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Mileshkin LR, Moore KN, Barnes E, Gebski V, Narayan K, Bradshaw N, Lee YC, Diamante K, Fyles AW, Small W, Gaffney DK, Khaw P, Brooks S, Thompson JS, Huh WK, Carlson M, Mathews CA, Rischin D, Stockler MR, Monk BJ. Adjuvant chemotherapy following chemoradiation as primary treatment for locally advanced cervical cancer compared to chemoradiation alone: The randomized phase III OUTBACK Trial (ANZGOG 0902, RTOG 1174, NRG 0274). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.lba3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA3 Background: Cervical cancer is a common cause of cancer-related death among women worldwide. Standard treatment for locally advanced disease is chemoradiation. However, a significant percentage of women still relapse and die from the development of distant metastatic disease. OUTBACK was designed to determine the effects of giving adjuvant chemotherapy after chemoradiation on survival. Methods: OUTBACK is an international randomized phase III trial of the Gynecologic Cancer InterGroup (GCIG). Participating groups (countries) included ANZGOG (Australia and New Zealand), NRG (USA, Saudi Arabia, Canada, China), and Singapore. Eligible women had locally advanced cervical cancer (FIGO 2008 stage IB1 and node positive, IB2, II, IIIB or IVA) that was suitable for primary treatment with chemo-radiation with curative intent. Women were randomly assigned to either standard cisplatin-based chemo-radiation (control) or standard cisplatin-based chemo-radiation followed by adjuvant chemotherapy (ACT) with 4 cycles of carboplatin and paclitaxel, after stratification for nodal status, participating site, FIGO stage, age, and planned extended-field radiotherapy. The primary end point was overall survival (OS) at 5 years. Secondary endpoints included progression-free survival (PFS); adverse events (AE); and patterns of disease recurrence. The target sample size of 900 provided 80% power with 95% confidence to detect an improvement in OS at 5 years from 72% (control) to 80% (ACT), with some over-accrual to account for non-compliance with ACT and loss to follow-up. Results: 919 of 926 women recruited from April 2011 to June 2017 were eligible and included in the primary analysis: 463 assigned ACT, 456 control. ACT was started in 361 (78%) women assigned to receive it. Median follow-up was 60 months (IQR 45-65). OS at 5 years was similar in those assigned ACT versus control (72% vs 71%, difference <1%, 95% CI -6 to +7; P = 0.91). The hazard ratio for OS was 0·91, (95% CI 0.70 to 1.18). PFS at 5 years was similar in those assigned ACT versus control (63% vs 61%, difference 2%, 95% CI -5 to +9; P = 0.61). The hazard ratio for PFS was 0·87, (95% CI 0.70 to 1.08). AE of grade 3-5 within a year of randomisation occurred in 81% who were assigned and received ACT versus 62% assigned control. There was no evidence of differences between treatment groups in AE beyond 1 year of randomisation. Patterns of disease recurrence were similar in the two treatment groups. Conclusions: Adjuvant chemotherapy given after standard cisplatin-based chemoradiation for women with locally advanced cervical cancer did not improve OS or PFS. Clinical trial information: ACTRN12610000732088.
