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Kohrt HE, Kapelner A, Holmes S, Lee PP. An interactive statistical imaging system and pilot application to characterize axillary lymph nodes in breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11059] [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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Digby S, MacDuff E, Blessing K, Holmes S. Nephrogenic systemic fibrosis: a histopathological study of eight cases of a recently described entity. Histopathology 2008; 52:531-4. [DOI: 10.1111/j.1365-2559.2008.02947.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Swanson N, Golding K, Nunn CM, Holmes S, Devlin GP. EFFECT OF STREAMLINING ADMISSION FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION (PPCI) ON DOOR TO BALLOON (D2B) TIMES. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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104
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Douglas A, Abbas S, Holmes S, Chin-Shong D. Seeing may be believing but measuring takes faith out of the equation. Br J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.bjoms.2007.07.054] [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]
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Bovell DL, Corbett AD, Holmes S, Macdonald A, Harker M. The absence of apoeccrine glands in the human axilla has disease pathogenetic implications, including axillary hyperhidrosis. Br J Dermatol 2007; 156:1278-86. [PMID: 17535227 DOI: 10.1111/j.1365-2133.2007.07917.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The existence of a third type of sweat gland in human axillary skin, the apoeccrine gland, with a capacity to produce much higher sweat output than the eccrine gland, was proposed from examination of microdissected glands. However, previous studies of axillary skin glands did not examine the entire individual glandular structure via serial sections and the markers used to identify the different glands gave conflicting results and, hence, the existence of the apoeccrine gland remains controversial. OBJECTIVES To investigate human axillary sweat glands by serial section histology and immunofluorescence. METHODS Human axillary sweat glands were investigated by serial sectioning of paraffin wax-embedded skin samples taken by biopsy from four male and six female volunteers (age range 20-35 years). Sections were examined by light microscopy and immunofluorescence, using antibodies to antigens reported to be markers for discriminating between eccrine and apocrine gland cells: CD15, CD44, S100 and human milk fat globulin. RESULTS Light microscopy demonstrated that there were hair follicles and a mean +/- SD of 76 +/- 14 sweat glands cm(-2). Eccrine and apocrine glands were found to be present; however, no glands resembling the apoeccrine glands were detected. Both types of sweat gland exhibited signs of being active, with segments of the secretory coils displaying flattened cells and dilated glandular lumina; however, this dilation did not extend to obvious changes in the width of the gland. None of the eccrine glands exhibited evidence of the presence of apocrine cells or vice versa. Immunofluorescence markers were found not to be specific and did not discriminate between the different types of glands or demonstrate the presence of apoeccrine glands. CONCLUSIONS This is the first time that serial sections of axillary skin have been examined by histology and immunofluorescence. The markers reported to discriminate between apocrine and eccrine glands were found to be nonspecific. No evidence of apoeccrine glands was found either by histology or by immunofluorescence.
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Selwyn R, Holmes S, Micka J, Thomadsen B, DeWerd L. SU-FF-T-440: Validation of a New Radiochromic Film Calibration Protocol and a Gel-Based Phantom for Beta Dosimetry Applications. Med Phys 2007. [DOI: 10.1118/1.2761165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Holmes S, DeWerd L, Palmer B. WE-E-BRA-04: Brachytherapy Source Power Measurements Using a Liquid Helium Active Radiometric Calorimeter. Med Phys 2007. [DOI: 10.1118/1.2761602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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109
