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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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2
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Collins PM, Elliott JA, Brennan MJ, McNamara M, O'Malley E, Barry K, Sweeney K, Malone C, Lowery A, McLaughlin R, Kerin MJ. O78: SARCOPENIA IN LOCALLY ADVANCED BREAST CANCER: PREVALENCE, AND IMPACT ON CLINICAL AND ONCOLOGIC OUTCOMES. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.078] [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: 11/13/2022]
Abstract
Abstract
Introduction
Sarcopenia in cancer may confer negative outcomes, but its prevalence and impact in the modern multimodal management of locally advanced breast cancer have not been systematically studied.
Method
Patients undergoing neoadjuvant therapy and surgery for locally advanced breast cancer between 2010 and 2015 were studied. Skeletal muscle index (SMI) and lean body mass (LBM) were determined. Sarcopenia was defined by computed tomography (CT) at L3 as SMI<38.5cm2/m2. Multivariable linear, logistic, and Cox regression analysis was undertaken to determine the independent impact of sarcopenia on clinical and oncologic outcome.
Result
258 patients were studied. Sarcopenia was present in 23.0%, 7.8% and 0.0% of patients with normal weight, overweight and obesity, respectively (P=0.001). Sarcopenia was not associated with baseline cT and cN stage, tumour grade, histologic type or receptor status. Patients with sarcopenia exhibited equivalent indices of neoadjuvant therapy response including ypT and ypN stage, pathologic complete response and Sataloff grade following surgical resection. Postoperatively, sarcopenia was not independently associated with comprehensive complications index (P=0.242), length of stay (P=0.716) or overall morbidity (P=0.365). However, on multivariable analysis, lower LBM independently predicted reduced invasive disease-free (P=0.049,HR0.93[95%CI0.87-1.00]) and overall (P=0.028,HR0.92[0.85-0.99]), but not disease-specific survival (P=0.070).
Conclusion
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
Take-home message
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
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Affiliation(s)
- PM Collins
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - JA Elliott
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Brennan
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - M McNamara
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - E O'Malley
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | | | - K Sweeney
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - C Malone
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - A Lowery
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
| | - R McLaughlin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Kerin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
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3
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Lloyd A, Ryan E, Boland M, Medani S, Elwahab A, Malone C, Sweeney K, Barry K, McLaughlin R, Lowery A, Kerin M. O39: THE HISTOPATHOLOGICAL AND MOLECULAR FEATURES OF BREAST CARCINOMA WITH HIGH-GRADE TUMOUR BUDDING. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.039] [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: 11/13/2022]
Abstract
Abstract
Background
Tumour budding (TB) is an adverse histological feature in many cancers. It is thought to represent epithelial-to-mesenchymal transition, a key step in the metastatic process. The role of TB in breast carcinoma (BC) remains unclear.
Aim
To investigate the relationship between TB and other histological and molecular features of BC.
Method
A systematic search was performed to identify studies that compared features of BC based on the presence or absence of high-grade TB. Dichotomous variables were pooled as odds ratios (OR) using the Cochran–Mantel–Haenszel method. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale (NOS).
Result
Seven studies with a total of 1040 patients (high grade TB n=519, 49.9%; low grade TB n=521, 50.1%) were included. A moderate- to high-risk of bias was noted. The median NOS was 7 (range 6-8). High-grade TB was significantly associated with lymph node involvement (OR 2.28, 95% c.i. 1.74 to 2.98, P<0.001) and lymphovascular invasion (OR 3.08, 95% c.i. 2.13 to 4.47, P<0.001). Regarding molecular subtypes, there was an increased likelihood of high-grade TB in oestrogen- (OR 1.66, 95% c.i. 1.21 to 2.29, P=0.002) and progesterone-receptor positive (OR 1.68, 95% c.i. 1.10 to 2.59, P=0.02) tumours. In contrast triple negative breast cancer had a reduced incidence of high-grade TB (OR 0.46, 95% c.i. 0.30 to 0.72, P=0.0006).
Conclusion
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
Take-home message
High-grade TB is enriched in hormone-positive BC and is associated with known adverse prognostic variables. TB may offer new insights into the metastatic processes of luminal BC.
