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Chaila MJ, Mcleod D, Vermund SH, Mbolongwe-Thornicroft M, Mbewe M, Mubekapi-Musadaidzwa C, Harper A, Schaap A, Floyd S, Hoddinott G, Hayes R, Fidler S, Ayles H, Shanaube K. Assessment of a screening tool to aid home-based identification of adolescents (aged 10-14) living with HIV in Zambia and South Africa: HPTN 071 (PopART) study. PLoS One 2024; 19:e0266573. [PMID: 38363733 PMCID: PMC10871489 DOI: 10.1371/journal.pone.0266573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/05/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The HPTN071 (PopART) for Youth (P-ART-Y) study evaluated the acceptability and uptake of a community-level combination HIV prevention package including universal testing and treatment (UTT) among young people in Zambia and South Africa. We determined whether a four-question primary care level screening tool, validated for use in clinical settings, could enhance community (door-to-door) identification of undiagnosed HIV-positive younger adolescents (aged 10-14) who are frequently left out of HIV interventions. METHOD Community HIV-care Providers (CHiPs) contacted and consented adolescents in their homes and offered them participation in the PopART intervention. CHiPs used a four question-screening tool, which included: history of hospital admission; recurring skin problems; poor health in last 3 months; and death of at least one parent. A "yes" response to one or more questions was classified as being "at risk" of being HIV-positive. Rapid HIV tests were offered to all children. Data were captured through an electronic data capture device from August 2016 to December 2017. The sensitivity, specificity, positive predictive value and negative predictive value were estimated for the screening tool, using the rapid HIV test result as the gold standard. RESULTS In our 14 study sites, 33,710 adolescents aged 10-14 in Zambia and 8,610 in South Africa participated in the study. About 1.3% (427/33,710) and 1.2% (106/8,610) self-reported to be HIV positive. Excluding the self-reported HIV-positive, we classified 11.3% (3,746/33,283) of adolescents in Zambia and 17.5% (1,491/8,504) in South Africa as "at risk". In Zambia the estimated sensitivity was 35.3% (95% CI 27.3%-44.2%) and estimated specificity was 88.9% (88.5%-89.2%). In South Africa the sensitivity was 72.3% (26.8%-94.9%) and specificity was 82.5% (81.6-83.4%). CONCLUSION The sensitivity of the screening tool in a community setting in Zambia was low, so this tool should not be considered a substitute for universal testing where that is possible. In South Africa the sensitivity was higher, but with a wide confidence interval. Where universal testing is not possible the tool may help direct resources to adolescents more likely to be living with undiagnosed HIV. TRIAL REGISTRATION Clinical Trial Number: NCT01900977.
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Affiliation(s)
- Mwate Joseph Chaila
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - David Mcleod
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sten H Vermund
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Madalitso Mbewe
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Constance Mubekapi-Musadaidzwa
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abigail Harper
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Albertus Schaap
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Graeme Hoddinott
- Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Helen Ayles
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kwame Shanaube
- Zambart, University of Zambia School of Medicine, Ridgeway Campus, Lusaka, Zambia
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Harper A, Rothberg A, Chirwa E, Sambu W, Mall S. Household Food Insecurity and Demographic Factors, Low Birth Weight and Stunting in Early Childhood: Findings from a Longitudinal Study in South Africa. Matern Child Health J 2023; 27:59-69. [PMID: 36169906 PMCID: PMC9516515 DOI: 10.1007/s10995-022-03555-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Low birthweight (LBW) as well as early childhood stunting are risk factors for increased childhood morbidity in low-and middle-income countries (LMIC). The Covid 19 pandemic has exacerbated food insecurity and unemployment globally, prompting concerns for maternal and child health. OBJECTIVES We used data from the great recession of 2008 to examine the relationship between household food security and other risk factors with LBW and stunting using a longitudinal sample of South African women and their offspring. METHODS Food security indicators, alcohol use, blood pressure and other characteristics were examined in relation to LBW (≤ 2500 g), stunting (height for age ≤ 2SD) and severe stunting (height for age ≤ 3SD). Regression modelling with clustering at maternal ID level were employed to adjust for maternal characteristics and women who gave birth more than once during the reference period. RESULTS Birthweight data were available for 1173 children and height for age 1216 children. The prevalence of LBW was 14.7% while stunting and severe stunting was 17.8% and 14.5%. Child hunger in the household, maternal hypertension and alcohol use were associated with low birthweight. Food expenditure below the Stats SA poverty line and low dietary diversity was associated with stunting and severe stunting respectively. Maternal height and low birthweight were associated with both stunting and severe stunting. CONCLUSIONS FOR PRACTICE Interventions that can improve household food security and nutritional status during the periconceptional and antenatal period may reduce the prevalence of low birthweight and subsequent stunting in low- and middle-income countries.
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Affiliation(s)
- Abigail Harper
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, 2193 South Africa
| | - Alan Rothberg
- School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2193 South Africa
| | - Esnat Chirwa
- Medical Research Council Gender and Health Research Unit, Pretoria, 0002 South Africa
| | - Winnie Sambu
- School of Economics, University of Cape Town, Cape Town, 7701 South Africa
| | - Sumaya Mall
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, 2193 South Africa
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Harper A, Goudge J, Chirwa E, Rothberg A, Sambu W, Mall S. Dietary diversity, food insecurity and the double burden of malnutrition among children, adolescents and adults in South Africa: Findings from a national survey. Front Public Health 2022; 10:948090. [PMID: 36211708 PMCID: PMC9540989 DOI: 10.3389/fpubh.2022.948090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023] Open
Abstract
Childhood stunting remains a global public health problem. Many stunted children live in the same household as overweight or obese adults (the so-called double burden of malnutrition), evidence that quality as well as quantity of food is important. In recent years, food security measurement has shifted away from anthropometry (e.g., stunting) to experiential measures (e.g., self-reported hunger). However, given the continued problem of stunting, it is important that national surveys identify malnutrition. Objectives To examine the associations between a variety of food security indicators, including dietary diversity, with adult, child (0-4 years) (5-9 years) and adolescent (10-17 years) anthropometry. To estimate the prevalence of double burden households. Methods The study utilized cross-sectional data from the South African National Income Dynamics Survey NIDS (2008). We examined the associations between five food security indicators and anthropometry outcomes. The indicators were adult and child hunger in the household, self-reported household food sufficiency, food expenditure>60% of monthly expenditure and household dietary diversity. Multinomial and logistic regression models were employed to examine the associations with adult BMI categories and children's stunting and BMI. Results The prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8 and 10.4%, respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. Among children <5, child hunger and medium dietary diversity were significantly associated with wasting. None of the food security indicators were associated with stunting in children aged 5-9. Among stunted children, 70.2% lived with an overweight or obese adult. Among adults, increased dietary diversity increased the risk of overweight and obesity. Conclusion Dietary diversity can be used as a proxy for poor nutritional status among children <5 years and adolescents but the relationship between dietary diversity and adult obesity is more complex. Given the double burden of malnutrition in many low- and middle-income countries, indicators of dietary quality remain important. These tools can be further refined to include an extra category for processed foods. Given the relative simplicity to collect this data, national surveys would be improved by its inclusion.
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Affiliation(s)
- Abigail Harper
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa,*Correspondence: Abigail Harper
| | - Jane Goudge
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Esnat Chirwa
- Gender and Health Research Division, The South African Medical Research Council, Johannesburg, South Africa
| | - Alan Rothberg
- School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Winnie Sambu
- School of Economics, The University of Cape Town, Cape Town, South Africa
| | - Sumaya Mall
- Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
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Sandhu J, Harper A, Combeer A. P.42 Unsuccessful conversion of epidural analgesia to epidural anaesthesia in obstetric patients. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Clemens P, Connolly A, Harper A, Mah J, McDonald C, Rao V, Smith E, Zaidman C, Nakagawa T, Hoffman E. DMD - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brooks S, Harper A, Pack L, Wheatley T. 460 THE IMPACT OF THE BONE MDT: EXPLORING CHANGES IN BONE PROTECTION DECISIONS BETWEEN 2015 AND 2018. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The Hip fracture Multidisciplinary metabolic bone Team (MDT) was developed in June 2016 as a collaboration between Orthogeriatricians and the Metabolic Bone Team. The objective was to improve the quality of bone protection treatment decisions. This audit aimed to assess the impact of the new MDT by reviewing treatment decisions prior to and post its introduction. Data collection and.
