an initiative of the US National Institute of Mental Health (NIMH) aimed at identifying the cognitive processes underlying normal and abnormal behavior. Similar to physical conditioning, cognitive fitness can be improved with deliberate practice. This paper reports the development of a prototype cognitive fitness training program for competitive athletes and the protocol for its evaluation. The program is focused on primary cognitive capacities and subtending skills for adjusting training rhythms and enhancing readiness for competition. The project is driven by the Australian Psychological Society's College of Sport & Exercise Psychology and includes the development of a Cognitive Gym program for a smartphone app-enhanced implementation. Its key building blocks are training protocols (drills) connected by a periodized training plan. A website with background supporting resources has also been developed as part of the project. National-level training squads will participate in a three-week pilot evaluation protocol, assessing the program's efficacy and usability through gamified cognitive assessment of participants' training gains and coaching staff evaluations, respectively. Both near and far transfer of training effects will be examined.
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Affiliation(s)
- Eugene Aidman
- College of Sport and Exercise Psychologists, Australian Psychological Society, Melbourne, VIC, Australia
- Division of Human and Decision Sciences, Defence Science and Technology Group, Edinburgh, SA, Australia
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Gerard J. Fogarty
- College of Sport and Exercise Psychologists, Australian Psychological Society, Melbourne, VIC, Australia
- School of Psychology, University of Southern Queensland, Toowoomba, QLD, Australia
| | - John Crampton
- College of Sport and Exercise Psychologists, Australian Psychological Society, Melbourne, VIC, Australia
| | - Jeffrey Bond
- College of Sport and Exercise Psychologists, Australian Psychological Society, Melbourne, VIC, Australia
| | - Paul Taylor
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Heathcote
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Leonard Zaichkowsky
- College of Education & Human Development, Boston University, Boston, MA, United States
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37
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Woo T, Li C, Ganesananthan S, Rajendram R, Uddin J, Lee R, Dayan C, Taylor P. 178 The Effect of Ophthalmic Surgery for Graves’ Orbitopathy on Quality of Life – A Systematic Review and Meta-Analysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac268.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Graves’ orbitopathy has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia and improve aesthetics. We aimed to quantify the effect of different surgical approaches on quality of life.
Method
Electronic databases were used from inception until 22nd March 2021 to identify studies assessing quality of life pre- and post-surgical intervention for Graves’ orbitopathy. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilised.
Results
10 articles comprising 632 patients were included. All used the Graves’ Ophthalmopathy Quality of Life questionnaire (GO-QOL). For GO-QOL appearance, the pooled standardised mean improvement for patients after surgery was +0.72 (95% CI 0.50–0.94) I2=69% (95% CI 52–80%). For GO-QOL visual functioning, the pooled SMD for patients after surgery was +0.41 (95% CI 0.25–0.58) I2=60% (95% CI 36–74%). For visual appearance, orbital decompression yielded the greatest improvement (SMD+0.84, 95%CI 0.54–1.13) followed by eyelid surgery (SMD+0.38, 95% CI 0.05–0.70), while strabismus correction had no significant effect (SMD +0.94, 95% CI -0.10–1.99). Conversely strabismus correction was associated with the greatest improvement (SMD+1.25, 95%CI 0.29–2.21) in visual functioning, outperforming orbital decompression (SMD+0.29, 95%CI 0.15–0.43) and eyelid surgery (SMD+0.12, 95%CI -0.18–0.41).
Conclusions
Ophthalmic surgery results in substantial improvements in quality of life in patients with Graves’ orbitopathy, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance, strabismus surgery may benefit both visual appearance and function equally whereas eyelid surgery benefits appearance alone.