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Affiliation(s)
- A Lloyd
- Royal College of Surgeons Ireland
| | - E Ryan
- Galway University Hospital
| | - M Boland
- Royal College of Surgeons Ireland
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4
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Zarog MA, O'Leary DP, Kiernan MG, Bolger J, Tibbitts P, Coffey SN, Lowery A, Byrnes GJ, Peirce C, Dunne CP, Coffey JC. Role of circulating fibrocytes in the diagnosis of acute appendicitis. BJS Open 2020; 4:1256-1265. [PMID: 33047514 PMCID: PMC7709380 DOI: 10.1002/bjs5.50350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/04/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Improved diagnostic biomarkers are required for acute appendicitis. The circulating fibrocyte percentage (CFP) is increased in inflammatory states, but has not been studied in acute appendicitis. This study aimed to determine CFP in acute appendicitis and compare diagnostic accuracy with standard serological biomarkers. Methods A prospective cohort study was carried out between June 2015 and February 2016 at University Hospital Limerick. The CFP was determined by dual‐staining peripheral venous samples for CD45 and collagen I using fluorescence‐activated cell sorting, and correlated with histopathological diagnoses. The accuracy of CFP in determining histological acute appendicitis was characterized and compared with the white cell count, C‐reactive protein concentration, neutrophil count, lymphocyte count and neutrophil : lymphocyte ratio. Results Of 95 adults recruited, 15 were healthy individuals and 80 had suspected appendicitis at presentation. Forty‐six of these 80 patients had an appendicectomy, of whom 34 had histologically confirmed appendicitis. The CFP was statistically higher in patients with pathologically proven acute appendicitis than in healthy controls (median 6·1 (i.q.r. 1·6–11·6) versus 2·3 (0·9–3·4) per cent respectively; P = 0·008). The diagnostic accuracy of CFP, as determined using the area under the receiver operating characteristic (ROC) curve, was similar to that of standard biomarkers. In multinomial regression analysis, only raised CFP was retained as an independent prognostic determinant of acute appendicitis (odds ratio 1·57, 95 per cent c.i. 1·05 to 2·33; P = 0·027). Conclusion The CFP is increased in histologically confirmed acute appendicitis and is as accurate as standard serological biomarkers in terms of diagnosis.
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Affiliation(s)
- M A Zarog
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - D P O'Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M G Kiernan
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - J Bolger
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - P Tibbitts
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - S N Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - A Lowery
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - G J Byrnes
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - C Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland
| | - C P Dunne
- Graduate Entry Medical School, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
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5
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Groeben H, Walz MK, Nottebaum BJ, Alesina PF, Greenwald A, Schumann R, Hollmann MW, Schwarte L, Behrends M, Rössel T, Groeben C, Schäfer M, Lowery A, Hirata N, Yamakage M, Miller JA, Cherry TJ, Nelson A, Solorzano CC, Gigliotti B, Wang TS, Wietasch JKG, Friederich P, Sheppard B, Graham PH, Weingarten TN, Sprung J. International multicentre review of perioperative management and outcome for catecholamine-producing tumours. Br J Surg 2020; 107:e170-e178. [PMID: 31903598 DOI: 10.1002/bjs.11378] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/02/2019] [Accepted: 08/31/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgery for catecholamine-producing tumours can be complicated by intraoperative and postoperative haemodynamic instability. Several perioperative management strategies have emerged but none has been evaluated in randomized trials. To assess this issue, contemporary perioperative management and outcome data from 21 centres were collected. METHODS Twenty-one centres contributed outcome data from patients who had surgery for phaeochromocytoma and paraganglioma between 2000 and 2017. The data included the number of patients with and without α-receptor blockade, surgical and anaesthetic techniques, complications and perioperative mortality. RESULTS Across all centres, data were reported on 1860 patients with phaeochromocytoma or paraganglioma, of whom 343 underwent surgery without α-receptor blockade. The majority of operations (78·9 per cent) were performed using minimally invasive techniques, including 16·1 per cent adrenal cortex-sparing procedures. The cardiovascular complication rate was 5·0 per cent overall: 5·9 per cent (90 of 1517) in patients with preoperative α-receptor blockade and 0·9 per cent (3 of 343) among patients without α-receptor blockade. The mortality rate was 0·5 per cent overall (9 of 1860): 0·5 per cent (8 of 517) in pretreated and 0·3 per cent (1 of 343) in non-pretreated patients. CONCLUSION There is substantial variability in the perioperative management of catecholamine-producing tumours, yet the overall complication rate is low. Further studies are needed to better define the optimal management approach, and reappraisal of international perioperative guidelines appears desirable.
