2024-03-29T12:08:00Zhttp://eastmid.openrepository.com/oai/requestoai:eastmid.openrepository.com:20.500.12904/2292021-06-03T09:41:31Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747).
Chakraborti, Prabir
Bone Protecting Treatments
Castrate Refractory Prostate Cancer
Prostate Cancer
Quality of Life
Cost Effectiveness
SR89
Zoledronic Acid
OBJECTIVES: To evaluate the cost-effectiveness of adding zoledronic acid (ZA) or strontium-89 (Sr89) to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). PATIENTS AND METHODS: Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2x2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the NHS and included expenditures for trial treatments, concomitant medications and use of related hospital and primary care services. QALYs were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument. Results are expressed as incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves. RESULTS: The per-patient cost for ZA was £12,667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group experienced on average 0.03 QALYs more than their counterparts in no ZA. The incremental cost-effectiveness ratio (ICER) for this comparison was £8,005. Sr89 was associated with a cost of £13,230, £1,365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16,884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively. CONCLUSIONS: The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources This article is protected by copyright. All rights reserved.
2016-08-23T11:01:15Z
2016-08-23T11:01:15Z
2016-06
Article
BJU Int.2017 Apr;119(4):522-529. doi: 10.1111/bju.13549. Epub 2016 Jul 10.
http://hdl.handle.net/20.500.12904/229
en
oai:eastmid.openrepository.com:20.500.12904/2302021-07-19T08:49:53Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial.
Chakraborti, Prabir
Chemotherapy
Upper Urinary Tract
BACKGROUND: Urothelial carcinomas of the upper urinary tract (UTUCs) are rare, with poorer stage-for-stage prognosis than urothelial carcinomas of the urinary bladder. No international consensus exists on the benefit of adjuvant chemotherapy for patients with UTUCs after nephroureterectomy with curative intent. The POUT (Peri-Operative chemotherapy versus sUrveillance in upper Tract urothelial cancer) trial aimed to assess the efficacy of systemic platinum-based chemotherapy in patients with UTUCs. METHODS: We did a phase 3, open-label, randomised controlled trial at 71 hospitals in the UK. We recruited patients with UTUC after nephroureterectomy staged as either pT2-T4 pN0-N3 M0 or pTany N1-3 M0. We randomly allocated participants centrally (1:1) to either surveillance or four 21-day cycles of chemotherapy, using a minimisation algorithm with a random element. Chemotherapy was either cisplatin (70 mg/m2) or carboplatin (area under the curve
[AUC]4•5/AUC5, for glomerular filtration rate <50 mL/min only) administered intravenously on day 1 and gemcitabine (1000 mg/m2) administered intravenously on days 1 and 8; chemotherapy was initiated within 90 days of surgery. Follow-up included standard cystoscopic, radiological, and clinical assessments. The primary endpoint was disease-free survival analysed by intention to treat with a Peto-Haybittle stopping rule for (in)efficacy. The trial is registered with ClinicalTrials.gov, NCT01993979. A preplanned interim analysis met the efficacy criterion for early closure after recruitment of 261 participants. FINDINGS: Between June 19, 2012, and Nov 8, 2017, we enrolled 261 participants from 57 of 71 open study sites. 132 patients were assigned chemotherapy and 129 surveillance. One participant allocated chemotherapy withdrew consent for data use after randomisation and was excluded from analyses. Adjuvant chemotherapy significantly improved disease-free survival (hazard ratio 0•45, 95% CI 0•30-0•68; p=0•0001) at a median follow-up of 30•3 months (IQR 18•0-47•5). 3-year event-free estimates were 71% (95% CI 61-78) and 46% (36-56) for chemotherapy and surveillance, respectively. 55 (44%) of 126 participants who started chemotherapy had acute grade 3 or worse treatment-emergent adverse events, which accorded with frequently reported events for the chemotherapy regimen. Five (4%) of 129 patients managed by surveillance had acute grade 3 or worse emergent adverse events. No treatment-related deaths were reported. INTERPRETATION: Gemcitabine-platinum combination chemotherapy initiated within 90 days after nephroureterectomy significantly improved disease-free survival in patients with locally advanced UTUC. Adjuvant platinum-based chemotherapy should be considered a new standard of care after nephroureterectomy for this patient population. FUNDING: Cancer Research UK.
2020-07-17T12:32:46Z
2020-07-17T12:32:46Z
2020-04
Article
Lancet. 2020 Apr 18;395(10232):1268-1277. doi: 10.1016/S0140-6736(20)30415-3. Epub 2020 Mar 5
http://hdl.handle.net/20.500.12904/230
en
oai:eastmid.openrepository.com:20.500.12904/2312021-06-03T09:41:32Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Lynch Syndrome Screening in Gynecological Cancers: Results of an International Survey with Recommendations for Uniform Reporting Terminology for Mismatch Repair Immunohistochemistry Results.
Van Schalkwyk, Gerhard
Lynch Syndrome
TCGA
Consent
Endometrial Carcinoma
Immunohistochemistry
Mismatch Repair
Screening
Terminology
Author(s) Pre Print Version. 12 Month Embargo on Post
AIM: Lynch Syndrome (LS) is associated with an increased risk of developing endometrial carcinoma (EC) and ovarian carcinoma (OC). There is considerable variability in current practices and opinions related to screening newly diagnosed patients with EC/OC for LS. An online survey was undertaken to explore the extent of these differences. METHODS: An online questionnaire was developed by a panel of experts and sent to all members of the British Association of Gynaecological Pathologists (BAGP) and the International Society of Gynecological Pathologists (ISGyP). Anonymised results were received and analyzed. RESULTS: Thirty-six BAGP and 44 ISGyP members completed the survey. More than 90% of respondents were aware of the association of LS with both EC and OC, but 34% were not aware of specific guidelines for LS screening. Seventy-one percent of respondents agreed that universal screening for LS should be carried out in all newly diagnosed EC cases, with immunohistochemistry (IHC) alone as the preferred approach. Only 36% of respondents currently performed IHC or microsatellite instability testing on all newly diagnosed EC, with most of the remaining respondents practicing selective screening, based on clinical or pathological features or both. A significant minority of respondents (35%) believed that patient consent was required before performing MMR IHC. Almost all respondents favored use of standardized terminology for reporting MMR staining results and this is proposed herein. CONCLUSION: There is wide support for universal LS screening in patients with EC, but this survey highlights areas of considerable variation in practice.
2019-08-13T15:15:27Z
2019-08-13T15:15:27Z
2019-07
Article
Histopathology. 2019 Jul 16. doi: 10.1111/his.13925. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/231
en
oai:eastmid.openrepository.com:20.500.12904/2322021-06-03T09:41:32Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Evaluation of a nudge intervention providing simple feedback to clinicians of the consequence of radiation exposure on demand for computed tomography: a controlled study.
Young, B
Shaw, D
Langley, T
Norwood, Mark
Computed Tomography
Age
Demand
Education
Nudge
Radiation
Author(s) Pre Print Version. 12 Month Embargo on Post and PDF
Computed tomography (CT) is readily available in developed countries. As one of the side effects includes an increased risk of cancer, interventions that may encourage more judicious use of CT are important. Behavioural economics theory includes the use of nudges that aim to help more informed decisions to be made, although these have been rarely used in hospitals to date. We aimed to evaluate the impact of a simple educational message appended to the CT report on subsequent numbers of CT completed using a controlled interrupted time series design based in two teaching hospitals in the UK. The intervention was the addition of a non-directional educational message on the risk of ionising radiation to all CT reports. There was a statistically significant reduction in the number of CT requested in the intervention hospital compared to the control hospital (-4.6%, 95% confidence intervals -7.4 to -1.7, p=0.002) in the 12 months after the intervention was implemented. We conclude that a simple, non-directional nudge intervention has the capacity to modify clinician use of CT. This approach is cheap, and has potential in helping support doctors make informed decisions.
2019-08-13T15:22:01Z
2019-08-13T15:22:01Z
2019-07
Article
Clin Med (Lond). 2019 Jul;19(4):290-293. doi: 10.7861/clinmedicine.19-4-290.
http://hdl.handle.net/20.500.12904/232
en
oai:eastmid.openrepository.com:20.500.12904/2332021-06-03T09:41:32Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): an overview of presentation and pathogenesis and guidelines for pathological diagnosis and management.
Deb, Rahul
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Central Reporting
Diagnostic Guidelines
Staging
AIMS: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon complication associated largely with textured implants. It is important that the symptoms associated with BIA-ALCL are recognised and that robust pathways are in place to establish the diagnosis. The aim of this paper is to review what is known of the incidence of the disease, current thoughts on pathogenesis, patterns of presentation and pathological features to provide standard guidelines for its diagnosis. METHODS AND RESULTS: Systematic review of the literature via PubMed covering cases series, modes of presentation, cytological, histological and immunohistochemical features and disease outcome. Since 1997, 518 cases throughout 25 countries have been registered on the American Society of Plastic Surgeons PROFILE registry, with an estimated risk for women with an implant of one to three per million per year. It most frequently presents as a late-onset accumulation of seroma fluid, sometimes as a mass lesion. The neoplastic cells are highly atypical, consistently strongly positive for CD30, with 43-90% also positive for EMA, and all are ALK-negative. Behaviour is best predicted using a staging system for solid tumours. CONCLUSION: BIA-ALCL is a rare but important complication of breast implants. While characterised by CD30-positive neoplastic cells this must be interpreted with care, and we provide pathological guidelines for the robust diagnosis of this lesion as well as the most appropriate staging system and management strategies. Finally, in order to generate more accurate data on incidence, we
recommend mechanisms for the routine central reporting of all cases.
2020-07-17T14:48:34Z
2020-07-17T14:48:34Z
2019-12
Article
Histopathology. 2019 Dec;75(6):787-796. doi: 10.1111/his.13932. Epub 2019 Oct 6.
http://hdl.handle.net/20.500.12904/233
en
oai:eastmid.openrepository.com:20.500.12904/2342021-06-03T09:41:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Lenalidomide before and after ASCT for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial.
Allotey, D
Multiple Myeloma
Lenalidomide
Thalidomide
The optimal way to use immunomodulatory drugs as components of induction and maintenance therapy for multiple myeloma is unresolved. We addressed this question in a large phase III randomized trial, Myeloma XI. Patients with newly diagnosed multiple myeloma (n = 2042) were randomized to induction therapy with cyclophosphamide, thalidomide, and dexamethasone (CTD) or cyclophosphamide, lenalidomide, and dexamethasone (CRD). Additional intensification therapy with cyclophosphamide, bortezomib and dexamethasone (CVD) was administered before ASCT to patients with a suboptimal response to induction therapy using a response-adapted approach. After receiving high-dose melphalan with autologous stem cell transplantation (ASCT), eligible patients were further randomized to receive either lenalidomide alone or observation alone. Co-primary endpoints were progression-free survival (PFS) and overall survival (OS). The CRD regimen was associated with significantly longer PFS (median: 36 vs. 33 months; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.75-0.96; P = 0.0116) and OS (3-year OS: 82.9% vs. 77.0%; HR, 0.77; 95% CI, 0.63-0.93; P = 0.0072) compared with CTD. The PFS and OS results favored CRD over CTD across all subgroups, including patients with International Staging System stage III disease (HR for PFS, 0.73; 95% CI, 0.58-0.93; HR for OS, 0.78; 95% CI, 0.56-1.09), high-risk cytogenetics (HR for PFS, 0.60; 95% CI, 0.43-0.84; HR for OS, 0.70; 95% CI, 0.42-1.15) and ultra high-risk cytogenetics (HR for PFS, 0.67; 95% CI, 0.41-1.11; HR for OS, 0.65; 95% CI, 0.34-1.25). Among patients randomized to lenalidomide maintenance (n = 451) or observation (n = 377), maintenance therapy improved PFS (median: 50 vs. 28 months; HR, 0.47; 95% CI, 0.37-0.60; P < 0.0001). Optimal results for PFS and OS were achieved in the patients who received CRD induction and lenalidomide maintenance. The trial was
(EudraCT 2009-010956-93) and ISRCTN49407852.
2020-07-15T12:43:10Z
2020-07-15T12:43:10Z
2020-06
Article
Haematologica. 2020 Jun 4. pii: haematol.2020.247130. doi: 10.3324/haematol.2020.247130. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/234
en
oai:eastmid.openrepository.com:20.500.12904/2352021-06-03T09:41:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Menstrual cycle associated changes in hormone-related gene expression in oestrogen receptor positive breast cancer.
Sibbering, Mark
Breast Cancer
Cancer Genomics
Tumour Biomarkers
The major changes in hormone levels that occur through the menstrual cycle have
been postulated to affect the expression of hormone-regulated and proliferation-associated genes (PAGs) in premenopausal ER+ breast cancer. Whilst previous studies have demonstrated differences in gene expression, here, we investigated if there are within patient changes in the expression of oestrogen- and progesterone-regulated genes (ERGs and PRGs) and PAGs in ER+ breast cancer during the menstrual cycle. Samples from 96 patients in two independent prospective studies of the effect of menstrual cycle on ER+ breast cancer were used. Plasma hormone measurements were used to assign tumours to one of three pre-defined menstrual cycle windows: W1 (days 27-35 and 1-6; low oestradiol and low progesterone), W2 (days 7-16; high oestradiol and low progesterone) and W3 (days 17-26; intermediate oestradiol and high progesterone). RNA expression of 50 genes, including 27 ERGs, 11 putative PRGs and seven PAGs was measured. The AvERG (geomean of PGR, GREB1, TFF1 and PDZK1) was used as a composite measure of ERG expression and showed significant changes between the three windows of the menstrual cycle increasing over 2.2-fold between W1 and W2 and decreasing between W2 and W3 and between W3 and W1. Proliferation gene expression also varied significantly, following the same pattern of changes as ERG expression, but the changes were of lower magnitude (1.4-fold increase between W1 and W2). Significant changes in the expression of eight individual ERGs, including GREB1, PGR and TFF1, and two PAGs were observed between W1 and either W2 or W3 with all genes showing higher levels in W2 or W3 (1.3-2.4-fold; FDR 0.016-0.05). The AvProg, a composite measure of PRG expression, increased significantly (1.5-fold) in W3 compared to W1 or W2 but no significant changes were observed for individual PRGs. In conclusion, we observed significant changes in ERG, PRG and PAG expression in ER+ breast tumours during the menstrual cycle that may affect the assessment and interpretation of prominent biomarkers (e.g. PgR) and commonly used multigene prognostic signatures in premenopausal ER+ breast cancer.
2020-01-24T10:01:49Z
2020-01-24T10:01:49Z
2019-11
Article
NPJ Breast Cancer. 2019 Nov 15;5:42. doi: 10.1038/s41523-019-0138-2. eCollection 2019.
http://hdl.handle.net/20.500.12904/235
en
oai:eastmid.openrepository.com:20.500.12904/2362021-06-03T09:41:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma.
Allotey, D
Multiple Myeloma
Author(s) pre print version. 6 month embargo on post-print. No PDF
PURPOSE: Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT. METHODS: Patients were randomly assigned to either sASCT or nontransplantation consolidation (NTC). Pain and QoL were assessed as secondary outcomes using validated QoL instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and myeloma-specific module, QLQ-MY20; the Brief Pain Inventory [Short Form]; and the Leeds Assessment of Neuropathic Symptoms and Signs [Self-Assessment] scale). RESULTS: A total of 288 patients (> 96%) consented to the QoL substudy. The median follow-up was 52 months. The European Organisation for Research and Treatment of Cancer QLQ-C30 Global health status scores were higher (better) in the NTC group at 100 days after random assignment (P = .0496), but not at later time points. Pain interference was higher (worse) in the sASCT group than in the NTC group at 6 months after random assignment (P = .0267), with patients with sASCT reporting higher scores for Pain interference with daily living for up to 2 years after random assignment. Patients reporting lower concerns about adverse effects of treatment after sASCT had a time to progression advantage. CONCLUSION: Patients with sASCT with relapsed MM demonstrated a comparative reduction in QoL and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received sASCT reported better outcomes. Patients who experienced lower adverse effects after sASCT had longer time to progression and overall survival, showing the need to improve symptom management peritransplantation. To our knowledge, this study provides the most comprehensive picture of QoL before and after sASCT in patients with relapsed MM.
2020-07-15T12:58:21Z
2020-07-15T12:58:21Z
2019-07
Article
J Clin Oncol. 2019 Jul 1;37(19):1617-1628. doi: 10.1200/JCO.18.01006. Epub 2019 Apr 10.
http://hdl.handle.net/20.500.12904/236
en
oai:eastmid.openrepository.com:20.500.12904/2372021-06-03T09:41:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Implementing TIMERS: the race against hard-to-heal wounds.
Moffatt, Christine
Wound Healing
Skin Ulcer
Chronic Disease
2020-02-05T11:25:15Z
2020-02-05T11:25:15Z
2019-03
Article
J Wound Care. 2019 Mar 1;23(Sup3a):S1-S50. doi: 10.12968/jowc.2019.28.Sup3a.S1.
http://hdl.handle.net/20.500.12904/237
en
oai:eastmid.openrepository.com:20.500.12904/2382021-06-03T09:41:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Cellulitis in chronic oedema of the lower leg: an international cross-sectional study
Keeley, Vaughan
Chronic Oedema
Cellulitis
Leg
Background: Cellulitis and chronic oedema are common conditions with considerable morbidity. The number of studies designed to assess the epidemiology of cellulitis in chronic oedema are scarce. Objectives: To investigate the prevalence and risk factors of cellulitis in chronic leg oedema, including lymphoedema. Methods: A cross-sectional study, including 40 sites in nine countries, 2014-2017. Adults with clinically proven unilateral or bilateral chronic oedema (oedema >3 months) of the lower leg were included. The main outcome measures were frequency and risk factors for cellulitis within the last 12 months. Results: Out of 7477 patients, 15⋅78% had cellulitis within the last 12 months, with a life-time prevalence of 37⋅47%. The following risk factors for cellulitis were identified by multivariable analysis: wounds [odds ratio (OR) 2⋅37, 95% confidence interval (CI) 2⋅03-2⋅78], morbid obesity (OR 1⋅51, CI 95% 1⋅27-1⋅80), obesity (OR 1⋅21, CI 95% 1⋅03-1⋅41), midline swelling (OR 1⋅32, CI 95% 1⋅04-1⋅66), male sex (OR 1⋅32, CI 95% 1⋅15-1⋅52) and diabetes (OR 1⋅27, CI 95% 1⋅08-1⋅49). Controlled swelling was associated with a reduced risk (OR 0⋅59, CI 95% 0⋅51-0⋅67). In a subgroup analysis, the risk increased with the stage of oedema [International Society of Lymphology (ISL), stage II OR 2⋅04, CI 95% 1⋅23-3⋅38, and stage III OR 4⋅88, CI 95% 2⋅77-8⋅56]. Conclusions: Cellulitis in chronic leg oedema is a global problem. Several risk factors for cellulitis were identified, of which some are potentially preventable. Our findings suggest that oedema control, is one of these. We also identified that advanced stages of oedema, with hard/fibrotic tissue, might be an important clinical indicator to identify patients at particular risk.
2021-01-15T10:21:30Z
2021-01-15T10:21:30Z
2021-01
Article
Br J Dermatol. 2021 Jan 6. doi: 10.1111/bjd.19803. Epub ahead of print.
http://hdl.handle.net/20.500.12904/238
en
oai:eastmid.openrepository.com:20.500.12904/2392021-06-03T09:41:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
The shape of the CUP service at Royal Derby Hospital following the adoption of UKONS guidelines
Prendergast, Andrew
Cancer of Unknown Primary
UK Oncology Nursing Society Guidelines
UKONS
Author(s) Pre or Post Print Version Only. No PDF
Background: Cancer of Unknown Primary (CUP) is a form of malignancy for which a primary site cannot be identified despite extensive investigations. The Royal Derby Hospital (RDH) have recently adopted UK Oncology Nursing Society (UKONS) guidelines which aim to promote early involvement of the CUP service, reduce delays in diagnosis and treatment, and prevent unnecessary investigations for suspected CUP patients.Method: A database for patients referred to the CUP service at RDH was compiled by CUP specialist nurses during the period May 2015-May 2016.Results: Referrals to the CUP service were decreased (25%) compared with the previous year but patients diagnosed with CUP had a reduced average life expectancy (17%). The number of MDT discussions per patient was reduced (18%) and time to diagnosis decreased by 29% compared with 2014-15. Only 24% of patients undergoing a biopsy received active treatment.Conclusion: Reduced referrals to the RDH CUP service and more efficient diagnoses do not translate to improved survival rates although this may be attributable to the inclusion of patients deceased prior to referral. Neither do invasive biopsies tend to alter management plans for patients. A restructuring of the national coding system for CUP would better serve patients if it were to differentiate between those who are unfit for investigations and true CUP patients. Finally, involving Haematology and Lung specialists in the CUP MDT may more efficiently identify those referred patients with site-specific cancers.
2018-01-23T14:21:48Z
2018-01-23T14:21:48Z
2017-11
Article
European Journal of Surgical Oncology; Nov 2017; vol. 43 (no. 11); p. 2223
http://hdl.handle.net/20.500.12904/239
en
oai:eastmid.openrepository.com:20.500.12904/2402021-06-03T09:41:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Survival Advantage with Total Intravenous Anesthesia in Cancer Surgery: Is This Confounded by Cancer Type and Stage?
