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Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, Buonaccorso L, de van der Schueren MAE, Baldwin C, Chasen M, Ripamonti CI. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines ☆. ESMO Open 2021; 6:100092. [PMID: 34144781 PMCID: PMC8233663 DOI: 10.1016/j.esmoop.2021.100092] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for managing cancer-related cachexia. •It covers screening, assessment and multimodal management of cancer cachexia. •All recommendations were compiled by a multidisciplinary group of experts. •Recommendations are based on available scientific data and the author's expert opinion.
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Affiliation(s)
- J Arends
- Department of Medicine I, Medical Center - University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Strasser
- Integrated Cancer Rehabilitation and Cancer Fatigue Clinic, Klinik Gais/Kliniken Valens; Clinic Medical Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - S Gonella
- Direction of Health Professions, Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy; Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - T S Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Cancer Clinic, Trondheim University Hospital, Trondheim, Norway
| | - C Madeddu
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P Ravasco
- Immuno-Hemotherapy and Oncology, University Hospital of Santa Maria, CHULN, Lisbon, Portugal; Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal; University of Lisbon, Portugal
| | - L Buonaccorso
- Psycho-Oncology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M A E de van der Schueren
- Department of Nutrition, Dietetics and Life Style, School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - C Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | - M Chasen
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Family Medicine, McMaster University, Hamilton, Canada; William Osler Health Services, Brampton, Canada
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer Unit, Department of Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
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Han CY, Sharma Y, Yaxley A, Baldwin C, Miller M. Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults. J Nutr Health Aging 2021; 25:1229-1234. [PMID: 34866150 DOI: 10.1007/s12603-021-1704-5] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia. MEASUREMENTS Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. RESULTS The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). CONCLUSION The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.
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Affiliation(s)
- C Y Han
- Chad Yixian Han, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA5042, Australia, E-mail address:
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Dabbous M, Baldwin C, Weekes C. Nutritional Screening In Falls Prevention Services. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.846] [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: 11/16/2022]
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Knight A, Baldwin C, Reidlinger DP, Whelan K. Communication skills teaching for student dietitians using experiential learning and simulated patients. J Hum Nutr Diet 2020; 33:601-613. [DOI: 10.1111/jhn.12743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A. Knight
- Department of Nutritional Sciences King’s College London London UK
| | - C. Baldwin
- Department of Nutritional Sciences King’s College London London UK
| | - D. P. Reidlinger
- Department of Nutritional Sciences King’s College London London UK
- Department of Nutrition and Dietetics Faculty of Health Sciences and Medicine Bond University Robina QLD Australia
| | - K. Whelan
- Department of Nutritional Sciences King’s College London London UK
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Dabbous M, Baldwin C, Weekes C. Nutrition risk status and documented nutritional care in older people accessing intermediate care and general practice services. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.017] [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: 10/25/2022]
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Jones DJ, Baldwin C, Lal S, Stanmore E, Farrer K, Connolly E, Weekes CE, Anderson L, Murphy J, Gillespie L, Welsh N, Ogden M, McDevitt M, Day R, Lynne S, Paulden P, Gronlund T, Burden ST. Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance. J Hum Nutr Diet 2019; 33:274-283. [DOI: 10.1111/jhn.12722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- D. J. Jones
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - C. Baldwin
- Department of Nutritional Sciences Kings College London London UK
| | - S. Lal
- Salford Royal Foundation Trust Salford UK
| | - E. Stanmore
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - K. Farrer
- NHS Salford CCG St James House Salford UK
| | | | - C. E. Weekes
- Guy's & St Thomas' NHS Foundation Trust London UK
| | - L. Anderson
- Buckinghamshire Healthcare NHS Trust Stoke Mandeville Hospital Aylesbury Bucks UK
| | - J. Murphy
- Bournemouth University Bournemouth UK
| | | | - N. Welsh
- Manchester University NHS Foundation Trust Manchester UK
| | - M. Ogden
- Patient and Carer Involvement/Representatives Manchester UK
| | - M. McDevitt
- Patient and Carer Involvement/Representatives Manchester UK
| | - R. Day
- Patient and Carer Involvement/Representatives Manchester UK
| | - S. Lynne
- Patient and Carer Involvement/Representatives Manchester UK
| | - P. Paulden
- Patient and Carer Involvement/Representatives Manchester UK
| | | | - S. T. Burden
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
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Dabbous M, Weekes C, Baldwin C. The Effectiveness of Nutritional Interventions Provided By Non-Dietitians on Functional Outcomes in Adults at Risk of Malnutrition: A Systematic Review. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.056] [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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Rodriguez-Villar S, Fife A, Baldwin C, Warne RR. Antibiotic-resistant hypervirulent Klebsiella pneumoniae causing community- acquired liver abscess: an emerging disease. Oxf Med Case Reports 2019; 2019:omz032. [PMID: 31198568 PMCID: PMC6544431 DOI: 10.1093/omcr/omz032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/19/2018] [Revised: 11/20/2018] [Accepted: 03/02/2019] [Indexed: 12/18/2022] Open
Abstract
We report a case of a patient with fatal community-acquired pyogenic liver abscess (CA-PLA) caused by multi drug-resistant, hypervirulent, Klebsiella pneumoniae (mdrhvKP). HvKP causing PLA has been described in East and South East Asia and it is recognized as an emerging infection worldwide. The syndrome is characterized by cryptogenic liver abscess formation without a previous history of hepatobiliary or colonic disease and metastatic spread of infection via the bloodstream to distant sites, including lungs, central nervous system and other organ systems. Diabetes mellitus is a recognized risk factor. Most previously reported cases have involved antibiotic susceptible strains of hvKP although reports of bloodstream infections caused by resistant strains, including carbapenemase producers, are increasing. Our report highlights the need for awareness of this devastating infection in patients presenting with sepsis and liver abscess without underlying hepatobiliary or colonic disease.
