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Hanna D, Merrick S, Ghose A, Devlin MJ, Yang DD, Phillips E, Okines A, Chopra N, Papadimatraki E, Ross K, Macpherson I, Boh ZY, Michie CO, Swampillai A, Gupta S, Robinson T, Germain L, Twelves C, Atkinson C, Konstantis A, Riddle P, Cresti N, Naik JD, Borley A, Guppy A, Schmid P, Phillips M. Real world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom. Br J Cancer 2024:10.1038/s41416-024-02685-9. [PMID: 38658782 DOI: 10.1038/s41416-024-02685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK. METHODS Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG. RESULTS 132 pts were included. Median age was 56 years (28-91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5-6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts. CONCLUSION This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience.
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Affiliation(s)
- Daire Hanna
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK.
- Barts Cancer Institute, Queen Mary University, London, UK.
| | | | - Aruni Ghose
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK
| | | | - Dorothy D Yang
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Edward Phillips
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Alicia Okines
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Neha Chopra
- The Royal Free, London NHS foundation trust, London, UK
| | | | - Kirsty Ross
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Zhuang Y Boh
- Edinburgh Cancer Centre and University of Edinburgh, Edinburgh, UK
| | | | | | - Sunnia Gupta
- Guy's and St Thomas' NHS foundation trust, London, UK
| | - Tim Robinson
- Bristol Haematology and Oncology Centre- NHS foundation trust, Bristol, UK
| | | | | | | | - Apostolos Konstantis
- UCLH NHS foundation trust, London, UK
- Princess Alexandra Hospital NHS trust, London, UK
| | | | - Nicola Cresti
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jay D Naik
- Harrogate and District NHS foundation trust, Harrogate, UK
| | | | - Amy Guppy
- Mount Vernon Cancer Centre, London, UK
| | - Peter Schmid
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK
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Pufulete M, Coyle V, Provan D, Shaw C, Kunzmann P, Bowrey DJ, Barlow R, Grocott MPW, Shah T, Atkinson C. Prehabilitation provision and practice in the UK: a freedom of information survey. Br J Anaesth 2024; 132:815-819. [PMID: 38326209 DOI: 10.1016/j.bja.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Maria Pufulete
- Bristol Heart Institute, University of Bristol, Bristol, UK; National Institute for Health and Care Research (NIHR), Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trusts/Boards and University of Bristol, Bristol, UK.
| | - Vicky Coyle
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Debbie Provan
- Cancer and Rehabilitation Unit, Scottish Government, NHS Ayrshire and Arran, Glasgow, UK
| | - Clare Shaw
- NIHR Biomedical Research Centre, The Royal Marsden and Institute of Cancer Research, London, UK
| | - Peter Kunzmann
- Policy and Public Affairs, Royal College of Anaesthetists, London, UK
| | - David J Bowrey
- Department of Surgery, University Hospitals of Leicester NHS Trusts/Boards, Leicester, UK
| | - Rachael Barlow
- Cardiff and Vale University Health Board and Swansea Bay University Health Board, Cardiff, NHS Wales, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK
| | - Toral Shah
- NIHR Cancer and Nutrition Collaboration, Southampton, UK
| | - Charlotte Atkinson
- National Institute for Health and Care Research (NIHR), Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trusts/Boards and University of Bristol, Bristol, UK
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Onwordi E, Harris A, Atkinson C, West C, Pearce K, Hancock J, Demetrescu C, Rakhit D, Shah BN, Khattar R, Gorman J, Encarnacion D, Lloyd G, Bhattacharyya S. Prevalence, characteristics and clinical impact of work-related musculoskeletal pain in echocardiography. Echo Res Pract 2024; 11:6. [PMID: 38443980 PMCID: PMC10916016 DOI: 10.1186/s44156-024-00042-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Work-related musculoskeletal pain (WRMSP) is increasingly recognised in cardiac ultrasound practice. WRMSP can impact workforce health, productivity and sustainability. We sought to investigate the prevalence, characteristics and clinical impact of WRMSP. METHODS Prospective electronic survey of 157 echocardiographers in 10 institutions. Data acquired on demographics, experience, working environment/pattern, WRMSP location, severity and pattern, the impact on professional, personal life and career. RESULTS 129/157 (82%) echocardiographers completed the survey, of whom 109 (85%) reported WRMSP and 55 (43%) reported work taking longer due to WRMSP. 40/129 (31%) required time off work. 78/109 (60%) reported sleep disturbance with 26/78 (33%) of moderate or severe severity. 56/129 (45%) required medical evaluation of their WRMSP and 25/129 (19%) received a formal diagnosis of musculoskeletal injury. Those with 11+ years of experience were significantly more likely to receive a formal diagnosis of WRMSP (p = 0.002) and require medication (p = 0.006) compared to those with 10 years or less experience. CONCLUSION WRMSP is very common amongst echocardiographers, with a fifth having a related musculoskeletal injury. WRMSP has considerable on impact on personal, social and work-related activities. Strategies to reduce the burden of WRMSP are urgently required to ensure sustainability of the workforce and patient access to imaging.
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Affiliation(s)
- Eunice Onwordi
- Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Alistair Harris
- University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | | | | | - Keith Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Dhrubo Rakhit
- University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - Benoy N Shah
- University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | | | | | | | - Guy Lloyd
- Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
- University College London Hospitals, London, UK
| | - Sanjeev Bhattacharyya
- Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- University College London Hospitals, London, UK.
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England C, Mitchell A, Atkinson C. Diet After Ileostomy Study: an observational study describing dietary intake and stoma-related symptoms in people with an ileostomy. J Hum Nutr Diet 2023; 36:1600-1612. [PMID: 36932682 DOI: 10.1111/jhn.13168] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND People with ileostomy are frequently advised to avoid specific foods and food groups, making it plausible that they are at risk of a range of nutrition-related adverse health consequences. Despite this there has been no recent study in the United Kingdom describing dietary intake, symptoms and food avoidance in people with ileostomy or post-reversal. METHODS A cross-sectional study was conducted at different time points in people with ileostomy and reversal. Participants were recruited at 6-10 weeks post-formation (n = 17) and ≥12 months with established ileostomy (n = 16) and with reversal (n = 20). In all participants, ileostomy/bowel-related symptoms in the previous week were assessed using a study-specific questionnaire. Dietary intake was assessed using three online diet recalls or 3-day dietary records. Food avoidance and reasons for food avoidance were assessed. Data were summarised using descriptive statistics. RESULTS Participants reported a few ileostomy/bowel-related symptoms in the previous week. However, over 85% of participants reported avoiding foods, particularly fruits and vegetables. At 6-10 weeks the most common reason was being advised to do so (71%), although 53% avoided foods due to gas. At ≥12 months the most common reasons were foods visible in the bag (60%) or advised to do so (60%). Reported intakes of most nutrients were comparable to population medians, apart from lower fibre in people with ileostomy. Intakes of free sugars and saturated fats were above recommended levels in all groups, due to high consumption of cakes and biscuits and sugar-sweetened drinks. CONCLUSION After the initial healing period, foods should not be automatically excluded unless found to be problematic after reintroduction. There may be a need for healthy eating advice for people with established ileostomies and post-reversal, targeting discretionary high-fat, high-sugar foods.
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Affiliation(s)
- Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Alexandra Mitchell
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
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Murray MJ, Bradley E, Ng Y, Thomas O, Patel K, Angus C, Atkinson C, Reeves MB. In silico interrogation of the miRNAome of infected hematopoietic cells to predict processes important for human cytomegalovirus latent infection. J Biol Chem 2023; 299:104727. [PMID: 37080390 PMCID: PMC10206818 DOI: 10.1016/j.jbc.2023.104727] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023] Open
Abstract
Human cytomegalovirus (HCMV) latency in CD34+ progenitor cells is the outcome of a complex and continued interaction of virus and host that is initiated during very early stages of infection and reflects pro- and anti-viral activity. We hypothesized that a key event during early infection could involve changes to host miRNAs, allowing for rapid modulation of the host proteome. Here, we identify 72 significantly upregulated miRNAs and three that were downregulated by 6hpi of infection of CD34+ cells which were then subject to multiple in silico analyses to identify potential genes and pathways important for viral infection. The analyses focused on the upregulated miRNAs and were used to predict potential gene hubs or common mRNA targets of multiple miRNAs. Constitutive deletion of one target, the transcriptional regulator JDP2, resulted in a defect in latent infection of myeloid cells; interestingly, transient knockdown in differentiated dendritic cells resulted in increased viral lytic IE gene expression, arguing for subtle differences in the role of JDP2 during latency establishment and reactivation of HCMV. Finally, in silico predictions identified clusters of genes with related functions (such as calcium signaling, ubiquitination, and chromatin modification), suggesting potential importance in latency and reactivation. Consistent with this hypothesis, we demonstrate that viral IE gene expression is sensitive to calcium channel inhibition in reactivating dendritic cells. In conclusion, we demonstrate HCMV alters the miRNAome rapidly upon infection and that in silico interrogation of these changes reveals new insight into mechanisms controlling viral gene expression during HCMV latency and, intriguingly, reactivation.
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Affiliation(s)
- M J Murray
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom.
| | - E Bradley
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - Y Ng
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - O Thomas
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - K Patel
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - C Angus
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - C Atkinson
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - M B Reeves
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom.
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Nord D, Langerude L, Gill B, Moussa H, Emtiazjoo A, Shahmohammadi A, Rackauskas M, Atkinson C. Increased Circulating Cell Junction Proteins are Associated with the Development of Primary Graft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1479] [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: 04/05/2023] Open
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Gill B, Tu Z, Langerude L, Nord D, Emtiazjoo A, Rackauskas M, Atkinson C. Administration of Exogenous Bmp9 Ameliorates Lung Transplant Ischemia Reperfusion Injury. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1478] [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: 04/05/2023] Open
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Mitchell A, Herbert G, England C, Atkinson C, Searle A. Healthcare professionals' perspectives on dietary advice provided to people with an ileostomy. J Hum Nutr Diet 2023; 36:716-728. [PMID: 36944550 DOI: 10.1111/jhn.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Diet is a common concern amongst people with an ileostomy as it can be associated with serious and burdensome complications, e.g., dehydration and obstruction, and dietary advice is often unsatisfactory. In this study, we explored healthcare professionals' (HCPs) perspectives on dietary advice for ileostomy management. METHODS Semi-structured interviews were conducted with HCPs, from multiple professions, who provide dietary advice to patients with an ileostomy. A Framework approach to thematic analysis was used to understand and compare HCPs experiences, beliefs, and attitudes that influence how dietary advice is provided and effectiveness of dietary management. RESULTS Findings from interviews with 21 HCPs, across three hospitals, related to seven key themes: tailoring of dietary advice to the patient, patient autonomy and communication, HCP knowledge and understanding, patient pathway, mixed messages, access to formal and social support, and patient understanding and relationship with dietary advice. Profession was a strong determinator of what and how dietary advice is provided; however, closer team working increased consistency of dietary advice. Lack of scientific research and consensus contribute to mixed messages and reduce confidence in dietary advice for people with an ileostomy. Due to individual differences between patients, experiential learning with diet is key to self-management and is encouraged in a controlled way by HCPs; however, a lack of 'one size fits all' guidance can be difficult for some. CONCLUSION The study findings should inform HCPs caring for patients with an ileostomy, and researchers designing and evaluating interventions, to improve how patients receive dietary advice for ileostomy management. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexandra Mitchell
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Georgia Herbert
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Clare England
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Aidan Searle
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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Schreiber S, Bleakman AP, Dubinsky MC, Rubin D, Hibi T, Panaccione R, Gibble TH, Kayhan C, Flynn E, Sapin C, Atkinson C, Travis S, Jones J. A190 THE IMPACT OF BOWEL URGENCY ON THE LIVES OF PATIENTS WITH ULCERATIVE COLITIS IN THE US AND EUROPE: COMMUNICATING NEEDS AND FEATURES OF IBD EXPERIENCES (CONFIDE) SURVEY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991179 DOI: 10.1093/jcag/gwac036.190] [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: 03/09/2023] Open
Abstract
Abstract
Background
Moderate to severe ulcerative colitis (UC) exerts a significant burden on patients’ lives. Patients with UC report that bowel urgency has a substantial negative impact on their quality of life and psychosocial functioning, however, this symptom is missing from most disease activity indices.