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Gregory SG, Barlow KF, McLay KE, Kaul R, Swarbreck D, Dunham A, Scott CE, Howe KL, Woodfine K, Spencer CCA, Jones MC, Gillson C, Searle S, Zhou Y, Kokocinski F, McDonald L, Evans R, Phillips K, Atkinson A, Cooper R, Jones C, Hall RE, Andrews TD, Lloyd C, Ainscough R, Almeida JP, Ambrose KD, Anderson F, Andrew RW, Ashwell RIS, Aubin K, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Beasley H, Bethel G, Bird CP, Bray-Allen S, Brown JY, Brown AJ, Bryant SP, Buckley D, Burford DC, Burrill WDH, Burton J, Bye J, Carder C, Chapman JC, Clark SY, Clarke G, Clee C, Clegg SM, Cobley V, Collier RE, Corby N, Coville GJ, Davies J, Deadman R, Dhami P, Dovey O, Dunn M, Earthrowl M, Ellington AG, Errington H, Faulkner LM, Frankish A, Frankland J, French L, Garner P, Garnett J, Gay L, Ghori MRJ, Gibson R, Gilby LM, Gillett W, Glithero RJ, Grafham DV, Gribble SM, Griffiths C, Griffiths-Jones S, Grocock R, Hammond S, Harrison ESI, Hart E, Haugen E, Heath PD, Holmes S, Holt K, Howden PJ, Hunt AR, Hunt SE, Hunter G, Isherwood J, James R, Johnson C, Johnson D, Joy A, Kay M, Kershaw JK, Kibukawa M, Kimberley AM, King A, Knights AJ, Lad H, Laird G, Langford CF, Lawlor S, Leongamornlert DA, Lloyd DM, Loveland J, Lovell J, Lush MJ, Lyne R, Martin S, Mashreghi-Mohammadi M, Matthews L, Matthews NSW, McLaren S, Milne S, Mistry S, oore MJFM, Nickerson T, O'Dell CN, Oliver K, Palmeiri A, Palmer SA, Pandian RD, Parker A, Patel D, Pearce AV, Peck AI, Pelan S, Phelps K, Phillimore BJ, Plumb R, Porter KM, Prigmore E, Rajan J, Raymond C, Rouse G, Saenphimmachak C, Sehra HK, Sheridan E, Shownkeen R, Sims S, Skuce CD, Smith M, Steward C, Subramanian S, Sycamore N, Tracey A, Tromans A, Van Helmond Z, Wall J. M. Wallis M, White S, Whitehead SL, Wilkinson JE, Willey DL, Williams H, Wilming L, Wray PW, Wu Z, Coulson A, Vaudin M, Sulston JE, Durbin R, Hubbard T, Wooster R, Dunham I, Carter NP, McVean G, Ross MT, Harrow J, Olson MV, Beck S, Rogers J, Bentley DR. Erratum: The DNA sequence and biological annotation of human chromosome 1. Nature 2006. [DOI: 10.1038/nature05152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
This article reviews the relationship between ageing and nutrition. The vulnerability of older adults to nutritional decline is explored and the importance of nutritional screening in this population is discussed. The author considers some of the barriers to achieving nutritional adequacy once patients have been admitted to hospital and suggests how these can be overcome.
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Tavadia S, Dawn G, Payne C, Ramrakha-Jones V, Murday A, Holmes S. Skin-cancer awareness in Scottish cardiac transplant recipients. Clin Exp Dermatol 2006; 31:354-7. [PMID: 16681574 DOI: 10.1111/j.1365-2230.2006.02098.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac transplant recipients have a greatly increased risk of nonmelanoma skin cancer, with a relative risk of up to 108. Skin cancer is more aggressive in transplant patients and results in substantial morbidity and mortality. It is therefore important that these patients understand this risk and take adequate sun-protection measures. AIM To assess awareness of skin cancer risk and sun protection measures used by cardiac transplant recipients and determine the impact of patient education. METHODS Using a detailed questionnaire, we surveyed 118 patients attending the cardiac transplant clinic at our centre to quantify knowledge of skin cancer risk (maximum total score 10) and behaviour in the sun (maximum total score 15). Of these patients, 50 were then seen by a dermatologist for education about skin cancer risk, sun protection measures and skin cancer screening. Six months later, we asked them to complete the same questionnaire again. RESULTS The mean knowledge score was 7.3/10 and the mean behaviour score was 11.2/15. In the group that received education, the mean knowledge score improved from 7.2/10 before the dermatology consultation to 7.8/10 after the consultation (P < 0.03). The mean score for the behaviour questions improved even more, from 11.2/15 before to 13.5/15 after the consultation (P < 0.0001). CONCLUSIONS. This study demonstrates that specialist advice can improve self-reported knowledge of skin cancer risk and sun protective behaviour in cardiac transplant recipients. It is hoped that this may reduce the risk of nonmelanoma skin cancer in these patients.
