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Heidenreich A, Schrader M, Dieckmann K, Winter C, Pfister DA. Prognostic clinical parameters to predict the necessity of reconstructive vascular surgery for patients who undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminatous germ cell tumors (NSGCT). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
229 Background: PC-RPLND remains an integral part of the multimodality treatment for advanced NSGCT. The need to resect and to replace the major retroperitoneal vessels must be known preoperatively to enable complete resection of the residual masses. Methods: PC-RPLND was performed in 411 patients with NSGCT and normalized (81%) or plateauing (19%) tumor markers following 3-4 cycles PEB/PEI. PC-RPLND was performed in 5 institutions with a variable surgical frequency of 14 to 158 PC-RPLNDs. Good, intermediate, and poor prognosis according to the IGCCCG criteria was identified in in 59.8%, 21.2%, and 19% respectively. Results: Resection of the inferior vena cava was performed in 28 (6.81%), resection of the abdominal aorta was necessary in 13 (3.16%) patients. In 29/41 (70.7%) adjunctive surgical procedures such as nephrectomy, small bowel resection, ureteral resection had to be performed to ensure complete resection of the residual masses. Histologically vital cancer or mature teratoma was identified in 78.1% of the resected vascular specimens. Mean time of surgery was 295 (243-615) Min., mean blood loss was 690 (350 – 3400) ml. Good prognosis was identified in 15.4%, intermediate and poor prognosis was present in 41%and 43.6%, resp. Of all 411 patients involvement of the major retroperitoneal vessels was found in 3.2%, 18.4% and 21.8% with good, intermediate, and poor prognosis, resp. The mean tumor diameter was 5.9 (1.0 – 32) cm for the entire cohort and 9.8 (4-32) cm for the cohort of patients with vascular surgery. Significant prognosticators to predict vascular involvement were identified by multivariate analysis: intermediate/poor prognosis, number of cycles of chemotherapy, tumor diameter > 14cm, circumferential encasement of > 50% of the vessel diameter. Conclusions: Complete resection of the inferior vena cava or the abdominal aorta during PC-RPLND is necessary in about 10% of patients. The identified predictors enable already preoperatively a risk adapted interdisciplinary approach for complete resection of the residual masses in an experienced centre. No significant financial relationships to disclose.
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Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H, Winter C, Crofts JF, Hunt LP, Fox R. Clinical efficiency in a simulated emergency and relationship to team behaviours: a multisite cross-sectional study. BJOG 2011; 118:596-607. [PMID: 21291509 DOI: 10.1111/j.1471-0528.2010.02843.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify specific aspects of teamworking associated with greater clinical efficiency in simulated obstetric emergencies. DESIGN Cross-sectional secondary analysis of video recordings from the Simulation & Fire-drill Evaluation (SaFE) randomised controlled trial. SETTING Six secondary and tertiary maternity units. SAMPLE A total of 114 randomly selected healthcare professionals, in 19 teams of six members. METHODS Two independent assessors, a clinician and a language communication specialist identified specific teamwork behaviours using a grid derived from the safety literature. MAIN OUTCOME MEASURES Relationship between teamwork behaviours and the time to administration of magnesium sulfate, a validated measure of clinical efficiency, was calculated. RESULTS More efficient teams were likely to (1) have stated (recognised and verbally declared) the emergency (eclampsia) earlier (Kendall's rank correlation coefficient τ(b) = -0.53, 95% CI from -0.74 to -0.32, P=0.004); and (2) have managed the critical task using closed-loop communication (task clearly and loudly delegated, accepted, executed and completion acknowledged) (τ(b) = 0.46, 95% CI 0.17-0.74, P=0.022). Teams that administered magnesium sulfate within the allocated time (10 minutes) had significantly fewer exits from the labour room compared with teams who did not: a median of three (IQR 2-5) versus six exits (IQR 5-6) (P=0.03, Mann-Whitney U-test). CONCLUSIONS Using administration of an essential drug as a valid surrogate of team efficiency and patient outcome after a simulated emergency, we found that more efficient teams were more likely to exhibit certain team behaviours relating to better handover and task allocation.