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Affiliation(s)
- T Woo
- Kings College Hospital , London , United Kingdom
- Cardiff University , Cardiff , United Kingdom
| | - C Li
- St George University Hospital , London , United Kingdom
- Cardiff University , Cardiff , United Kingdom
| | - S Ganesananthan
- Chelsea and Westminster Hospital Foundation Trust , London , United Kingdom
- Cardiff University , Cardiff , United Kingdom
| | - R Rajendram
- Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
| | - J Uddin
- Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
| | - R Lee
- Moorfields Eye Hospital NHS Foundation Trust , London , United Kingdom
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London , London , United Kingdom
| | - C Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine , Cardiff , United Kingdom
| | - P Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine , Cardiff , United Kingdom
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38
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Pak HYV, Hayhurst C, Taylor P. 414 Are Lumbar Drains Necessary in Endoscopic Transellar Surgery with an Intraoperative High Flow Leak? a Systematic Review. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
Perioperative lumbar drains have been used to facilitate healing of the dura and prevent postoperative cerebrospinal fluid (CSF) leaks. However, the use of perioperative lumbar drains is controversial and has primarily been left to the surgeon's preferences. Through the use of meta-analysis, we aim to find out whether lumbar drains effectively reduce the risk of postoperative CSF leak in the context of a high flow intraoperative leak.
Method
A systematic review was conducted using PRISMA guidelines. Databases used in literature searching include PubMed, Ovid (including Embase and Medline), Scopus and Cochrane Library. Articles published in 2006 or later were searched. The random-effects model was used in statistical analysis.
Results
A total of 2623 articles were identified. After screening and full-text reviews, 21 studies were included. From the quantitative data analysis, lumbar drains did not significantly lower the rates of postoperative CSF leaks. In addition, lumbar drains were associated with complications as well as a lengthier hospital stay.
Conclusions
Modern and rigorous repair techniques after endoscopic transsellar surgery are sufficient, and the use of lumbar drains is not necessary.
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Affiliation(s)
- HYV Pak
- Cardiff University , Cardiff , United Kingdom
| | - C Hayhurst
- University Hospital Wales , Cardiff , United Kingdom
| | - P Taylor
- Cardiff University , Cardiff , United Kingdom
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39
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Bandettini PA, Gonzalez-Castillo J, Handwerker D, Taylor P, Chen G, Thomas A. The challenge of BWAs: Unknown unknowns in feature space and variance. Med (N Y) 2022; 3:526-531. [PMID: 35963233 DOI: 10.1016/j.medj.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The recent paper by Marek et al.1 has shown that, to capture brain-wide associations using fMRI and MRI measures, thousands of individuals are required. These results can be potentially misunderstood to imply that MRI or fMRI lack sensitivity or specificity. This commentary discusses the demonstrated sensitivity of fMRI and focuses on methodology that may allow improvements in BWA studies. While individual variation may be an ultimate constraint, refinements in acquisition, population selection, and processing may bring about higher correlations.
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Affiliation(s)
- Peter A Bandettini
- Section on Functional Imaging Methods, National Institute of Mental Health, Bethesda, MD 20817, USA; Functional MRI Core Facility, National Institute of Mental Health, Bethesda, MD 20817, USA.
| | - Javier Gonzalez-Castillo
- Section on Functional Imaging Methods, National Institute of Mental Health, Bethesda, MD 20817, USA
| | - Dan Handwerker
- Section on Functional Imaging Methods, National Institute of Mental Health, Bethesda, MD 20817, USA
| | - Paul Taylor
- Scientific and Statistical Computing Core Facility, National Institute of Mental Health, Bethesda, MD 20817, USA
| | - Gang Chen
- Scientific and Statistical Computing Core Facility, National Institute of Mental Health, Bethesda, MD 20817, USA
| | - Adam Thomas
- Data Science and Sharing Team, National Institute of Mental Health, Bethesda, MD 20817, USA
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40
