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Harwood R, Bethell G, Eastwood MP, Hotonu S, Allin B, Boam T, Rees CM, Hall NJ, Rhodes H, Ampirska T, Arthur F, Billington J, Bough G, Burdall O, Burnand K, Chhabra S, Driver C, Ducey J, Engall N, Folaranmi E, Gracie D, Ford K, Fox C, Green P, Green S, Jawaid W, John M, Koh C, Lam C, Lewis S, Lindley R, Macafee D, Marks I, McNickle L, O’Sullivan BJ, Peeraully R, Phillips L, Rooney A, Thompson H, Tullie L, Vecchione S, Tyraskis A, Maldonado BN, Pissaridou M, Sanchez-Thompson N, Morris L, John M, Godse A, Farrelly P, Cullis P, McHoney M, Colvin D. The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres. Eur J Trauma Emerg Surg 2023; 49:2249-2256. [PMID: 35727342 PMCID: PMC10520113 DOI: 10.1007/s00068-022-01990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance. METHODS UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres. RESULTS All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic. CONCLUSIONS UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.
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Kendrick D, Kettlewell J, das Nair R, Kellezi B, Morriss R, Holmes J, Timmons S, Bridger K, Lindley R, Patel P, Brooks A, Hoffman K, Blackburn L, Radford K. Vocational Rehabilitation To Enhance Return to Work After Trauma: Findings From A Non-Randomised Feasibility Study. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Craven K, Holmes J, Powers K, Clarke S, Cripps RL, Lindley R, Phillips J, Tyerman R, McKevitt C, Clarke D, Radford K. Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors. BMC Med Res Methodol 2021; 21:203. [PMID: 34602054 PMCID: PMC8487447 DOI: 10.1186/s12874-021-01382-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors' roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. METHODS Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically. RESULTS Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6-100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs' understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. CONCLUSIONS Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial. TRIAL REGISTRATION ISRCTN, ISRCTN12464275 . Registered on 13th March 2018.
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Affiliation(s)
- Kristelle Craven
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jain Holmes
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Katie Powers
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sara Clarke
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Rachel L Cripps
- School of Population Health & Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - Rebecca Lindley
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Julie Phillips
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Ruth Tyerman
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Woodhouse Lane, Leeds, LS2 9UT, UK
| | - Kathryn Radford
- Rehabilitation & Ageing Research Group, Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
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Sherrington C, Hassett L, van den Berg M, Lindley R, Crotty M, McCluskey A, van der Ploeg H, Smith S, Schurr K. The effectiveness of affordable technology in rehabilitation to improve mobility and physical activity: Amount (activity and mobility using technology) rehabilitation trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Liu H, Mohammed A, Felix C, Gandhi D, Verma S, Tugnawat D, Syrigapu A, Ramamurthy R, Pandian J, Walker M, Forster A, Hackett M, Anderson C, Langhorn P, Murthy G, Maulik P, Harvey L, Jan S, Lindley R. Process evaluation of a randomised controlled trial of a post stroke family-led rehabilitation intervention in India. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barker A, Morello R, Wolfe R, Lindley R, Kamar J. THE 6-PACK PROGRAM TO DECREASE FALL INJURIES IN HOSPITALS: THE WORLDS LARGEST FALLS PREVENTION TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A.L. Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - R.T. Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - R. Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - R. Lindley
- University of Sydney, Sydney, New South Wales, Australia,
| | - J. Kamar
- The Northern Hospital, Melbourne, Victoria, Australia
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Anderson C, Lavado P, Sharma V, Huang Y, Thang NNH, Robinson T, Lee T, Kim J, Martins S, Pontes-Neto O, Lindley R, Levi C. Randomised evaluation of low-dose rtPA and intensive BP lowering in acute ischemic stroke: the enchanted trial. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kirk MD, Moffatt CRM, Hall GV, Becker N, Booy R, Heron L, MacIntyre R, Dwyer DE, Lindley R. The Burden of Infectious Gastroenteritis in Elderly Residents and Staff of Long-Term Care Facilities, Australia. Infect Control Hosp Epidemiol 2015; 31:860-3. [DOI: 10.1086/654000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We estimated the incidence of gastroenteritis in 16 Australian long-term care facilities. During 12 months' surveillance, 245 (96%) of 254 episodes of gastroenteritis among long-term care residents were associated with 17 outbreaks in 11 facilities. Incidence in long-term care residents was 0.64 episodes per 1,000 bed-days (95% confidence interval, 0.29-1.42).