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Daly I, Lampic C, Skoog Svanberg A, Sydsjo G, Fryk N, Shyshak O, Donarelli Z, Lo Coco G, Gullo S, Marino A, Volpes A, Allegra A, Hinton L, Kurinczuk JJ, Ziebland S, Frederiksen Y, Zachariae R, Schmidt L, Ingerslev HJ, Vercammen L, Stoop D, De Vos M, Polyzos NP, Nekkebroeck J, Devroey P, Graham S, Jadva V, Morrissette M, Golombok S, Hamilton J, Behan H, Venables R, Maher B, Moorhead C, Hughes C, Mocanu E, Smeenk JMJ, Verhaak CM, Valladolid N, Guijarro JA, Brod M, Simone Crespi MPH, Hein Fennema P, Jadva V, Blake L, Readings J, Casey P, Golombok S, Jordan C, Broderick P, Winter C, Belva F, Nekkebroeck J, Bondulle M, Van den Broeck U, Vandermeeren M, Vanderschueren D, Enzlin P, Demyttenaere K, D'Hooghe TM, Harrison C, Bunting L, Tsibulsky I, Boivin J, Overbeek A, van den Berg MH, Louwe L, Hilders C, Veening MA, Lambalk CB, Stiggelbout AM, van Dulmen-den Broeder E, Ter Kuile MM, Indekeu A, D'Hooghe T, De Sutter P, Demyttenaere K, Vanderschueren D, Vanderschot B, Welkenhuysen M, Rober P, Colpin H, Riedel P, Baeckert-Sifedine IT, Iversen C. V, Ludwig O, Ludwig S, Kentenich H, Skoog Svanberg A, Lampic C, Brandstrom S, Geijervall AL, Gudmundsson J, Karlstrom PO, Solensten NG, Sydsjo G, Van Dongen AJCM, Kremer JAM, Van Sluisveld PHJ, Verhaak CM, Nelen WLDM, Galhardo A, Cunha M, Pinto-Gouveia J, Huppelschoten DA, Aarts JWM, van Empel IWH, Nelen WL, Kremer JAM, Ockhuysen H, Boivin J, Hoogen A, Macklon NS, Aarts A, van den Haak P, Nelen W, Tuil W, Faber M, Kremer J, Bak CW, Seok HH, Song SH, Yoo SW, Lee WS, Yoon TK. POSTER VIEWING SESSION - PSYCHOLOGY AND COUNSELLING. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mehlhorn G, Münzenmayer C, Kage A, Benz M, Koch M, Winter C, Beckmann M, Wittenberg T. Computer-assistierte Diagnostik (CAD) für die Kolposkopie - Evaluation einer Pilotstudie. ACTA ACUST UNITED AC 2010. [DOI: 10.1055/s-0030-1262651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Beucke JC, Plotkin M, Winter C, Endrass T, Amthauer H, Juckel G, Kupsch A. Midbrain serotonin transporters in de novo and L-DOPA-treated patients with early Parkinson’s disease - a [123I]-ADAM SPECT study. Eur J Neurol 2010; 18:750-5. [DOI: 10.1111/j.1468-1331.2010.03274.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quentin M, Barski D, Winter C, Blondin D. [3 T MRI of the prostate in patients with symptomatic prostatic utricle cyst]. Urologe A 2010; 49:1532-4. [PMID: 21076809 DOI: 10.1007/s00120-010-2451-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cystic lesions of the prostate are rare and often asymptomatic. Medial cysts are conventionally divided into so-called Müllerian duct cysts and prostatic utricle cysts which seems rather questionable in light of recent studies. We report a case of a patient with a 10-year history of dysuria. Diagnostic imaging was performed using 3 T prostate MRI with a body coil. Because of the potential risk of retrograde ejaculation with subsequent infertility and of incontinence by the transurethral resection, the interventional therapy of his utricle cyst was abandoned.
