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Amugongo L, Osorio EV, Green A, Cobben D, van Herk M, McWilliam A. Impact of registration uncertainties on the prediction of early tumour response to radiotherapy in NSCLC patients. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tzilivakis J, Warner DJ, Green A, Lewis KA. A broad-scale spatial analysis of the environmental benefits of fertiliser closed periods implemented under the Nitrates Directive in Europe. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 299:113674. [PMID: 34492440 DOI: 10.1016/j.jenvman.2021.113674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Nutrient pollution from agriculture has been an ongoing challenge for decades, contributing to numerous negative environmental impacts. In the European Union policies have been developed to address nutrient pollution, including Nitrate Action Programmes under Council Directive 91/676/EEC. Although Member States report on progress on implementation, there have been few studies that explore how measures have been implemented; the environmental implications of any differences; and how they vary spatially on a European scale. This study aims to address this gap with respect to fertiliser closed periods (1155 different closed periods across 69 Nitrate Action Programmes). This included the development of an approach that can be applied using readily available spatial data. Each closed period was scored for its coverage of risk periods for losses of nitrate; organic material; nitrous oxide and ammonia. Closed periods were then matched to relevant combinations of spatial data for each environmental zone and fertiliser type. The scores for each combination were used to create maps and calculate spatial statistics. The results show that in addition to nitrate, closed periods also reduce the risk of organic material run-off, emissions of nitrous oxide and to a lesser extent ammonia. However, risk reduction is spatially variable across all the impacts and the scope for synergy is also variable (e.g. nitrate loss does not always correlate with nitrous oxide or ammonia risk reduction). Regions in the Atlantic, Lustanian and some areas within the Mediterranean zones appear to provide the greatest combined risk reduction, with other zones, especially in eastern Europe, having a lower combined risk reduction (due to a combination of different risk periods coupled with lower coverage of individual risks). The spatial analysis within this study is relatively simple; is based on a snapshot of closed periods during 2019-2020; and only explores one measure. However, it does provide some useful data and insights that could support policy development in the future. This includes scope for Member States and regions to learn from others where greater coverage of risk periods has been achieved; and highlighting how a more holistic perspective can be taken to the environmental management of nutrients. As we strive towards developing sustainable production systems, farmers and policy makers need to take a more integrated approach to incorporate additional environmental objectives; which increases the complexity of the challenge. Consequently, the demand for pragmatic approaches that take a more holistic approach is likely to increase in the future.
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Green S, Tuck S, Long J, Green T, Green A, Ellis P, Haire A, Moss C, Cahill F, McCartan N, Brown L, Santaolalla A, Marsden T, Justo MR, Hadley J, Punwani S, Attard G, Ahmed H, Moore CM, Emberton M, Van Hemelrijck M. ReIMAGINE: a prostate cancer research consortium with added value through its patient and public involvement and engagement. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:81. [PMID: 34789334 PMCID: PMC8596340 DOI: 10.1186/s40900-021-00322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND ReIMAGINE aims to improve the current prostate specific antigen (PSA)/biopsy risk stratification for prostate cancer (PCa) and develop a new image-based method (with biomarkers) for diagnosing high/low risk PCa in men. ReIMAGINE's varied patient and public involvement (PPI) and engagement (PE) strategy maximises the impact of its scientific output by informing and shaping the different stages of research. AIMS Through including the voice of patients and the public, the ReIMAGINE Consortium aims to translate these different perspectives into the design and implementation process. This will improve the overall quality of the research by: reflecting the needs and priorities of patients and the public, ensuring methods and procedures are feasible and appropriate ensuring information is relevant and accessible to those being recruited to the study identifying dissemination channels relevant to patients/the public and developing outputs that are accessible to a lay audience With support from our patient/user groups, the ReIMAGINE Consortium aims to improve our ability to derive prognostic information and allocate men to the most appropriate and effective therapies, using a novel image-based risk stratification with investigation of non-imaging biomarkers. FINDINGS We have been working with patients and the public from initiation of the project to ensure that the research is relevant to men and their families. Our PPI Sub-Committee, led by a PCa patient, has been involved in our dissemination strategy, outreach activities, and study design recommendations. For example, the sub-committee have developed a variety of informative videos relevant and accessible to those being recruited, and organised multiple online research engagement events that are accessible to a lay audience. As quoted by one of the study participants, "the more we present the benefits and opportunities to patients and the public, the more research commitment we obtain, and the sooner critical clinical questions such as PCa diagnostics will be addressed".
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Abravan A, Vasquez Osorio E, Green A, McPartlin A, van Herk M. Anatomical Association of Dose Distribution With Radiotherapy-Related Lymphopenia in Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Phan H, Daines C, Green A, Camick N, Goodman A, Woo T, Riekert K. 290: Feasibility and acceptability of a medication schedule mobile application as part of CF care: A pilot, real-world, mobile health study in CF clinics. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jegatheeswaran L, Choi B, Rocha MF, Green A. 1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals.