Doleman, Brett
Lund, Jonathan
Williams, John P
Anaesthesia
Cancer Surgery
Author(s) Pre Print Version Only. 12 month embargo on Post Print
2018-01-04T15:12:58Z
2018-01-04T15:12:58Z
2016-08
Article
Anesthesiology. 2016 Aug;125(2):417. doi: 10.1097/ALN.0000000000001173.
http://hdl.handle.net/20.500.12904/240
en
oai:eastmid.openrepository.com:20.500.12904/2412021-06-03T09:41:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
'Real-world' experience of colonic stents for obstructive colon cancer-feasible and safe with low morbidity and mortality
Liptrot, S
Singh, Rajeev
Tou, Samson
Self Expanding Metallic Stent
SEMS
Surgery
Author(s) Pre Print Version Only. 12 Month Embargo on Post Print. No PDF
Aim: To define the 'real-world' incidence of technical and clinical success, morbidity and mortality in consecutive patients undergoing self-expanding metallic stent (SEMS) implantation for obstructive colonic cancer. Method: Retrospective review of 163 patients undergoing SEMS at two centres (Royal Derby Hospital, UK and Chesterfield Royal Hospital, UK) between 2008 and 2016 cross-referenced with electronic databases for accuracy. Results: 163 patients received a total of 188 SEMS over a 99 month. The mean age was 72 (range 26-102). 82 (49.5%) presented with features of acute or sub-acute obstruction, 37 (22.7%) as a surgical emergency, 8 (5%) with fistulating tumors and 12 (7.4%) received SEMS as a bridge to semi-elective curative surgery. There were high rates of technical and clinical success (89% and 88% respectively) with a low overall incidence of complications (3.2%). Major complications included 2 (1.1%) early (<1 month) stent migrations, 4 (2.1%) perforations (day 0, 5 and 12) but no significant haemorrhage. Overall major complication rate of 6/188 (3.2%). Delayed stent migration (>1 month) occurred in 2 patient. Overall 10 procedures (6.1%) were abandoned for various reasons including that the lesion could not be crossed. Information on overall 30 day mortality (1/96, 1.04%) was available at Royal Derby Hospital. Conclusion: In this large 'real-world' case series SEMS was technically feasible with high levels of technical and clinical success and low 30-day morbidity and mortality. These results support the positive findings of randomised trials and the use of SEMS for palliation and in selected patients prior to staged surgical resection.
2018-01-23T14:25:39Z
2018-01-23T14:25:39Z
2017-10
Article
Colorectal Disease; Oct 2017; vol. 19 ; p. 33
http://hdl.handle.net/20.500.12904/241
en
oai:eastmid.openrepository.com:20.500.12904/2422021-06-03T09:41:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Risk of colon cancer after acute uncomplicated diverticulitis: Is routine colonoscopy necessary?
Liptrot, S
Al Chalabi, Hasan
Colon Cancer
Colonoscopy
Author(s) Pre Print Version Only. 12 Month Embargo on Post Print. No PDF
Background & Aims: It has long been recommended that patients undergo follow up colonoscopy to exclude colon cancer after an episode of acute diverticulitis. The role of colonoscopy following an episode of acute uncomplicated diverticulitis remains controversial. Our aim was to evaluate the need for colonoscopy after an episode of acute uncomplicated diverticulitis, diagnosed both clinically and by Computed tomography scan (CT). Methodology: We performed a retrospective case review of patients with first presentation of acute uncomplicated diverticulitis over a six year period at two centres: Royal Derby Hospital, Derby, UK; and St. James's University Hospital, Ireland Results: A total of 5461 were admitted with a primary diagnosis of acute diverticulitis In 110 patients (2.29%) a histological diagnosis of colonic malignancy was made. The yield of colonic neoplasia at any stage in our study was equivalent to that detected by screening programmes in asymptomatic individuals among an international standards (0.8-1.1%) and comparable to the estimated prevalence of 1.4% among adults older than 65 years Conclusion: The incidence of colorectal cancer in patients presenting with acute diverticulitis was low at 2.29%. Unless colonoscopy is part of a screening programme routine colonoscopy following an episode of CT-diagnosed acute uncomplicated diverticulitis is unnecessary in the absence of other alarming clinical signs of colorectal cancer. We suggest that this group of patients may suitable for protocolized symptom-driven follow-up shared with primary care.
2018-01-23T14:28:24Z
2018-01-23T14:28:24Z
2017-10
Article
Colorectal Disease; Oct 2017; vol. 19 ; p. 14-15
http://hdl.handle.net/20.500.12904/242
en
oai:eastmid.openrepository.com:20.500.12904/2432021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres.
Walker, GA
Keni, Manjusha
CHART
Continuous Hyperfractionated Accelerated Radiotherapy
NSCLC
Non Small Cell Lung Cancer
Author(s) Pre or Post Print Version Only
AIM: Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS: UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS: In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION: In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.
2018-01-23T13:30:23Z
2018-01-23T13:30:23Z
2018-01
Article
Clin Oncol (R Coll Radiol). 2018 Jan 11. pii: S0936-6555(17)30541-1. doi: 10.1016/j.clon.2017.12.019. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/243
en
oai:eastmid.openrepository.com:20.500.12904/2442021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Faecal occult blood testing (FOBT) and interval bowel cancers-results of a multicentre study
George, Anil Thomas
Cancer
Demographics
Author(s) Pre or Post Print Version Only
Introduction We aimed to assess the incidence and demographics of interval cancers (cancers diagnosed within 2 years of a negative FOBT screening) in the eligible population of the East Midlands region. Method The National Bowel Cancer Audit Programme data from three centres (Queens Medical Centre, Nottingham; Royal Derby Hospital and Sherwood Forest Hospitals) for all colorectal cancers in the screening age group (60-74 years)over a 2- year period (August 2011-August 2013) were linked for their FOBT screening status (BCSP database/Eastern Hub). Three cancer groups were identified: interval cancers, screen detected (positive FOBT) and those in the non-uptake group (eligible patients who declined screening). Tumours at and distal to the splenic flexure were classed as left sided tumours. Dukes C and D tumours were classed as advanced tumours. All three centres were in incident rounds of screening. Results Of the 521 colorectal cancers identified, 128 (25%) were interval cancers, 162(31%) were screen detected and 231 (44%) were from the non-uptake group. Gender, ethnicity and Deprivation index were comparable between the three groups. The mean age in the interval cancer group was greater (67 yrs) compared to the screen detected (66 yrs) (p = 0.005). The interval cancer group had a higher incidence of right sided cancers (38% vs. 25% and 29%; X2=6.59; p = 0.033) compared to the screen-detected and non-uptake groups. Cancers detected in the interval cancer group were of a more advanced stage (Dukes C/D) (70% vs. 34% and 54%; X2=37.2;p < 0.005) in comparison to screen-detected and non-uptake groups. The one year mortality in the interval cancer group (16%) was higher than the non-uptake group (12%) and the screen detected group (3%) (16%vs12% and 3%; X2=13.8;p < 0.005). Conclusion A quarter of colorectal cancers identified in our screening-eligible population were interval cancers. We highlight the probability that these cancers were 'missed' by the guaiacbased FOBT screening tests. The interval cancer group also had poorer outcomes when compared to the screen-detected group. We highlight the need for a test with a lower false negative rate for population based FOBT screening.
2018-01-24T15:02:36Z
2018-01-24T15:02:36Z
2015-06
Article
Gut; Jun 2015; vol. 64
http://hdl.handle.net/20.500.12904/244
en
oai:eastmid.openrepository.com:20.500.12904/2452021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Lymphedema Research Prioritization Partnership: A Collaborative Approach to Setting Research Priorities for Lymphedema Management.
Keeley, Vaughan
Riches, Katie
Patient and Public Involvement
Research Prioritisation
Lymphedema
Author(s) Pre or Post Print Version Only
BACKGROUND: More research is needed in lymphedema management to strengthen the evidence base and ensure patients receive clinically and cost-effective treatment. It is critical that patients and clinicians are involved in prioritizing research to ensure that it reflects their needs and is not biased by commercial interests. This study aimed to set the research priorities for lymphedema management in the United Kingdom, through collaboration with patients, carers, and clinicians. METHODS AND RESULTS: Following the James Lind Alliance's methodology, a national survey was conducted to identify unanswered questions about lymphedema management from the perspective of patients, carers, and clinicians. These were collated and verified against an in-depth evidence review. Unanswered questions were formatted into broad research questions, which were prioritized by a purposive sample of patients, carers, and clinicians, using an online Delphi survey. The initial survey generated 631 submissions from 213 participants, including 108 patients, 9 carers, and 88 clinicians. Of these, 485 met inclusion criteria and were grouped into 12 overarching themes. The evidence review demonstrated that 101 submissions were answered by existing research and identified an additional 78 questions. The remaining unanswered submissions were collated into 126 broad research questions, which were prioritized over four rounds of the Delphi survey to produce the top 10 priorities. CONCLUSIONS: This study is the first to attempt to systematically identify research priorities for lymphedema management in the United Kingdom, from the perspective of patients, carers, and clinicians. The results provide guidance for researchers and funders to ensure future research meets the needs of those living with lymphedema.
2018-11-13T15:29:13Z
2018-11-13T15:29:13Z
2018-10
Article
Lymphat Res Biol. 2019 Jun;17(3):356-361. doi: 10.1089/lrb.2018.0026. Epub 2018 Oct 24.
http://hdl.handle.net/20.500.12904/245
en
oai:eastmid.openrepository.com:20.500.12904/2462021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol.
Chakraborti, Prabir
Abiraterone Acetate
Prednisolone
Docetaxel
Author(s) Pre Print Version Only. 12 Month Embargo on Post Print. No PDF
Background: Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in STAMPEDE: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC+AAP vs SOC+DocP. Method: Recruitment to SOC+DocP and SOC+AAP overlapped Nov-2011─Mar-2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2yrs and RT to the primary tumour. Stratified randomisation allocated pts 2:1:2 to SOC; SOC+docetaxel 75mg/m2 3-weekly x6 + prednisolone 10mg daily; or SOC+abiraterone acetate 1000mg + prednisolone 5mg daily. AAP duration depended on stage & intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards & flexible parametric models, adjusted for stratification factors. This was not a formally-powered comparison. A hazard ratio (HR)<1 favours SOC+AAP, HR > 1 favours SOC+DocP. Results: 566 consenting patients were contemporaneously randomised: 189 SOC+DocP, 377 SOC+AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66yr & median PSA 56ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1·16 (95%CI 0·82-1·65); failure-free survival HR = 0·51 (95%CI 0·39-0·67); progression-free survival HR = 0·65 (95%CI 0·48-0·88); metastasis-free survival HR = 0·77 (95%CI 0·57-1·03); prostate cancer-specific survival HR = 1·02 (0·70-1·49); and symptomatic skeletal events HR = 0·83 (95%CI 0·55-1·25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC+DocP, & 40%, 7% and 1% SOC+AAP; prevalence 11% at 1 and 2yrs on both arms. Relapse treatment patterns varied by arm. Conclusions: This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer (HNPC) showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events, suggesting that Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration: Clinicaltrials.gov: NCT00268476.
2018-03-20T15:42:33Z
2018-03-20T15:42:33Z
2018-02
Article
Ann Oncol. 2018 Feb 26. doi: 10.1093/annonc/mdy072.
http://hdl.handle.net/20.500.12904/246
en
oai:eastmid.openrepository.com:20.500.12904/2472021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer.
Leeder, Paul
Evaluation Methodology
Health Services Research
Healthcare Quality Improvement
Performance Measures
Statistics
Background: Cancer survival in the UK has doubled in the last 40 years; however, 1-year and 5-year survival rates are still lower than other countries. One cause may be a delay between referral into secondary care and subsequent investigation. We set out to evaluate the impact of a straight to test pathway (STTP) on time to diagnosis for upper gastrointestinal (UGI) cancer. Methods: Six hospital Trusts across the East Midlands Clinical Network introduced a STTP enabling general practitioners to refer patients with suspected UGI cancer (oesophageal/gastric) for immediate investigation, without the need to see a hospital specialist first. Data were collected for all patients referred between 2013 and 2015 with suspected UGI cancer and stratified by STTP or traditional referral pathway. Overall time from referral to diagnosis was compared. Data from two Trusts who did not implement STTP acted as control. Results: 340 patients followed the STTP pathway and 495 followed the traditional route. STTP saved a mean of 7 days from referral to treatment (with a 95% CI of 3 to 11 days, p<0.008) and a mean of 16 days from referral to diagnosis, when compared with a traditional referral pathway. The number of diagnostic tests performed using STTP or traditional referral pathways were similar. Conclusion: A STTP is associated with an overall reduction of 1 week from referral to treatment for UGI cancer. The approach is feasible and did not require more resource. Larger studies are required to assess whether this time saving translates into improved cancer outcomes.
2018-08-20T11:12:04Z
2018-08-20T11:12:04Z
2018-07
Article
BMJ Open Qual. 2018 Jul 21;7(3):e000328. doi: 10.1136/bmjoq-2018-000328. eCollection 2018.
http://hdl.handle.net/20.500.12904/247
en
oai:eastmid.openrepository.com:20.500.12904/2482021-06-03T09:41:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit.
Beckett, Paul
Lung Cancer
Nurse Specialist
Workload
Author(s) Pre or Post Print Version Only
PURPOSE: Health services across the world utilise advanced practice in cancer care. In the UK, lung cancer nurse specialists (LCNS) are recognised as key components of quality care in national guidelines, yet access to LCNS contact is unequal and some responsibilities are reportedly left undone. We assess whether any variation in working practices of LCNS is attributable to factors of the lung cancer service at the hospital trust. METHOD: Nationwide workload analysis of LCNS working practices in England, linked at trust level to patient data from the National Lung Cancer Audit. Chi-squared tests were performed to assess whether patient contact, workload, involvement in multidisciplinary teams (MDT), and provision of key interventions were related to 1) the trust's lung cancer service size, 2) LCNS caseload, 3) anti-cancer treatment facilities and 4) lung cancer patient survival. RESULTS: Unpaid overtime was substantial for over 60% of nurses and not associated with particular service factors assessed; lack of administrative support was associated with large caseloads and chemotherapy facilities. LCNS at trusts with no specialty were more likely to challenge all MDT members (80%) compared with those at surgical (53%) or chemotherapy (58%) trusts. The most frequent specialist nursing intervention to not be routinely offered was proactive case management. CONCLUSION: Working practices of LCNS vary according to service factors, most frequently associated with trust anti-cancer treatment facilities. High workload pressures and limited ability to provide key interventions should be addressed across all services to ensure patients have access to recommended standards of care.
2018-10-22T10:58:04Z
2018-10-22T10:58:04Z
2018-10
Article
Eur J Oncol Nurs. 2018 Oct;36:103-111. doi: 10.1016/j.ejon.2018.07.006. Epub 2018 Sep 6.
http://hdl.handle.net/20.500.12904/248
en
oai:eastmid.openrepository.com:20.500.12904/2492021-06-03T09:41:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
The Prognosis in Palliative care Study II (PiPS2): study protocol for a multi-centre, prospective, observational, cohort study.
Keeley, Vaughan
Cancer
Observational Study
Palliative Care
Prognosis
BACKGROUND: More accurate methods of prognostication are likely to lead to improvements in the quality of care of patients approaching the ends of their lives. The Prognosis in Palliative care Scales (PiPS) are prognostic models of survival. The scores are calculated using simple clinical data and observations. There are two separate PiPS models; PiPS-A for patients without blood test results and PiPS-B for patients with blood test results. Both models predict whether a patient is likely to live for "days", "weeks" or "months" and have been shown to perform as well as clinicians' estimates of survival. PiPS-B has also been found to be significantly better than doctors' estimates of survival. We report here a protocol for the validation of PiPS and for the evaluation of the accuracy of other prognostic tools in a new, larger cohort of patients with advanced cancer. METHODS: This is a national, multi-centre, prospective, observational cohort study, aiming to recruit 1778 patients via palliative care services across England and Wales. Eligible patients have advanced, incurable cancer and have recently been referred to palliative care services. Patients with or without capacity are included in the study. The primary outcome is the accuracy of PiPS predictions and the difference in accuracy between these predictions and the clinicians' estimates of survival; with PiPS-B being the main model of interest. The secondary outcomes include the accuracy of predictions by the Palliative Prognostic Index (PPI), Palliative Performance Scale (PPS), Palliative Prognostic score (PaP) and the Feliu Prognostic Nomogram (FPN) compared with actual patient survival and clinicians' estimates of survival. A nested qualitative sub-study using face-to-face interviews with patients, carers and clinicians is also being undertaken to assess the acceptability of the prognostic models and to identify barriers and facilitators to clinical use. DISCUSSION: The study closed to recruitment at the end of April 2018 having exceeded the required sample size of 1778 patients. The qualitative sub-study is nearing completion. This demonstrates the feasibility of recruiting large numbers of participants to a prospective palliative care study. TRIAL REGISTRATION: ISRCTN13688211 (registration date: 28/06/2016).
2018-08-20T11:00:59Z
2018-08-20T11:00:59Z
2018-08
Article
BMC Palliat Care. 2018 Aug 13;17(1):101. doi: 10.1186/s12904-018-0352-y.
http://hdl.handle.net/20.500.12904/249
en
oai:eastmid.openrepository.com:20.500.12904/2502021-06-03T09:41:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Carcinoma of Unknown Primary (CUP) in a patient presenting with lower back pain: An Important Clinical Lesson
Hind, Jamie
Sidhu, Gur Aziz
Powell, Chris
Lacon, Andrew
Ashwood, Neil
Carcinoma
Tumour
Computerised Tomography
Carcinoma of unknown primary (CUP) is associated with high rates of morbidity and mortality. We report a case of a 33-year-old female, diagnosed with CUP, after presenting with gradual onset worsening lower back pain. Immunohistochemistry, blood tests, further investigations, and Multidisciplinary team meetings failed to identify the primary malignancy. This is not an uncommon pathway for patients with CUP. This report highlights how CUP can affect the quality of life of patients and how management for CUP should be focused on enhancing Quality of Life (QOL). It also addresses the difficulty of identifying which group of patients may benefit from further investigations to identify the primary and thus receive target treatment therapy.
2020-09-28T12:01:37Z
2020-09-28T12:01:37Z
2020-09
Article
Hind J, Sidhu GA, Powell C, et al. (2020) Carcinoma of Unknown Primary (CUP) in Female Presenting with Lower Back Pain: An Important Clinical Lesson. Onco Tum Res 1(1): pp. 1-3.
http://hdl.handle.net/20.500.12904/250
en
oai:eastmid.openrepository.com:20.500.12904/2512021-06-03T09:41:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
6 versus 12 months of adjuvant trastuzumab for HER2-positive early breast cancer (PERSEPHONE): 4-year disease-free survival results of a randomised phase 3 non-inferiority trial.
Woodings, P
Adjuvant Trastuzumab
Breast Cancer
Author(s) Pre or Post Print Version
BACKGROUND: Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the standard 12-month treatment regarding disease-free survival. METHODS: This study is an open-label, randomised phase 3 non-inferiority trial. Patients were recruited from 152 centres in the UK. We randomly assigned patients with HER2-positive early breast cancer, aged 18 years or older, and with a clear indication for chemotherapy, by a computerised minimisation process (1:1), to receive either 6-month or 12-month trastuzumab delivered every 3 weeks intravenously (loading dose of 8 mg/kg followed by maintenance doses of 6 mg/kg)
or subcutaneously (600 mg), given in combination with chemotherapy (concurrently
or sequentially). The primary endpoint was disease-free survival, analysed by intention to treat, with a non-inferiority margin of 3% for 4-year disease-free survival. Safety was analysed in all patients who received trastuzumab. This trial is registered with EudraCT (number 2006-007018-39), ISRCTN (number 52968807), and ClinicalTrials.gov (number NCT00712140). FINDINGS: Between Oct 4, 2007, and July 31, 2015, 2045 patients were assigned to 12-month trastuzumab treatment and 2044 to 6-month treatment (one patient was excluded because they were double randomised). Median follow-up was 5·4 years (IQR 3·6-6·7) for both treatment groups, during which a disease-free survival event occurred in 265 (13%) of 2043 patients in the 6-month group and 247 (12%) of 2045 patients in the 12-month group. 4-year disease-free survival was 89·4% (95% CI 87·9-90·7) in the 6-month group and 89·8% (88·3-91·1) in the 12-month group (hazard ratio 1·07 [90% CI 0·93-1·24], non-inferiority p=0·011), showing non-inferiority of the 6-month treatment. 6-month trastuzumab treatment resulted in fewer patients reporting severe adverse events (373 [19%] of 1939 patients vs 459 [24%] of 1894 patients, p=0·0002) or stopping early because of cardiotoxicity (61 [3%] of 1939 patients vs 146 [8%] of 1894 patients, p<0·0001). INTERPRETATION: We have shown that 6-month trastuzumab treatment is non-inferior to 12-month treatment in patients with HER2-positive early breast cancer, with less cardiotoxicity and fewer severe adverse events. These results support consideration of reduced duration trastuzumab for women at similar risk of recurrence as to those included in the trial. FUNDING: UK National Institute for Health Research, Health Technology Assessment Programme.
2019-07-17T16:10:07Z
2019-07-17T16:10:07Z
2019-06
Article
Lancet. 2019 Jun 6. pii: S0140-6736(19)30650-6. doi: 10.1016/S0140-6736(19)30650-6. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/251
en
oai:eastmid.openrepository.com:20.500.12904/2522021-06-03T09:41:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
TRAPEZE: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of chemotherapy with zoledronic acid, strontium-89, or both, in men with bony metastatic castration-refractory prostate cancer.