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Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, Hunt LP, Draycott T. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG 2010. [DOI: 10.1111/j.1471-0528.2010.02740.x] [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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Sathyanarayanan S, Watkins D, Sykes K, Howard S, Valentine E, Bloecher A, Clark E, Hsu K, Cunningham D, Winter C. 229 Anti-IGF1R therapy with dalotuzumab is efficacious in a sub-set of KRAS mutant cetuximab refractory CRC models. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Winter C, Harnack D, Kupsch A. [Deep brain stimulation for neurological and psychiatric diseases: animal experiments on effect and mechanisms]. DER NERVENARZT 2010; 81:711-8. [PMID: 20502860 DOI: 10.1007/s00115-010-2936-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation at high frequencies has emerged as a powerful therapeutic strategy in the treatment of basal ganglia-related movement disorders. Attempts have also been made to establish this for the treatment of therapy-resistant psychiatric disorders. To date the mechanisms underlying the clinical efficacy of high frequency stimulation remain largely unknown. Their detailed description, however, is essential for promoting the extended application of high frequency stimulation as a therapeutic alternative and may simultaneously allow conclusions to be drawn on the pathophysiological mechanisms underlying the diseases benefiting from deep brain stimulation. This review demonstrates how animal models contribute to i) further understand the mechanisms underlying deep brain stimulation at high frequencies and ii) promote the establishment of high frequency stimulation for the treatment of therapy-resistant psychiatric disorders.
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Winter C, Kimmerle K, Schlichter B. Zentrifugalabscheider mit Einbauten zur Fest/Flüssig- und Flüssig/Flüssig-Trennung. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Winter C, Vollmayr B, Djodari-Irani A, Klein J, Sartorius A. Pharmacological inhibition of the lateral habenula improves depressive-like behavior in an animal model of treatment resistant depression. Behav Brain Res 2010; 216:463-5. [PMID: 20678526 DOI: 10.1016/j.bbr.2010.07.034] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/19/2010] [Accepted: 07/25/2010] [Indexed: 11/26/2022]
Abstract
Identifying new treatment approaches for treatment resistant depression (TRD) is an important topic for translational psychiatry. Functional inhibition of the lateral habenula (LHb) has recently been claimed to offer such an option for TRD. Rats which are bred for high susceptibility to develop learned helplessness provide a genetic model for TRD. We used the gamma-aminobutyric acid agonist muscimol to inhibit the LHb in Sprague-Dawley rats with congenital learned helplessness (cLH). Stereotactic pharmacological inhibition of the LHb exerted antidepressive effects in treatment resistant cLH rats.
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Siassakos D, Draycott TJ, Crofts JF, Hunt LP, Winter C, Fox R. More to teamwork than knowledge, skill and attitude. BJOG 2010; 117:1262-9. [PMID: 20618313 DOI: 10.1111/j.1471-0528.2010.02654.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess whether team performance in simulated eclampsia is related to the knowledge, skills and attitudes of individual team members. DESIGN Cross-sectional analysis of data from the Simulation and Fire Drill Evaluation randomised controlled trial. SETTING Six secondary and tertiary maternity units in south-west England. PARTICIPANTS One hundred and fourteen maternity professionals in 19 teams of six members; one senior and one junior obstetrician; two senior and two junior midwives. METHODS We validated a team performance ranking scheme with respect to magnesium administration (Magnesium Administration Rank, MAR) by expert consensus (face validity) and correlation with clinical measures (construct validity). We tested for correlation between MAR and measures of knowledge, skills and attitudes. MAIN OUTCOME MEASURES Correlation between team performance (MAR) and scores in validated multiple-choice questionnaires (MCQs) (knowledge), a measure of individual manual skill to manage an obstetric emergency (skill) and scores in a widely used teamwork/safety attitude questionnaire (attitude). RESULTS There was no relationship between team performance and cumulative individual MCQs, skill or teamwork/safety attitude scores. CONCLUSIONS The knowledge, manual skills and attitudes of the individuals comprising each team, measured by established methods, did not correlate in this study with the team's clinical efficiency in the management of simulated eclampsia. The inference is that unidentified characteristic(s) play a crucial part in the efficiency of teams managing emergencies. Any emphasis of training programmes to promote individual knowledge, skills and attitudes alone may have to be re-examined. This highlights a need to understand what makes a team efficient in dealing with clinical emergencies.