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Hutchins C, Henderson A, Henden A, Barnes E, Abaca-Cleopas M, Acworth M, McEnroe B, Mudie K, Dropulic B, Schneider D, Kennedy G, Tey S. Place-of-care manufacturing of car19-t cells using an automated closed-system device. Cytotherapy 2021. [DOI: 10.1016/s1465324921006125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhatraju PK, Morrell ED, Zelnick L, Sathe NA, Chai XY, Sakr SS, Sahi SK, Sader A, Lum DM, Liu T, Koetje N, Garay A, Barnes E, Lawson J, Cromer G, Bray MK, Pipavath S, Kestenbaum BR, Liles WC, Fink SL, West TE, Evans L, Mikacenic C, Wurfel MM. Comparison of host endothelial, epithelial and inflammatory response in ICU patients with and without COVID-19: a prospective observational cohort study. Crit Care 2021; 25:148. [PMID: 33874973 PMCID: PMC8054255 DOI: 10.1186/s13054-021-03547-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19. METHODS We prospectively enrolled 171 ICU patients, including 78 (46%) patients positive and 93 (54%) negative for SARS-CoV-2 infection from April to September, 2020. We compared 22 plasma biomarkers in blood collected within 24 h and 3 days after ICU admission. RESULTS In critically ill COVID-19 and non-COVID-19 patients, the most common ICU admission diagnoses were respiratory failure or pneumonia, followed by sepsis and other diagnoses. Similar proportions of patients in both groups received invasive mechanical ventilation at the time of study enrollment. COVID-19 and non-COVID-19 patients had similar rates of acute respiratory distress syndrome, severe acute kidney injury, and in-hospital mortality. While concentrations of interleukin 6 and 8 were not different between groups, markers of epithelial cell injury (soluble receptor for advanced glycation end products, sRAGE) and acute phase proteins (serum amyloid A, SAA) were significantly higher in COVID-19 compared to non-COVID-19, adjusting for demographics and APACHE III scores. In contrast, angiopoietin 2:1 (Ang-2:1 ratio) and soluble tumor necrosis factor receptor 1 (sTNFR-1), markers of endothelial dysfunction and inflammation, were significantly lower in COVID-19 (p < 0.002). Ang-2:1 ratio and SAA were associated with mortality only in non-COVID-19 patients. CONCLUSIONS These studies demonstrate that, unlike other well-studied causes of critical illness, endothelial dysfunction may not be characteristic of severe COVID-19 early after ICU admission. Pathways resulting in elaboration of acute phase proteins and inducing epithelial cell injury may be promising targets for therapeutics in COVID-19.
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Ord JJ, Crockett M, Green J, Bell LTO, Hicks V, Crawford-Smith H, Morss A, Poulton L, Pellisery B, Hayes M, Ludeman L, Beasley M, Fulmali R, Anniss M, Barnes E, Foy C, Nayar RC, McMeekin F, Gilbert H, Okeke A, Akhtar M, Patel B, Eaton J. Correlation of Likert scores III–V with increasingly worse pathology in radical prostatectomy specimens significant only for men aged <60 or PSAD >0.15, with age <60 as good as PSAD <0.15 at discriminating lower risk in Likert III. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821995107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This study aimed to compare Likert scores with radical prostatectomy specimens. Methods: This study examined 443 men with validated pre-biopsy magnetic resonance imaging results and used cross-tabulation and chi-square significance testing with National Comprehensive Cancer Network risk categories. Results: The mean prostate-specific antigen (PSA) was 10, and the mean age was 64 years. Comparing Likert III to Likert V and Likert IV to Likert V, both (each p=0.02) were significantly associated with higher prostate cancer risk groups, but Likert III versus Likert IV was not ( p=0.1). Within the subgroup PSA density (PSAD) <0.15 ( n=140), the correlation of Likert score and final pathological risk group was lost ( p=0.5), but it was not lost within the subgroup PSAD >0.15 ( n=281; p=0.045 III vs. IV only and p=0.055 overall). Within the subgroup age <60 ( n=104), the correlation of Likert score and final pathological risk group was significant ( p=0.006 for III vs. IV and p=0.04 overall), whereas within the subgroup age >60 ( n=339) this significant difference was lost ( p=0.34). Further subgroup analysis within Likert III ( n=86) found that men <60 ( n=22) had neither high-grade (G3 or G4 or G5) nor very high-risk disease. There were only two high-risk cases, both of which were G2T3a (2/22; 10%). In men with Likert III and PSAD <0.15 ( n=31), there were seven high-risk and two very high-risk cases (9/31; 25%). This difference was not significant ( p=0.31) Conclusion: With these two findings, we recommend that men <60 with Likert III can be counselled like men with Likert III and PSAD <0.15, that they are unlikely to have unfavourable or high-risk disease and that they may wish to avoid biopsy or treatment. Level of evidence: Level 1b.