Chakraborti, Prabir
Prostate Cancer
BACKGROUND: Bony metastatic castration-refractory prostate cancer is associated with a poor prognosis and high morbidity. TRAPEZE was a two-by-two factorial randomised controlled trial of zoledronic acid (ZA) and strontium-89 (Sr-89), each combined with docetaxel. All have palliative benefits, are used to control bone symptoms and are used with docetaxel to prolong survival. ZA, approved on the basis of reducing skeletal-related events (SREs), is commonly combined with docetaxel in practice, although evidence of efficacy and cost-effectiveness is lacking. Sr-89, approved for controlling metastatic pain and reducing need for subsequent bone treatments, is generally palliatively used in patients unfit for chemotherapy. Phase II analysis confirmed the safety and feasibility of combining these agents. TRAPEZE aimed to determine the clinical effectiveness and cost-effectiveness of each agent. METHODS: Patients were randomised to receive six cycles of docetaxel plus prednisolone: alone, with ZA, with a single Sr-89 dose after cycle 6, or with both. Primary outcomes were clinical progression-free survival (CPFS: time to pain progression, SRE or death) and cost-effectiveness. Secondary outcomes were SRE-free interval (SREFI), total SREs, overall survival (OS) and quality of life (QoL). Log-rank test and Cox regression modelling were used to determine clinical effectiveness. Cost-effectiveness was assessed from the NHS perspective and expressed as cost per additional quality-adjusted life-year (QALY). An additional analysis was carried out for ZA to reflect the availability of generic ZA. RESULTS: PATIENTS: 757 randomised (median age 68.7 years; Eastern Cooperative Oncology Group scale score 0, 40%; 1, 52%; 2, 8%; prior radiotherapy, 45%); median prostate-specific antigen 143.78 ng/ml (interquartile range 50.8-353.9 ng/ml). Stratified log-rank analysis of CPFS was statistically non-significant for either agent (Sr-89, p = 0.11; ZA, p = 0.45). Cox regression analysis adjusted for stratification variables showed CPFS benefit for Sr-89 [hazard ratio (HR) 0.845, 95% confidence interval (CI) 0.72 to 0.99; p = 0.036] and confirmed no effect of ZA (p = 0.46). ZA showed a significant SREFI effect (HR 0.76; 95% CI 0.63 to 0.93; p = 0.008). Neither agent affected OS (Sr-89, p = 0.74; ZA, p = 0.91), but both increased total cost (vs. no ZA and no Sr-89, respectively); decreased post-trial therapies partly offset costs [net difference: Sr-89 £1341; proprietary ZA (Zometa(®), East Hanover, NJ, USA) £1319; generic ZA £251]. QoL was maintained in all trial arms; Sr-89 (0.08 additional QALYs) and ZA (0.03 additional QALYs) showed slight improvements. The resulting incremental cost-effectiveness ratio (ICER) for Sr-89 was £16,590, with £42,047 per QALY for Zometa and £8005 per QALY for generic ZA. CONCLUSION: Strontium-89 improved CPFS, but not OS. ZA did not improve CPFS or OS but significantly improved SREFI, mostly post progression, suggesting a role as post-chemotherapy maintenance therapy. QoL was well maintained in all treatment arms, with differing patterns of care resulting from the effects of Sr-89 on time to progression and ZA on SREFI and total SREs. The addition of Sr-89 resulted in additional cost and a small positive increase in QALYs, with an ICER below the £20,000 ceiling per QALY. The additional costs and small positive QALY changes in favour of ZA resulted in ICERs of £42,047 (Zometa) and £8005 for the generic alternative; thus, generic ZA represents a cost-effective option. Additional analyses on the basis of data from the Hospital Episode Statistics data set would allow corroborating the findings of this study. Further research into the use of ZA (and other bone-targeting therapies) with newer prostate cancer therapies would be desirable. STUDY REGISTRATION: Current Controlled Trials ISRCTN12808747. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 53. See the NIHR Journals Library website for further project information.
2016-08-16T14:29:20Z
2016-08-16T14:29:20Z
2016-07
Article
Health Technology Assessment. 2016 Jul;20(53):1-288. doi: 10.3310/hta20530.
http://hdl.handle.net/20.500.12904/252
en
oai:eastmid.openrepository.com:20.500.12904/2532021-06-03T09:41:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Impact of a CUP service at the Royal Derby Hospital - One year on
Warren, Rebecca
Raworth, Alison
Shankland, Catherine
Cancer
Cancer of Unknown Primary
Poster
Author(s) pre or post print version only
Background: 9600 UK patients are diagnosed with Cancer of Unknown Primary (CUP) each year. CUP represents 3-5% of all malignancies. Studies showthe diagnostic pathway to be lengthy, fractured between specialities, and that patients find it a difficult diagnosis to accept. In 2010 National Institute of Health & Clinical Excellence (NICE) issued guidelines recommending a Multidisciplinary Team (MDT) approach to managing patients with CUP. In 2013 Royal Derby Hospital (RDH), serving 600,000 people, launched a CUP MDT led by a Consultant Oncologist and two Specialist Nurses. Method: Utilising an in-house database of patients referred to CUP MDT, data for May 2014-15 was extracted, analysed and compared with data audited from May 2013-14. Results: 119 patients were referred to CUP MDT in May 2014-15. 74% of patients were seen by a member of CUP MDT. 56 (47.1%) were eventually diagnosed with CUP, 50 (42%) had a primary cancer site identified and 13 (10.9%) did not have cancer. Mean age was 72.2 years with minimal gender variation. Mean survival was 62 days with patients who died before registration, and 71 days without that data set. There were substantial reductions in number of MDT discussions per patient. 13 (10.9%) patients had Positron Emission Tomography (PET) scans. 58 (48.7%) patients solely received best supportive care. Conclusion: Average age, gender, life expectancy, and cancer subtypes reflect national trends. Primary site identification, investigations and treatment show alignment with national guidelines. Reduction in number of MDT discussions is encouraging as it improves patient experience, as do Palliative Medicine and Specialist Nurse input. RDH CUP MDT has demonstrated improvements in speed and accuracy of diagnosis in a well co-ordinated approach to care. A recommendation would be to participate in future gene expression profiling trials, when available, to optimise diagnostic accuracy, treatment options and survival.
2017-01-04T09:08:35Z
2017-01-04T09:08:35Z
2016-11
Poster
European Journal of Surgical Oncology, November 2016, vol./is. 42/11(S224), 1532-2157 (November 2016)
http://hdl.handle.net/20.500.12904/253
en
oai:eastmid.openrepository.com:20.500.12904/2542021-06-03T09:41:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Clinical Outcomes and Survival Following Treatment of Metastatic Castrate-Refractory Prostate Cancer With Docetaxel Alone or With Strontium-89, Zoledronic Acid, or Both: The TRAPEZE Randomized Clinical Trial.
Chakraborti, Prabir
Prostate Cancer
Zoledronic Acid
SR89
Not Supported
IMPORTANCE: Bony metastatic castrate-refractory prostate cancer (CRPC) has a poor prognosis and high morbidity. Zoledronic acid (ZA) is commonly combined with docetaxel in practice but lacks evidence that combining is effective, and strontium-89 (Sr89) is generally used palliatively in patients unfit for chemotherapy. Phase 2 analysis of the TRAPEZE trial confirmed combining the agents was safe and feasible, and the objectives of phase 3 include assessment of the treatments on survival. OBJECTIVE: To determine clinical effectiveness and cost-effectiveness of combining docetaxel, ZA, and Sr89, all having palliative benefits and used in bony metastatic CRPC to control bone symptoms and, for docetaxel, to prolong survival. DESIGN, SETTING, AND PARTICIPANTS: The TRAPEZE trial is a 2 × 2 factorial trial comparing docetaxel alone or with ZA, Sr89, or both. A cohort of 757 participants were recruited between February 2005 and February 2012 from hospitals in the United Kingdom. Overall, 169 participants (45%) had received palliative radiotherapy, and the median (IQR) prostate-specific antigen level was 146 (51-354). Follow-ups were performed for at least 12 months. INTERVENTIONS: Up to 10 cycles of docetaxel alone; docetaxel with ZA; docetaxel with a single Sr89 dose after 6 cycles; or docetaxel with both ZA and Sr89. MAIN OUTCOMES AND MEASURES: Primary outcomes included clinical progression-free survival (CPFS) (pain progression, skeletal-related events [SREs], or death) and cost-effectiveness. Secondary outcomes included SRE-free interval, pain progression-free interval, total SREs, and overall survival (OS). RESULTS: Overall, of 757 participants, 349 (46%) completed docetaxel treatment. Median (IQR) age was 68 (63-73) years. Clinical progression-free survival did not reach statistical significance for either Sr89 or ZA. Cox regression analysis adjusted for all stratification variables showed benefit of Sr89 on CPFS (hazard ratio [HR], 0.85; 95% CI, 0.73-0.99; P = .03) and confirmed no effect of ZA (HR, 0.98; 95% CI, 0.85-1.14; P = .81); ZA had a significant effect on SRE-free interval (HR, 0.78; 95% CI, 0.65-0.95; P = .01). For OS, there was no effect of either Sr89 (HR, 0.92; 95% CI, 0.79-1.08; P = 0.34) or ZA (HR, 0.99; 95% CI, 0.84-1.16; P = 0.91). CONCLUSIONS AND RELEVANCE: Strontium-89 combined with docetaxel improved CPFS but did not improve OS, SRE-free interval, or total SREs; ZA did not improve CPFS or OS but did significantly improve median SRE-free interval and reduced total SREs by around one-third, suggesting a role as postchemotherapy maintenance therapy. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN12808747.
2016-08-23T15:49:30Z
2016-08-23T15:49:30Z
2016-04
Article
JAMA Oncol. 2016 Apr 1;2(4):493-9. doi: 10.1001/jamaoncol.2015.5570.
http://hdl.handle.net/20.500.12904/254
en
oai:eastmid.openrepository.com:20.500.12904/2552021-07-19T08:50:51Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Indolent CD8-positive lymphoid proliferation of acral sites: three further cases of a rare entity and an update on a unique patient.
Persic, Mojca
CD8
Acral
Indolent
Lymphoid Proliferation
Lymphoma
Author(s) Pre Print Only
BACKGROUND: Primary cutaneous indolent CD8-positive lymphoid proliferation is an emerging entity characterized by slowly enlarging papules and nodules that are pathologically comprised of clonal nonepidermotropic medium-sized atypical CD8(+) T-cells. Although the majority of lesions are solitary and located on the ears,v bilateral symmetrical presentations have been described and lesions may arise at other peripheral or 'acral' sites. Patients follow a benign clinical course and systemic involvement has not yet been observed. Despite this, some medical practitioners classify such lesions as peripheral T-cell lymphoma, NOS, a category implying aggressive disease. OBJECTIVES: We present three cases seen in our institutions and provide an update on a previously reported unique patient who continues to develop recurrent and multifocal skin lesions. RESULTS: Systemic disease progression has not been observed, even in the presence of recurrent and multifocal cutaneous disease. CONCLUSIONS: Indolent CD8-positive lymphoid proliferation of acral sites is a distinctive and readily identifiable entity and should be included in the next consensus revision of cutaneous lymphoma classification. Although cases described thus far have followed an indolent clinical course, dermatologists should remain guarded about the prognosis and full staging and longitudinal observation are recommended until this condition is better understood
2016-08-24T12:47:39Z
2016-08-24T12:47:39Z
2016-02
Article
J Cutan Pathol. 2016 Feb;43(2):125-36. doi: 10.1111/cup.12633. Epub 2015 Nov 13.
http://hdl.handle.net/20.500.12904/255
en
oai:eastmid.openrepository.com:20.500.12904/2562021-06-03T09:41:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Update and audit of the St George's classification algorithm of primary lymphatic anomalies: a clinical and molecular approach to diagnosis.
Keeley, Vaughan
Riches, Katie
Central Conducting Lymphatic Anomaly (CCLA)
Generalised Lymphatic Anomalies (GLA)
Lymphatic
Primary Lymphoedema
Primary lymphatic anomalies may present in a myriad of ways and are highly heterogenous. Careful consideration of the presentation can lead to an accurate clinical and/or molecular diagnosis which will assist with management. The most common presentation is lymphoedema, swelling resulting from failure of the peripheral lymphatic system. However, there may be internal lymphatic dysfunction, for example, chylous reflux, or lymphatic malformations, including the thorax or abdomen. A number of causal germline or postzygotic gene mutations have been discovered. Some through careful phenotyping and categorisation of the patients based on the St George's classification pathway/algorithm. The St George's classification algorithm is aimed at providing an accurate diagnosis for patients with lymphoedema based on age of onset, areas affected by swelling and associated clinical features. This has enabled the identification of new causative genes. This update brings the classification of primary lymphatic disorders in line with the International Society for the Study of Vascular Anomalies 2018 classification for vascular anomalies. The St George's algorithm considers combined vascular malformations and primary lymphatic anomalies. It divides the types of primary lymphatic anomalies into lymphatic malformations and primary lymphoedema. It further divides the primary lymphoedema into syndromic, generalised lymphatic dysplasia with internal/systemic involvement, congenital-onset lymphoedema and late-onset lymphoedema. An audit and update of the algorithm has revealed where new genes have been discovered and that a molecular diagnosis was possible in 26% of all patients overall and 41% of those tested.
2020-07-17T11:19:19Z
2020-07-17T11:19:19Z
2020-05
Article
J Med Genet. 2020 May 14. pii: jmedgenet-2019-106084. doi: 10.1136/jmedgenet-2019-106084. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/256
en
oai:eastmid.openrepository.com:20.500.12904/2572021-06-03T09:41:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Occult breast carcinoma in breast reduction specimens in European women.
Goyal, Amit
Breast Reduction
Breast Cancer
Mammography
Reduction Mammoplasty
Screening
Author(s) Pre Print and Post Print Only
Breast reduction is a common surgical procedure performed by plastic and oncoplastic breast surgeons. The authors report on the incidence and management of cancer and atypical hyperplasia in breast reduction specimens from one institution over a 10-year period. All patients who underwent breast reduction surgery at Northern General Hospital, Sheffield were identified from an electronic prospective database. The histopathology reports were analyzed. Case records of all patients with significant abnormalities were retrieved and examined to identify their management and follow-up. Between October 1999 and April 2010, 1,588 patients underwent breast reduction. Nine specimens showed atypical hyperplasia (0.57%). Five cancers were detected (0.31%). Four of the five patients had normal screening mammograms 1-3 years before the reduction operation. Of these cancers, four were invasive (three lobular, one ductal) (0.25%) and one was DCIS (0.06%). A lump was felt macroscopically by the pathologist in two of the four patients with invasive cancer. The patients with DCIS did not undergo further surgery, whereas those with invasive disease underwent mastectomy (three patients) and axillary nodal staging (four patients). None of the patients with normal post-reduction breast imaging had residual cancer on histology. The incidence of occult carcinoma in breast reduction specimens is low. Patients should be counseled with regards to the possible consequences preoperatively.
2016-10-19T16:02:40Z
2016-10-19T16:02:40Z
2011-08
Article
Breast Cancer Res Treat. 2011 Aug;128(3):749-53. doi: 10.1007/s10549-011-1589-9. Epub 2011 May 28.
http://hdl.handle.net/20.500.12904/257
en
oai:eastmid.openrepository.com:20.500.12904/2582021-06-03T09:41:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Systematic review of pre-operative exercise in colorectal cancer patients.
Boereboom, CL
Doleman, Brett
Lund, Jonathan
Williams, John P
Colorectal Cancer
Exercise
Mortality
Author(s) Pre or Post Print Version Only
The aim of this systematic review was to evaluate the evidence for exercise interventions prior to surgery for colorectal cancer resection. The evidence for use of exercise to improve physical fitness and surgical outcomes is as yet unknown. A systematic search was performed of MEDLINE, EMBASE, CINAHL, AMED and BNI databases for studies involving pre-operative exercise in colorectal cancer patients. Eight studies were included in the review. There is evidence that pre-operative exercise improves functional fitness, and to a lesser extent objectively measurable cardio-respiratory fitness prior to colorectal cancer resection. There is no clear evidence at present that this improvement in fitness translates into reduced peri-operative risk or improved post-operative outcomes. Current studies are limited by risk of bias. This review highlights the common difficulty in transferring promising results in a research setting, into significant improvements in the clinical arena. Future research should focus on which type of exercise is most likely to maximise patient adherence and improvements in cardio-respiratory fitness. Ultimately, adequately powered, randomised controlled trials are needed to investigate whether pre-operative exercise improves post-operative morbidity and mortality.
2016-10-18T10:04:27Z
2016-10-18T10:04:27Z
2016-02
Article
Tech Coloproctol. 2016 Feb;20(2):81-9. doi: 10.1007/s10151-015-1407-1. Epub 2015 Nov 27.
http://hdl.handle.net/20.500.12904/258
en
oai:eastmid.openrepository.com:20.500.12904/2592021-06-03T09:41:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
A preliminary randomized controlled study to determine the application frequency of a new lymphoedema bandaging system.
Moffatt, Christine
Lymphedema
Bandaging
Safety
Author(s) Pre or Post Version Only
BACKGROUND: Bandaging plays an important role in the treatment of lymphoedema. OBJECTIVE: To investigate efficacy and safety of the 3M™ Coban™ 2 compression system (Coban 2 system) with different application frequencies in comparison to short-stretch bandaging. METHODS: A multicentre, randomized, prospective study was performed with 82 patients suffering from arm or leg lymphoedema stage II or late stage II. Patients were allocated to traditional short-stretch bandaging five times per week or to the Coban 2 system applied two, three or five times per week for 19 days. Limb volume and adverse events were recorded at each study visit. The primary endpoint was percentage volume reduction. RESULTS: The highest lymphoedema volume reduction was achieved with the Coban 2 system applied two times per week. A mean reduction of 18•7% (SD 14•5) in legs and 10•5% (SD 8•3) in arms was achieved. More frequent bandage changes of three and five times per week did not demonstrate additional benefits. Short-stretch bandaging five times per week showed a mean volume reduction of 10•9% (SD 5•2) and 8•2% (SD 3•1) for legs and arms, respectively. Bandage slippage was low for all treatment groups. A relevant change in overall mobility was achieved during the use of the Coban 2 system. The adverse reactions were in agreement with already known side-effects and did not differ remarkably between the treatment groups. CONCLUSION: The 3M™ Coban™ 2 compression system applied twice weekly demonstrated a high rate of volume reduction and a good safety profile. Oedema reduction was still effective with 4 days between bandage change, which allows a constant therapeutic effect in routine practice. This should give the patient a high degree of independence and mobility.
2016-10-18T16:09:06Z
2016-10-18T16:09:06Z
2012-03
Article
http://hdl.handle.net/20.500.12904/259
en
oai:eastmid.openrepository.com:20.500.12904/2602021-06-03T09:41:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
MRI in T staging of rectal cancer: How effective is it?
Mulla, Mulbashir
Deb, Rahul
Singh, Rajeev
Rectal Cancer
Staging
Histopathology
MRI
Author(s) Pre or Post Print Version Only
BACKGROUND: Rectal cancer constitutes about one-third of all gastrointestinal (GI) tract tumors. Because of the high recurrence rates (30%) in rectal cancer, it is vitally important to accurately stage these tumours preoperatively so that appropriate surgical resection can be undertaken. MRI is the ideal technique for the preoperative staging of these tumours. AIM: To determine the accuracy of local T staging of rectal cancer with MRI, using histopathological staging as the gold. MATERIALS AND METHODS: Forty consecutive patients admitted with rectal cancer over a period of 18 months were included in this retrospective study. MRI scans were performed prior to surgery in all patients, on 1.5T scanners. Two radiologists, with a special interest in gastrointestinal imaging reported all images. Two dedicated histopathologists reported the histology slides. The accuracy of preoperative local MRI T staging was assessed by comparison with postoperative histopathological staging. RESULTS: There was agreement between MRI and histopathology (TNM) staging in 12 patients (30%). The sensitivity and specificity of MRI for T staging was 89% and 67% respectively. The circumferential resection margin (CRM) status was accurately staged in 94.1% of the patients. CONCLUSIONS: Preoperative staging with MRI is sensitive in identifying CRM involvement, which is the main factor affecting the outcome of surgery.
2016-10-26T10:31:11Z
2016-10-26T10:31:11Z
2012-05
Article
Indian J Radiol Imaging. 2010 May;20(2):118-21. doi: 10.4103/0971-3026.63055.
http://hdl.handle.net/20.500.12904/260
en
oai:eastmid.openrepository.com:20.500.12904/2612021-06-03T09:41:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Poor tolerability of thalidomide in end-stage oesophageal cancer.
Wilkes, Emilie
Selby, A
Cole, Andrew
Freeman, Jan
Rennie, M
Khan, Z
Oesophageal Cancer
Cachexia
Author(s) Pre Print Version Only
Oesophageal cancer cachexia is a significant clinical problem, resulting in excessive morbidity and mortality. In a pilot study, 10 patients with cachexia due to advanced cancer of the oesophagus gained weight, including lean tissue, after 14-day treatment with thalidomide. Here, we present randomised placebo controlled trial data over a 6-week period to test the hypothesis that thalidomide is superior to placebo in terms of weight gain in patients with cachexia caused by oesophageal cancer. Thalidomide, 200 mg daily, or an identical placebo was given to patients with advanced oesophageal cancer. Total body weight and lean body mass were assessed in addition to drug tolerability and performance indices. Thirty-four patients were recruited. Of these, six given thalidomide and 16 given placebo completed the protocol; all withdrawals were due to adverse drug reactions or complications of disease. Thalidomide showed no benefit over placebo in participants who completed the protocol. These data suggest that thalidomide is poorly tolerated in patients with advanced cancer of the oesophagus and may not ameliorate the progression of cachexia. In the absence of hard supportive evidence, off-licence treatment with thalidomide should be used with great caution as an adjunct to nutritional support in patients with advanced cancer.
2016-10-19T13:58:07Z
2016-10-19T13:58:07Z
2011-09
Article
http://hdl.handle.net/20.500.12904/261
en
oai:eastmid.openrepository.com:20.500.12904/2622021-06-03T09:41:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Improving primary care identification of familial breast cancer risk using proactive invitation and decision support.