Methodology
Case notes were reviewed for admissions from September to October 2015 and from September to November 2018. For both time periods the inpatient list, discharge summary and blood tests were reviewed in order to collect data regarding demographics, type of surgery, co-morbidities, calcium and vitamin D levels, bone protection prior to admission and bone protection decisions at discharge.
Results
In 2015, 83% of patients were admitted with no form of bone protection. Around 6% of patients were admitted on a bisphosphonate and 36% were discharged on a bisphosphonate. Less than 2% of people received denosumab prior to their admission, with this number rising to 9.4% at discharge. In 2018, 77% of patients were admitted on no form of bone protection. 5.4% were admitted on a bisphosphonate rising to 16% on discharge. No patients were admitted on denosumab, but 27% were discharged having received it in hospital, or with a plan to receive it from their GP.
Conclusions
There was a fall in bisphosphonate use and a significant increase in the frequency of denosumab prescription after the introduction of the Bone MDT. This MDT facilitated better decision-making through access to the further specialist skills from the endocrinologist and specialist nurses. Individual case discussion enhanced the delivery of personalised medicine.
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Affiliation(s)
- S Brooks
- Princess Royal Hospital, Haywards Heath
| | - A Harper
- Princess Royal Hospital, Haywards Heath
| | - L Pack
- Princess Royal Hospital, Haywards Heath
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Thomas R, Probert WJM, Sauter R, Mwenge L, Singh S, Kanema S, Vanqa N, Harper A, Burger R, Cori A, Pickles M, Bell-Mandla N, Yang B, Bwalya J, Phiri M, Shanaube K, Floyd S, Donnell D, Bock P, Ayles H, Fidler S, Hayes RJ, Fraser C, Hauck K. Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial. Lancet Glob Health 2021; 9:e668-e680. [PMID: 33721566 PMCID: PMC8050197 DOI: 10.1016/s2214-109x(21)00034-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention. METHODS Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030. FINDINGS During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa. INTERPRETATION Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings. FUNDING US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - William J M Probert
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rafael Sauter
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Surya Singh
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nosivuyile Vanqa
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abigail Harper
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - Anne Cori
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nomtha Bell-Mandla
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Blia Yang
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Peter Bock
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katharina Hauck
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
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Batra A, Cuthbert C, Harper A, Boyne D, Yang L, Cheung W. P-239 Patient-reported outcomes in patients with metastatic gastric and esophageal cancers near end-of-life. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Batra A, Cuthbert C, Yang L, Harper A, Boyne D, Cheung W. PD-11 Impact of baseline symptom burden as assessed by patient-reported outcomes on overall survival of patients with metastatic gastrointestinal cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Harper A, Gerth A, Marsh C, Park C. Atrial fibrillation and non-ischaemic cardiomyopathy in the peripartum period. Anaesth Rep 2020; 8:152-155. [PMID: 33305289 DOI: 10.1002/anr3.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/07/2022] Open
Abstract
A 31-year-old primiparous woman with a history of bigeminy as a teenager developed atrial fibrillation with rapid ventricular response during elective caesarean section. Initial postoperative medical management was undertaken on the maternal high dependency unit and involved the administration of beta-blockers and digoxin. On postoperative day 1 the patient was transferred to the coronary care unit where she subsequently required synchronised direct current cardioversion to restore sinus rhythm. The patient remained on the coronary care unit for 5 days before discharge. Magnetic resonance imaging undertaken 6 weeks postpartum showed non-ischaemic cardiomyopathy. In this report, we discuss tachycardia-induced and peripartum cardiomyopathies, along with their potential underlying pathologies, incidence and associated morbidity. We describe potential pharmacological therapies including beta-blockers and angiotensin-converting enzyme inhibitors, as well as the implications of such medications for breastfeeding mothers. Patients presenting with palpitations in the antenatal period should receive prompt investigation including electrocardiography with ambulatory monitoring considered for those with persistent symptoms. Anyone with a proven cardiac arrhythmia should undergo echocardiography. This report illustrates the importance of the investigation of the symptoms of arrhythmia during pregnancy and emphasises the role of multidisciplinary working in the management of obstetric patients with complex medical comorbidity.
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Affiliation(s)
- A Harper
- Department of Paediatric Intensive Care Bristol Royal Hospital for Children Bristol UK
| | - A Gerth
- Addenbrookes Hospital Cambridge UK
| | - C Marsh
- Department of Anaesthesia Royal United Hospital Bath UK
| | - C Park
- Department of Obstetrics Royal United Hospital Bath UK
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Batra A, Cuthbert C, Rigo R, Harper A, Boyne D, Yang L, Cheung W. 187P Patient-reported outcomes near end-of-life in patients with breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Donkervoort S, Sabouny R, Yun P, Gauquelin L, Chao KR, Hu Y, Al Khatib I, Töpf A, Mohassel P, Cummings BB, Kaur R, Saade D, Moore SA, Waddell LB, Farrar MA, Goodrich JK, Uapinyoying P, Chan SS, Javed A, Leach ME, Karachunski P, Dalton J, Medne L, Harper A, Thompson C, Thiffault I, Specht S, Lamont RE, Saunders C, Racher H, Bernier FP, Mowat D, Witting N, Vissing J, Hanson R, Coffman KA, Hainlen M, Parboosingh JS, Carnevale A, Yoon G, Schnur RE, Boycott KM, Mah JK, Straub V, Foley AR, Innes AM, Bönnemann CG, Shutt TE. MSTO1 mutations cause mtDNA depletion, manifesting as muscular dystrophy with cerebellar involvement. Acta Neuropathol 2019; 138:1013-1031. [PMID: 31463572 PMCID: PMC6851037 DOI: 10.1007/s00401-019-02059-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 01/12/2023]
Abstract
MSTO1 encodes a cytosolic mitochondrial fusion protein, misato homolog 1 or MSTO1. While the full genotype–phenotype spectrum remains to be explored, pathogenic variants in MSTO1 have recently been reported in a small number of patients presenting with a phenotype of cerebellar ataxia, congenital muscle involvement with histologic findings ranging from myopathic to dystrophic and pigmentary retinopathy. The proposed underlying pathogenic mechanism of MSTO1-related disease is suggestive of impaired mitochondrial fusion secondary to a loss of function of MSTO1. Disorders of mitochondrial fusion and fission have been shown to also lead to mitochondrial DNA (mtDNA) depletion, linking them to the mtDNA depletion syndromes, a clinically and genetically diverse class of mitochondrial diseases characterized by a reduction of cellular mtDNA content. However, the consequences of pathogenic variants in MSTO1 on mtDNA maintenance remain poorly understood. We present extensive phenotypic and genetic data from 12 independent families, including 15 new patients harbouring a broad array of bi-allelic MSTO1 pathogenic variants, and we provide functional characterization from seven MSTO1-related disease patient fibroblasts. Bi-allelic loss-of-function variants in MSTO1 manifest clinically with a remarkably consistent phenotype of childhood-onset muscular dystrophy, corticospinal tract dysfunction and early-onset non-progressive cerebellar atrophy. MSTO1 protein was not detectable in the cultured fibroblasts of all seven patients evaluated, suggesting that pathogenic variants result in a loss of protein expression and/or affect protein stability. Consistent with impaired mitochondrial fusion, mitochondrial networks in fibroblasts were found to be fragmented. Furthermore, all fibroblasts were found to have depletion of mtDNA ranging from 30 to 70% along with alterations to mtDNA nucleoids. Our data corroborate the role of MSTO1 as a mitochondrial fusion protein and highlight a previously unrecognized link to mtDNA regulation. As impaired mitochondrial fusion is a recognized cause of mtDNA depletion syndromes, this novel link to mtDNA depletion in patient fibroblasts suggests that MSTO1-deficiency should also be considered a mtDNA depletion syndrome. Thus, we provide mechanistic insight into the disease pathogenesis associated with MSTO1 mutations and further define the clinical spectrum and the natural history of MSTO1-related disease.
