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Singh A, Kazi R, De Cordova J, Nutting C, Clarke P, Harrington K, RhysEvans P. Multidimensional Assessment of Voice After Vertical Partial Laryngectomy: A Comparison With Normal and Total Laryngectomy Voice. J Voice 2008; 22:740-5. [DOI: 10.1016/j.jvoice.2007.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 04/16/2007] [Indexed: 11/28/2022]
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Argent R, Yin Y, Grabowska A, Clarke P, Mann N, Royal E, Watson S. 65 POSTER Hypoxic conditions increase hypoxia response element and vascular endothelial growth factor promoter reporter activity within the hollow fibre assay in vivo. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71997-9] [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] Open
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Abstract
BACKGROUND Several studies have suggested that glibenclamide may be used safely and effectively in women with gestational diabetes mellitus (GDM). The aim of our study was to assess effectiveness and safety of glibenclamide for GDM in UK clinical practice. METHODS Women with GDM requiring pharmacological therapy were offered a choice of insulin or glibenclamide. Maternal and foetal outcomes were assessed in women treated with insulin (45) or glibenclamide (44) and also compared with women treated with diet alone (55). RESULTS Thirty-four (77%) achieved adequate glycaemic control with glibenclamide. Women choosing glibenclamide were more likely to be Asian and had higher fasting and 2-h glucose at diagnosis than those choosing insulin. There was no difference in maternal age or parity. Ten women treated with glibenclamide switched to insulin [inadequate control (7), unpredictable hypoglycaemia (1) and other reason (2)]. There was no difference in mode of birth, birth weight or birth weight centile between groups. One stillbirth occurred with glibenclamide. Glibenclamide treatment was associated with lower Apgar scores and increased neonatal jaundice. Neonatal hypoglycaemia occurred more frequently in babies of women treated with either glibenclamide or insulin. CONCLUSION The use of glibenclamide in pregnancy is associated with adequate glycaemic control in 77% of women and achieved similar foetal outcomes to women treated with insulin.
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Morris TCM, Kettle PJ, Drake M, Jones FCG, Hull DR, Boyd K, Morrison A, Clarke P, O'Reilly P, Quinn J. Clarithromycin with low dose dexamethasone and thalidomide is effective therapy in relapsed/refractory myeloma. Br J Haematol 2008; 143:349-54. [PMID: 18759764 DOI: 10.1111/j.1365-2141.2008.07360.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A combination of clarithromycin, low dose of thalidomide and low dose dexamethasone was used in a phase II study to treat patients with relapsed and refractory myeloma. Thirty patients received clarithromycin 250 mg twice daily and thalidomide 50 mg at night on an ongoing basis with 4-d pulses of 10 mg dexamethasone given monthly. Eight patients had permitted escalation of thalidomide dosage up to 200 mg daily. The combination was well tolerated and could be given to elderly, infirm and severely cytopenic patients. Response rates were high, with 89% achieving at least 50% reduction in paraprotein and a 96% overall response rate. Although clarithromycin has only minimal anti-myeloma properties when used as a single agent, its combination with thalidomide and dexamethasone appears very effective, allowing these to be used in lower and more tolerable doses with good clinical effects.
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Abstract
An economic analysis was not initially included in the study design of the UK Prospective Diabetes Study (UKPDS). However, data were collected throughout the study on hospital drugs and medications used and these were supplemented near the end of the study by cross-sectional surveys of non-inpatient healthcare use and quality of life. Evaluations of tight vs. less tight blood pressure control, intensive vs. less conventional blood glucose control and metformin showed that each was highly cost-effective and that all could be provided at modest total cost. Further analyses showed that amputations and stroke had particularly severe consequences for quality of life, and that amputations and non-fatal MI had high cost consequences. Finally, patient-level data were used to construct a diabetes outcomes model, which estimates the probability of longer-term complications from patient-specific risk factors and can be used in populations at different stages of diabetes progression. The economic analyses arising from the UKPDS have provided new evidence to clinicians, policymakers and researchers on the consequences of diabetes and the cost-effectiveness of interventions, thereby assisting the development of treatment guidelines and improved standards of care. The analyses also illustrated a number of methodological innovations. Finally, the UKPDS Outcomes Model is gaining widespread acceptance as a validated tool for long-term economic and clinical prediction in diabetes.