Chorley, W
Breast Cancer
Decision Support
Family History
Medical Genetics
Primary Health Care
Risk Assessment
Author(s) Pre or Post-Print Version Only
Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40-60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40-50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored.Trial registration: CRUK Clinical Trials Database 11779.
2020-07-15T12:17:56Z
2020-07-15T12:17:56Z
2020-06
Article
Fam Cancer. 2020 Jun 11. doi: 10.1007/s10689-020-00188-z. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/262
en
oai:eastmid.openrepository.com:20.500.12904/2632021-06-03T09:41:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
Scott, Ian
Ovarian Cancer Screening
Transvaginal Ultrasound
Risk Algorithm
BACKGROUND: To assess the within-trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy. METHODS: Within-trial economic evaluation of no screening (C) vs either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second-line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model.RESULTS: Using a CA125-ROCA cost of £20, the within-trial results show USS to be strictly dominated by MMS, with the MMS vs C comparison returning an incremental cost-effectiveness ratio (ICER) of £91 452 per life year gained (LYG). If the CA125-ROCA unit cost is reduced to £15, the ICER becomes £77 818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30 033 per LYG, while Markov modelling produces an ICER of £46 922 per QALY. CONCLUSION: Analysis suggests that, after accounting for the lead time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared with the within-trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort.
2017-08-15T11:56:45Z
2017-08-15T11:56:45Z
2017-07
Article
Br J Cancer. 2017 Jul 25. doi: 10.1038/bjc.2017.222.
http://hdl.handle.net/20.500.12904/263
en
oai:eastmid.openrepository.com:20.500.12904/2642021-06-03T09:41:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Individualising breast cancer treatment to improve survival and minimise complications in older women: a research programme including the PLACE RCT.
Riches, Katie
Breast Cancer
BACKGROUND: Over 44,000 women are diagnosed with breast cancer annually in the UK. The research comprised three workstreams (WSs) focused on older women. MAXIMISING SURVIVAL: WS1 – to identify the role of older women’s and surgeons’ preferences in cancer treatment decisions and whether comorbidity or fitness for surgery has an impact on survival. MINIMISING COMPLICATIONS: WS2 – to assess multifrequency bioimpedance (BEA) compared with perometry in identifying women predisposed to develop lymphoedema after axillary node clearance (ANC) surgery. WS3 – to assess, in women at risk of lymphoedema, whether or not applying compression garments prevents the onset of lymphoedema. DESIGN: WS1 – a prospective, consecutive cohort of surgical consultations with women aged ≥ 70 years with operable breast cancer. Interviews and questionnaire surveys of surgeons’ and women’s perceptions of responsibility for treatment decisions (Controlled Preference Score), effects related to survival and secondary outcomes. WS2 – women undergoing ANC for cancer in 21 UK centres underwent baseline and subsequent BEA, and perometer arm measurements and quality-of-life (QoL) assessments. WS3 – a randomised controlled trial testing standard versus applying graduated compression garments to the affected arm, for 1 year, in WS2 patients developing arm swelling. SETTING: Breast outpatient clinics in hospitals with specialist lymphoedema clinics. PARTICIPANTS: WS1 – patients aged ≥ 70 years with newly diagnosed, operable, invasive breast cancer. WS2 – women with node-positive cancer scheduled to undergo ANC. WS3 – WS2 participants developing a 4–9% increase in arm volume. INTERVENTIONS: WS1 – observational study. WS2 – observational study. WS3 – application of graduated compression garments to affected arm, compared with standard management, for 1 year. OUTCOMES: WS1 – self-report and clinically assessed health, QoL, complications and survival. WS2 – perometer and bioimpedance spectroscopy (BIS) measurements, QoL and health utility; and sensitivity and specificity of BIS for detecting lymphoedema compared with perometer arm measurements; in addition, a health economics assessment was performed. WS3 – time to the development of lymphoedema [≥ 10% relative arm-volume increase (RAVI)] from randomisation. RESULTS: WS1 – overall, 910 women were recruited, but numbers in the substudies differ depending on consent/eligibility. In a study of patient/surgeon choice, 83.0% [95% confidence interval (CI) 80.4% to 85.6%] had surgery. Adjusting for health and choice, only women aged > 85 years had reduced odds of surgery [odds ratio (OR) 0.18, 95%CI 0.07 to 0.44]. Patient role in treatment decisions made no difference to receipt of surgery. A qualitative study of women who did not have surgery identified three groups: ‘patient declined’, ‘patient considered’ and ‘surgeon decided’. In a survival substudy, adjusting for tumour stage, comorbidity and functional status, women undergoing surgery had one-third the hazard of dying from cancer. Serious complications from surgery were low and not predicted by older age. In a substudy of the effect of surgical decision-making on HRQoL, 59 (26%) received preferred treatment decision-making style. In multivariate analyses, change in HRQoL was associated neither with congruence (p = 0.133) nor with receipt of surgery (p = 0.841). In a substudy of receipt of chemotherapy in women aged ≥ 65 years, adjusting for tumour characteristics, health measures and choice, women aged ≥ 75 years had reduced odds of chemotherapy (OR 0.06, 95%CI 0.02 to 0.16). WS2 – lymphoedema by 24 months was detected in 21.4% of women by perometry (24.4% sleeve application) and in 39.4% by BIS. Perometer and BIS measurements correlated at 6 months (r = 0.61). Specificity for sleeve application was greater for perometry (94% CI 93% to 96%) at 24 months, as was a positive predictive value of 59% (95% CI 48% to 68%). Lymphoedema diagnosis reduced QoL scores. Sleeve application in the absence of RAVI of > 9% did not improve QoL or symptoms. A composite definition of lymphoedema was developed, comprising a 9% cut-off point for perometer and self-reported considerable swelling. Diagnostic accuracy was ≥ 94% at 6, 12 and 24 months. WS3 – the PLACE (Prevention of Lymphoedema After Clearance of External compression) trial recruited 143 patients, but recruitment was slow and closed early on the advice of the Independent Data Monitoring Committee. A qualitative substudy identified a number of barriers to recruitment. CONCLUSIONS: Half of older patients felt that they influenced decisions about their treatment. No relationship between decision preference being fulfilled and HRQoL in elderly patients diagnosed with cancer occurred, and older age did not predict complications. Primary surgery reduced the hazard of dying of cancer by two-thirds, independent of age, health and tumour characteristics. Women aged ≥ 75 years have reduced odds of receiving chemotherapy. Lymphoedema (along with a BMI of > 30 kg/m2, cigarette smoking and chemotherapy) reduces QoL. Changes in arm volume of > 9% predicted lymphoedema requiring and benefiting from sleeve application. The PLACE trial qualitative work provides a number of insights into problems of recruitment that were specific to this trial (stigma of compression garments) but that are also generalisable to other RCTs. LIMITATIONS: Both WS1 and WS2 were large, multicentre, UK cohort, observational studies. The WS3 PLACE trial has not reported yet but closed with approximately half of the patients originally planned. FUTURE WORK: Research producing objective measures for sleeve prescription in the NHS is required. TRIAL REGISTRATION: Current Controlled Trials ISRCTN48880939. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 5. See the NIHR
2019-09-10T16:11:57Z
2019-09-10T16:11:57Z
2019-08
Article
Programme Grants for Applied Research, V7 (5) Aug 2019
http://hdl.handle.net/20.500.12904/264
en
oai:eastmid.openrepository.com:20.500.12904/2652021-06-03T09:41:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
The experience of patients with complex wounds and the use of NPWT in a home-care setting.
Moffatt, Christine
Murray, Susan
Morgan, PA
NPWT
Negative Pressure Wound Therapy
Author(s) Print Version Only
OBJECTIVE: To explore the experience of patients living with complex wounds and the impact of undergoing negative pressure wound therapy (NPWT) as part of their treatment. METHOD: Qualitative data were collected from eight patients, using semi-structured interviews. A purposive, stratified sampling approach was used to identify participants with a range of wound types, as well as age and gender. Participants were recruited from one primary care trust and were interviewed, following 10 days of treatment with NPWT. The matrix-based 'Framework' approach, from the National Centre for Social Research, was used to structure the analysis. RESULTS: Of the eight participants recruited, five were female and three male, with an age range of 46-77 years. Five overarching categories, with their constituent themes, were identified from the data. The first, developing a wound through crisis, has three themes: a failing body, missed diagnosis and failed professional intervention. The second category, decreased control, has four related themes: poor communication; failed wound healing; poor discharge planning and failure to recover. The third category, increased control, has four themes: understanding what is happening; symptom control; positive professional relationships and returning to health. The fourth category, using NPWT, has two themes: information and understanding of NPWT and expectations and experience of NPWT. The final category sets out participant recommendations about the device and has two themes: device issues and improving professional practice. CONCLUSION: This study investigated the experience of patients undergoing NPWT for complex wounds in the home setting and reveals a number of the psychosocial effects of using this therapy in this environment. Participants saw NPWT as an active intervention, associated with improved wound healing and symptom control. The participant experience described in this study, and the recommendations they make, provide a valuable resource to inform service improvement programmes and wound research.DECLARATION OF INTEREST: This study was supported by a research grant from Smith & Nephew Ltd.
2016-10-19T12:47:12Z
2016-10-19T12:47:12Z
2011-11
Article
J Wound Care. 2011 Nov;20(11):512, 514, 516, passim.
http://hdl.handle.net/20.500.12904/265
en
oai:eastmid.openrepository.com:20.500.12904/2662021-06-03T09:41:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Are patients with cancers 'missed' on faecal occult blood (FOB) testing truly asymptomatic?-a multicentre analysis
George, Anil Thomas
Colorectal Cancer
Cancer Screening
Introduction We aimed to identify the symptomatology of patients who develop interval cancers (cancers diagnosed within 2 years of a negative FOBT screening) in the eligible population of the East Midlands region. Method Data from the National Bowel Cancer Audit Programme from three tertiary colorectal centres (Queens Medical Centre, Nottingham; Royal Derby Hospital and Sherwood Forest Hospitals ll) in the FOB testing age group (60-74 years) over 2 years (August 2011 to August 2013) were analysed and linked to the regional FOB hub to identify patients who had developed colorectal cancer after a negative FOBT in the screening interval (2 years) status. Tumours from and distal to the splenic flexure were classed as left sided tumours. Dukes C/D tumours were classed as advanced tumours. All three centres were in incident rounds of screening. Results The study covered a population of 2 million of which 200,000 were eligible for screening. 521 colorectal cancers were diagnosed in the above population (0.11%). Of these, 231 cancers (44%) were in patients who had declined screening,162 (31%) were picked up following on from a positive FOBT and 128 (25%) were picked up in patients who had a negative FOBT. Of these 128 patients (M: F; 84:44),median age 67 years (SD:3.8) the commonest presenting symptoms for these patients were change in bowel habits in 50(39%). Other presentations included bleeding per-rectum in 44 patients (34%), abdominal pain in 38 (30%) patients, anaemia in 36(28%) patients, loss of weight in14 (11%)patients, bowel obstruction in 13 (10%) patients, bowel perforation in 3(2%) patients. Only two patients were truly asymptomatic from the bowel cancer with this being identified in one patient during surgery for an ovarian cyst and during a trauma laparotomy in the other patient. In the 28% patients who had anaemia the blood picture included a Hb (mean)of 10.3gm;MCV of 82.4 and;MCH of 26.3. In 61% of anaemic patients, the cancer was located on the right side of the colon with an equal percentage being of advanced Duke's stage. The median interval between the negative FOB test and the diagnosis of cancer in these patients was 15 months (range 0.5-24 months). Conclusion Our findings suggest that the majority of patients with 'missed' interval cancers were symptomatic with 'red flag symptoms' inspite of the negative FOB test. We also raise the possibility of a natural bias of subjects volunteering for the FOB test in that some who opt for the test may not be 'truly' asymptomatic but may have bowel symptoms not yet discussed with their general practitioner. We highlight the need for improved awareness to reduce delays in symptomatic patients seeking medical advice against a background of a negative FOBT.
2016-08-17T14:54:56Z
2016-08-17T14:54:56Z
2015-06
Article
Gut, June 2015, vol./is. 64/(A335), 0017-5749 (June 2015)
http://hdl.handle.net/20.500.12904/266
en
oai:eastmid.openrepository.com:20.500.12904/2672021-06-03T09:41:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial.
Chakraborti, Prabir
Prostate Cancer
Docetaxel
Zoledronic Acid
Hormone Therapy
BACKGROUND: Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone. METHODS: Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544). FINDINGS: 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. INTERPRETATION: Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy. FUNDING: Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.
2016-08-17T11:02:44Z
2016-08-17T11:02:44Z
2016-03
Article
Lancet. 2016 Mar 19;387(10024):1163-77. doi: 10.1016/S0140-6736(15)01037-5. Epub 2015 Dec 21.
http://hdl.handle.net/20.500.12904/267
en
oai:eastmid.openrepository.com:20.500.12904/2682021-06-03T09:41:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Demographics, management and survival of patients with malignant pleural mesothelioma in the National Lung Cancer Audit in England and Wales
Beckett, Paul
Mesothelioma
Survival
Audit
Chemotherapy
Surgery
Performance Status
INTRODUCTION AND METHODS: Malignant pleural mesothelioma (MPM) is an uncommon cancer with poor survival. We have used data collected for the UK National Lung Cancer Audit to assess current practice and to highlight regional variation in the management of mesothelioma patients, as well as to describe survival patterns in subgroups. RESULTS: Our data on 8740 cases seen in hospitals in England and Wales is the largest cohort of MPM in the literature and represents approximately 80% of the total incident cases. 83% are male and median age is 73 years. Performance status is recorded in 81% and of these approximately 70% are PS 0-2. Stage is poorly recorded and unreliable in this dataset. The patient pathway is similar to lung cancer with approximately one-fifth having a non-elective referral to secondary care. A histo-cytological diagnosis is made in 87% and varies across organisations. Only 67% have anti-cancer treatment, and this also varies across organisations, but there has been an annual increase in the proportion receiving chemotherapy. Overall median survival was 9.5 months, with a 1YS of 41.4% and 3YS of 12.0%, but was strongly linked to performance status and histological subtype. Median survival also varied by cancer network from 209 days to 349 days, but appeared to increase from of 9.2 months in 2008 to 10.5 months in 2012. CONCLUSION: Our data provide a large scale, detailed assessment of MPM epidemiology, treatment choices and outcomes. Incidence is increasing in line bwith predictions and uptake of treatments has generally mirrored publication of key MPM treatment trials, in particular increasing use of chemotherapy but low uptake of radical surgery. However, there is significant variation in care patterns and outcomes that may reflect limited expertise in area with low incidence. Initiatives to improve outcomes should include improved recording of clinical stage.
2016-11-02T16:11:32Z
2016-11-02T16:11:32Z
2015-06
Article
Lung Cancer. 2015 Jun;88(3):344-8. doi: 10.1016/j.lungcan.2015.03.005.
http://hdl.handle.net/20.500.12904/268
en
oai:eastmid.openrepository.com:20.500.12904/2692021-06-03T09:41:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort.
Walton, Tom
Ontological Outcomes
Multivariable Analysis
Statistical Analysis
Nephroureterectomy
OBJECTIVE: • To compare oncological outcomes in patients undergoing open radical nephroureterectomy (ONU) with those in patients undergoing laparoscopic radical nephroureterectomy (LNU). PATIENTS AND METHODS: • A total of 773 patients underwent radical nephroureterectomy at nine centres worldwide; 703 patients underwent ONU and 70 underwent LNU. • Demographic, perioperative and oncological outcome data were collected retrospectively. • Statistical analysis of data was performed using chi-squared, Mann-Whitney U- and log-rank tests, and Cox regression analyses. • The median (interquartile range) follow-up for the cohort was 34 (15-65) months. RESULTS: • The two groups were well matched for tumour stage, presence of lymphovascular invasion (LVI) and concomitant carcinoma in situ (CIS). • There were more high-grade tumours (77.1% vs. 56.3%; P < 0.001) but fewer lymph node positive patients (2.9% vs. 6.8%; P= 0.041) in the LNU group. • Estimated 5-year recurrence-free survival (RFS) was 73.7% and 63.4% for the ONU and LNU groups, respectively (P= 0.124) and estimated 5-year cancer-specific survival (CSS) was 75.4% and 75.2% for the ONU and LNU groups, respectively (P= 0.897). • On multivariable analyses, which included age, gender, race, previous endoscopic treatment for bladder cancer, technique for distal ureter management, tumour location, pathological stage, grade, lymph node status, LVI and concomitant CIS, the procedure type (LNU vs. ONU) was not predictive of RFS (Hazard ratio [HR] 0.80; P= 0.534) or CSS (HR 0.96; P= 0.907). CONCLUSION: • The present study is the second large, independent, multicentre cohort to show oncological equivalence between ONU and LNU for well selected patients with upper urinary tract urothelial cancer, and the first to suggest parity for the techniques in patients with unfavourable disease.
2016-10-19T15:52:49Z
2016-10-19T15:52:49Z
2011-08
Article
BJU Int. 2011 Aug;108(3):406-12. doi: 10.1111/j.1464-410X.2010.09826.x. Epub 2010 Nov 15.
http://hdl.handle.net/20.500.12904/269
en
oai:eastmid.openrepository.com:20.500.12904/2702021-06-03T09:41:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Personalised Care Plans in the Last Days of Life
Bussooa, Karen
North, Elizabeth
End of Life Care
Care Plans
Palliative Care
Nursing
Personalised care plans prompt nursing staff to consider the priorities of care for patients nearing the end of life, in line with guidance from the Leadership Alliance for the Care of Dying People, when planning care. This article discusses the results of an acute hospital audit comparing the quality of care planning for patients in the last days of life using the trust care record documentation with the use of a personalised care plan for patients.
2016-09-14T09:00:15Z
2016-09-14T09:00:15Z
2016-07
Article
Nursing Times, Online Issue 9, 9.7.16
http://hdl.handle.net/20.500.12904/270
en
oai:eastmid.openrepository.com:20.500.12904/2712021-07-19T08:51:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
The Role of Computed Tomography Scanning of the Thorax in the Initial Assessment of Gestational Trophoblastic Neoplasia.
Price, JM
Choriocarcinoma
Gestational Trophoblastic Disease
Gestational Trophoblastic Neoplasia
OBJECTIVE: The aim of this study was to determine whether lesions found on computed tomography (CT) imaging of the thorax would affect FIGO (International Federation of Gynecology and Obstetrics) 2000 risk score and/or alter clinical management. METHODS: The Sheffield Trophoblastic Disease database was searched for all new patients registered for staging/scoring investigations between January 1, 2006, and June 30, 2010. The FIGO 2000 score was noted and then recalculated using information from CT scan reports. Where a change of risk score would have affected a patient's management, the case notes were further reviewed. RESULTS: 191 patients had undergone both modalities of imaging. Using standard FIGO scoring, 169 and 22 patients were noted to be at low and high risk, respectively. Using information from CT imaging, only a further 20 patients would have been reclassified as high risk. Fifteen of these "new" high-risk patients required salvage treatment with intravenous chemotherapy; all were cured. CONCLUSIONS: With no potential advantage in terms of patient outcome and significantly increased radiation dose, there is little justification for routine CT imaging of the thorax in the initial assessment of new patients with gestational trophoblastic neoplasia.
2016-08-24T10:34:25Z
2016-08-24T10:34:25Z
2015-11
Article
Int J Gynecol Cancer. 2015 Nov;25(9):1731-6.
http://hdl.handle.net/20.500.12904/271
en
oai:eastmid.openrepository.com:20.500.12904/2722021-06-03T09:41:42Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Chronic oedema: a prevalent health care problem for UK health services
Keeley, Vaughan
Moffatt, Christine
Rich, Anna
Chronic Oedema
Chronic oedema (CO) is a major clinical problem worldwide, which has many important secondary consequences for health, activity and participation. Effective treatment planning and organisation of services is dependent on an understanding of the condition and its epidemiology. This cross-sectional study was designed to estimate the point prevalence of CO within the health services of one UK urban population and to determine the proportions that have concurrent leg ulceration.
Patients with CO in all anatomic sites were ascertained by health care professionals in one acute and one community hospital, all relevant outpatient and community nursing services, general practices and all nursing/residential homes in one urban catchment area (Derby City). The presence and distribution of oedema was confirmed through a brief clinical examination. A battery of demographic and clinical details was recorded for each case.
Within the study population of Derby City residents, 971 patients were identified with CO [estimated crude prevalence 3·93 per 1000, 95% confidence interval (CI) 3·69–4·19]. The prevalence was the highest among those aged 85 or above (28·75 per 1000) and was higher among women (5·37 per 1000) than men (2·48 per 1000). The prevalence among hospital inpatients was 28·5%. Only five (3%) patients in the community population had oedema related to cancer or cancer treatment. Of the 304 patients identified with oedema from the Derby hospitals or community health services, 121 (40%) had a concurrent leg ulcer.
Prevalence statistics and current demographic trends indicate that CO is a major and growing health care problem.
2016-12-13T15:13:29Z
2016-12-13T15:13:29Z
2016-12
Article
International Wound Journal, December 2016
http://hdl.handle.net/20.500.12904/272
en
oai:eastmid.openrepository.com:20.500.12904/2732021-06-03T09:41:42Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Future Research Priorities for Morbidity Control of Lymphedema.
Keeley, Vaughan
Ayurveda
Integrative Medicine
Lymphatic Filariasis
Lymphedema
Priority Setting Partnership
Yoga
BACKGROUND: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. METHODS: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients' priorities. RESULTS: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. CONCLUSION: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP.
