76
|
Batchelor R, Thomas C, Gardiner BJ, Lee SJ, Fleming S, Wei A, Coutsouvelis J, Ananda-Rajah M. When Azoles Cannot Be Used: The Clinical Effectiveness of Intermittent Liposomal Amphotericin Prophylaxis in Hematology Patients. Open Forum Infect Dis 2021; 8:ofab113. [PMID: 34337090 PMCID: PMC8318248 DOI: 10.1093/ofid/ofab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin B (L-AMB) prophylaxis in a heterogenous group of hematology patients. Methods A retrospective cohort of all hematology patients who received a course of intravenous L-AMB, defined as 1 mg/kg thrice weekly from July 1, 2013 to June 30, 2018, were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation, and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n = 19 of 198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven BIFD occurred in 13 patients (6.6%, 13 of 198), including molds in 54% (n = 7) and non-albicans Candidemia in 46% (n = 6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukemia (6.8%) followed by acute lymphoblastic leukemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy, or anticancer drug-azole interactions (75% of courses) dominated by vincristine, or acute myeloid leukemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury, using a modified international definition, complicated 27% of courses but was not clinically significant, accounting for only 3.3% (9 of 273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help researchers find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios in which azoles are unsuitable, especially as targeted anticancer drugs increase in use.
Collapse
|
77
|
Gonzalez Albo G, Broderick G, Cockerill K, Baird B, Thomas C. 049 Does the Clasification of Peyronie's Disease with Doppler US Affect Surgical Intervention Pursued by the Patient? J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
78
|
Gill E, Thomas C, Sonwalkar S, Howell S. Perioperative analgesia for colorectal cancer patients. Br J Anaesth 2021. [DOI: 10.1016/j.bja.2020.11.010] [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] Open
|
79
|
Bass-Stringer S, Donner D, Kiriazis H, Brown A, Gregorevic P, May C, Bernardo B, Thomas C, Weeks K, McMullen J. Generation and Characterisation of Novel PI3K-Based Gene Therapies for the Treatment of Heart Failure. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.034] [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]
|
80
|
Song SH, McMurray C, Thomas C, Kavanagh S, Stephenson J. Improving pre-pregnancy care for women with diabetes: a community-focused strategy. Diabet Med 2020; 37:2171-2172. [PMID: 32617999 DOI: 10.1111/dme.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
|
81
|
Rapp MA, Tschorn M, Supprian T, Thomas C, Kreisel S, Benninghoff J, Schumann G, Heinz A. [Potentials and limits of aging cohort studies for geriatric psychiatry]. DER NERVENARZT 2020; 92:219-227. [PMID: 33242121 DOI: 10.1007/s00115-020-01035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
The sizeable number of population-based cohort studies of aging in Germany have provided highly valuable contributions for the specification of risk factors and predictors for frequent mental disorders in old age, especially dementia and depression. The results from these cohort studies enable the specification of mechanisms for the development of and preventative interventions for common mental disorders in old age. On the other hand, there is a significant paucity of clinical cohort studies investigating disease trajectories and possible markers for specific individualized interventions of frequent mental disorders in old age. In this article, we report selected key findings from cohort studies of aging and discuss novel approaches for the integration and harmonization of population-based and clinical cohort studies.