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Affiliation(s)
- H Groeben
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Essen, Germany
| | - M K Walz
- Department of Minimally and General Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - B J Nottebaum
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Essen, Germany
| | - P F Alesina
- Department of Minimally and General Surgery, Kliniken Essen-Mitte, Essen, Germany
| | - A Greenwald
- Department of Anaesthesiology, Columbia University, New York
| | - R Schumann
- Department of Anaesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - M W Hollmann
- Department of Anaesthesiology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - L Schwarte
- VU University Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - M Behrends
- Department of Anaesthesiology and Perioperative Medicine, University of California, San Francisco, California
| | - T Rössel
- Department of Anaesthesiology and Intensive Care Medicine, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany.,Department of Urology, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany
| | - C Groeben
- Department of Anaesthesiology and Intensive Care Medicine, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany.,Department of Urology, Carl-Gustav Carus University Hospital Dresden, Dresden, Germany
| | - M Schäfer
- Department of Anaesthesiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - A Lowery
- Discipline of Surgery, School of Medicine, University of Ireland, Galway, Ireland
| | - N Hirata
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - M Yamakage
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - J A Miller
- Endocrine Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - T J Cherry
- Endocrine Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A Nelson
- Department of Anaesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois
| | - C C Solorzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, Tennessee
| | - B Gigliotti
- Department of General and Endocrine Surgery, Harvard Medical School, Boston, Massachusetts
| | - T S Wang
- Division of Surgical Oncology - Endocrine Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J K G Wietasch
- Department of Anaesthesiology, University of Groningen, Groningen, the Netherlands
| | - P Friederich
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Klinikum Bogenhausen, Munich, Germany
| | - B Sheppard
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - P H Graham
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - T N Weingarten
- Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J Sprung
- Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Fullard A, Earley H, Lowery A, Lal A, Merrigan A, Tormey S. Timing of Low Molecular Weight Heparin Administration in Breast Surgery and Post-Operative Haematoma Formation. Ir Med J 2020; 113:54. [PMID: 32268047] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aims The aims of this study were to: identify current practice regarding low molecular weight heparin (LMWH) prophylaxis in elective breast surgery, to determine if timing of administration of LMWH prophylaxis or specific patient demographic factors impacts the rate of post-operative haematoma formation. Methods Retrospective cohort study involving 100 patients who underwent elective breast surgery in a tertiary centre in Ireland in 2017. Medical charts were reviewed to collect data on; timing of LMWH administration, incidence of post-operative haematoma and patient's age, BMI, smoking status and anti-coagulant use. Statistical analysis was then performed. Results Forty-two patients (42%) received enoxaparin pre-operatively and thirty-one patients (31%) post-operatively. Incidence of post-operative haematoma was 4% (n=4). Of the haematoma group, three patients (75%) received post-operative enoxaparin (p=0.166). Independent patient factors did not significantly impact rate of haematoma formation. Conclusions Post-operative haematoma rate is 4%. Timing of LMWH prophylaxis administration did not significantly affect this rate.
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Affiliation(s)
- A Fullard
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
| | - H Earley
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
| | - A Lowery
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
| | - A Lal
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
| | - A Merrigan
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
| | - S Tormey
- Symptomatic Breast Unit, Department of Surgery, University Hospital Limerick
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7
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Abstract
BACKGROUND The management of breast cancer has changed dramatically in the molecular era. Micro-RNAs can contribute to multiple facets of cancer surgery. METHODS This narrative review, based on years of research on the role of micro-RNAs, focused on the potential of these small, robust RNAs to influence all aspects of breast cancer surgery. RESULTS Micro-RNAs have a potential role as biomarkers in the diagnosis, prognosis and evaluation of response to therapy in breast cancer. They may also contribute to future therapeutic strategies. CONCLUSION The molecular era has changed understanding of cancer. Micro-RNAs have the potential for use in personalized cancer strategies.