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Wright L, Hill KM, Bernhardt J, Lindley R. Reply. Intern Med J 2012. [DOI: 10.1111/imj.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L. Wright
- Guidelines Program; National Stroke Foundation; Melbourne Victoria Australia
| | - K. M. Hill
- Guidelines Program; National Stroke Foundation; Melbourne Victoria Australia
| | - J. Bernhardt
- Stroke Division; Florey Neuroscience Institutes; Melbourne and La Trobe University; Melbourne Victoria Australia
| | - R. Lindley
- Discipline of Medicine; University of Sydney; Sydney New South Wales Australia
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Venables G, Sandercock PAG, Lindley R, Wardlaw J, Dennis M, Cohen G. THE THIRD INTERNATIONAL STROKE TRIAL (IST-3) MAIN RESULTS PART I: PRIMARY AND SECONDARY OUTCOMES AMONG 3035 PATIENTS RANDOMISED. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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MacIntyre R, Dwyer D, Lindley R, Gao Z, Tan T, Seale H, Heywood A, Ridda I, Kovoor P, Mitchell P. Does influenza precipitate acute ischaemic heart disease? A prospective case control study. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Wright L, Hill KM, Bernhardt J, Lindley R, Ada L, Bajorek BV, Barber PA, Beer C, Golledge J, Gustafsson L, Hersh D, Kenardy J, Perry L, Middleton S, Brauer SG, Nelson MR. Stroke management: updated recommendations for treatment along the care continuum. Intern Med J 2012; 42:562-9. [DOI: 10.1111/j.1445-5994.2012.02774.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Collinson A, Lindley R, Campbell A, Waters I, Lindley T, Wallace A. An evaluation of an Internet-based approach to weight loss with low glycaemic load principles. J Hum Nutr Diet 2012; 24:192-5. [PMID: 21843154 DOI: 10.1111/j.1365-277x.2010.01138.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing worldwide at an alarming rate. An Internet-based weight-loss programme has the potential to reach larger numbers of people than traditional face-to-face programmes. A growing body of evidence supports the use of low glycaemic load (GL) diets for weight loss. The present study aimed to investigate the efficacy of an Internet-based weight-loss programme that included foods with a low GL. METHODS One hundred and three volunteers, with a body mass index (BMI) ≥28 kg m(-2) , enrolled into an Internet weight-loss programme. A dietitian counselled participants over the Internet via weekly interactive chat rooms and monthly e-mails. Participants self-recorded body weight and food intake directly on to the Internet site. Weight, BMI and waist circumference were measured, and dietary data collected, at baseline and 6 months. RESULTS Seventy participants completed the 6-month weight-loss programme. Among these, mean weight, BMI and waist circumference significantly decreased by 3.5 kg (95% CI = 2.3-4.7), 1.2 kg m(-2) (95% CI = 0.8-1.7) and 4.8 cm (95% CI = 2.8-6.8), of baseline values respectively (P < 0.001). Twenty-five (36%) of the 70 participants lost a clinically significant amount of weight (>5% of initial body weight). CONCLUSIONS This descriptive study has shown that an Internet-based weight-loss programme with low GL principles can promote weight loss. This type of intervention and approach could be used to enhance other weight-loss strategies.
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Affiliation(s)
- A Collinson
- School of Health Professions, University of Plymouth, Plymouth, UK.