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Datta MK, Clarke P. Current practices in skin antisepsis for central venous catheterisation in UK tertiary-level neonatal units. Arch Dis Child Fetal Neonatal Ed 2008; 93:F328. [PMID: 18567744 DOI: 10.1136/adc.2008.137430] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Singh A, Kazi R, Venkitaraman R, Kapoor K, Nutting C, Clarke P, Rhys Evans P, Harrington K. Does flexible videostroboscopy compare with rigid videostroboscopy in the assessment of the neoglottis? A preliminary report. Clin Otolaryngol 2008; 33:60-3. [PMID: 18302558 DOI: 10.1111/j.1749-4486.2007.01571.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate rigid and flexible stroboscopy of the neoglottis. STUDY DESIGN Prospective pilot study set at a tertiary level Head & Neck Unit. PARTICIPANTS Twenty-four patients recruited. All had undergone a total laryngectomy and were voicing using a Blom-singer valve. All had stroboscopic evaluation of their neoglottis using flexible and rigid endoscopes. MAIN OUTCOME MEASURES A rating form was devised based on six parameters with clear definitions. Secondary measures included ability to tolerate the procedure and completeness of the rating form for each parameter using the two systems. RESULTS There was good reliability between individual raters for the assessment of each system based on Spearman Rho correlation. Importantly, two-thirds of the patients were unable to tolerate the rigid videostroboscopy managed flexible videostroboscopy. Correlation between rigid and flexible videostroboscopy was poor for both raters. Flexible systems picked up more mucosal waves and allowed further analysis of the mucosal wave pattern. CONCLUSIONS To our knowledge, this is the first study to demonstrate that fibreoptic videstroboscopy is as good as rigid videostroboscopy in the assessment of the neoglottis. In fact, flexible videostroboscopy should be routinely used, as it is better tolerated and allows a more detailed analysis of the neoglottis.
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Kiverniti E, Singh A, Clarke P. Küttner's tumour: an unusual cause of salivary gland enlargement. Hippokratia 2008; 12:56-58. [PMID: 18923750 PMCID: PMC2532958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Enlargement of the submandibular gland is a condition that raises the alarm for further investigation as the risk of an underlying malignancy is higher in comparison to parotid gland enlargement. Chronic sclerosing sialadenitis or Küttner's tumour is usually mis-recognised as it is only after excision of the gland that the correct diagnosis is made.We present a case of a 47-year-old male patient who presented with one year history of firm non-tender enlarged right submandibular gland which was removed surgically and histology showed to be sclerosing sialadenitis.Küttner's tumour is a rare disease, which mimics malignancy. There is not enough evidence to support any diagnostic means that could help in the differential diagnosis of this benign condition. Given the high rate of malignancy in firm, painless lesions of the submandibular gland, surgical excision is often advocated and Küttner's tumour is usually diagnosed by the histopathologist.