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Bartos NSO, Hamilton S, Barnes E, Caldwell PHY. Toilet training children with special needs using a Potty Monkey toy device. J Paediatr Child Health 2021; 57:365-370. [PMID: 33078489 DOI: 10.1111/jpc.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/09/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
AIM Toilet training children with special needs can be challenging and can result in long-term consequences if inadequately addressed. This study evaluates the use of a 'Potty Monkey' toy for toilet training children with special needs. METHODS A pilot study using a 'Potty Monkey' to model timed voiding in children with special needs. We collected parental feedback and examined the experience of families using a 'Potty Monkey' to toilet train their child. Using logistic regression we explored patient factors for association with outcomes. RESULTS Of 21 children in our study, 15 were male. Age ranged 4-10 years (median 6.3 years). Days that 'Potty Monkey' was used ranged 0-156 (median 22 days). At 6 months, nine children had improved, five were unchanged and four were worse (three were unknown). We found no evidence of association between patient factors (age, gender, days using 'Potty Monkey', baseline toileting ability, Paediatric Incontinence Questionnaire score) and toileting outcome. The experience of families was ambivalent. 10 families reported 'Potty Monkey' had been helpful however many complained it interfered with family schedules. Reasons for the child not responding positively were due to sensory issues, embarrassment and being developmentally not ready. Our study demonstrated the practical challenges of conducting research among children with special needs. CONCLUSION Although some children's toileting improved after using 'Potty Monkey', we are uncertain 'Potty Monkey' is effective for toilet training children with special needs.
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Agar M, Nowak A, Hovey E, Barnes E, Simes J, Vardy J, Wheeler H, Leonard R, Hall M, Tim E, Spyridopoulos D, Sim HW, Lwin Z, Dowling A, Harrup R, Jennens R, Kichenadasse G, Dunlop T, Gzell C, Koh ES. QOLP-23. PHASE II RANDOMISED PLACEBO-CONTROLLED DOUBLE-BLIND STUDY OF ACETAZOLAMIDE VERSUS PLACEBO FOR CEREBRAL OEDEMA IN RECURRENT AND/OR PROGRESSIVE HIGH-GRADE GLIOMA REQUIRING TREATMENT WITH DEXAMETHASONE. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Symptoms of raised intracranial pressure (ICP) in recurrent or progressive high-grade glioma (HGG) generally require corticosteroid treatment, often causing toxicity with variable effects on reversing ICP symptoms. Acetazolamide reduces ICP in other clinical settings including case series in glioma.
AIM
To explore whether addition of oral acetazolamide enables safe dexamethasone dose reduction in management of raised ICP in recurrent and/or progressive HGG.
METHODS
Participants had recurrent, progressive and/or persistent residual HGG requiring recommencement of dexamethasone, dose increase or dexamethasone dependency; prior/current bevacizumab was an exclusion. Eligible participants were randomised 1:1 to acetazolamide 250mg twice daily or placebo for 8 weeks. Standardised protocols were used for dexamethasone dose changes in both arms, with planned dose decrease from day 5 once ICP symptoms were stable. The primary endpoint was a composite of dexamethasone dose reduction and stability of performance status. Secondary endpoints included toxicity and feasibility (accrual and compliance).