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Tan T, Siu D, Seale H, Heywood A, Ridda I, Dwyer D, Lo V, Ghotane S, Katelaris A, Lindley R, Wood N, Fox J, Mitchell P, Kovoor P, MacIntyre R. The Relationship Between Seasonal Influenza Vaccine Uptake and Socioeconomic Status in Western Sydney. Substudy of the Heart-Flu Study 2008–2009. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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MacIntyre R, Tan T, Heywood A, Ridda I, Seale H, Dwyer D, Lindley R, Siu D, Lo V, Katelaris A, Wood N, Fox J, Mitchell P, Kovoor P. Influenza as Risk Factor for Ischaemic Cardiac Events and the Effects of Influenza Vaccination. Outcomes from a Three-Year Prospective Case–control Study Conducted in the Australian Winters of 2008–2010 (HEART-FLU Study). Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ridda I, Macintyre CR, Lindley R, McIntyre PB, Brown M, Oftadeh S, Sullivan J, Gilbert GL. Lack of pneumococcal carriage in the hospitalised elderly. Vaccine 2010; 28:3902-4. [PMID: 20398618 DOI: 10.1016/j.vaccine.2010.03.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/24/2010] [Accepted: 03/28/2010] [Indexed: 11/28/2022]
Abstract
UNLABELLED There have been few surveys of Streptococcus pneumoniae and Neisseria meningitidis carriage in sick or frail elderly people who, with the very young, comprise the group who are at highest risk for pneumococcal disease. We studied pneumococcal carriage among participants in a pneumococcal immunisation study in the frail elderly. METHODS Subjects aged >or=60 years were recruited from a large tertiary referral hospital in Sydney, Australia. Nose and throat swabs were collected at the time of enrolment and 12 months after immunisation. RESULTS Before immunisation, only 1 of 315 participants was identified as a nasal carrier of S. pneumoniae; another was identified as throat carrier of N. meningitidis. None of the participants examined after immunisation was carrying either S. pneumoniae or N. meningitidis. CONCLUSION The low rate of pneumococcal carriage in this population of hospitalised elderly patients was unexpected. The most likely reason is that long-term carriage is rare in this population and suggests that pneumococcal disease primarily follows recent acquisition of S. pneumoniae types not associated with carriage.
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Affiliation(s)
- I Ridda
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia.
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Delcourt C, Huang Y, Wang J, Heeley E, Lindley R, Stapf C, Tzourio C, Arima H, Parsons M, Sun J, Neal B, Chalmers J, Anderson C. The Second (Main) Phase of an Open, Randomised, Multicentre Study to Investigate the Effectiveness of an Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (Interact2). Int J Stroke 2010; 5:110-6. [DOI: 10.1111/j.1747-4949.2010.00415.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale: The INTERACT pilot study demonstrated the feasibility of the protocol, safety of early intensive blood pressure lowering and effects on haematoma expansion within 6h of onset of intracerebral haemorrhage. This article describes the design of the second, main phase, INTERACT2. Aims: To compare the effects of a management strategy of early intensive blood pressure lowering with a more conservative guideline-based blood pressure management policy in patients with acute intracerebral hemorrhage. Design: INTERACT2 is a prospective, randomized, open label, assessor-blinded end-point (PROBE). Patients with a systolic blood pressure greater than 150 mmHg and no definite indication for or contraindication to blood pressure-lowering treatment are centrally randomised to either of two treatment groups within 6h onset of intracerebral haemorrhage. Those allocated to intensive blood pressure lowering will receive primarily intravenous, hypotensive agents to achieve a systolic blood pressure target of <140 mmHg within 1 h of randomisation and to maintain this level for up to 7 days in hospital. The control group will receive blood pressure-lowering treatment to a target systolic blood pressure of < 180 mmHg. Both groups are to receive similar acute stroke unit care, therapy and active management. Oral antihypertensive therapy is recommended in patients before hospital discharge with a long-term systolic blood pressure goal of 140 mmHg according to secondary stroke prevention guidelines. A projected 2800 subjects are to be enrolled from approximately 140 centres worldwide to provide 90% power (α 0·05) to detect a 14% difference in the risk of death and dependency between the groups, which equates to one or more cases of a poor outcome prevented in every 15 patients treated. Study outcomes: The primary outcome is the combined end-point of death and dependency according to the modified Rankin Scale at 90 days. The secondary outcomes are the separate components of the primary end-point in patients treated <4 hours of ICH onset, grades of physical function on the modified Rankin Scale, health-related quality of life on the EuroQoL, recurrent stroke and other vascular events, days of hospitalisation, requirement for permanent residential care and unexpected serious adverse events. The study is registered under NCT00716079, ISRCTN73916115 and ACTRN12608000362392.