2017-03-01T15:17:32Z
2017-03-01T15:17:32Z
2017-01
Article
Indian J Dermatol. 2017 Jan-Feb;62(1):33-40. doi: 10.4103/0019-5154.198039.
http://hdl.handle.net/20.500.12904/273
en
oai:eastmid.openrepository.com:20.500.12904/2742021-06-03T09:41:42Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Randomized Phase II Study Investigating Pazopanib Versus Weekly Paclitaxel in Relapsed or Progressive Urothelial Cancer.
Chakraborti, Prabir
Chemotherapy
Pazopanib
Urothelial Cancer
Purpose Two previous single-arm trials have drawn conflicting conclusions regarding the activity of pazopanib in urothelial cancers after failure of platinum-based chemotherapy. Patients and Methods This randomized (1:1) open-label phase II trial compared the efficacy of pazopanib 800 mg orally with paclitaxel (80 mg/m(2) days 1, 8, and 15 every 28 days) in the second-line setting. The primary end point was overall survival (OS). Results Between August 2012 and October 2014, 131 patients, out of 140 planned, were randomly assigned. The study was terminated early on the recommendation of the independent data monitoring committee because of futility. Final analysis after the preplanned number of deaths (n = 110) occurred after a median follow-up of 18 months. One hundred fifteen deaths had occurred at the final data extract presented here. Median OS was 8.0 months for paclitaxel (80% CI, 6.9 to 9.7 months) and 4.7 months for pazopanib (80% CI, 4.2 to 6.4 months). The hazard ratio (HR) adjusted for baseline stratification factors was 1.28 (80% CI, 0.99 to 1.67; one-sided P = .89). Median progression-free survival was 4.1 months for paclitaxel (80% CI, 3.0 to 5.6 months) and 3.1 months for pazopanib (80% CI, 2.7 to 4.6 months; HR, 1.09; 80% CI, 0.85 to 1.40; one-sided P = .67). Discontinuations for toxicity occurred in 7.8% and 23.1% for paclitaxel and pazopanib, respectively. Conclusion Pazopanib did not have greater efficacy than paclitaxel in the second-line treatment of urothelial cancers. There was a trend toward superior OS for paclitaxel.
2017-04-18T13:40:35Z
2017-04-18T13:40:35Z
2017-04
Article
J Clin Oncol. 2017 Apr 12:JCO2016707828. doi: 10.1200/JCO.2016.70.7828. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/274
en
oai:eastmid.openrepository.com:20.500.12904/2752021-06-03T09:41:43Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy.
Chakraborti, Prabir
Prostate Cancer
ADT
Androgen Deprivation Therapy
Abiraterone Acetate
Prednisolone
Background Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. Methods We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). Results A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). Conclusions Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476 , and Current Controlled Trials number, ISRCTN78818544
2017-06-13T15:04:52Z
2017-06-13T15:04:52Z
2017-06
Article
N Engl J Med. 2017 Jun 3. doi: 10.1056/NEJMoa1702900. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/275
en
oai:eastmid.openrepository.com:20.500.12904/2762021-06-03T09:41:43Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Development of Prognosis in Palliative care Study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study
Keeley, Vaughan
Palliative Care
Prognosis
Comorbidity
Advanced Cancer
OBJECTIVE: To develop a novel prognostic indicator for use in patients with advanced cancer that is significantly better than clinicians' estimates of survival. DESIGN: Prospective multicentre observational cohort study. SETTING: 18 palliative care services in the UK (including hospices, hospital support teams, and community teams). PARTICIPANTS: 1018 patients with locally advanced or metastatic cancer, no longer being treated for cancer, and recently referred to palliative care services. MAIN OUTCOME MEASURES: Performance of a composite model to predict whether patients were likely to survive for "days" (0-13 days), "weeks" (14-55 days), or "months+" (>55 days), compared with actual survival and clinicians' predictions. RESULTS: On multivariate analysis, 11 core variables (pulse rate, general health status, mental test score, performance status, presence of anorexia, presence of any site of metastatic disease, presence of liver metastases, C reactive protein, white blood count, platelet count, and urea) independently predicted both two week and two month survival. Four variables had prognostic significance only for two week survival (dyspnoea, dysphagia, bone metastases, and alanine transaminase), and eight variables had prognostic significance only for two month survival (primary breast cancer, male genital cancer, tiredness, loss of weight, lymphocyte count, neutrophil count, alkaline phosphatase, and albumin). Separate prognostic models were created for patients without (PiPS-A) or with (PiPS-B) blood results. The area under the curve for all models varied between 0.79 and 0.86. Absolute agreement between actual survival and PiPS predictions was 57.3% (after correction for over-optimism). The median survival across the PiPS-A categories was 5, 33, and 92 days and survival across PiPS-B categories was 7, 32, and 100.5 days. All models performed as well as, or better than, clinicians' estimates of survival. CONCLUSIONS: In patients with advanced cancer no longer being treated, a combination of clinical and laboratory variables can reliably predict two week and two month survival.
2016-08-18T11:14:02Z
2016-08-18T11:14:02Z
2015-12
Article
BMJ Support Palliat Care. 2015 Dec;5(4):390-8. doi: 10.1136/bmjspcare-2012-d4020rep.
http://hdl.handle.net/20.500.12904/276
en
oai:eastmid.openrepository.com:20.500.12904/2772021-06-03T09:41:43Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Effect of colon cancer and surgical resection on skeletal muscle mitochondrial enzyme activity in colon cancer patients: a pilot study.
Lund, Jonathan
Cancer
Muscle
Mitochondria
Pyruvate Dehydrogenase
BACKGROUND: Colon cancer (CC) patients commonly suffer declines in muscle mass and aerobic function. We hypothesised that CC would be associated with reduced muscle mass and mitochondrial enzyme activity and that curative resection would exacerbate these changes. METHODS: We followed age-matched healthy controls and CC patients without distant metastasis on radiological imaging before and 6 weeks after hemi-colectomy surgery. Body composition was analysed using dual energy X-ray absorptiometry. Mitochondrial enzyme activity and protein concentrations were analysed in vastus lateralis muscle biopsies. RESULTS: In pre-surgery, there were no differences in lean mass between CC patients and age-matched controls (46.1 + 32.5 vs. 46.1 + 37.3 kg). Post-resection lean mass was reduced in CC patients (43.8 + 30.3 kg, P < 0.01). When comparing markers of mitochondrial function, the following were observed: pyruvate dehydrogenase (PDH) activity was lower in CC patients pre-surgery (P < 0.001) but normalized post-resection and cytochrome c oxidase and pyruvate dehydrogenase E2 subunit protein expression were lower in CC patients pre-surgery and not restored to control values post-resection (P < 0.001). Nuclear factor kappa-B, an inflammatory marker, was higher in CC patients pre-surgery compared to controls (P < 0.01), returning to control levels post-resection. CONCLUSION: Muscle mass was affected by surgery rather than cancer per se. PDH activity was however lower in cancer patients, suggesting that muscle mass and mitochondrial enzyme activity are not inextricably linked. This reduction in mitochondrial enzyme activity may well contribute to the significant risks of major surgery to which CC patients are exposed.
2016-10-12T11:11:23Z
2016-10-12T11:11:23Z
2013-03
Article
J Cachexia Sarcopenia Muscle. 2013 Mar;4(1):71-7. doi: 10.1007/s13539-012-0073-7.
http://hdl.handle.net/20.500.12904/277
en
oai:eastmid.openrepository.com:20.500.12904/2782021-06-03T09:41:43Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Undissected Axilla and Axillary Radiotherapy
Goyal, Amit
Axilla
Breast Surgery
Breast Neoplasms
Lymph Nodes
Radiotherapy
Comment in Undissected Axilla and Axillary Radiotherapy-In Reply. [JAMA Oncol. 2019]
Comment on Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer. [JAMA Oncol. 2018]
2020-03-12T12:13:33Z
2020-03-12T12:13:33Z
2019-05
Article
JAMA Oncol. 2019 May 1;5(5):741-742. doi: 10.1001/jamaoncol.2019.0031.
http://hdl.handle.net/20.500.12904/278
en
oai:eastmid.openrepository.com:20.500.12904/2792022-11-09T15:44:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Safe investigation of isolated change in bowel habit with a flexible sigmoidoscopy? A systematic review and meta-analysis.
Herrod, Philip
Boyd-Carson, H
Doleman, Brett
Blackwell, James
Hardy, EJO
Harper, Frazer
Lund, Jonathan
Colon and Rectal Surgery
Colon Cancer
Rectal Cancer
No Pre or Post. 12 Month Embargo on PDF
INTRODUCTION: Public awareness campaigns have led to increasing referrals of patients to colorectal surgery for possible cancer. Change in bowel habit, is traditionally described as a symptom of a left sided bowel cancer. If this is the case in practice, it raises the potentially attractive option of investigating such patients with flexible sigmoidoscopy only. This study sought to systematically review the literature describing tumour location of patients with bowel cancer presenting with left-sided symptoms to establish the safety of potential investigation of these patients with flexible sigmoidoscopy alone. METHODS: A systematic review of studies reporting both the presenting symptoms of patients with bowel cancer and the location of their cancer in the bowel was prospectively registered (CRD42017072492). MEDLINE, EMBASE and CENTRAL were searched with no date or language restriction. RESULTS: Seven studies were included. Isolated change in bowel habit (with or without rectal bleeding) was a presenting symptom of 73% (95% CI 41-96%, I2 = 99%) of left-sided cancers but also in 13% (95% CI 2-30%, I2 = 96%) of right-sided cancers. In all patients with cancer who presented with isolated change in bowel habit (with or without rectal bleeding), the cancer was right sided in 8% (95% CI 4-12%, I2 = 69%). CONCLUSIONS: There is a higher than expected risk that if a cancer is diagnosed in a patient presenting with either an isolated change in bowel habit or a combination of change in bowel habit with rectal bleeding, the cancer may be right sided.
2019-07-17T15:36:48Z
2019-07-17T15:36:48Z
2019-07
Article
Ann R Coll Surg Engl. 2019 Jul;101(6):379-386. doi: 10.1308/rcsann.2019.0012. Epub 2019 Mar 11.
http://hdl.handle.net/20.500.12904/279
en
oai:eastmid.openrepository.com:20.500.12904/2802021-06-03T09:41:44Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of the rectum: an observational study of 100 patients.
Thomas, PW
Blackwell, James
Herrod, Philip
Peacock, Oliver
Singh, Rajeev
Williams, John P
Hurst, NG
Speake, WJ
Bhalla, Ashish
Lund, Jonathan
Abdominoperineal Excision
Hernia
Rectal Cancer
Surgical Mesh
Author(s) Pre or Post Print Version Only
BACKGROUND: Current evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data islacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis®, Biodesign™) reconstruction following ELAPER. METHODS: A retrospective review of all patients having ELAPER in a single institution between 2008 and 2018 was perfomed. Clinic letters were scrutinised for wound complications and all available cross sectional imaging was reviewed to identify evidence of perineal herniation (defined as presence of intra-abdominal content below a line between the coccyx and the lower margin of the pubic symphysis on sagittal view). RESULTS: One hundred patients were identified (median age 66, IQR 59-72 years, 70% male). Median length of follow-up was 4.9 years (IQR 2.3-6.7 years). One, 2- and 5-year mortality rates were 3, 8 and 12%, respectively. Thirty three perineal wounds had not healed by 1 month, but no mesh was infected and no mesh needed to be removed. Only one patient developed a symptomatic perineal hernia requiring repair. On review of imaging a further 7 asymptomatic perineal hernias were detected. At 4 years the cumulative radiologically detected perineal hernia rate was 8%. CONCLUSIONS: This study demonstrates that pelvic floor reconstruction using biological mesh following ELAPER is both safe and effective as a long-term solution, with low major complication rates. Symptomatic perineal herniation is rare following mesh reconstruction, but may develop sub clinically and be detectable on cross-sectional imaging.
2019-08-13T14:42:26Z
2019-08-13T14:42:26Z
2019-08
Article
Tech Coloproctol. 2019 Aug 7. doi: 10.1007/s10151-019-02056-0. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/280
en
oai:eastmid.openrepository.com:20.500.12904/2812021-06-03T09:41:44Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Mesothelioma and Radical Surgery 2 (MARS 2): protocol for a multicentre randomised trial comparing (extended) pleurectomy decortication versus no (extended) pleurectomy decortication for patients with malignant pleural mesothelioma.
Keni, Manjusha
Chemotherapy
Oncology
Thoracic Medicine
Thoracic Surgery
INTRODUCTION: Mesothelioma remains a lethal cancer. To date, systemic therapy with pemetrexed and a platinum drug remains the only licensed standard of care. As the median survival for patients with mesothelioma is 12.1 months, surgery is an important consideration to improve survival and/or quality of life. Currently, only two surgical trials have been performed which found that neither extensive (extra-pleural pneumonectomy) or limited (partial pleurectomy) surgery improved survival (although there was some evidence of improved quality of life). Therefore, clinicians are now looking to evaluate pleurectomy decortication, the only radical treatment option left. METHODS AND ANALYSIS: The MARS 2 study is a UK multicentre open parallel group randomised controlled trial comparing the effectiveness and cost-effectiveness of surgery-(extended) pleurectomy decortication-versus no surgery for the treatment of pleural mesothelioma. The study will test the hypothesis that surgery and chemotherapy is superior to chemotherapy alone with respect to overall survival. Secondary outcomes include health-related quality of life, progression-free survival, measures of safety (adverse events) and resource use to 2 years. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment. ETHICS AND DISSEMINATION: Research ethics approval was granted by London - Camberwell St. Giles Research Ethics Committee (reference 13/LO/1481) on 7 November 2013. We will submit the results for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBERS: ISRCTN-ISRCTN44351742 and ClinicalTrials.gov-NCT02040272.
2020-10-01T14:21:54Z
2020-10-01T14:21:54Z
2020-09
Article
BMJ Open. 2020 Sep 1;10(9):e038892. doi: 10.1136/bmjopen-2020-038892.
http://hdl.handle.net/20.500.12904/281
en
oai:eastmid.openrepository.com:20.500.12904/2822021-06-03T09:41:44Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
Prolonged interruption of chemotherapy in patients undergoing delayed debulking surgery for advanced high grade serous ovarian cancer is associated with a worse prognosis.
Phillips, A
Chemotherapy
Debulking Surgery
High Grade Serous
Ovarian Cancer
INTRODUCTION: The current standard of care for advanced high grade serous ovarian cancer (HGSC) comprises a combination of debulking surgery and platinum-based chemotherapy given in the neoadjuvant or adjuvant setting. In the neoadjuvant setting, patients usually undergo 3 cycles of chemotherapy followed by interval cytoreductive surgery (ICS), then 3 further cycles of chemotherapy. However, the optimum timeframe to administer chemotherapy before and after ICS remains unclear. We therefore examine the survival impact of the interval between pre- and post-operative chemotherapy in patients undergoing ICS in a well-established patient cohort. Factors leading to "delays" in recommencing post-operative chemotherapy were also examined. METHODS: The study comprises of a retrospective cohort of 205 cases with FIGO stage III and IV HGSC undergoing ICS. The duration of the interval between pre-operative and post-operative chemotherapy was correlated with progression-free (PFS) and overall survival (OS). Univariate and multivariate analyses were constructed to identify factors associated with survival and prolonged chemotherapy interruption. RESULTS: The median interval between pre-operative and post-operative chemotherapy was 63 days. Multivariate analyses revealed macroscopic residual disease (HR:2.280, 95% CI:1.635-3.177, p ≤ 0.001) and interruption of chemotherapy >10 weeks (HR:1.65, 95%CI:1.201-2.290, p = 0.002) were associated with poorer OS. Existing medical comorbidities and longer hospital stay were independent prognostic factors for prolonging the chemotherapy interruption. CONCLUSION: Our study recommends that interruption to chemotherapy to allow patients to undergo ICS should be ≤10 weeks; otherwise, OS is significantly impacted. Patients with pre-existing medical comorbidities should receive additional support pre- and post-operatively to keep the chemotherapy interruption to a minimum.
2020-07-17T12:35:15Z
2020-07-17T12:35:15Z
2020-04
Article
Gynecol Oncol. 2020 Apr 25. pii: S0090-8258(20)30307-3. doi: 10.1016/j.ygyno.2020.04.048. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/282
en
oai:eastmid.openrepository.com:20.500.12904/2832021-06-03T09:41:44Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_3
A multicentre cross-sectional observational study of cancer multidisciplinary teams: Analysis of team decision making.
Bali, Anish
Asher, Viren
Cancer
Cancer Multidisciplinary Team Meetings
Decision Making
Multidisciplinary Teams
BACKGROUND: Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case-complexity affect the quality of MDT decision making. METHODS: This was a cross-sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions. RESULTS: The full regression model with the variables proposed by the functional perspective was significant, R2 = 0.52, F(20, 801) = 43.47, P < .001, adjusted R2 = 0.51. Positive predictors of DM quality were asking questions (P = .001), providing answers (P = .001), team size (P = .007), gender balance (P = .003), and clinical complexity (P = .001), while negative socioemotional reactions (P = .007), gender imbalance (P = .003), logistical issues (P = .001), time-workload pressures (P = .002), and time spent in the meeting (P = .001) were negative predictors. Second half of the meetings also saw significant decrease in the DM quality (P = .001), interactions (P = .001), group size (P = .003), and clinical complexity (P = .001), and an increase in negative socioemotional reactions (P = .001) and time-workload pressures (P = .001). DISCUSSION: To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in cancer MDTs. One novel finding is the effect of sociocognitive factors on team DM quality, while another is the cognitive-catch 22 effect: while the case discussions are significantly simpler in the second half of the meeting, there is significantly less time left to discuss the remaining cases, further adding to the cognitive taxation in teams who are now rapidly attempting to close their time-workload gap. Implications are discussed in relation to quality and safety.
2020-08-25T12:38:04Z
2020-08-25T12:38:04Z
2020-08
Article
Cancer Med. 2020 Aug 13. doi: 10.1002/cam4.3366. Online ahead of print.
http://hdl.handle.net/20.500.12904/283
en
oai:eastmid.openrepository.com:20.500.12904/2842021-06-03T09:44:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Forensic radiology: The role of cross-sectional imaging in virtual post-mortem examinations
Higginbotham-Jones, Joshua
Autopsy
Diagnostic imaging
The aim of this review is to assess the benefits and limitations of using Multi Slice Computed Tomography and Magnetic Resonance as non-invasive post-mortem imaging methods. Method: The author utilised SciVerse (Science Direct), Scopus, PubMed and Discover to search for relevant articles. The following search terms were used: virtopsy, minimally invasive post-mortem imaging, autopsy, Multi Slice Computed Tomography, Magnetic Resonance. Articles which discussed the use of non-invasive imaging techniques for post-mortem examinations were included in the review. Any articles published before 2003 were excluded with a few exceptions. Findings: The decline in use of the conventional post-mortem method has led to the need for an alternative method of investigation which increases both sensitivity and specificity, and also is more acceptable to the family of the deceased. Discussion/conclusion: There are numerous factors affecting the usability of these non-invasive post-mortem options including cost and availability. With the price of non-invasive post-mortem examinations often rising above 1000, it is considered to be less economically viable than the conventional method. Therefore, further research into this method and its implementation in hospitals has been delayed.
2018-01-03T13:47:54Z
2018-01-03T13:47:54Z
2014-02
Article
Radiography; Feb 2014; vol. 20 (no. 1); p. 87-90
http://hdl.handle.net/20.500.12904/284
en
oai:eastmid.openrepository.com:20.500.12904/2852021-06-03T09:44:33Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Audit of Pectoralis (PECS) and Serratus Anterior Plane (SAP) blocks for breast surgery
Subramanian, Krishnan
Breast Surgery
Serratus Anterior Plane Block
Author(s) Pre Print Version Only. 12 Month Embargo on Post Print. No PDF
Introduction The principal objective of the audit is to -"Improve the quality of care delivered to the patient by minimising the opioid consumption intra and postop and to reduce the complication from opioids." Materials and methods (NA for case report) Formal approval of Derby Hopitals NHS Trust Clinical Governance Team ( equivalent to IRB ) acquired and medical records depatment were contacted for data collection. Retrospective data collection of patients undergoing "minor" breast surgery, between April 2015 - January 2016, in Derby Teaching Hospitals NHS Trust. Procedures excluded: - Reconstruction - Bilateral surgery - Free Flaps Data collected: - Procedure type - PECS block (Y/N) - SAP block (Y/N) - Intraoperative analgesia - Recovery pain score - Recovery opioid consumption - Recovery Nausea and vomiting Results/Case report Conclusions:- Out of 67 patients, 16 had blocks 49 of those with no block, received intra-op opiods +/- adjuvant IV analgesics In recovery, 1 in 16 with PECs required rescue analgesia (6.25%); opposed to 6 in 51 without PECs (11.76%). PONV rates were higher in patients without PECs. Surgery associated with stress response, which has metabolic neuroendocrine haematological and inflammatory /immunological response (cytokine stress responses, suppressed cell-mediated immunity) These are the major factors for peri-op immune suppression and provide a milieu for possible tumor cell proliferation leading to metastases. PECS and SAP Blocks are - Depositing Local Anaesthetic between Thoracic muscles "Myofascial block", similar to Transversus Abdominal Plane (TAP) block easy to do with the advent of USG, increasing accuracy Ability of RA to improve long term outcome after cancer surgery can be attributed to at least 3 different mechanismsattenuates the immunosuppressive effect of surgery decreases the opioid requirement RA + GA more balanced anaesthesia.
2018-01-23T14:14:34Z
2018-01-23T14:14:34Z
2017-04
Article
Regional Anesthesia and Pain Medicine; 2017; vol. 42 (no. 6)
http://hdl.handle.net/20.500.12904/285
en
oai:eastmid.openrepository.com:20.500.12904/2862021-06-03T09:44:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes.
