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Wong Y, Joshi K, Khetrapal P, Ismail M, Linares J, Akarca A, Reading J, Furness A, Feber A, McGovern U, Swanton C, Freeman A, Briggs T, Kelly J, Marafioti T, Peggs K, Powles T, Chain B, Linch M, Quezada S. Urine-derived lymphocytes (UDLs) as a non-invasive surrogate marker of tumour infiltrating lymphocytes (TILs) in patients with muscle invasive bladder cancer (MIBC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Freeman A, Hurtado N, Ousley J, Leatherman S. ISQUA17-3337IMPROVING CARE IN COMPLEX HUMANITARIAN CRISES: A PROCESS EVALUATION OF MÉDECINS SANS FRONTIÈRES’ APPROACH TO QUALITY. Int J Qual Health Care 2017. [DOI: 10.1093/intqhc/mzx125.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kravvas G, Shim T, Doiron P, Freeman A, Jameson C, Minhas S, Muneer A, Bunker C. The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients. J Eur Acad Dermatol Venereol 2017; 32:91-95. [DOI: 10.1111/jdv.14488] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
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Swinbourne F, Jeffery N, Tivers M, Artingstall R, Bird F, Charlesworth T, Doran I, Freeman A, Hall J, Hattersley R, Henken J, Hughes J, de la Puerta B, Rutherford L, Ryan T, Williams H, Woods S, Nicholson I. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors. J Small Anim Pract 2017; 58:495-503. [DOI: 10.1111/jsap.12696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/28/2022]
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Rashed D, Shah D, Freeman A, Cook RJ, Hopper C, Perrett CM. Rapid ex vivo examination of Mohs specimens using optical coherence tomography. Photodiagnosis Photodyn Ther 2017; 19:243-248. [PMID: 28619614 DOI: 10.1016/j.pdpdt.2017.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/07/2017] [Accepted: 06/11/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is an effective treatment for certain non-melanoma skin cancers. Optical coherence tomography (OCT) is a biomedical imaging modality that permits high-resolution imaging of the epidermis and dermis with the potential to detect both healthy tissue and tumour. OCT may also provide a means of detecting and differentiating between the various histological subtypes of basal cell carcinomas (BCC) in vivo. OBJECTIVE The aim of this prospective ex vivo study was to evaluate the efficacy of OCT in recognising healthy and pathological margins of excised BCC lesions and detecting different BCC subtypes. METHODS Seventy-three subjects with biopsy-proven BCCs on the facial region undergoing MMS were recruited. Narrow clinically healthy margins of the skin surrounding the tumour were included in the excisional biopsy. Biopsies were scanned with the OCT instrument immediately ex vivo and processed to obtain horizontal Mohs frozen sections and compared with their corresponding OCT images. RESULTS Histopathological analysis of 280 margins showed 232 tumour free margins and 48 tumour-involved margins. OCT showed very good sensitivity (81.2%) and specificity (94.3%) in detecting healthy from tumour-involved margins. OCT accuracy was 93.4%, and the intra- and inter-observer reliability was substantial (Kappa value ranged between 0.63-0.76). CONCLUSION This study shows the accuracy of ex vivo OCT in identifying the margin status of BCCs of the head and neck region. Moreover, this modality has demonstrated good capability in distinguishing different BCC subtypes and the potential for in vivo in situ diagnostics.
