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Elbanna M, Shiue K, Edwards D, Cerra-Franco A, Agrawal N, Hinton J, Mereniuk T, Huang C, Ryan JL, Smith J, Aaron VD, Burney H, Zang Y, Holmes J, Langer M, Zellars R, Lautenschlaeger T. Impact of Lung Parenchymal-Only Failure on Overall Survival in Early-Stage Lung Cancer Patients Treated With Stereotactic Ablative Radiotherapy. Clin Lung Cancer 2020; 22:e342-e359. [PMID: 32736936 DOI: 10.1016/j.cllc.2020.05.024] [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: 12/26/2019] [Revised: 03/28/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The impact of lung parenchymal-only failure on patient survival after stereotactic ablative body radiotherapy (SABR) for early-stage non-small-cell lung cancer (NSCLC) remains unclear. PATIENTS AND METHODS The study population included 481 patients with early-stage NSCLC who were treated with 3- to 5-fraction SABR between 2000 and 2016. The primary study objective was to assess the impact of out-of-field lung parenchymal-only failure (OLPF) on overall survival (OS). RESULTS At a median follow-up of 5.9 years, the median OS was 2.7 years for all patients. Patients with OLPF did not have a significantly different OS compared to patients without failure (P = .0952, median OS 4.1 years with failure vs. 2.6 years never failure). Analysis in a 1:1 propensity score-matched cohort for Karnofsky performance status, comorbidity score, and smoking status showed no differences in OS between patients without failure and those with OLPF (P = .8). In subgroup analyses exploring the impact of time of failure on OS, patients with OLPF 6 months or more after diagnosis did not have significantly different OS compared to those without failure, when accounting for immortal time bias (P = .3, median OS 4.3 years vs. 3.5 years never failure). Only 7 patients in our data set experienced failure within 6 months of treatment, of which only 4 were confirmed to be true failures; therefore, limited data are available in our cohort on the impact of OLPF for ≤ 6 months on OS. CONCLUSION OLPF after SABR for early-stage NSCLC does not appear to adversely affect OS, especially if occurring at least 6 months after SABR. More studies are needed to understand if OLPF within 6 months of SABR is associated with adverse OS. These data are useful when discussing prognosis of lung parenchymal failures after initial SABR.
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Stephens R, Holmes J, Eadie E. Lesion compression during light activation may improve efficacy of photodynamic treatment of basal cell carcinoma: preliminary results and rationale. J Eur Acad Dermatol Venereol 2020; 34:e628-e630. [PMID: 32311807 DOI: 10.1111/jdv.16503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huang C, Shiue K, Bartlett G, Agrawal N, Arbab M, Maxim P, DesRosiers C, Mereniuk T, Ellsworth S, Rhome R, Holmes J, Langer M, Zellars R, Lautenschlaeger T. Exploiting tumor position differences between deep inspiration and expiration in lung stereotactic body radiation therapy planning. Med Dosim 2020; 45:293-297. [PMID: 32249105 DOI: 10.1016/j.meddos.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE We demonstrate proof of principle that normal tissue doses can be greatly reduced in lung stereotactic body radiation therapy (SBRT) for mobile tumors, if the delivered dose is split between opposite respiratory states. METHODS Patients that underwent 5 fraction lung SBRT at our institution and had deep inspiration breath hold (DIBH) and free breathing 4D computed tomography scans were included. Volumetric modulated arc therapy plans were generated on both respiratory phases and a third composite plan was generated delivering half the dose using the DIBH plan and the other half using the expiratory phase plan for each fraction. Computed tomography scans for the composite plan were fused based on ribs adjacent to the tumor to evaluate the dose volume histogram of critical structures. RESULTS Four patients with 4 total tumors had requisite planning scans available. Tumor size was between 0.7 to 2.9 cm and tumor movement 1.4 to 2.9 cm. Median reduction in the chest wall (CW) V30Gy for the composite plan was 74.6% (range 33.7 to 100%), 76.9% (range 32.9 to 100%), and 89.3% (range 69.5 to 100%) compared to the DIBH, expiration phase, and free breathing plans, respectively. Median reduction in CW maximum dose for the composite plan was 23.3% (range 0.27% to 46.4%), 23.5% (range 3.2 to 48.2%), and 23.4% (range 0.27% to 48.4%) compared to the DIBH, expiration phase, and free breathing plans, respectively. Greater reduction in CW maximum dose was observed when patients had no overlap in planning target volumes between DIBH and expiration phases (median reduction 43.9% for no overlap vs 2.7% with overlap). Between all plans, lung V20Gy absolute differences were within 1.3%. For 2 of 4 patients, the composite plan met constraints for 3 fraction SBRT, while standard plans did not. CONCLUSIONS We conclude that composite DIBH-expiration SBRT planning has the potential to improve organ at risk sparing.