RESULTS
Thirty participants of a planned sample of 84 were enrolled (mean age 58 y (32-89)) from 7 Australian sites. The mean baseline dexamethasone dose was 6.2mg (4-16mg). Mean duration on treatment was 38 days (4-57) in placebo group and 31 days (3-60) in acetazolamide group, with 9 participants (30%) completing all study treatment (6 placebo, 3 acetazolamide). Study withdrawal was due to adverse events (n=6 (1 placebo, 5 acetazolamide)) and disease progression (n=6 (3 per arm)). Four participants (13%) (2 per arm) were stable responders meeting the primary endpoint criteria (≥50% corticosteroid dose reduction from baseline by 28 days maintained for 7 days, and no deterioration in performance status). Ten participants experienced a total of 13 serious adverse events (acetazolamide arm: 5 participants (33%), 6 events, 2 related).
DISCUSSION
The addition of acetazolamide did not facilitate dexamethasone reduction. The study closed early due to poor accrual and increasing availability of bevacizumab.
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Voruganti I, Poon I, Husain Z, Zhang L, Chin L, Erler D, Barnes E, Higgins K, Enepekides D, Eskander A, Karam I. SBRT For Head and Neck Skin Cancer: An Initial Experience in 106 Medically Unfit Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.714] [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]
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Donovan E, Cheung P, Erler D, Davidson M, Sahgal A, Chung H, Poon I, Taggar A, Barnes E, Jerzak K, Gien L, Leung E. Stereotactic Ablative Radiotherapy (SABR) in Oligometastatic and Oligoprogressive Gynecologic Cancers: Clinical Outcomes of a Single Institution Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1389] [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]
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Peyronnet B, Barnes E, Palma J, Spalink C, Kauffman H, Brucker B. Dysfonctions vésicosphinctériennes chez les patients atteints de dysautonomie familiale : une étude prospective. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leung E, D'Alimonte L, Taggar A, Barnes E, Donovan E, Barbera L, Ravi A. Integrated Intraoperative MRI-Guided Brachytherapy for Cervical Cancer: An Institutional Experience of Treatment Workflow, Planning and Patient Toxicities. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1538] [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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Nash L, Scott K, Pit S, Barnes E, Ivory K, Hooker C. Evaluation of a workshop using verbatim theatre stimuli to address challenging workplace situations: a pilot study. CLINICAL TEACHER 2020; 18:43-50. [PMID: 32767630 DOI: 10.1111/tct.13229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Challenging workplace situations such as bullying, harassment, depression, suicide and fatigue exist in health care. The performing arts can generate dialogue and engagement with these difficult issues. This study evaluates a workshop for health care students that used filmed vignettes from a verbatim theatre play that used real stories of such situations. The workshop aimed to improve health professional students' confidence in seeking help for depression, addressing mistreatment, understanding mandatory reporting laws and the impact of driver fatigue. METHODS Two workshops were held: one with a mixture of professions, including nursing, medical and allied health students, and the other with medical students only. Participants completed questionnaires before and after each workshop, responding to four Likert questions on understanding and confidence about the issues discussed and free-text responses about the perceived value of the workshop. RESULTS Sixty-five people took part in the workshops, with a 100% response rate to the pre-workshop survey and a 98% response rate (n = 64) to the post workshop survey. Students most frequently reported an improvement in understanding mandatory reporting laws (57%), followed by an increase in confidence in dealing with bullying and harassment (44%). Students in the workshop with a mix of professions noted the benefit of learning about these challenging issues alongside students from other health professions. DISCUSSION Students valued the facilitated discussion of sensitive issues. Although many respondents increased their understanding or confidence in the four topics, a smaller proportion reported a reduction after the workshop. Perhaps this resulted from greater appreciation of the complexities of these issues. Health care students valued hearing from other professional groups in the mixed professions workshop.