Purpose
The Communicating Needs and Features of IBD Experiences (CONFIDE) study aims to increase understanding of the impact of symptoms, including bowel urgency, on the lives of patients (pts) with moderate to severe UC and Crohn’s disease in the United States (US), Europe (EUR), and Japan. These data focus on pts in the US and EUR.
Method
Online, quantitative, cross-sectional surveys of pts with moderate to severe UC were conducted in the US and EUR (France, Germany, Italy, Spain, and UK). Data included pt perspectives on their UC symptoms and the impact on their daily lives. Moderate to severe UC was defined based on treatment, steroid use, and/or hospitalization history. Descriptive statistics summarise the data.
Result(s)
200 US pts (62% male, mean age 40.4 years) and 556 EUR pts (57% male, mean age 38.9 years) completed the survey, with 77% and 54% currently receiving advanced therapies (biologic or novel oral therapy), respectively. The top 3 symptoms currently (past month) experienced by US and EUR pts were diarrhoea (63% and 50%), bowel urgency (47% and 30%) and increased stool frequency (39% and 30%). In past 3 months, pts who have ever experienced bowel urgency or urge incontinence reported bowel urgency (93% US, 89% EUR) and urge incontinence (86% US, 71% EUR) at least once a month (Table). 69% and 65% of all US and EUR pts, respectively, reported wearing a diaper/pad/protection at least once a month in the past 3 months due to fear/anticipation of urge incontinence. For pts receiving advanced therapies, similar patterns were observed. Among both US and EUR pts, the most common UC-related reasons for declining participation in social events were bowel urgency (43% and 30%) and fear of urge incontinence (40% and 32%). Similarly, the most common reasons for declining participation in work/school and sports/physical exercise were bowel urgency and fear of urge incontinence.
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Conclusion(s)
Bowel urgency, which was the second-most frequently reported symptom, has an extensive impact on the lives of pts with moderate to severe UC. In this younger pt population, including pts receiving advanced therapies, almost two thirds of US and EUR pts reported wearing diapers/pads/protection at least once a month in the past 3 months due to fear/anticipation of urge incontinence. Both US and EUR pts reported bowel urgency and fear of urge incontinence as the top reasons for declining participation in social events, work/school, and sports/physical exercise.
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Eli Lilly and Company
Disclosure of Interest
S. Schreiber Grant / Research support from: personal fees and/or travel support from: AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly and Company, Dr. Falk Pharma, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos NV, Gilead Sciences, I-MAB Biopharma, Janssen, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Protagonist Therapeutics, Provention Bio, Roche, Sandoz/Hexal, Shire, Takeda, Theravance Biopharma, and UCB Pharma, A. Bleakman Employee of: Eli Lilly and Company, M. Dubinsky Shareholder of: Trellus Health, Grant / Research support from: AbbVie, Janssen, Pfizer, and Prometheus Biosciences, Consultant of: AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, F. Hoffmann-La Roche, Genentech, Gilead Sciences, Janssen, Pfizer, Prometheus Therapeutics and Diagnostics, Takeda, and UCB Pharma, D. Rubin Grant / Research support from: Takeda, Consultant of: AbbVie, Allergan, AltruBio, American College of Gastroenterology, Arena Pharmaceuticals, Athos Therapeutics, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene/Syneos Health, Cornerstones Health (non-profit), Eli Lilly and Company, Galen/Atlantica, Genentech/Roche, Gilead Sciences, GoDuRn, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen, Materia Prima, Pfizer, Prometheus Therapeutics and Diagnostics, Reistone Biopharma, Takeda, and TechLab, T. Hibi Grant / Research support from: AbbVie, Activaid, Alfresa Pharma, Bristol Myers Squibb, Eli Lilly Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceutical K.K., JMDC, Nippon Kayaku, Mochida Pharmaceutical, Pfizer Japan, and Takeda, Consultant of: AbbVie, Apo Plus Station, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly and Company, Gilead Sciences, Janssen, Kyorin, Mitsubishi Tanabe Pharma, Nichi-Iko Pharmaceutical, Pfizer, Takeda, and Zeria Pharmaceutical, Speakers bureau of: AbbVie, Aspen Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen, JIMRO, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Pfizer, and Takeda, R. Panaccione Grant / Research support from: AbbVie, Ferring Pharmaceuticals, Janssen, Pfizer, and Takeda, Consultant of: Abbott, AbbVie, Alimentiv, Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cosmo Pharmaceuticals, Eisai, Elan Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Galapagos NV, Genentech, Gilead Sciences, GlaxoSmithKline, Janssen, Merck, Mylan, Oppilan Pharma, Pandion Therapeutics, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda, Theravance Biopharma, and UCB Pharma, T. Gibble Employee of: Eli Lilly and Company, C. Kayhan Employee of: Eli Lilly and Company, E. Flynn Employee of: Eli Lilly and Company, C. Sapin Employee of: Eli Lilly and Company, C. Atkinson Consultant of: Eli Lilly and Company in connection with the development of this publication, Employee of: Adelphi Real World, S. Travis Grant / Research support from: AbbVie, BUHLMANN Diagnostics, ECCO, Eli Lilly and Company, Ferring Pharmaceuticals, International Organization for the Study of Inflammatory Bowel Disease, Janssen, Merck Sharp & Dohme, Normal Collision Foundation, Pfizer, Procter & Gamble, Schering-Plough, Takeda, UCB Pharma, Vifor Pharma, and Warner Chilcott, J. Jones: None Declared
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Affiliation(s)
- S Schreiber
- University Hospital Schleswig-Holstein , Kiel , Germany
| | | | | | - D Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center , Chicago , United States
| | - T Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital , Tokyo , Japan
| | | | | | - C Kayhan
- Eli Lilly and Company , Indianapolis
| | - E Flynn
- Eli Lilly and Company , Indianapolis , India
| | - C Sapin
- Eli Lilly and Company , Indianapolis
| | | | - S Travis
- University of Oxford , Oxford , United Kingdom
| | - J Jones
- Division of Digestive Care and Endoscopy, Department of Medicine, Department of Community Health and Epidemiology, Dalhousie University , Halifax , Canada
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Travis S, Bleakman AP, Rubin D, Dubinsky MC, Panaccione R, Hibi T, Gibble TH, Kayhan C, Flynn E, Sapin C, Atkinson C, Schreiber S, Jones J. A216 BOWEL URGENCY COMMUNICATION GAP BETWEEN HEALTH CARE PROFESSIONALS AND PATIENTS WITH ULCERATIVE COLITIS IN THE US AND EUROPE: COMMUNICATING NEEDS AND FEATURES OF IBD EXPERIENCES (CONFIDE) SURVEY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991380 DOI: 10.1093/jcag/gwac036.216] [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: 03/09/2023] Open
Abstract
Background The Communicating Needs and Features of IBD Experiences (CONFIDE) study aims to increase understanding of the impact of symptoms on patients with moderate to severe UC and Crohn’s disease and to investigate gaps in communication with healthcare professionals (HCPs) in the United States (US), Europe (EUR), and Japan. Purpose This report focuses on patients with moderate to severe UC and HCPs from the US and EUR. Method Online, quantitative, cross-sectional surveys of patients with UC and HCPs were conducted in the US and EUR (France, Germany, Italy, Spain, and UK). HCP surveys included physicians and non-physician HCPs responsible for making prescribing decisions. Moderate to severe UC was defined based on treatment, steroid use, and/or hospitalization history. Data collected included perspectives on the experience of patients with UC. Result(s) A total of 200 US (62% male, mean age 40.4 years) and 556 EUR patients (57% male, mean age 38.9 years), and 200 US and 503 EUR HCPs completed the survey. According to US and EUR patients, the top 3 symptoms currently (past month) experienced were diarrhoea (63% and 50%), bowel urgency (47% and 30%) and increased stool frequency (39% and 30%). Blood in stool was reported as currently experienced by 27% and 24% of US and EUR patients, respectively. Among patients currently experiencing bowel urgency, 47% of US and 27% of EUR patients discuss this symptom at every appointment. Among those who do not discuss bowel urgency at every appointment, 74% and 75% of US and EUR patients would like to discuss this symptom more frequently with their HCP. A total of 30% and 43% of US and EUR patients that ever experienced bowel urgency were not comfortable reporting it to their HCP, with 62% and 58% of these US and EUR patients feeling embarrassed talking about this symptom (Table). HCPs in both the US and EUR ranked diarrhoea (74% and 65%), blood in stool (69% and 65%) and increased stool frequency (38% and 34%) as the top 3 symptoms most reported by patients. According to US and EUR HCPs, the top 4 symptoms proactively discussed in routine appointments were blood in stool (93% and 94%), diarrhoea (90% and 91%), increased stool frequency (82% and 82%) and bowel urgency (76% and 82%). Among HCPs who did not proactively discuss bowel urgency, 47% of US and 40% of EUR HCPs expect patients to bring this up if it is an issue. Image ![]()
Conclusion(s) Communication gaps were similar between US and EUR patients and HCPs. Bowel urgency is the second-most reported symptom by patients with moderate to severe UC. However, this symptom is not among the HCP-perceived top 3 most reported symptoms. Although a substantial proportion of patients reported a desire to discuss bowel urgency more frequently with their HCP, some patients reported feeling embarrassed talking about it. Many HCPs who do not proactively discuss this symptom expect patients to bring this up. A communication gap was identified and highlights the under-appreciation of bowel urgency as an important symptom of UC. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Eli Lilly and Company Disclosure of Interest S. Travis Grant / Research support from: AbbVie, BUHLMANN Diagnostics, ECCO, Eli Lilly and Company, Ferring Pharmaceuticals, International Organization for the Study of Inflammatory Bowel Disease, Janssen, Merck Sharp & Dohme, Normal Collision Foundation, Pfizer, Procter & Gamble, Schering-Plough, Takeda, UCB Pharma, Vifor Pharma, and Warner Chilcott, A. Bleakman Employee of: Eli Lilly and Company, D. Rubin Grant / Research support from: Takeda, Consultant of: AbbVie, Allergan, AltruBio, American College of Gastroenterology, Arena Pharmaceuticals, Athos Therapeutics, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene/Syneos Health, Cornerstones Health (non-profit), Eli Lilly and Company, Galen/Atlantica, Genentech/Roche, Gilead Sciences, GoDuRn, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen, Materia Prima, Pfizer, Prometheus Therapeutics and Diagnostics, Reistone Biopharma, Takeda, and TechLab, M. Dubinsky Shareholder of: Trellus Health, Grant / Research support from: AbbVie, Janssen, Pfizer, and Prometheus Biosciences, Consultant of: AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, F. Hoffmann-La Roche, Genentech, Gilead Sciences, Janssen, Pfizer, Prometheus Therapeutics and Diagnostics, Takeda, and UCB Pharma, R. Panaccione Grant / Research support from: AbbVie, Ferring Pharmaceuticals, Janssen, Pfizer, and Takeda, Consultant of: Abbott, AbbVie, Alimentiv, Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cosmo Pharmaceuticals, Eisai, Elan Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Galapagos NV, Genentech, Gilead Sciences, GlaxoSmithKline, Janssen, Merck, Mylan, Oppilan Pharma, Pandion Therapeutics, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda, Theravance Biopharma, and UCB Pharma, T. Hibi Grant / Research support from: AbbVie, Activaid, Alfresa Pharma, Bristol Myers Squibb, Eli Lilly Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceutical K.K., JMDC, Nippon Kayaku, Mochida Pharmaceutical, Pfizer Japan, and Takeda, Consultant of: AbbVie, Apo Plus Station, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly and Company, Gilead Sciences, Janssen, Kyorin, Mitsubishi Tanabe Pharma, Nichi-Iko Pharmaceutical, Pfizer, Takeda, and Zeria Pharmaceutical, Speakers bureau of: AbbVie, Aspen Japan K.K., Ferring Pharmaceuticals, Gilead Sciences, Janssen, JIMRO, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Pfizer, and Takeda, T. Gibble Employee of: Eli Lilly and Company, C. Kayhan Employee of: Eli Lilly and Company, E. Flynn Employee of: Eli Lilly and Company, C. Sapin Employee of: Eli Lilly and Company, C. Atkinson Consultant of: Eli Lilly and Company in connection with the development of this publication, Employee of: Adelphi Real World, S. Schreiber Grant / Research support from: personal fees and/or travel support from: AbbVie, Amgen, Arena Pharmaceuticals, Biogen, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly and Company, Dr. Falk Pharma, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos NV, Gilead Sciences, I-MAB Biopharma, Janssen, Merck Sharp & Dohme, Mylan, Novartis, Pfizer, Protagonist Therapeutics, Provention Bio, Roche, Sandoz/Hexal, Shire, Takeda, Theravance Biopharma, and UCB Pharma, J. Jones: None Declared
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Affiliation(s)
- S Travis
- University of Oxford, Oxford, United Kingdom
| | | | - D Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago
| | | | | | - T Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | | | - C Kayhan