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Kazi R, Prasad V, Venkitaraman R, Nutting C, Clarke P, Rhys-Evans P, Harrington K. Questionnaire Analysis of Swallowing-Related Outcomes following Glossectomy. ACTA ACUST UNITED AC 2008; 70:151-5. [DOI: 10.1159/000124287] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 06/17/2007] [Indexed: 11/19/2022]
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Kazi R, De Cordova J, Singh A, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Voice-related Quality of Life in Laryngectomees: Assessment Using the VHI and V-RQOL Symptom Scales. J Voice 2007; 21:728-34. [PMID: 16815670 DOI: 10.1016/j.jvoice.2006.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Accepted: 05/22/2006] [Indexed: 11/23/2022]
Abstract
The primary purpose of this study was to investigate the effect of the voice impairment across the physical, emotional, and functional domains in patients using valved speech following total laryngectomy with the help of two symptom specific scales. The study design used was a cross-sectional cohort. The setting was the Head and Neck Oncology Unit of a tertiary referral centre. Subjects were 54 patients who had undergone total laryngectomy. Two voice-specific questionnaires, the Voice-Related Quality of Life (V-RQOL-short form) Measure, and the Voice Handicap Index (VHI-long form) were used. The main outcome measure was patient perception of the voice following total laryngectomy in response to specific questions correlated with sociodemographic/treatment factors. Responses were received from 40 males and 14 females (response rate of 85.7%) with a median age of 63.4 years (range: 37-84). The V-RQOL overall analysis showed that 3 patients (5.6%) scored "excellent," 29 patients (53.7%) "fair to good," 14 patients (25.9%) "poor to fair," and 8 patients (14.8%) "poor." Analysis of the VHI revealed that 20 patients (37.0%) had a minimal handicap, 20 patients (37.0%) a moderate handicap, and 14 patients (25.9%) had a serious voice handicap. The individual domain or subscale scores for the VHI revealed a mean (SD) functional score of 15.8 (7.7), a physical score of 13.6 (7.2), and finally an emotional score of 11.6 (8.9). Functional aspects of the voice were significantly affected by age, radiotherapy, and chemotherapy (Spearman rho, P=0.01; Mann-Whitney, P=0.04 and P=0.01). The physical aspects of the voice were significantly affected by age and chemotherapy (Spearman rho, P=0.004; Mann-Whitney, P=0.04). Only age significantly affected the emotional aspects of the voice (Spearman rho, P=0.002). We found a strong correlation (Spearman rho, P<0.001) between the V-RQOL and VHI questionnaires. Our study revealed that the V-RQOL and VHI scores in our series of patients following voice restoration in laryngectomees were consistent with that reported in the literature. Only age, radiation, and chemotherapy were seen to influence the voice handicap scores. In addition, both symptom scales had good correlation between them and either one could be used with reliability in laryngectomees with a few modifications.
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Thankamony A, Harlow FH, Ponnampalam J, Clarke P. Congenital brain tumour mimicking fetal intracranial haemorrhage. J OBSTET GYNAECOL 2007; 27:314-7. [PMID: 17464824 DOI: 10.1080/01443610701241217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rao S, Cunningham D, Benson M, Te Poele R, Welsh L, Starling N, Norman A, Saffery C, Workman P, Clarke P. A prospective study to evaluate the role of gene expression profiles (GEP) in predicting clinical outcome of patients (pts) receiving preoperative chemotherapy for oesophagogastric (OG) cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4501 Background: Whilst preoperative chemotherapy has demonstrated survival benefit for pts with potentially resectable OG cancer it is not possible to predict the benefit for an individual pt. This study was designed to prospectively correlate GEP with clinical outcome. Methods: Eligible pts were deemed to have resectable disease after staging CT, EUS, and laparoscopy as indicated & following discussion at the multidisciplinary team meeting. All pts received neoadjuvant platinum & fluoropyrimidine based chemotherapy & clinical data were entered prospectively onto a study specific database. GEP were produced from total RNA isolated from snap frozen pre treatment tumour biopsies obtained at baseline endoscopy. Labelled cDNA was hybridised versus a universal human reference using an in house c DNA array of 22,000 clones. Results: Of the pts with adequate follow up accrued between 2002–2005, 35 met the quality control measures for the arrays. Median age=66 yrs (47–83); male=32, female=3; tumour subsites: oesophagus=23, oesophago-gastric junction (OGJ)=12; adenocarcinoma=35; T stage: T 2=3, T3=30, T4=2; N stage: N0=12, N1=23; performance status 0=7, 1=28. Median follow up=938 days. Median overall survival (OS) = 570 days. Prognostic groups were designated according to the median OS (days) of the group: good > median and poor < median. Supervised hierarchical clustering of normalised data revealed significantly differentially expressed genes based on OS (p<0.01) with 2 distinct clusters: a poor outcome group: N= 17 (2yr OS 17.6%) [95% CI: 4.3–38.3], a good outcome group: N=18 (2 yr OS 55%) [95% CI: 30.5–74.8]. Of the differentially expressed genes, those involved in receptor tyrosine kinase signalling & cell growth were amongst the most significantly affected pathways. Conclusions: This novel technique using GEP in tumour biopsies has successfully identified groups of tumours with distinct gene expression profiles that correlate with survival. The approach warrants further validation in a larger cohort. It could facilitate the development of tailored treatment according to individual tumour biology in OG cancer. No significant financial relationships to disclose.