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Han K, Mendez L, D'Souza D, Velker V, Barnes E, Milosevic MF, Fyles A, Ferguson SE, Taggar A, Croke J, Donovan E, Leung E. Management of gynecologic cancer: Choosing radiotherapy wisely by 3 Southern Ontario academic centers during the COVID-19 pandemic. Radiother Oncol 2020; 151:15-16. [PMID: 32673779 PMCID: PMC7357506 DOI: 10.1016/j.radonc.2020.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
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Jones T, Spence R, Sandler C, Obermair A, Friedlander M, Mileshkin L, Davis A, Janda M, Eakin E, Barnes E, Beesley V, Gordon L, Brand A, Hayes S. Are The ACSM Exercise Guidelines Safe And Achievable For Women Receiving Chemotherapy For Ovarian Cancer? Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679180.61253.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mendez LC, Raziee H, Davidson M, Velker V, D'Souza D, Barnes E, Leung E. Should we embrace hypofractionated radiotherapy for cervical cancer? A technical note on management during the COVID-19 pandemic. Radiother Oncol 2020; 148:270-273. [PMID: 32474128 PMCID: PMC7255703 DOI: 10.1016/j.radonc.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/03/2020] [Accepted: 05/17/2020] [Indexed: 12/25/2022]
Abstract
Cervical cancer is a deadly disease and the COVID-19 pandemic has the potential to further impact its lethality. Hypofractionated radiotherapy could mitigate this impact, however robust data in cervical cancer setting still is lacking. Information provided here could help institutions in reducing radiotherapy fractions for cervical cancer patients.
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Mendez LC, Ravi A, Martell K, Raziee H, Alayed Y, Wronski M, Paudel M, Barnes E, Taggar A, Wong CS, Leung E. Comparison of CTV HR and organs at risk contours between TRUS and MR images in IB cervical cancers: a proof of concept study. Radiat Oncol 2020; 15:73. [PMID: 32252792 PMCID: PMC7137277 DOI: 10.1186/s13014-020-01516-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/18/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare CTVHR and OAR dimensions and inter-rater agreement between magnetic resonance (MR) and trans-rectal ultrasound (TRUS) images in IB cervical cancer patients. Methods IB cervical cancer patients treated with (chemo)radiotherapy plus MR-guided brachytherapy (BT) were prospectively enrolled in this study. Radiation oncologists contoured CTVHR and OARs in pre-BT MR images (MRI) and intra-operative TRUS images. These contours were subsequently compared in regard to volume and dimension. Contour inter-rater agreement analysis was also investigated using kappa index (KI). Stata 15.0 was used for statistical analysis and a p-value < 0.05 was considered statistically significant. Results TRUS CTVHR volumes were statistically smaller than the respective MRI contoured volumes. TRUS CTVHR thickness was found to be consistently smaller than MRI contours in all patients. No statistical difference was seen in width and height between the two different imaging modalities. MRI contours had a median KI of 0.66 (range: 0.56–0.77) while TRUS-based contours had a median KI of 0.64 (range: 0.47–0.77). Bladder and rectum had very satisfactory KI in both imaging modalities. Vaginal contours had moderate agreement in MR (0.52) and in TRUS images (0.58). Conclusion TRUS images allow good visualization of CTVHR and OARs in IB cervical cancer patients. Inter-rater contour variability was comparable between TRUS and MR images. TRUS is a promising modality on its own for image-guided BT.