- Eli Lilly and Company, Indianapolis
| | - E Flynn
- Eli Lilly and Company, Indianapolis, India
| | - C Sapin
- Eli Lilly and Company, Indianapolis
| | - C Atkinson
- Adelphi Real World, Bollington, United Kingdom
| | - S Schreiber
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Jones
- Division of Digestive Care and Endoscopy, Department of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
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Gomes AC, Baraniak IA, Lankina A, Moulder Z, Holenya P, Atkinson C, Tang G, Mahungu T, Kern F, Griffiths PD, Reeves MB. The cytomegalovirus gB/MF59 vaccine candidate induces antibodies against an antigenic domain controlling cell-to-cell spread. Nat Commun 2023; 14:1041. [PMID: 36823200 PMCID: PMC9950427 DOI: 10.1038/s41467-023-36683-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Vaccination against human cytomegalovirus (CMV) infection remains high priority. A recombinant form of a protein essential for CMV entry, glycoprotein B (gB), demonstrated partial protection in a clinical trial (NCT00299260) when delivered with the MF59 adjuvant. Although the antibody titre against gB correlated with protection poor neutralising responses against the 5 known antigenic domains (AD) of gB were evident. Here, we show that vaccination of CMV seronegative patients induces an antibody response against a region of gB we term AD-6. Responses to the polypeptide AD-6 are detected in >70% of vaccine recipients yet in <5% of naturally infected people. An AD-6 antibody binds to gB and to infected cells but not the virion directly. Consistent with this, the AD-6 antibody is non-neutralising but, instead, prevents cell-cell spread of CMV in vitro. The discovery of AD-6 responses has the potential to explain part of the protection mediated by gB vaccines against CMV following transplantation.
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Affiliation(s)
- A C Gomes
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - I A Baraniak
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - A Lankina
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - Z Moulder
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - P Holenya
- JPT Peptide Technologies GmbH, Berlin, Germany
| | - C Atkinson
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - G Tang
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - T Mahungu
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - F Kern
- JPT Peptide Technologies GmbH, Berlin, Germany
- Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - P D Griffiths
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom
| | - M B Reeves
- Institute of Immunity & Transplantation, UCL, London, NW3 2PP, United Kingdom.
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12
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Moseley RL, Atkinson C, Surman R, Greville-Harris M, May L, Vuillier L. Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia. J Eat Disord 2023; 11:18. [PMID: 36765413 PMCID: PMC9912205 DOI: 10.1186/s40337-023-00746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth 'autism'). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships. METHODS Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales. RESULTS In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia. CONCLUSIONS While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.
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Affiliation(s)
- R L Moseley
- Department of Psychology, Bournemouth University, Poole, UK.
| | - C Atkinson
- Department of Psychology, Bournemouth University, Poole, UK
| | - R Surman
- Department of Psychology, Bournemouth University, Poole, UK
| | | | - L May
- Dorset Healthcare University NHS Foundation Trust, Poole, UK
| | - L Vuillier
- Department of Psychology, Bournemouth University, Poole, UK
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton 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Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, 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S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Herbert G, England C, Perry R, Whitmarsh A, Moore T, Searle A, Chotaliya S, Ness A, Beasley M, Atkinson C. Impact of low iodine diets on ablation success in differentiated thyroid cancer: A mixed-methods systematic review and meta-analysis. Clin Endocrinol (Oxf) 2022; 97:702-729. [PMID: 35484696 PMCID: PMC9790217 DOI: 10.1111/cen.14751] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Debate remains regarding whether to recommend a low iodine diet (LID) before radioactive-iodine treatment and its duration and stringency. This mixed-methods review aimed to determine if iodine status affects treatment success, the most effective diet to reduce iodine status, and how LID impacts wellbeing. METHODS Five electronic databases were searched until February 2021. An effectiveness synthesis (quantitative studies) and views synthesis (qualitative, survey, and experience-based evidence) were conducted individually and then integrated. Quality assessment was undertaken. RESULTS Fifty-six quantitative and three qualitative studies were identified. There was greater ablation success for those with an iodine status of <50 mcg/L (or mcg/gCr) compared with ≥250 (odds ratio [OR] = 2.63, 95% confidence interval [CI], 1.18-5.86, n = 283, GRADE certainty of evidence very low). One study compared <50 mcg/L (or mcg/gCr) to 100-199 and showed similar rates of ablation success (OR = 1.59, 95% CI, 0.48-6.15, n = 113; moderate risk of bias). People following a stricter LID before ablation had similar rates of success to a less-strict diet (OR = 0.67, 95% CI, 0.26-1.73, n = 256, GRADE certainty of evidence very low). A stricter LID reduced iodine status more than a less strict (SMD = -0.40, 95% CI, -0.56 to -0.24, n = 816), and reduction was seen after 1 and 2 weeks. The main challenges were a negative impact on psychological health, over restriction, confusion, and difficulty for sub-groups. CONCLUSIONS Although a LID of 1-2 weeks reduces iodine status, it remains unclear whether iodine status affects treatment success as only a few low-quality studies have examined this. LIDs are challenging for patients. Higher-quality studies are needed to confirm whether a LID is necessary.
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Affiliation(s)
- Georgia Herbert
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Rachel Perry
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Alex Whitmarsh
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Theresa Moore
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | | | - Andy Ness
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
| | - Matthew Beasley
- University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme)University Hospitals Bristol and Weston NHS Foundation Trust and University of BristolBristolUK
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Delahunt B, Steigler A, Atkinson C, Christie D, Duchesne G, Egevad L, Joseph D, Kenwright D, Matthews J, Murray J, Oldmeadow C, Samaratunga H, Spry N, Thunders M, Hondermarck H, Denham J. Percentage grade 4 tumour predicts outcome for prostate adenocarcinoma in needle biopsies from patients with advanced disease: 10-year data from the TROG 03.04 RADAR trial. Pathology 2021; 54:49-54. [DOI: 10.1016/j.pathol.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
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Herbert G, England C, Perry R, Whitmarsh A, Moore T, Searle A, Chotaliya S, Ness A, Beasley M, Atkinson C. The impact of low iodine diets on people with differentiated thyroid cancer: a mixed methods systematic review. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Perry R, Herbert G, Atkinson C, England C, Northstone K, Baos S, Brush T, Chong A, Ness A, Harris J, Haase A, Shah S, Pufulete M. Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis. BMJ Open 2021; 11:e050806. [PMID: 34593498 PMCID: PMC8487197 DOI: 10.1136/bmjopen-2021-050806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020). SETTING Secondary care. PARTICIPANTS Patients (≥18 years) undergoing major elective surgery (curative or palliative). INTERVENTIONS Any intervention administered in the preoperative period with the aim of improving postoperative outcomes. OUTCOMES AND MEASURES Primary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use. REVIEW METHODS Two authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials. RESULTS 178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: -1.81 days, 95% CI -2.31 to -1.31; -2.11 days, 95% CI -3.07 to -1.15; -1.67 days, 95% CI -2.31 to -1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64). CONCLUSIONS Some prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low. PROSPERO REGISTRATION NUMBER CRD42015019191.
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Affiliation(s)
- Rachel Perry
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Georgia Herbert
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Clare England
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Baos
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Brush
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Chong
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Bristol BRC, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
- School of Oral and Dental Science, University of Bristol, Bristol, UK
| | - Jessica Harris
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
| | - Anne Haase
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sanjoy Shah
- University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, UK
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Mitchell A, England C, Perry R, Lander T, Shingler E, Searle A, Atkinson C. Dietary management for people with an ileostomy: a scoping review. JBI Evid Synth 2021; 19:2188-2306. [PMID: 34054034 DOI: 10.11124/jbies-20-00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review was to identify and map the evidence for oral dietary management of ileostomies. INTRODUCTION Dietary advice is commonly provided for ileostomy management but can be inconsistent, conflicting, and inadequate. There is a lack of high-quality research investigating dietary management of ileostomies. This scoping review highlights gaps in the literature that need addressing to inform practice, and identifies dietary strategies and outcomes to be investigated in future studies. INCLUSION CRITERIA Evidence relating to the use of oral dietary strategies to manage complications and nutritional consequences associated with having an ileostomy was included. Evidence included all types of original research (ie, quantitative and qualitative methodologies, expert opinion articles, and consensus guidelines). METHODS This review followed JBI methodology for scoping reviews. A pre-determined search of 13 databases, including MEDLINE, Embase, and Web of Science, was conducted in August 2019. The search was not limited by date, but during screening, expert opinion evidence was limited to 2008 onward. Data extraction was carried out by two reviewers for each study/article using a database tool designed specifically for this review. Results are presented using a combination of tabular summaries and narrative reports. RESULTS Thirty-one research studies were included: 11 experimental (including four crossover randomized controlled trials), three pre-post design, 13 observational (12 cross-sectional, one longitudinal), and four qualitative. Forty-four expert opinion articles/guidelines were also included. In experimental studies, nine nutrient modifications and 34 individual foods/drinks were investigated. In pre-post studies, 10 nutrient modifications, 80 foods/drinks, and 11 eating-related behaviors were investigated. In observational studies, eight nutrient modifications, 94 foods/drinks, and five eating-related behaviors were reported. In qualitative studies, two nutrient modifications, 17 foods/drinks, and one eating-related behavior were reported. In expert opinion articles/guidelines, recommendations relating to 51 nutrient modifications, 339 foods/drinks, and 23 eating-related behaviors were reported. Although large numbers of individual foods and drinks were suggested to be associated with outcomes relating to ileostomy management, findings from observational studies showed these were generally reported by <50% of people with an ileostomy. The most common nutrients reported in association with outcomes related to ileostomy management were fiber, fat, and alcohol. Across most outcomes and studies/expert opinion, low fiber and low fat were suggested to be beneficial, while alcohol was detrimental. Other nutrient associations frequently reported in expert opinion (but with minimal attention in research studies) included negative consequences of caffeinated drinks and positive effects of white starchy carbohydrates on stoma output. Output volume and consistency were the most commonly reported outcomes relating to ileostomy management across all study types. Flatulence and odor were also common outcomes in observational studies. CONCLUSIONS This review found an abundance of literature, particularly expert opinion, reporting on dietary management for people with an ileostomy. However, this literature was highly heterogeneous in terms of dietary strategies and outcomes reported. It is likely that most dietary advice provided in practice is based on expert opinion with some supported by limited research. High-quality research investigating the effect of the dietary strategies identified in this review on commonly associated outcomes relating to ileostomy management is needed to improve evidence-based advice.