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Affiliation(s)
- P McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland, Galway, Ireland
| | - A Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland, Galway, Ireland
| | - M J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland, Galway, Ireland
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8
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O'Halloran N, Lowery A, Kalinina O, Sweeney K, Malone C, McLoughlin R, Kelly J, Hussey A, Kerin M. Trends in breast reconstruction practices in a specialized breast tertiary referral centre. BJS Open 2017; 1:148-157. [PMID: 29951617 PMCID: PMC5989961 DOI: 10.1002/bjs5.23] [Citation(s) in RCA: 10] [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: 07/10/2017] [Accepted: 08/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Breast reconstruction is an important component of multidisciplinary breast cancer management. The practice of breast reconstruction after mastectomy has evolved significantly in the past decade as a result of both increasing mastectomy rates and advances in reconstructive strategy. These changes have significantly influenced the contemporary surgical management of breast cancer. The aim of this study was to examine trends in breast reconstruction after mastectomy in an Irish population. METHODS Data were reviewed from a database of all patients who had mastectomy with or without breast reconstruction at Galway University Hospital, a tertiary breast cancer referral centre, between 2004 and 2014. Trends in breast reconstruction after mastectomy were explored with respect to patient demographics, clinicopathological features, and neoadjuvant and adjuvant therapy. RESULTS Of 1303 patients who underwent mastectomy during interval studied, 706 (54.2 per cent) had breast reconstruction after mastectomy. In 629 patients (89·1 per cent), breast reconstruction was performed in the immediate setting. Reconstruction rates increased over time from 20·5 per cent in 2004 to 44·7 per cent in 2014. Reconstruction was more commonly performed in younger patients and those with benign, in situ and early-stage disease. A negative relationship between radiotherapy and reconstruction was observed. A pedicled flap with or without an implant was the most commonly used reconstructive approach in patients receiving radiotherapy. CONCLUSION Breast reconstruction after mastectomy has become the standard of care in the surgical treatment of breast cancer. Recent trends show a transition favouring implant-based approaches.
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Affiliation(s)
- N. O'Halloran
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - A. Lowery
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - O. Kalinina
- Department of MathematicsNational University of Ireland GalwayGalwayIreland
| | - K. Sweeney
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - C. Malone
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - R. McLoughlin
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - J. Kelly
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - A. Hussey
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
| | - M. Kerin
- Department of SurgeryNational University of Ireland GalwayGalwayIreland
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9
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Courtney D, Moloney B, Lowery A, Kerin M. Patient nutritional status: serum albumin levels a predictive indicator of survival in patients with metastatic breast cancer. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30195-8] [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: 10/20/2022]
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10
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Posluszny DM, Dew MA, Beckjord E, Bovbjerg DH, Schmidt JE, Low CA, Lowery A, Nutt SA, Arvey SR, Rechis R. Existential challenges experienced by lymphoma survivors: Results from the 2010 LIVESTRONG Survey. J Health Psychol 2015; 21:2357-66. [PMID: 25845834 DOI: 10.1177/1359105315576352] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We sought to examine the existential challenges that cancer survivors may experience as they strive to make meaning, regain their self-identity, cope with fear of recurrence, and experience feelings of grief and guilt. Lymphoma survivors (n = 429) completed the 2010 LIVE STRONG: survey and provided responses about meaning, cancer worry, security, identity, grief, guilt, and perceived functional impairment due to these concerns. Most survivors (73%-86%) endorsed existential concerns, with 30-39 percent reporting related perceived functional impairment. Concerns were associated with being female, younger, unmarried, and having undergone stem cell transplantation. Lymphoma survivors experience existential challenges that impact their life even years after diagnosis.