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Ortega-Franco A, Hodgson C, Raja H, Carter M, Lindsay C, Hughes S, Cove-Smith L, Taylor P, Summers Y, Blackhall F, Califano R. Real-World Data on Pembrolizumab for Pretreated Non-Small-Cell Lung Cancer: Clinical Outcome and Relevance of the Lung Immune Prognostic Index. Target Oncol 2022; 17:453-465. [PMID: 35781861 DOI: 10.1007/s11523-022-00889-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pembrolizumab is licensed for the treatment of pre-treated and PD-L1 positive non-small cell lung cancer (NSCLC), but response is heterogeneous. In this context, the Lung Immune Prognostic Index (LIPI) has been proposed as tool to prognosticate outcome. OBJECTIVE To investigate the real-world efficacy and safety of pembrolizumab in pre-treated NSCLC patients and the clinical utility of LIPI for patients' selection. PATIENTS AND METHODS Patients with pre-treated NSCLC and PD-L1 ≥ 1% treated with pembrolizumab were included in this retrospective series. The LIPI was used to classify patients in 3 prognostics subgroups according to the pre-treatment dNLR (derived neutrophil to lymphocyte ratio) and LDH in blood. The prognostic impact of the LIPI on progression free survival (PFS) and overall survival (OS) was evaluated with Cox regression. The combined effect of LIPI and other relevant prognostic factors was explored with multivariate regression. RESULTS In total, 113 consecutive patients were included. Median (mPFS) and mOS was 4.3 (2.6-6.7) and 13.5 (10.3-17.7) months, respectively. Good-, intermediate-, and poor-LIPI was found in 54 (47.8%), 45 (39.8%), and 8 (7.1%) patients, respectively. Median PFS was 5.1 (2.8-9.1), 3.0 (2.5-6.8), and 1.4 (0.5-18.7) months, and mOS was 17.2 (12.0-26.4), 11.8 (8.4-17.1), and 3.7 (0.5-not calculable) months for good-, intermediate-, and poor-LIPI group, respectively. Patients with intermediate-LIPI and poor-LIPI had worse PFS versus good-LIPI, and statistically significant worse OS (p = 0.030 and p = 0.013, respectively). In the multivariate analysis, intermediate- versus good-LIPI (p = 0.190) was not independently associated to PFS or OS. Patients with both good-LIPI and high (≥ 50%) PD-L1 had better OS than all other subgroups defined by LIPI and PD-L1. Immune-related adverse events (irAEs) occurred in 47 (41.6%) patients (12.4% grade ≥ 3). In a time-varying analysis, irAEs were statistically associated with longer OS (HR 0.51, 0.31-0.84; p = 0.008). CONCLUSION In our series, the outcome of pembrolizumab in pre-treated NSCLC is consistent with the registration trial. Lung Immune Prognostic Index is a readily available tool able to prognosticate outcome, also in PD-L1-high patients. The positive association between irAEs and OS might aid decision making.
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Affiliation(s)
- Ana Ortega-Franco
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Clare Hodgson
- Digital Services, The Christie NHS Foundation Trust, Manchester, UK
| | - Haseem Raja
- Department of ENT, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mathew Carter
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Colin Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Sarah Hughes
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Cove-Smith
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Paul Taylor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Yvonne Summers
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. .,Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Fennell DA, Porter C, Lester J, Danson S, Taylor P, Sheaff M, Rudd RM, Gaba A, Busacca S, Nixon L, Gardner G, Darlison L, Poile C, Richards C, Jordan PW, Griffiths G, Casbard A. Active symptom control with or without oral vinorelbine in patients with relapsed malignant pleural mesothelioma (VIM): A randomised, phase 2 trial. EClinicalMedicine 2022; 48:101432. [PMID: 35706488 PMCID: PMC9124711 DOI: 10.1016/j.eclinm.2022.101432] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Currently, there is no US Food and Drug Administration approved therapy for patients with pleural mesothelioma who have relapsed following platinum-doublet based chemotherapy. Vinorelbine has demonstrated useful clinical activity in mesothelioma, however its efficacy has not been formally evaluated in a randomised setting. BRCA1 expression is required for vinorelbine induced apoptosis in preclinical models. Loss of expression may therefore correlate with vinorelbine resistance. Methods In this randomised, phase 2 trial, patients were eligible if they met the following criteria: age ≥ 18 years, Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, histologically confirmed pleural mesothelioma, post platinum-based chemotherapy, and radiological evidence of disease progression. Consented patients