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Doiron PR, Menage HP, Freeman A, Muneer A, Bunker CB. Peri-meatal PeIN and urethral SCC: a case report. J Eur Acad Dermatol Venereol 2017; 31:e400-e401. [PMID: 28295605 DOI: 10.1111/jdv.14207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Shanmugabavan Y, Bass E, Hulme A, Freeman A, Brew-Graves C, Potyka I, Ramachandran N, Emberton M, Ahmed H. Intra-prostatic injection of PRX302 to focally ablate clinically significant prostate cancer: An open label, phase 2a study. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30811-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kravvas G, Veitch D, Doiron PR, Freeman A, Muneer A, Dinneen M, Francis N, Bunker CB. Recurrent penile squamous cell carcinoma in an elderly circumcised man. Clin Exp Dermatol 2017; 42:360-362. [PMID: 28218423 DOI: 10.1111/ced.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
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Dean DC, Lange N, Travers BG, Prigge MB, Matsunami N, Kellett KA, Freeman A, Kane KL, Adluru N, Tromp DPM, Destiche DJ, Samsin D, Zielinski BA, Fletcher PT, Anderson JS, Froehlich AL, Leppert MF, Bigler ED, Lainhart JE, Alexander AL. Multivariate characterization of white matter heterogeneity in autism spectrum disorder. Neuroimage Clin 2017; 14:54-66. [PMID: 28138427 PMCID: PMC5257193 DOI: 10.1016/j.nicl.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
The complexity and heterogeneity of neuroimaging findings in individuals with autism spectrum disorder has suggested that many of the underlying alterations are subtle and involve many brain regions and networks. The ability to account for multivariate brain features and identify neuroimaging measures that can be used to characterize individual variation have thus become increasingly important for interpreting and understanding the neurobiological mechanisms of autism. In the present study, we utilize the Mahalanobis distance, a multidimensional counterpart of the Euclidean distance, as an informative index to characterize individual brain variation and deviation in autism. Longitudinal diffusion tensor imaging data from 149 participants (92 diagnosed with autism spectrum disorder and 57 typically developing controls) between 3.1 and 36.83 years of age were acquired over a roughly 10-year period and used to construct the Mahalanobis distance from regional measures of white matter microstructure. Mahalanobis distances were significantly greater and more variable in the autistic individuals as compared to control participants, demonstrating increased atypicalities and variation in the group of individuals diagnosed with autism spectrum disorder. Distributions of multivariate measures were also found to provide greater discrimination and more sensitive delineation between autistic and typically developing individuals than conventional univariate measures, while also being significantly associated with observed traits of the autism group. These results help substantiate autism as a truly heterogeneous neurodevelopmental disorder, while also suggesting that collectively considering neuroimaging measures from multiple brain regions provides improved insight into the diversity of brain measures in autism that is not observed when considering the same regions separately. Distinguishing multidimensional brain relationships may thus be informative for identifying neuroimaging-based phenotypes, as well as help elucidate underlying neural mechanisms of brain variation in autism spectrum disorders.
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M A, Parnham A, Sandev V, Christodoulidou M, Akers C, Freeman A, Nigam R, Minhas S, Malone P, Muneer A. 172 Predicting Local Recurrence (LR) Following Glansectomy Combined With A Split-Thickness Skin Graft in Patients With Penile Squamous Cell Carcinoma. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.117] [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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Ahmed U, Freeman A, Kirkham A, Ralph DJ, Minhas S, Muneer A. Self injection of foreign materials into the penis. Ann R Coll Surg Engl 2016; 99:e78-e82. [PMID: 27869491 DOI: 10.1308/rcsann.2016.0346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Injection of the subcutaneous tissues of the penis for enlargement of penile girth has been practised for many years by laypeople and medical practitioners alike. However, with recognition of the complications, the practice has died out. We report a series of five patients who presented having injected foreign materials into the subcutaneous tissues of their penises, including paraffin and mineral oils. Our patients had a variable time course of presentation ranging from 1 day following injection to over 26 years. Self-injection of the subcutaneous tissues of the penis is an unusual presentation for a penile mass but should be considered as a differential diagnosis in patients with a long latent period to presentation or with characteristic magnetic resonance imaging and histological appearances.