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Kazi R, Singh A, De Cordova J, Al-Mutairy A, O'Leary L, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Postlaryngectomy vocal rehabilitation: assessment using a validated questionnaire in 51 patients. ORL J Otorhinolaryngol Relat Spec 2007; 69:289-94. [PMID: 17565232 DOI: 10.1159/000103873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Accepted: 11/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to assess valved speech and related issues in total laryngectomy patients with the help of the validated Voice Prosthesis Questionnaire (VPQ). PATIENTS AND METHODS We identified 61 patients who had undergone a surgical voice restoration with a valve following total laryngectomy and who were sent the VPQ by mail. RESULTS Fifty-one patients (37 males) completed the questionnaire giving a response rate of 83.6%. Fifty-three percent of the patients (n = 27) were fully aware of the dimensions of their valve including the length and diameter, whilst 25% (n = 13) were aware of only one of the two. There was a strong correlation between the patient's perception of tone and their gender with the tone scores significantly lower in women as compared to men (Mann-Whitney test, p = 0.04). Ten patients (19.6%) had had leakage-related issues during the previous 7 days. CONCLUSIONS This questionnaire provided a significant amount of valuable data. Based on our experience, we recommend the VPQ for prospective use in the serial monitoring and audit of total laryngectomy patients.
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Beckham JD, Goody RJ, Clarke P, Bonny C, Tyler KL. Novel strategy for treatment of viral central nervous system infection by using a cell-permeating inhibitor of c-Jun N-terminal kinase. J Virol 2007; 81:6984-92. [PMID: 17475657 PMCID: PMC1933289 DOI: 10.1128/jvi.00467-07] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Viral encephalitis is a major cause of morbidity and mortality worldwide, yet there is no proven efficacious therapy for most viral infections of the central nervous system (CNS). Many of the viruses that cause encephalitis induce apoptosis and activate c-Jun N-terminal kinase (JNK) following infection. We have previously shown that reovirus infection of epithelial cell lines activates JNK-dependent apoptosis. We now show that reovirus infection resulted in activation of JNK and caspase-3 in the CNS. Treatment of reovirus-infected mice with a cell-permeating peptide that competitively inhibits JNK activity resulted in significantly prolonged survival of intracerebrally infected mice following an otherwise lethal challenge with T3D (100 x 50% lethal dose). Protection correlated with reduced CNS injury, reduced neuronal apoptosis, and reduced c-Jun activation without altering the viral titer or viral antigen distribution. Given the efficacy of the inhibitor in protecting mice from viral encephalitis, JNK inhibition represents a promising and novel treatment strategy for viral encephalitis.
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Clarke P, Tyler KL. Down-regulation of cFLIP following reovirus infection sensitizes human ovarian cancer cells to TRAIL-induced apoptosis. Apoptosis 2007; 12:211-23. [PMID: 17136319 PMCID: PMC2365758 DOI: 10.1007/s10495-006-0528-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) shows promise as a chemotherapeutic agent. However, many human cancer cells are resistant to killing by TRAIL. We have previously demonstrated that reovirus infection increases the susceptibility of human lung (H157) and breast (ZR75-1) cancer cell lines to TRAIL-induced apoptosis. We now show that reovirus also increases the susceptibility of human ovarian cancer cell lines (OVCAR3, PA-1 and SKOV-3) to TRAIL-induced apoptosis. Reovirus-induced increases in susceptibility of OVCAR3 cells to TRAIL require virus uncoating and involve increased activation of caspases 3 and 8. Reovirus infection results in the down-regulation of cFLIP (cellular FLICE inhibitory protein) in OVCAR3 cells. Down-regulation of cFLIP following treatment of OVCAR3 cells with antisense cFLIP oligonucleotides or PI3 kinase inhibition also increases the susceptibility of OVCAR3 cells to TRAIL-induced apoptosis. Finally, over-expression of cFLIP blocks reovirus-induced sensitization of OVCAR3 cells to TRAIL-induced apoptosis. The combination of reovirus and TRAIL thus represents a promising new therapeutic approach for the treatment of ovarian cancer.