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Affiliation(s)
- Alexandra Mitchell
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Rachel Perry
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Tom Lander
- Department of Nutrition and Dietetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ellie Shingler
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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Atkinson C, Ganeshan B, Endozo R, Wan S, Aldridge MD, Groves AM, Bomanji JB, Gaze MN. Radiomics-Based Texture Analysis of 68Ga-DOTATATE Positron Emission Tomography and Computed Tomography Images as a Prognostic Biomarker in Adults With Neuroendocrine Cancers Treated With 177Lu-DOTATATE. Front Oncol 2021; 11:686235. [PMID: 34408979 PMCID: PMC8366561 DOI: 10.3389/fonc.2021.686235] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Neuroendocrine tumors (NET) are rare cancers with variable behavior. A better understanding of prognosis would aid individualized management. The aim of this hypothesis-generating pilot study was to investigate the prognostic potential of tumor heterogeneity and tracer avidity in NET using texture analysis (TA) of 68Ga-DOTATATE positron emission tomography (PET) and non-enhanced computed tomography (CT) performed at baseline in patients treated with 177Lu-DOTATATE. It aims to justify a larger-scale study to evaluate its clinical value. Methods The pretherapy 68Ga-DOTATATE PET-CT scans of 44 patients with metastatic NET (carcinoid, pancreatic, thyroid, head and neck, catecholamine-secreting, and unknown primary NET) treated with 177Lu-DOTATATE were analyzed retrospectively using commercially available texture analysis research software. Image filtration extracted and enhanced objects of different sizes (fine, medium, coarse), then quantified heterogeneity by statistical and histogram-based parameters (mean intensity, standard deviation, entropy, mean of positive pixels, skewness, and kurtosis). Regions of interest were manually drawn around up to five of the most 68Ga-DOTATATE avid lesions for each patient. 68Gallium uptake on PET was quantified as SUVmax and SUVmean. Associations between imaging and clinical markers with progression-free (PFS) and overall survival (OS) were assessed using univariate Kaplan-Meier analysis. Independence of the significant univariate markers of survival was tested using multivariate Cox regression analysis. Results Measures of heterogeneity (higher kurtosis, higher entropy, and lower skewness) on coarse-texture scale CT and unfiltered PET images predicted shorter PFS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness: p=0.03) and shorter OS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness p=0.02). Conventional PET parameters such as SUVmax and SUVmean showed trends towards predicting outcome but were not statistically significant. Multivariate analysis identified that CT-TA (coarse kurtosis: HR=2.57, 95% CI=1.22–5.38, p=0.013) independently predicted PFS, and PET-TA (unfiltered skewness: HR=9.05, 95% CI=1.19–68.91, p=0.033) independently predicted OS. Conclusion These preliminary data generate a hypothesis that radiomic analysis of neuroendocrine cancer on 68Ga-DOTATATE PET-CT may be of prognostic value and a valuable addition to the assessment of patients.
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Affiliation(s)
- Charlotte Atkinson
- Departments of Oncology and Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Raymond Endozo
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Simon Wan
- Departments of Oncology and Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Matthew D Aldridge
- Departments of Oncology and Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Jamshed B Bomanji
- Departments of Oncology and Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark N Gaze
- Departments of Oncology and Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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McQuiston A, Li C, Patel K, Tu Z, Cheng Q, Tomlinson S, Atkinson C. A Novel Natural Autoantibody Targeted Complement Inhibitor Protects against Lung Transplant Ischemia Reperfusion Injury. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1874] [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: 11/27/2022] Open
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James S, Tyrrell-Price J, Atkinson C, Hunt L, Searle A, Phillips K, Penfold C, Carter J, Ness A. Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study. Clin Nutr ESPEN 2021; 42:339-347. [PMID: 33745603 DOI: 10.1016/j.clnesp.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL). METHODS Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements. RESULTS 10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's rs = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading. CONCLUSIONS Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
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Affiliation(s)
- S James
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - J Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - L Hunt
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - A Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Phillips
- Department of Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - J Carter
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
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Mitchell A, England C, Atkinson C. Provision of dietary advice for people with an ileostomy: a survey in the UK and Ireland. Colorectal Dis 2020; 22:2222-2231. [PMID: 32668070 DOI: 10.1111/codi.15268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore whether people with an ileostomy in the UK and Ireland receive the dietary advice they require. METHOD An online survey with multiple-choice questions asked people with an ileostomy about the dietary advice they received and would have preferred to receive. Participants were recruited via websites of the Ileostomy and Internal Pouch Association and Crohn's and Colitis UK and via social media. People with a current ileostomy, age 16 years or over, and living in the UK or Ireland were eligible for inclusion. Responses were analysed using descriptive statistics. RESULTS In all, 291 eligible responses were received and included in the analysis; 201 (69%) received advice on diet for their ileostomy from a healthcare professional or the internet. Of the 90 who did not receive dietary advice, 82 (91%) would have liked advice. Stoma nurses were the most common source of dietary advice (55%), but many other sources were frequently reported. Most (62%) felt that at least some dietary advice they received was conflicting. Over half (55%) felt anxious about managing their diet with a new ileostomy, 39% were confused, and 31% frustrated. Of 291 respondents, 29% received advice from a dietitian compared to 60% who would have preferred advice from a dietitian. CONCLUSION Many people undergoing ileostomy surgery do not receive the dietary advice and support they require. Healthcare professionals working with people with an ileostomy should be mindful they are often anxious about their diet and require clear and consistent dietary advice and support.
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Affiliation(s)
- A Mitchell
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - C England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
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Mitchell A, England C, Atkinson C. A survey of dietary advice for people with an ileostomy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.561] [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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Atkinson C, Pufulete M, Herbert G, England C, Perry R. Nutrition-based pre-admission interventions to improve outcome after elective surgery: Preliminary findings from a systematic review. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.562] [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: 11/29/2022]
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Mycock K, Zhan L, Hart K, Taylor-Stokes G, Milligan G, Atkinson C, Mitra D. Real world treatment patterns and clinical outcomes associated with palbociclib combination therapy in nine european countries: Results from the IRIS study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30813-3] [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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Herbert G, Searle A, England CY, Ness A, Beasley M, Haupt-Schott I, Moss L, Wescott J, Atkinson C. Experiences of low iodine diets in the treatment of differentiated thyroid cancer with radioactive iodine ablation therapy. Clin Nutr ESPEN 2020; 39:190-197. [PMID: 32859315 DOI: 10.1016/j.clnesp.2020.06.017] [Citation(s) in RCA: 2] [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] [Received: 01/06/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS International guidelines on the treatment of differentiated thyroid cancers (DTC) promote the use of low iodine diets (LID) prior to radioactive iodine remnant ablation (RIA), as high iodine status may interfere with radioiodine uptake. Most UK treatment centres adhere to these guidelines and advise people to consume a LID. There is limited research as to how people cope with the LID or its impact on daily life and wellbeing, and no studies have been conducted in the UK. This study explored peoples' views and experiences in relation to consuming a LID during treatment for DTC with RIA. METHODS Twenty-eight semi-structured interviews were conducted with people from across three treatment centres where differing advice had been delivered regarding a LID. Interviews were recorded, transcribed verbatim and key themes were developed through inductive thematic analyses. RESULTS Individuals advised to consume a LID believed that adhering to the diet would help their treatment. Most restricted their diets beyond what was recommended and there was confusion surrounding what they could eat as part of the diet. Food selection and preparation were important which included substitution of foods and ingredient checking. Being on the diet was considered to have both a physical and psychological impact. CONCLUSIONS The findings of this study provide a qualitative insight into the lived experiences of people with DTC in relation to consuming a LID. The results have relevance for professionals providing dietary guidance at oncology centres treating patients with RIA therapy in the UK.