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Affiliation(s)
- C. Delcourt
- The George Institute for International Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Y. Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - J. Wang
- Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - E. Heeley
- The George Institute for International Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - R. Lindley
- Sydney Medical School – Western, University of Sydney, Sydney, NSW, Australia
| | - C. Stapf
- Department of Neurology, European Regional Coordinating Centre, Clinical Research Unit, Lariboisière Hospital, APHP, Paris, France
- INSERM Unit 708, APHP, Paris, France
| | | | - H. Arima
- The George Institute for International Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - M. Parsons
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - J. Sun
- The George Institute, Beijing, China Conflict of interest: None
| | - B. Neal
- The George Institute for International Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - J. Chalmers
- The George Institute for International Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
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Kane I, Hand PJ, Rivers C, Armitage P, Bastin ME, Lindley R, Dennis M, Wardlaw JM. A practical assessment of magnetic resonance diffusion-perfusion mismatch in acute stroke: observer variation and outcome. J Neurol 2009; 256:1832-8. [PMID: 19536582 DOI: 10.1007/s00415-009-5202-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 05/17/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
Abstract
MR diffusion/perfusion mismatch may help identify patients for acute stroke treatment, but mixed results from clinical trials suggest that further evaluation of the mismatch concept is required. To work effectively, mismatch should predict prognosis on arrival at hospital. We assessed mismatch duration and associations with functional outcome in acute stroke. We recruited consecutive patients with acute stroke, recorded baseline clinical variables, performed MR diffusion and perfusion imaging and assessed 3-month functional outcome. We assessed practicalities, agreement between mismatch on mean transit time (MTT) or cerebral blood flow (CBF) maps, visually and with lesion volume, and the relationship of each to functional outcome. Of 82 patients starting imaging, 14 (17%) failed perfusion imaging. Overall, 42% had mismatch (56% at <6 h; 41% at 12-24 h; 23% at 24-48 h). Agreement for mismatch by visual versus volume assessment was fair using MTT (kappa 0.59, 95% CI 0.34-0.84) but poor using CBF (kappa 0.24, 95% CI 0.01-0.48). Mismatch by either definition was not associated with functional outcome, even when the analysis was restricted to just those with mismatch. Visual estimation is a reasonable proxy for mismatch volume on MTT but not CBF. Perfusion is more difficult for acute stroke patients than diffusion imaging. Mismatch is present in many patients beyond 12 h after stroke. Mismatch alone does not distinguish patients with good and poor prognosis; both can do well or poorly. Other factors, e.g. reperfusion, may influence outcome more strongly, even in patients without mismatch.
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Affiliation(s)
- I Kane
- Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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Battersby M, Hoffmann S, Cadilhac D, Osborne R, Lalor E, Lindley R. ‘Getting your Life Back on Track after Stroke’: A Phase II Multi-Centered, Single-Blind, Randomized, Controlled Trial of the Stroke Self-Management Program Vs. the Stanford Chronic Condition Self-Management Program or Standard Care in Stroke Survivors. Int J Stroke 2009; 4:137-44. [DOI: 10.1111/j.1747-4949.2009.00261.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial. Methods Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements. Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either; standard care, standard care plus a six week generic chronic condition self-management group education program, or, standard care plus an eight week stroke specific self-management education group program. Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months. Study Outcomes The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events. Secondary outcomes include: positive and active engagement in life measured by the Health Education Impact Questionnaire, improvements in quality of life measured by the Assessment of Quality of Life instrument, improvements in mood measured by the Irritability, Depression and Anxiety Scale, health resource utilization measured by a participant held diary and safety. Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified.