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Bolton LA, Walsh SM, O'Sullivan NB, Barnes E, McCormick AP, Corish CA. Patient Perspectives of Weight Gain Following Orthotopic Liver Transplantation: A Qualitative Study. Liver Transpl 2020; 26:591-597. [PMID: 31808289 DOI: 10.1002/lt.25698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/01/2019] [Indexed: 02/07/2023]
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Martell K, Law C, Hasan Y, Taggar A, Barnes E, Ravi A, Leung E. Using infrared depth-sensing technology to improve the brachytherapy operating room experience. Brachytherapy 2020; 19:323-327. [PMID: 32220519 DOI: 10.1016/j.brachy.2020.02.001] [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] [Received: 11/26/2019] [Revised: 01/31/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to discuss the merits of using depth-sensing infrared camera technology in the brachytherapy operating room during interstitial brachytherapy for gynecologic malignancies. MATERIALS AND METHODS The infrared depth-sensing camera from a Microsoft Kinect that had been adapted for surgical use was introduced into a high-volume interstitial brachytherapy operating room. Brachytherapists then used the touchless, gestural interface to review preoperative MRI in real time to guide needle insertion. RESULTS The interface was used for 10 consecutive procedures by 4 separate brachytherapists. The initial training and adjustment to the technology was variable among brachytherapists. All brachytherapists found the controls intuitive and were able to successfully navigate MRI on the system after 1, 30, 30, and 45 min. Qualitatively, brachytherapists found the system helpful for interpretation of intraoperative ultrasound imaging. Furthermore, it ensured adequate needle positioning and deposition was maintained for large tumors. Surgeons involved in its use agreed on potential for considerable benefit when performing interstitial brachytherapy. CONCLUSIONS Adapting this technology for use in the brachytherapy suite provided a higher level of comfort with interstitial catheter placement. This novel tool or similar technology might be considered within other brachytherapy suites.
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Diamond T, Clark W, Bird P, Gonski P, Barnes E, Gebski V. Early vertebroplasty within 3 weeks of fracture for acute painful vertebral osteoporotic fractures: subgroup analysis of the VAPOUR trial and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1606-1613. [PMID: 32170438 DOI: 10.1007/s00586-020-06362-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND VAPOUR found vertebroplasty (V) more effective than placebo (P) in patients with severe pain and fracture duration less than 6 weeks. Exploratory analysis suggested that benefits were concentrated in the subgroup of patients with fractures ≤ 3-week duration. This difference may account for the three negative blinded trials that included few patients within this fracture time frame. PURPOSE To assess the safety and efficacy of early vertebroplasty for acute painful vertebral osteoporotic fractures within 3 weeks of fracture onset in the VAPOUR study. METHODS Spearman's rank log coefficients were calculated to reassess the relationship of pain reduction from vertebroplasty and fracture duration in the VAPOUR trial. We more fully report baseline and outcome data in patients with fractures ≤ 3-week duration. RESULTS There were 46V and 47P patients with fractures ≤ 3-week duration. Baseline characteristics were similar. In total, 86 patients (41V, 45P) completed the 14-day questionnaire. The proportion of patients with reduction in pain from severe (NRS ≥ 7/10 was an inclusion requirement) to mild (NRS < 4) at 14 days was 21 (51%) V-group and 9 (20%) in the P-group (between-group difference 31 percentage points, 95% CI 12-50; p = 0.002). Early vertebroplasty provided greater reductions in mean NRS pain and Roland-Morris Disability. CONCLUSION Analysis of this patient subgroup from the VAPOUR trial, in the context of other randomised trial evidence, suggests clinically significant benefits from early vertebroplasty if performed within 3 weeks of fracture. These slides can be retrieved from Electronic Supplementary Material.
