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Bishr MK, Banks J, Abdelaziz MS, Badawi M, Crane PW, Donigiewicz UJ, Elkorety M, Girgis M, Humphreys A, Isherwood J, Kahan J, Keelan S, Lindqvist EK, Nixon I, Sackey H, Sars C, Soliman H, Touqan N, Remoundos DD, Ahmed M. Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland. Clin Oncol (R Coll Radiol) 2024; 36:e31-e39. [PMID: 38294995 DOI: 10.1016/j.clon.2023.10.050] [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: 08/11/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 02/02/2024]
Abstract
AIMS Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. MATERIALS AND METHODS An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. RESULTS Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. CONCLUSION The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.
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Affiliation(s)
- M K Bishr
- The Royal Marsden NHS Foundation Trust, London, UK.
| | - J Banks
- The Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - M S Abdelaziz
- National Cancer Institute, Cairo University, Cairo, Egypt; University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Badawi
- East Sussex Healthcare Trust, Conquest Hospital, St Leonards-on-sea, UK
| | - P W Crane
- Queen Elizabeth II Hospital, Welwyn Garden City, UK
| | | | - M Elkorety
- West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
| | - M Girgis
- West Suffolk NHS Hospital, Bury St Edmunds, UK
| | - A Humphreys
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - J Isherwood
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Kahan
- Velindre Cancer Centre, Cardiff, UK
| | - S Keelan
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - E K Lindqvist
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - I Nixon
- Management Science, Business School, Strathclyde University, Glasgow, UK; The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - H Sackey
- Division of Cancer, Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital Stockholm, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Sars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - H Soliman
- Kings' College Hospital, Orpington, UK
| | - N Touqan
- Manchester University NHS Foundation Trust, North Manchester General Hospital, Manchester, UK
| | - D D Remoundos
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Ahmed
- University College London Hospitals NHS Foundation Trust, London, UK
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Vahabi S, Kharati-Koopaei E, Norouzi M, Maddox J, Humphreys A, Hancock H, Zaman A, Austin D. Anthracycline chemotherapy and its effects on left ventricular mechanics: insights into the PROACT PLUS study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund
Background
Anthracyclines continue to form the backbone of chemotherapy treatment for breast cancer and lymphoma. However, their use has been directly associated with dose-dependent cardiotoxicity. Most studies to date have focused on the effects of high dose anthracyclines on left ventricular (LV) systolic function with a particular interest in peak global longitudinal strain (GLS). Not much attention has been directed to the effects of lower dose anthracyclines and other strain parameters of LV systolic and diastolic function.
Purpose
In this prospective study, we performed a comprehensive 2-dimensional echocardiographic assessment on the effects of anthracyclines on both the LV systolic and diastolic strain measures. We focused on the changes in the LV end-systolic (ES) GLS, myocardial GLS (myoGLS), global radial strain (GRS), global circumferential strain (GCS), myocardial GCS (myoGCS), twist and torsion. Additionally, peak systolic (PS), ES, early-diastolic (ED), and late-diastolic (LD) strain-rates were measured.
Methods
Patients with a new diagnosis of breast cancer or lymphoma undergoing anthracycline chemotherapy (any dose) were recruited between October 2018 to March 2020. Echocardiograms were performed pre-chemotherapy (V1) and 1 month post treatment (V2). These were analysed offline using vendor-independent software (TomTec 2D CPA). The study was ethically approved by the Health Research Association (REC reference 18/EM/0177).
Results
A total number of 62 were recruited into the study of which 7 patients passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, 6 dropped their LV ejection fraction (EF) to < 53% at V2 (G1). In these patients, a significant reduction in the LV ES-GLS (-19.3% vs. -15.3%, p = 0.0041), myoGLS (-16.8% vs. -12.8%, p = 0.0014), LV longitudinal PS strain-rate (-1 1/s vs. 0.78 1/s, p = 0.0063), and LV longitudinal ED strain-rate (1.1 1/s vs. 0.67 1/s, p = 0.026) was seen from V1 to V2. There was no statistically significant change in the other systolic and diastolic strain parameters in this group of patients. In patients with a normal EF at V2 (G2), a reduction in the LV ES-GLS (-20.8% vs. -19.9%, p = 0.013) and myoGLS (-17.9% vs. -16.9%, p = 0.012) was also seen from V1 to V2. Additionally, a deterioration in the LV radial ED strain-rate (-1.37 1/s vs. -1.2 1/s, p = 0.009), LV longitudinal ED strain-rate (0.98 1/s vs. 0.85 1/s, p = 0.01), and LV circumferential ED strain rate (1.62 1/s vs. 1.33 1/s, p = 0.045) was observed.
Conclusion
In G1, a more extensive deterioration (>15%) in the LV ES-GLS, myoGLS, and longitudinal ED strain-rate was evident when compared to G2. The additional reduction in LV early diastolic strain-rate in both patient groups highlights the global insult that anthracyclines can pose on both LV systolic and diastolic function. However, whether these findings translate into future development of cardiotoxicity is not yet known.