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Affiliation(s)
- S Rodriguez-Villar
- Critical Care Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - A Fife
- Microbiology Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - C Baldwin
- Critical Care Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - R R Warne
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
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Gibbs M, Drey N, Baldwin C. Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition: a survey of clinical practice amongst UK dietitians. J Hum Nutr Diet 2018; 32:108-118. [PMID: 30264530 DOI: 10.1111/jhn.12599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Guidance on choosing oral nutritional support strategies varies and the evidence for different approaches is discordant. The present study aimed to examine opinion and practice in the use of oral nutritional support amongst UK dietitians and to assess the factors that influence these clinical decisions. METHODS The study comprised a cross-sectional, anonymous, national survey of UK dietitians. RESULTS There were 207 completed responses (3% response rate). More dietitians reported using combined approaches (COMB) [n = 129 (62%)] over food-based (FB) strategies [n = 70 (34%)] or oral nutritional supplements (ONS) alone [n = 8 (4%)] (N = 207, P < 0.001). Intervention choice was associated with clinical setting and clinical speciality; community dietitians reported more frequent use of FB or ONS alone [n = 48 (59%)] versus COMB [n = 34 (41%)] compared to acute dietitians [COMB: n = 83 (78%) COMB versus FB or ONS alone: n = 24 (22%)] (N = 207, P < 0.0001). Specialist nutrition support dietitians reported more frequent use of FB or ONS alone [n = 22 (54%)] versus COMB [n = 19 (46%)] compared to nonspecialists [FB or ONS alone: n = 17 (45%) versus COMB: n = 21 (55%)] and other specialist dietitians [FB or ONS: n = 39 (30%) alone versus COMB: n = 89 (70%)] (P = 0.017). The greatest influences on choice were ease of implementation [n = 192 (93%)], departmental protocols [n = 184 (89%)], professional management pathways [n = 179 (87%)] and published research [n = 165 (80%)]. Patient circumstances [n = 117 (57%) and n = 99 (48%)] and ease of implementation [n = 35 (17%) and n = 48 (24%)] were reported as most influential in the first and second case scenarios, respectively. CONCLUSIONS There is a need for further research on approaches to the dietetic management of adult malnutrition.
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Affiliation(s)
- M Gibbs
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - N Drey
- School of Health Sciences, City, University of London, London, UK
| | - C Baldwin
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Ingadottir A, Beck A, Baldwin C, Weekes C, Geirsdottir O, Ramel A, Gislason T, Gunnarsdottir I. SUN-P117: Energy- and Protein Intake in Hospitalized Patients with Chronic Obstructive Pulmonary Disease (COPD) and Associations with Body Composition, Lung Function and Health Related Outcomes. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30510-1] [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: 12/01/2022]
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Ingadottir A, Beck A, Baldwin C, Weekes C, Geirsdottir O, Ramel A, Gislason T, Gunnarsdottir I. PT07.1: Two Components of the New ESPEN Diagnostic Criteria for Malnutrition are Independent Predictors of Lung Function in Hospitalized Patients with Chronic Obstructive Pulmonary Disease (COPD). Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30682-9] [Citation(s) in RCA: 3] [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: 11/29/2022]
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Baldwin C, Weekes C. OR07: What is the Quality of the Evidence Supporting the Role of Oral Nutritional Supplements (ONS) in the Management of Malnutrition. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30246-1] [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: 11/16/2022]
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Baldwin C, Gertig R, Smith V, Jackson TA. 42IMPROVING THE ASSESSMENT OF DELIRIUM: COMBINING TRADITIONAL AND NOVEL TEACHING METHODS. Age Ageing 2016. [DOI: 10.1093/ageing/afw027] [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: 11/14/2022] Open
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Baldwin C, Moore K, Steele C, Young C, Arakji M, Dudhiya N, Gilson A, Majumdar A. The effect of food fortification with or without oral nutritional supplements on energy and protein provision and intake in nursing home residents: a service evaluation. Clin Nutr ESPEN 2015; 10:e188-e189. [PMID: 28531498 DOI: 10.1016/j.clnesp.2015.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Baldwin
- Division of Diabetes & Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - K Moore
- Division of Diabetes & Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - C Steele
- Division of Diabetes & Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - C Young
- Department of Nutrition & Dietetics, London Metropolitan University, London N7 8DB, UK
| | - M Arakji
- Department of Nutrition & Dietetics, London Metropolitan University, London N7 8DB, UK
| | - N Dudhiya
- Department of Nutrition & Dietetics, London Metropolitan University, London N7 8DB, UK
| | - A Gilson
- Barts Health NHS Trust, Newham University Hospital, E13 8SL, UK
| | - A Majumdar
- Department of Nutrition & Dietetics, London Metropolitan University, London N7 8DB, UK
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Baldwin C, Gibbs M, Weekes C. A systematic review to determine the effect of organisational level interventions on nutritional, clinical and patient-centred outcomes. Clin Nutr ESPEN 2015; 10:e185-e186. [DOI: 10.1016/j.clnesp.2015.03.023] [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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Smith R, Baldwin C. The effects of oral nutrition support on nutritional, functional, clinical and healthcare outcomes in malnourished patients: an overview of systematic reviews. Clin Nutr ESPEN 2015; 10:e208. [DOI: 10.1016/j.clnesp.2015.03.073] [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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Kimber K, Gibbs M, Weekes CE, Baldwin C. Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults: a systematic review of nonrandomised studies. J Hum Nutr Diet 2015; 28:517-45. [DOI: 10.1111/jhn.12329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Kimber
- Barts Health NHS Trust; Newham University Hospital; Plaistow London UK
| | - M. Gibbs
- Diabetes and Nutritional Sciences Division; King's College London; London UK
| | - C. E. Weekes