Method
An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020.
Results
In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November.
Conclusions
Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.
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Warr H, Murray O, McSweeney D, McWilliam A, Green A. PD-0783 Automated sarcopenia assessment in the neck and survival analysis in head and neck cancer patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Robbins J, Argota-Perez R, Green A, van Herk M, Korreman S, Vasquez Osorio E. OC-0363 Evaluation of how well a PCA model represents anatomical variations during H&N radiation treatment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McSweeney D, Bromiley P, van Herk M, Green A, McWilliam A. PO-1673 Improving data collection for deep-learning auto-segmentation models. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Henderson E, Vasquez Osorio E, van Herk M, Brouwer C, Steenbakkers R, Green A. PO-1695 Accurate H&N 3D segmentation with limited training data using 2-stage CNNs. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08146-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hague C, McPartlin A, Lee LW, Hughes C, Mullan D, Beasley W, Green A, Price G, Whitehurst P, Slevin N, van Herk M, West C, Chuter R. An evaluation of MR based deep learning auto-contouring for planning head and neck radiotherapy. Radiother Oncol 2021; 158:112-117. [PMID: 33636229 DOI: 10.1016/j.radonc.2021.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Auto contouring models help consistently define volumes and reduce clinical workload. This study aimed to evaluate the cross acquisition of a Magnetic Resonance (MR) deep learning auto contouring model for organ at risk (OAR) delineation in head and neck radiotherapy. METHODS Two auto contouring models were evaluated using deep learning contouring expert (DLCExpert) for OAR delineation: a CT model (modelCT) and an MR model (modelMRI). Models were trained to generate auto contours for the bilateral parotid glands and submandibular glands. Auto-contours for modelMRI were trained on diagnostic images and tested on 10 diagnostic, 10 MR radiotherapy planning (RTP), eight MR-Linac (MRL) scans and, by modelCT, on 10 CT planning scans. Goodness of fit scores, dice similarity coefficient (DSC) and distance to agreement (DTA) were calculated for comparison. RESULTS ModelMRI contours improved the mean DSC and DTA compared with manual contours for the bilateral parotid glands and submandibular glands on the diagnostic and RTP MRs compared with the MRL sequence. There were statistically significant differences seen for modelMRI compared to modelCT for the left parotid (mean DTA 2.3 v 2.8 mm), right parotid (mean DTA 1.9 v 2.7 mm), left submandibular gland (mean DTA 2.2 v 2.4 mm) and right submandibular gland (mean DTA 1.6 v 3.2 mm). CONCLUSION A deep learning MR auto-contouring model shows promise for OAR auto-contouring with statistically improved performance vs a CT based model. Performance is affected by the method of MR acquisition and further work is needed to improve its use with MRL images.
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Heyneke L, Green A. The prevalence and severity of lower back pain in South African university rowers. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2021; 33:v33i1a9323. [PMID: 36816898 PMCID: PMC9924537 DOI: 10.17159/2078-516x/2021/v33i1a9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Low back pain (LBP) is a condition prevalent among rowers due to the repetitive and physically demanding nature of rowing. Information concerning LBP among university-level rowers is, however, outdated and not widely available. Objective To determine the prevalence, severity and disabilities of LBP among university-level rowers in South Africa. Methods An online questionnaire, including the Athlete Disability Index (ADI) Questionnaire, was distributed to nine South African university rowing clubs. One-hundred participants aged between 18 to 30 years completed the online questionnaires. Results Eighty-seven rowers admitted to sustaining LBP either at the time of the study or previously in their university rowing career. These rowers (n=87) completed the Athlete Disability Index (ADI) Questionnaire which provided a moderate LBP disability score (ADI score: 8.1±6.0; ADI %: 24.7%±18.1). Rowers who had been rowing for a longer duration reported a higher severity of LBP (p=0.001). There was no statistically significant difference for LBP prevalence (p=0.584), or severity (p=0.445) between the sexes. A small significant correlation between age and the ADI score (r=0.25, p= 0.021) was reported. The high prevalence and moderate severity highlight the significance of LBP among university rowers. Conclusion This study illustrates the prevalence of LBP with moderate severity among university rowers. Future research on LBP risk factors and aetiology is recommended to decrease the negative impact of this condition.