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11
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Posluszny DM, Dew MA, Beckjord EI, Bovbjerg DH, Schmidt JE, Low CA, Lowery A, Nutt S, Arvey SR, Rechis R. Long-term psychological reactions among lymphoma survivors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20585] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Carissa A. Low
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Amy Lowery
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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12
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Lowery A, Bovbjerg DH, Beckjord EI, Brufsky A, Greco CM, Low CA, Martin J, Posluszny DM, Schmidt JE, Shaffer JR, Belfer I. Persistent pain following breast cancer surgery: Why does it hurt more for some survivors than others? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20634] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amy Lowery
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | - Adam Brufsky
- University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - Carissa A. Low
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Jodi Martin
- Magee-Women's Hospital of UPMC, Pittsburgh, PA
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13
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Beckjord EI, Nutt S, Van Londen GJ, Bovbjerg DH, Low CA, Lowery A, Posluszny DM, Schmidt JE, Arvey SR, Rechis R. Treatment summaries and care plans for post-treatment cancer survivors: Association of quality of life with empowerment. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9520] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Carissa A. Low
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Amy Lowery
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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14
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Bovbjerg DH, Peters T, Manculich J, Lowery A, Posluszny DM, Schmidt JE, Hall M, Buysse D, Boyiadzis M, Im AP. Comparison of sleep variables between healthy participants and hospitalized acute myeloid leukemia patients treated with decitabine, followed by cytarabine. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e18022] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Tonia Peters
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | - Amy Lowery
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | | | | | | | | | | | - Annie P. Im
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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15
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Lowery W, Lowery A, Barnett J, Lopez Acecevdo M, Lee P, Alvarez-Secord A, Havrilesky L. Abstract 13: Cost effectiveness of early palliative care intervention in recurrent platinum resistant ovarian cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.043] [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: 10/26/2022]
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16
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Lowery W, Lowery A, Barnett J, Lopez-Acevedo M, Lee P, Alvarez-Secord A, Havrilesky L. Cost-effectiveness of early palliative care intervention in recurrent plati- num-resistant ovarian cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.130] [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: 11/25/2022]
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17
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Passik SD, Lowery A. Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice. Pain Med 2011; 12 Suppl 2:S36-42. [PMID: 21668755 DOI: 10.1111/j.1526-4637.2011.01130.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become "chemical copers" as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose.
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Affiliation(s)
- Steven D Passik
- Department of Psychiatry and Anesthesiology, Vanderbilt University Medical Center, Psychosomatic Medicine, Nashville, Tennessee 37232, USA.
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18
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Randall JM, Bazhenova L, White M, Bharne AA, Shimabukuro KA, Matusov Y, Messer K, Lowery A, Loscalzo M, Clark K, Bardwell W. Prevalence and correlates of suicidal ideation among outpatients at a comprehensive cancer center. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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19
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Bardwell WA, Norman D, Ancoli-Israel S, Loredo JS, Lowery A, Lim W, Dimsdale JE. Effects of 2-week nocturnal oxygen supplementation and continuous positive airway pressure treatment on psychological symptoms in patients with obstructive sleep apnea: a randomized placebo-controlled study. Behav Sleep Med 2007; 5:21-38. [PMID: 17313322 DOI: 10.1207/s15402010bsm0501_2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 10/31/2022]
Abstract
Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights with polysomnography and then randomized to 2-weeks therapeutic CPAP, placebo CPAP, or O(2) supplementation. Pre and post-treatment, patients completed the Brief Symptom Inventory (BSI): Higher scores indicate greater severity. Repeated measures analysis of covariance reveals a Time x Treatment interaction for BSI Global Severity Index (GSI): significant pre- to post-treatment reductions in GSI with O(2) supplementation and therapeutic CPAP, but not placebo CPAP. A Time x Treatment interaction was also found for depression: Depression decreased with O(2) supplementation but not with therapeutic CPAP or placebo CPAP. Both therapeutic CPAP and O(2) supplementation resulted in decreased psychological symptoms. Results suggest hypoxemia may play a stronger role than sleep disruption vis-à-vis OSA related psychological distress.
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Affiliation(s)
- Wayne A Bardwell
- Department of Psychiatry, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0804, USA.