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Barnes E, Zhao J, Giumenta A, Johnson M. The Effect of an Integrated Health System Specialty Pharmacy on HIV Antiretroviral Therapy Adherence, Viral Suppression, and CD4 Count in an Outpatient Infectious Disease Clinic. J Manag Care Spec Pharm 2020; 26:95-102. [PMID: 32011966 PMCID: PMC10391253 DOI: 10.18553/jmcp.2020.26.2.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to antiretroviral (ARV) therapy is critical in order to achieve and maintain viral suppression and improve immune function. Clinical pharmacists and pharmacies focused on human immunodeficiency virus (HIV) have demonstrated the ability to increase ARV medication adherence and subsequently have a positive effect on these lab markers. OBJECTIVES To evaluate the effect of an integrated health system specialty pharmacy service with a clinic-embedded, HIV-trained pharmacist and pharmacy technician on ARV medication adherence rate, viral load, and CD4 count. METHODS This was a single-center, retrospective cohort study conducted from August 7, 2017, to June 30, 2018, at an indigent outpatient infectious disease clinic within Atrium Health (AH), a not-for-profit health system based in Charlotte, NC. The intervention group (opt-in group) received HIV patient care that involved the health system specialty pharmacy service. Once a patient was enrolled in the specialty pharmacy service, medication reconciliation was completed by the pharmacist, financial assistance and prior authorizations were completed if needed; prescriptions were delivered to the patient; and monthly refills calls were conducted to assess adherence, tolerability, and medication changes. The control group (opt-out group) received HIV patient care that did not incorporate the health system specialty pharmacy. The primary endpoints were medication adherence, viral suppression, and CD4 counts. Within-group comparisons from baseline to follow-up were made along with group-to-group comparisons. Adherence was calculated using medication possession ratio. RESULTS For those patients using Atrium Health Specialty Pharmacy Service (AH SPS; n = 46), the overall median adherence rate was higher at 100% versus only 94% for those patients (n = 50) that opted out of the service (P < 0.01). All but 3 patients (21.7% at baseline vs. 6.5% at follow-up, P = 0.03) using AH SPS reached viral suppression, and all but 1 had improved immune function with a CD4 count of 200 or greater by the end of the observation period (P = 0.03). The change in viral suppression and CD4 count of 200 or greater was not statistically improved between baseline and follow-up in those opting out of using AH SPS. When comparing the 2 groups at reaching these endpoints, there was no statistically significant difference in viral suppression and CD4 count. CONCLUSIONS AH SPS was able to demonstrate improved ARV adherence in those patients using an integrated specialty pharmacy with an embedded pharmacy team, coordinated monthly medication delivery, and refill reminder and adherence calls. This in turn led to improved viral suppression and immune markers by the end of the observation window for patients using AH SPS. DISCLOSURES No outside funding supported this study. The authors have nothing to disclose.
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Khasraw M, Leanne McDonald K, Rosenthal M, Lwin Z, Ashley D, Wheeler H, Barnes E, Foote M, Koh ES, Sulman E, Back M, Buckland M, Sim HW, Fisher L, Leonard R, Hall M, Yip S, Simes J. ACTR-24. A RANDOMIZED PHASE II TRIAL OF VELIPARIB (V), RADIOTHERAPY (RT) AND TEMOZOLOMIDE (TMZ) IN PATIENTS (PTS) WITH UNMETHYLATED MGMT (uMGMT) GLIOBLASTOMA (GBM): THE VERTU STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
TMZ offers minimal benefit in pts with de novo uMGMT GBM. V is synergistic with RT and TMZ in uMGMT preclinical GBM models, safe when combined with either RT or TMZ clinically, but the triplet (V+RT+TMZ) is poorly tolerated. VERTU tested V in pts with uMGMT GBM.
METHODS
VERTU is a randomized Phase 2 trial comparing Standard Arm (Arm A), RT (60Gy/30 fractions) + TMZ (75mg/m2 daily) followed by TMZ (150–200mg/m2D 1–5) every 28 days for 6 cycles vs Experimental Arm (Arm B), RT (60Gy/30 fractions) + V (200mg PO BID) followed by TMZ (150–200mg/m2D 1–5) + V (40mg bid, D 1–7) every 28 days for 6 cycles in pts with de novo uMGMT GBM according to centralised testing.
RESULTS
125 pts were randomized 1:2 (41:84). The 2 groups were matched for age, sex, performance status and extent of resection. Median follow-up was 25.8 months and 91 pts had died. The 6-month Progression-Free Survival (6mPFS) for Arms A and B were 34% (95% CI 20–48) and 46% (95% CI 36–57) respectively. The median PFS for Arms A and B were 4.2m (95% CI 2.5–6.0) and 5.7m (95% CI 4.1–6.6) respectively (HR = 0.80, 95%CI 0.55–1.18). 55% of pts in both arms experienced Grade 3/4 adverse events (AEs) with no significant differences in frequency or severity between the arms. Most common Grade 3/4 AEs were thrombocytopenia, seizures, hyperglycaemia and diarrhoea.