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Gavens L, Holmes J, Bühringer G, McLeod J, Neumann M, Lingford-Hughes A, Hock ES, Meier PS. Interdisciplinary working in public health research: a proposed good practice checklist. J Public Health (Oxf) 2019; 40:175-182. [PMID: 28334984 DOI: 10.1093/pubmed/fdx027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Indexed: 11/14/2022] Open
Abstract
Background Guidance on how different disciplines from the natural, behavioural and social sciences can collaborate to resolve complex public health problems is lacking. This article presents a checklist to support researchers and principle investigators to develop and implement interdisciplinary collaborations. Methods Fourteen individuals, representing 10 disciplines, participated in in-depth interviews to explore the strengths and challenges of working together on an interdisciplinary project to identify the determinants of substance use and gambling disorders, and to make recommendations for future interdisciplinary teams. Data were analysed thematically and a checklist was derived from insights offered by participants during interview and discussion among the authors on the implications of findings. Results Participants identified 18 scientific, interactional and structural strengths and challenges of interdisciplinary research. These findings were used to develop an 18-item BASICS checklist to support future interdisciplinary collaborations. The five domains of the checklist are: (i) Blueprint, (ii) Attitudes, (iii) Staffing, (iv) Interactions and (v) Core Science. Conclusion Interdisciplinary work has the potential to advance public health science but the numerous challenges should not be underestimated. Use of a checklist, such as BASICS, when planning and managing projects may help future collaborations to avoid some of the common pitfalls of interdisciplinary research.
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Allen LA, Pyart RD, Holmes J, Donovan KL, Anderson RA, Phillips AO. Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study. QJM 2019; 112:669-674. [PMID: 31161203 DOI: 10.1093/qjmed/hcz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 05/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with renal disease are less likely to undergo percutaneous coronary intervention (PCI) due to concerns about poor outcomes. AIM We describe outcomes following PCI in individuals with chronic kidney disease (CKD), as compared with matched controls with comparable CKD who did not undergo PCI. We also identified factors predictive of poor outcomes following PCI amongst patients with CKD. DESIGN Retrospective observational case-control study. METHODS Cases were individuals with CKD (stages 1-5) undergoing PCI between 2008 and 2014. Controls were age, gender and creatinine-matched individuals not requiring PCI. We compared mortality between groups using Kaplan-Meier curves and Cox regression modelling. We assessed changes in serum creatinine using Wilcoxon Rank testing. We explored the relationship between biochemical and haematological measures (baseline creatinine, calcium, phosphate, calcium-phosphate product, parathyroid hormone, white cell count, haemoglobin, platelet count, c-reactive protein and total cholesterol) and post-PCI mortality, using logistic regression. RESULTS We identified 144 cases and 144 controls. Mortality was significantly lower amongst cases compared with controls [hazard ratio 0.46 (95% confidence intervals 0.31, 0.69)]. PCI did not result in a significant change in renal function (P=0.52). Amongst cases, serum creatinine and calcium-phosphate product were predictors of mortality following PCI. CONCLUSION Cases undergoing PCI had lower mortality, and PCI was not associated with accelerated CKD progression. On this data, PCI should not be deferred as a treatment option in patients with CKD. Serum creatinine and calcium-phosphate product predict mortality following PCI in this cohort, and may be useful in risk-stratifying patients with CKD being considered for PCI.
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Holmes J, Kearsey RJ, Paske KA, Singer FN, Atallah S, Pask CM, Phillips RM, Willans CE. Tethered N-Heterocyclic Carbene-Carboranyl Silver Complexes for Cancer Therapy. Organometallics 2019. [DOI: 10.1021/acs.organomet.9b00228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Holmes J, Pathirathna P, Hashemi P. Novel frontiers in voltammetric trace metal analysis: Towards real time, on-site, in situ measurements. Trends Analyt Chem 2019. [DOI: 10.1016/j.trac.2018.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hersey M, Berger SN, Holmes J, West A, Hashemi P. Recent Developments in Carbon Sensors for At-Source Electroanalysis. Anal Chem 2018; 91:27-43. [PMID: 30481001 DOI: 10.1021/acs.analchem.8b05151] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Phillips D, Holmes J, Davies R, Geen J, Williams JD, Phillips AO. The influence of socioeconomic status on presentation and outcome of acute kidney injury. QJM 2018; 111:849-857. [PMID: 30137472 DOI: 10.1093/qjmed/hcy180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
AIM Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. DESIGN The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. METHODS Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. RESULTS Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. CONCLUSION This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.