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Affiliation(s)
- S Vahabi
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic Services, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - E Kharati-Koopaei
- University of Durham, Stockton-on-Tees, United Kingdom of Great Britain & Northern Ireland
| | - M Norouzi
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - J Maddox
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - A Humphreys
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - H Hancock
- Newcastle University, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Zaman
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic Services, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - D Austin
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
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Vahabi S, Kharati-Koopaei E, Norouzi M, Maddox J, Humphreys A, Hancock H, Zaman A, Austin D. Right ventricular mechanics in anthracycline chemotherapy: insights into the PROACT PLUS study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.418] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund
Background
Anthracyclines are highly effective chemotherapy agents used in the treatment of many breast and haematological malignancies. However, one of the well-recognised associated risks with their use includes cardiotoxicity which can lead to heart failure and poor prognosis. Most studies have focused on the effects of these agents on the left ventricular systolic function. Right ventricular (RV) mechanics in anthracycline chemotherapy have so far been neglected.
Purpose
The PROACT PLUS study is an observational, prospective, cohort study which assesses the effects of anthracyclines on the RV systolic and diastolic measures using 2 dimensional conventional echocardiography and speckle tracking imaging (STE).
Methods
From October 2018 to March 2020, patients with a new diagnosis of lymphoma or breast cancer undergoing anthracycline chemotherapy were recruited into the PROACT PLUS study. Echocardiography was performed pre-chemotherapy (V1) and 1 month post chemotherapy (V2). Using vendor-independent software (TomTec Imaging Systems, 2D Cardiac Performance Analysis, Unterschleisshiem, Germany), offline analysis of tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), tricuspid annular systolic velocity (S’), RV global longitudinal strain (RV GLS), RV myocardial longitudinal strain (RV myoGLS), RV free wall strain (RV FWS), RV- and RV free wall peak systolic (PS) strain-rates, end-systolic (ES) strain-rates, early-diastolic (ED) strain-rates and late-diastolic (LD) strain-rates were measured. This study was ethically approved by the Health Research Association (REC reference 18/EM/0177).
Results
62 patients were recruited into this study. Of these, 7 passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, a significant deterioration in the RV GLS (-25.4% vs. -22.5%, p < 0.0001), RV myoGLS (-22.4% vs. -20.9%, p = 0.005), RV ED strain-rate (1.08 1/s vs. 0.9 1/s, p = 0.01) and RV free wall ED strain-rate (1.24 1/s vs. 1.07 1/s, p = 0.02) was seen between V1 and V2. No statistical significant change was observed in the conventional and other strain measures of RV function. A total number of 6 patients developed left ventricular systolic dysfunction at V2 with ≥ 10% drop in the LV ejection fraction (LVEF) to < 53%. In this group of patients, there was a statistical significant reduction in the RV FWS (-25.5% vs. -22.7%, p = 0.03) which was not evident in the group of patients with preserved LVEF.
Conclusion
These findings suggest that adverse effects of anthracyclines are not purely confined to the LV, and RV systolic and diastolic changes are evident during treatment with anthracyclines, emphasising the global effect of these agents. A comprehensive RV assessment needs to be taken into consideration during the assessment of cardiotoxicity in patients undergoing chemotherapy treatment.
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Affiliation(s)
- S Vahabi
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - E Kharati-Koopaei
- University of Durham, Stockton-on-Tees, United Kingdom of Great Britain & Northern Ireland
| | - M Norouzi
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - J Maddox
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - A Humphreys
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - H Hancock
- Newcastle University, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Zaman
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic Services, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - D Austin
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
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Vahabi S, Kharati-Koopaei E, Norouzi M, Maddox J, Humphreys A, Hancock H, Zaman A, Austin D. Atrial mechanics in anthracycline chemotherapy: insights into a prospective study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund
Background
In cancer treatment, detection of anthracycline induced cardiotoxicity (AIC) has been dependent on serial cardiac imaging to identify a reduction in left ventricular ejection fraction (LVEF) and more recently LV global longitudinal strain (GLS). However, studies have failed to assess the adverse effects of these agents on other cardiac chambers such as the left (LA) and right atria (RA).
Purpose
The PROACT PLUS study is an observational, prospective, cohort study investigating the effects of anthracyclines on the left and right atrial mechanics using 2 dimensional speckle tracking echocardiography (STE). We hypothesize that anthracyclines can affect the heart as a whole rather than solely affecting the LV.
Methods
From October 2018 to March 2020, patients with a new diagnosis of lymphoma or breast cancer receiving anthracycline chemotherapy were recruited into this study. Echocardiography was performed pre-chemotherapy (V1) and 1 month post-chemotherapy (V2). LA and RA volumes, LA (4-chamber)- and RA GLS, reservoir strains (RS), conduit strains (CS), contractile strains (CoS), peak-systolic (PS) strain-rates, early-diastolic (ED) strain-rates, and late-diastolic (LD) strain-rates were measured offline using vendor-independent software. This study was ethically approved by the Health Research Association (REC reference 18/EM/0177).
Results
A total number of 62 patients were recruited into this study. Unfortunately, 7 patients passed away during their treatment and 5 failed to attend their follow-up appointment at V2. From V1 to V2, there was a significant deterioration in the LA CS (-18.1% vs. -14.5%, p = 0.02) and LA ED strain-rate (-1.24 1/s vs. -0.86 1/s, p = 0.001). There was no other statistical significant change in the LA volume or other strain parameters. Additionally, there was a statistically significant decline in RA GLS (34.9% vs. 30.8%, p = 0.029), RA RS (41.1% vs. 37.1%, p = 0.03), RA CS (-23.8 vs. -20.6, p = 0.05), and RA ED strain-rate (-1.17 vs. -0.99, p = 0.02) with no significant change in the RA volume and other measures of RA strain.