- Department of Nutrition & Dietetics; Guy's & St Thomas NHS Foundation Trust; London UK
| | - C. Baldwin
- Diabetes and Nutritional Sciences Division; King's College London; London UK
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Baldwin C, Moss K, Offenbacher S, Beck J, White R. The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risks Study. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.019] [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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Buman M, Kurka J, Winkler E, Gardiner P, Hekler E, Healy G, Owen N, Baldwin C, Ainsworth B. Estimated replacement effects of accelerometer-derived physical activity and self-reported sleep duration on chronic disease biomarkers. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Baldwin C, Weekes CE. Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet 2012; 25:411-26. [DOI: 10.1111/j.1365-277x.2012.01264.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ciovati G, Anlage SM, Baldwin C, Cheng G, Flood R, Jordan K, Kneisel P, Morrone M, Nemes G, Turlington L, Wang H, Wilson K, Zhang S. Low temperature laser scanning microscopy of a superconducting radio-frequency cavity. Rev Sci Instrum 2012; 83:034704. [PMID: 22462945 DOI: 10.1063/1.3694570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An apparatus was developed to obtain, for the first time, 2D maps of the surface resistance of the inner surface of an operating superconducting radio-frequency niobium cavity by a low-temperature laser scanning microscopy technique. This allows identifying non-uniformities of the surface resistance with a spatial resolution of about 2.4 mm and surface resistance resolution of ~1 μΩ at 3.3 GHz. A signal-to-noise ratio of about 10 dB was obtained with 240 mW laser power and 1 Hz modulation frequency. The various components of the apparatus, the experimental procedure and results are discussed in detail in this contribution.
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Affiliation(s)
- G Ciovati
- Thomas Jefferson National Accelerator Facility, 12000 Jefferson Avenue, Newport News, Virginia 23606, USA.
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Fong A, Sibley C, Coyne J, Baldwin C. Method for Characterizing and Identifying Task Evoked Pupillary Responses During Varying Workload Levels. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1071181311551043] [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: 11/16/2022]
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Garcia A, Baldwin C, Funke M, Funke G, Knott B, Finomore V, Warm J. Team Vigilance: The Effects of Co-Action on Workload in Vigilance. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/1071181311551247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baldwin C, Spiro A, McGough C, Norman AR, Gillbanks A, Thomas K, Cunningham D, O'Brien M, Andreyev HJN. Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial. J Hum Nutr Diet 2011; 24:431-40. [PMID: 21733143 DOI: 10.1111/j.1365-277x.2011.01189.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. METHODS Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. RESULTS In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. CONCLUSIONS Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.
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Affiliation(s)
- C Baldwin
- Department of Medicine Royal Marsden Hospital, London and Sutton, UK
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Devine DV, Sher GD, Reesink HW, Panzer S, Hetzel PAS, Wong JK, Horvath M, Leitner GC, Schennach H, Nussbaumer W, Genoe K, Cioffi JM, Givisiez FN, Rogerson M, Howe D, Delage G, Sarappa C, Fu Y, Sarlija D, Vuk T, Strauss Patko M, Balija M, Jukić I, Ali A, Auvinen MK, Jaakonsalo E, Cazenave JP, Waller C, Kientz D, David B, Walther-Wenke G, Heiden M, Lin CK, Tsoi WC, Lee CK, Barotine-Toth K, Sawant RB, Murphy W, Quirke B, Bowler P, Shinar E, Yahalom V, Aprili G, Piccoli P, Gandini G, Tadokaro K, Nadarajan VS, de Kort W, Jansen N, Flanagan P, Forsberg PO, Hervig T, Letowska M, Lachert E, Dudziak K, Antoniewicz-Papis J, de Olim G, Nascimento F, Hindawi S, Teo D, Reddy R, Scholtz J, Swanevelder R, Rovira LP, Sauleda S, Carasa MAV, Vaquero MP, Ania MA, Gulliksson H, Holdsworth S, Cotton S, Howell C, Baldwin C, Cusick RM, Geele GA, Paden C, McEvoy P, Gottschall JL, McLaughlin LS, Benjamin RJ, Eder A, Draper NL, AuBuchon JP, León de González G. Inventory management. Vox Sang 2010; 98:e295-363. [PMID: 20432515 DOI: 10.1111/j.1423-0410.2009.01252.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.
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Weekes CE, Spiro A, Baldwin C, Whelan K, Thomas JE, Parkin D, Emery PW. A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost. J Hum Nutr Diet 2009; 22:324-35. [PMID: 19624401 DOI: 10.1111/j.1365-277x.2009.00971.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The association between malnutrition and poor clinical outcome is well-established, yet most research has focussed on the role of artificial nutritional support in its management. More recently, emphasis has been placed on the provision of adequate nutritional care, including nutritional screening and the routine provision of food and drink. The aim of this literature review is to establish the evidence for the efficacy of interventions that might result in improvements in nutritional and clinical outcomes and costs. METHODS A structured literature review was conducted investigating the role of nutritional care interventions in adults, and their effects on nutritional and clinical outcomes and costs, in all healthcare settings. Ten databases were searched electronically using keywords relating to nutritional care, patient outcomes and healthcare costs. High quality trials were included where available. RESULTS Two hundred and ninety-seven papers were identified and reviewed. Of these, only two randomised, controlled trials and six other trials were identified that addressed the major issues. A further 99 addressed some aspects of the provision of nutritional care, although very few formally evaluated nutritional or clinical outcomes and costs. CONCLUSIONS This review reveals a serious lack of evidence to support interventions designed to improve nutritional care, in particular with reference to their effects on nutritional and clinical outcomes and costs. The review suggests that screening alone may be insufficient to achieve beneficial effects and thus more research is required to determine the most cost-effective interventions in each part of the nutritional care pathway, in a variety of healthcare settings and across all age ranges, to impact upon nutritional and clinical outcomes.