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Guillen A, Finotello R, Wynne P, Harper A, Killick D, Amores-Fuster I, Blackwood L. Toxicity of cytarabine constant rate infusion in dogs with high-grade non-Hodgkin lymphoma with bone marrow or central nervous system involvement. Aust Vet J 2019; 98:69-78. [PMID: 31769013 DOI: 10.1111/avj.12895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cytarabine, a cell-cycle phase-specific antimetabolite, has been reported to improve outcomes in dogs with bone marrow (BM) or central nervous system (CNS) lymphoma involvement receiving combination chemotherapy. The objective of this study was to evaluate the incidence and severity of toxicity of cytarabine constant rate infusion (CRI) in dogs with high-grade non-Hodgkin lymphoma. METHODS Medical records of canine lymphoma patients with confirmed or suspected BM (group 1) or CNS (group 2) involvement, treated with a modified cyclophosphamide, epirubicin, vincristine and prednisolone protocol, including a single dose of cytarabine given as CRI, were reviewed and adverse events graded. RESULTS Twenty-six dogs were included. Gastrointestinal toxicity occurred in 17 dogs (65.3%), with 5 (19.2%) experiencing grade III or IV toxicity. Neutropenia occurred in nine dogs (34.6%), but was grade I or II in most cases. Three dogs (11.5%) had thrombocytopenia: one grade III and two grade IV. Four dogs (15.3%) experienced increases in alanine amino transferase: one each grade I and II and two grade III. Five dogs (19.2%) required hospitalisation to manage toxicity after completing cytarabine CRI, and haematological toxicity resulted in treatment delays in five dogs (median delay of 4 days, range: 3-7 days). CONCLUSION Our findings suggest that gastrointestinal toxicity should be expected in lymphoma patients undergoing cytarabine CRI.
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Affiliation(s)
- A Guillen
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - P Wynne
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - A Harper
- Southfields Veterinary Specialists, Southfields, Laindon Essex, SS15 6TP, UK
| | - D Killick
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - L Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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Guglieri M, Clemens P, Haberlova J, Horrocks I, Selby K, Webster R, Smith E, Straub V, McMillan H, Yang M, Harper A, Tulinius M, Mah J, Childs A, Finkel R, Nevo Y, McDonald C, Morgenroth L, Bendixon R, Hoffman E. P.336Vision DMD: a phase IIb randomized, double-blind, parallel group, placebo- and active-controlled study to assess the efficacy and safety of vamorolone in boys with Duchenne muscular dystrophy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Clemens P, Rao V, Connolly A, Zaidman C, Harper A, Mah J, Morgenroth L, Yamashita T, Hoffman E. P.337Dystrophin restoration by exon 53 skipping in patients with Duchenne muscular dystrophy after viltolarsen treatment: phase 2 study update. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Bjornsdottir-Butler K, Abraham A, Harper A, Dunlap PV, Benner RA. Biogenic Amine Production by and Phylogenetic Analysis of 23 Photobacterium Species. J Food Prot 2018; 81:1264-1274. [PMID: 29985067 DOI: 10.4315/0362-028x.jfp-18-022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Photobacterium species are members of the bacterial communities typically associated with scombrotoxin-forming fish. Reclassification and discovery of new Photobacterium species has caused confusion as to which species are capable of biogenic amine production. We analyzed histamine, cadaverine, and putrescine production by 104 Photobacterium strains representing 23 species. The presence of the genes for histidine decarboxylase ( hdc), lysine decarboxylase ( ldc), and ornithine decarboxylase ( odc) was determined by real-time or conventional PCR and whole genome sequencing. Significant histamine production (>200 ppm) was detected in five Photobacterium species: P. angustum, P. aquimaris, P. kishitanii, P. damselae, and P. phosphoreum. The hdc gene was detected in all of these histamine-producing species except P. phosphoreum. Cadaverine was produced by eight Photobacterium species: P. angustum, P. aquimaris, P. damselae, P. iliopiscarium, P. kishitanii, P. leiognathi, P. mandapamensis, and P. phosphoreum. Putrescine was produced by six Photobacterium species: P. angustum, P. aquimaris, P. kishitanii, P. leiognathi, P. mandapamensis, and Photobacterium sp. Cadaverine production correlated closely with the presence of the ldc gene, but putrescine production did not correlate closely with the presence of the odc gene. Characterization of the biogenic amine production by Photobacterium species will allow identification of these marine bacteria and help ensure that current guidelines account for mitigation of these bacteria.
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Affiliation(s)
- K Bjornsdottir-Butler
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - A Abraham
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - A Harper
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
| | - P V Dunlap
- 2 Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - R A Benner
- 1 U.S. Food and Drug Administration, Division of Seafood Science and Technology, Gulf Coast Seafood Laboratory, Dauphin Island, Alabama 36528; and
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17
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Crossland D, Jansen K, O'Sullivan JJ, Best KE, Parry G, MacGowan GA, Harper A, Perri G, Derita F, Davidson A, Hasan A, Coats L. P3473Outcome following assessment for orthotopic heart transplant in adults with congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Crossland
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - K Jansen
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - J J O'Sullivan
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - K E Best
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, United Kingdom
| | - G Parry
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - G A MacGowan
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - A Harper
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - G Perri
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - F Derita
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - A Davidson
- Freeman Hospital, Cardiology Department, Newcastle upon Tyne, United Kingdom
| | - A Hasan
- Freeman Hospital, Adult Congenital and Paediatric Heart Unit, Newcastle upon Tyne, United Kingdom
| | - L Coats
- Newcastle University, Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom
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18
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Blackwood L, Tanis JB, Harper A, Amores-Fuster I, Killick DR, Finotello R. Acute radiotherapy toxicity in 57 dogs with gross and microscopic mast cell tumours. Vet Comp Oncol 2018; 16:431-440. [PMID: 29761612 DOI: 10.1111/vco.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 10/16/2022]
Abstract
Mast cell tumours (MCTs) are commonly treated with radiation therapy, most often in a microscopic disease setting. Poorer outcomes are expected in patients with gross disease, and irradiation of gross disease may be associated with greater toxicity. The aim of this study was to compare acute radiation adverse events (AE) in dogs with gross and microscopic MCTs receiving radiotherapy. Fifty-seven dogs were included, 28 with gross disease and 29 with microscopic. In order to assess mucosal and skin toxicity, patients were assigned to 2 groups: head (29 patients, 14 patients with gross and 15 microscopic) and other sites (28 patients, 14 each). All were treated with external beam radiotherapy, and toxicity assessed at the end of treatment and 10 to 14 days later (first recheck). All patients developed some acute radiation toxicity by the end of the course. However, there was no difference in the severity of toxicity between gross and microscopic disease in either site group at either time point. The only variable associated with an increased frequency of grade 2 or 3 toxicity at the first recheck was the use of prednisolone prior to radiotherapy (P = .05). No other factors were identified which were associated with increased toxicity. For the head group, the site of highest grade toxicity was mucosa or, if included in the field, nasal planum, which was often more severely affected than the mucosa. No significant late toxicity was identified. Two dogs developed acute haematemesis during the radiotherapy course, but both completed the course without further events.