Conclusion
These findings support our hypothesis that anthracyclines exert their cardiotoxic effects on all cardiac chambers including the atria. Whether these changes lead to subsequent permanent structural abnormalities in the atria hence increasing the future risk of atrial arrhythmias, or whether these changes predate subsequent cardiac dysfunction and poor prognosis, remains unknown. Long-term follow up and assessment of atrial mechanics is crucial in better understanding of AIC to help guide the future monitoring and management of patients undergoing cancer treatment.
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Affiliation(s)
- S Vahabi
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - E Kharati-Koopaei
- University of Durham, Stockton-on-Tees, United Kingdom of Great Britain & Northern Ireland
| | - M Norouzi
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - J Maddox
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - A Humphreys
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - H Hancock
- Newcastle University, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Zaman
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic Services, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - D Austin
- South Tees Acute Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
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Humphreys A, Walker EG, Bratman GN, Errett NA. What can we do when the smoke rolls in? An exploratory qualitative analysis of the impacts of rural wildfire smoke on mental health and wellbeing, and opportunities for adaptation. BMC Public Health 2022; 22:41. [PMID: 34991532 PMCID: PMC8740038 DOI: 10.1186/s12889-021-12411-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extreme, prolonged wildfire smoke (WFS) events are becoming increasingly frequent phenomena across the Western United States. Rural communities, dependent on contributions of nature to people's quality of life, are particularly hard hit. While prior research has explored the physical health impacts of WFS exposure, little work has been done to assess WFS impacts on mental health and wellbeing, or potential adaptation solutions. METHODS Using qualitative methods, we explore the mental health and wellbeing impacts experienced by community members in a rural Washington State community that has been particularly hard hit by WFS in recent years, as well as individual, family, and community adaptation solutions. We conducted focus groups with residents and key informant interviews with local health and social service providers. RESULTS Participants identified a variety of negative mental health and wellbeing impacts of WFS events, including heightened anxiety, depression, isolation, and a lack of motivation, as well as physical health impacts (e.g., respiratory issues and lack of exercise). Both positive and negative economic and social impacts, as well as temporary or permanent relocation impacts, were also described. The impacts were not equitably distributed; differential experiences based on income level, outdoor occupations, age (child or elderly), preexisting health conditions, housing status, and social isolation were described as making some residents more vulnerable to WFS-induced physical and mental health and wellbeing challenges than others. Proposed solutions included stress reduction (e.g., meditation and relaxation lessons), increased distribution of air filters, development of community clean air spaces, enhancing community response capacity, hosting social gatherings, increasing education, expanding and coordination risk communications, and identifying opportunities for volunteering. Findings were incorporated into a pamphlet for community distribution. We present a template version herein for adaptation and use in other communities. CONCLUSIONS Wildfire smoke events present significant mental health and wellbeing impacts for rural communities. Community-led solutions that promote stress reduction, physical protection, and community cohesion have the opportunity to bolster resilience amid this growing public health crisis.
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Affiliation(s)
- Anna Humphreys
- Department of Health Systems and Population Health, University of Washington, Box 351621, 3980 15th Ave NE, Fourth Floor, Seattle, WA, 98195, USA
| | - Elizabeth G Walker
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- Clean Air Methow, Methow Valley Citizens Council, PO Box 774, Twisp, WA, 98856, USA
| | - Gregory N Bratman
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA
- School of Environmental and Forest Sciences, University of Washington, Anderson Hall, Box 352100, Seattle, WA, 98195, USA
| | - Nicole A Errett
- Department of Health Systems and Population Health, University of Washington, Box 351621, 3980 15th Ave NE, Fourth Floor, Seattle, WA, 98195, USA.
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA, 98105, USA.