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Affiliation(s)
- Georgia Herbert
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Clare Yvonne England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Andy Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Matthew Beasley
- University Hospitals Bristol NHS Trust, Marlborough Street, Bristol, UK
| | | | - Laura Moss
- Velindre Cancer Centre, Velindre Road, Whitchurch, Cardiff, UK
| | | | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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Touma Z, Hoskin B, Atkinson C, Bell D, Massey O, Lofland JH, Berry P, Karyekar C, Costenbader K. SAT0213 IMPACT OF FLARES ON HEALTHCARE RESOURCE USAGE AND PROS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The effect of flares on healthcare resource usage and patient-reported outcome scores in SLE patients is not well quantified.Objectives:To understand how flares impact healthcare resource utilization (HCRU) and patient-reported outcomes amongst an international real-world dataset of SLE patients.Methods:The Adelphi Real World 2015 Lupus Disease Specific Programme (DSP) is a cross-sectional study of 263 rheumatologists in the US and EU5. Rheumatologists were asked to complete patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; the same patients were asked to complete patient self-completion (PSC) forms describing how SLE affected them. PRFs collected data pertaining to the patient’s diagnosis, disease history, current clinical outcomes, treatment and management history. PSCs collected similar data and included patient-reported outcome measures (PROs) to assess humanistic burden. Propensity score matching was used to assess differences in HCRU and health status between SLE patients who had flared (physician defined) in the last 12 months and those who had not. Matching variables were patient ethnicity, time since diagnosis, and severity at diagnosis. Data were extracted from 1278 PRFs, and 591 PSCs. Propensity score matching was carried out on two matched groups of 408 patients.Results:Demographic data are reported in Table 1. Propensity score matching showed patients who flared in the last 12 months experienced significantly greater hospitalizations, visits to the ER, and total HCP consults in the last 12 months. Significantly greater drug burden lower physician and patient satisfaction, lower EQ-5D score (worse health status), lower FACIT Fatigue score (greater fatigue), and greater overall work impairment (Table 2) were also observed.Table 1.Demographic dataVariableFlared in last 12 monthsNot flared in the last 12 monthsMean age (years)41.842.4% Female86.087.0% White/Caucasian66.276.3Mean years diagnosed5.95.4Table 2.Propensity score matching resultsOutcome variableFlared meanNot flared meanCoefficient95% CIp-valueHospitalisations in last 12 months24.267.630.17[0.12 – 0.21]<0.001Emergency department visits in last 12 months20.834.190.17[0.12 – 0.21]<0.001Number of tests in last 12 months46.4938.907.59[3.74 – 11.44]<0.001Number of current medications2.762.190.57[0.43 – 0.72]<0.001Physician satisfied64.4686.63-0.22[-0.28 – -0.17]<0.001Patient satisfied69.2985.09-0.16[-0.24 – -0.08]<0.001EQ-5D-3L0.720.83-0.11[-0.15 – -0.07]<0.001FACIT Fatigue30.0636.48-6.42[-8.5 – -4.3]<0.001WPAI overall percentage work impairment42.7430.2312.5[7.51 – 17.50]<0.001Conclusion:The analysis of international real-world data confirmed that SLE patients who flared in the last year represent a greater burden on healthcare resource and demonstrate significantly worse health status, greater fatigue, lower patient and physician satisfaction and greater overall work impairment compared with non-flaring patients. There is a need for more effective treatments in this patient population to reduce patient and healthcare burden.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, Olivia Massey Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Touma Z, Hoskin B, Atkinson C, Bell D, Massey O, Lofland JH, Berry P, Karyekar C, Costenbader K. THU0246 DIAGNOSTIC CLUSTER PROFILING OF PATIENTS IN A REAL-WORLD DATA SET WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Previous systemic lupus erythematosus (SLE) studies have identified potential clusters of SLE clinical manifestations post diagnosis.Objectives:To describe the presentation of SLE at diagnosis across different cohorts of patients and describe management and outcomes after diagnosis within clusters.Methods:Cross-sectional study of 263 rheumatologists in the US and EU5. Data were collected from the Adelphi Real World 2015 Lupus Disease Specific Programme. Rheumatologists completed patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; these patients completed patient self-completion (PSC) forms describing how SLE affected them. PRF data includes patient’s characteristics and management history. PSCs focused on similar data collection, including patient reported outcome measures on the humanistic burden. Age at diagnosis, symptoms at diagnosis, organ involvement at diagnosis, and severity at diagnosis were used as covariates in a latent cluster analysis.Results:Data were extracted from 1376 PRFs. Cluster analysis resulted in up to 6 clusters, and disease understanding led to the selection of a 4-cluster solution.Cluster 1 displayed the mildest disease, characterised by joint involvement, while cluster 2 displayed more skin involvement in conjunction with joint. Cluster 3 were characterised by renal involvement and cluster 4 had skin and joint involvement, but also high constitutional and haematological involvement at diagnosis (Table 1).Table 1Cluster analysisClustersOrgan involvement at diagnosis, n (%)Overall(n=1304)1(n=210)2(n=493)3(n=162)4(n=439)p-valueMusculoskeletal1145 (87.8)174 (82.9)444 (90.1)134 (82.7)393 (89.5)0.0065Mucocutaneous898 (68.9)5 (2.4)397 (80.5)95 (58.6)401 (91.3)<0.0001Neuropsychiatric87 (6.7)19 (9.0)9 (1.8)16 (9.9)43 (9.8)<0.0001Cardiorespiratory176 (13.5)36 (17.1)14 (2.8)22 (13.6)104 (23.7)<0.0001Gastrointestinal44 (3.4)8 (3.0)14 (2.8)8 (4.9)14 (3.2)0.6115Opthalmic47 (3.6)020 (4.1)10 (6.2)17 (3.9)0.0102Renal213 (16.6)15 (7.1)9 (1.8)162 (100)27 (6.2)<0.0001Constitutional425 (32.6)45 (21.4)89 (18.1)55 (34.0)236 (53.8)<0.0001Haematological452 (34.7)64 (30.5)22 (4.5)80 (49.4(286 (65.1)<0.0001Severity at diagnosis, n (%)Mild209 (16.0)55 (26.2)99 (20.1)1 (0.6)54 (12.3)<0.0001Moderate806 (61.8)122 (58.1)324 (65.7)75 (46.3)285 (64.9)Severe289 (22.2)33 (15.7)70 (14.2)86 (53.1)100 (22.8)Significant between-cluster differences were observed when comparing outcomes; cluster 4 have been diagnosed longest (mean weeks diagnosed 354.6 v. 1: 232.6, 2: 228.7, 3: 338.2, p<0.0001). Cluster 3 consulted more in the last 12 months (mean number of visits 7.9 vs. 1: 5.7, 2: 6.3, 4: 7.6).Significant differences were also observed between clusters in relation to current treatment proportions: corticosteroid (highest cluster 3: 78.4%), immunosuppressant (highest cluster 3: 75.3%), biologic DMARD (highest cluster 4: 17.8%) and antidepressant (highest cluster 4: 4.1%).Conclusion:This study demonstrates the heterogeneity of SLE at diagnosis and highlights four distinct presentations of the disease at diagnosis. Significant proportions of patients present with advanced disease, these clusters go on to present the greatest burden demonstrating the need for better diagnostic tools and novel earlier intervention.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, Olivia Massey Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Touma Z, Hoskin B, Atkinson C, Bell D, Pike J, Lofland JH, Berry P, Karyekar C, Costenbader K. AB1170 THE IMPACT OF HIGH DISEASE ACTIVITY AS MEASURED BY SLEDAI AND DRUG BURDEN-ON HEALTHCARE UTILIZATION, QUALITY OF LIFE AND WORK PRODUCTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Although there is abundant literature on healthcare utilization in SLE patients, the impact of disease activity in SLE patients is not well understood.Objectives:To quantify the impact of disease activity, as measured by SLEDAI score and drug burden, in SLE patients on health care resource utilization (HCRU), health related quality of life (HRQoL) and work productivity (WP).Methods:Data were collected from a cross-sectional survey of 754 rheumatologists in US and EU5 from the Adelphi Real World 2010/2013/2015 Lupus Disease Specific Programmes (DSP). Physicians were asked to complete patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; the same patients were asked to complete patient self-completion (PSC) forms describing how SLE affected them. PRFs collected data pertaining to the patient’s diagnosis, disease history, current clinical outcomes, treatment and management history. PSCs focused on similar data collection and included patient reported outcome measures (PROs). Propensity score matching was used to assess differences in HCRU and PRO scores between SLE patients who had a low disease activity and those who had a high disease activity. Low disease activity was defined as a SLEDAI score of ≤4, a steroid dose of <7.5mg/day, and not on immunosuppressant or biologic. High disease activity was a SLEDAI score of >4, or on an immunosuppressant, biologic, or steroid dose of >7.5mg/day. Patients were matched on age, sex, and ethnicity.Results:Data was extracted from 1278 PRFs, and 591 PSCs. Using the estimated propensity score each low disease activity patient (n=44) was matched with a high disease activity patient (n=1187). Using 1:1 matching, with replacement and allowing for ties, matching resulted in 414 high disease activity patients being used as matches for 44 low disease activity patients. Demographic data are reported in Table 1. Patients with a low disease activity were significantly less likely to be currently flaring, lower number of flares in last 12 months, less likely to have been hospitalized in the last 12 months, had fewer consultations in the last 12 months, reported better HrQoL (EQ5D), more favourable levels of fatigue (FACIT), and lower work impairment (WPAI). (Table 2).Table 1.Demographic dataVariableLow disease activityHigh disease activityMean age (years)38.140.0% Female90.788.2% White/Caucasian76.767.7Mean years diagnosed5.55.0Table 1.Propensity score matching resultsOutcome variableLow activity meanHigh activity meanCoefficient95% CIp-valueFlared in the last 12 months11.6337.97-0.26[-0.38 – -0.14]<0.001Number of flares in last 12 months0.210.70-0.49[-0.72 - -0.26]<0.001Hospitalised in last 12 months4.6514.98-0.10[-0.17 – -0.04]0.001Number of consults in last 12 months2.843.52-0.68[-1.19 – -0.17]0.009EQ-5D-3L0.780.880.10[0.03 – 0.17]0.004FACIT Fatigue34.6839.865.19[0.80 – 9.57]0.02WPAI overall percentage work impairment14.4245.35-30.93[-45.32 – -16.54]<0.001Conclusion:Systemic lupus erythematosus patients with lower levels of disease activity are less burdensome to the healthcare system and experience a significantly better HRQoL and lower levels of productivity impairment. There is a need to establish a universal definition of low disease activity as a treatment goal to benefit patient quality of life and reduce HCRU.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, James Pike Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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England CY, Moss L, Beasley M, Haupt-Schott I, Herbert G, Atkinson C. A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer. Eur Thyroid J 2020; 9:132-138. [PMID: 32523889 PMCID: PMC7265714 DOI: 10.1159/000504706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice. METHODS We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer 131I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed. RESULTS Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when 131I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24-48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice. CONCLUSIONS UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.
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Affiliation(s)
- Clare Yvonne England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
- *Clare Yvonne England, Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ (UK), E-Mail
| | - Laura Moss
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - Matthew Beasley
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | | | - Georgia Herbert
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Atkinson C, Monk VC, Ness AR, Lewis SJ, Longman RJ, Thomas SJ, Leary SD, Hollingworth W, Penfold CM. Factors associated with early postoperative feeding: An observational study in a colorectal surgery population. Clin Nutr ESPEN 2020; 36:99-105. [PMID: 32220375 DOI: 10.1016/j.clnesp.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/19/2019] [Accepted: 01/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Early post-operative feeding is recommended within enhanced recovery after surgery programmes. This study aimed to describe post-operative feeding patterns and associated factors among patients following colorectal surgery, using a post-hoc analysis of observational data from a previous RCT on chewing gum after surgery. METHODS Data from 301 participants (59% male, median age 67 years) were included. Amounts of meals consumed on post-operative days (POD) 1-5 were recorded as: none, a quarter, half, three-quarters, all. 'Early' consumers were those who ate ≥a quarter of a meal on POD1. 'Early' tolerance was the consumption of at least half of three meals on POD1 or 2 without vomiting. Exploration of selected peri-operative factors with early feeding and tolerance were assessed using logistic regression. RESULTS 222 people (73.8%) consumed solid food early, and 109 people (36.2%) tolerated solid food early. Several factors were associated with postoperative feeding: provision of pre-operative bowel preparation was associated with delayed consumption [odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83] and tolerance (OR 0.35, 95% CI 0.16-0.81) of food; and laparoscopic/laparoscopic assisted (vs. open/converted to open surgery) was associated with early tolerance of food (OR 1.99, 95% CI 1.17-3.39). CONCLUSIONS While three-quarters of the study population ate solid food early, only one-third tolerated solid food early. Findings suggest that bowel preparation and surgery type are factors warranting further investigation in future studies to improve uptake of early post-operative feeding.
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Affiliation(s)
- Charlotte Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Bristol Dental School, University of Bristol, Bristol, UK.
| | - Vaneesha C Monk
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Andy R Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Bristol Dental School, University of Bristol, Bristol, UK
| | - Stephen J Lewis
- Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Sam D Leary
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Bristol Dental School, University of Bristol, Bristol, UK
| | | | - Chris M Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Bristol Medical School, University of Bristol, Bristol, UK
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Hassett BR, Dean MC, Ring S, Atkinson C, Ness AR, Humphrey L. Effects of maternal, gestational, and perinatal variables on neonatal line width observed in a modern UK birth cohort. Am J Phys Anthropol 2020; 172:314-332. [DOI: 10.1002/ajpa.24042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/06/2020] [Accepted: 02/26/2020] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Susan Ring
- Bristol Medical School, University of Bristol Bristol UK
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Kingdon J, Aadan H, Husain S, Atkinson C, Thomson C, Braude P. 22 Design and Implementation of A Nutrition Clinical Pathway for Patients with Fractured Neck of Femur. Age Ageing 2020. [DOI: 10.1093/ageing/afz183.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with a fractured neck of femur (FNOF) are commonly malnourished pre-admission, have reduced oral intake in hospital and a hypermetabolic state up to three months postoperatively (E Paillaud 2000). Malnutrition is associated with functional deterioration, higher morbidity and mortality.