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Affiliation(s)
- M. Battersby
- Flinders Human Health and Behaviour
Research Unit, Flinders University, Margaret Tobin Centre, Bedford Park, SA, Australia
| | - S. Hoffmann
- National Stroke Foundation,
Melbourne, Vic., Australia
| | - D. Cadilhac
- Public Health Division, Repatriation
Hospital, Austin Health, Melbourne, Vic., Australia
| | - R. Osborne
- Centre for Rheumatic Diseases,
Department of Medicine (RMH/WH), The University of Melbourne, Melbourne, Vic.,
Australia
| | - E. Lalor
- National Stroke Foundation,
Melbourne, Vic., Australia
| | - R. Lindley
- Department of Geriatric Medicine,
Westmead Hospital, Westmead, NSW, Australia
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Abstract
Muir-Torre syndrome is a rare genodermatosis (hereditary cancer syndrome associated with distinguishing cutaneous signs) characterised by occurrence of sebaceous neoplasia and visceral malignancy. Colorectal cancer is the commonest visceral malignancy associated with Muir-Torre syndrome. We discuss a case report along with recommendations for diagnosis and screening.
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Affiliation(s)
- A Pancholi
- Department of General and Colorectal Surgery, Medway Maritime Hospital, Gillingham, Kent, UK.
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Ridda I, MacIntyre C, Lindley R, Gao Z, Sullivan J, Yuan F, McIntyre P. Immunological responses to pneumococcal vaccine in frail older people. Vaccine 2009; 27:1628-36. [DOI: 10.1016/j.vaccine.2008.11.098] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 11/18/2008] [Accepted: 11/28/2008] [Indexed: 11/30/2022]
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MacIntyre C, Tan T, Dwyer D, Lindley R, Seale H, Ridda I, Ghotane S, Heron L, Wood N, Mitchell P, Fox J, Kovoor P. Undiagnosed, unrecognised influenza and other respiratory viruses as a risk factor for ischaemic vascular events. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prescott RJ, Kunkler IH, Williams LJ, King CC, Jack W, van der Pol M, Goh TT, Lindley R, Cairns J. A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial. Health Technol Assess 2007; 11:1-149, iii-iv. [PMID: 17669280 DOI: 10.3310/hta11310] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess whether omission of postoperative radiotherapy in women with 'low-risk' axillary node negative breast cancer (T0-2) treated by breast-conserving surgery and endocrine therapy improves quality of life and is more cost-effective. DESIGN A randomised controlled clinical trial, using a method of minimisation balanced by centre, grade of cancer, age, lymphatic/vascular invasion and preoperative endocrine therapy, was performed. A non-randomised cohort was also recruited, in order to complete a comprehensive cohort study. SETTING The setting was breast cancer clinics in cancer centres in the UK. PARTICIPANTS Patients aged 65 years or more were eligible provided that their cancers were considered to be at low risk of local recurrence, were suitable for breast-conservation surgery, were receiving endocrine therapy and were able and willing to give informed consent. INTERVENTIONS The standard treatment of postoperative breast irradiation or the omission of radiotherapy. MAIN OUTCOME MEASURES Quality of life was the primary outcome measure, together with anxiety and depression and cost-effectiveness. Secondary outcome measures were recurrence rates, functional status, treatment-related morbidity and cosmesis. The principal method of data collection was by questionnaire, completed at home with a research nurse at four times over 15 months. RESULTS The hypothesised improvement in overall quality of life with the omission of radiotherapy was not seen in the EuroQol assessment or in the functionality and symptoms summary domains of the European Organisation for Research in the Treatment of Cancer (EORTC) scales. Some differences were apparent within subscales of the EORTC questionnaires, and insights into the impact of treatment were also provided by the qualitative data obtained by open-ended questions. Differences were most apparent shortly after the time of completion of radiotherapy. Radiotherapy was then associated with increased breast symptoms and with greater fatigue but with less insomnia and endocrine side-effects. Patients had significant concerns about the delivery of radiotherapy services, such as transport, accommodation