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Humphreys A, Patel A, Hunt R. Self-retaining retraction technique for axillary lymph node dissection for breast surgeons. Ann R Coll Surg Engl 2020; 102:750-751. [PMID: 32808804 DOI: 10.1308/rcsann.2020.0167] [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: 11/22/2022] Open
Affiliation(s)
- A Humphreys
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - A Patel
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - R Hunt
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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Gault A, Dobeson C, Haney S, Graham J, Humphreys A. Review of Outcomes in North East England for Patients Receiving Neoadjuvant Chemotherapy for Breast Carcinoma. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.017] [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]
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR, Nathan P, Lorigan P, Dziewulski P, Holikova S, Panwar U, Tahir S, Faust G, Thomas A, Corrie P, Sirohi B, Kelly C, Middleton M, Marples M, Danson S, Lester J, Marshall E, Ajaz M, Houston S, Board R, Eaton D, Waterston A, Nobes J, Loo S, Gray G, Stubbings H, Gore M, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Marsden J, Westwell S, Casasola R, Chao D, Maraveyas A, Marshall E, Patel P, Ottensmeier C, Farrugia D, Humphreys A, Eccles B, Dega R, Herbert C, Price C, Brunt M, Scott-Brown M, Hamilton J, Hayward RL, Smyth J, Woodings P, Nayak N, Burrows L, Wolstenholme V, Wagstaff J, Nicolson M, Wilson A, Barlow C, Scrase C, Podd T, Gonzalez M, Stewart J, Highley M, Wolstenholme V, Grumett S, Goodman A, Talbot T, Nathan K, Coltart R, Gee B, Gore M, Farrugia D, Martin-Clavijo A, Marsden J, Price C, Farrugia D, Nathan K, Coltart R, Nathan K, Coltart R. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 29:1843-1852. [PMID: 30010756 PMCID: PMC6096737 DOI: 10.1093/annonc/mdy229] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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] [Indexed: 12/27/2022] Open
Abstract
Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18–88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74–0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78–1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information ISRCTN 81261306; EudraCT Number: 2006-005505-64
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Affiliation(s)
- P G Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - P D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, UK
| | - P Lorigan
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - M Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | - S Tahir
- Oncology Research, Broomfield Hospital, Chelmsford, UK
| | - G Faust
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - C G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Marples
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S J Danson
- Weston Park Hospital, Academic Unit of Clinical Oncology, Sheffield, UK
| | - E Marshall
- Cancer & Palliative Care, St. Helen's Hospital, St. Helens, UK
| | - S J Houston
- Oncology Department, Royal Surrey County Hospital, Guildford, UK
| | - R E Board
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - A M Waterston
- Clinical Trials Unit, Beatson WOS Cancer Centre, Glasgow, UK
| | - J P Nobes
- Department of Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, UK
| | - M Harries
- Guy's & St. Thomas' Hospital, Guy's Cancer Centre, London, UK
| | - S Kumar
- Velindre Cancer Centre, Cardiff, UK
| | - A Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - A Dalgleish
- St George's Hospital, Cancer Centre, London, UK
| | | | - S Westwell
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - R Casasola
- Cancer Centre, Ninewells Hospital, Dundee, UK
| | - D Chao
- Royal Free Hospital, London, UK
| | | | - P M Patel
- Academic Unit of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C H Ottensmeier
- CRUK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - D Farrugia
- Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - A Humphreys
- Oncology Department, James Cook University Hospital, Middlesbrough, UK
| | - B Eccles
- Oncology Department, Poole Hospital, Dorset, UK
| | - G Young
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E O Barker
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harman
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Weiss
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K A Myers
- Department of Oncology, University of Oxford, Oxford, UK; Experimental Cancer Medicine Centre, Oxford, UK
| | - A Chhabra
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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9
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 30:2013-2014. [PMID: 31430371 PMCID: PMC6938599 DOI: 10.1093/annonc/mdz237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Humphreys A, Bravis V, Kaur A, Walkey HC, Godsland IF, Misra S, Johnston DG, Oliver NS. Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: An ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis. Diabetes Res Clin Pract 2019; 155:107789. [PMID: 31326456 DOI: 10.1016/j.diabres.2019.107789] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
AIMS People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. Identification of predictors of this 'remission' could inform a better understanding of glycaemic control. METHODS Participants in the ADDRESS-2 study were included who had 1 or 2 assessments of remission status (coincident insulin dose and HbA1c measurement, with remission defined by ≤0.4 units insulin/kg-body-weight/day with HbA1c < 53 mmol/mol). Demographic and clinical presentation characteristics were compared according to remission status and predictors of remission were explored by logistic regression analysis. RESULTS 1470 first and 469 second assessments of remission status were recorded within 12 months of diagnosis of T1D. Step increases in the probability of remission were identified at age-at-diagnosis 20 years and 3 months after diagnosis (both p < 0.001). Among those aged < 20 years, remission was associated with male gender (p = 0.02), no ketoacidosis (p = 0.02) and fewer than 2 symptoms at presentation (p = 0.004). None of these characteristics predicted remission in those aged ≥ 20 years. In the subgroup with two assessments, transition to remission was independently associated with first remission assessment in months 1-2 post-diagnosis (p = 0.01), with age-at-diagnosis ≥ 20 years (p = 0.01) and, in those aged < 20 years, with an early HbA1c of <57 mmol/mol. Adiposity, ethnicity, autoantibody status and other autoimmune disease were unrelated to remission. CONCLUSIONS For those diagnosed before 20 years of age, males, ketoacidosis-free, with fewer symptoms and low early HbA1c were more likely to experience remission, but remission was most likely in anyone aged ≥ 20 at diagnosis.
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Affiliation(s)
- Anna Humphreys
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Vassiliki Bravis
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Akaal Kaur
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Helen C Walkey
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Ian F Godsland
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK.
| | - Shivani Misra
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Desmond G Johnston
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
| | - Nick S Oliver
- Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, St. Mary's Campus, London, UK
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11
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Humphreys A, Abbara A, Williams S, John L, Corrah T, McGregor A, Davidson RN. Screening contacts of patients with extrapulmonary TB for latent TB infection. Thorax 2017; 73:277-278. [PMID: 28495787 DOI: 10.1136/thoraxjnl-2016-209639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/28/2016] [Revised: 03/21/2017] [Accepted: 04/21/2017] [Indexed: 11/03/2022]
Abstract
2016 TB National Institute for Health and Care Excellence (NICE) guidelines imply that contacts of extrapulmonary TB do not require screening for latent TB infection. At our high TB prevalence site, we identified 189 active cases of TB for whom there were 698 close contacts. 29.1% of the contacts of pulmonary TB and 10.7% of the contacts of extrapulmonary TB had active or latent TB infection. This supports screening contacts of extrapulmonary TB at our site and presents a way to access high-risk individuals. We propose to continue to screen the contacts of our patients with extrapulmonary TB and recommend other TB units audit their local results.