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Kanthabalan A, Abd-Alazeez M, Arya M, Allen C, Freeman A, Jameson C, Kirkham A, Mitra A, Payne H, Punwani S, Ramachandran N, Walkden M, Emberton M, Ahmed H. Transperineal Magnetic Resonance Imaging-targeted Biopsy versus Transperineal Template Prostate Mapping Biopsy in the Detection of Localised Radio-recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 28:568-76. [DOI: 10.1016/j.clon.2016.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/19/2016] [Accepted: 03/08/2016] [Indexed: 12/14/2022]
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El-Shater Bosaily A, Valerio M, Hu Y, Freeman A, Jameson C, Brown L, Kaplan R, Hindley RG, Barratt D, Emberton M, Ahmed HU. The concordance between the volume hotspot and the grade hotspot: a 3-D reconstructive model using the pathology outputs from the PROMIS trial. Prostate Cancer Prostatic Dis 2016; 19:322. [PMID: 27502740 PMCID: PMC5411669 DOI: 10.1038/pcan.2016.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shah TT, Peters M, Kanthabalan A, McCartan N, Fatola Y, van der Voort van Zyp J, van Vulpen M, Freeman A, Moore CM, Arya M, Emberton M, Ahmed HU. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Prostate Cancer Prostatic Dis 2016; 19:311-6. [PMID: 27431499 PMCID: PMC4983180 DOI: 10.1038/pcan.2016.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 12/03/2022]
Abstract
Background: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. Methods: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA>nadir+2 ng ml−1)), start of systemic therapies or metastases. Results: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml−1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgen-deprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir <0.5 ng ml−1, 15/50 (30%) had a nadir ⩾0.5 ng ml−1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir <0.5 ng ml−1, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (P<0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). Conclusions: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
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Valerio M, Dickinson L, Ali A, Ramachadran N, Donaldson I, McCartan N, Freeman A, Ahmed H, Emberton M. 839 A prospective development study evaluating focal irreversible electroporation in men with localised prostate cancer: The NEAT trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)60841-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Valerio M, Anele C, Bott SRJ, Charman SC, van der Meulen J, El-Mahallawi H, Emara AM, Freeman A, Jameson C, Hindley RG, Montgomery BSI, Singh PB, Ahmed HU, Emberton M. The Prevalence of Clinically Significant Prostate Cancer According to Commonly Used Histological Thresholds in Men Undergoing Template Prostate Mapping Biopsies. J Urol 2015; 195:1403-1408. [PMID: 26626221 DOI: 10.1016/j.juro.2015.11.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Transrectal prostate biopsies are inaccurate and, thus, the prevalence of clinically significant prostate cancer in men undergoing biopsy is unknown. We determined the ability of different histological thresholds to denote clinically significant cancer in men undergoing a more accurate biopsy, that of transperineal template prostate mapping. MATERIALS AND METHODS In this multicenter, cross-sectional cohort of men who underwent template prostate mapping biopsies between May 2006 and January 2012, 4 different thresholds of significance combining tumor grade and burden were used to measure the consequent variation with respect to the prevalence of clinically significant disease. RESULTS Of 1,203 men 17% (199) had no previous biopsy, 38% (455) had a prior negative transrectal ultrasound biopsy, 24% (289) were on active surveillance and 21% (260) were seeking risk stratification. Mean patient age was 63.5 years (SD 7.6) and median prostate specific antigen was 7.4 ng/ml (IQR 5.3-10.5). Overall 35% of the patients (424) had no cancer detected. The prevalence of clinically significant cancer varied between 14% and 83% according to the histological threshold used, in particular between 30% and 51% among men who had no previous biopsy, between 14% and 27% among men who had a prior negative biopsy, between 36% and 74% among men on active surveillance, and between 47% and 83% among men seeking risk stratification. CONCLUSIONS According to template prostate mapping biopsy between 1 in 2 and 1 in 3 men have prostate cancer that is histologically defined as clinically significant. This suggests that the commonly used thresholds may be set too low.
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Orczyk C, Punwani S, Kirkham A, Ramachandran N, Walkden M, Freeman A, Jameson C, Shehada M, Moore C, Arya M, Emberton M, Ahmed H. [Not Available]. Prog Urol 2015; 25:829-30. [PMID: 26544420 DOI: 10.1016/j.purol.2015.08.226] [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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Michel C, Freeman A, Jameson C, Waddington W, Cathcart P. Détection des marges chirurgicales en imagerie par Cerenkov Luminescence au cours des prostatectomies radicales cœliosocpiques robot-assistées – résultats initiaux de l’étude PRIME. Prog Urol 2015; 25:796-7. [DOI: 10.1016/j.purol.2015.08.160] [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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Kanthabalan A, Shah T, Arya M, Punwani S, Bomanji J, Haroon A, Illing RO, Latifoltojar A, Freeman A, Jameson C, van der Meulen J, Charman S, Emberton M, Ahmed HU. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. Contemp Clin Trials 2015; 44:175-186. [PMID: 26184343 DOI: 10.1016/j.cct.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. AIM FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. METHODS Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. RESULTS Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. CONCLUSION Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