Evidence suggests nutritional supplementation post-surgery can reduce postoperative complications. As a result, nutritional assessment is included in the National Hip Fracture Database best practice tariff (Avenell, Cochrane Database of Systematic Reviews 2016).
Introduction
Our aim was to design and implement a clinical pathway for patients with FNOF to identify malnutrition and provide appropriate nutritional support.
Intervention
A retrospective audit of 25 patients was completed to understand baseline rates of assessment, prescription of supplements and referral to dietetics. Using these data meetings were arranged to develop a clinical pathway. Key stakeholders included dietetics, orthopaedic surgeons, geriatricians, physiotherapists and nurses. The pathway was evaluated and optimised with two Plan-Do-Study-Act (PDSA) cycles looking at 25 patients each time.
Results
Baseline: 79% received a nutritional assessment, 32% had nutritional supplements prescribed and 36% (n=9) met criteria for referral to a dietician, of which 55%were referred. However, an additional 5 referrals were made to dietetics for patients who did not meet criteria, a 50% inappropriate referral rate.
PDSA cycle 1: increased nutritional assessment (85%), increased nutritional supplements prescribed (92%), decreased inappropriate referrals to dietetics (43%).
PDSA cycle 2: increased nutritional assessment & nutritional supplements prescribed (100%), increased inappropriate referrals to dietetics (80%).
Conclusions
The implementation of a nutrition pathway has led to increased identification and treatment of malnutrition, which has in addition improved accrual of the best practice tariff. However, greater number of inappropriate referrals have been made to dietetics. This is partly attributed to difficulty weighing patients on admission, and where no weight is inputted on the Malnutrition Universal Screening Tool a “High Risk” score is generated triggering a referral. We are now looking at alternative methods to obtaining a weight such a mid-upper arm circumference.
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Affiliation(s)
- J Kingdon
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
| | - H Aadan
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
| | - S Husain
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
| | - C Atkinson
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
| | - C Thomson
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
| | - P Braude
- Department of Aging and Health, Guy’s and St Thomas’s Hospital
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Maugars G, Pasquier J, Atkinson C, Lafont AG, Campo A, Kamech N, Lefranc B, Leprince J, Dufour S, Rousseau K. Gonadotropin-inhibitory hormone in teleosts: New insights from a basal representative, the eel. Gen Comp Endocrinol 2020; 287:113350. [PMID: 31794732 DOI: 10.1016/j.ygcen.2019.113350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/27/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
Since its discovery in birds, gonadotropin-inhibitory hormone (GnIH) has triggered investigation in the other groups of vertebrates. In the present study, we have identified a single gnih gene in the European eel (Anguilla anguilla), a representative species of a basal group of teleosts (Elopomorphs). We have also retrieved a single gnih gene in Osteoglossomorphs, as well as in more recently emerged teleosts, Clupeocephala. Phylogeny and synteny analyses allowed us to infer that one of the two gnih paralogs emerged from the teleost-specific whole genome duplication (TWGD or 3R), would have been lost shortly after the 3R, before the emergence of the basal groups of teleosts. This led to the presence of a single gnih in extant teleosts as in other vertebrates. Two gnih paralogs were still found in some teleost species, such as in salmonids, but resulting from the additional whole genome duplication that specifically occurred in this lineage (4R). Eel gnih was mostly expressed in the diencephalon part of the brain, as analyzed by quantitative real-time PCR. Cloning of eel gnih cDNA confirmed that the sequence of the GnIH precursor encoded three putative mature GnIH peptides (aaGnIH-1, aaGnIH-2 and aaGnIH-3), which were synthesized and tested for their direct effects on eel pituitary cells in vitro. Eel GnIH peptides inhibited the expression of gonadotropin subunits (lhβ, fshβ, and common a-subunit) as well as of GnRH receptor (gnrh-r2), with no effect on tshβ and gh expression. The inhibitory effect of GnIH peptides on gonadotropic function in a basal teleost is in agreement with an ancestral inhibitory role of GnIH in the neuroendocrine control of reproduction in vertebrates.
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Affiliation(s)
- G Maugars
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - J Pasquier
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - C Atkinson
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - A-G Lafont
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - A Campo
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - N Kamech
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - B Lefranc
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, INSERM U1239, Normandy University, Rouen, France
| | - J Leprince
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, INSERM U1239, Normandy University, Rouen, France
| | - S Dufour
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France
| | - K Rousseau
- Muséum National d'Histoire Naturelle, Research Unit BOREA, Biology of Aquatic Organisms and Ecosystems, CNRS, IRD, SU, UCN, UA, Paris, France.
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Hau E, Hegi-Johnson F, Atkinson C, Barber J, Browne LH, Chin Y, Dwyer P, Graham PH, O'Hare J, Lu D, Rains M, Ragusa C, Schmidth L, Small K, Unicomb K, West K, White S, Last A, Ludbrook J, Azzi M, Aherne NJ, Van Tilburg K, Vinod S, Ma X, Yeghiaian Alvandi R. Collaborative implementation of stereotactic ablative body radiotherapy: A model for the safe implementation of complex radiotherapy techniques in Australia. Asia Pac J Clin Oncol 2019; 16:39-44. [PMID: 31777176 DOI: 10.1111/ajco.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/04/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) for lung cancer is a modality of treatment that has improved outcomes for lung cancer patients. However, radiotherapy for lung cancer is underutilized and fewer than half of elderly patients with non-small cell lung cancer (NSCLC) receive active treatment. The purpose of this study is to report on a collaboration in implementing an NSCLC SABR (stereotactic ablative body radiation) program safely, efficiently, and uniformly across several centers, including regional sites. The first aim of this paper is to detail the collaboration and implementation that started in 2013 and is ongoing. The second aim of this paper is to document early toxicities and quality of life outcomes. METHOD A tripartite approach was used to develop the protocol and networks required for the implementation of SABR across multiple sites in NSW. Departments starting the programmes were supported and physics credentialing with central site submission was required before commencing the treatment. Additional ongoing support was available via an email discussion group involving all members of the collaboration. RESULTS Between July 22, 2013 and February 22, 2016, 41 patients were enrolled with 34 patients in active follow up. The toxicity profile so far is similar to those of published studies with no appreciable effect on quality of life outcomes. CONCLUSION The collaboration formed an effective framework in facilitating the implementation of SABR across several sites in NSW and could be used as a model for the safe and uniform implementation of new technologies in Australia.
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Affiliation(s)
- Eric Hau
- Sydney West Radiation Oncology Network, Sydney, Australia.,University of Sydney, Sydney, Australia
| | | | | | - Jeffrey Barber
- Blacktown Haematology and Cancer Care Centre, Sydney, Australia
| | | | - Yaw Chin
- St George Hospital, Kogarah, NSW, Australia
| | - Patrick Dwyer
- Northern New South Wales Cancer Institute, Lismore, NSW, Australia
| | | | - Jolyne O'Hare
- Northern Ireland Cancer Centre on the Belfast City Hospital site
| | - Dan Lu
- St George Hospital, Kogarah, NSW, Australia
| | | | | | | | | | | | | | - Sean White
- Nepean Cancer Care Centre, NSW, Australia
| | - Andrew Last
- Mid North Coast Cancer Institute, Port Macquarie, NSW, Australia
| | | | - Maria Azzi
- Nepean Cancer Care Centre, Nepean, Australia
| | - Noel J Aherne
- Mid North Coast Cancer Institute Coffs Harbour, NSW, Australia
| | | | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, UNSW, NSW, Australia
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Abstract
Abstract
Phytoestrogens occur naturally in plants and are structurally similar to mammalian estrogens. The lignans are a class of phytoestrogen and can be metabolized to the biologically active enterolignans, enterodiol, and enterolactone by a consortium of intestinal bacteria. Secoisolariciresinol diglucoside (SDG), a plant lignan, is metabolized to enterodiol and, subsequently, enterolactone. Matairesinol, another plant lignan, is metabolized to enterolactone. Other dietary enterolignan precursors include lariciresinol, pinoresinol, syringaresinol, arctigenin, and sesamin. Enterolignan exposure is determined in part by intake of these precursors, gut bacterial activity, and host conjugating enzyme activity. A single SDG dose results in enterolignan appearance in plasma 810 h latera timeframe associated with colonic bacterial metabolism and absorption. Conjugation of enterolignans with sulfate and glucuronic acid occurs in the intestinal wall and liver, with the predominant conjugates wall and liver, with the predominant conjugates have demonstrated dose-dependent urinary lignan excretion in response to flaxseed consumption (a source of SDG); however, even in the context of controlled studies, there is substantial interindividual variation in plasma concentrations and urinary excretion of enterolignans. The complex interaction between colonic environment and external and internal factors that modulate it likely contribute to this variation. Knowledge of this field, to date, indicates that understanding the sources of variation and measuring the relevant panel of compounds are important in order to use these measures effectively in evaluating the impact of lignans on human health.