Puri, Shama
Goyal, Amit
Lymph Nodes
Breast
Axillary Tumour
Ultrasound
Author(s) Pre or Post Print Version Only. No PDF
AIM: To determine if the number of abnormal nodes seen on preoperative axillaryultrasound (AUS) is a predictor of the number of positive nodes at histology for women with needle-biopsy-proven positive nodes. MATERIALS AND METHODS: This prospective multicentre cohort study included consecutive patients with early breast cancer who had needle-biopsy-proven positive nodes on AUS and underwent axillary lymph node dissection (ALND) between October 2015 and July 2016. The number of abnormal nodes at preoperative AUS was recorded by breast radiologists or radiographers. RESULTS: One hundred and twenty-three patients were included in the study. The median age of the women was 62 (range 30-93) years. Fifty-four of the 123 (44%) women had one abnormal node, whereas 69 (56%) had multiple abnormal nodes on AUS. Forty of the 123 (33%) women had two or fewer nodes with metastases at histology after ALND. Tumours ≤20 mm (p<0.001) and one abnormal node on AUS (p<0.001) were associated with two or fewer nodes with metastases at ALND. Both remained significant in logistic regression analysis. The likelihood of at least three metastases based on the combination of these two factors had 95% sensitivity (79 of 83), 35% specificity (14 of 40), a negative predictive value of 78% (14 of 18), and a positive predictive value of 75% (79 of 105). CONCLUSION: Among women with needle-biopsy-proven positive nodes, around three in four women (78%) with an invasive tumour ≤2 cm and one abnormal node on AUS have two or fewer positive nodes at ALND. These women are overtreated by upfront ALND and can be offered sentinel node biopsy (SNB).
2018-01-30T15:43:15Z
2018-01-30T15:43:15Z
2018-01
Article
Clin Radiol. 2018 Jan 15. pii: S0009-9260(17)30610-4. doi: 10.1016/j.crad.2017.12.014. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/286
en
oai:eastmid.openrepository.com:20.500.12904/2872021-06-03T09:44:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study.
Goyal, Amit
Breast Cancer
Lumpectomy
Magnetic
Mastectomy
Seed Localisation
Author(s) Pre or Post Print Version Only
PURPOSE: Wire localization has several disadvantages, notably wire migration and difficulty scheduling the procedure close to surgery. Radioactive seed localization overcomes these disadvantages, but implementation is limited due to radiation safety requirements. Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed, with easier implementation. This study was designed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization. METHODS: A two-centre open-label cohort study to assess the feasibility and safety of magnetic seed (Magseed) localization of breast lesions. Magseeds were placed under radiological guidance into women having total mastectomy surgery. The primary outcome measure was seed migration distance. Secondary outcome measures included accuracy of placement, ease of transcutaneous detection, seed integrity and safety. RESULTS: Twenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance. There was no migration of the seeds between placement and surgery. Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away. All seeds were detectable transcutaneously in all breast sizes and at all depths. There were no complications or safety issues. CONCLUSIONS: Magnetic seeds are a feasible and safe method of breast lesion localization. They can be accurately placed, demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue. Now that safety and feasibility have been demonstrated, further clinical studies are required to evaluate the seed's effectiveness in wide local excision surgery.
2018-03-07T17:21:15Z
2018-03-07T17:21:15Z
2018-02
Article
Breast Cancer Res Treat. 2018 Feb 16. doi: 10.1007/s10549-018-4709-y.
http://hdl.handle.net/20.500.12904/287
en
oai:eastmid.openrepository.com:20.500.12904/2882021-07-19T08:50:05Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Patient and public beliefs about the role of imaging in the management of non-specific low back pain: a scoping review.
Taylor, Stephanie
Imaging
Low Back Pain
MRI
Patient
Public
Beliefs
BACKGROUND OR CONTEXT: Routine imaging for non-specific low back pain is advised against in guidelines yet imaging continues to occur. Patient and public beliefs regarding imaging may be a driving factor contributing to this. OBJECTIVES: To review the current evidence in relation to patient and public beliefs regarding imaging for low back pain. DATA SOURCES: A systematic scoping review was conducted in databases Medline, Embase, Cinahl, Psyc info (inception - Jan 2018). STUDY SELECTION: Any method of study including beliefs of adults about imaging for non-specific low back pain. DATA EXTRACTION AND DATA SYNTHESIS: Descriptive data was extracted and patient and public beliefs about imaging for low back pain was analysed using conventional qualitative content analysis. RESULTS: 12 studies from an initial search finding of 1135 were analysed. 3 main themes emerged; (1) The Desire for imaging; (2) Influences on patient desire for imaging including (a) clinical presentation, (b) past experience and (c)relationships with care professionals and (3) Negative consequences of imaging. LIMITATIONS: Few qualitative studies were found, all studies were in English language, the majority of studies were older than 2003. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: There is little available evidence on patient and public beliefs about imaging but what evidence there is suggests that imaging is seen as positive in the management of low back pain and patient desire for a diagnosis is a big driver of this. There is also a suggestion that these beliefs may still be being influenced by health care professionals.
2020-02-27T12:06:46Z
2020-02-27T12:06:46Z
2019-08
Article
Physiotherapy. 2019 Aug 31;107:224-233. doi: 10.1016/j.physio.2019.08.014. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/288
en
oai:eastmid.openrepository.com:20.500.12904/2892021-06-03T09:44:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Effective positioning of the fingers for intraoperative x-rays.
Wright, J
Nicholson, S
Arrowsmith, J
X-Ray
Hand
Fingers
12 Month Embargo on PDF. No Pre or Post
2018-06-05T16:03:56Z
2018-06-05T16:03:56Z
2018-01
Article
Ann R Coll Surg Engl. 2018 Jan;100(1):81. doi: 10.1308/rcsann.2017.0126. Epub 2017 Aug 25.
http://hdl.handle.net/20.500.12904/289
en
oai:eastmid.openrepository.com:20.500.12904/2902021-06-03T09:44:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Axillary conservation in early breast cancer.
Goyal, Amit
Breast Cancer
Axillary Conservation
Author(s) Pre Print Only
2016-08-25T14:11:49Z
2016-08-25T14:11:49Z
2015-10
Article
Br J Surg. 2015 Oct;102(11):1297-9. doi: 10.1002/bjs.9881. Epub 2015 Jul 7.
http://hdl.handle.net/20.500.12904/290
en
oai:eastmid.openrepository.com:20.500.12904/2912021-06-03T09:44:34Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
The accuracy of breast volume measurement methods: A systematic review.
Goyal, Amit
Breast Volume Measurement
Author(s) pre and post print only
Breast volume is a key metric in breast surgery and there are a number of different methods which measure it. However, a lack of knowledge regarding a method's accuracy and comparability has made it difficult to establish a clinical standard. We have performed a systematic review of the literature to examine the various techniques for measurement of breast volume and to assess their accuracy and usefulness in clinical practice. Each of the fifteen studies we identified had more than ten live participants and assessed volume measurement accuracy using a gold-standard based on the volume, or mass, of a mastectomy specimen. Many of the studies from this review report large (>200 ml) uncertainty in breast volume and many fail to assess measurement accuracy using appropriate statistical tools. Of the methods assessed, MRI scanning consistently demonstrated the highest accuracy with three studies reporting errors lower than 10% for small (250 ml), medium (500 ml) and large (1000 ml) breasts. However, as a high-cost, non-routine assessment other methods may be more appropriate.
2016-08-23T10:38:28Z
2016-08-23T10:38:28Z
2016-06
Article
Breast. 2016 Jun 8;28:121-129. doi: 10.1016/j.breast.2016.05.010. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/291
en
oai:eastmid.openrepository.com:20.500.12904/2922021-06-03T09:44:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Accuracy of GE digital breast tomosynthesis vs supplementary mammographic views for diagnosis of screen-detected soft-tissue breast lesions.
Turnbull, Anne
Digital Breast Tomosynthesis
Soft Tissue Abnormality
Mammography
Author(s) Pre Print Only
OBJECTIVE: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. METHODS: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. RESULTS: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views-the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review-AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. CONCLUSION: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. ADVANCES IN KNOWLEDGE: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.
2016-08-24T13:09:22Z
2016-08-24T13:09:22Z
2016-06
Article
Br J Radiol. 2016;89(1058):20150735. doi: 10.1259/bjr.20150735. Epub 2015 Nov 11.
http://hdl.handle.net/20.500.12904/292
en
oai:eastmid.openrepository.com:20.500.12904/2932021-06-03T09:44:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Multicentre analysis of incidental findings on low-resolution CT attenuation correction images: an extended study
Birchall, James
Myocardial Perfusion Imaging
CT Images
Author(s) pre-print version only
OBJECTIVE: To review new incidental findings detected on low-resolution CT attenuation correction (CTAC) images acquired during single-photon emission CT-CT myocardial perfusion imaging as an extension to our initial study. METHODS: CTAC images acquired as part of myocardial perfusion imaging performed using single-photon emission CT at four UK nuclear medicine centres were evaluated as part of a multicentre study. New incidental findings that were considered to be clinically significant were evaluated further. Positive-predictive value (PPV) was determined at the time of definitive diagnosis. RESULTS: Out of 3485 patients, 962 (28%) patients had a positive finding on the CTAC image, of which 824 (24%) were new findings. 84 (2.4%) patients had findings that were considered clinically significant at the time of the CTAC report and which had not been previously diagnosed. However, only 10 (0.29%) of these had findings that were confirmed as clinically significant, with the potential to be detrimental to patient outcome, after follow-up and definitive diagnosis. CONCLUSION: The overall PPV from all centres over the 2-year period was 12%. Each centre achieved what we considered to be low PPVs with no significant difference between the present and initial studies. The additional data from the combined studies show that, statistically, there is no significant difference between the PPVs from any of the centres. We conclude that routine reporting of CTAC images is not beneficial. ADVANCES IN KNOWLEDGE: This study combined with the previous study offers a unique evaluation of new clinically significant incidental findings on low-resolution CT images in an attempt to determine the benefit of reporting the CTAC images.
2016-09-13T10:49:59Z
2016-09-13T10:49:59Z
2015-10
Article
Br J Radiol. 2015;88(1056):20150555. doi: 10.1259/bjr.20150555. Epub 2015 Oct 23.
http://hdl.handle.net/20.500.12904/293
en
oai:eastmid.openrepository.com:20.500.12904/2942021-06-03T09:44:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Non-invasive assessment of Portal Hypertension Using Quantitative Magnetic Resonance Imaging.
Austin, Andrew
Singh, Rajeev
Thurley, Peter
Radiology
MRI
BACKGROUND & AIMS: Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure. METHODS: 30 patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase-contrast MRI) were assessed. We estimated the liver stiffness measurement (LSM) and Enhanced Liver Fibrosis (ELF) score. The correlation of all non-invasive parameters with HVPG was evaluated. RESULTS: The mean (range) HVPG of the patients was 9.8(1-22)mmHg, and 14 patients (48%) had clinically significant portal hypertension (CSPH, HVPG ⩾10mmHg). Liver T1 relaxation time, splenic artery and superior mesenteric artery velocity correlated significantly with HVPG. Using multiple linear regression, liver T1 and splenic artery velocity remained as the two parameters in the multivariate model significantly associated with HVPG (R=0.90, p<0.001). This correlation was maintained in patients with CSPH (R=0.85, p<0.001). A validation cohort (n=10) showed this linear model provided a good prediction of HVPG. LSM and ELF score correlated significantly with HVPG in the whole population but the correlation was absent in CSPH. CONCLUSIONS: MR parameters related to both hepatic architecture and splanchnic haemodynamics correlate significantly with HVPG. This proposed model, confirmed in a validation cohort, could replace the invasive HVPG measurement. LAY SUMMARY: In patients with cirrhosis, the development and progression of portal hypertension is related to worse outcomes. However, the standard technique of assessing portal pressure is invasive and not widely used in clinical practice. Here, we have studied the use of non-invasive MRI in evaluating portal pressure. The MRI measures of liver architecture and blood flow in the splenic artery correlated well with portal pressure. Therefore, this non-invasive method can potentially be used to assess portal pressure in clinical trials and monitoring treatment in practice.
2016-08-16T13:47:06Z
2016-08-16T13:47:06Z
2016-07
Article
Journal of Hepatology. 2016 Jul 27. pii: S0168-8278(16)30348-8. doi: 10.1016/j.jhep.2016.07.021.
http://hdl.handle.net/20.500.12904/294
en
oai:eastmid.openrepository.com:20.500.12904/2952021-06-03T09:44:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Evaluation of the impact of a brief educational message on clinicians' awareness of risks of ionising-radiation exposure in imaging investigations: a pilot pre-post intervention study.
Skelly, Robert
Sturrock, Nigel
Norwood, Mark
Thurley, Peter
Clinician Education
Clinician Knowledge
Computed Tomography
Radiation Protection
Radiation Risks
BACKGROUND: In the context of increasing availability of computed tomography (CT) scans, judicious use of ionising radiation is a priority to minimise the risk of future health problems. Hence, education of clinicians on the risks and benefits of CT scans in the management of patients is important. METHODS: An educational message about the associated lifetime cancer risk of a CT scan was added to all CT scan reports at a busy acute teaching hospital in the UK. An online multiple choice survey was completed by doctors before and after the intervention, assessing education and knowledge of the risks involved with exposure to ionising radiation. RESULTS: Of 546 doctors contacted at baseline, 170 (31%) responded. Over a third (35%) of respondents had received no formal education on the risks of exposure to ionising radiation. Over a quarter (27%) underestimated (selected 1 in 30,000 or negligible lifetime cancer risk) the risk associated with a chest, abdomen and pelvis CT scan for a 20 year old female. Following exposure to the intervention for 1 year there was a statistically significant improvement in plausible estimates of risk from 68.3 to 82.2% of respondents (p < 0.001). There was no change in the proportion of doctors correctly identifying imaging modalities that do or do not involve ionising radiation. CONCLUSIONS: Training on the longterm risks associated with diagnostic radiation exposure is inadequate among hospital doctors. Exposure to a simple non-directional educational message for 1 year improved doctors' awareness of risks associated with CT scans. This demonstrates the potential of the approach to improve knowledge that could improve clinical practice. This approach is easily deliverable and may have applications in other areas of clinical medicine. The wider and longer term impact on radiation awareness is unknown, however, and there may be a need for regular mandatory training in the risks of radiation exposure.
2020-02-07T14:20:34Z
2020-02-07T14:20:34Z
2019-11
Article
BMC Health Serv Res. 2019 Nov 14;19(1):841. doi: 10.1186/s12913-019-4712-y.
http://hdl.handle.net/20.500.12904/295
en
oai:eastmid.openrepository.com:20.500.12904/2962021-06-03T09:44:35Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Development and assessment of a Microsoft Kinect based system for imaging the breast in three dimensions.
Goyal, Amit
Three Dimensional Scanning
Mammometrics
Breast Surgery
Mannequin
Three-dimensional surface imaging technologies have been used in the planning and evaluation of breast reconstructive and cosmetic surgery. The aim of this study was to develop a 3D surface imaging system based on the Microsoft Kinect and assess the accuracy and repeatability with which the system could image the breast. A system comprising two Kinects, calibrated to provide a complete 3D image of the mannequin was developed. Digital measurements of Euclidean and surface distances between landmarks showed acceptable agreement with manual measurements. The mean differences for Euclidean and surface distances were 1.9mm and 2.2mm, respectively. The system also demonstrated good intra- and inter-rater reliability (ICCs>0.999). The Kinect-based 3D surface imaging system offers a low-cost, readily accessible alternative to more expensive, commercially available systems, which have had limited clinical use.
2016-11-02T16:26:16Z
2016-11-02T16:26:16Z
2014-06
Article
Med Eng Phys. 2014 Jun;36(6):732-8. doi: 10.1016/j.medengphy.2013.12.018
http://hdl.handle.net/20.500.12904/296
en
oai:eastmid.openrepository.com:20.500.12904/2972021-06-03T09:44:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Dosimetric Comparison and Potential for Improved Clinical Outcomes of Paediatric CNS Patients Treated with Protons or IMRT.
Armoogum, Kris
Paediatrics
Proton Therapy
IMRT
CNS
Medulloblastoma
Craniopharyngioma
Ependymoma
BACKGROUND: We compare clinical outcomes of paediatric patients with CNS tumours treated with protons or IMRT. CNS tumours form the second most common group of cancers in children. Radiotherapy plays a major role in the treatment of many of these patients but also contributes to late side effects in long term survivors. Radiation dose inevitably deposited in healthy tissues outside the clinical target has been linked to detrimental late effects such as neurocognitive, behavioural and vascular effects in addition to endocrine abnormalities and second tumours. METHODS: A literature search was performed using keywords: protons, IMRT, CNS and paediatric. Of 189 papers retrieved, 10 were deemed relevant based on title and abstract screening. All papers directly compared outcomes from protons with photons, five papers included medulloblastoma, four papers each included craniopharyngioma and low grade gliomas and three papers included ependymoma. RESULTS: This review found that while proton beam therapy offered similar clinical target coverage, there was a demonstrable reduction in integral dose to normal structures. CONCLUSIONS: This in turn suggests the potential for superior long term outcomes for paediatric patients with CNS tumours both in terms of radiogenic second cancers and out-of-field adverse effects.
2016-09-08T13:22:37Z
2016-09-08T13:22:37Z
2015-04
Article
Cancers (Basel). 2015 Apr 28;7(2):706-22. doi: 10.3390/cancers7020706.
http://hdl.handle.net/20.500.12904/297
en
oai:eastmid.openrepository.com:20.500.12904/2982021-06-03T09:44:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Skin sparing mastectomy and immediate breast reconstruction: a review.
Agrawal, Amit
Sibbering, Mark
Courtney, Carol-Ann
Breast
Mastectomy
Breast Reconstruction
Author(s) Pre or Post Print Only
AIMS: Skin Sparing Mastectomy (SSM) is widely practised now in major centres which manage large numbers of breast cancer but anxiety still exists over the safety of SSM both from oncological and aesthetic points of view. We aim to review literature to date in SSM and summarise and discuss the current evidence. METHODS: Studies were identified by an online search of the English language literature in the PubMed database till April 2012 followed by an extensive review of bibliographies from relevant articles. RESULTS: There is abundance of evidence with regards to the safety of SSM both oncologically and aesthetically especially in immediate breast reconstruction. The use of SSM technique broadens the repertoire of oncoplastic techniques and at the same time facilitates such techniques by preserving patient's native skin and anatomical landmarks. CONCLUSIONS: SSM is a safe technique providing better cosmetic outcome without compromising oncological safety as per the current evidence. However, prospective data collection of its application in various newer types of reconstructions, and continuing long-term follow-up of current data series would be prudent to evaluate long-term outcomes.
2016-10-11T15:33:39Z
2016-10-11T15:33:39Z
2013-04
Article
Eur J Surg Oncol. 2013 Apr;39(4):320-8. doi: 10.1016/j.ejso.2012.12.015. Epub 2013 Jan 17.
http://hdl.handle.net/20.500.12904/298
en
oai:eastmid.openrepository.com:20.500.12904/2992021-06-03T09:44:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
The radiological management of pseudoaneurysms complicating pancreatitis.
De Rosa, Antonella
Gomez, Dhanwant
Pollock, John
Bungay, Peter
De Nunzio, Mario
Hall, Richard
Thurley, Peter
Pancreatitis
Pseudoaneurysm
Endovascular Embolisation
CONTEXT: Pseudoaneurysms associated with pancreatitis are rare, and bleeding pseudoaneurysms are associated with a high mortality. OBJECTIVE: The aim of this study was to report the outcomes of endovascular and percutaneous therapy in the management of pseudoaneurysms secondary to pancreatitis. PATIENTS: Patients who underwent angiography for pseudoaneurysms associated with pancreatitis from 2005 to 2011 were identified from the angiography database. MAIN OUTCOME MEASURES: Patient demographics, clinical presentation, radiological findings, treatment, and outcomes were retrospectively reviewed. RESULTS: Nineteen pseudoaneurysms associated with pancreatitis in 13 patients were identified. The diagnosis of a pseudoaneurysm was made by computerised tomography angiography in seven patients, followed by portal venous phase contrast enhanced CT (n=4), duplex ultrasound (n=1) and angiography (n=1). At angiography, coil embolisation was attempted in 11 patients with an initial success rate of 82% (n=9). One patient underwent successful embolisation with percutaneous thrombin injection. The recurrence rate following initial successful embolisation was 11% (n=1). There were no episodes of re-bleeding following embolisation but re-bleeding following thrombin injection was observed in one case. The morbidity and mortality rate in the 12 patients that were successfully treated was 25% (n=3) and 8% (n=1), respectively. All 12 patients that were successfully treated demonstrated radiological resolution of their pseudoaneurysms, with a median follow-up of 20 months. CONCLUSION: Endovascular embolisation is a suitable first-line management strategy associated with low recurrence rates. The role of percutaneous thrombin injection is yet to be defined.
2016-10-13T15:01:24Z
2016-10-13T15:01:24Z
2012-11
Article
JOP. 2012 Nov 10;13(6):660-6. doi: 10.6092/1590-8577/1193.
http://hdl.handle.net/20.500.12904/299
en
oai:eastmid.openrepository.com:20.500.12904/3002021-06-03T09:44:36Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Axillary treatment for patients with early breast cancer and lymph node metastasis: systematic review protocol.