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Holmes S, Palmer B, DeWerd L, Micka J, Stump K. SU-FF-T-312: Liquid Helium Calorimeter for Brachytherapy Source Strength Measurement. Med Phys 2006. [DOI: 10.1118/1.2241229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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113
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Holmes S, DeWerd L, Micka J. SU-FF-T-322: Miniature TLDs for Use in Beta Dosimetry. Med Phys 2006. [DOI: 10.1118/1.2241244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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114
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Gregory SG, Barlow KF, McLay KE, Kaul R, Swarbreck D, Dunham A, Scott CE, Howe KL, Woodfine K, Spencer CCA, Jones MC, Gillson C, Searle S, Zhou Y, Kokocinski F, McDonald L, Evans R, Phillips K, Atkinson A, Cooper R, Jones C, Hall RE, Andrews TD, Lloyd C, Ainscough R, Almeida JP, Ambrose KD, Anderson F, Andrew RW, Ashwell RIS, Aubin K, Babbage AK, Bagguley CL, Bailey J, Beasley H, Bethel G, Bird CP, Bray-Allen S, Brown JY, Brown AJ, Buckley D, Burton J, Bye J, Carder C, Chapman JC, Clark SY, Clarke G, Clee C, Cobley V, Collier RE, Corby N, Coville GJ, Davies J, Deadman R, Dunn M, Earthrowl M, Ellington AG, Errington H, Frankish A, Frankland J, French L, Garner P, Garnett J, Gay L, Ghori MRJ, Gibson R, Gilby LM, Gillett W, Glithero RJ, Grafham DV, Griffiths C, Griffiths-Jones S, Grocock R, Hammond S, Harrison ESI, Hart E, Haugen E, Heath PD, Holmes S, Holt K, Howden PJ, Hunt AR, Hunt SE, Hunter G, Isherwood J, James R, Johnson C, Johnson D, Joy A, Kay M, Kershaw JK, Kibukawa M, Kimberley AM, King A, Knights AJ, Lad H, Laird G, Lawlor S, Leongamornlert DA, Lloyd DM, Loveland J, Lovell J, Lush MJ, Lyne R, Martin S, Mashreghi-Mohammadi M, Matthews L, Matthews NSW, McLaren S, Milne S, Mistry S, Moore MJF, Nickerson T, O'Dell CN, Oliver K, Palmeiri A, Palmer SA, Parker A, Patel D, Pearce AV, Peck AI, Pelan S, Phelps K, Phillimore BJ, Plumb R, Rajan J, Raymond C, Rouse G, Saenphimmachak C, Sehra HK, Sheridan E, Shownkeen R, Sims S, Skuce CD, Smith M, Steward C, Subramanian S, Sycamore N, Tracey A, Tromans A, Van Helmond Z, Wall M, Wallis JM, White S, Whitehead SL, Wilkinson JE, Willey DL, Williams H, Wilming L, Wray PW, Wu Z, Coulson A, Vaudin M, Sulston JE, Durbin R, Hubbard T, Wooster R, Dunham I, Carter NP, McVean G, Ross MT, Harrow J, Olson MV, Beck S, Rogers J, Bentley DR, Banerjee R, Bryant SP, Burford DC, Burrill WDH, Clegg SM, Dhami P, Dovey O, Faulkner LM, Gribble SM, Langford CF, Pandian RD, Porter KM, Prigmore E. The DNA sequence and biological annotation of human chromosome 1. Nature 2006; 441:315-21. [PMID: 16710414 DOI: 10.1038/nature04727] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2005] [Accepted: 03/13/2006] [Indexed: 11/08/2022]
Abstract
The reference sequence for each human chromosome provides the framework for understanding genome function, variation and evolution. Here we report the finished sequence and biological annotation of human chromosome 1. Chromosome 1 is gene-dense, with 3,141 genes and 991 pseudogenes, and many coding sequences overlap. Rearrangements and mutations of chromosome 1 are prevalent in cancer and many other diseases. Patterns of sequence variation reveal signals of recent selection in specific genes that may contribute to human fitness, and also in regions where no function is evident. Fine-scale recombination occurs in hotspots of varying intensity along the sequence, and is enriched near genes. These and other studies of human biology and disease encoded within chromosome 1 are made possible with the highly accurate annotated sequence, as part of the completed set of chromosome sequences that comprise the reference human genome.
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Ali N, Carter J, Cheng L, Coghlan K, Hardee P, Holmes S. Opportunistic and reprehensible. Br Dent J 2006; 200:359. [PMID: 16607295 DOI: 10.1038/sj.bdj.4813433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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116
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MacDonald A, Berty C, Holmes S. An audit of the management of melanoma patients at Glasgow Royal Infirmary 1998-2003. Scott Med J 2006; 51:30-3. [PMID: 16562423 DOI: 10.1258/rsmsmj.51.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melanoma is an important cause of morbidity and mortality. Recently published Scottish Intercollegiate Guideline Network (SIGN) guidelines outline standard management for melanoma patients in Scotland. METHODS We audited the management of consecutive patients diagnosed with melanoma in Glasgow Royal Infirmary (1998-2003), using the SIGN guidelines as a gold standard. RESULTS Of 102 patients, 41% were male and 59% were female. The mean ages of men and women were 58 and 50 years respectively. Fifty five per cent of all patients had a superficial spreading melanoma, and the median Breslow thickness was 0.64 mm. The most commonly affected site was the head and neck (29%). Most patients (87%) were referred by their general practitioner, but only 30% were marked as urgent by the referrer, and accordingly the median time to first appointment varied between 20 days (1998) and 52 days (2001). The most frequently noted suspicious feature was irregular pigmentation. The median time to biopsy was 6 days. Seventy-one per cent of patients had an excision biopsy, and of those who did not, most (71%) had lesions on the head and neck. There was poor recording of surgical margins (13%) and histological margins were used to determine the need for re-excision. The SIGN guidelines for re-excision and sentinel lymph node biopsy were closely followed. CONCLUSION The SIGN guidelines for melanoma have been adhered to in our department, although time to first appointment exceeded national recommendations.