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Affiliation(s)
- Johanna W Lampe
- Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Seattle, WA 98109; University of Washington, Department of Epidemiology, Nutritional Sciences Program, Seattle, WA 98195
| | - Charlotte Atkinson
- Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Seattle, WA 98109
| | - Meredith A J Hullar
- Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Seattle, WA 98109
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Shingler E, Perks C, Herbert G, Ness A, Atkinson C. A feasibility randomised controlled trial of short-term fasting prior to CAPOX chemotherapy for stage 2/3 colorectal cancer: SWiFT protocol. Pilot Feasibility Stud 2019; 5:134. [PMID: 31832229 PMCID: PMC6868731 DOI: 10.1186/s40814-019-0505-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background Capecitabine and oxaliplatin (CAPOX) chemotherapy is a standard treatment for stage 2/3 colorectal cancer. Treatment is associated with dose-limiting toxicities such as neutropenia, vomiting, diarrhoea, and stomatitis. Short-term fasting prior to chemotherapy may help protect normal cells from the toxic effects of chemotherapy by allowing them to conserve energy for maintenance and repair. However, there is a lack of evidence to support the efficacy of short-term fasting in protecting against chemotherapy-related toxicities in humans, and it is not known whether people due to undergo chemotherapy will be willing and able to follow a short-term fast. Preliminary data confirming this is feasible are required before adequately powered trials can be designed and conducted. Methods The short-term, water only, fasting trial (SWiFT) is a two-armed feasibility randomised controlled trial, aiming to recruit 30 people scheduled to begin routine treatment with CAPOX chemotherapy for stage 2/3 colorectal cancer. Participants will be randomly allocated, in a 1:1 ratio, to either a 36-h fast or standard dietary advice prior to chemotherapy administration for the first 3 cycles of chemotherapy. The primary outcome measures will assess the feasibility of the trial and include: adherence to intervention, recruitment, retention, and data completion rates as well as the acceptability of the intervention which will be qualitatively assessed. The secondary outcome measures aim to provide further information on possible outcomes of interest for a definitive trial and include side effects of chemotherapy, quality of life, markers of cellular metabolism and inflammation, appetite, and sarcopenia. Discussion It is not known whether it is possible to recruit to a trial of short-term fasting in this population, or whether participants would be able to adhere to the intervention. Therefore, we aim to test the feasibility of a pre-chemotherapy, 36-h, water-only fast in people receiving CAPOX chemotherapy for stage 2/3 colorectal cancer. Trial registration This trial has been registered with the ISRCTN Registry. Trial registration no: ISRCTN17994717. Date of registration: 23 October 2018. URL: http://www.isrctn.com/ISRCTN17994717
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Affiliation(s)
- Ellie Shingler
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE England
| | - Claire Perks
- 2School of Clinical Sciences, University of Bristol, Bristol, England
| | - Georgia Herbert
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE England
| | - Andy Ness
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE England
| | - Charlotte Atkinson
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE England
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Atkinson C. A200 ASTHMA POPULATION MANAGEMENT IN THE CHILDREN'S HOSPITAL EMERGENCY DEPARTMENT. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.044] [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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Herbert G, Perry R, Andersen HK, Atkinson C, Penfold C, Lewis SJ, Ness AR, Thomas S. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev 2019; 7:CD004080. [PMID: 31329285 PMCID: PMC6645186 DOI: 10.1002/14651858.cd004080.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/30/2023]
Abstract
BACKGROUND This is an update of the review last published in 2011. It focuses on early postoperative enteral nutrition after lower gastrointestinal surgery. Traditional management consisted of 'nil by mouth', where patients receive fluids followed by solids after bowel function has returned. Although several trials have reported lower incidence of infectious complications and faster wound healing upon early feeding, other trials have shown no effect. The immediate advantage of energy intake (carbohydrates, protein or fat) could enhance recovery with fewer complications, and this warrants a systematic evaluation. OBJECTIVES To evaluate whether early commencement of postoperative enteral nutrition (within 24 hours), oral intake and any kind of tube feeding (gastric, duodenal or jejunal), compared with traditional management (delayed nutritional supply) is associated with a shorter length of hospital stay (LoS), fewer complications, mortality and adverse events in patients undergoing lower gastrointestinal surgery (distal to the ligament of Treitz). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library 2017, issue 10), Ovid MEDLINE (1950 to 15 November 2017), Ovid Embase (1974 to 15 November 2017). We also searched for ongoing trials in ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (15 November 2017). We handsearched reference lists of identified studies and previous systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCT) comparing early commencement of enteral nutrition (within 24 hours) with no feeding in adult participants undergoing lower gastrointestinal surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality using the Cochrane 'Risk of bias' tool tailored to this review and extracted data. Data analyses were conducted according to the Cochrane recommendations.We rated the quality of evidence according to GRADE.Primary outcomes were LoS and postoperative complications (wound infections, intraabdominal abscesses, anastomotic dehiscence, pneumonia).Secondary outcomes were: mortality, adverse events (nausea, vomiting), and quality of life (QoL).LoS was estimated using mean difference (MD (presented as mean +/- SD). For other outcomes we estimated the common risk ratio (RR) and calculated the associated 95% confidence intervals. For analysis, we used an inverse-variance random-effects model for the primary outcome (LoS) and Mantel-Haenszel random-effects models for the secondary outcomes. We also performed Trial Sequential Analyses (TSA). MAIN RESULTS We identified 17 RCTs with 1437 participants undergoing lower gastrointestinal surgery. Most studies were at high or unclear risk of bias in two or more domains. Six studies were judged as having low risk of selection bias for random sequence generation and insufficient details were provided for judgement on allocation concealment in all 17 studies. With regards to performance and deception bias; 14 studies reported no attempt to blind participants and blinding of personnel was not discussed either. Only one study was judged as low risk of bias for blinding of outcome assessor. With regards to incomplete outcome data, three studies were judged to be at high risk because they had more than 10% difference in missing data between groups. For selective reporting, nine studies were judged as unclear as protocols were not provided and eight studies had issues with either missing data or incomplete reporting of results.LOS was reported in 16 studies (1346 participants). The mean LoS ranged from four days to 16 days in the early feeding groups and from 6.6 days to 23.5 days in the control groups. Mean difference (MD) in LoS was 1.95 (95% CI, -2.99 to -0.91, P < 0.001) days shorter in the early feeding group. However, there was substantial heterogeneity between included studies (I2 = 81, %, Chi2 = 78.98, P < 0.00001), thus the overall quality of evidence for LoS is low. These results were confirmed by the TSA showing that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit.We found no differences in the incidence of postoperative complications: wound infection (12 studies, 1181 participants, RR 0.99, 95%CI 0.64 to 1.52, very low-quality evidence), intraabdominal abscesses (6 studies, 554 participants, RR 1.00, 95%CI 0.26 to 3.80, low-quality evidence), anastomotic leakage/dehiscence (13 studies, 1232 participants, RR 0.78, 95%CI 0.38 to 1.61, low-quality evidence; number needed to treat for an additional beneficial outcome (NNTB) = 100), and pneumonia (10 studies, 954 participants, RR 0.88, 95%CI 0.32 to 2.42, low-quality evidence; NNTB = 333).Mortality was reported in 12 studies (1179 participants), and showed no between-group differences (RR = 0.56, 95%CI, 0.21 to 1.52, P = 0.26, I2 = 0%, Chi2 = 3.08, P = 0.96, low-quality evidence). The most commonly reported cause of death was anastomotic leakage, sepsis and acute myocardial infarction.Seven studies (613 participants) reported vomiting (RR 1.23, 95%CI, 0.96 to 1.58, P = 0.10, I2 = 0%, Chi2 = 4.98, P = 0.55, low-quality evidence; number needed to treat for an additional harmful outcome (NNTH) = 19), and two studies (118 participants) reported nausea (RR 0.95, 0.71 to 1.26, low-quality evidence). Four studies reported combined nausea and vomiting (RR 0.94, 95%CI 0.51 to 1.74, very low-quality evidence). One study reported QoL assessment; the scores did not differ between groups at 30 days after discharge on either QoL scale EORTC QLQ-C30 or EORTC QlQ-OV28 (very low-quality evidence). AUTHORS' CONCLUSIONS This review suggests that early enteral feeding may lead to a reduced postoperative LoS, however cautious interpretation must be taken due to substantial heterogeneity and low-quality evidence. For all other outcomes (postoperative complications, mortality, adverse events, and QoL) the findings are inconclusive, and further trials are justified to enhance the understanding of early feeding for these. In this updated review, only a few additional studies have been included, and these were small and of poor quality.To improve the evidence, future trials should address quality issues and focus on clearly defining and measuring postoperative complications to allow for better comparison between studies. However due to the introduction of fast track protocols which already include an early feeding component, future trials may be challenging. A more feasible trial may be to investigate the effect of differing postoperative energy intake regimens on relevant outcomes.
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Affiliation(s)
- Georgia Herbert
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolAvonUKBS2 8AE
| | - Rachel Perry
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolAvonUKBS2 8AE
| | - Henning Keinke Andersen
- Bispebjerg Hospital, Building 39NThe Cochrane Colorectal Cancer Group23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 CPH NV
| | - Charlotte Atkinson
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolAvonUKBS2 8AE
| | - Christopher Penfold
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolAvonUKBS2 8AE
| | - Stephen J Lewis
- Derriford HospitalDepartment of GastroenterologyDerriford RoadPlymouthDevonUKPL6 8DH
| | - Andrew R Ness
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolAvonUKBS2 8AE
| | - Steven Thomas
- University Hospitals Bristol NHS TrustHead & Neck SurgeryMarlborough StreetBristolUKBS1 3NU
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Li C, Patel K, Allen P, TU Z, Kilkenny J, Wallace C, Nadig S, Tomlinson S, Atkinson C. A Novel Injury Site-Targeted Complement Inhibitor Which Protects against Lung Transplant Ischemia Reperfusion Injury. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.016] [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] Open
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Tu Z, Allen P, Wallace C, Li C, Kilkenny J, Patel K, Nadig S, Atkinson C. Endothelial Stabilization Reduces the Effects of Brain Death Induced Acute Lung Injury Post-Transplant. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tran D, Tu Z, Atkinson C, Nadig S. Modulating Mitochondrial Fusion/Fission Induces Immunoprotective Effects in Models of Cardiac Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Herbert G, Perry R, Andersen HK, Atkinson C, Penfold C, Lewis SJ, Ness AR, Thomas S. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev 2018; 10:CD004080. [PMID: 30353940 PMCID: PMC6517065 DOI: 10.1002/14651858.cd004080.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 01/30/2023]
Abstract
BACKGROUND This is an update of the review last published in 2011. It focuses on early postoperative enteral nutrition after lower gastrointestinal surgery. Traditional management consisted of 'nil by mouth', where patients receive fluids followed by solids after bowel function has returned. Although several trials have reported lower incidence of infectious complications and faster wound healing upon early feeding, other trials have shown no effect. The immediate advantage of energy intake (carbohydrates, protein or fat) could enhance recovery with fewer complications, and this warrants a systematic evaluation. OBJECTIVES To evaluate whether early commencement of postoperative enteral nutrition (within 24 hours), oral intake and any kind of tube feeding (gastric, duodenal or jejunal), compared with traditional management (delayed nutritional supply) is associated with a shorter length of hospital stay (LoS), fewer complications, mortality and adverse events in patients undergoing lower gastrointestinal surgery (distal to the ligament of Treitz). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library 2017, issue 10), Ovid MEDLINE (1950 to 15 November 2017), Ovid Embase (1974 to 15 November 2017). We also searched for ongoing trials in ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (15 November 2017). We handsearched reference lists of identified studies and previous systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCT) comparing early commencement of enteral nutrition (within 24 hours) with no feeding in adult participants undergoing lower gastrointestinal surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study quality using the Cochrane 'Risk of bias' tool tailored to this review and extracted data. Data analyses were conducted according to the Cochrane recommendations.We rated the quality of evidence according to GRADE.Primary outcomes were LoS and postoperative complications (wound infections, intraabdominal abscesses, anastomotic dehiscence, pneumonia).Secondary outcomes were: mortality, adverse events (nausea, vomiting), and quality of life (QoL).LoS was estimated using mean difference (MD (presented as mean +/- SD). For other outcomes we estimated the common risk ratio (RR) and calculated the associated 95% confidence intervals. For analysis, we used an inverse-variance random-effects model for the primary outcome (LoS) and Mantel-Haenszel random-effects models for the secondary outcomes. We also performed Trial Sequential Analyses (TSA). MAIN RESULTS We identified 17 RCTs with 1437 participants undergoing lower gastrointestinal surgery. Most studies were at high or unclear risk of bias in two or more domains. Six studies were judged as having low risk of selection bias for random sequence generation and insufficient details were provided for judgement on allocation concealment in all 17 studies. With regards to performance and deception bias; 14 studies reported no attempt to blind participants and blinding of personnel was not discussed either. Only one study was judged as low risk of bias for blinding of outcome assessor. With regards to incomplete outcome data, three studies were judged to be at high risk because they had more than 10% difference in missing data between groups. For selective reporting, nine studies were judged as unclear as protocols were not provided and eight studies had issues with either missing data or incomplete reporting of results.LOS was reported in 16 studies (1346 participants). The mean LoS ranged from four days to 16 days in the early feeding groups and from 6.6 days to 23.5 days in the control groups. Mean difference (MD) in LoS was 1.95 (95% CI, -2.99 to -0.91, P < 0.001) days shorter in the early feeding group. However, there was substantial heterogeneity between included studies (I2 = 81, %, Chi2 = 78.98, P < 0.00001), thus the overall quality of evidence for LoS is low. These results were confirmed by the TSA showing that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit.We found no differences in the incidence of postoperative complications: wound infection (12 studies, 1181 participants, RR 0.99, 95%CI 0.64 to 1.52, very low-quality evidence), intraabdominal abscesses (6 studies, 554 participants, RR 1.00, 95%CI 0.26 to 3.80, low-quality evidence), anastomotic leakage/dehiscence (13 studies, 1232 participants, RR 0.78, 95%CI 0.38 to 1.61, low-quality evidence; number needed to treat for an additional beneficial outcome (NNTB) = 100), and pneumonia (10 studies, 954 participants, RR 0.88, 95%CI 0.32 to 2.42, low-quality evidence; NNTB = 333).Mortality was reported in 12 studies (1179 participants), and showed no between-group differences (RR = 0.56, 95%CI, 0.21 to 1.52, P = 0.26, I2 = 0%, Chi2 = 3.08, P = 0.96, low-quality evidence). The most commonly reported cause of death was anastomotic leakage, sepsis and acute myocardial infarction.Seven studies (613 participants) reported vomiting (RR 1.23, 95%CI, 0.96 to 1.58, P = 0.10, I2 = 0%, Chi2 = 4.98, P = 0.55, low-quality evidence; number needed to treat for an additional harmful outcome (NNTH) = 19), and two studies (118 participants) reported nausea (RR 0.95, 0.71 to 1.26, low-quality evidence). Four studies reported combined nausea and vomiting (RR 0.94, 95%CI 0.51 to 1.74, very low-quality evidence). One study reported QoL assessment; the scores did not differ between groups at 30 days after discharge on either QoL scale EORTC QLQ-C30 or EORTC QlQ-OV28 (very low-quality evidence). AUTHORS' CONCLUSIONS This review suggests that early enteral feeding may lead to a reduced postoperative LoS, however cautious interpretation must be taken due to substantial heterogeneity and low-quality evidence. For all other outcomes (postoperative complications, mortality, adverse events, and QoL) the findings are inconclusive, and further trials are justified to enhance the understanding of early feeding for these. In this updated review, only a few additional studies have been included, and these were small and of poor quality.To improve the evidence, future trials should address quality issues and focus on clearly defining and measuring postoperative complications to allow for better comparison between studies. However due to the introduction of fast track protocols which already include an early feeding component, future trials may be challenging. A more feasible trial may be to investigate the effect of differing postoperative energy intake regimens on relevant outcomes.