and travel costs associated with receiving radiotherapy. By the end of follow-up, patients receiving radiotherapy were expressing less anxiety about recurrence than those who had not received radiotherapy. Functionality was not greatly affected by treatment. Within the randomised controlled trial, the Barthel Index demonstrated a small but significant fall in functionality with radiotherapy compared with the no radiotherapy arm of the trial. Results from the non-randomised patients did not confirm this effect, however. Cosmetic results were better in those not receiving radiotherapy but this did not appear to be an important issue to the patients. The use of home-based assessments by a research nurse proved to be an effective way of obtaining high-quality data. Costs to the NHS associated with postoperative radiotherapy were calculated to be of the order of 2000 pounds per patient. In the follow-up in this study, there were no recurrences, and the quality of life utilities from EuroQol were almost identical. CONCLUSIONS Although there are no differences in overall quality of life scores between the patients treated with and without radiotherapy, there are several dimensions that exhibit significant advantage to the omission of irradiation. Over the first 15 months, radiotherapy for this population is not a cost-effective treatment. However, the early postoperative outcome does not give a complete answer and the eventual cost-effectiveness will only become clear after long-term follow-up. Extrapolations from these data suggest that radiotherapy may not be a cost-effective treatment unless it results in a recurrence rate that is at least 5% lower in absolute terms than those treated without radiotherapy. Further research is needed into a number of areas including the long-term aspects of quality of life, clinical outcomes, costs and consequences of omitting radiotherapy.
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Affiliation(s)
- R J Prescott
- Medical Statistics Unit, University of Edinburgh, UK
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Prescott R, Kunkler I, Williams L, King C, Jack W, Dixon J, van der Pol M, Goh T, Lindley R, Cairns J. O-19 Post-operative radiotherapy (RT) in minimum-risk elderly (PRIME) assessing the impact of breast radiotherapy on quality of life in low risk older patients. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kunkler I, Prescott R, Williams L, King C, Dixon J, Lindley R, Leonard R, Cairns J, Rodger A, Sainsbury R. PRIME: A randomised trial assessing the role of post-operative breast radiotherapy in older patients. Breast 2003. [DOI: 10.1016/s0960-9776(03)80144-3] [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: 11/26/2022] Open
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Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan J, Lewis S, Lindley R, Neilson A, Thomas B, Wardlaw J. A systematic review of the effectiveness, cost-effectiveness and barriers to implementation of thrombolytic and neuroprotective therapy for acute ischaemic stroke in the NHS. Health Technol Assess 2003; 6:1-112. [PMID: 12433319 DOI: 10.3310/hta6260] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P Sandercock
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland
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Abstract
Sarcoidosis occurs rarely in Caucasian males and seldom involves the testis. We report an unusual case of asymptomatic testicular sarcoid in a Caucasian man.
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Affiliation(s)
- S Naseem
- Department of Urology, Medway Maritime Hospital, Gillingham, UK
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Abstract
BACKGROUND Research into the causes of small-vessel stroke has been hindered by technical constraints. Cases of intracerebral hemorrhage occurring in unusual clinical contexts suggest a causal role for sudden increases in blood pressure and/or cerebral blood flow. CASE DESCRIPTION We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset. At autopsy, the brain harbored several perforating artery fibrinoid lesions adjacent to and remote from the hematoma as well as old lacunar infarcts and healed destructive small-vessel lesions. CONCLUSIONS We postulate that the emotional upset caused a sudden rise in blood pressure/cerebral blood flow, mediating small-vessel fibrinoid necrosis and rupture. This or a related mechanism may underlie many small-vessel strokes.