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Winter C, Bingoel C, Witthuhn R, De Geeter P, Albers P. Residual tumor resection in patients with germ cell tumors (GCT): Use of IGCCCG risk group and tumor volume to predict additional vascular procedures. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, Hunt LP, Draycott T. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG 2010; 117:929-36. [PMID: 20482535 DOI: 10.1111/j.1471-0528.2010.02585.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the effectiveness of carbetocin and oxytocin when they are administered after caesarean section for prevention of postpartum haemorrhage (PPH). STUDY DESIGN Double-blind randomised single centre study (1:1 ratio). SETTING Teaching hospital in Bristol, UK with 6000 deliveries per annum. POPULATION Women at term undergoing elective or emergency caesarean section under regional anaesthesia, excluding women with placenta praevia, multiple gestation and placental abruption. METHODS Women were randomised to receive either carbetocin 100 microg or oxytocin 5 IU intravenously after the delivery of the baby. Perioperative care was otherwise normal and use of additional oxytocics was at the discretion of the operating obstetrician. Analysis was by intention to treat. PRIMARY OUTCOME MEASURE The proportion of women in each arm of the trial that needed additional pharmacological oxytocic interventions. RESULTS Significantly more women needed additional oxytocics in the oxytocin group (45.5% versus 33.5%, Relative risk 0.74, 95% CI 0.57-0.95). The majority of women had oxytocin infusions. There were no significant differences in the secondary outcomes, including major PPH, blood transfusions and fall in haemoglobin. CONCLUSIONS Carbetocin is associated with a reduced use of additional oxytocics. It is unclear whether this may reduce rates of PPH and blood transfusions.
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Faude O, Kerper O, Multhaupt M, Winter C, Beziel K, Junge A, Meyer T. Football to tackle overweight in children. Scand J Med Sci Sports 2010; 20 Suppl 1:103-10. [DOI: 10.1111/j.1600-0838.2009.01087.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Marsico A, Henschel A, Winter C, Tuukkanen A, Vassilev B, Scheubert K. Structural fragment clustering reveals novel structural and functional motifs in alphahelical transmembrane proteins. N Biotechnol 2010. [DOI: 10.1016/j.nbt.2010.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siassakos D, Fox R, Farey J, Laxton C, Winter C, Draycott T. O864 Profile of attitudes to safety, teamwork and working conditions in a maternity unit with embedded inter-professional learning. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61237-6] [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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Winter C. I366 Practical advice to organise local training. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tammam J, Ware C, Efferson C, O'Neil J, Rao S, Qu X, Gorenstein J, Angagaw M, Kim H, Kenific C, Kunii K, Leach KJ, Nikov G, Zhao J, Dai X, Hardwick J, Scott M, Winter C, Bristow L, Elbi C, Reilly JF, Look T, Draetta G, Van der Ploeg L, Kohl NE, Strack PR, Majumder PK. Down-regulation of the Notch pathway mediated by a gamma-secretase inhibitor induces anti-tumour effects in mouse models of T-cell leukaemia. Br J Pharmacol 2009; 158:1183-95. [PMID: 19775282 DOI: 10.1111/j.1476-5381.2009.00389.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE gamma-Secretase inhibitors (GSIs) block NOTCH receptor cleavage and pathway activation and have been under clinical evaluation for the treatment of malignancies such as T-cell acute lymphoblastic leukaemia (T-ALL). The ability of GSIs to decrease T-ALL cell viability in vitro is a slow process requiring >8 days, however, such treatment durations are not well tolerated in vivo. Here we study GSI's effect on tumour and normal cellular processes to optimize dosing regimens for anti-tumour efficacy. EXPERIMENTAL APPROACH Inhibition of the Notch pathway in mouse intestinal epithelium was used to evaluate the effect of GSIs and guide the design of dosing regimens for xenograft models. Serum Abeta(40) and Notch target gene modulation in tumours were used to evaluate the degree and duration of target inhibition. Pharmacokinetic and pharmacodynamic correlations with biochemical, immunohistochemical and profiling data were used to demonstrate GSI mechanism of action in xenograft tumours. KEY RESULTS Three days of >70% Notch pathway inhibition was sufficient to provide an anti-tumour effect and was well tolerated. GSI-induced conversion of mouse epithelial cells to a secretory lineage was time- and dose-dependent. Anti-tumour efficacy was associated with cell cycle arrest and apoptosis that was in part due to Notch-dependent regulation of mitochondrial homeostasis. CONCLUSIONS AND IMPLICATIONS Intermittent but potent inhibition of Notch signalling is sufficient for anti-tumour efficacy in these T-ALL models. These findings provide support for the use of GSI in Notch-dependent malignancies and that clinical benefits may be derived from transient but potent inhibition of Notch.