Goyal, Amit
Fakis, Apostolos
Axillary Treatment
Breast Cancer
Breast
Cancer
Radiotherapy
BACKGROUND: For patients with early breast cancer and lymph node metastasis, axillary treatment is widely recommended. This is either surgical removal of the axillary lymph nodes, or axillary radiotherapy. The rationale for axillary treatment is that it will reduce the risk of recurrence in the axilla, and may improve survival. However, both treatments are associated with adverse effects, such as lymphedema, pain and sensory loss, and are costly to the health services and to patients. With improvements in adjuvant therapy, routine axillary treatment may no longer offer any overall advantage. OBJECTIVES: To assess the short and long term benefits and adverse effects of routine axillary treatment (axillary lymph node clearance or axillary radiotherapy) for patients with lymph node positive early-stage breast cancer. METHODS/DESIGN: Criteria for potentially eligibility for the study will be that the participants are men and women with early breast cancer and lymph nodes with metastasis. The study compares either axillary treatment with no axillary treatment, or axillary node clearance with axillary radiotherapy, and the study is a randomized trial. Primary outcomes are axillary recurrence, disease-free and overall survival. Secondary outcomes include breast or chest wall recurrence, distant metastasis, time to axillary recurrence, axillary recurrence-free survival, arm morbidity, quality of life and health economic costs. The search strategy will include the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform (ICTRP) search portal. Two independent reviewers will assess studies for inclusion in the review, assess study quality and extract data. Characteristics of included studies will be described. Meta-analysis will be conducted using ReVman software. COMMENT: This review addresses an important clinical question, and results will inform clinical practice and health care policy.
2016-10-11T15:53:15Z
2016-10-11T15:53:15Z
2013-01
Article
World J Surg Oncol. 2013 Jan 14;11:6. doi: 10.1186/1477-7819-11-6.
http://hdl.handle.net/20.500.12904/300
en
oai:eastmid.openrepository.com:20.500.12904/3012021-06-03T09:44:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Invasive lobular carcinoma arising in accessory breast tissue.
Devine, Catriona
Courtney, Carol-Ann
Deb, Rahul
Agrawal, Amit
Invasive Lobular Carcinoma
Breast Tissue
Breast
Excision Biopsy
Lobular
BACKGROUND: Lobular carcinoma in accessory breast tissue is a rare occurrence. We present such a case in a 61-year-old woman. CASE PRESENTATION: A skin nodule in the axillary skin on excision biopsy revealed invasive lobular carcinoma. CONCLUSIONS: Carcinoma in accessory breast tissue is uncommon especially invasive lobular type. A high index of suspicion may avoid late diagnosis.
2016-10-11T14:11:38Z
2016-10-11T14:11:38Z
2013-02
Article
World J Surg Oncol. 2013 Feb 26;11:47. doi: 10.1186/1477-7819-11-47.
http://hdl.handle.net/20.500.12904/301
en
oai:eastmid.openrepository.com:20.500.12904/3022021-06-03T09:44:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
MRI findings in herniation of the spinal cord.
Kwong, Yune
Jakanani, George
Rao, Nitin
Fang, Christopher
Spinal Cord
Herniation
MRI
Neurosurgical
Herniation of the spinal cord is a rare condition that causes non specific neurological deficits that are often a diagnostic challenge to clinicians. Despite several reports in the neurosurgical literature, it is only recently that the imaging appearances of this condition have come to be recognised, due mainly to the widespread adoption of spinal MRI. It is important for radiologists to recognise the telltale MRI features of this condition, as several cases have undergone initial misdiagnosis, resulting in delayed treatment We present a case with typical imaging features to familiarise radiologists with this condition, as it is likely that more cases will come to the fore, with more spinal MRIs being performed.
2016-10-26T13:32:41Z
2016-10-26T13:32:41Z
2010
Article
J Radiol Case Rep. 2010;4(10):1-5. doi: 10.3941/jrcr.v4i10.528. Epub 2010 Oct 1.
http://hdl.handle.net/20.500.12904/302
en
oai:eastmid.openrepository.com:20.500.12904/3032021-06-03T09:44:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Symmetrisation procedures in breast reconstruction patients constitute a rising workload in our DGH.
Al-Khyatt, Waleed
Mathew, J
Courtney, Carol-Ann
Symmetrisation Procedure
Breast Cancer
Reconstructive Surgery
INTRODUCTION: In breast cancer patients undergoing reconstructive surgery, achieving symmetry is of considerable importance. The aim of our study was to identify the proportion of breast cancer patients undergoing reconstructive surgery requiring contralateral symmetrisation procedures. PATIENTS AND METHODS: This is a retrospective review of consecutive patients undergoing reconstructive procedures following cancer surgery from April 2005 to April 2012. RESULTS: One hundred and fifty three patients had symmetrisation procedure of the opposite side during this period. The median age was 53 years (22-79). Reduction mammoplasty was the commonest procedure (94 patients), followed by mastopexy (34 patients) and augmentation mammoplasty (25 patients). Overall, it represent approximately one third of (153/489; 31.2%) of all the major reconstruction procedures in this unit. CONCLUSION: Almost half the number of patients (153/336) undergoing breast reconstruction as a part of breast cancer surgery had a symmetrisation procedure performed on the opposite side which constitutes a significant reconstructive workload in our unit. Consideration should be given to the above when planning departmental work force and training.
2016-11-03T16:38:23Z
2016-11-03T16:38:23Z
2014-12
Article
Surgeon. 2014 Dec;12(6):307-9. doi: 10.1016/j.surge.2013.11.023. Epub 2014 Jan 18.
http://hdl.handle.net/20.500.12904/303
en
oai:eastmid.openrepository.com:20.500.12904/3042021-06-03T09:44:37Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
POSNOC: A Randomised Trial Looking at Axillary Treatment in Women with One or Two Sentinel Nodes with Macrometastases
Goyal, Amit
Breast Cancer
Lymph Nodes
Morbidity
Axillary Treatment
2016-08-18T11:23:02Z
2016-08-18T11:23:02Z
2015-12
Article
Clin Oncol (R Coll Radiol). 2015 Dec;27(12):692-5. doi: 10.1016/j.clon.2015.07.005. Epub 2015 Aug 5.
http://hdl.handle.net/20.500.12904/304
en
oai:eastmid.openrepository.com:20.500.12904/3052021-06-03T09:44:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Initial experience with a new fenestrated stent graft.
Bungay, Peter
De Nunzio, Mario
Stent Graft
Endovascular Aneurysm
Renal Arteries
OBJECTIVES: The Anaconda fenestrated stent graft (Vascutek, Inchinnan, United Kingdom) is a new device that can easily be repositioned during deployment. This study evaluated its feasibility for treating abdominal aortic aneurysms with inadequate infrarenal sealing zones. METHODS: Patients undergoing stent graft placement at two institutions in the United Kingdom were recruited. RESULTS: A total of 12 visceral vessels were accommodated with 8 fenestrations for renal arteries and 4 superior mesenteric artery valleys/scallops in 4 successfully treated. CONCLUSIONS: The Anaconda fenestrated stent graft device can be used for the repair of abdominal aortic aneurysms with hostile anatomy and has acceptable immediate and short-term results.
2016-10-19T11:25:11Z
2016-10-19T11:25:11Z
2011-12
J Vasc Surg. 2011 Dec;54(6):1832-8. doi: 10.1016/j.jvs.2011.05.115. Epub 2011 Sep 29.
http://hdl.handle.net/20.500.12904/305
oai:eastmid.openrepository.com:20.500.12904/3062021-06-03T09:44:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Development and evaluation of a brief educational cartoon on trainee clinicians' awareness of risks of ionising-radiation exposure: a feasibility pre-post intervention study of a novel educational tool to promote patient safety
Thurley, Peter
Bowker, R
Bhatti, Imran
Skelly, Robert
Communication
Medical Education
Patient Safety
Background: Over recent decades, CT scans have become routinely available and are used in both acute medical and outpatient environments. However, there is a small increase in the risk of adverse consequences, including an increase in the risk of both malignancy and cataracts. Clinicians are often unaware of these facts, and this represents a challenge for medical educators in England, where almost 5 million CT scans are done annually. New whiteboard methodologies permit development of innovative educational tools that are efficient and scalable in communicating simple educational messages that promote patient safety.
Methods: A short educational whiteboard cartoon was developed to explore the prior observation that adolescents under the care of paediatricians had a much lower risk of receiving a CT scan than those under the care of clinicians who care for adults. This explored the risks after receiving a CT scan and strategies that can be used to avoid them. The educational cartoon was piloted on new doctors who were attending induction training at a busy teaching hospital. Results: The main output was the educational whiteboard cartoon itself. Before the new medical trainees' induction, 56% (25/45) had received no formal training in radiation awareness, and this decreased to 26% (6/23) after the exposure to the educational cartoon (p=0.02). At baseline, 60% (27/45) of respondents considered that young females were at highest risk from exposure to ionising radiation, and this increased to 87% (20/23) after exposure to the educational cartoon (p=0.06). Conclusions: This proof-of-concept feasibility study demonstrates that whiteboard cartoons provide a novel and feasible approach to efficiently promote patient safety issues, where a short succinct message is often appropriate.
2020-12-14T11:00:59Z
2020-12-14T11:00:59Z
2020-11
Article
BMJ Open Qual. 2020 Nov;9(4):e000900. doi: 10.1136/bmjoq-2019-000900.
http://hdl.handle.net/20.500.12904/306
en
oai:eastmid.openrepository.com:20.500.12904/3072021-06-03T09:44:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Modelling the radiobiological effect of intraoperative X-ray brachytherapy for breast cancer using an air-filled spherical applicator.
Armoogum, Kris
Evans, Simon
Brachytherapy
Breast Cancer
Radiobiology
X-Ray
PURPOSE: We present a framework, in which we compare a conventional standard dose of 50 Gy in 25 fractions with accelerated partial breast irradiation (APBI) using electronic brachytherapy (eBT). We discuss how radiobiological modelling enables us to establish a framework, within which we can compare external beam radiotherapy (EBRT). This leads to a determination of the shell of isoeffect in breast tissue, at which very low kV eBT can be considered to be clinically equivalent to standard EBRT. MATERIAL AND METHODS: To estimate relative biological effectiveness (RBE) values as a function of dose and irradiation time, we used a modified linear quadratic (LQ) approach, taking into account the ability of this new device, to deliver 20 Gy at the surface of a 40 mm diameter rigid, hollow spherical applicator in less than 2 minutes. In this study, we considered the radiobiological effectiveness of the Papillon +™ X-ray brachytherapy device operating at 30 kV, 0.3 mA producing dose rates in excess of 14 Gy/min. RESULTS: Calculated clinical RBEs ranged from 1.154 at the surface of a 40 mm diameter applicator to 1.100 at 35 mm from the applicator surface for the Papillon+ device. The absolute physical dose D (abs) 30 kV ranged from 20.00 Gy at the applicator surface to 1.20 at 35 mm distant. The product of the isoeffective single dose of (60)Co reference radiation - (RBE)(60)Co, and the RBE corrected standard 2 Gy equivalent dose fractions (EQD2) doses, EQD2(30 kV) * (RBE)(60)Co ranged from 98.62 Gy at the applicator surface to 1.13 at 35 mm. The 'shell of isoeffect', the value on the X-axis where the EQD2(30 kV) * (RBE)(60)Co line crosses the 50 Gy mark on the Y-axis, was found to be approximately 3.5 mm beyond the applicator surface. CONCLUSIONS: The 'shell of isoeffect' can serve as a useful metric with which to compare the radiobiological effectiveness of low kV eBT with various regimes of conventional EBRT.
2016-09-27T14:04:22Z
2016-09-27T14:04:22Z
2016-09
Article
J Contemp Brachytherapy. 2016 Aug;8(4):313-8. doi: 10.5114/jcb.2016.61758. Epub 2016 Aug 16.
http://hdl.handle.net/20.500.12904/307
en
oai:eastmid.openrepository.com:20.500.12904/3082021-06-03T09:44:38Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip?
Tafazal, Suhayl
Hip Dysplasia
Family History
Ultrasound
Developmental Dysplasia Hip
BACKGROUND: We routinely perform a pelvic radiograph between 6 and 12 months of age for children with a family history of developmental dysplasia of hip (DDH). We conducted this study to determine whether children with a family history of DDH and a normal hip ultrasound after birth require any further radiological follow-up. METHODS: We identified all children referred to our hip-screening clinic in a 3-year period between August 2008 and August 2011 with a family history of DDH and a normal hip ultrasound after birth. A total of 119 patients with a normal hip ultrasound after birth had a pelvic radiograph at a median age of 6.6 months. RESULTS: Six patients had residual dysplasia (acetabular index >30°) on the initial radiograph; five of these had resolved spontaneously by age 12 months, and the remaining patient had a normal radiograph at 21 months of age and was discharged. CONCLUSION: We have found no cases of residual hip dysplasia requiring treatment in children with a family history of DDH and a normal hip ultrasound after birth. We have therefore changed our practice accordingly and no longer routinely followed up such cases. LEVEL OF EVIDENCE: Diagnostic study, Level II.
2016-08-16T14:39:58Z
2016-08-16T14:39:58Z
2016-07
Article
Eur J Orthop Surg Traumatol. 2015 Oct;25(7):1171-5. doi: 10.1007/s00590-015-1668-4. Epub 2015 Jul 15.
http://hdl.handle.net/20.500.12904/308
en
oai:eastmid.openrepository.com:20.500.12904/3092021-06-03T09:44:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Adequacy of percutaneous non-targeted liver biopsy under real-time ultrasound guidance when comparing the Biopince™ and Achieve™ biopsy needle.
Hall, Thomas
Deakin, Claire
Atwal, Gurprit
Singh, Rajeev
Percutaneous Liver Biopsy
Parenchymal Liver Disease
12 month embargo
AIM: The purpose of this study was to compare the adequacy rates of percutaneous liver biopsies, in parenchymal liver disease, using the Biopince™ 16G and Achieve™ 18G biopsy needles in relation to the Royal College of Pathologists guidelines and to assess risk of complications. METHOD: Data for all percutaneous non-targeted 'medical' liver biopsies using the Biopince™ 16G and Achieve™ 18G biopsy needles were collected retrospectively over a 2-year period. Total biopsy core length and number of portal tracts was recorded along with adequacy of biopsy as assessed according to RCPath criteria. RESULTS: In total 194 percutaneous liver biopsies met the inclusion criteria; 53 using the Biopince™ needle and 141 using the Achieve™ needle.The mean total core length was 23mm (SD 4.1) and 20mm (SD 6.8) for the Biopince™ and Achieve™ needles respectively (p=0.0005). The mean number of portal tracts was 11 (SD 4.2) and 7 (SD 3.4) for the Biopince™ and Achieve™ needles respectively (p<0.0001). An adequate biopsy was obtained in 15 (31.3%) and 1 (1.3%) case using the Biopince™ and Achieve™ needles respectively (p<0.001). Compromised biopsies were obtained in 32 (66.7%) and 39 (50.6%) cases using the Biopince™ and Achieve™ needles respectively. Inadequate biopsies were obtained in 1 (2%) and 37 (48.1%) cases using the Biopince™ and Achieve™ needles respectively. CONCLUSION: The Biopince™ 16G needle, when compared with the Achieve™ 18G needle, acquires a significantly greater total core length and number of portal tracts with significantly improved adequacy rates. There were no major complications associated with its use. Advances in knowledge: The Biopince™ 16G needle achieves significantly better specimen adequacy, when compared with the Achieve™ 18G needle and with no added major complications associated with its use.
2017-10-11T15:39:14Z
2017-10-11T15:39:14Z
2017-10
Article
Br J Radiol. 2017 Oct 3:20170397. doi: 10.1259/bjr.20170397. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/309
en
oai:eastmid.openrepository.com:20.500.12904/3102021-06-03T09:44:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Factors influencing local control in patients undergoing breast conservation surgery for ductal carcinoma in situ.
Mathew, J
Robertson, JF
Ductal Carcinoma
Local Recurrence
Prognostic Factors
Breast Conservation Surgery
BACKGROUND: The aim of our study was to assess various predictors for local recurrence (LR) in patients undergoing breast conservation surgery (BCS) for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: An audit was performed of 582 consecutive patients with DCIS between Jan 1975 to June 2008. In patients undergoing BCS, local guidelines reported a margin of ≥10 mm during the above period. Guideline with regard to margin of excision changes soon after this period. We retrospectively analysed clinical and pathological risk factors for local recurrence in patients undergoing BCS. Statistical analysis was carried out using SPSS version 19, and a cox regression model for multivariate analysis of local recurrence was used. RESULTS: Overall 239 women had BCS for DCIS during the above period. The actuarial 5-year recurrence rate was 9.6%. The overall LR rate was 17% (40/239. LR was more common in patients ≤50 years: (10/31 patients, 32%) compared to patients > 50 years (30/208, 14%, P = 0.02). Forty three per cent of patients (6/14) with <5 mm margin developed LR which was significantly higher compared to patients with 5-9 mm margin (12%, 3/25) and with ≥10 mm margin (14%, 27/188, P = 0.01). On multivariate analysis age ≤50 years, <5 mm pathological margin were independent prognostic factors for local recurrence. CONCLUSION: Our study shows that younger age (≤50 years) and a margin < 5 mm are poor prognostic factors for LR in patients undergoing breast conservation surgery for DCIS.
2016-12-01T10:04:11Z
2016-12-01T10:04:11Z
2016-11
Article
Breast. 2016 Nov 18;31:181-185. doi: 10.1016/j.breast.2016.11.002
http://hdl.handle.net/20.500.12904/310
en
oai:eastmid.openrepository.com:20.500.12904/3112021-06-03T09:44:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
Turner, G
Ovarian Cancer
Ultrasound
OBJECTIVE: To describe the quality assurance (QA) processes and their impact on visualization of postmenopausal ovaries in the ultrasound arm of a multicentre screening trial for ovarian cancer. METHODS: In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 50 639 women aged 50-74 years were randomized to the ultrasound arm and underwent annual transvaginal ultrasound (TVS) examinations. QA processes were developed during the course of the trial and included regular monitoring of the visualization rate (VR) of the right ovary. Non-subjective factors identified previously as impacting on VR of the right ovary were included in a generalized estimating equation model for binary outcomes to enable comparison of observed vs adjusted VR between individual sonographers who had undertaken > 1000 scans during the trial and comparison between centers. Observed and adjusted VRs of sonographers and centers were ranked according to the highest VR. Analysis of annual VRs of sonographers and those of the included centers was undertaken. RESULTS: Between June 2001 and December 2010, 48 230 of 50 639 women attended one of 13 centers for a total of 270 035 annual TVS scans. One or both ovaries were seen in 228 145 (84.5%) TVS scans. The right ovary was seen on 196 426 (72.7%) of the scans. For the 78 sonographers included in the model, the median difference between observed and adjusted VR was -0.7% (range, -7.9 to 5.9%) and the median change in VR rank after adjustment was 3 (range, 0-18). For the 13 centers, the median difference between observed and adjusted VR was -0.5% (range, -2.2 to 1%), with no change in ranking after adjustment. The median adjusted VR was 73% (interquartile range (IQR), 65-82%) for sonographers and 74.7% (IQR, 67.1-79.0%) for centers. Despite the increasing age of the women being scanned, there was a steady decrease in the number of sonographers with VR < 60% (21.4% in 2002 vs 2.0% in 2010) and an increase in sonographers with VR > 80% (14.3% in 2002 vs 40.8% in 2010). The median VR of the centers increased from 65.5% (range, 55.7-81.0%) in 2001 to 80.3% (range, 74.5-90.9%) in 2010. CONCLUSIONS: A robust QA program can improve visualization of postmenopausal ovaries and is an essential component of ultrasound-based ovarian cancer screening trials. While VR should be adjusted for non-subjective factors that impact on ovarian visualization, subjective factors are likely to be the largest contributors to differences in VR.
2016-08-17T14:34:38Z
2016-08-17T14:34:38Z
2016-02
Article
http://hdl.handle.net/20.500.12904/311
en
oai:eastmid.openrepository.com:20.500.12904/3122021-06-03T09:44:39Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Breast pain
Goyal, Amit
Breast
Breast Pain
INTRODUCTION: Breast pain may be cyclical (worse before a period) or noncyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E.
2016-10-25T12:52:32Z
2016-10-25T12:52:32Z
2011-01
Article
BMJ Clin Evid. 2011 Jan 17;2011. pii: 0812.
http://hdl.handle.net/20.500.12904/312
en
oai:eastmid.openrepository.com:20.500.12904/3132021-06-03T09:44:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Demand for CT scans increases during transition from paediatric to adult care: An observational study from 2009 to 2015.
Thurley, Peter
Crookdake, Jonathan
Norwood, Mark
Sturrock, Nigel
CT Scan
12 month Embargo on PDF
OBJECTIVE: Avoiding unnecessary radiation exposure is a clinical priority in children and young adults. We aimed to explore demand for CT scans in a busy general hospital with particular interest in the period of transition from paediatric to adult medical care. METHODS: We used an observational epidemiological study based in a teaching hospital. Data were obtained on numbers and rates of CT scans from 2009 to 2015. The main outcome was age-stratified rates of receiving a CT scan. RESULTS: There were a total of 262,221 CT scans. There was a large step change in the rate of CT scans over the period of transition from paediatric to adult medical care. Individuals aged 10-15 years experienced 6.7 CT scans per 1000 clinical episodes, while those aged 19-24 years experienced 19.8 CT scans per 1000 clinical episodes (p<0.001). This difference remained significant for all sensitivity analyses. CONCLUSION: There is almost a threefold increase in rates of CT scans in the two populations before and after the period of transition from paediatric to adult medical care. While we were unable to adjust for case mix or quantify radiation exposure, paediatricians' diagnostic strategies to minimize radiation exposure may have clinical relevance for adult physicians, and hence enable reductions in ionizing radiation to patients. Advances in knowledge: A large increase in rates of CT scans occurs during adolescence and paediatricians' strategies to minimize radiation exposure may enable reductions to all patients.