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Michel C, Freeman A, Jameson C, Waddington W, Tuch D. 2533 Intra-operative margin detection using Cerenkov luminescence Imaging during radical prostatectomy - initial results from the PRIME study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31352-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Freeman A. Acquired haemophilia A presenting at a District General Hospital. CASE REPORTS 2015; 2015:bcr-2014-208001. [DOI: 10.1136/bcr-2014-208001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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El-Shater Bosaily A, Arya M, Punwani S, Emberton M, Kirkham A, Freeman A, Ahmed H. Re: Multiparametric Magnetic Resonance Imaging Guided Diagnostic Biopsy Detects Significant Prostate Cancer and could Reduce Unnecessary Biopsies and Over Detection: A Prospective Study. J Urol 2015; 193:735-6; discussion 736. [DOI: 10.1016/j.juro.2014.08.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 11/16/2022]
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Tétreault S, Freeman A, Carrière M, Beaupré P, Gascon H, Marier Deschênes P. Understanding the parents of children with special needs: collaboration between health, social and education networks. Child Care Health Dev 2014; 40:825-32. [PMID: 24028505 DOI: 10.1111/cch.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/29/2022]
Abstract
CONTEXT In 2003, Quebec's Ministry of Health and Social Services (MSSS) and the Ministry of Education, Recreation and Sports (MELS) concluded the Agreement for the complementarity of services between the health and social services network and the education network. The objectives of the current investigation were to evaluate the implementation of this Agreement and its impact upon renewal of practices and services, and to investigate the consequences for children with special needs and their families. The specific focus of this article is to describe parents' perspectives regarding the impact of this Agreement upon them and their children. METHODS Interviews were conducted with 56 parents of children with disabilities, social maladjustment or learning difficulties across the province of Quebec. Data were analysed using content analysis. RESULTS Most parents were not directly aware of any contact between school staff and health or social professionals, although discussions might have been held without their knowledge. The intervention plans seemed to be the main vehicle through which some parents perceived collaboration to be occurring. For parents, the impact upon actual practices or collaborative work is either minimal or non-existent. CONCLUSION School inclusion of children with special needs is a challenge for all societies. The Agreement illustrates the Quebec government's intent to promote an alliance between two complex networks and has the potential to greatly benefit children and their families. However, more concrete action is required in order to realize specific changes regarding work cohesion and service organization for these groups.
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Factor SA, Scullin MK, Sollinger AB, Land JO, Wood-Siverio C, Zanders L, Freeman A, Bliwise DL, Goldstein FC. Freezing of gait subtypes have different cognitive correlates in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1359-64. [PMID: 25446341 DOI: 10.1016/j.parkreldis.2014.09.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Freezing of gait (FOG) is a major concern for Parkinson's disease (PD) patients because it is a leading cause of falls and is associated with poor quality of life. The pathophysiology is unknown but it is hypothesized that it relates to cognitive abnormalities; particularly executive and visuospatial dysfunction. However, prior results have been discrepant. Pharmacologic subtypes of FOG include those that are responsive and unresponsive to levodopa. OBJECTIVE To determine whether executive and visuospatial dysfunction are associated specifically with the levodopa unresponsive subtype of FOG. METHODS 135 PD subjects completed a single assessment included FOG questionnaire, UPDRS motor scale, comprehensive cognitive battery and measure of hallucinations. Analyses compared unresponsive (n = 16), responsive (n = 20) and no FOG (n = 99) subtypes. RESULTS The unresponsive subtype had a significantly older age of onset of PD than the responsive group (p = .03) and had worse motor scores (p = .003) than the no FOG group. Longer disease duration was associated with the responsive group compared to the no FOG group (p = .002). The unresponsive FOG group had significantly poorer visuospatial ability (p = .001) and executive functioning (p = .02) than both the no and responsive FOG subgroups. These latter groups were not significantly different. The responsive FOG group was associated with the presence of hallucinations. CONCLUSION Aside from pharmacological differences, unresponsive FOG is associated with executive and visuospatial dysfunction implicating frontostriatal pathways while responsive FOG is associated with hallucinations suggesting involvement of posterior cortical regions. Further study and treatment of FOG should include appropriate subtype classification.
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Zhao RY, Freeman A, Naughton MT. Cost of misdiagnosing difficult asthma. Intern Med J 2014; 43:1258. [PMID: 24237652 DOI: 10.1111/imj.12277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/02/2013] [Indexed: 11/26/2022]
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