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Hale D, Mittendorf E, Brown T, Clifton G, Vreeland T, Myers J, Peace K, Jackson D, Greene J, Holmes J, Peoples G. Pre-specified interim analysis of a randomized phase IIb trial of trastuzumab + nelipeptimut-S (NeuVax) vs trastuzumab for the prevention of recurrence demonstrates benefit in triple negative (HER2 low-expressing) breast cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dutton P, Holmes J. Single arm two-stage studies: Improved designs for molecularly targeted agents. Pharm Stat 2018; 17:761-769. [PMID: 30112838 DOI: 10.1002/pst.1896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/26/2018] [Accepted: 06/29/2018] [Indexed: 11/06/2022]
Abstract
Mechanistic understanding of cancers and their potential interactions with molecularly targeted agents is driving the need for stratified medicine to ensure each participant receives the best possible care. This understanding, backed by scientific research, should be used to guide the design of clinical trials for these agents. The mechanism of action of a molecularly targeted agent often suggests that a biomarker can be used as a predictor of activity of the agent on the targeted disease. A biomarker driven trial is needed to confirm that the molecularly targeted agent stratifies the participant population with disease into high and low responder groups. We assume that the biomarker of interest can be dichotomised and propose a balanced parallel two-stage single-arm phase II trial that builds on existing two-stage single-arm designs. A single-arm trial cannot distinguish between a marker being predictive in the population as a whole and the agent causing an increased response in the marker positive group, but it is a first step. We compare this approach to the existing single-arm approaches, sequential enrichment, tandem two-stage, and parallel two-stage designs, and discuss the advantages and disadvantages of each design. We show that our design compares favourably to existing designs in the Bayesian framework, making a more efficient use of collected data. We recommend using the parallel two-stage balanced or sequential enrichment designs when randomisation is not practical in a phase II trial.
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Olsen J, Birch-Johansen FH, Themstrup L, Holmes J, Jemec GBE. Dynamic optical coherence tomography of histamine induced wheals. Skin Res Technol 2018; 24:592-598. [DOI: 10.1111/srt.12470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 01/08/2023]
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018. [DOI: 10.1111/bjd.16612] [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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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. 基底细胞癌光学相干断层成像:位置、亚型、观察者变化和图像质量对诊断性能的影响. Br J Dermatol 2018. [DOI: 10.1111/bjd.16631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Holmes J, Rainer T, Geen J, Williams JD, Phillips AO. Adding a new dimension to the weekend effect: an analysis of a national data set of electronic AKI alerts. QJM 2018; 111:249-255. [PMID: 29361145 DOI: 10.1093/qjmed/hcy012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate. AIM We compared mortality following detection of acute kidney injury (AKI) on week and weekend days across community and hospital settings. DESIGN A prospective national cohort study, with AKI identified using the Welsh National electronic AKI reporting system. METHODS Data were collected on outcome for all cases of adult AKI in Wales between 1 November 2013 and 31 January 2017. RESULTS There were a total of 107 298 episodes. Weekday detection of AKI was associated with 28.8% (26 439); 90-day mortality compared to 90-day mortality of 31.9% (4551) for AKI detected on weekdays (RR: 1.11, 95% CI: 1.08-1.14, P < 0.001, HR: 1.16 95% CI: 1.12-1.20, P < 0.001). There was no 'weekend effect' for mortality associated with hospital-acquired AKI. Weekday detection of community-acquired AKI (CA-AKI) was associated with a 22.6% (10 356) mortality compared with weekend detection of CA-AKI, which was associated with a 28.6% (1619) mortality (RR: 1.26, 95% CI: 1.21-1.32, P < 0.001, HR: 1.34, 95%CI: 1.28-1.42, P < 0.001). The excess mortality in weekend CA-AKI was driven by CA-AKI detected at the weekend that was not admitted to hospital compared with CA-AKI detected on weekdays which was admitted to hospital (34.5% vs. 19.1%, RR: 1.8, 95% CI: 1.69-1.91, P < 0.001, HR: 2.03, 95% CI: 1.88-2.19, P < 0.001). CONCLUSION 'Weekend effect' in AKI relates to access to in-patient care for patients presenting predominantly to hospital emergency departments with AKI at the weekend.