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Affiliation(s)
- C E Weekes
- Department of Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
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Postinikova E, Baldwin C, Whitehouse CA, Sechler A, Schaad NW, Sampath R, Harpin V, Li F, Melton R, Blyn L, Drader J, Hofstadler S, Schneider WL. Identification of bacterial plant pathogens using multilocus polymerase chain reaction/electrospray ionization-mass spectrometry. Phytopathology 2008; 98:1156-1164. [PMID: 18943403 DOI: 10.1094/phyto-98-11-1156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Polymerase chain reaction/electrospray ionization-mass spectrometry (PCR/ESI-MS, previously known as "TIGER") utilizes PCR with broad-range primers to amplify products from a wide array of organisms within a taxonomic group, followed by analysis of PCR amplicons using mass spectrometry. Computer analysis of precise masses allows for calculations of base compositions for the broad-range PCR products, which can then be compared to a database for identification. PCR/ESI-MS has the benefits of PCR in sensitivity and high-throughput capacity, but also has the distinct advantage of being able to detect and identify organisms with no prior characterization or sequence data. Existing broad range PCR primers, designed with an emphasis on human pathogens, were tested for their ability to amplify DNA of well characterized phytobacterial strains, as well as to populate the existing PCR/ESI-MS bacterial database with base counts. In a blinded panel study, PCR/ESI-MS successfully identified 93% of unknown bacterial DNAs to the genus level and 73% to the species/subspecies level. Additionally, PCR/ESI-MS was capable of detecting and identifying multiple bacteria within the same sample. The sensitivity of PCR/ESI-MS was consistent with other PCR based assays, and the specificity varied depending on the bacterial species. Preliminary tests with real life samples demonstrate a high potential for using PCR/ESI-MS systems for agricultural diagnostic applications.
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Affiliation(s)
- E Postinikova
- USDA-ARS, Foreign Disease-Weed Science Research Unit, Fort Detrick, MD, USA
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Abstract
Ten individuals with idiopathic neutropenia and similar numbers of normal and abnormal controls were tested for mobilization of their marginal granulocyte pools and bone marrow reserve by using epinephrine and hydrocortisone intravenously. Individuals with 'benign' idiopathic neutropenia appeared to have a normal response while half the abnormal controls responded poorly. It is suggested that granulocyte mobilization tests are valuable in the assessment of individuals with neutropenia.
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McGough C, Wedlake L, Baldwin C, Hackett C, Norman AR, Blake P, Harrington K, Tait D, Khoo V, Frost G, Andreyev HJN. Clinical trial: normal diet vs. partial replacement with oral E028 formula for the prevention of gastrointestinal toxicity in cancer patients undergoing pelvic radiotherapy. Aliment Pharmacol Ther 2008; 27:1132-9. [PMID: 18315590 DOI: 10.1111/j.1365-2036.2008.03665.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 12/13/2022]
Abstract
BACKGROUND Acute gastrointestinal symptoms affect 90% of patients during pelvic radiotherapy. Elemental diet is protective in animal models. A nonrandomized study suggested benefit from a partial elemental diet. A pilot study suggested that radiotherapy patients only tolerate oral elemental diet comprising one-third of total calories for 3 weeks. AIM To assess the feasibility and efficacy of replacing one-third of normal diet with elemental diet during the first 3 weeks of pelvic radiotherapy in reducing acute gastrointestinal toxicity. METHODS Patients were randomized to elemental diet or no intervention. Toxicity was assessed using the Inflammatory Bowel Disease Questionnaire, Vaizey Incontinence scale and Radiation Therapy Oncology Group tool. Faecal calprotectin measured intestinal mucosal inflammation. RESULTS Twenty-nine women and 21 men, median age 61.5 years were randomized. Patients taking elemental diet did not have lower gastrointestinal toxicity ratings or inflammatory markers (P > 0.2). The mean dose taken was 21% (2-36%) of total caloric requirements. CONCLUSIONS Patients cannot tolerate large volumes of oral elemental diet. The quantities consumed in this study produced no therapeutic benefit. Future studies should aim to replace a higher proportion of nutritional intake for a longer duration of radiotherapy treatment.
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Affiliation(s)
- C McGough
- Department of Nutrition & Dietetics, The Royal Marsden Hospital, London, UK
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Abstract
BACKGROUND Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition. OBJECTIVES To examine evidence that dietary advice to improve nutritional intake in adults with illness-related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements given in combination with dietary advice. SEARCH STRATEGY Relevant publications were identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional studies were sought by contacting dietitians, clinicians and the manufacturers of nutritional supplements. Last search: September 2007 SELECTION CRITERIA Randomised controlled trials of dietary advice in people with illness-related malnutrition compared with:(1) no advice;(2) oral nutritional supplements; and(3) dietary advice plus oral nutritional supplements. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, methodological quality and extracted data. MAIN RESULTS Thirty-six studies (37 comparisons) met the inclusion criteria with 2714 randomised participants. Twelve trials (comparing dietary advice plus supplements if required with no advice) identified during searching are included as a separate comparison. Follow up ranged from 18 days to 24 months. No comparison showed a significant difference in mortality. There are several significant results for change in weight and other nutritional indices favouring nutritional intervention, but the precise contributions of the different strategies have yet to be determined. It is uncertain whether nutritional supplements and dietary advice produce the same effects. There was insufficient evidence to draw conclusions about clinical outcomes and cost. Few data were available for other outcomes. AUTHORS' CONCLUSIONS This review highlights the lack of evidence for the provision of dietary advice in managing illness-related malnutrition. Dietary advice plus nutritional supplements may be more effective than dietary advice alone or no advice in enhancing short-term weight gain, but whether this is sustainable, or whether survival and morbidity are improved remains uncertain. A large adequately-powered randomised controlled trial is needed comparing the efficacy of different therapies to increase dietary intake in people with illness-related malnutrition and examining the impact of this on clinical function and survival.