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Affiliation(s)
| | - Aula Abbara
- NHLI, Imperial College, London, UK.,Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Sion Williams
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Laurence John
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Tumena Corrah
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Alastair McGregor
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
| | - Robert N Davidson
- Department of Infectious Diseases, Northwick Park Hospital, London, UK
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12
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Kallaway C, Humphreys A, Laurence N, Sutton R. Latissimus dorsi myocutaneous reconstruction: a study of long-term outcomes in a district general hospital. Ann R Coll Surg Engl 2017; 98:574-577. [PMID: 27791411 DOI: 10.1308/rcsann.2016.0311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the long-term outcome and durability of both autologous and implant-assisted latissimus dorsi reconstruction in a district general hospital over a 10-year follow-up period. METHODS A prospective cohort study was carried out using a detailed database of all latissimus dorsi flap reconstructions performed by a single consultant surgeon between 2003 and 2013 at the Royal United Hospital, Bath. The long-term outcome following reconstruction was assessed by analysing all episodes of 'reconstruction-specific' operations required from 6 months after the initial surgery. RESULTS The study included 110 patients with latissimus dorsi flap reconstructions, 21 autologous and 95 implant-assisted. Radiotherapy was given to 27 patients with reconstructed flaps. Mean follow-up was 69 months. Further reconstruction-specific surgery was needed in 27 (23%) cases, with 5 of these being post-radiotherapy flaps. Implant-related surgery was the most common reason for further surgery. Complications of the implant itself made up 52% of these cases, chronic sepsis being the most common. The rate of symptomatic capsular contracture requiring further surgery was 4.2%. Of these, one of four patients had undergone radiotherapy. DISCUSSION In our institution, latissimus dorsi reconstruction is durable and safe over the long term, with limited need for further substantial intervention to maintain a good outcome from the initial reconstruction. Autologous flaps were less likely to require further surgery over the long term compared with implant-based reconstructions. The low rate of symptomatic capsular contracture may be due to the protective mechanism provided by the extended harvest flap used.
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Affiliation(s)
- C Kallaway
- Breast Unit, Royal United Hospital, Bath NHS Trust , Bath, Avon , UK
| | - A Humphreys
- Breast Unit, Royal United Hospital, Bath NHS Trust , Bath, Avon , UK
| | - N Laurence
- Breast Unit, Royal United Hospital, Bath NHS Trust , Bath, Avon , UK
| | - R Sutton
- Breast Unit, Royal United Hospital, Bath NHS Trust , Bath, Avon , UK
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13
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Haden M, Heitz E, Humphreys A. 16 * ASSESSING THE IMPACT OF SATURDAY TRAUMA OPERATING LISTS ON THE TIME TO SURGERY FOR PATIENTS WITH FRACTURED NECK OF FEMUR. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.16] [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: 11/13/2022] Open
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14
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Humphreys A, Karran A, Reid T, Trent N, Boyce T. Does the seniority of operating surgeon influence the length of stay after laparoscopic appendicectomy? Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.417] [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: 10/27/2022]
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15
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Warren P, Humphreys A, Richmond P, Johnson M, Sekules V, Gamble R. John Richard Humphrey Humphreys. West J Med 2010. [DOI: 10.1136/bmj.c7032] [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: 11/04/2022]
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16
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17
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Sainsbury D, Stevens D, Humphreys A, Kessell G, Bond J, Muir T. 9342 Electrochemotherapy treatment of metastatic cutaneous cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71986-x] [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] Open
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18
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Jia W, Slominski B, Guenter W, Humphreys A, Jones O. The Effect of Enzyme Supplementation on Egg Production Parameters and Omega-3 Fatty Acid Deposition in Laying Hens Fed Flaxseed and Canola Seed. Poult Sci 2008; 87:2005-14. [DOI: 10.3382/ps.2007-00474] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [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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Malinovszky KM, Gould A, Foster E, Cameron D, Humphreys A, Crown J, Leonard RCF. Quality of life and sexual function after high-dose or conventional chemotherapy for high-risk breast cancer. Br J Cancer 2007; 95:1626-31. [PMID: 17160080 PMCID: PMC2360752 DOI: 10.1038/sj.bjc.6603454] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Three hundred and ninety women participated in the quality of life (QL) study of ACCOG1, a high-dose vs conventional adjuvant chemotherapy breast cancer trial, for patients with a high risk of relapse. Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30, questions on menopausal symptoms and the Sexual Activity Questionnaire. Pretreatment, 6,12, 24, 36, 48 and 60-month assessments were conducted. For the high dose group the median decrease in global QL at 6 months was significantly greater than in the conventional group. At 12 months, however, the median change had returned to 0 for both groups. Social functioning was also significantly lower in the high-dose group at 6 months, again returning to prebaseline levels for both groups after 12 months. The most persistent changes appear to be in the effect of treatment in both arms on sexual outcomes, reflected in problems with discomfort and pleasure. Both high-dose and conventional chemotherapy showed persisting negative effects on sexual health. This has not been previously reported as a long-term complication of high-dose chemotherapy. However, it did not have long-term affects on sexual habit, which appeared to return to pretreatment frequency and similar to that of conventional chemotherapy by about 12 months from treatment.