were randomised 2:1 to either active symptom control with oral vinorelbine versus active symptom control (ASC) every 3 weeks until disease progression, unacceptable toxicity or withdrawal at an initial dose of 60 mg/m2 increasing to 80 mg/m2 post-cycle 1. Randomisation was stratified by histological subtype, white cell count, gender, ECOG performance status and best response during first-line therapy. The study was open label. The primary endpoint was progression-free survival (PFS), measured from randomisation to time of event (or censoring). Analyses were carried out according to intention-to-treat (ITT) principles. Recruitment and trial follow-up are complete. This trial is registered with ClinicalTrials.gov, number NCT02139904. Findings Between June 1, 2016 and Oct 31, 2018, we performed a randomised phase 2 trial in 14 hospitals in the United Kingdom. 225 patients were screened for eligibility, of whom 154 were randomly assigned to receive either ASC + vinorelbine (n = 98) or ASC (n = 56). PFS was significantly longer for ASC+vinorelbine compared with ASC alone; 4.2 months (interquartile range (IQR) 2.2-8.0) versus 2.8 months (IQR 1.4-4.1) for ASC, giving an unadjusted hazard ratio (HR) of 0·60 (80% CI upper limit 0.7, one-sided unadjusted log rank test p = 0.002); adjusted HR 0.6 (80% CI upper limit 0.7, one-sided adjusted log rank test p < 0.001). BRCA1 did not predict resistance to ASC+vinorelbine. Neutropenia was the most common grades 3, 4 adverse events in the ASC +vinorelbine arm. Interpretation Vinorelbine plus ASC confers clinical benefit to patients with relapsed pleural mesothelioma who have progressed following platinum-based doublet chemotherapy. Funding This study was funded by Cancer Research UK (grant CRUK A15569).
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Affiliation(s)
- Dean A. Fennell
- Mesothelioma Research Programme, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Sarah Danson
- Sheffield ECMC, University of Sheffield and Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Paul Taylor
- Department of Medical Oncology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Aarti Gaba
- Mesothelioma Research Programme, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Sara Busacca
- Mesothelioma Research Programme, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Lisette Nixon
- Centre for Trials Research, Cardiff University, Wales, UK
| | | | - Liz Darlison
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charlotte Poile
- Mesothelioma Research Programme, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Cathy Richards
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Peter-Wells Jordan
- Mesothelioma Research Programme, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Gareth Griffiths
- CRUK Southampton Clinical Trials Unit, University of, Southampton, Southampton, UK
| | - Angela Casbard
- Centre for Trials Research, Cardiff University, Wales, UK
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42
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Badr H, Blutrich R, Chan K, Tong J, Taylor P, Zhang W, Kafri R, Röst HL, Tsao MS, Moran MF. Proteomic characterization of a candidate polygenic driver of metabolism in non-small cell lung cancer. J Mol Biol 2022; 434:167636. [PMID: 35595168 DOI: 10.1016/j.jmb.2022.167636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/18/2022]
Abstract
Proteome analysis revealed signatures of co-expressed upregulated metabolism proteins highly conserved between primary and non-small cell lung cancer (NSCLC) patient-derived xenograft tumors (Li et al. 2014, Nat. Communications 5:5469). The C10 signature is encoded by seven genes (ADSS, ATP2A2, CTPS1, IMPDH2, PKM2, PTGES3, SGPL1) and DNA alterations in C10-encoding genes are associated with longer survival in a subset of NSCLC. To explore the C10 signature as an oncogenic driver and address potential mechanisms of action, C10 protein expression and protein-protein interactions were determined. In independent NSCLC cohorts, the coordinated expression of C10 proteins was significant and mutations in C10 genes were associated with better outcome. Affinity purification-mass spectrometry and in vivo proximity-based biotin identification defined a C10 interactome involving 667 proteins including candidate drug targets and clusters associated with glycolysis, calcium homeostasis, and nucleotide and sphingolipid metabolism. DNA alterations in genes encoding C10 interactome components were also found to be associated with better survival. These data support the notion that the coordinated upregulation of the C10 signature impinges metabolic processes that collectively function as an oncogenic driver in NSCLC.