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Collingridge R, Matthews I, Clarke P. Convergence enabled by BT’s next generation of clients. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10550-007-0037-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krass I, Mitchell B, Clarke P, Brillant M, Dienaar R, Hughes J, Lau P, Peterson G, Stewart K, Taylor S, Wilkinson J, Armour C. Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy. Diabetes Res Clin Pract 2007; 75:339-47. [PMID: 16884811 DOI: 10.1016/j.diabres.2006.06.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 06/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the efficacy and cost-effectiveness of two methods of screening for undiagnosed type 2 diabetes in Australian community pharmacy. METHODS A random sample of 30 pharmacies were allocated into two groups: (i) tick test only (TTO); or (ii) sequential screening (SS) method. Both methods used the same initial risk assessment for type 2 diabetes. Subjects with one or more risk factors in the TTO group were offered a referral to their general practitioner (GP). Under the SS method, patients with risk factors were offered a capillary blood glucose test and those identified as being at risk referred to a GP. The effectiveness and cost-effectiveness of these approaches was assessed. RESULTS A total of 1286 people were screened over a period of 3 months. The rate of diagnosis of diabetes was significantly higher for SS compared with the TTO method (1.7% versus 0.2%; p=0.008). The SS method resulted in fewer referrals to the GP and a higher uptake of referrals than the TTO method and so was the more cost-effective screening method. CONCLUSIONS SS is the superior method from a cost and efficacy perspective. It should be considered as the preferred option for screening by community based pharmacists in Australia.
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Kazi R, Singh A, Mullan GPJ, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis. Clin Otolaryngol 2006; 31:518-24. [PMID: 17184458 DOI: 10.1111/j.1365-2273.2006.01320.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. STUDY DESIGN Cross-sectional study. SETTING Head and Neck Oncology Unit, Tertiary Referral Centre. PATIENTS Forty-two patients following total laryngectomy. INTERVENTION Videofluoroscopy using an e-tool (JRuler). MAIN OUTCOME MEASURES Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. RESULTS Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. CONCLUSIONS Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
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Kazi R, De Cordova J, Kanagalingam J, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Quality of Life following Total Laryngectomy: Assessment Using the UW-QOL Scale. ORL J Otorhinolaryngol Relat Spec 2006; 69:100-6. [PMID: 17148941 DOI: 10.1159/000097792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 06/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the quality of life (QOL) in patients using valved speech following total laryngectomy with a validated patient self-report scale. STUDY DESIGN Cross-sectional cohort study. PATIENTS 63 patients following total laryngectomy using valved speech. INTERVENTION University of Washington Quality of Life (UW-QOL) questionnaire. MAIN OUTCOME MEASURES Patient perception of the QOL over the last 7 days following total laryngectomy in response to specific questions and correlated with sociodemographic and treatment factors. RESULTS Responses were received from 44 males and 11 females (response rate: 87.3%) with a median age of 66 years (range: 40-84). The mean (SD) composite score of the QOL in our series of patients with total laryngectomy was 81.3 (10.9). As regards the overall QOL, 80% of our patients cited it as very good (45.5%) to good (34.5%). Patients identified speech, appearance, and activity as the most important issues following total laryngectomy. Only age and pharyngo-oesophageal segment closure were significant predictors of QOL scores (Student t test, p < 0.05) and not other demographic and treatment variables. CONCLUSIONS The composite score and overall QOL were high in our series of total laryngectomy patients and this possibly reflects adequate multidisciplinary management. We strongly urge the use of prospective longitudinal studies that will adequately identify any QOL changes over time. Although the UW-QOL questionnaire is a simple and brief scale, it has limitations that can curtail its effective use in laryngectomy patients and we advise supplementing it with the use of domain-specific questionnaires.