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Affiliation(s)
- K M Malinovszky
- South West Wales Cancer Institute, Singleton Hospital, Swansea University, Swansea SA2 8QA, UK
| | - A Gould
- Quantics Consulting Limited, Kippilaw Mains, Melrose TD6 9HF, UK
| | - E Foster
- NHS Scotland, Information and Statistics Division, 1st Floor, Gyle Square, South Gyle, Edinburgh EH12 9EB, UK
| | - D Cameron
- Edinburgh University, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - A Humphreys
- James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - J Crown
- St Vincents University Hospital, Elm Park, Dublin 4, Republic of Ireland
| | - R C F Leonard
- Hammersmith Hospitals NHS Trust and Imperial College, Du Cane Road, London, W12 0HS, UK
- Cancer Services & Clinical Haematology, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. E-mail:
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20
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Abstract
The role of aromatase inhibitors in the treatment of hormone-dependent breast cancer is well established. However, it is now recognised that steroid sulphatase (STS) inhibitors represent a new form of endocrine therapy. To explore the potential advantage of dual inhibition by a single agent, we recently developed a series of dual aromatase-sulphatase inhibitors (DASIs) based on the aromatase inhibitor YM511. We report here a new structural class of DASI obtained by obtained introducing the pharmacophore for STS inhibition, i.e. a phenol sulphamate ester into another established aromatase inhibitor letrozole. Hence, the bis-sulphamate 9 was synthesised which exhibited IC(50) values of 3044 nM for aromatase and >10 microM for STS in JEG-3 cells. However, at a single oral dose of 10mg/kg, 9 inhibited aromatase and rat liver STS by 60% and 88%, respectively, 24h after administration. A proposed metabolite of 9, carbinol 10, was synthesised. Despite also showing weak STS inhibition in JEG-3 cells, 10 inhibited rat liver STS activity to the same extent as 9 at a single oral dose of 10mg/kg. Thus, the concept of a letrozole-based DASI has been validated and could be further developed and modified for therapeutic exploitation.
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Affiliation(s)
- Paul M Wood
- Medicinal Chemistry, Department of Pharmacy and Pharmacology and Sterix Ltd, University of Bath, Claverton Down, Bath, England BA2 7AY, UK
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21
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Humphreys A. Dispensing of medicines. Vet Rec 2001; 148:700. [PMID: 11425261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
This paper is the second of a series on the role of the nurse teacher and is based on a review of the literature and the personal experience of the authors. Identifying the most appropriate way to support students in both the academic and clinical setting has been a major concern for nurse teachers. The move of nurse education into the higher education arena has increased the diverse nature of the nurse teachers role and raised questions about the nature and function of the personal tutor in relation to students undertaking nursing courses. This paper discusses the concept of the personal tutor, with particular focus on the academic aspects of the role. The time implication of adopting an all encompassing personal tutor role, within the current climate of higher education, is considered. The paper also highlights that the roles tutors adopt in practice are diverse and usually as a result of convenience rather than identified outcomes.
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Affiliation(s)
- J Gidman
- Health Studies, School of Health and Community Studies, North East Wales Institute, Plas Coch, Mold Road, Wrexham, Clwyd, LL11 2AW, UK
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Abstract
This paper examines the role of lecturers in nursing in pre-registration education. It focuses on the nature and purpose of the nurse lecturer's contribution in the practice setting, with particular emphasis on the issues surrounding clinical credibility. This is particularly pertinent in the light of current recommendations, which emphasise the importance of clinical learning in pre-registration education programmes. The purpose of the lecturer's role in clinical practice settings is ill defined. This lack of clear consensus regarding the expected outcomes for lecturers (in practice), leads to difficulty outlining what they should do in practice settings. Although lecturers accept that they have an important part to play in maximizing the learning opportunities for students in both university and practice settings, they are less clear about how this should be achieved in the latter. This paper argues that: It is opportune to examine and realign the lecturers contribution in practice settings given that there has been a shift in the responsibility for clinical learning; nurse education is now embedded in the higher education sector and there is a need for a greater emphasis on practice development. Clinical credibility for lecturers is about the development of nursing practice through education which is not always achieved by 'hands on' care. For example, assisting nurses in a ward area to develop expertise in evidence based practice may not involve 'hands on' care giving but does involve being conversant with current research and practice issues. The lecturer's expertise in practice settings is in teaching and facilitating learning, rather than direct care giving. No one common model for practice may be either feasible or desirable. However, it is important that nurse lecturers do not follow a particular approach because the debate about the nurse lecturer's role in practice settings fails to acknowledge the strengths and weaknesses of each model. It is important that the approach is based on sound rationale.