Collapse
|
82
|
Spannhorst S, Weller S, Thomas C. [Inpatient equivalent treatment : A new form of care also in gerontopsychiatry]. Z Gerontol Geriatr 2020; 53:713-720. [PMID: 33231760 PMCID: PMC7683866 DOI: 10.1007/s00391-020-01823-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
Seit 2018 ist es nach einer Novellierung des SGB V psychiatrischen Kliniken möglich, stationäre aufsuchende Behandlung im Lebensumfeld psychiatrisch Erkrankter zu realisieren. Dabei sind besondere Strukturmerkmale und Dokumentationspflichten zu beachten. So muss dem Behandlungsteam neben einem Mitglied der ärztlichen und der pflegerischen Berufsgruppe auch mindestens ein Mitglied einer dritten Berufsgruppe angehören (z. B. Ergotherapie, Sozialarbeit, Physiotherapie). Die Leistungsvergütung wird zwischen der jeweiligen Klinik und den Krankenkassen verhandelt und schließt, regional divergent, Abrechnungen nach Pauschalen, nach geleisteten Minuten oder gemischte Modelle ein. Aus psychiatrisch-psychotherapeutischer Sicht bietet die Behandlung gerontopsychiatrischer Patienten in ihrem Wohnumfeld und damit in ihren sozialen Kontexten viele Vorteile. Voraussetzung für ein Gelingen dieses Ansatzes ist ein auch in somatischen Erkrankungen erfahrenes und logistisch hochflexibles multiprofessionelles Behandlungsteam. Unter den Bedingungen der Coronapandemie stellen sich besondere Herausforderungen aufgrund der Besuchsverbote in Pflegeheimen und der mit aufsuchender Arbeit verbundenen Infektionsgefahr für Patienten und Mitglieder des Behandlungsteams.
Collapse
|
83
|
Huang S, Zhang Z, Gambeta E, Xu SC, Thomas C, Godfrey N, Chen L, M'Dahoma S, Borgland SL, Zamponi GW. Dopamine Inputs from the Ventral Tegmental Area into the Medial Prefrontal Cortex Modulate Neuropathic Pain-Associated Behaviors in Mice. Cell Rep 2020; 33:108393. [PMID: 33176145 DOI: 10.1016/j.celrep.2020.108393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
84
|
Michaelidou A, Adjogatse D, Suh Y, Pike L, Thomas C, Woodley O, Rackely T, Palaniappan N, Jayaprakasam V, Sanchez-Nieto B, Evans M, Barrington S, Lei M, Guerrero Urbano T. 18F-FDG-PET in guided dose-painting with intensity modulated radiotherapy in oropharyngeal tumours: A phase I study (FiGaRO). Radiother Oncol 2020; 155:261-268. [PMID: 33161013 DOI: 10.1016/j.radonc.2020.10.039] [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: 06/17/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The FiGaRO trial assessed the feasibility and safety of using an FDG-PET-based dose-painting technique to deliver a radiotherapy (RT) boostto the FDG-avid primary tumour in patients with locally advanced high and intermediate risk oropharyngeal cancer. MATERIALS AND METHOD Patients underwent a planning 18FDG-PET-CT scan, immobilised in the treatment position, after one cycle of induction chemotherapy. The volume of persistent FDG-avidity in the primary tumour was escalated to 71.5 Gy in30 fractions delivered using a simultaneous integrated boost Intensity Modulated RT (SIB-IMRT) technique. RT was delivered with concomitant Cisplatin following 2 cycles of induction chemotherapy. The primary outcome was the incidence of grade ≥ 3 late mucosal toxicity 12 months post-treatment, with an excess rate of >10% regarded as unacceptable. RESULTS Twenty-nine patients were included and twenty-four were treated between 2014 and 2018, in two UK centres. Median follow-up was 36 months (range 4-56 months). Pre-defined planning target volume objectives and organ at risk dose constraints were met in all cases. There were no incidents of acute grade 4 toxicity. There were 4 cases of grade ≥ 3 mucosal toxicity at 12 months post-treatment (19.1%). There were no cases of persistent mucosal ulceration at 12 months. Overall survival at 3-years was 87.5%, 92.9% for intermediate and 70.0% for high risk patients. CONCLUSION Late toxicity rates, although higher than anticipated, are comparable to contemporary published data for standard dose chemo-IMRT. Results suggest improved 3y survival rates for high risk patients. This approach merits further investigation. ClinicalTrials.gov Identifier: NCT02953197.