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Kazi R, Kiverniti E, Prasad V, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Multidimensional assessment of female tracheoesophageal prosthetic speech. Clin Otolaryngol 2006; 31:511-7. [PMID: 17184457 DOI: 10.1111/j.1365-2273.2006.01290.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech. STUDY DESIGN A cross-sectional cohort study. SETTING Head and Neck Unit in a tertiary oncology referral centre. PATIENTS Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers. INTERVENTION(S) Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III). RESULTS Median age of the female larygectomy patients was 65 years (range: 41-81), that of male laryngectomees was 66.5 years (range: 40-79) and that of the normal female subjects was 47.5 years (range: 35-72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7). CONCLUSIONS Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts.
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Kazi R, Prasad V, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Questionnaire analysis of the swallowing-related outcomes following total laryngectomy. Clin Otolaryngol 2006; 31:525-30. [PMID: 17184459 DOI: 10.1111/j.1365-2273.2006.01335.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the effects of a total laryngectomy on the swallow and subsequent quality of life in head and neck cancer patients. DESIGN Cross-sectional single centre cohort study. SETTING Head and Neck Oncology Unit, Tertiary Referral Unit. PATIENTS Sixty-two patients who underwent total laryngectomy at our centre participated in the study. METHODS Subjects were stratified by age, sex, tumour stage, other procedures such as myotomy and nerve re-implantation. Pharyngectomy, glossectomy, flap reconstruction, neck dissection and previous radio- and chemotherapy were also assessed to see if they affected swallow and subsequent quality of life. Main outcome was measured using the MD Anderson Dysphagia Inventory questionnaire. RESULTS Responses were received from 46 males and 16 females (response rate of 80.5%) with a mean age of 64.7 years (SD 9.4). Median follow-up in patients was 90 months (range 1-276). The mean MD Anderson Dysphagia Inventory total score in our series of patients was 77.7 (SD 16.6). MD Anderson Dysphagia Inventory global score was 79.4 (SD 22.6), Emotional score was 77.7 (SD 17.8), Functional score 81.3 (SD 15.9) and Physical score was 74.1(SD 18). Statistically significant differences were seen between the emotional scores of glossectomised and non-glossectomised patients (Mann Whitney, P = 0.04). No significant correlation was seen between the subscale scores and the remaining treatment variables such as age, gender, site, tumour stage, myotomy, nerve implantation, radiotherapy, reconstruction and major complications. CONCLUSION This questionnaire study is the largest of its type to assess the swallow of patients who have undergone laryngectomy at a single centre. The overall result confirmed that most patients had a subjectively good swallow. Only glossectomy and the method of PE segment closure were shown to significantly affect swallowing outcomes following surgery. We recommend further work especially prospective studies pre and post surgery using this or similarly validated instruments to fully assess swallow in the laryngectomy population.
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Williams GL, Clarke P, Vellacott KD. Anxieties should not be forgotten when screening relatives of colorectal cancer patients by colonoscopy. Colorectal Dis 2006; 8:781-4. [PMID: 17032325 DOI: 10.1111/j.1463-1318.2006.01092.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Individuals with a strong family history have a high risk of developing colorectal cancer. They could well benefit from targeted screening and their increased risk warrants an invasive procedure such as colonoscopy. This study aims to assess the anxieties of symptom-free relatives offered screening by colonoscopy. METHOD A simple questionnaire was sent to 50 consecutive people who had colorectal cancer screening by colonoscopy because of a strong family history. RESULTS Forty-five questionnaires were answered. On assessing their anxiety levels before and after colonoscopy, 56% noticed an improvement after the test, 33% were still as anxious and 11% had raised anxiety levels despite screening. Although most of the screening colonoscopies were normal, 44% of asymptomatic relatives undergoing invasive screening had no improvement of their cancer anxieties. CONCLUSION Screening people with a strong family history of colorectal cancer may be an efficient, cost-effective and focussed way of detecting early neoplasms rather than screening the general population. Using colonoscopy alone however, a large proportion of people still have cancer anxieties after being screened. This small study suggests that in order to attempt to alleviate anxieties, a colonoscopy alone is insufficient for some in this high-risk group.