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24
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Shum C, Humphreys A, Wheeler D, Cochrane MA, Skoda S, Clement S. Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial. BMJ 2000; 320:1038-43. [PMID: 10764365 PMCID: PMC27346 DOI: 10.1136/bmj.320.7241.1038] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the acceptability and safety of a minor illness service led by practice nurses in general practice. DESIGN Multicentre, randomised controlled trial. SETTING 5 general practices in south east London and Kent representing semi-rural, suburban, and urban settings. PARTICIPANTS 1815 patients requesting and offered same day appointments by receptionists. INTERVENTION Patients were assigned to treatment by either a specially trained nurse or a general practitioner. Patients seen by a nurse were referred to a general practitioner when appropriate. MAIN OUTCOME MEASURES The general satisfaction of the patients as measured by the consultation satisfaction questionnaire. Other outcome measures included the length of the consultation, number of prescriptions written, rates of referral to general practitioners, patient's reported health status, patient's anticipated behaviour in seeking health care in future, and number of patients who returned to the surgery, visits to accident and emergency, and out of hours calls to doctors. RESULTS Patients were very satisfied with both nurses and doctors, but they were significantly more satisfied with their consultations with nurses (mean (SD) score of satisfaction 78.6 (16. 0) of 100 points for nurses v 76.4 (17.8) for doctors; 95% confidence interval for difference between means -4.07 to -0.38). Consultations with nurses took about 10 minutes compared with about 8 minutes for consultations with doctors. Nurses and doctors wrote prescriptions for a similar proportion of patients (nurses 481/736 (65.4%) v doctors 518/816 (63.5%)). 577/790 (73%) patients seen by nurses were managed without any input from doctors. CONCLUSION Practice nurses seem to offer an effective service for patients with minor illnesses who request same day appointments.
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Affiliation(s)
- C Shum
- Walderslade Village Surgery, Walderslade ME5 9LD.
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25
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Kamalesh M, Sawada S, Humphreys A, Tawam M, Blessent R, Winter L. Prognostic value of negative transesophageal dobutamine stress echocardiography in men at high risk for coronary artery disease. Am J Cardiol 2000; 85:41-4. [PMID: 11078234 DOI: 10.1016/s0002-9149(99)00602-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
Recently published reviews have called into question the sensitvity of transthoracic stress echocardiography to predict cardiac events, especially when the test is negative, compared with myocardial perfusion imaging studies. To our knowledge there are a lack of data assessing the prognostic value of transesophageal echocardiography-dobutamine stress echocardiography (TEE-DSE) in predicting cardiac events. Because TEE-DSE has been reported to be highly accurate for detecting ischemia in patients with suspected coronary artery disease, we tested the hypothesis that a negative TEE-DSE can identify a low-risk group in a population with a high likelihood of coronary artery disease. Between October 1996 and December 1997, 46 high-risk patients with negative TEE-DSE were identified. Annualized pretest risk for all cardiac events using the Framingham model was 4% based on risk factors. Mean age was 64 years. Mean follow-up time was 16.2 months. There were no cardiac deaths. There were 6 soft and 1 hard cardiac event. The annualized combined ischemic cardiac event rate was 3.8%, and for hard cardiac events it was 1.1%. By Kaplan-Meier analysis, 97% of the population remained free of any ischemic event at the end of 1 year and 93% were free at 22 months. We conclude that optimal image quality and enhanced endocardial definition for assessing wall motion changes with TEE translates into better prognostication and approaches that of myocardial perfusion imaging for negative studies. Advances in ultrasound medicine such as contrast enhancement of myocardial definition, which improve diagnostic accuracy of DSE, should translate into better prognostication.
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Affiliation(s)
- M Kamalesh
- Veterans Affairs Medical Center, University of Illinois College of Medicine, Danville 61832, USA
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26
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MacRae K, Humphreys A, Lind M. Home care for stem cell transplantation patients. Prof Nurse 1999; 15:87-90. [PMID: 10765310] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Following high-dose chemotherapy patients need to undergo bone marrow rescue through stem cell transplantation. Patients who received stem cell transplantation at home expressed satisfaction with this form of therapy. Performing stem cell transplantation in the home can reduce both costs and the risk of infection.
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Affiliation(s)
- K MacRae
- Department of Medical Oncology, Newcastle General Hospital
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27
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Iganski P, Mason D, Humphreys A, Watkins M. Are black nurses an endangered species? Nurs Times 1998; 94:54-7. [PMID: 10026538] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In the late 1980s it was feared that black nurses in Britain were a dying species. There was a belief that young people of minority ethnic descent were being deterred from choosing nursing as a career owing to the discrimination, disadvantage and harassment experienced by their parents as health service workers. Anecdotal evidence and limited statistical evidence suggested that the number of black applicants to preregistration training in nursing and midwifery was lower than would be expected when compared with the representation of the minority ethnic groups in the population as a whole. Nevertheless, the evidential base has, to date, been limited. Using the most comprehensive data set available, this paper presents an analysis of the national pattern of applications from members of minority ethnic groups to preregistration nursing and midwifery training. The evidence indicates complex patterns of under- and, in some cases, over-representation of black and Asian minority ethnic groups.
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Abstract
It is generally accepted that nurses who engage in reflective activity do so to develop their practice. However, there is little empirical evidence to suggest that practice development or improved patient care occurs as a direct result of reflection. The UKCC, as part of its framework for postregistration education, expects all nurses to engage in some form of reflective activity and to provide written accounts within a personal professional profile. This article examines some of the assumptions surrounding the practice of reflection and asserts that, in the main, nurses do not readily engage in reflection in a purposeful way.