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Affiliation(s)
- G A Lammie
- Department of Pathology, University of Edinburgh, Scotland.
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Affiliation(s)
- A Giles
- Department of Histology, All Saints Hospital, Chatham, UK
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Theodossi A, Spiegelhalter DJ, Jass J, Firth J, Dixon M, Leader M, Levison DA, Lindley R, Filipe I, Price A. Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut 1994; 35:961-8. [PMID: 8063225 PMCID: PMC1374845 DOI: 10.1136/gut.35.7.961] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
If skilled histopathologists disagree over the same biopsy specimen, at least one must have an incorrect interpretation. Thus, disagreement is associated with, although not the cause of, diagnostic error. The present study aimed to determine the magnitude of variation among 10 observers with a special interest in gastrointestinal histopathology. They independently interpreted the same biopsy specimens for morphological features which may discriminate between patients with Crohn's disease and ulcerative colitis and normal subjects. Thirty of 41 features had agreement measures significantly better than expected by chance (p < 0.05). The range of agreement in the 45 observer pairs over the final diagnosis was 65-76%. There was good agreement in discriminating between normal slides and those showing confirmed inflammatory bowel disease. For normal slides, however, the term nonspecific inflammation was often applied and without any consistency. In addition, true Crohn's disease slides were often and consistently thought to be ulcerative colitis. Having identified 11 important discriminatory morphological features, two multiple regression analyses were then carried out to produce a scoring system for inflammatory bowel disease. These results suggest there is considerable room for improvement in the reliability of colonic biopsy specimen interpretation and that this could probably be achieved using more exact definitions of morphological features and diseases.
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Affiliation(s)
- A Theodossi
- Department of Gastroenterology, Mayday University Hospital, Croydon
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Abstract
AIMS To assess histologically the amount of iron deposited in liver biopsy specimens from HIV positive patients; and to perform estimations of liver iron on tissue from patients with an increase in parenchymal stainable iron. To correlate the amount of blood transfused and the degree of iron overload. METHODS Liver biopsy specimens (n = 120) from 109 HIV positive patients, 74 of whom had AIDS, were examined retrospectively and the amount of iron, as visualised with Perls's stain, was graded. Fibrosis was assessed using connective tissue stains. Estimations of liver iron were performed on tissue retrieved from paraffin wax blocks in cases with histological grade 3 or 4 iron overload. The amount of blood transfused before liver biopsy was determined from the notes for each patient. RESULTS Fifteen of the 120 liver biopsy specimens had significantly increased amounts of iron in their hepatocytes, as assessed histologically, and this was confirmed in seven cases by measurement of liver iron. There was a close correlation between the amount of blood transfused and the degree of iron overload. In the initial biopsy specimens only one case showed portal tract expansion. Three of the five patients who had repeat biopsies, however, showed progressive fibrosis. CONCLUSION Multiply transfused HIV positive patients may develop clinically important iron overload and are at risk of developing progressive fibrosis. Superimposed liver disease, especially viral hepatitis, in these high risk patients may exacerbate the effects of the iron overload.
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Affiliation(s)
- R D Goldin
- Department of Histopathology, St Mary's Hospital Medical School, London
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Lindley R, Waddell F, Livingstone M, Sandercock P, Dennis M, Warlow C, Smith B, Slattery J. Can We Abandon Measurement Scales and Ask Just Two Questions to Assess Outcome in Stroke Survivors? Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p10-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lindley R, Sandercock R, Slattery J. International Stroke Trial Pilot Study: Absolute Risks of Poor Long-Term Outcome in the Elderly. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_3.p9-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lindley R. Glove puncture in the post mortem room. J Clin Pathol 1992; 45:548. [PMID: 1624611 PMCID: PMC495240 DOI: 10.1136/jcp.45.6.548-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sandercock P, Lindley R, Wardlaw J. Antiplatelet, anticoagulant and fibrinolytic agents in acute ischaemic stroke and TIA. Br J Hosp Med (Lond) 1992; 47:731-7. [PMID: 1606457] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In acute ischaemic stroke and transient ischaemic attacks both platelets and coagulation factors are activated. This is the rationale for the use of antiplatelet and anticoagulant agents in the prevention of acute ischaemic stroke. Evidence also suggests that antiplatelet agents anticoagulants and dissolution of a thrombus occluding a major cerebral vessel (by means of fibrinolytic agents) may be beneficial as therapy for the acute phase of ischaemic stroke.