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Affiliation(s)
- C Baldwin
- Department of Nutrition and Dietetics, School of Biomedical and Health Sciences, Franklin Wilkins Building, 150 Stamford Street, London, UK SE1 9NH.
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Piggott C, Baldwin C, Dissanayake A, Sloman K. The effects of sublethal contaminant exposure on foraging behaviour in the shore crab Carcinus maenas (Crustacea: Decapoda). Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.106] [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: 11/29/2022]
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Abstract
BACKGROUND Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition. OBJECTIVES To examine evidence that dietary advice to improve nutritional intake in adults with illness-related malnutrition improves survival, weight and anthropometry; to estimate the size of any additional effect of nutritional supplements given in combination with dietary advice. SEARCH STRATEGY Relevant publications were identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Additional studies were sought by contacting dietitians, clinicians and the manufacturers of nutritional supplements. Last search: October 2006 SELECTION CRITERIA Randomised controlled trials of dietary advice in people with illness-related malnutrition compared with:(1) no advice;(2) oral nutritional supplements; and(3) dietary advice plus oral nutritional supplements. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, methodological quality and extracted data. MAIN RESULTS Thirty-five studies (37 comparisons) met the inclusion criteria with 2648 randomised participants. Twelve trials (comparing dietary advice plus supplements if required with no advice) identified during searching are included as a separate comparison. Follow up ranged from 18 days to 24 months. No comparison showed a significant difference in mortality. Significant improvements in weight at three months were found for groups receiving dietary advice plus nutritional supplements compared with dietary advice alone, WMD 1.68 kg (95% CI 0.14 to 3.21) or no additional advice, WMD 1.97 (95% CI 0.07 to 3.86). There were significant improvements in grip strength and mid-arm muscle circumference in the advice plus supplement groups compared with dietary advice alone. It is uncertain whether nutritional supplements and dietary advice produce the same effects. No significant differences were found between groups for clinical outcomes. Few data were available for other outcomes. AUTHORS' CONCLUSIONS This review highlights the lack of evidence for the provision of dietary advice in managing illness-related malnutrition. Dietary advice plus nutritional supplements may be more effective than dietary advice alone or no advice in enhancing short-term weight gain, but whether this is sustainable, or whether survival and morbidity are improved remains uncertain. A large adequately-powered randomised controlled trial is needed comparing the efficacy of different therapies to increase dietary intake in people with illness-related malnutrition and examining the impact of this on clinical function and survival.
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Affiliation(s)
- C Baldwin
- Institute of Child Health, c/o Cochrane CF & Genetic Disorders Group, University of Liverpool, RLCH NHS Trust, Eaton Road, Liverpool, UK, L12 2AP.
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Baldwin C, McGough C, Norman AR, Frost GS, Cunningham DC, Andreyev HJN. Failure of dietetic referral in patients with gastrointestinal cancer and weight loss. Eur J Cancer 2006; 42:2504-9. [PMID: 16930990 DOI: 10.1016/j.ejca.2006.05.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Revised: 05/02/2006] [Accepted: 05/05/2006] [Indexed: 11/18/2022]
Abstract
This study examined whether staff working within a cancer centre treating patients with gastrointestinal malignancy routinely identified individuals from outpatients for referral to a dietitian. A nutrition screening tool is employed only for in-patient admissions. Height, current and usual weight were recorded prospectively in all patients referred for consideration of treatment. First appointment with the dietitian, first hospital admission, demographic and clinical details were obtained from hospital records. Time from first appointment to referral to a dietitian was examined. Between September 2002 and March 2004, 920 patients were included. Five hundred and seventeen patients had lost weight, of whom 223 patients had lost between 5% and 10% and 294 patients had lost more than 10% of their pre-morbid weight. Three hundred and twenty-seven patients (36%) were referred to dietitians. Twenty eight (9%) of referrals were made by staff in outpatients. Two hundred and ninety-nine were referred during or after an inpatient admission but only 39% of these occurred within the first seven days following admission. One third of patients with more than 10% weight loss were not referred for dietary assessment, even following admission. The likelihood of referral was significantly associated with the degree of weight loss (univariate analysis hazard ratio (HR) 1.75, 95% Confidence Interval (CI) 1.4-2.19, multivariate HR 1.65, 95% CI 1.22-2.23) and was independent of factors such as performance status and clinical setting. Few patients were identified early in their treatment for referral to a dietitian. Since most chemotherapy is now given on an outpatient basis, patients are unlikely to be referred if they do not require admission. This study suggests that an out-patient dietetic screening tool is urgently required. Such screening is likely to result in considerable improvements to the clinical care of cancer patients with weight loss.
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Affiliation(s)
- C Baldwin
- Division of Medicine, Chelsea and Westminster Campus, Imperial College London, and Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, United Kingdom
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Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJN. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer 2006; 95:431-4. [PMID: 16880793 PMCID: PMC2360668 DOI: 10.1038/sj.bjc.6603280] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [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: 12/21/2022] Open
Abstract
Malnutrition in patients with cancer is common and an adverse prognostic indicator. A questionnaire answered by 357 (72%) UK specialist oncological trainees suggests that they lack the ability to identify factors that place patients at risk from malnutrition. Major barriers to effective nutritional practice included lack of guidelines, knowledge and time.