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Abstract
The development of transgenic mice expressing human DR and DQ major histocompatibility complex (MHC) class II molecules has been of value in studying the immunopathology of human MHC class II-associated autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, insulin-dependent diabetes mellitus and celiac disease. Such mice have been used to identify the target antigens that are involved in the initiation of these diseases. Many of the mice develop aspects of the human diseases, either spontaneously or following immunization with the relevant antigen, thus providing an in vivo disease model, which may be used as a tool for further understanding the disease mechanisms and testing novel immunotherapies.
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MacDonald AJ, Drummond A, Chui D, Holmes S. Lichen nitidus and lichen spinulosus or spinous follicular lichen nitidus? Clin Exp Dermatol 2005; 30:452-3. [PMID: 15953104 DOI: 10.1111/j.1365-2230.2005.01807.x] [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: 11/29/2022]
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120
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Abstract
Until recently, the concept of antibodies as in vivo therapeutics was still considered to be an exceedingly ambitious goal. However, in 2003, the situation has been completely transformed, with 14 FDA-approved monclonal antibodies (mAbs), 70 in late stage clinical (Phase II+) trials and > 1000 in preclinical development. The driving force behind this reversal in fortune has been advances in antibody engineering and the emergence of novel discovery techniques which overcame stability and immunogenicity issues that had blighted previous clinical trials of murine antibodies. For indications as diverse as inflammation, cancer and infectious disease, it is clear that unique properties of antibodies make them safe, effective and versatile therapeutics. These drugs can be used to neutralise pathogens, toxins and endogenous mediators of pathology. As cell targeting reagents, antibodies can be used to modulate cytoplasmic cascades or to 'tag' specific cells for complement- or effector-mediated lysis. Antibodies can also be modified to deliver toxic or modulatory payloads (small molecules, radionuclides and enzymes) and engineered to bind multiple epitopes (bispecifics) or even to have novel catalytic activity (abzymes). The modular structure of immunoglobulins and the availability of antibody fragment libraries also make it possible to produce variable-domain therapeutics (Fab, single-chain and domain antibodies). Although exhibiting less favourable kinetics in vivo, these fragments are simple to express and have an increased tissue penetration, making them especially useful as neutralising agents or in the delivery of payload. The number of approved antibodies is expected to increase arithmetically in the near term, as the platform is adopted as a valid alternative to small molecule discovery. This review provides an introduction to the antibody discovery process and discusses the past, present and future applications of therapeutic antibodies, with reference to several FDA-approved precedents.
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Bogduk N, Holmes S. Controlled zygapophysial joint blocks: the travesty of cost-effectiveness. PAIN MEDICINE 2004; 1:24-34. [PMID: 15101961 DOI: 10.1046/j.1526-4637.2000.99104.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to develop equations by which the costs could be compared of various models of performing diagnostic blocks for spinal pain. DESIGN Algorithms were elaborated describing different strategies for the diagnosis of cervical or lumbar zygapophysial joint pain using placebo-controlled diagnostic blocks, comparative local anaesthetic blocks, or no control blocks, and its treatment with radiofrequency neurotomy. For each step in each algorithm cost functions were applied. Summary equations were derived that allowed the cost of the algorithms to be compared algebraically. A selection of costs were substituted for the unknown variables in the equations in order to illustrate the cost-effectiveness of different algorithms under Australian and US conditions. RESULTS The equations indicated that cost-effectiveness was critically dependent on the ratio between the cost of treatment and the cost of a diagnostic block. For cervical zygapophysial joint pain, reimbursements discourage best practice, both in Australia and in the United States, by rendering the use of controlled blocks more expensive than no controls. For lumbar zygapophysial joint pain, controlled blocks are cost-effective under Australian fee schedules, and under some but not all American schedules. In the name of cost-effectiveness, the US fee structure encourages presumptive therapy without regard to diagnosis, but ignores the ethical and logistic consequences of inordinately high failure rates of therapy when a diagnosis is not established using controlled blocks. CONCLUSIONS Best practice, using placebo-controlled diagnostic blocks before neurosurgical therapy of zygapophysial joint pain, is not encouraged and rewarded in the United States. In Australia it is compensated only in the context of lumbar zygapophysial joint pain. In the interests of short-term financial savings, the US fee structure sacrifices the majority of patients to failed treatment because of lack of proper diagnosis. Clinical absurdity, rather than evidence-based, best practice is encouraged.