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Affiliation(s)
- P Sandercock
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh
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Abstract
In the 6-year period 1984-1989, 101 liver biopsies or 'needle necropsies' from human immunodeficiency virus positive patients were examined histologically. Of these, only nine showed no abnormality whatsoever. The commonest histological findings were either fatty change or changes related to co-existent chronic viral hepatitis. Granulomas were seen in 15 cases, four of which were positive for acid-fast bacilli. A range of organisms were recorded: cytomegalovirus (4); Histoplasma capsulatum (1); Pneumocystis carinii (2); Cryptococcus neoformans (1); and Leishmania donovani (1). There were two cases of non-Hodgkin's lymphoma, but no cases of Kaposi's sarcoma. Marked iron deposition, which correlated with multiple blood transfusions was seen in nine biopsies. We were unable to identify any histological feature in the liver as being specific for HIV infection. The high incidence of liver abnormalities reflects: (i) the coincident exposure to hepatotropic viruses; (ii) the presence of opportunistic infections and neoplasms, usually part of a disseminated multi-organ process arising in the setting of profound immune depression; (iii) iatrogenic causes, in particular iron overload related to multiple blood transfusions received for treatment of zidovudine-induced anaemia; and (iv) non-specific changes associated with chronic debilitating disease.
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Affiliation(s)
- M J Wilkins
- Department of Histopathology, St Mary's Hospital, London, UK
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Abstract
We report our experience of peripheral blood and bone marrow changes in patients with HIV disease. Abnormalities were most commonly seen in patients with advanced disease. In AIDS group IV patients (CDC classification) anaemia (92%) neutropenia (85%) monocytopenia (75%) and thrombocytopenia (61%) have their highest incidence, the reason being a combination of factors such as infection, myelosuppressive drugs and HIV infection itself. Bone marrow examinations were performed most commonly for microbiological culture (25%) and the investigation of anaemia (16%). Morphological changes in the bone marrow were non-specific and not pathognomic; however erythroid hypoplasia was found to be a distinctive feature associated with MAI infection. The procedure provided a high yield for microbiological culture, particularly in MAI infection.
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Affiliation(s)
- N Mir
- Department of Haematology, St. Stephen's Hospital, London, U.K
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Lindley R, Bulman A, Parsons P, Phillips R, Henry K, Ellis H. Histologic features predictive of an increased risk of early local recurrence after treatment of breast cancer by local tumor excision and radical radiotherapy. Surgery 1989; 105:13-20. [PMID: 2911801] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A histopathologic review was undertaken of 293 patients with breast cancer treated by local tumor excision and radical radiotherapy. In a 6-year period, there were 37 local treatment failures with 16 deaths, and an additional 20 patients died without local recurrence. Pathologic data were available for 272 patients. Multivariate analysis indicated that the pathologic features in an invasive tumor most predictive for local recurrence were the combination of a high proportion of intraduct carcinoma with extensive necrosis (comedocarcinoma). Of 18 patients with these features, nine have had early local recurrence (a risk of 50% with these features vs 10% in those without), and four have died (a risk of 22% against 12%). Despite the short follow-up, the results already appear significant, and the study is ongoing. The importance of comedonecrosis in the intraduct component as a prognostic indicator in invasive carcinoma of the breast is not widely recognized and might constitute a relative contraindication to conservative treatment of the breast.
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Affiliation(s)
- R Lindley
- Department of Surgery, Westminster Hospital, London, England
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