CONCLUSION
VERTU demonstrated that a novel treatment strategy for patients with de novo uMGMT GBM was feasible and tolerable. The observed 6mPFS and PFS were similar in both arms. Overall survival and other endpoints will be presented. Central MRI review, biomarker analyses, including DNA repair and methylation signature analyses are ongoing.
(ANZCTR#ACTRN12615000407594).
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Antill Y, Kok P, Stockler M, Robledo K, Yip S, Parry M, Smith D, Spurdle A, Barnes E, Friedlander M, Baron-Hay S, Shannon C, Coward J, Beale P, Goss G, Meniawy T, Andrews J, Kelly M, Mileshkin L. Updated results of activity of durvalumab in advanced endometrial cancer (AEC) according to mismatch repair (MMR) status: The phase II PHAEDRA trial (ANZGOG1601). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Misra S, Peters G, Barnes E, Ardern-Holmes S, Webster R, Troedson C, Mohammad SS, Gill D, Menezes M, Gupta S, Procopis P, Antony J, Kurian MA, Dale RC. Yield of comparative genomic hybridization microarray in pediatric neurology practice. NEUROLOGY-GENETICS 2019; 5:e367. [PMID: 31872051 PMCID: PMC6878849 DOI: 10.1212/nxg.0000000000000367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022]
Abstract
Objective The present study investigated the diagnostic yield of array comparative genomic hybridization (aCGH) in a large cohort of children with diverse neurologic disorders as seen in child neurology practice to test whether pathogenic copy number variants (CNVs) were more likely to be detected in specific neurologic phenotypes. Methods A retrospective cross-sectional analysis was performed on 555 children in whom a genetic etiology was suspected and who underwent whole-genome aCGH testing between 2006 and 2012. Neurologic phenotyping was performed using hospital medical records. An assessment of pathogenicity was made for each CNV, based on recent developments in the literature. Results Forty-seven patients were found to carry a pathogenic CNV, giving an overall diagnostic yield of 8.59%. Certain phenotypes predicted for the presence of a pathogenic CNV, including developmental delay (odds ratio [OR] 3.69 [1.30-10.51]), cortical visual impairment (OR 2.73 [1.18-6.28]), dysmorphism (OR 2.75 [1.38-5.50]), and microcephaly (OR 2.16 [1.01-4.61]). The combination of developmental delay/intellectual disability with dysmorphism and abnormal head circumference was also predictive for a pathogenic CNV (OR 2.86 [1.02-8.00]). For every additional clinical feature, there was an increased likelihood of detecting a pathogenic CNV (OR 1.18 [1.01-1.38]). Conclusions The use of aCGH led to a pathogenic finding in 8.59% of patients. The results support the use of aCGH as a first tier investigation in children with diverse neurologic disorders, although whole-genome sequencing may replace aCGH as the detection method in the future. In particular, the yield was increased in children with developmental delay, dysmorphism, cortical visual impairment, and microcephaly.
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Ebert-Uphoff I, Samarasinghe S, Barnes E. Thoughtfully Using Artificial Intelligence in Earth Science. ACTA ACUST UNITED AC 2019. [DOI: 10.1029/2019eo135235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Deriving scientific insights from artificial intelligence methods requires adhering to best practices and moving beyond off-the-shelf approaches.
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Cozma A, Martell K, Ravi A, Barnes E, Paudel M, Leung E, Taggar A. 78 Acute and Late Genitourinary Toxicity Among Patients Receiving Vaginal High Dose Rate Interstitial Brachytherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martell K, Han K, Mendez L, Barnes E, Taggar A, Ravi A, Leung E. 170 Utility of MRI Based ADC Image Sets in Delineating GTVRES Volumes in Cervical Brachytherapy: A Multicentre Study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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