Collapse
|
85
|
Thomas C, Dregely I, Oksuz I, Guerrero-Urbano T, Greener A, King A, Barrington S. OC-0351: Deep learning for rectal spacer stratification in prostate boost radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
86
|
Thomas C, Dregely I, Oksuz I, Guerrero-Urbano T, Greener A, King A, Barrington S. PO-1751: Effect of pseudoCT methods on dose-derived rectal toxicity prediction in MR-only prostate RT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01769-2] [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]
|
87
|
Hanumanthappa N, Goldsmith C, Mullassery V, Morris S, Aggarwal A, Taylor B, Gaya A, Smith D, Dunne E, GuerreroUrbano T, Qureshi A, Staykova V, Thomas C, Williams C, Hartill C, Taylor L, Harris V, Edwards C, Grandi V, Vivekanandan S, Sisodia C, Ahmad S. PO-1248: Preliminary safety and survival report of Stereotactic radiotherapy to oligometastases. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
88
|
George M, Balantac Z, Gillette C, Farooqui N, Tervonen T, Thomas C, Gilbert I, Gandhi H, Israel E. P213 UNMET MEDICAL NEED ACROSS THE ASTHMA DISEASE SPECTRUM: A US FOCUS GROUP STUDY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.110] [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]
|
89
|
Adams E, Currie S, Thomas C, Pediaditaki A, Temple S, South C, Currie G, Nisbet A. PD-0193: Validation of a multi-centre knowledge-based planning model for radiotherapy of cervical cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
90
|
Valanou E, Oakenful R, Thomas C, Tsouli C, Adkin A. Integration of tools and social science into food safety risk assessments. EFSA J 2020; 18:e181104. [PMID: 33294043 PMCID: PMC7691613 DOI: 10.2903/j.efsa.2020.e181104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The European Food Risk Assessment (EU-FORA) Fellowship work programme 'Integration of tools and social science into food safety risk assessments' was proposed and delivered by the Food Standards Agency (FSA), UK. The Food Standards Agency is a non-ministerial government department of the UK, responsible for protecting public health in relation to food in England, Wales and Northern Ireland. The programme was tailored to several different activities to provide an overview of the different tools that can be employed in food safety risk assessment also accounting for the interaction between risk assessment and social science. In order to structure the proposed work, the programme was split into four modules to run over the 12-month period of 'learning-by-doing'. In the first module, the fellow was introduced to Microbiological Risk Assessment (MRA), in the second to Chemical Risk Assessment (CRA), in the third to Social Science, and finally, in the fourth to the Risk Prioritization Tools and Networks in UK - National Dietary Data (NDNS), collection methodology, coding and analysis. The fellow was assigned to the Risk Assessment Unit within the Science, Evidence and Research Department which brings together specialist expertise from Microbiological, Chemical Risk Assessment, and Analytics Units, under one department together with additional staff from the food allergy and radiological risk assessment fields. The aim was to be fully integrated in the organisation's work gaining first-hand experience, increase knowledge of scientific aspects relevant to food safety risk assessment, and more importantly, to enhance network connection activities in the EU food risk assessment environment.