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Affiliation(s)
- L Blackwood
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - J B Tanis
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - A Harper
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - D R Killick
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
| | - R Finotello
- Department of Small Animal Clinical Science, University of Liverpool, Leahurst Campus, Neston, Cheshire, UK
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Tanis JB, Mason SL, Maddox TW, Blackwood L, Killick DR, Amores-Fuster I, Harper A, Finotello R. Evaluation of a multi-agent chemotherapy protocol combining lomustine, procarbazine and prednisolone (LPP) for the treatment of relapsed canine non-Hodgkin high-grade lymphomas. Vet Comp Oncol 2018; 16:361-369. [PMID: 29380942 DOI: 10.1111/vco.12387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 11/27/2022]
Abstract
The standard of care treatment for canine lymphoma is multi-agent chemotherapy containing prednisolone, cyclophosphamide, vincristine and an anthracycline such as doxorubicin (CHOP) or epirubicin (CEOP). Lomustine, vincristine, procarbazine, and prednisone (LOPP) has been evaluated as a rescue, with encouraging results; however, resistance to vincristine is likely in patients relapsing on CHOP/CEOP, and this agent may enhance LOPP toxicity without improving efficacy. The aim of this study was to evaluate responses to a modified-LOPP protocol that does not include vincristine (LPP) and is administered on a 21-day cycle. Medical records of dogs with high-grade multicentric lymphoma from 2012 to 2017 were reviewed. Dogs with relapsed lymphoma that received LPP as a rescue protocol were enrolled. Response, time from initiation to discontinuation (TTD) and toxicity of LPP were assessed. Forty-one dogs were included. Twenty-five dogs (61%) responded to LPP including 12 complete responses (CR) and 13 partial responses (PR). Responders had a significantly longer TTD (P < .001) compared to non-responders with 84 days for CR and 58 days for PR. Neutropenia was documented in 20 dogs (57%): 12 grade I to II, 8 grade III to IV. Thrombocytopenia was infrequent (20%): 5 grade I to II, 2 grade III to IV. Twelve dogs developed gastrointestinal toxicity (30%): 10 grade I to II and 2 grade III. Nineteen dogs had elevated ALT (59%): 9 grade I to II, 10 grade III to IV. Treatment was discontinued due to toxicity in 8 dogs (19%). The LPP protocol shows acceptable efficacy and toxicity-profile and minimizes in-hospital procedures.
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Affiliation(s)
- J-B Tanis
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - S L Mason
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - T W Maddox
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - L Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - D R Killick
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - I Amores-Fuster
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - A Harper
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
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Daien V, Nguyen V, Essex RW, Morlet N, Barthelmes D, Gillies MC, Gillies M, Hunt A, Essex R, Dayajeewa C, Hunyor A, Fraser-Bell S, Younan C, Fung A, Guymer R, Louis D, Arnold J, Chan D, Cass H, Harper A, O’Day J, Daniell M, Field A, Chow L, Barthelmes D, Cohn A, Young S, Lal S, Ferrier R, Barnes R, Thompson A, Vincent A, Manning L, Lake S, Phillips R, Perks M, Chen J, Landers J, Niladri, Banerjee G, Swamy B, Windle P, Dunlop A, Tang K, McLean I, Amini A, Hunt A, Clark G, McAllister I, Chen F, Squirrell D, Ng C, Hinchcliffe P, Barry R, Ah-Chan J, Steiner H, Morgan M, Thompson C, Game J, Murray N. Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration. Ophthalmology 2018; 125:66-74. [DOI: 10.1016/j.ophtha.2017.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
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21
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Thomas R, Burger R, Harper A, Kanema S, Mwenge L, Vanqa N, Bell-Mandla N, Smith PC, Floyd S, Bock P, Ayles H, Beyers N, Donnell D, Fidler S, Hayes R, Hauck K. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Glob Health 2017; 5:e1133-e1141. [PMID: 28964756 PMCID: PMC5640509 DOI: 10.1016/s2214-109x(17)30367-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 08/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. METHODS As part of the HPTN 071 (PopART) study, data from adults aged 18-44 years were gathered between Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use. FINDINGS We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratory-confirmed HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa; 4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and 18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score -0·002, 95% CI -0·01 to 0·001; p=0·219) nor in South Africa (0·000, -0·002 to 0·003; p=0·939). However, scores did differ between HIV-positive individuals who had initiated ART less than 5 years previously and HIV-negative individuals in Zambia (-0·006, 95% CI -0·008 to -0·003; p<0·0001). A large proportion of people with clinically confirmed HIV were unaware of being HIV-positive (1768 [43%] of 4128 people in Zambia and 2026 [50%] of 4012 people in South Africa) and reported good HRQoL, with no significant differences from that of HIV-negative people (change in mean HRQoL score -0·001, 95% CI -0·003 to 0·001, p=0·216; and 0·001, -0·001 to 0·001, p=0·997, respectively). In South Africa, HRQoL scores were lower in HIV-positive individuals who were aware of their status but not enrolled in HIV care (change in mean HRQoL -0·004, 95% CI -0·01 to -0·001; p=0·010) and those in HIV care but not on ART (-0·008, -0·01 to -0·004; p=0·001) than in HIV-negative people, but the magnitudes of difference were small. INTERPRETATION ART is successful in helping to reduce inequalities in HRQoL between HIV-positive and HIV-negative individuals in this general population sample. These findings highlight the importance of improving awareness of HIV status and expanding ART to prevent losses in HRQoL that occur with untreated HIV progression. The gains in HRQoL after individuals initiate ART could be substantial when scaled up to the population level. FUNDING National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Abigail Harper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Kanema
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Lawrence Mwenge
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Peter C Smith
- Imperial College Business School, Imperial College London, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Naude CE, Durao S, Harper A, Volmink J. Scope and quality of Cochrane reviews of nutrition interventions: a cross-sectional study. Nutr J 2017; 16:22. [PMID: 28388919 PMCID: PMC5384134 DOI: 10.1186/s12937-017-0244-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND All countries face significant challenges from complex manifestations of malnutrition, which affects one in three people globally. Systematic reviews provide ready-to-use syntheses of quality-appraised evidence to inform decision-making for actions. To enhance the utility and quality of future Cochrane nutrition evidence, we described the scope and quality of all nutrition systematic reviews in the Cochrane Database of Systematic Reviews (CDSR). METHODS We screened all active CDSR records (31 July 2015) to identify reviews and protocols using pre-specified eligibility criteria and definitions. Duplicate, independent data extraction included criteria for inclusion of studies in completed reviews (PICOS). We assessed methodological quality (AMSTAR), use of GRADE, mapped reviews against 2013 Global Burden of Disease data, and categorised the paradigm (medical, lifestyle and socio-ecological) of the review question. We analysed our results using descriptive statistics. RESULTS We screened 8484 records, and included 470 (8%) completed reviews (in 45 Cochrane Review Groups (CRGs)) and 169 (7%) protocols (in 41 CRGs) published by 47 of 53 CRGs with reviews. Most completed reviews were produced by the Pregnancy and Childbirth (n = 73), Neonatal (n = 64), Metabolic and Endocrine Disorders (n = 33), Developmental, Psychosocial and Learning Problems (n = 26), Kidney and Transplant (n = 18) and Heart (n = 18) CRGs. Only 27% (n = 129) of reviews had searches for new studies in 2013 or thereafter. Supplementation/supplement interventions were most common (50%; n = 235; majority with micronutrients; 73%, n = 173), followed by food interventions (20%; n = 95). All reviews included randomised controlled trials; about 5% included other designs; 25% used GRADE; the median AMSTAR score was 9 (interquartile range: 7 to 10), 51% were high (AMSTAR 9-11) and 49% moderate (AMSTAR 5-8) quality. More than 80% framed questions using a medical paradigm. For top causes of years-of-life-lost, most reviews addressed preterm birth, diabetes and ischaemic heart disease; for leading risk factors for disability-adjusted-life-years, most targeted childhood undernutrition and high body mass index. CONCLUSIONS Nutrition reviews comprised 8% of active CDSR records, were widely distributed across nearly all CRGs and reflected the double nutrition burden. This analysis presents a comprehensive description of the scope and quality of Cochrane nutrition reviews, and identifies gaps for future activities to support actions to address the nutrition burden, in line with the current nutrition agenda and impetus.