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018; 178:1102-1110. [DOI: 10.1111/bjd.16154] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
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Boucher BJ, Tsoumanis J, Noonan K, Holmes J. Dependence of Retinopathy (and other Complications) on Glycaemic Control and on Weight over 5/10 Years from Diagnosis of Type II Diabetes. J R Soc Med 2018; 89:27-30. [PMID: 8709079 PMCID: PMC1295638 DOI: 10.1177/014107689608900108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Glycosylated haemoglobins and weights were recorded for 200 consecutive diabetic clinic attendere seen yearly for 5 years, 76 of whom were also seen up to 10 years from diagnosis of type 2 diabetes, representing 1380 patient years. Weight fluctuation (≥3 kg) was associated with increased final prevalence of hypertension, macroalbuminaemia and a raised creatinine (P≤ 0.002) but this relationship was abolished by correction for higher initial weight. Average giycaemia over 5/10 years [itself related to initial weight in women on tablets (N=53) but not others, and to waist but not waist/hip ratio], correlated with prevalence and severity of retinopathy (N=200; r=0.38, P≤0.0006) seen also in the subgroup of patients on tablets (N=145, P≤0.006). At HbA1 levels ≥10.5% an increased prevelance of retinopathy was seen in those on insulin (W=37, P≤0.001) and an increased prevalence of peripheral vascular disease was seen in men but not women (x2=2.87, P≤0.01) as well as in the prevalence of neuropathy. These findings suggest that good glycaemic control is of value in type 2 diabetes and less easily achieved in obesity.
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Sud S, Holmes J, Eblan M, Chen R, Jones E. Clinical characteristics associated with racial disparities in endometrial cancer outcomes: A surveillance, epidemiology and end results analysis. Gynecol Oncol 2018; 148:349-356. [DOI: 10.1016/j.ygyno.2017.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/14/2017] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
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Pannala R, Baldwin B, Aluru V, Grys TE, Holmes J, Miller LJ, Harrison ME, Nguyen CC, Tenover FC, Persing D, Faigel DO. Prospective study of the feasibility of point-of-care testing strategy for carbapenem-resistant organism detection. Endosc Int Open 2018; 6:E58-E63. [PMID: 29340299 PMCID: PMC5766332 DOI: 10.1055/s-0043-122141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND/AIMS In an investigator-initiated, prospective study, we evaluated the feasibility of a five-gene sequence point-of-care (POC) testing strategy (Xpert CARBA-R Assay, Cepheid Inc., Sunnyvale, CA, USA), compared to reference laboratory PCR (48 - 72 hours turnaround time, two gene sequences), in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and in a hospital outbreak investigation. METHODS After informed consent, patients undergoing ERCP (September 2015 - April 2016, n = 191) at Mayo Clinic and potential hospital contacts (n = 9) of an index carbapenem-resistant organism (CRO)-positive inpatient were included. Two rectal swabs, one each for reference and POC assays were obtained. The Xpert CARBA-R Assay enables qualitative rapid detection of five beta-lactamase gene sequences associated with carbapenem-non-susceptibility in Gram-negative bacteria. Feasibility parameters (specimen processing and assay run time, ease of use) and percent agreement between the tests were calculated using JMP Pro11 (SAS Corp, Cary, NC, USA). RESULTS Mean age was 62 ± 15 years; 108 (54 %) were male. Both tests were successfully performed in all patients. The POC test was rated by endoscopy nurses as easy/very easy to conduct in 193 patients (97 %); median assay run time and median time for specimen collection and processing were 55 minutes (interquartile range IQR: 53 - 55 minutes) and 3 minutes (IQR: 3 - 6 minutes), respectively. In 200/201 (99.5 %) tests, there was agreement between the POC and reference PCR. CONCLUSIONS The more comprehensive POC CRO testing of patients in the endoscopy suite is feasible and results are available in < 1 hour. This strategy may enable rapid risk stratification of duodenoscope exposure to CRO and potentially improve operational efficiency and decrease costs.