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Agrawal V, Mansuri S, Singh A, Staiano J, Searle A, Harris P, Clarke P. 55 ORAL Angiosarcoma of the head and neck: an 18 year experience. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yang XL, So WY, Kong APS, Clarke P, Ho CS, Lam CWK, Ng MHL, Lyu RR, Yin DD, Chow CC, Cockram CS, Tong PCY, Chan JCN. End-stage renal disease risk equations for Hong Kong Chinese patients with type 2 diabetes: Hong Kong Diabetes Registry. Diabetologia 2006; 49:2299-308. [PMID: 16944095 DOI: 10.1007/s00125-006-0376-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 06/08/2006] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS The objective of the study was to investigate risk factors and develop risk equations for end-stage renal disease (ESRD) in Chinese patients with type 2 diabetes. SUBJECTS AND METHODS A prospective cohort of 4,438 patients with type 2 diabetes mellitus and without ESRD (median observation period 2.9 years, interquartile range 1.6-4.1 years) was included in the analysis. The end-point (ESRD) was defined by: (1) death due to diabetes with renal manifestations or renal failure; (2) hospitalisation due to renal failure; (3) estimated GFR (eGFR) <15 ml min(-1) 1.73 m(-2). Cox proportional hazards regression was used to develop risk equations. The data were randomly and evenly divided into the training data for development of the risk equations and the test data for validation. The validation was performed using the area under the receiver operating characteristic curve (aROC), which takes into account follow-up time and censoring. RESULTS During the observation period, 159 patients or 12.45 per 1,000 person-years (95% CI 10.52-14.37 per 1,000 person-years) developed ESRD. Known duration of diabetes, systolic blood pressure, log(10) total cholesterol:HDL cholesterol ratio and retinopathy were significant predictors of ESRD. After further adjusting for eGFR, log(10) spot albumin:creatinine ratio (ACR) and haematocrit, only eGFR, haematocrit and log(10) ACR remained as independent predictors of ESRD. The risk equation derived from these three independent predictors had good discrimination, with an aROC of 0.97. CONCLUSIONS/INTERPRETATION Estimated GFR, haematocrit and ACR were independent predictors of ESRD and the derived risk equation performed well in Chinese patients with type 2 diabetes.
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Kazi R, Singh A, De Cordova J, Al-Mutairy A, Clarke P, Nutting C, Rhys-Evans P, Harrington K. Validation of a voice prosthesis questionnaire to assess valved speech and its related issues in patients following total laryngectomy. Clin Otolaryngol 2006; 31:404-10. [PMID: 17014450 DOI: 10.1111/j.1749-4486.2006.01289.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To establish the reliability and validity of a new self-administered questionnaire to assess valved speech and its related issues in patients who have undergone a total laryngectomy operation. DESIGN Cross-sectional psychometric validation study. SETTING Tertiary cancer care centre. PATIENTS We identified sixty-one total laryngectomy patients with no sign of recurrent disease and using voice prosthesis from the speech and language therapy database of the Royal Marsden Hospital. The patients were assessed using a postal self-administered voice prosthesis questionnaire concerning the voice valve and it's related issues. Patients were also asked to complete the University of Michigan voice related quality of life and University of Washington head and neck quality of life (version 4) questionnaires. MAIN OUTCOME MEASURES Test-retest and internal consistency reliability; content; criterion and construct validity. RESULTS We received completed questionnaires from fifty-one of the sixty-one total laryngectomy patients identified for the study providing a response rate of 84%. The median age of the group was 65 years (range: 40-85) with thirty-seven males and fourteen females. The internal consistency reliability using the Cronbach's alpha coefficient was 0.87 (range: 0.85 to 0.89). Test-retest reliability showed that more than 75% of patients had a score on re-test that was within 1 point of their original score. Content validity was ensured during the design process. The median Spearman correlation coefficient was 0.25 for convergent construct validity with the University of Washington head and neck quality of life questionnaire and 0.64 for criterion validity on comparison with the University of Michigan voice related quality of life scale. CONCLUSIONS The voice prosthesis questionnaire is the first validated and reliable self-administered questionnaire designed specifically for evaluating valved speech and its related issues in patients who have undergone total laryngectomy. The voice prosthesis questionnaire has significant utility for audit, outcomes research and monitoring in this unique group of patients.
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