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Affiliation(s)
- Celeste E Naude
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Abigail Harper
- The Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa
| | - Jimmy Volmink
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, South Africa.,Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Tygerberg, 7505, South Africa
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Harper A, Blackwood L. Toxicity of metronomic cyclophosphamide chemotherapy in a UK population of cancer-bearing dogs: a retrospective study. J Small Anim Pract 2017; 58:227-230. [DOI: 10.1111/jsap.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/20/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A. Harper
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
| | - L. Blackwood
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
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Davies J, Harper A, Kadir RA. The role of rotational thromboelastometry in assessment of haemostasis during pregnancy in women with factor XI deficiency. Haemophilia 2015; 22:276-284. [DOI: 10.1111/hae.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J. Davies
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - A. Harper
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - R. A. Kadir
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
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Hollingworth M, Harper A, Hamer M. An observational study of erectile dysfunction, infertility, and prostate cancer in regular cyclists: Cycling for health UK study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, McAllister IL, Essex RW, Morlet N, Gillies MC, Gillies M, Hunt A, Hunyor A, Arnold J, Young S, Clark G, Banerjee G, Phillips R, Perks M, Essex R, McAllister I, Constable I, Guymer R, Guymer R, Lim L, Harper A, Chow L, Wickremansinghe S, Wickremasinghe S, Wickremasinghe S. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015; 122:1212-9. [PMID: 25846847 DOI: 10.1016/j.ophtha.2015.02.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice. DESIGN Database observational study. PARTICIPANTS We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry. METHODS A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry. MAIN OUTCOME MEASURES Change in visual acuity (VA) over 2 years and number of injections and visits. RESULTS Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits. CONCLUSIONS These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
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Affiliation(s)
| | - Anna Campain
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Alex P Hunyor
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia
| | - Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Western Australia
| | - Rohan W Essex
- Academic Unit of Ophthalmology, Australian National University, Acton, Canberra, Australia
| | - Nigel Morlet
- University of Western Australia Department of Population Health, Perth, Western Australia
| | - Mark C Gillies
- Marsden Eye Specialists, Parramatta, New South Wales, Australia
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Williams C, Jiang YH, Shashi V, Crimian R, Schoch K, Harper A, McHale D, Goldstein D, Petrovski S. Additional evidence thatPGAP1loss of function causes autosomal recessive global developmental delay and encephalopathy. Clin Genet 2015; 88:597-9. [DOI: 10.1111/cge.12581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. Williams
- Duke School of Medicine; Duke University; Durham NC USA
| | - Y.-H. Jiang
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
- Department of Neurobiology; Duke University; Durham NC USA
| | - V. Shashi
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - R. Crimian
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - K. Schoch
- Department of Pediatrics, Division of Genetics; Duke University; Durham NC USA
| | - A. Harper
- Department of Neurology; Wake Forest University North Carolina Baptist Hospital; Durham NC USA
| | | | - D. Goldstein
- Institute for Genomic Medicine; Columbia University; New York NY USA
| | - S. Petrovski
- Institute for Genomic Medicine; Columbia University; New York NY USA
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
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Obel J, Brockstein B, Marschke M, Robicsek A, Konchak C, Sefa M, Ziomek N, Benfield T, Peterson C, Gustafson C, Eriksson J, Harper A, Tabachow C, Raymond M, Hensing T. Outpatient advance care planning for patients with metastatic cancer: a pilot quality improvement initiative. J Palliat Med 2014; 17:1231-7. [PMID: 25343403 DOI: 10.1089/jpm.2014.0085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommending that oncologists discuss advance care planning (ACP) with patients with stage IV cancer early in treatment, in standard practice ACP remains a late step of a terminal illness. ACP preserves comfort and dignity at the end of life, ensuring patients receive the care that they desire. METHODS AND MATERIALS A feasibility study in patients with stage IV cancer was developed to test whether incorporating ACP immediately after a stage IV cancer diagnosis is feasible. Inclusion criteria were consecutive new gastrointestinal and thoracic oncology patients treated by one of two oncologists. The project included creation of new workflow; development of an ACP patient education guidebook; training seminars for oncology staff; and enhancements to the electronic health record (EHR) to improve ACP documentation. RESULTS The oncologists recorded 33 of 48 (69%) advance directive notes (ADNs) and 22 of 48 (46%) code status orders (CSOs) in the EHR of patients newly diagnosed with stage IV cancer by following ACP protocol during the 6-month trial period. Twenty-one of 33 ADNs were entered within 7 days of first consultation. The median time to ADN placement was 1 day after consultation. Twenty-two of 33 patients with ADNs had CSOs placed, of which 16 were do-not-resuscitate (DNR) and 6 were full code. One year prior to the feasibility study, only 1 of 75 deceased patients of the two oncologists had outpatient ADNs and CSOs. CONCLUSIONS Outpatient ACP is feasible early in the care of patients with stage IV cancer through systematic improvement in workflow and motivated providers. Education and infrastructure were pivotal to routine development of advance care plans.
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Affiliation(s)
- Jennifer Obel
- NorthShore University HealthSystem , Evanston, Illinois
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30
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Carro GW, Hensing TA, Brockstein B, Gavin SM, Harper A, Jee C, Palafox A, Schiavo K, Hui W, Blankenship A, Hughes B, Uhlig WJ, Spath W, Hullett AM, Marciniak M, Filippini J, Azhar Y. EMR optimized oral chemotherapy monitoring program: Adherence and ADR outcomes. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.30_suppl.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
77 Background: Utilization of oral anticancer agents (OAA) has drastically increased over the past decade, accounting for more than 70% of new oncology agents approved in 2013. There are many challenges associated with OAA, including monitoring of adverse drug reactions (ADR) and adherence. While few studies estimate adherence of OAA, it is known that a multidisciplinary approach with intensive pharmacist counseling may improve outcomes. Currently, the electronic medical record (EMR) at our institution has many limitations on tracking OAA. In 2007, 1,872 OAA prescriptions were written. The 2014 annualized OAA prescriptions will surpass 5,510, demonstrating a growth of 194%. The purpose of this project is to establish an OAA monitoring program to allow consistent documentation, closer monitoring, and timely management of ADR. Methods: American Society of Clinical Oncology’s Quality Oncology Practice Initiative criteria were utilized to develop a unique monitoring tool, specific for OAA, which was employed via EMR. The monitoring tool assesses the current regimen, ADR, labs, adherence, and drug interactions. The initial analysis focused on testing the tools on two of the most commonly prescribed OAA agents within our institution. New start patients were identified through utilization of an OAA pharmacist verification queue. The pharmacist provided education, intensive follow up, and communicated treatment complications to other healthcare team members. Results: Follow-up calls were placed for 24 capecitabine patients and four erlotinib patients. Over half of the patients required an intervention. For capecitabine, there were seven patients with barriers to adherence. There were two patients who were non-adherent and one patient who was lost to follow-up; therefore, overall adherence rate was 91%. For erlotinib, adherence rate was 100% with no barriers to adherence. Symptom management and education were provided to 16 patients with grade 1 toxicities, and four drug interactions were identified. Conclusions: Oral chemotherapy should be treated with the same intensive monitoring as IV chemotherapy. A multidisciplinary pharmacist driven OAA monitoring program may improve adherence and allow more timely management of ADR.