2017-11-28T11:44:56Z
2017-11-28T11:44:56Z
2017-11
Article
Br J Radiol. 2017 Nov 16:20170467. doi: 10.1259/bjr.20170467.
http://hdl.handle.net/20.500.12904/313
en
oai:eastmid.openrepository.com:20.500.12904/3142021-06-03T09:44:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Response to Letter to the Editor re Patient and public beliefs about the role of imaging in the management of non-specific low back pain: a scoping review
Taylor, Stephanie
Imaging
Low Back Pain
2020-12-03T10:32:07Z
2020-12-03T10:32:07Z
2020-09
Article
Physiotherapy. 2020 Sep 1:S0031-9406(20)30409-0. doi: 10.1016/j.physio.2020.08.005.
http://hdl.handle.net/20.500.12904/314
en
oai:eastmid.openrepository.com:20.500.12904/3152021-06-03T09:44:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial.
Turnbull, Anne
Breast Cancer
Breast Cancer Screening
BACKGROUND: In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). METHODS: In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX
numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. FINDINGS: We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%]
of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). INTERPRETATION: These findings show that a policy of second appointments with
fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. FUNDING: National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
2017-05-23T16:04:15Z
2017-05-23T16:04:15Z
2017-05
Article
Lancet Oncol. 2017 May 15. pii: S1470-2045(17)30340-6. doi: 10.1016/S1470-2045(17)30340-6. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/315
en
oai:eastmid.openrepository.com:20.500.12904/3162021-06-03T09:44:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Current trends in breast surgery.
Goyal, Amit
Breast Cancer
Breast Surgery
Breast Reconstruction
Lipofilling
Therapeutic Mammoplasty
Breast surgery has evolved significantly over the last decade. This includes developments in pre-operative assessment of patients and surgical options offered to patients. Oncoplastic breast surgery has emerged as a new approach and uses plastic surgery techniques for reconstructing the wide local excision defect.
2016-10-13T13:43:48Z
2016-10-13T13:43:48Z
2012-12
Article
Indian J Surg Oncol. 2012 Dec;3(4):287-91. doi: 10.1007/s13193-012-0175-x. Epub 2012 Aug 3.
http://hdl.handle.net/20.500.12904/316
en
oai:eastmid.openrepository.com:20.500.12904/3172021-06-03T09:44:40Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
Breast Pain.
Goyal, Amit
Breast
Breast Pain
2016-08-23T15:01:48Z
2016-08-23T15:01:48Z
2016-05
Article
Am Fam Physician. 2016 May 15;93(10):872-3.
http://hdl.handle.net/20.500.12904/317
en
oai:eastmid.openrepository.com:20.500.12904/3182021-06-03T09:44:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
The development of a low cost 3D surface imaging system to measure breast volume: Defining minimum standards using an adapted Delphi consensus study.
Goyal, Amit
Breast
Breast Reconstruction
3D Imaging
2016-11-08T15:15:13Z
2016-11-08T15:15:13Z
2015-12
Article
J Plast Reconstr Aesthet Surg. 2015 Dec;68(12):1770-2. doi: 10.1016/j.bjps.2015.09.014. Epub 2015 Oct 9.
http://hdl.handle.net/20.500.12904/318
en
oai:eastmid.openrepository.com:20.500.12904/3192021-06-03T09:44:41Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_4
CT imaging doses in radiotherapy-a single centre audit
Armoogum, Kris
Cornish, G
Evans, Simon
CT Scan
Dosage
Radiotherapy
Author(s) Pre or Post Print Version Only
: Purpose or Objective: There is a growing awareness of dose delivered to parts the body outside the target volume during external beam radiotherapy. This concomitant dose could arise from external linac head leakage and scatter, scattered therapy dose outside the target volume, as well as nontherapeutic doses from imaging for planning and delivery, such as CT planning scans. Total concomitant dose has increased steadily with the introduction of more imaging procedures to the treatment process and the drive for better images quality. Much of this exposure is only loosely monitored and it could be the case that the cumulative concomitant dose has a negative biological effect even within the context of radiotherapy [1]. To quantify the dose contributed by CT planning scans, a retrospective dose audit was carried out on a TOSHIBA AQUILION LB multislice CT scanner at Derby Teaching Hospitals in July 2015. Material and Methods: A cohort of 200 patients were identified, twenty each from ten of the most frequently used CT scanning protocols who were scanned in the 12 months immediately prior to the dose audit. Patients undergoing CT planning scans were initially identified in the Mosaiq Oncology Information System (Elekta, Crawley, UK) and subsequently interrogated via the PACSWeb system, (Centricity Enterprise Web V3.0, GE Healthcare, Barrington, IL). Data harvested from PACSWeb included: Number of slices, slice thickness, CTDIVOL, DLP, Patient sex, Patient Age, total scan time, transverse width and AP width. Mean Effective Dose (E) was derived from values of DLP for each examination using appropriately normalised coefficients. As yet, there are no published UK national guidelines for planning CT scans. However, to put the results of this audit into context we have compared local DLP and CTDIvol to similar values published for a previous UK national (diagnostic CT) dose audit [2]. The following relationships were reported: CSA vs Age, CTDIvol vs CSA, DLP vs CSA, CTDIvol by Patient, DLP by Patient. Results: The mean scan length, DLP, CTDIvol and Effective Dose by Protocol were found for each protocol. The most significant result was that the DLP values from the Head & Neck protocol were tightly clustered but higher than one would normally expect. The mean DLP was a factor of 4 greater than the head and neck reference level reported in the previous UK national (diagnostic CT) dose audit. Conclusion: The results from this CT dose audit can be used as local Radiotherapy Imaging Reference Levels (RIRL). They will be able to guide protocol optimisation, allow comparison with other similarly equipped radiotherapy departments and participation in regional and national audits. The higher than expected DLP values for the Head & Neck protocol highlighted here has prompted a reassessment of the scanning parameters and may lead to protocol optimisation. (Figure Presented).
2018-01-23T17:01:08Z
2018-01-23T17:01:08Z
2016-04
Article
Radiotherapy and Oncology; Apr 2016; vol. 119
http://hdl.handle.net/20.500.12904/319
en
oai:eastmid.openrepository.com:20.500.12904/3202021-06-03T09:46:24Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Mortality and Institutionalization After Percutaneous Endoscopic Gastrostomy in Parkinson's Disease and Related Conditions.
Skelly, Robert
Brown, Lisa
PEG
Parkinson's Disease
Percutaneous Endoscopic Gastroscopy
Tube Feeding
Background: Percutaneous endoscopic gastrostomy (PEG) can facilitate feeding and medication administration in dysphagic patients with Parkinson's disease and related disorders. Information on survival, institutionalization, and complications post PEG might inform feeding decisions. Method: A total of 93 patients with Parkinson's disease and related disorders were identified by review of PEG registers and by searching the administrative databases in 2 large UK university hospitals (2005-2017); 83 case notes were available for retrospective review. Care processes and outcomes were assessed. Results: The following were the diagnoses: 58 (70%) had Parkinson's disease, 10 (12%) had progressive supranuclear palsy, 5 (6%) had multiple system atrophy, 3 (4%) had dementia with Lewy bodies, and 7 (8%) had vascular parkinsonism. The median age was 78 years (interquartile range 72-82); 29 (35%) were women. Care processes included a future care plan in place prior to admission for 18 patients (22%), and PEG was placed during emergency admission in 68 patients (82%). The outcomes included median survival at 422 days; 30-day mortality rate was 6% (5 patients); and of 56 patients admitted from home, 18 (32%) were discharged to institutions (nursing or care homes). The most common complication was aspiration pneumonia for 18 (22%) of patients. Age, sex, diagnosis, admission type, comorbidities, and place of residence did not predict survival. Discharge to own home and follow-up by the home enteral feeding team were associated with longer survival. Conclusion: We recommend markers of advanced disease should prompt advanced care planning. Discussions about PEG feeding should include information about post-PEG survival, complications, and risk of institutionalization. Further research is needed on quality-of-life post PEG and ways to reduce aspiration pneumonia. All PEG patients should have nutrition team follow-up.
2020-07-20T11:09:36Z
2020-07-20T11:09:36Z
2020-06
Article
Mov Disord Clin Pract. 2020 Jun 9;7(5):509-515. doi: 10.1002/mdc3.12971. eCollection 2020 Jul.
http://hdl.handle.net/20.500.12904/320
en
oai:eastmid.openrepository.com:20.500.12904/3212021-06-03T09:46:24Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Remote Ischemic Conditioning After Stroke Trial 2: A Phase IIb Randomized Controlled Trial in Hyperacute Stroke.
England, Tim
Feasibility
Randomised Controlled Trial
Remote Ischaemic Conditioning
Stroke
Background Repeated episodes of limb ischemia and reperfusion (remote ischemic
conditioning [RIC]) may protect the brain from ischemic reperfusion injury.
Methods and Results We performed a phase IIb blinded dose-escalation
sham-controlled trial in patients with hyperacute stroke, randomized 1:1 to
receive RIC (four 5-minute cycles) or sham to the nonparetic upper limb, in 3
blocks of increasing dose, starting within 6 hours of ictus. The primary outcome
was trial feasibility (recruitment, attrition). Secondary outcomes included
adherence, tolerability, safety (serious adverse events), plasma biomarkers at
days 1 and 4 (S100-ß protein, matrix metalloproteinase-9, and neuron-specific
enolase), and functional outcome. Sixty participants were recruited from 2
centers (3 per month) with no loss to follow-up: time to randomization 4 hours
5 minutes (SD 72 minutes), age 72 years (12), men 60%, blood pressure
154/80 mm Hg (25/12), National Institutes of Health Stroke Scale 8.4 (6.9), and
55% thrombolyzed. RIC was well tolerated with adherence not differing between RIC
and sham, falling in both groups on day 3 (P=0.001, repeated measures ANOVA)
because of discharge or transfer. S100ß increased in the sham group (mean rise
111 pg/mL [302], P=0.041, repeated measures ANCOVA) but not the RIC group. There were no differences in matrix metalloproteinase-9, neuron-specific enolase,
number with serious adverse events (RIC 10 versus sham 10, P=0.81), deaths (2
versus 4, P=0.36), or modified Rankin Scale score (2 [interquartile range 1-4], 2
[interquartile range, 1-3]; P=0.85). Conclusions RIC in hyperacute stroke is
feasible when given twice daily for 2 days and appears safe in a small population
with hyperacute stroke. A larger phase III trial is warranted. Clinical Trial
Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02779712.
2020-01-24T11:07:54Z
2020-01-24T11:07:54Z
2019-12
Article
J Am Heart Assoc. 2019 Dec 3;8(23):e013572. doi: 10.1161/JAHA.119.013572. Epub 2019 Nov 21.
http://hdl.handle.net/20.500.12904/321
en
oai:eastmid.openrepository.com:20.500.12904/3222021-06-03T09:46:24Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Short-term preoperative high-intensity interval training does not improve fitness of colorectal cancer patients.
Boereboom, CL
Blackwell, James
Williams, John P
Phillips, Bethan
Lund, Jonathan
Cardiorespiratory Fitness
Exercise Programmes
Cancer Patients
Author(s) Pre Print Version. 12 month Embargo on Post
BACKGROUND: Preoperative cardiorespiratory fitness (CRF) in colorectal cancer (CRC) patients has been shown to affect postoperative outcomes. The aim of this study was to test the feasibility of high-intensity interval training (HIIT) for improving fitness in preoperative CRC patients within the 31-day cancer waiting time targets imposed in the UK. METHODS: Eighteen CRC patients (13 males, mean age: 67 years (range: 52-77 years) participated in supervised HIIT on cycle ergometers 3 or 4 times each week prior to surgery. Exercise intensity during 5x1-minute HIIT intervals (interspersed with 90-seconds recovery) was 100-120% maximum wattage achieved at a baseline cardiopulmonary exercise test (CPET). CPET before and after HIIT was used to assess CRF. RESULTS: Patients completed a mean of 8 HIIT sessions (range 6-14) over 19 days (SD 7). There was no significant increase in VO2 peak (23.9±7.0 vs. 24.2±7.8 ml/kg/min (mean±SD), p=0.58) or anaerobic threshold (AT: 14.0±3.4 vs. 14.5±4.5 ml/kg/min, p=0.50) after HIIT. There was a significant reduction in resting systolic blood pressure (152±19 vs. 142±19 mmHg, p=0.0005) and heart rate at submaximal exercise intensities after HIIT. CONCLUSIONS: Our pragmatic HIIT exercise protocol did not improve the preoperative fitness of CRC patients within the 31-day window available in the UK to meet cancer surgical waiting time targets.
2019-06-05T15:06:35Z
2019-06-05T15:06:35Z
2019-05
Article
Scand J Med Sci Sports. 2019 May 22. doi: 10.1111/sms.13460. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/322
en
oai:eastmid.openrepository.com:20.500.12904/3232021-06-03T09:46:24Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Time-efficient physical activity interventions to reduce blood pressure in older adults: a randomised controlled trial.
Herrod, Philip
Lund, Jonathan
Ageing
Blood Pressure
Exercise
Health
Older People
Static
Background: Hypertension is a risk factor for both cardiovascular and cerebrovascular disease, with an increasing incidence with advancing patient age. Exercise interventions have the potential to reduce blood pressure in older adults, however, rates of exercise uptake and adherence are low, with 'lack of time' a commonly cited reason. As such, there remains the need for time-efficient physical activity interventions to reduce blood pressure in older adults. Objective: To compare the effect of three, novel time-efficient physical activity interventions on resting blood pressure in older adults. Methods: Forty-eight, healthy, community-dwelling older adults (mean age: 71 years) were recruited to a 6-week randomised control trial. Resting blood pressure was measured before and after one of three supervised, time-efficient interventions: high-intensity interval training (HIIT) on a cycle ergometer; isometric handgrip training (IHG); unilateral, upper limb remote ischaemic preconditioning (RIPC) or non-intervention control. Results: Both HIIT and IHG led to a statistically significant reduction in resting systolic blood pressure (SBP) of 9 mmHg, with no significant change in the RIPC or control groups. There was no change in diastolic blood pressure or pulse pressure in any group. Conclusions: Supervised HIIT or IHG using the protocols described in this study can lead to statistically significant and clinically relevant reductions in resting SBP in healthy older adults in just 6 weeks.
2020-12-03T11:14:02Z
2020-12-03T11:14:02Z
2020-10
Article
Age Ageing. 2020 Oct 17:afaa211. doi: 10.1093/ageing/afaa211. Online ahead of print
http://hdl.handle.net/20.500.12904/323
en
oai:eastmid.openrepository.com:20.500.12904/3242021-06-03T09:46:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Delayed administration of dopaminergic drugs is not associated with prolonged length of stay of hospitalized patients with Parkinson's disease.
Skelly, Robert
Brown, Lisa
Delay
Length of Stay
Medication
Parkinson's Disease
I-Dopa
BACKGROUND: Punctual delivery of dopaminergic medication to Parkinson's disease (PD) patients may be important in optimizing disease control. We tested the hypothesis that prompt delivery of l-dopa medications to emergency hospital inpatients was associated with a decreased length of stay in hospital. METHODS: The study population consisted of all urgent hospitalizations for patients with a diagnosis of PD to the Royal Derby Hospital over a two-year period. Data were extracted on timing of delivery of drugs, number of co-morbidities and length of stay. Statistical analysis used linear regression adjusting for within admission clustering. RESULTS: 431 individuals provided data from a total of 737 admissions. 39% of scheduled l-dopa doses were either not given or administered over 30 min later than the scheduled time. There was no association between the omission or timing of a dose of PD medication and length of stay in hospital. The number of coded diagnoses was strongly associated with length of stay with a dose-response association (pTREND<0.001). Those with 10 concurrent diagnoses had a 11 day longer stay (95% confidence intervals: +2 to +21) than those with no comorbidities. CONCLUSIONS: Delayed administration of dopaminergic drugs is not associated with prolonged length of stay of in patients with PD who were admitted to hospital as an emergency. However, the number of co-existing medical diagnoses was associated with length of stay, and early attention to these has the potential to improve patient care and decrease length of stay in hospital.
2016-12-06T11:19:06Z
2016-12-06T11:19:06Z
2016-11
Article
Parkinsonism Relat Disord. 2016 Nov 14. pii: S1353-8020(16)30435-7. doi: 10.1016/j.parkreldis.2016.11.004. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/324
en
oai:eastmid.openrepository.com:20.500.12904/3252021-06-03T09:46:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Cannabidiol protects an in vitro model of the blood-brain barrier from oxygen-glucose deprivation via PPARγ and 5-HT1A receptors.
England, Tim
Cannabidiol
Stroke
Acute Stroke
BACKGROUND AND PURPOSE: In vivo and in vitro studies have demonstrated a protective effect of cannabidiol (CBD) in reducing infarct size in stroke models and against epithelial barrier damage in numerous disease models. We aimed to investigate whether CBD also affects blood-brain barrier (BBB) permeability following ischaemia. EXPERIMENTAL APPROACH: Human brain microvascular endothelial cell (HBMEC) and human astrocyte co-cultures modelled the BBB. Ischaemia was modelled by oxygen-glucose deprivation (OGD) and permeability was measured by transepithelial electrical resistance. KEY RESULTS: CBD (10 μM) prevented the increase in permeability caused by 4 h OGD. CBD was most effective when administered before the OGD, but protective effects were observed up to 2 h into reperfusion. This protective effect was inhibited by a PPARγ antagonist and partly reduced by a 5-HT1A receptor antagonist, but was unaffected by antagonists of cannabinoid CB1 or CB2 receptors, TRPV1 channels or adenosine A2A receptors. CBD also reduced cell damage, as measured by LDH release and by markers of cellular adhesion, such as the adhesion molecule VCAM-1. In HBMEC monocultures, CBD decreased VCAM-1 and increased VEGF levels, effects which were inhibited by PPARγ antagonism. CONCLUSIONS AND IMPLICATIONS: These data suggest that preventing permeability changes at the BBB could represent an as yet unrecognized mechanism of CBD-induced neuroprotection in ischaemic stroke, a mechanism mediated by activation of PPARγ and 5-HT1A receptors.
2016-12-20T16:15:33Z
2016-12-20T16:15:33Z
2016-03
Article
Br J Pharmacol. 2016 Mar;173(5):815-25. doi: 10.1111/bph.13368
http://hdl.handle.net/20.500.12904/325
en
oai:eastmid.openrepository.com:20.500.12904/3262021-06-03T09:46:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.
Gordon, Adam
Health Services for the Aged
Homes for the Aged
Nursing Homes
Older People
Primary Care
Author(s) Pre or Post Print Version Only. No PDF
Introduction: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. Methods: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied
health professionals and General Practitioners. Results: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. Conclusion: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.
2018-01-16T09:29:07Z
2018-01-16T09:29:07Z
2018-01
Article
Age Ageing. 2018 Jan 5. doi: 10.1093/ageing/afx195.
http://hdl.handle.net/20.500.12904/326
en
oai:eastmid.openrepository.com:20.500.12904/3272021-06-03T09:46:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial
Blackwell, James
Doleman, Brett
Boereboom, CL
Atherton, P
Smith, K
Williams, John P
Phillips, Bethan
Lund, Jonathan
Cancer Therapy
Prostate Cancer
Objectives: To assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks. Subjects/patients and methods: A randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO2AT) following HIIT vs. standard care. Results: Forty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO2AT; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25-3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: -8.2 mmHg (95% CI -16.09 to -0.29) and DBP: -6.47 mmHg (95% CI -12.56 to -0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%. Conclusions: HIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable pre-operative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socio-economic impact and long-term survival.
2020-12-07T14:02:18Z
2020-12-07T14:02:18Z
2020-12
Article
Prostate Cancer Prostatic Dis. 2020 Dec;23(4):696-704. doi: 10.1038/s41391-020-0219-1. Epub 2020 Mar 10.
http://hdl.handle.net/20.500.12904/327
en
oai:eastmid.openrepository.com:20.500.12904/3282021-06-03T09:46:25Zcom_20.500.12904_2com_20.500.12904_1col_20.500.12904_7
A meta-analysis of remote ischaemic conditioning in experimental stroke.
England, Tim
Ischaemic Stroke
Author(s) pre or post print version only
Remote ischaemic conditioning (RIC) is achieved by repeated transient ischaemia of a distant organ/limb and is neuroprotective in experimental ischaemic stroke. However, the optimal time and methods of administration are unclear. Systematic review identified relevant preclinical studies; two authors independently extracted data on infarct volume, neurological deficit, RIC method (administration time, site, cycle number, length of limb occlusion (dose)), species and quality. Data were analysed using random effects models; results expressed as standardised mean difference (SMD). In 57 publications incorporating 99 experiments (1406 rats, 101 mice, 14 monkeys), RIC reduced lesion volume in transient (SMD -2.0; 95% CI -2.38, -1.61; p < 0.00001) and permanent (SMD -1.54; 95% CI -2.38, -1.61; p < 0.00001) focal models of ischaemia and improved neurological deficit (SMD -1.63; 95% CI -1.97, -1.29, p < 0.00001). In meta-regression, cycle length and number, dose and limb number did not interact with infarct volume, although country and physiological monitoring during anaesthesia did. In all studies, RIC was ineffective if the dose was <10 or ≥50 min. Median study quality was 7 (range 4-9/10); Egger's test suggested publication bias (p < 0.001). RIC is most effective in experimental stroke using a dose between 10 and 45 min. Further studies using repeated dosing in animals with co-morbidities are warranted.
2020-07-15T14:38:47Z
2020-07-15T14:38:47Z
2020-06
Article
J Cereb Blood Flow Metab. 2020 Jun 14:271678X20924077. doi: 10.1177/0271678X20924077. [Epub ahead of print]
http://hdl.handle.net/20.500.12904/328
en
oai_dc////100