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Affiliation(s)
- M Andrews
- School of Health and Community Studies, North East Wales Institute (NEWI), Wrexham, Clwyd
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29
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Laohavinij S, Wedge SR, Lind MJ, Bailey N, Humphreys A, Proctor M, Chapman F, Simmons D, Oakley A, Robson L, Gumbrell L, Taylor GA, Thomas HD, Boddy AV, Newell DR, Calvert AH. A phase I clinical study of the antipurine antifolate lometrexol (DDATHF) given with oral folic acid. Invest New Drugs 1996; 14:325-35. [PMID: 8958188 DOI: 10.1007/bf00194536] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lometrexol is an antifolate which inhibits glycinamide ribonucleotide formyltransferase (GARFT), an enzyme essential for de novo purine synthesis. Extensive experimental and limited clinical data have shown that lometrexol has activity against tumours which are refractory to other drugs, notably methotrexate. However, the initial clinical development of lometrexol was curtailed because of severe and cumulative antiproliferative toxicities. Preclinical murine studies demonstrated that the toxicity of lometrexol can be prevented by low dose folic acid administration, i.e. for 7 days prior to and 7 days following a single bolus dose. This observation prompted a Phase I clinical study of lometrexol given with folic acid supplementation which has confirmed that the toxicity of lometrexol can be markedly reduced by folic acid supplementation. Thrombocytopenia and mucositis were the major toxicities. There was no clear relationship between clinical toxicity and the extent of plasma folate elevation. Associated studies demonstrated that lometrexol plasma pharmacokinetics were not altered by folic acid administration indicating that supplementation is unlikely to reduce toxicity by enhancing lometrexol plasma clearance. The work described in this report has identified for the first time a clinically acceptable schedule for the administration of a GARFT inhibitor. This information will facilitate the future evaluation of this class of compounds in cancer therapy.
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Affiliation(s)
- S Laohavinij
- Cancer Research Unit, Medical School, University of Newcastle-upon-Tyne, UK
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30
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Bailey N, Humphreys A, Laohavinij S, Lind M, Robson L, Calvert A. 931 Oral folic acid improves lometrexol toxicity profile: A phase I study. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96180-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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31
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Calvert AH, Boddy A, Bailey NP, Siddiqui N, Humphreys A, Hughes A, Robson L, Gumbrell L, Thomas H, Chapman F. Carboplatin in combination with paclitaxel in advanced ovarian cancer: dose determination and pharmacokinetic and pharmacodynamic interactions. Semin Oncol 1995; 22:91-8; discussion 99-100. [PMID: 7481870] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Data from various phase I/II studies of carboplatin in combination with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) have suggested that the degree of thrombocytopenia seen is less than that expected when carboplatin is given alone. However, some studies also have suggested that the area under the plasma concentration-time curve (AUC) of carboplatin is lower than that expected, raising the possibility of a pharmacokinetic interaction. Patients with advanced epithelial ovarian cancer were treated with first-line carboplatin (AUC = 7, using the 51Cr EDTA [edetic acid] clearance method) and escalating doses of paclitaxel. Thrombocytopenia was mild and was significantly less when the paclitaxel dose was 175 mg/m2 versus 150 mg/m2. Paclitaxel kinetics were nonlinear, as previously reported. The achieved carboplatin AUC was 7 +/- 1 mg/mL.min, indicating that the pharmacokinetics of carboplatin are not affected by paclitaxel. Glomerular filtration rates measured in 184 patients using the 51Cr EDTA clearance method were compared with rates estimated from the plasma creatinine level using the Cockcroft-Gault or Jeliffe formulas and showed a significant bias of these two formulas. Clearances above 50 mL/min were underestimated by an amount that became greater as the clearance increased and was approximately 25% to 35% for patients with clearances in the normal range. Since creatinine-based methods have been used in many previous studies, care is needed in interpreting the predicted AUC values from these studies. Carboplatin and paclitaxel may be given safely in combination at full doses, and the thrombocytopenia seen is significantly less than that observed with single-agent carboplatin. No evidence exists of a pharmacokinetic interaction, and the observation in some studies that the carboplatin AUC was lower than expected was probably due to the methodology used to estimate the glomerular filtration rate.
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Affiliation(s)
- A H Calvert
- Northern Centre for Cancer Treatment, Freeman Group Hospitals NHS Trust, Newcastle upon Tyne, UK
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Abstract
The case history presented illustrates that, following an overdose of 'Whizz' and alcohol, a protracted dystonic syndrome can develop, clinically indistinguishable from tetanus. A prolonged period of ventilation may be necessary, but, in this case, complete recovery eventually occurred.
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Affiliation(s)
- A Humphreys
- Department of Medicine, North Tees General Hospital, Stockton on Tees, Cleveland, UK
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Binks PR, Robson GD, Goosey MW, Humphreys A, Trinci APJ. Chitin synthesis in Fusarium graminearum and its inhibition by edifenphos (Hinosan). ACTA ACUST UNITED AC 1991. [DOI: 10.1099/00221287-137-3-615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Humphreys A. Hepatolenticular degeneration--Wilson's disease. Aust Nurses J 1977; 7:23-4. [PMID: 243400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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