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Affiliation(s)
| | | | | | | | | | - Cheryl Jee
- NorthShore University HealthSystem, Evanston, IL
| | - Anna Palafox
- NorthShore University HealthSystem, Evanston, IL
| | | | - Wendy Hui
- NorthShore University HealthSystem, Evanston, IL
| | | | - Brad Hughes
- NorthShore University HealthSystem, Evanston, IL
| | | | | | | | | | | | - Yousuf Azhar
- NorthShore University HealthSystem, Evanston, IL
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31
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Hollingworth M, Harper A, Hamer M. Dose-response associations between cycling activity and risk of hypertension in regular cyclists: The UK Cycling for Health Study. J Hum Hypertens 2014; 29:219-23. [PMID: 25273856 PMCID: PMC4357858 DOI: 10.1038/jhh.2014.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 11/09/2022]
Abstract
Most population studies on physical activity and health have involved largely inactive men and women, thus making it difficult to infer if health benefits occur at exercise levels above the current minimum guidelines. The aim was to examine associations between cycling volume and classical cardiovascular risk markers, including hypertension and hypercholesterolemia, in a population sample of habitual cyclists. A nationwide sample comprising 6949 men and women (aged 47.6 years on average) completed questions about their cycling levels, demographics and health. Nearly the entire sample (96.3%) achieved the current minimum physical activity recommendation through cycling alone. There was a dose–response association between cycling volume and risk of diagnosed hypertension (P-trend =0.001), with odds ratios of 0.98 (95% confidence interval (CI), 0.80–1.21), 0.86 (0.70, 1.06), 0.67 (95% CI, 0.53–0.83) across categories of 23–40, 40–61 and >61 metabolic equivalent hours/week (MET-h/week) compared with <23 MET-h/week. These associations persisted in models adjusted for age, sex, smoking, alcohol, body mass index (BMI) and other moderatevigorous physical activities. We also observed inverse associations between cycling volume and other risk factors including BMI and hypercholesterolemia. In summary, results from a population sample of cyclists suggest that additional cardiovascular health benefits can be achieved beyond the current minimum physical activity recommendation.
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Affiliation(s)
| | - A Harper
- University College London Medical School, London, UK
| | - M Hamer
- Physical Activity Research Group, Department of Epidemiology and Public Health, University College London, London, UK
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32
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Anbazhagan A, Harper A, Hunter A, Benson G, Cadden I, Cash J, McDougall N. Budd-Chiari syndrome during puerperium requiring liver transplantation. J OBSTET GYNAECOL 2014; 33:739-40. [PMID: 24127969 DOI: 10.3109/01443615.2013.810200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Anbazhagan
- Department of Obstetrics and Gynaecologist, Royal Jubilee Maternity Hospital
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33
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Carro GW, Brockstein B, Hensing TA, Fleming PJ, Gavin SM, Spath W, Harper A, Hui W, Uhlig WJ, Hughes B. Evaluation of oral chemotherapy prescribing at an outpatient oncology clinic. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
191 Background: Oral chemotherapy’s exponentially increasing role in the treatment of malignancies continues to pose unique challenges to oncology. The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) drafted measures in the Chemotherapy Administration Safety Standards that help address some of these issues concerning oral chemotherapy. There is a lack of data describing the prescribing process for oral chemotherapy. In a retrospective chart review, prescriptions at a hospital-based outpatient oncology center were evaluated for completeness of prescribing and follow up measures. Methods: A retrospective chart review of ten oral chemotherapy medications from May 2012 to July 2012 was conducted. The primary outcome measure was compliance with ASCO and ONS Chemotherapy Administration Safety Standards. A secondary outcome was frequency of pharmacist interventions on oral chemotherapy prescriptions. Results: 412 prescriptions were evaluated. Prescriptions were graded on a scale from 1 to 8. One point was given for inclusion of each of the following: prescribing physician, patient name, drug name, dose, dosing methodology, quantity, refills, and accurate directions. Of all the prescriptions, 23% contained all aspects of a complete prescription. The most common reasons for point deductions were contradictory or unclear directions and allowing refills for oral chemotherapy which should not be refillable. Four percent of prescriptions had a documented pharmacist intervention. Conclusions: This study revealed areas for improvement in the prescribing process of oral chemotherapy. Targeting directions and refill fields within prescription templates will improve compliance with ASCO and ONS standards. This can be accomplished by implementing customized oral chemotherapy prescription templates within treatment plans in the electronic medical record system. Unlike chemotherapy administered in the clinic setting, oral chemotherapy prescriptions are not generally reviewed by oncology trained pharmacists. With the collaboration of medical and nursing staff, a new work flow was implemented which includes pharmacist review of electronic oral chemotherapy prescriptions.
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Affiliation(s)
| | | | | | | | | | | | | | - Wendy Hui
- NorthShore University HealthSystem, Evanston, IL
| | | | - Brad Hughes
- NorthShore University HealthSystem, Evanston, IL
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34
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Obel JC, Orlando-Brooks D, Konchak C, Harper A, Marschke M, Kharasch M, Brockstein B, Raymond M, Robicsek A. Medical informatics: Documenting quality of end-of-life oncologic care. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
311 Background: NorthShore University HealthSystem has created, via the Electronic Health Record (EHR), quarterly reports to measure quality of care for patients who die of cancer during the reporting time frame. Specific reports for 22 oncology providers and measurements across the population will be derived. Reports are automated with seamless data retrieval based on algorithms designed through the use of discrete, searchable entry fields. Goals include establishing a pre-report baseline, educating oncologists about their terminally ill patients’ outcomes and documenting improvements in end-of-life care through educational initiatives for patients and providers. Methods: To standardize reporting, a cohort of terminally ill patients was created based on QOPI definitions (Denominator). A set of quality end points to describe cancer utilization near the end of life was added as Numerator Values, to establish rates of potential inappropriate use of resources. Results: The OP, oncology EHR was changed to allow ADN/CSO placement that carry over to the IP EHR (hyperlink in patient header). The average time between a patient’s first OP, oncology visit and when the oncologist placed ADN/CSO will be calculated. ADN/CSO reports will be stratified by a patient’s age, race and oncologist. Each separate report will be validated prior to the “go live” phase. Conclusions: These metrics allow routine hypothesis generating queries of end-of-life care to assess compliance with quality measures. [Table: see text]
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Affiliation(s)
| | | | - Chad Konchak
- NorthShore University HealthSystem, Evanston, IL
| | | | | | | | | | | | - Ari Robicsek
- NorthShore University HealthSystem, Evanston, IL
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35
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Smith JM, Biggins SW, Haselby DG, Kim WR, Wedd J, Lamb K, Thompson B, Segev DL, Gustafson S, Kandaswamy R, Stock PG, Matas AJ, Samana CJ, Sleeman EF, Stewart D, Harper A, Edwards E, Snyder JJ, Kasiske BL, Israni AK. Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant 2012; 12:3191-212. [PMID: 23157207 PMCID: PMC3565841 DOI: 10.1111/j.1600-6143.2012.04259.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplant and liver transplant are the treatments of choice for patients with end-stage renal disease and end-stage liver disease, respectively. Pancreas transplant is most commonly performed along with kidney transplant in diabetic end-stage renal disease patients. Despite a steady increase in the numbers of kidney and liver transplants performed each year in the United States, a significant shortage of kidneys and livers available for transplant remains. Organ allocation is the process the Organ Procurement and Transplantation Network (OPTN) uses to determine which candidates are offered which deceased donor organs. OPTN is charged with ensuring the effectiveness, efficiency and equity of organ sharing in the national system of organ allocation. The policy has changed incrementally over time in efforts to optimize allocation to meet these often competing goals. This review describes the history, current status and future direction of policies regarding the allocation of abdominal organs for transplant, namely the kidney, liver and pancreas, in the United States.