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Affiliation(s)
- A Spiro
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
- The Gastrointestinal Unit, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Gastrointestinal Units, Royal Marsden Hospital, Surrey, UK
| | - C Baldwin
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK
- The Gastrointestinal Unit, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Gastrointestinal Units, Royal Marsden Hospital, Surrey, UK
| | - A Patterson
- Department of Nutrition and Dietetics, King's College London, London, UK
| | - J Thomas
- Department of Nutrition and Dietetics, King's College London, London, UK
| | - H J N Andreyev
- The Gastrointestinal Unit, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
- The Gastrointestinal Units, Royal Marsden Hospital, Surrey, UK
- The Gastrointestinal Unit, Department of Medicine, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; E-mail:
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Khalid U, Spiro A, Baldwin C, Sharma B, McGough C, Norman AR, Eisen T, O'Brien MER, Cunningham D, Andreyev HJN. Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer 2006; 15:39-46. [PMID: 16786329 DOI: 10.1007/s00520-006-0091-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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: 01/15/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Weight loss is an independent prognostic factor for decreased survival in cancer patients. The effectiveness of treatment is impaired in patients with weight loss. The aetiology of this weight loss is complex and poorly characterised. Decreased calorie intake may be important. The reasons for decreased intake are unknown. AIMS AND METHODS To determine in adult patients with cancer, who had not started chemotherapy or radiotherapy, the prevalence of symptoms which carry a risk to nutritional status and how these relate to weight loss, tumour burden and primary tumour site. New patients referred for treatment of any form of gastrointestinal (GI) cancer, non-small cell lung cancer or lung mesothelioma completed a validated questionnaire recording symptoms contributing to weight loss (Patient-generated Subjective Global Assessment--PG-SGA). In a subset of patients without metastatic disease, computed tomography scans were assessed to determine tumour burden. RESULTS Between August and October 2004, 122 patients with GI and 29 with lung cancers were recruited. There were 48% of GI and 28% of lung cancer patients who had lost weight. Sixty-two percent of the patients had one or more symptoms at presentation. The frequency of symptoms varied according to the site of disease. The most common symptom at all tumour sites was loss of appetite (38%). There was a weak but significant correlation between the number of symptoms and amount of weight loss (r=0.347). Patients reporting a reduced food intake had more symptoms than patients who had not lost weight. Tumour burden did not correlate with weight loss. CONCLUSION The symptoms in cancer patients occur across different types of primary tumours, may affect food intake and have a part in causing weight loss. More information on the role of symptom management in improving nutritional status is needed.
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Affiliation(s)
- U Khalid
- Division of Medicine, Imperial College London, Fulham Road, London, SW10 9NH, UK
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Nolan VG, Wilcox M, Sebastiani P, Baldwin C, Wyszynski D, Ma Q, Farrer LA, Steinberg MH. Modeling Genetic Polymorphisms and Sickle Cell Associated Vasoocclusive Events Using Classification and Regression Trees (CART) and Stochastic Gradient Boosting (SGB). Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s130-a] [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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Koenen KC, Saxe G, Purcell S, Smoller JW, Bartholomew D, Miller A, Hall E, Kaplow J, Bosquet M, Moulton S, Baldwin C. Polymorphisms in FKBP5 are associated with peritraumatic dissociation in medically injured children. Mol Psychiatry 2005; 10:1058-9. [PMID: 16088328 DOI: 10.1038/sj.mp.4001727] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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McGough C, Baldwin C, Norman A, Frost G, Blake P, Tait D, Khoo V, Harrington K, Andreyev HJN. Is supplementation with elemental diet feasible in patients undergoing pelvic radiotherapy? Clin Nutr 2005; 25:109-16. [PMID: 16289498 DOI: 10.1016/j.clnu.2005.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 02/14/2005] [Accepted: 09/19/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute gastrointestinal upset occurs in approximately 80% of patients undergoing radiotherapy for pelvic cancers. Underlying changes relate to denudation of the mucosal layer which renders the small intestine vulnerable to additional damage from proteolytic enzymes and bile acids. Severe acute bowel symptoms may predispose to progressive fibrotic and ischaemic changes. Elemental diet given during treatment may reduce acute and chronic bowel symptoms induced by pelvic radiotherapy. METHODS This study aimed to assess compliance with elemental diet during pelvic radiotherapy. Patients with gynaecological, urological or rectal malignancy undergoing radical or adjuvant pelvic radiotherapy were randomised to one of five groups. Each group was assigned a target quantity of three different elemental sip feeds (Group 1, 20%, Group 2, 50%, Group 3, 75% of calorie requirements taken as E028 extra liquid; Group 4, 50% of calorie requirements taken as E028 extra powder; Group 5, 50% of calorie requirements taken as Emsogen powder). Compliance was assessed using a diary card and weekly assessment. Statistical analyses were conducted on an intention to treat basis. RESULTS Fifty patients (44 female, six male) mean age 58 yr (95% CI 55-61), were recruited to the study (24 endometrial, 17 cervical, 7 rectal, 1 vulval and 1 bladder carcinoma). Mean weight at baseline was 74.5 kg (95% CI 69-80) and this did not change during treatment. Full compliance was achieved in three patients, all from Group 1. By week 5, only 46% of patients were consuming elemental diet. Post hoc analysis of variance with repeated measures indicated that there were no significant differences in volume of elemental diet consumed between groups (P = 0.937). There was a significant inverse linear relationship between intake of elemental diet and time (P < 0.001). CONCLUSIONS Different formulations of elemental diet do not influence compliance. Patients are unlikely to be able to consume more than one-third of their calorie requirements in the form of an elemental sip feed. Further investigation is warranted to determine if intervention with this volume of elemental diet is beneficial.