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20
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O'Sullivan CJ, Hynes N, Mahendran B, Andrews EJ, Avalos G, Tawfik S, Lowery A, Sultan S. Haemoglobin A1c (HbA1C) in Non-diabetic and Diabetic Vascular Patients. Is HbA1C an Independent Risk Factor and Predictor of Adverse Outcome? Eur J Vasc Endovasc Surg 2006; 32:188-97. [PMID: 16580235 DOI: 10.1016/j.ejvs.2006.01.011] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Accepted: 01/08/2006] [Indexed: 01/27/2023]
Abstract
BACKGROUND Plasma Haemoglobin A1c (HbA1c) reflects ambient mean glycaemia over a 2-3 months period. Reports indicate that patients, with and without diabetes, with an elevated HbA1c have an increased risk of adverse outcome following surgical intervention. Our aim was to determine whether elevated plasma HbA1c level was associated with increased postoperative morbidity and mortality in patients undergoing vascular surgical procedures. METHODS Plasma HbA1c was measured prospectively in 165 consecutive patients undergoing emergency and elective vascular surgical procedures over a 6-month period. Patients were categorized into four groups depending on whether their plasma HbA1c was < or =6%, 6.1-7%, 7.1-8% or >8% and clinical data was entered into a prospectively maintained database. Patients were also classified by diabetic status with suboptimal HbA1c in a patient without diabetes being >6 to < or =7% and suboptimal HbA1c in a patient with diabetes being >7%. Patients with plasma HbA1c >7% were reclassified as having undiagnosed diabetes mellitus. Composite primary endpoints were all cause 30-day morbidity and mortality and all cause 6-month mortality. Composite secondary endpoints were procedure specific complications, adverse cardiac events, stroke, infection and mean length of hospital stay. RESULTS Of the 165 patients studied, 43 (26.1%) had diabetes and the remaining 122 (73.9%) did not. The mean age was 72 years and 59% were male. Suboptimal HbA1c levels were found in 58% patients without diabetes and in 51% patients with diabetes. In patients without diabetes those with suboptimal HbA1c levels (6-7%) had a significantly higher incidence of overall 30-day morbidity compared to patients with HbA1c levels < or =6% (56.5 vs 15.7%, p<0.001). Similarly, for patients with diabetes those with suboptimal HbA1c levels (HbA1c >7%) had a significantly higher incidence of 30-day morbidity compared to those with HbA1c levels < or =7% (59.1% vs 19%, p=0.018). Multivariate analysis revealed that a plasma HbA1c level of >6 to < or =7% was a significant independent predictor of overall 30-day morbidity in patients without diabetes undergoing vascular surgical procedures. No difference in mortality, composite secondary endpoints, procedure specific complications, stroke or mean length of hospital stay was observed between any of the groups in the study. CONCLUSION Suboptimal HbA1c levels may hold prognostic significance in patients without diabetes undergoing vascular surgery.
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Affiliation(s)
- C J O'Sullivan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland
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21
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Shaw BF, Elkin I, Yamaguchi J, Olmsted M, Vallis TM, Dobson KS, Lowery A, Sotsky SM, Watkins JT, Imber SD. Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. J Consult Clin Psychol 2000. [PMID: 10596506 DOI: 10.1037//0022-006x.67.6.837] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.
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Affiliation(s)
- B F Shaw
- Department of Psychiatry, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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22
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Shaw BF, Elkin I, Yamaguchi J, Olmsted M, Vallis TM, Dobson KS, Lowery A, Sotsky SM, Watkins JT, Imber SD. Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. J Consult Clin Psychol 1999; 67:837-46. [PMID: 10596506 DOI: 10.1037/0022-006x.67.6.837] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [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] [Indexed: 01/28/2023]
Abstract
This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.
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Affiliation(s)
- B F Shaw
- Department of Psychiatry, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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23
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Conard RA, Meyer LM, Sutow WW, Blumberg BS, Lowery A, Cohn SH, Lewis WH, Hollingsworth JW, Lyon HW. Medical Status of Marshall Islanders in 1959, Five Years after Exposure to Fallout Radiation. Nuklearmedizin 1961. [DOI: 10.1055/s-0037-1621158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryA medical survey of the Marshallese people in March 1959, five years after exposure to fallout radiation, showed that the people had recovered from the acute effects of their radiation exposure and appeared to be generally in good health. The following specific statements can be made in regard to their radiation health status:1. No illnesses or diseases were found that could be directly associated with acute radiation effects.2. One case of cancer and three deaths have occurred, but with no direct relation to radiation effects.3. Fertility does not appear to have been affected. The incidence of miscarriages and stillbirths appears to be somewhat higher than in the unexposed Marshallese, but a deficiency of vital statistics precludes definite conclusions as to whether or not this is a radiation effect.4. Suggestive evidence of slight lag in growth and development of exposed children noted previously is being re-evaluated on the basis of better age data obtained during the latest survey.5. Blood platelet levels are within the normal range but somewhat below that for the unexposed population.6. Only 12 cases show residual changes in the skin from beta burns. None show any evidence of cancerous change.7. Possible late effects of radiation such as shortening of life span, premature aging, increased incidence of leukemia and malignancies, increased incidence of degenerative diseases, opacities of the lens of the eyes, and genetic changes have not been detected.8. The original body burdens of internally absorbed fission products appear to be too low to have produced any acute or to be causing long-term effects.9. The return of the people to the slightly contaminated island of Rongelap has resulted in some increase in body burdens of Cesium137, Zinc65 and Strontium90. However, the levels are far below the accepted maximum permissible limits and it is not believed any untoward effects will result.
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