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Affiliation(s)
- Heba Badr
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Ron Blutrich
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada
| | - Kaitlin Chan
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada
| | - Jiefei Tong
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Paul Taylor
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; SPARC BioCentre, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Wen Zhang
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada
| | - Ran Kafri
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada
| | - Hannes L Röst
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada; Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, ON M5S 3E1, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; Departments of Medical Biophysics and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Michael F Moran
- Program in Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 3E1, Canada; SPARC BioCentre, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada.
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Panettieri V, Taylor P, Kry S. MO-0048 Impact of suboptimal community dose delivery on TCP in advanced radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02281-2] [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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44
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Zauderer MG, Szlosarek PW, Le Moulec S, Popat S, Taylor P, Planchard D, Scherpereel A, Koczywas M, Forster M, Cameron RB, Peikert T, Argon EK, Michaud NR, Szanto A, Yang J, Chen Y, Kansra V, Agarwal S, Fennell DA. EZH2 inhibitor tazemetostat in patients with relapsed or refractory, BAP1-inactivated malignant pleural mesothelioma: a multicentre, open-label, phase 2 study. Lancet Oncol 2022; 23:758-767. [DOI: 10.1016/s1470-2045(22)00277-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/27/2022]
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45
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Thomas DS, Warwick A, Olvera-Barrios A, Egan C, Schwartz R, Patra S, Eleftheriadis H, Khawaja A, Lotery A, Muller PL, Hamilton R, Preston E, Taylor P, Tufail A. Estimating excess visual loss from neovascular age-related macular degeneration in the UK during the COVID-19 pandemic: a retrospective clinical audit and simulation model. BMJ Open 2022; 12:e057269. [PMID: 35428639 PMCID: PMC9013793 DOI: 10.1136/bmjopen-2021-057269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at 1 year. DESIGN Retrospective clinical audit and simulation model. SETTING Multiple UK National Health Service (NHS) ophthalmology centres. PARTICIPANTS Data on the reduction in new nAMD referrals were obtained from four NHS Trusts comparing April 2020 with April 2019. To estimate the potential impact on 1-year visual outcomes, a stratified bootstrap simulation model was developed drawing on an electronic medical records dataset of 20 825 nAMD eyes from 27 NHS Trusts. MAIN OUTCOME MEASURES Simulated mean visual acuity and proportions of eyes with vision ≤6/60, ≤6/24 and ≥6/12 at 1 year under four hypothetical scenarios: 0-month, 3-month, 6-month and 9-month treatment delays. Estimated additional number of eyes with vision ≤6/60 at 1 year nationally. RESULTS The number of nAMD referrals dropped on average by 72% (range 65%-87%). Simulated 1-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision ≤6/60 from 15.5% (13.2%-17.9%) to 23.3% (20.7%-25.9%), and a decrease in the proportion of eyes with vision ≥6/12 (driving vision) from 35.1% (32.1%-38.1%) to 26.4% (23.8%-29.2%). Outcomes worsened incrementally with longer modelled delays. Assuming nAMD referrals are reduced to this level for 1 month nationally, these simulated results suggest an additional 186-365 eyes with vision ≤6/60 at 1 year. CONCLUSIONS We report a large decrease in nAMD referrals during the COVID-19 lockdown and provide an important public health message regarding the risk of delayed treatment. As a conservative estimate, a treatment delay of 3 months could lead to a >50% relative increase in the number of eyes with vision ≤6/60 and 25% relative decrease in the number of eyes with driving vision at 1 year.