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Holmes S, Zwar N, Jiménez-Ruiz CA, Ryan PJ, Browning D, Bergmann L, Johnston JA. Bupropion as an aid to smoking cessation: a review of real-life effectiveness. Int J Clin Pract 2004; 58:285-91. [PMID: 15117097 DOI: 10.1111/j.1368-5031.2004.00153.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Clinical trials rigorously demonstrate the efficacy of new products and justify their marketing. However, it is only after use in real-life settings that the clinical value (effectiveness) of a new treatment is fully known. The purpose of this review was to summarise the effectiveness data for bupropion SR as an aid to smoking cessation. Available reports of effectiveness data for bupropion SR were obtained from the literature, presentations at smoking cessation meetings and from the manufacturer. Twelve sources of effectiveness data were found and included clinical practice trials, observational studies/surveys, motivational support programme results and employer-based cessation programme results. The 6-month point prevalence smoking cessation rates ranged from 25 to 49%. There is a growing body of evidence supporting the effectiveness of bupropion SR as an aid to smoking cessation. Real-life quit rates for bupropion SR are similar to those seen in the original clinical trial programme.
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Rampaul RS, Mullinger K, Macmillan RD, Cid J, Holmes S, Morgan DAL, Blamey RW. Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer. Eur J Cancer 2003; 39:2165-7. [PMID: 14522373 DOI: 10.1016/s0959-8049(03)00539-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There has recently been considerable interest for the need for specialist lymphoedema nurses to be appointed in the NHS. However, we had noticed in our cancer follow-up clinics that the incidence of lymphoedema appeared to be very low. Treatment for primary breast cancer (>5 cm) has been surgery and low axillary sampling (ANS). Radiotherapy (RT) or axillary clearance is subsequently performed in patients found to be node positive. The patients are followed-up in the primary breast cancer (PBC) clinic weekly. Follow-up is initially at 3-month intervals up to 2 years and then 1 yearly indefinitely. We conducted a two phased study in patients being followed up in our post cancer clinic in order to identify the incidence of LE in these patients. Phase 1 involved symptomatic patients identified at routine follow up in a 15-week period and the number of patients reporting arm swelling was recorded. The aim of this was to provide an estimate to power a phase 2 study (prospective questionnaire based). Phase 2 was conducted over a 13-week period. All patients attending the clinic were administered modified FACT B4, EQ-50 and Speilberger questionnaires. A total of 1242 patients were examined and lymphoedema found in 5 (0.04%). Of these 5, 3 had undergone axillary clearance, 1 ANS plus radiotherapy and only 1 had ANS alone. A policy of ANS, with prophylactic treatment for lymph node positivity either by surgery or RT alone, gives a very low rate of lymphoedema.
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Holmes S, Coghlan K, McAllinden P, Hardee P, Chan O. Complications with use of the Epistat in the arrest of midfacial haemorrhage. Injury 2003; 34:901-7. [PMID: 14636731 DOI: 10.1016/s0020-1383(02)00372-8] [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: 02/02/2023]
Abstract
Control of midfacial haemorrhage can be difficult, especially in the multiply injured patient, either at the scene of injury, or in the Accident and Emergency Department. The use of Epistats has proven invaluable in this setting. Potential problems exist with their use and this is illustrated with examples, together with strategies for overcoming them. A summary of the didactic method of safe use of this life saving technique is insert the Epistat, aiming for a fingertip placed at the soft palate;inflate the posterior cuff;withdraw the Epistat slightly, to position the posterior cuff within the nasal choanae;inflate the anterior (intranasal) cuff.
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Abstract
Giant cell arteritis is a systemic disease of the elderly which affects large and medium-sized arteries and which may occur in association with polymyalgia rheumatica. Scalp necrosis is a rare cutaneous complication of giant cell arteritis, and this dermatological presentation is not commonly reported.1-4 Giant cell arteritis should be considered in all elderly patients with scalp ulceration. We describe two patients who presented in this manner.
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