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Abstract
In recent years electrotherapy has become an accepted treatment option in several medical subfields such as defibrillation during cardiopulmonary resuscitation, electroconvulsive shock treatment (ECT) in conjunction with antidepressant therapy, pain management and physical therapy [transcutaneous electrical nerve stimulation (TENS), diathermia, Stanger bath therapy, etc.]. In recent years several groups, especially from Asia, have investigated the therapeutic effect of electricity in the treatment of malignant tumours. They determined basic principles of electrotherapy and developed different theories of tumour destruction. They postulated a multifactorial tissue effect of continuous current based on tumour cell necrosis due to pH shifting and alteration of membrane potential. In clinical trials similar oncological results of electrotherapy in several malignant tumours compared to established therapeutic methods were observed, whereas clinical trial designs to some extent were not consistent with internationally accepted scientific standards. Regarding electrotherapy of localised prostate cancer only limited data with a few cases and controversial study designs were published. According to EAU guidelines electrotherapy of localised prostate cancer as an alternative treatment option is not recommended and is still an experimental method. For this procedure well-designed clinical trials and a longer follow-up are mandatory to assess the true role of electrotherapy in the management of prostate cancer.
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Siassakos D, Hasafa Z, Sibanda T, Fox R, Donald F, Winter C, Draycott T. Retrospective cohort study of diagnosis-delivery interval with umbilical cord prolapse: the effect of team training. BJOG 2009; 116:1089-96. [PMID: 19438496 DOI: 10.1111/j.1471-0528.2009.02179.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis-delivery interval (DDI). DESIGN Retrospective cohort study. SETTING Large tertiary maternity unit within a University Hospital in the United Kingdom. SAMPLE All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training. METHODS Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993-99) and post-training (2001-07). MAIN OUTCOME MEASURES Diagnosis-delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g). RESULTS After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%. CONCLUSIONS The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.
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Siassakos D, Crofts JF, Winter C, Weiner CP, Draycott TJ. The active components of effective training in obstetric emergencies. BJOG 2009; 116:1028-32. [PMID: 19438497 DOI: 10.1111/j.1471-0528.2009.02178.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Confidential enquiries into poor perinatal outcomes have identified deficiencies in team working as a common factor and have recommended team training in the management of obstetric emergencies. Isolated aviation-based team training programmes have not been associated with improved perinatal outcomes when applied to labour ward settings, whereas obstetric-specific training interventions with integrated teamwork have been associated with clinical improvements. This commentary reviews obstetric emergency training programmes from hospitals that have demonstrated improved outcomes to determine the active components of effective training. The common features identified were: institution-level incentives to train; multi-professional training of all staff in their units; teamwork training integrated with clinical teaching and use of high fidelity simulation models. Local training also appeared to facilitate self-directed infrastructural change.
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Sibanda T, Crofts JF, Barnfield S, Siassakos D, Epee MJ, Winter C, Draycott T. PROMPT education and development: saving mothers’ and babies’ lives in resource poor settings. BJOG 2009; 116:868-9. [DOI: 10.1111/j.1471-0528.2009.02117.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abd El Rahman S, El-Kenawy AA, Neumann U, Herrler G, Winter C. Comparative analysis of the sialic acid binding activity and the tropism for the respiratory epithelium of four different strains of avian infectious bronchitis virus. Avian Pathol 2009; 38:41-5. [PMID: 19156578 DOI: 10.1080/03079450802632049] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Avian infectious bronchitis virus (IBV) is a major pathogen in commercial poultry flocks. We recently demonstrated that sialic acid serves as a receptor determinant for IBV on the tracheal epithelium. Here we compared the IBV strains Beaudette, 4/91, Italy02, and QX for their sialic acid-binding properties. We demonstrate that sialic acid binding is important for the infection of primary chicken kidney cells and the tracheal epithelium by all four strains. There were only slight differences between the four strains, indicating the universal usage of sialic acids as receptor determinants by IBV. In addition, we analysed the primary target cells in the respiratory epithelium of the four different strains and found that all of them infected ciliated cells and goblet cells.
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Deneux-Tharaux C, Macfarlane A, Winter C, Zhang WH, Alexander S, Bouvier-Colle MH. Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe. BJOG 2008; 116:119-24. [DOI: 10.1111/j.1471-0528.2008.01996.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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