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Affiliation(s)
- Darren S Thomas
- Institute of Health Informatics, University College London, London, UK
| | - Alasdair Warwick
- Institute of Cardiovascular Science, University College London, London, UK
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Abraham Olvera-Barrios
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Catherine Egan
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Roy Schwartz
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | | | - Anthony Khawaja
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Andrew Lotery
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philipp L Muller
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Robin Hamilton
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ella Preston
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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46
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Mirhadi S, Tam S, Li Q, Moghal N, Pham NA, Tong J, Golbourn BJ, Krieger JR, Taylor P, Li M, Weiss J, Martins-Filho SN, Raghavan V, Mamatjan Y, Khan AA, Cabanero M, Sakashita S, Huo K, Agnihotri S, Ishizawa K, Waddell TK, Zadeh G, Yasufuku K, Liu G, Shepherd FA, Moran MF, Tsao MS. Integrative analysis of non-small cell lung cancer patient-derived xenografts identifies distinct proteotypes associated with patient outcomes. Nat Commun 2022; 13:1811. [PMID: 35383171 PMCID: PMC8983714 DOI: 10.1038/s41467-022-29444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths worldwide. Only a fraction of NSCLC harbor actionable driver mutations and there is an urgent need for patient-derived model systems that will enable the development of new targeted therapies. NSCLC and other cancers display profound proteome remodeling compared to normal tissue that is not predicted by DNA or RNA analyses. Here, we generate 137 NSCLC patient-derived xenografts (PDXs) that recapitulate the histology and molecular features of primary NSCLC. Proteome analysis of the PDX models reveals 3 adenocarcinoma and 2 squamous cell carcinoma proteotypes that are associated with different patient outcomes, protein-phosphotyrosine profiles, signatures of activated pathways and candidate targets, and in adenocarcinoma, stromal immune features. These findings portend proteome-based NSCLC classification and treatment and support the PDX resource as a viable model for the development of new targeted therapies. With non-small cell lung cancer (NSCLC) being the leading cause of cancer deaths worldwide, the development of targeted therapies remains crucial. Here, the generation and multi-omics characterization of 137 NSCLC patient-derived xenografts provides a resource for potential classifications and targets.
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Affiliation(s)
- Shideh Mirhadi
- Program in Cell Biology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Shirley Tam
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Quan Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nadeem Moghal
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nhu-An Pham
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jiefei Tong
- Program in Cell Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - Brian J Golbourn
- John G. Rangos Sr. Research Center, Children's Hospital of Pittsburgh, and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Paul Taylor
- Program in Cell Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - Ming Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sebastiao N Martins-Filho
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Vibha Raghavan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yasin Mamatjan
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Aafaque A Khan
- Program in Cell Biology, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Cabanero
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Shingo Sakashita
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kugeng Huo
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sameer Agnihotri
- John G. Rangos Sr. Research Center, Children's Hospital of Pittsburgh, and Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kota Ishizawa
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael F Moran
- Program in Cell Biology, Hospital for Sick Children, Toronto, ON, Canada. .,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada. .,Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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Kindler HL, Novello S, Bearz A, Ceresoli GL, Aerts JGJV, Spicer J, Taylor P, Nackaerts K, Greystoke A, Jennens R, Calabrò L, Burgers JA, Santoro A, Cedrés S, Serwatowski P, Ponce S, Van Meerbeeck JP, Nowak AK, Blumenschein G, Siegel JM, Kasten L, Köchert K, Walter AO, Childs BH, Elbi C, Hassan R, Fennell DA. Anetumab ravtansine versus vinorelbine in patients with relapsed, mesothelin-positive malignant pleural mesothelioma (ARCS-M): a randomised, open-label phase 2 trial. Lancet Oncol 2022; 23:540-552. [PMID: 35358455 PMCID: PMC10512125 DOI: 10.1016/s1470-2045(22)00061-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few treatment options exist for second-line treatment of malignant pleural mesothelioma. We aimed to assess the antibody-drug conjugate