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Affiliation(s)
- C McGough
- Department Medicine & Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK
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Faraone SV, Skol AD, Tsuang DW, Young KA, Haverstock SL, Prabhudesai S, Mena F, Menon AS, Leong L, Sautter F, Baldwin C, Bingham S, Weiss D, Collins J, Keith T, Vanden Eng JL, Boehnke M, Tsuang MT, Schellenberg GD. Genome scan of schizophrenia families in a large Veterans Affairs Cooperative Study sample: evidence for linkage to 18p11.32 and for racial heterogeneity on chromosomes 6 and 14. Am J Med Genet B Neuropsychiatr Genet 2005; 139B:91-100. [PMID: 16152571 DOI: 10.1002/ajmg.b.30213] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 12/18/2022]
Abstract
Genome-wide linkage analyses of schizophrenia have identified several regions that may harbor schizophrenia susceptibility genes but, given the complex etiology of the disorder, it is unlikely that all susceptibility regions have been detected. We report results from a genome scan of 166 schizophrenia families collected through the Department of Veterans Affairs Cooperative Studies Program. Our definition of affection status included schizophrenia and schizoaffective disorder, depressed type and we defined families as European American (EA) and African American (AA) based on the probands' and parents' races based on data collected by interviewing the probands. We also assessed evidence for racial heterogeneity in the regions most suggestive of linkage. The maximum LOD score across the genome was 2.96 for chromosome 18, at 0.5 cM in the combined race sample. Both racial groups showed LOD scores greater than 1.0 for chromosome 18. The empirical P-value associated with that LOD score is 0.04 assuming a single genome scan for the combined sample with race narrowly defined, and 0.06 for the combined sample allowing for broad and narrow definitions of race. The empirical P-value of observing a LOD score as large as 2.96 in the combined sample, and of at least 1.0 in each racial group, allowing for narrow and broad racial definitions, is 0.04. Evidence for the second and third largest linkage signals come solely from the AA sample on chromosomes 6 (LOD = 2.11 at 33.2 cM) and 14 (LOD = 2.13 at 51.0). The linkage evidence differed between the AA and EA samples (chromosome 6 P-value = 0.007 and chromosome 14 P-value = 0.004).
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Affiliation(s)
- S V Faraone
- Genetics Research Program and Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Abstract
Up to 12000 patients with gynaecological, urological and rectal cancer undergo radical pelvic radiotherapy annually in the UK. More than 70% develop acute inflammatory changes causing gastrointestinal symptoms during treatment because healthy bowel tissue is encompassed in the radiation field. In total, 50% go on to develop chronic bowel symptoms, which affect quality of life due to permanent changes in the small and large intestine. Nutritional intervention may influence acute and chronic bowel symptoms but the validity of the advice given to patients is not clear. To assess the incidence and significance of malnutrition and to examine the efficacy of therapeutic nutritional interventions used to manage gastrointestinal side effects in patients undergoing pelvic radiotherapy and those with chronic bowel side effects after treatment, a critical review of relevant original studies on human subjects was carried out using a specific set of mesh terms in MEDLINE and EMBASE databases and the Cochrane Library in September 2003. Full texts of all relevant articles were collected and reference lists were checked. Sources of grey literature including conference abstracts and web-based information were also reviewed. A total of 36 papers published in peer-reviewed journals between 1966 and 2003 were identified. In all, 14 randomised controlled trials, 12 prospective cohorts, four retrospective, two qualitative, one validation, one pilot study and two case reports were obtained. These included 2646 patients. Eight articles including three conference abstracts and web-based information were found. None of the studies was definitive because of weakness in methodology. No studies could be combined because the interventions and the end points were different. There is no evidence base for the use of nutritional interventions to prevent or manage bowel symptoms attributable to radiotherapy. Low-fat diets, probiotic supplementation and elemental diet merit further investigation.
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Affiliation(s)
- C McGough
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK
| | - C Baldwin
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK
| | - G Frost
- Department of Nutrition and Dietetics, Hammersmith Hospitals NHS Trust, Du Cane Rd, London W12 0HS
| | - H J N Andreyev
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK
- Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK. E-mail:
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Farrer L, Friedland R, Bowirrat A, Green R, Yip A, Inzelberg R, Baldwin C. S2-01-02 Using a genetic approach to understand the vascular basis of Alzheimer disease. Neurobiol Aging 2004. [DOI: 10.1016/s0197-4580(04)80080-0] [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: 11/17/2022]
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Martin S, Phillpot M, Baldwin C, Madden A. The prevalence of malnutrition in patients with human immunodeficiency virus on admission to hospital. J Hum Nutr Diet 2003. [DOI: 10.1046/j.1365-277x.2003.04675.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: 11/20/2022]
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Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
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Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
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Moyle GJ, Baldwin C, Langroudi B, Mandalia S, Gazzard BG. A 48-week, randomized, open-label comparison of three abacavir-based substitution approaches in the management of dyslipidemia and peripheral lipoatrophy. J Acquir Immune Defic Syndr 2003; 33:22-8. [PMID: 12792351 DOI: 10.1097/00126334-200305010-00004] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [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: 11/27/2022]
Abstract
BACKGROUND The mechanisms by which dyslipidemia and lipoatrophy develop during antiretroviral therapy are not clear. No treatment of lipoatrophy is currently established. METHODS This was an open-label randomized study of HIV-positive individuals on a first-line therapy containing stavudine (d4T) with either a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) and with hypercholesterolemia (defined as total cholesterol >5.2 mmol/L or >180 mg/dL) and/or lipoatrophy and with a viral load of <50 copies/mL. Patients switched d4T to abacavir (ABC) (group 1), a PI or NNRTI to ABC (group 2), or d4T and PI or NNRTI to ABC plus AZT (group 3). Patients were followed-up with fasting blood levels, dual-energy X-ray absorptiometry (DXA), and computed tomography (CT) scans for 48 weeks. RESULTS Thirty patients were included, with 27 completing 48 weeks of therapy. One ABC hypersensitivity reaction was the only serious adverse event. All patients' viral loads remained at <50 copies/mL. CD4 cell counts rose in groups 2 and 3 but fell modestly in group 1. Total and low-density lipoprotein cholesterol improved significantly in groups 2 and 3. Triglycerides fell significantly in group 2. In contrast, total, arm, and leg fat mass (by DXA) rose significantly in group 1 but fell modestly in groups 2 and 3. Visceral adiposity (by CT scan) was unaffected in all groups. CONCLUSIONS Abacavir represents a virologically effective replacement for d4T, PI, or NNRTI in persons on successful first-line therapy. Replacement of a PI or NNRTI with ABC leads to modest improvement in both cholesterol and triglycerides. Replacement of d4T with ABC leads to modest improvements in fat mass.