Collapse
|
91
|
Brandt MP, Gust KM, Bon D, Tsaur I, Thomas C, Neisius A, Haferkamp A, Herrmann E, Bartsch G. Trend analysis and regional tumor incidence in Germany for testicular cancer between 2003 and 2014. Andrology 2020; 7:408-414. [PMID: 31310057 DOI: 10.1111/andr.12666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/12/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Testicular germ cell tumor (TGCT) is one the most common solid tumors in men between the age of 15 and 35 with an overall incidence rate of 1-1.5 %. Epidemiologic studies have demonstrated different incidence patterns in western civilized countries with overall rising incidence trends. OBJECTIVE To analyze differences in regional tumor incidence rates for TGCT and perform a trend analysis for TGCT between 2003 and 2014 in Germany. MATERIAL AND METHODS TGCT cases in Germany which were diagnosed between 2003 and 2014 were provided by the Robert-Koch-Institute, Berlin. For statistical analysis, cluster and spatial scan tests according to Kulldorff were used for cases with seminoma and non-seminoma. Results are presented in administrative districts and graphically illustrated. We performed a trend-analysis in order to evaluate age-adjusted incidence trends in Germany. Tests were two-sided with a level of significance of α=0.05. RESULTS In total we included 35,066 patients. Overall, 22,634 cases had newly diagnosed seminoma and 12,432 were diagnosed as non-seminoma. Maximum incidence of seminoma and non-seminoma was observed for age-group 38-40 years and 26-28 years, respectively. No second peak for the incidences of seminoma and non-seminoma with respect to age were observed. Cluster analysis revealed areas with high and low incidence rates as well as slightly different spatial distribution in Germany between seminoma and nonseminoma. Furthermore, there was no significant increase in age-adjusted incidence rates over the reviewed time period in both cohorts. DISCUSSION In this study differences in reginal tumor incidence rates for seminoma and non-seminoma are reported with both tumor entities revealing distinct clusters. Furthermore, tumor incidence trends for seminoma and nonseminoma between 2003 and 2014 were stable which might indicate the beginning of a plateau phase for TGCT incidence rates in Germany. CONCLUSION In this analysis we were able to identify regions with significantly higher tumor incidence rates for both seminoma and non-seminoma which were specific for these two subtypes. Furthermore, trend analysis revealed a steady incidence rate for testicular cancer in Germany.
Collapse
|
92
|
Klessova S, Thomas C, Engell S. Structuring inter-organizational R&D projects: Towards a better understanding of the project architecture as an interplay between activity coordination and knowledge integration. INTERNATIONAL JOURNAL OF PROJECT MANAGEMENT 2020. [DOI: 10.1016/j.ijproman.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
93
|
Baunacke M, Schmidt ML, Groeben C, Borkowetz A, Thomas C, Koch R, Chun F, Weissbach L, Huber J. Treatment of postprostatectomy urinary incontinence and erectile dysfunction: Is there insufficient access to care in Germany? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
94
|
Whiticar AM, Fornieri A, O'Farrell ECT, Drachmann ACC, Wang T, Thomas C, Gronin S, Kallaher R, Gardner GC, Manfra MJ, Marcus CM, Nichele F. Coherent transport through a Majorana island in an Aharonov-Bohm interferometer. Nat Commun 2020; 11:3212. [PMID: 32587242 PMCID: PMC7316771 DOI: 10.1038/s41467-020-16988-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022] Open
Abstract
Majorana zero modes are leading candidates for topological quantum computation due to non-local qubit encoding and non-abelian exchange statistics. Spatially separated Majorana modes are expected to allow phase-coherent single-electron transport through a topological superconducting island via a mechanism referred to as teleportation. Here we experimentally investigate such a system by patterning an elongated epitaxial InAs-Al island embedded in an Aharonov-Bohm interferometer. With increasing parallel magnetic field, a discrete sub-gap state in the island is lowered to zero energy yielding persistent 1e-periodic Coulomb blockade conductance peaks (e is the elementary charge). In this condition, conductance through the interferometer is observed to oscillate in a perpendicular magnetic field with a flux period of h/e (h is Planck’s constant), indicating coherent transport of single electrons through the islands, a signature of electron teleportation via Majorana modes. Theories predict teleportation of phase-coherent single electrons through a topological superconducting island. Here, the authors report persistent Coulomb blockade conductance peaks due to coherent transport of single electrons through patterned InAs-Al islands embedded in an Aharonov-Bohm interferometer.