anetumab ravtansine versus vinorelbine in patients with unresectable locally advanced or metastatic disease overexpressing mesothelin who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. METHODS In this phase 2, randomised, open-label study, done at 76 hospitals in 14 countries, we enrolled adults (aged ≥18 years) with unresectable locally advanced or metastatic malignant pleural mesothelioma, an Eastern Cooperative Oncology Group performance status of 0-1, and who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. Participants were prospectively screened for mesothelin overexpression (defined as 2+ or 3+ mesothelin membrane staining intensity on at least 30% of viable tumour cells by immunohistochemistry) and were randomly assigned (2:1), using an interactive voice and web response system provided by the sponsor, to receive intravenous anetumab ravtansine (6·5 mg/kg on day 1 of each 21-day cycle) or intravenous vinorelbine (30 mg/m2 once every week) until progression, toxicity, or death. The primary endpoint was progression-free survival according to blinded central radiology review, assessed in the intention-to-treat population, with safety assessed in all participants who received any study treatment. This study is registered with ClinicalTrials.gov, NCT02610140, and is now completed. FINDINGS Between Dec 3, 2015, and May 31, 2017, 589 patients were enrolled and 248 mesothelin-overexpressing patients were randomly allocated to the two treatment groups (166 patients were randomly assigned to receive anetumab ravtansine and 82 patients were randomly assigned to receive vinorelbine). 105 (63%) of 166 patients treated with anetumab ravtansine (median follow-up 4·0 months [IQR 1·4-5·5]) versus 43 (52%) of 82 patients treated with vinorelbine (3·9 months [1·4-5·4]) had disease progression or died (median progression-free survival 4·3 months [95% CI 4·1-5·2] vs 4·5 months [4·1-5·8]; hazard ratio 1·22 [0·85-1·74]; log-rank p=0·86). The most common grade 3 or worse adverse events were neutropenia (one [1%] of 163 patients for anetumab ravtansine vs 28 [39%] of 72 patients for vinorelbine), pneumonia (seven [4%] vs five [7%]), neutrophil count decrease (two [1%] vs 12 [17%]), and dyspnoea (nine [6%] vs three [4%]). Serious drug-related treatment-emergent adverse events occurred in 12 (7%) patients treated with anetumab ravtansine and 11 (15%) patients treated with vinorelbine. Ten (6%) treatment-emergent deaths occurred with anetumab ravtansine: pneumonia (three [2%]), dyspnoea (two [1%]), sepsis (two [1%]), atrial fibrillation (one [1%]), physical deterioration (one [1%]), hepatic failure (one [1%]), mesothelioma (one [1%]), and renal failure (one [1%]; one patient had 3 events). One (1%) treatment-emergent death occurred in the vinorelbine group (pneumonia). INTERPRETATION Anetumab ravtansine showed a manageable safety profile and was not superior to vinorelbine. Further studies are needed to define active treatments in relapsed mesothelin-expressing malignant pleural mesothelioma. FUNDING Bayer Healthcare Pharmaceuticals.
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Affiliation(s)
- Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Alessandra Bearz
- Department of Medical Oncology and Immune-Related Cancers, CRO-IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giovanni L Ceresoli
- Department of Medical Oncology, Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Centre, Rotterdam, Netherlands
| | - James Spicer
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Paul Taylor
- Department of Medical Oncology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kristiaan Nackaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, Universitair Ziekenhuis Leuven, KU Leuven, Leuven, Belgium
| | - Alastair Greystoke
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Ross Jennens
- Epworth Cancer Services Clinical Institute, Epworth Healthcare, Richmond, VIC, Australia
| | - Luana Calabrò
- Department of Oncology, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Jacobus A Burgers
- Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Armando Santoro
- Humanitas University, Milan, Italy; Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Susana Cedrés
- Department of Medical Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Piotr Serwatowski
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jan P Van Meerbeeck
- Department of Thoracic Oncology, Antwerp University and University Hospital and European Reference Network for Rare or Low Prevalence Complex Disease (ERN-LUNG), Antwerp, Belgium
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia; National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - George Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan M Siegel
- Clinical Statistics Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Linda Kasten
- Statistics, Syneos Health Clinical Solutions, Morrisville, NC, USA
| | - Karl Köchert
- Biomarker and Data Insights, Bayer AG Pharma, Berlin, Germany
| | - Annette O Walter
- Translational Medicine Oncology, Bayer AG Pharma, Berlin, Germany
| | - Barrett H Childs
- Oncology Development, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Cem Elbi
- Global Clinical Development, Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Raffit Hassan