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Affiliation(s)
- J. M. Smith
- Department of Pediatrics, University of Washington, Seattle, Washington, DC,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - S. W. Biggins
- Division of Gastroenterology and Hepatology, University of Colorado, Denver, CO
| | - D. G. Haselby
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - W. R. Kim
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - J. Wedd
- Division of Gastroenterology and Hepatology, University of Colorado, Denver, CO
| | - K. Lamb
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - B. Thompson
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - D. L. Segev
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S. Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
| | - R. Kandaswamy
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of Minnesota, Minneapolis, MN
| | - P. G. Stock
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of California, San Francisco, CA
| | - A. J. Matas
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | | | - D. Stewart
- United Network for Organ Sharing, Richmond, VA
| | - A. Harper
- United Network for Organ Sharing, Richmond, VA
| | - E. Edwards
- United Network for Organ Sharing, Richmond, VA
| | - J. J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - B. L. Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - A. K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN,Corresponding author: Ajay K. Israni,
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Donkervoort S, Hu Y, Dastgir J, Meilleur K, Zou Y, Foley A, Harper A, Bonnemann C. G.P.22 Possible mutation dependent mechanisms for intra-familial variation of severity in Collagen VI-Related Myopathies (COL6-RM). Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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37
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Viswanathan GV, Harper A, Balasubramaniam K, Badimon JJ, Marshall SM, Zaman AZ. 113 Blood thrombogenicity is inversely related to coronary lesion severity in patients with non ST-elevation acute coronary syndrome and type 2 diabetes mellitus. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Chambers A, Harper A. Removal of a titanium ring using a dental saw. J Plast Reconstr Aesthet Surg 2012; 65:e128-9. [DOI: 10.1016/j.bjps.2011.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/23/2011] [Indexed: 11/17/2022]
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39
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Menas P, Merkel D, Hui W, Lawton J, Harper A, Carro G. Incidence and management of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic. J Oncol Pharm Pract 2012; 18:387-93. [DOI: 10.1177/1078155211434853] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Aromatase inhibitors (AIs) are routinely used as first-line adjuvant treatment of breast cancer in postmenopausal women with hormone receptor positive tumors. The current recommended length of treatment with an AI is 5 years. Arthralgias have been frequently cited as the primary reason for discontinuation of AI therapy. Various treatment strategies are proposed in literature, but a standardized treatment algorithm has not been established. The initial purpose of this study was to describe the incidence and management of AI-induced arthralgias in patients treated at Kellogg Cancer Center (KCC). Further evaluation led to the development and the implementation of a treatment algorithm and electronic medical record (EMR) documentation tools. Methods: The retrospective chart review included 206 adult patients with hormone receptor positive breast cancer who were receiving adjuvant therapy with an AI. A multidisciplinary treatment team consisting of pharmacists, collaborative practice nurses, and physicians met to develop a standardized treatment algorithm and corresponding EMR documentation tool. The treatment algorithm and documentation tool were developed after the study to better monitor and proactively treat patients with AI-induced arthralgias. Results/conclusions: The overall incidence of arthralgias at KCC was 48% ( n = 98/206). Of these patients, 32% were documented as having arthralgias within the first 6 months of therapy initiation. Patients who reported AI-induced arthralgias were younger than patients who did not report AI-induced arthralgias (61 vs. 65 years, p = 0.002). There was no statistical difference in the incidence of arthralgias in patients with a history of chemotherapy (including taxane therapy) compared to those who did not receive chemotherapy ( p = 0.352). Of patients presenting with AI-induced arthralgias, 41% did not have physician-managed treatment documented in the EMR. A standardized treatment algorithm and electronic chart documentation tools were then developed by the multidisciplinary team.
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Affiliation(s)
- Pamela Menas
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
| | - Douglas Merkel
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
| | - Wendy Hui
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
| | - Jessica Lawton
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
| | - Abigail Harper
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
| | - George Carro
- Kellogg Cancer Center, NorthShore University Health System, Evanston, IL, USA
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Fogh S, Farach A, Intenzo C, Axelrod R, McCue P, Harper A, Nelson A, Werner-Wasik M. Pathologic Correlation of PET-CT Based Auto Contouring for Radiation Planning in Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Guiteau JJ, Cotton RT, Washburn WK, Harper A, O'Mahony CA, Sebastian A, Cheng S, Klintmalm G, Ghobrial M, Halff G, Mieles L, Goss J. An early regional experience with expansion of Milan Criteria for liver transplant recipients. Am J Transplant 2010; 10:2092-8. [PMID: 20883543 DOI: 10.1111/j.1600-6143.2010.03222.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Milan Criteria (MC) showed that orthotopic liver transplantation (OLT) was an effective treatment for patients with nonresectable, nonmetastatic HCC. There is growing evidence that expanding the MC does not adversely affect patient or allograft survival following OLT. The adult OLT programs in UNOS Region 4 reached an agreement allowing lesions outside MC (one lesion <6 cm, ≤3 lesions, none >5 cm and total diameter <9 cm-[R4 T3]) to receive the same exception points as MC lesions. Kaplan-Meier curves and log-rank tests were used to compare survival data. Chi-squared and Mann-Whitney U tests were used to compare patient data. A p-value of <0.05 was considered significant. All statistical analyses were performed on SPSS 15 (SPSS, Chicago, IL). Four hundred and forty-five patients were transplanted for HCC (363-MC and 82-R4 T3). Patient demographics were found to be similar between the two groups. Three year patient, allograft and recurrence free survival between MC and R4 T3 were found to be 72.9% and 77.1%, 71% and 70.2% and 90.5% and 86.9%, respectively (all p > 0.05). We report the first regionalized multicenter, prospective study showing benefit of OLT in patients exceeding MC based on preoperative imaging.
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Affiliation(s)
- J J Guiteau
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
Patients with hepatocellular carcinoma (HCC) within Milan criteria receive priority on the liver transplant waiting list (WL) and compete with non-HCC patients. Dropout from the WL is an indirect measure of transplant access. Competing risks (CR) evaluation of dropout for HCC and non-HCC patients has not previously been reported. Patients listed between 16 March 2005 and 30 June 2008 were included. Probability of dropout was estimated using a CR technique as well as a Cox model for time to dropout. Overall, non-HCC patients had a higher dropout rate from the WL than HCC patients (p < 0.0001). This was reproducible throughout all regions. In Cox regression, tumor size, model for end-stage liver disease (MELD) score and alpha fetoprotein (AFP) were associated with increased dropout risk. Multivariable analysis with CR showed that MELD score and AFP, were most influential in predicting dropout for HCC patients. The index of concordance for predicting dropout with the CR was 0.70. HCC patients appear to be advantaged in the current allocation scheme based on lower dropout rates without regard to geography. A continuous score incorporating MELD, AFP and tumor size may help to prioritize HCC patients to better equate dropout rates with non-HCC patients and equalize access.
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Affiliation(s)
- K Washburn
- University of Texas Health Science Center, San Antonio, USA.
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43
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Menas P, Merkel DE, Hui W, Carro GW, Lawton J, Blankenship A, Harper A. Management and monitoring of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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Jee C, Brockstein B, Hui W, Lawton J, Harper A, Carro G. Incidence and management of bevacizumab associated hypertension in outpatient oncology clinic. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20677 Background: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor is utilized to treat a wide range of cancers. However, clinical trials of bevacizumab reported the incidence of hypertension (HTN) up to 36%. A national guideline has not been established to manage bevacizumab-induced HTN. The incidence and management of bevacizumab associated HTN were evaluated in an outpatient oncology clinic. Methods: A randomized, retrospective chart review of 100 patients who received at least one dose of bevacizumab from 1/1/07 to 12/31/07 was conducted. The overall incidence and management of hypertension were evaluated. Other bevacizumab associated toxicities were compared in patients with or without hypertension. Results: The overall incidence of bevacizumab-induced HTN was 31% (95%CI: 22%-40%) with CTC (v 3.0) grade 3 HTN rate of 10%. The number of patients with a history of HTN or uncontrolled BP prior to bevacizumab therapy was significantly different across the four HTN grade groups (p= 0.0019). Out of 31 patients who had grade 1–3 HTN, 8 patients (26%) were managed by the oncologists, 8 patients (26%) by the primary care physicians, and 15 patients (48%) had no management. Bevacizumab was held in 3 patients due to high blood pressure (BP) resulting in one patient discontinuing bevacizumab therapy. The odds of other bevacizumab associated adverse events in patients with grades 1–3 HTN was 2.776 times than that of patients with grade 0 HTN (p=0.0201). Conclusions: Bevacizumab was associated with HTN in 31% of patients. Patients with history of HTN or uncontrolled BP prior to initiating bevacizumab were at an increased risk to develop a higher grade of HTN. Management of bevacizumab-induced HTN could be improved since BP of 63% of patients with grades 2 and 3 HTN was not adequately controlled. No significant financial relationships to disclose.