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Affiliation(s)
- Georgia Herbert
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolUKBS2 8AE
| | - Rachel Perry
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolUKBS2 8AE
| | - Henning Keinke Andersen
- Bispebjerg Hospital, Building 39NThe Cochrane Colorectal Cancer Group23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 CPH NV
| | - Charlotte Atkinson
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolUKBS2 8AE
| | - Christopher Penfold
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolUKBS2 8AE
| | - Stephen J Lewis
- Derriford HospitalDepartment of GastroenterologyDerriford RoadPlymouthUKPL6 8DH
| | - Andrew R Ness
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreEducation and Research Centre, Upper Maudlin StreetBristolUKBS2 8AE
| | - Steven Thomas
- University Hospitals Bristol NHS TrustHead & Neck SurgeryMarlborough StreetBristolUKBS1 3NU
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Zamora C, Hung SC, Tomingas C, Atkinson C, Castillo M. Engorgement of Deep Medullary Veins in Neurosarcoidosis: A Common-Yet-Underrecognized Cerebrovascular Finding on SWI. AJNR Am J Neuroradiol 2018; 39:2045-2050. [PMID: 30237298 DOI: 10.3174/ajnr.a5783] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
We describe the prevalence and potential significance of deep medullary vein engorgement on SWI in patients with neurosarcoidosis, a finding that has not been described previously. Engorgement was evaluated for possible associations with meningeal or perivascular disease, intracranial hemorrhage, and venous thrombosis, as well as with modified Rankin Scale scores at the time of MR imaging and at follow-up. Deep medullary vein engorgement was seen in 7 of 21 patients and was more common in men. Patients with venous engorgement had a significantly increased incidence of microhemorrhages, perivascular disease, and hydrocephalus. There was no association with the degree of leptomeningeal disease, venous dural sinus thrombosis, or modified Rankin Scale scores. In conclusion, deep medullary vein engorgement was common in our patients with neurosarcoidosis. Although its pathophysiology remains uncertain, it could be related to venous or perivenous abnormalities and may represent a useful secondary finding of cerebrovascular disease.
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Affiliation(s)
- C Zamora
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - S-C Hung
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - C Tomingas
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - C Atkinson
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - M Castillo
- From the Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Atkinson C, Howes N, Thomas S, Lewis S. Immunonutrition for patients undergoing surgery for head and neck cancer – a systematic review and meta-analysis. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Patients with head and neck cancer are often malnourished. Surgery for such cancers is complex and may be undertaken after a course of radiotherapy. As a result, patients may have postoperative complications such as fistulae and wound infections, as well as more generalised infections such as pneumonia. One possible way to enhance recovery, and reduce the incidence of these complications, is by improving nutrition. Nutritional formulas that deliver basic nutrients as well as amino acids (arginine and glutamine), ribonucleic acid (RNA) and/or lipids (omega-3 fatty acids) are known as immunonutrition. OBJECTIVES To assess the effects of immunonutrition treatment, compared to standard feeding, on postoperative recovery in adult patients undergoing elective (non-emergency) surgery for head and neck cancer. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 February 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing immunonutrition given either preoperatively, postoperatively or perioperatively to adult patients (18 years of age or older) undergoing an elective surgical procedure for head and neck cancer, compared with a control group receiving either standard polymeric nutritional supplements or no supplements. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were: length of hospital stay (days), wound infection, fistula formation and adverse events/tolerance of feeds, as defined by trial authors. Secondary outcomes were: all-cause mortality and postoperative complications (as defined by trial authors). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included 19 RCTs (1099 participants). The mean age of participants ranged from 47 to 66 years. Most studies (12/19) had fewer than 25 patients in each treatment group. Most studies (16/19) used immunonutrition formulas containing arginine, but there was variation in the actual products and amounts used, and in the length of intervention postoperatively. Follow-up time for outcome measurement varied considerably across studies, ranging from five days to greater than or equal to 16 months.Primary outcomesWe found no evidence of a difference in the length of hospital stay (mean difference -2.5 days, 95% confidence interval (CI) -5.11 to 0.12; 10 studies, 757 participants; low-quality evidence). Similarly, we found no evidence of an effect of immunonutrition on wound infection (risk ratio (RR) 0.94, 95% CI 0.70 to 1.26; 12 studies, 812 participants; very low-quality evidence). Fistula formation may be reduced with immunonutrition; the absolute risks were 11.3% and 5.4% in the standard care and immunonutrition groups, with a RR of 0.48 (95% CI 0.27 to 0.85; 10 studies, 747 participants; low-quality evidence). We found no evidence of a difference in terms of tolerance of feeds ('adverse events') between treatments (RR 1.33, 95% CI 0.86 to 2.06; 9 studies, 719 participants; very low-quality evidence).Secondary outcomesWe found no evidence of a difference between treatments in all-cause mortality (RR 1.33, 95% CI 0.48 to 3.66; 14 studies, 776 participants; low-quality evidence). Other postoperative complications such as pneumonia and urinary tract infections were not commonly reported. AUTHORS' CONCLUSIONS The risk of postoperative fistula formation may be reduced with immunonutrition, but we found no evidence of an effect of immunonutrition on any of the other outcomes that we assessed. The studies included in this review were generally small or at high risk of bias (or both). We judged the overall quality of the evidence to be low for the outcomes length of hospital stay and all-cause mortality, and very low for wound infection and adverse events. Further research should include larger, better quality studies.
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Affiliation(s)
| | - Charlotte Atkinson
- University Hospitals Bristol NHS Foundation Trust and the University of BristolNIHR Bristol Biomedical Research CentreUpper Maudlin StreetBristolAvonUKBS2 8AE
| | - Steven Thomas
- University Hospitals Bristol NHS TrustHead & Neck SurgeryMarlborough StreetBristolUKBS1 3NU
| | - Stephen J Lewis
- Derriford HospitalDepartment of GastroenterologyDerriford RoadPlymouthDevonUKPL6 8DH
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Richmond RC, Sharp GC, Herbert G, Atkinson C, Taylor C, Bhattacharya S, Campbell D, Hall M, Kazmi N, Gaunt T, McArdle W, Ring S, Davey Smith G, Ness A, Relton CL. The long-term impact of folic acid in pregnancy on offspring DNA methylation: follow-up of the Aberdeen Folic Acid Supplementation Trial (AFAST). Int J Epidemiol 2018; 47:928-937. [PMID: 29546377 PMCID: PMC6005053 DOI: 10.1093/ije/dyy032] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2018] [Accepted: 02/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It has been proposed that maternal folic-acid supplement use may alter the DNA-methylation patterns of the offspring during the in-utero period, which could influence development and later-life health outcomes. Evidence from human studies suggests a role for prenatal folate levels in influencing DNA methylation in early life, but this has not been extended to consider persistent effects into adulthood. METHODS To better elucidate the long-term impact of maternal folic acid in pregnancy on DNA methylation in offspring, we carried out an epigenome-wide association study (EWAS) nested within the Aberdeen Folic Acid Supplementation Trial (AFAST-a trial of two different doses: 0.2 and 5 mg, folic acid vs placebo). Offspring of the AFAST participants were recruited at a mean age of 47 years and saliva samples were profiled on the Illumina Infinium Human Methylation450 array. Both single-site and differentially methylated region analyses were performed. RESULTS We found an association at cg09112514 (p = 4.03×10-9), a CpG located in the 5' untranslated region of PDGFRA, in the main analysis comparing the intervention arms [low- (0.2 mg) and high-dose (5 mg) folic acid combined (N = 43)] vs placebo (N = 43). Furthermore, a dose-response reduction in methylation at this site was identified in relation to the intervention. In the regional approach, we identified 46 regions of the genome that were differentially methylated in response to the intervention (Sidak p-value <0.05), including HLA-DPB2, HLA-DPB1, PAX8 and VTRNA2-1. Whereas cg09112514 did not replicate in an independent EWAS of maternal plasma folate, there was suggested replication of differential methylation in PAX8. CONCLUSIONS The results of this study suggest that maternal folic-acid supplement use is associated with changes in the DNA methylation of the offspring that persist for many years after exposure in utero. These methylation changes are located in genes implicated in embryonic development, immune response and cellular proliferation. Further work to investigate whether these epigenetic changes translate into detectable phenotypic differences is required.
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Affiliation(s)
- Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Georgia Herbert
- NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
| | - Charlotte Atkinson
- NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Caroline Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | | | - Doris Campbell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Marion Hall
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nabila Kazmi
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Gaunt
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Wendy McArdle
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Susan Ring
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andy Ness
- NIHR Biomedical Research Centre (Nutrition Theme), University of Bristol, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Sutton E, Herbert G, Burden S, Lewis S, Thomas S, Ness A, Atkinson C. Correction: Using the Normalization Process Theory to qualitatively explore sense-making in implementation of the Enhanced Recovery After Surgery programme: "It's not rocket science". PLoS One 2018; 13:e0197790. [PMID: 29772001 PMCID: PMC5957368 DOI: 10.1371/journal.pone.0197790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0195890.].
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