- Department of Thoracic and GI Malignancies, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
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48
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Taylor P, Stone T, Simpson R, Kyeremateng S, Mason S. Emergency department presentations in palliative care patients: a retrospective cohort study. BMJ Support Palliat Care 2022:bmjspcare-2022-003563. [PMID: 35351800 DOI: 10.1136/bmjspcare-2022-003563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To map the patient journey for individuals known to palliative care presenting to the emergency department (ED). METHODS A linked dataset from the CUREd database and palliative care services in a region in the North of England was used. The study describes day and time of presentations, events occurring in the ED, mode of leaving the department and length of hospital admissions for presentations occurring within 90 days of a contact with palliative care. Findings were compared with the wider population in the CUREd database. RESULTS A significant proportion of individuals known to palliative care (29.4%) presented to the ED. Presentations typically occurred in working hours. Most presented by ambulance (84.4%) and were admitted to hospital (75.1%); these observations persisted across age groups. Most presentations involved investigations (88.5%) and/or treatment (84.1%). CONCLUSIONS Palliative patients exhibit significant use of the ED; some have the potential to benefit from attendances, but there is a minority for whom ED is unlikely to have improved their care. Advance care planning and communication between services are important for empowering those who stand to benefit from ED, while ensuring appropriate care is planned for those who prefer to avoid presenting.
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Affiliation(s)
- Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- St Luke's Hospice, Sheffield, UK
| | - Tony Stone
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebecca Simpson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Suzanne Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Cohen JN, Nguyen A, Rafiq M, Taylor P. Impact of a case-management intervention for reducing emergency attendance on primary care: randomised control trial. Br J Gen Pract 2022; 72:BJGP.2021.0545. [PMID: 35577585 PMCID: PMC9119815 DOI: 10.3399/bjgp.2021.0545] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The impact on primary care workload of case-management interventions to reduce emergency department (ED) attendances is unknown. AIM To examine the impact of a telephone-based case-management intervention targeting people with high ED attendance on primary care use. DESIGN AND SETTING A single-site data extract from a larger randomised control trial, using the patient-level data from primary care electronic health records (2015-2020), was undertaken. METHOD A total of 363 patients at high risk of ED usage were randomised to receive a 6-month case-management intervention (253 patients) or standard care (110 patients). Poisson regression models were used to calculate monthly rates of primary care use over time for the 2 years post-randomisation, comparing both arms. Usage was subclassified into face-to-face, telephone, letter, and community and secondary care referrals, stratified by patient demographics. RESULTS No significant difference was found in the mean annual rate of primary care events between the intervention and control arms (P = 0.70). Secondary care referrals saw a 26% reduction in the mean annual referral rate (incident rate ratio [IRR] 0.74, 95% confidence interval [CI] = 0.64 to 0.86, P<0.001) and letters sent increased by 6% in the intervention arm compared with the control arm (IRR 1.06, 95% CI = 1.01 to 1.11, P = 0.01). In the case-managed arm, in patients aged ≥80 years there was a 33% increase in primary care usage (IRR 1.33, 95% CI = 1.28 to 1.40, P<0.001); with a corresponding 10% decrease in patients aged <80 years when compared with controls (IRR 0.90, 95% CI = 0.87 to 0.92, P<0.001). CONCLUSION A targeted case-management intervention to reduce ED attendances did not increase overall primary care use. Redistribution of usage is seen among some patient groups, particularly older people, which may have important implications for primary healthcare planning.
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Affiliation(s)
- Jonathan N Cohen
- Institute of Health Informatics, University College London, London
| | | | - Meena Rafiq
- Epidemiology of Cancer and Healthcare Outcomes, Institute of Epidemiology and Health Care, University College London, London
| | - Paul Taylor
- Institute of Health Informatics, University College London, London
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Beardsworth S, Bayman N, Coote J, Cove-Smith L, Faivre-Finn C, Harris M, Salem A, Sheikh H, Taylor P, Woolf D, Fenemore J, Chan C. An evaluation of concurrent chemoradiotherapy practice for locally advanced non-small cell lung cancer (NSCLC) in a single centre institution. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00157-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: 11/28/2022]
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