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Affiliation(s)
- G J Moyle
- Chelsen and Westminster Hospital, London, Uned Kingdom.
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48
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Skol AD, Young KA, Tsuang DW, Faraone SV, Haverstock SL, Bingham S, Prabhudesai S, Mena F, Menon AS, Yu CE, Rundell P, Pepple J, Sauter F, Baldwin C, Weiss D, Collins J, Keith T, Boehnke M, Schellenberg GD, Tsuang MT. Modest evidence for linkage and possible confirmation of association between NOTCH4 and schizophrenia in a large Veterans Affairs Cooperative Study sample. Am J Med Genet B Neuropsychiatr Genet 2003; 118B:8-15. [PMID: 12627457 DOI: 10.1002/ajmg.b.10055] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [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: 11/06/2022]
Abstract
Wei and Hemmings [2000: Nat Genet 25:376-377], using 80 British parent-offspring trios, identified a number of NOTCH4 variants and haplotypes that showed statistically significant evidence of association to schizophrenia. Specifically, the 10 repeat allele of a (CTG)(n) marker and the 8 repeat allele of a (TAA)(n) marker demonstrated excess transmission to affected individuals; SNP21 and haplotypes SNP2-(CTG)(n) and SNP12-SNP2-(CTG)(n) also showed significant associations. In an attempt to replicate these findings, we tested for linkage and association between the same five markers used by Wei and Hemmings in 166 families collected from a multi-center study conducted by the Department of Veterans Affairs (DVA) Cooperative Study Program (CSP). The families include 392 affected subjects (schizophrenia or schizoaffective disorder, depressed) and 216 affected sibling pairs. The families represent a mix of European Americans (n = 62, 37%), African Americans (n = 60, 36%), and racially mixed or other races (n = 44, 27%). We identified moderate evidence for linkage in the pooled race sample (LOD = 1.25) and found excess transmission of the 8 (P = 0.06) and 13 (P = 0.04) repeat alleles of the (TAA)(n) marker to African American schizophrenic subjects. The 8 and 13 repeat alleles were previously identified to be positively associated with schizophrenia by Wei and Hemmings [2000: Nat Genet 25:376-377] and Sklar et al. [2001: Nat Genet 28:126-128], respectively.
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Affiliation(s)
- A D Skol
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
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Faraone SV, Skol AD, Tsuang DW, Bingham S, Young KA, Prabhudesai S, Haverstock SL, Mena F, Menon ASK, Bisset D, Pepple J, Sautter F, Baldwin C, Weiss D, Collins J, Keith T, Boehnke M, Tsuang MT, Schellenberg GD. Linkage of chromosome 13q32 to schizophrenia in a large veterans affairs cooperative study sample. Am J Med Genet 2002; 114:598-604. [PMID: 12210272 DOI: 10.1002/ajmg.10601] [Citation(s) in RCA: 27] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Several prior reports have suggested that chromosomal region 13q32 may harbor a schizophrenia susceptibility gene. In an attempt to replicate this finding, we assessed linkage between chromosome 13 markers and schizophrenia in 166 families, each with two or more affected members. The families, assembled from multiple centers by the Department of Veterans Affairs Cooperative Studies Program, included 392 sampled affected subjects and 216 affected sib pairs. By DSM-III-R criteria, 360 subjects (91.8%) had a diagnosis of schizophrenia and 32 (8.2%) were classified as schizoaffective disorder, depressed. The families had mixed ethnic backgrounds. The majority were northern European-American families (n = 62, 37%), but a substantial proportion were African-American kindreds (n = 60, 36%). Chromosome 13 markers, spaced at intervals of approximately 10 cM over the entire chromosome and 2-5 cM for the 13q32 region were genotyped and the data analyzed using semi-parametric affected only linkage analysis. For the combined sample (with race broadly defined and schizophrenia narrowly defined) the maximum LOD score was 1.43 (Z-score of 2.57; P = 0.01) at 79.0 cM between markers D13S1241 (76.3 cM) and D13S159 (79.5 cM). Both ethnic groups showed a peak in this region. The peak is within 3 cM of the peak reported by Brzustowicz et al. [1999: Am J Hum Genet 65:1096-1103].
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Affiliation(s)
- Stephen V Faraone
- Brockton/West Roxbury Veterans Affairs Medical Center, Brockton, Massachusetts, USA.
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Tsuang DW, Skol AD, Faraone SV, Bingham S, Young KA, Prabhudesai S, Haverstock SL, Mena F, Menon AS, Bisset D, Pepple J, Sauter F, Baldwin C, Weiss D, Collins J, Boehnke M, Schellenberg GD, Tsuang MT. Examination of genetic linkage of chromosome 15 to schizophrenia in a large Veterans Affairs Cooperative Study sample. ACTA ACUST UNITED AC 2002. [DOI: 10.1002/ajmg.1550] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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