Collapse
|
95
|
Nichele F, Portolés E, Fornieri A, Whiticar AM, Drachmann ACC, Gronin S, Wang T, Gardner GC, Thomas C, Hatke AT, Manfra MJ, Marcus CM. Relating Andreev Bound States and Supercurrents in Hybrid Josephson Junctions. PHYSICAL REVIEW LETTERS 2020; 124:226801. [PMID: 32567899 DOI: 10.1103/physrevlett.124.226801] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/03/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
We demonstrate concomitant measurement of phase-dependent critical current and Andreev bound state spectrum in a highly transmissive InAs Josephson junction embedded in a dc superconducting quantum interference device (SQUID). Tunneling spectroscopy reveals Andreev bound states with near unity transmission probability. A nonsinusoidal current-phase relation is derived from the Andreev spectrum, showing excellent agreement with the one extracted from the SQUID critical current. Both measurements are reconciled within a short junction model where multiple Andreev bound states, with various transmission probabilities, contribute to the entire supercurrent flowing in the junction.
Collapse
|
96
|
Burel-Vandenbos F, Pierron G, Thomas C, Reynaud S, Gregoire V, Duhil de Benaze G, Croze S, Chivoret N, Honavar M, Figarella-Branger D, Maurage CA, Pedeutour F, Hasselblatt M, Godfraind C. A polyphenotypic malignant paediatric brain tumour presenting a MN1-PATZ1 fusion, no epigenetic similarities with CNS High-Grade Neuroepithelial Tumour with MN1 Alteration (CNS HGNET-MN1) and related to PATZ1-fused sarcomas. Neuropathol Appl Neurobiol 2020; 46:506-509. [PMID: 32397004 DOI: 10.1111/nan.12626] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/29/2022]
|
97
|
Thomas C, Tzitzika M, Konstantinidis C. P-03-2 Female Urethral Diverticulum Presenting as Dyspareunia. A Case Report. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
98
|
Chapman C, Thomas C, Morling J, Tangri A, Oliver S, Simpson JA, Humes DJ, Banerjea A. Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham. Colorectal Dis 2020; 22:679-688. [PMID: 31876975 DOI: 10.1111/codi.14944] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/29/2019] [Indexed: 12/29/2022]
Abstract
AIM We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach. METHOD FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018. RESULTS Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P < 0.0001). FIT results ≥ 10.0 μg Hb/g faeces identified patients with significantly higher risk of significant noncancer bowel pathology (24.1% vs 4.9%, chi-square 73.6, P < 0.0001) and FIT results < 4.0 μg Hb/g faeces identified a group more likely to have non-CRC pathology (5.1% vs 2.4%, chi-square 3.9, P < 0.05). The CRC detection rate in 531 patients investigated after a FIT result of < 4.0 μg Hb/g faeces was 0.2%. In 899 investigated patients, a FIT result with a threshold of 4.0 μg Hb/g faeces had sensitivity 97.2% (85.5-99.9% CI), specificity 61.4% (58.1-64.7% CI), negative predictive value 99.8% (98.7-100.0% CI) and positive predictive value 9.5% (8.7-10.4% CI). CONCLUSION A symptomatic pathway incorporating FIT is feasible and appears more clinically effective than pathways based on age and symptoms alone.
Collapse
|
99
|
Savic L, Thomas C, Fallaha D, Hopkins P, Hutchinson M, Savic S, Clark S. Drug allergy labels in elective surgical patients: what do patients and their anaesthetists think about penicillin allergy labels? Br J Anaesth 2020. [DOI: 10.1016/j.bja.2019.11.008] [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] Open
|
100
|
Thomas C, Matthies M, Homey B, Meller S. [Intertriginous psoriasis]. Hautarzt 2020; 71:263-268. [PMID: 32144441 DOI: 10.1007/s00105-020-04558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intertriginous psoriasis is a variant of psoriasis that is associated with inflammatory lesions in skin folds. Patients often feel ashamed, are subjected to stigmatization, social isolation, or experience mental health issues. There is no general consensus on the definition of intertriginous psoriasis. Depending on the definition used, the prevalence varies substantially. Due to the particular location of skin lesions, therapeutic management is very challenging. Mild symptoms can be treated with topical corticosteroids or topical immunomodulators. There are encouraging data demonstrating the efficacy of ixekizumab, possibly charting the way for it to become a systemic treatment option.
Collapse
|