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Le Roux C, Lombard A, Green A. The physical attributes of sub-elite rugby union referees of inland provinces in South Africa. SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE 2021; 33:v33i1a8835. [PMID: 36816899 PMCID: PMC9924520 DOI: 10.17159/2078-516x/2021/v33i1a8835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The purpose of the on-field referee is to implement the laws of the game. For the referee to do this successfully, he is required to keep up with the pace of play. Objectives The aim of this study was to determine the physical attributes of sub-elite rugby union referees of inland provinces in South Africa. Methods A total of 82 referees (age: 26.5 ± 6.4 years; stature: 177.3 ± 6.8 cm; body mass: 79.1 ± 14.7 kg) were assessed with a reliable testing battery. Results The participants showed a refined aerobic capacity (VO2max: 61.8 ± 11.0 mL·min-1·kg-1) and good agility (Illinois Agility Test: 17.2 ± 3.8 s). A two-way unbalanced ANOVA was performed for all referees' attributes between qualification levels (levels 1-4) and union affiliations (three unions) at a significance level of p<0.05. The results yielded significant differences across the three unions in age (p=0.002), Yo-Yo distance (p=0.0001), aerobic capacity (p=0.0001), plank time (p=0.0001) and agility (p=0.027). Similarly, differences were reported across the four qualifications in aerobic capacity (p=0.0001) and agility (p=0.037). Conclusion These differences may be due to the diverse training programmes offered by the various unions. Additionally, an increased level of physical fitness may occur when progressing up the qualification levels.
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Welby-Everard P, Quantick O, Green A. Emergency preparedness, resilience and response to a biological outbreak. BMJ Mil Health 2020; 166:37-41. [PMID: 31999617 DOI: 10.1136/jramc-2019-001323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 11/03/2019] [Indexed: 11/04/2022]
Abstract
Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.
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Elfassy MD, Duncan LJ, Green A, Sun H, Guimond T, Tzanetos K, Nyhof-Young J. Patients as teachers: Evaluating the experiences of volunteer inpatients during medical student clinical skills training. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e8-e16. [PMID: 33349749 PMCID: PMC7749683 DOI: 10.36834/cmej.70158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Early patient encounters in medical education are an important element of clinical skill development. This study explores the experiences of volunteer inpatients (VIPs) participating in clinical skills training with junior medical students (JMS) solely for educational purposes. METHODS Following first-year medical students practicing history taking and clinical examinations with VIPs at Toronto General Hospital (TGH) and Toronto Western Hospital (TWH), patients completed a questionnaire and a short audio-recorded interview. This study used a mixed methodological approach. A 5-point Likert-scaled survey queried satisfaction regarding the recruitment process, student and faculty interactions and patient demographics (e.g. age and educational background). A 10-minute follow-up interview investigated patient perspectives. Survey responses were correlated to patient demographics and descriptive thematic analysis summarized trends in patient perspectives. RESULTS Of 93 consenting VIPs, 66% were male and 58% participated at TGH. The mean overall experience was positive (4.76 and 4.93 at TGH and TWH, respectively). Three themes emerging through thematic analysis were Not "Just" a Medical Student, Patient as Teacher, and Promoting Best Practices. VIPs reported positive experiences when they were adequately informed of the VIP role during recruitment, and when students exhibited confidence, interest, and respect throughout the session. CONCLUSION Study results provide clarity about VIP experiences with JMS and lay a foundation for improved patient satisfaction and best practices within clinical skills curricula in the health professions.
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Robbins J, Van Herk M, Green A, Eiben B, McPartlin A, Vásquez Osorio E. PO-1650: Evaluating plan robustness for organ deformation and set-up uncertainties in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mcsweeney D, Green A, Bromiley P, Van Herk M, Mansoor W, Weaver J, McWilliam A. PD-0541: Transfer learning for automatic sarcopenia evaluation at T12 vertebral level. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Corden M, Chin S, Cree A, Hoskin P, McWilliam A, Satiti A, Song Y, Green A, Choudhury A. PO-1216: Can sarcopenia predict outcomes in bladder cancer patients treated with chemoradiotherapy? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Amugongo L, Vasquez Osorio E, Green A, Cobben D, Van Herk M, McWilliam A. PO-1569: Early prediction of tumour-response to radiotherapy in NSCLC patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Henderson E, Vasquez Osorio E, Van Herk M, Green A. PO-1755: Use of ‘Jigsaw puzzles’ to train convolutional neural networks for segmentation with limited data. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Green A, Van Herk M, Osorio EV, Weaver J, McWilliam A. PD-0428: Large scale evaluation of sarcopenia as prognostic factor in lung cancer radiotherapy patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Green A, Olsen K, Persson G, Bliddal M, Andersen K, Hallerbäck T, Jakobsen E. 1796P Treatment patterns and survival for small cell lung cancer patients: A nationwide Danish register study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lewis A, Green A, Weaver J, Mansoor W, Cook N. 589P The impact of sarcopenia in patients enrolled in early phase cancer trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bain SC, Bakhai A, Evans M, Green A, Menown I, Strain WD. An update to: Pharmacological treatment for type 2 diabetes integrating findings from cardiovascular outcome trials: an expert consensus in the UK. Diabet Med 2019; 36: 1063-1071. Diabet Med 2020; 37:1405-1407. [PMID: 31691349 DOI: 10.1111/dme.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/27/2022]
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Fischer S, Clements S, Green A, McWilliam A, Descamps T, Oing C, Gillessen S. Influence of treatment with abiraterone and enzalutamide on development of sarcopenia in patients with metastatic castration resistant prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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