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Affiliation(s)
- C. Jee
- NorthShore University HealthSystem, Evanston, IL
| | | | - W. Hui
- NorthShore University HealthSystem, Evanston, IL
| | - J. Lawton
- NorthShore University HealthSystem, Evanston, IL
| | - A. Harper
- NorthShore University HealthSystem, Evanston, IL
| | - G. Carro
- NorthShore University HealthSystem, Evanston, IL
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Gonzales J, Thompson B, Thistlethwaite J, Harper A, Scheuermann B. Muscle Strength and Pressor Response. Int J Sports Med 2009; 30:320-4. [DOI: 10.1055/s-0028-1111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wong N, Wang SS, Lamoureux E, Wong TY, Tikellis G, Harper A, Wang JJ. Blood pressure control and awareness among patients with diabetes and hypertension attending a tertiary ophthalmic clinic. Diabet Med 2009; 26:34-9. [PMID: 19125758 DOI: 10.1111/j.1464-5491.2008.02614.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To assess the proportion of patients who had diabetes and hypertension with optimal blood pressure (BP) control and to describe patients' awareness of the importance of BP control. METHODS A cross-sectional survey of out-patients with diabetes who attended the Royal Victorian Eye and Ear Hospital (Melbourne, Australia) was conducted between October 2006 and February 2007. Of 245 patients invited, 220 (90%) participated. Optimal BP control was defined as BP < 130/80 mmHg recorded at the latest visit; proportions of patients with awareness of BP control were defined non-exclusively by: (i) ability to recall a previous BP record and rate the appropriateness of that BP level; (ii) ability to recall the recommended optimal BP control level by current diabetes management guidelines; (iii) knowledge that optimal BP control is important to diabetes management; and (iv) knowledge that optimal BP control is important to eye health. RESULTS Of the 220 patients, 176 had both diabetes and hypertension. Of these, 49 of 176 (28%) had BP controlled optimally, and 30 of 176 (17%) recalled and rated a previous recorded BP level appropriately. Fewer than one in four (22%) acknowledged the recommended optimum BP level of < 130/80 mmHg, fewer than one in two (48%) rated BP as important to diabetes management, and one in three (35%) rated BP control as important to eye health. CONCLUSIONS In this sample of patients with diabetes and hypertension, fewer than one-third achieved the BP level recommended by clinical guidelines, and fewer than half were aware of the importance of BP control.
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Affiliation(s)
- N Wong
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Affiliation(s)
- A Harper
- Burns Service of Western Australia, Royal Perth Hospital, Mc Comb Foundation, School of Paediatrics University of Western Australia, WA, Australia
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Zeller M, DiMuzio SJ, Bee K, Clemente J, Frederick J, Fucci A, Gordon L, Harper A, Kasmar A, Kasmar C, Polomsky S, Simmons A, Smallsreed D, Underwood T, Hunter AD. Crystal structures of the methylene chloride disolvates of tetrakis ( 3,5 - dimethoxy phenyl) porphyrin and its isotypic copper (II) and nickel (II) complexes , C52H46N4O8 · 2CH2C12 , Cu (C52H44N4O8)· 2CH2C12 , Ni(C12H44N4O8) · 2CH2C12. Z KRIST-NEW CRYST ST 2006. [DOI: 10.1524/ncrs.2006.221.14.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zeller M, DiMuzio SJ, Bee K, Clemente J, Frederick J, Fucci A, Gordon L, Harper A, Kasmar A, Kasmar C, Polomsky S, Simmons A, Smallsreed D, Underwood T, Hunter AD. Crystal structures of the methylene chloride disolvates of tetrakis(3,5- dimethoxyphenyl)porphyrin and its isotypic copper(II) and nickel(II) complexes, C52H46N4O8 · 2CH2Cl2, Cu(C52H44N4O8) · 2CH2Cl2, Ni(C52H44N4O8) · 2CH2Cl2. Z KRIST-NEW CRYST ST 2006. [DOI: 10.1524/ncrs.2006.221.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract C54H50Cl4N4O8, triclinic, P1̅ (no. 2), a = 11.295(1) Å, b = 11.255(1) Å, c = 11.797(1) Å, α = 108.904(2)°, β = 101.091(2)°, γ = 110.992(2)°, V = 1241.4 Å3, Z = 1, Rgt(F) = 0.056, wRref(F2) = 0.135, T = 100 K.C54H48Cl4CuN4O8, triclinic, P1̅ (no. 2), a = 11.2204(5) Å, b = 11.3499(6) Å, c = 11.7610(6) Å, α = 109.187(1)°, β = 100.830(1)°, γ = 110.681(1)°, V = 1242.7 Å3, Z = 1, Rgt(F) = 0.033, wRref(F2) = 0.092, T = 100 K.C54H48Cl4N4NiO8, triclinic, P1̅ (no. 2), a = 11.196(1) Å, b = 11.329(1) Å, c = 11.785(1) Å, α = 109.486(2)°, β = 101.230(2)°, γ = 110.607(2)°, V = 1233.8 Å3, Z = 1, Rgt(F) = 0.040, wRref(F2) = 0.110, T = 100 K.
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Affiliation(s)
- M. Zeller
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
| | - S. J. DiMuzio
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - K. Bee
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - J. Clemente
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - J. Frederick
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Fucci
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
| | - L. Gordon
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Harper
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Kasmar
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - C. Kasmar
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - S. Polomsky
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. Simmons
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - D. Smallsreed
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - T. Underwood
- 2LaBrae High School, 1001 N. Leavitt Road, Leavittsburg, OH 44430, USA
| | - A. D. Hunter
- 1Youngstown State University, STaRBURSTT-Cyberdiffraction Consortium @ YSU & Department of Chemistry, 1 University Plaza, Youngstown, OH 44555-3663, USA
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Abstract
The objective of the study was to assess factors associated with treatment satisfaction among patients receiving antihypertensive therapy. A weighted cross-sectional online survey was conducted with hypertensive patients participating in a chronic disease panel in the US. Patients on monotherapy with medications from the following classes were identified: ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta blockers (BBs), calcium channel blockers (CCBs), and diuretics. The control group included patients without treatment. Pairwise comparisons between groups were conducted for factors that may affect patients' satisfaction. The study population had a mean age of 54.7+/-14.2 years and was 56.7% female. Participants with blood pressure (BP) controlled to JNC 7 guidelines were more satisfied with their medication than those with uncontrolled BP (90.3 vs 71.5%, P<0.05). Patients who had not experienced adverse events had higher satisfaction than patients experiencing adverse events (90.9 vs 75.8%, P<0.05). The most frequently self-reported adverse events were frequent urination, sexual dysfunction, and fatigue ranging from 7.0 to 9.6% across classes. The adverse event rates differed by class and were lowest among the ARBs. Patients on ARBs were the most likely to have switched from a previous antihypertensive class as compared to other classes (57.1% ARBs vs 49.8% ACEIs, 38.7% diuretics, 36.3% CCBs, and 31.7% BBs). Physician recommendation was the most common reason for switching. In conclusion, the ability to effectively treat hypertension depends upon a patient's satisfaction with antihypertensive therapy, which may be improved by achieving BP control and minimizing the occurrence of adverse events.
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Affiliation(s)
- K Chen
- Cerner Health Insights, Beverly Hills, CA, USA
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