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Holmes J, Geen J, Phillips B, Williams JD, Phillips AO. Community acquired acute kidney injury: findings from a large population cohort. QJM 2017; 110:741-746. [PMID: 29025142 DOI: 10.1093/qjmed/hcx151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The extent of patient contact with medical services prior to development of community acquired-acute kidney injury (CA-AKI)is unknown. AIM We examined the relationship between incident CA-AKI alerts, previous contact with hospital or primary care and clinical outcomes. DESIGN A prospective national cohort study of all electronic AKIalerts representing adult CA-AKI. METHODS Data were collected for all cases of adult (≥18 years of age) CA-AKI in Wales between 1 November 2013 and 31 January 2017. RESULTS There were a total of 50 560 incident CA-AKI alerts. In 46.8% there was a measurement of renal function in the 30 days prior to the AKI alert. In this group, in 63.8% this was in a hospital setting, of which 37.6% were as an inpatient and 37.5% in Accident and Emergency. Progression of AKI to a higher AKI stage (13.1 vs. 9.8%, P < 0.001) (or for AKI 3 an increase of > 50% from the creatinine value generating the alert), the proportion of patients admitted to Intensive Care (5.5 vs. 4.9%, P = 0.001) and 90-day mortality (27.2 vs. 18.5%, P < 0.001) was significantly higher for patients with a recent test. 90-day mortality was highest for patients with a recent test taken in an inpatient setting prior to CA-AKI (30.9%). CONCLUSION Almost half of all patients presenting with CA-AKI are already known to medical services, the majority of which have had recent measurement of renal function in a hospital setting, suggesting that AKI for at least some of these may potentially be predictable and/or avoidable.
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De Carvalho N, Schuh S, Kindermann N, Kästle R, Holmes J, Welzel J. Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery-recommendations regarding the marking and scanning technique. Skin Res Technol 2017; 24:145-151. [PMID: 29057513 DOI: 10.1111/srt.12407] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND/PURPOSE Mohs Micrographic Surgery (MMS) is the preferred therapeutic treatment for high-risk basal cell carcinoma (BCC). Optical Coherence Tomography (OCT) is a non-invasive imaging technique that enables the diagnosis of BCC. We thought to determine the margins of BCCs with OCT, prior to MMS, to reduce the number of surgical steps. METHODS Different permanent markers were tested on the skin regarding line width, resistance against disinfection and brightness in the OCT image. The visible tumor margins of BCCs were defined by dermoscopy, adding a safety margin of 2 mm and labeled using the selected pen, causing a signal shadow in OCT. Scans of the center and of entire margin were performed. If parts of the BCC were visible outside the margin, another 2 mm were added and the scan was repeated until the tissue outside the labeling looked tumor free. RESULTS Eight out of ten BCCs were totally excised in a single stage when margin delineation was done by OCT. Macroscopic margins were enlarged after OCT scanning in four patients, saving further stages of MMS. CONCLUSION OCT may help to better define the microscopic dimensions of BCCs and therefore reduce the number of stages of MMS.
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Holmes J, Allen N, Roberts G, Geen J, Williams JD, Phillips AO. Acute kidney injury electronic alerts in primary care - findings from a large population cohort. QJM 2017; 110:577-582. [PMID: 28402560 DOI: 10.1093/qjmed/hcx080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. AIMS We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. DESIGN A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI. METHOD The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service. RESULTS 28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function. CONCLUSION The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.
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Ulrich M, Themstrup L, de Carvalho N, Ciardo S, Holmes J, Whitehead R, Welzel J, Jemec G, Pellacani G. Dynamic optical coherence tomography of skin blood vessels - proposed terminology and practical guidelines. J Eur Acad Dermatol Venereol 2017; 32:152-155. [DOI: 10.1111/jdv.14508] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/12/2017] [Indexed: 12/01/2022]
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Murphy J, Holmes J, Brooks C. Erratum to: Measurements of daily energy intake and total energy expenditure in people with dementia in care homes: The use of wearable technology. J Nutr Health Aging 2017. [DOI: 10.1007/s12603-017-0945-9] [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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Jones D, Holmes J, Currey J, Fugaccia E, Psirides AJ, Singh MY, Fennessy GJ, Hillman K, Pilcher DV, Bellomo R, DeVita M. Proceedings of the 12th International Conference on Rapid Response Systems and Medical Emergency Teams. Anaesth Intensive Care 2017; 45:511-517. [PMID: 28673223 DOI: 10.1177/0310057x1704500416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid Response Teams (RRTs) have been introduced into hospitals worldwide in an effort to improve the outcomes of deteriorating hospitalised patients. Recently, there has been increased awareness of the need to develop systems other than RRTs for deteriorating patients. In May 2016, the 12th International Conference on Rapid Response Systems and Medical Emergency Teams was held in Melbourne. This represented a collaboration between the newly constituted International Society for Rapid Response Systems (iSRRS) and the Australian and New Zealand Intensive Care Society. The conference program included broad ranging presentations related to general clinical deterioration in the acute care setting, as well as deterioration in the emergency department, during pregnancy, in the paediatric setting, and deterioration in mental health status. This article briefly summarises the key features of the conference, links to presentations, and the 18 abstracts of the accepted free papers.
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