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Negri A, Ward C, Bucci A, D'Angelo G, Cauchy P, Radesco A, Ventura AB, Walton DS, Clarke M, Mandriani B, Pappagallo SA, Mondelli P, Liao K, Gargano G, Zaccaria GM, Viggiano L, Lasorsa FM, Ahmed A, Di Molfetta D, Fiermonte G, Cives M, Guarini A, Vegliante MC, Ciavarella S, Frampton J, Volpe G. Reversal of MYB-dependent suppression of MAFB expression overrides leukaemia phenotype in MLL-rearranged AML. Cell Death Dis 2023; 14:763. [PMID: 37996430 PMCID: PMC10667525 DOI: 10.1038/s41419-023-06276-z] [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: 07/27/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
The transcription factor MYB plays a pivotal role in haematopoietic homoeostasis and its aberrant expression is involved in the genesis and maintenance of acute myeloid leukaemia (AML). We have previously demonstrated that not all AML subtypes display the same dependency on MYB expression and that such variability is dictated by the nature of the driver mutation. However, whether this difference in MYB dependency is a general trend in AML remains to be further elucidated. Here, we investigate the role of MYB in human leukaemia by performing siRNA-mediated knock-down in cell line models of AML with different driver lesions. We show that the characteristic reduction in proliferation and the concomitant induction of myeloid differentiation that is observed in MLL-rearranged and t(8;21) leukaemias upon MYB suppression is not seen in AML cells with a complex karyotype. Transcriptome analyses revealed that MYB ablation produces consensual increase of MAFB expression in MYB-dependent cells and, interestingly, the ectopic expression of MAFB could phenocopy the effect of MYB suppression. Accordingly, in silico stratification analyses of molecular data from AML patients revealed a reciprocal relationship between MYB and MAFB expression, highlighting a novel biological interconnection between these two factors in AML and supporting new rationales of MAFB targeting in MLL-rearranged leukaemias.
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Affiliation(s)
- A Negri
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - C Ward
- Edge Impulse Inc., San Jose, CA, USA
| | - A Bucci
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - G D'Angelo
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - P Cauchy
- Max Planck Institute of Immunobiology and Epigenetics, 79108, Freiburg, Germany
| | - A Radesco
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - A B Ventura
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - D S Walton
- Clent Life Sciences, DY84HD, Stourbridge, UK
| | - M Clarke
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, Birmingham, UK
| | - B Mandriani
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - S A Pappagallo
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - P Mondelli
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - K Liao
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
| | - G Gargano
- Department of Mathematics, University of Bari "Aldo Moro", Bari, Italy
| | - G M Zaccaria
- Department of Electrical and Information Engineering, Polytechnic University of Bari, Bari, Italy
| | - L Viggiano
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy
| | - F M Lasorsa
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - A Ahmed
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - D Di Molfetta
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - G Fiermonte
- Department of Bioscience, Biotechnology and Environment, University of Bari "Aldo Moro", 70125, Bari, Italy
| | - M Cives
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - A Guarini
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - M C Vegliante
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - S Ciavarella
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - J Frampton
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, B152TT, Birmingham, UK.
| | - G Volpe
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
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McBean B, Michmerhuizen AR, Wilder-Romans K, Chandler B, Lerner L, Ward C, Liu M, Boyle AP, Speers C. Mechanisms of Intrinsic Radioresistance in Breast Cancer Identify Potential Therapeutic Vulnerabilities. Int J Radiat Oncol Biol Phys 2023; 117:e250. [PMID: 37784974 DOI: 10.1016/j.ijrobp.2023.06.1191] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Clinical management of breast cancer (BC) includes radiation therapy (RT) for most women, though the molecular mechanisms that underly RT response and intrinsic radioresistance are poorly understood. Both in vitro and in vivo models aid in our understanding of radiobiology, and we hypothesized that transcriptional changes caused by radiation in vitro in BC cell lines would be recapitulated in an in vivo mouse xenograft model and uncover targetable mechanisms of radioresistance in BC. MATERIALS/METHODS Radiosensitivity was measured with clonogenic survival assays in 16 cell lines. RNA-seq experiments in vitro and in vivo were performed in an RT resistant (SUM-159) and RT sensitive (ZR-75) cell line 24 hrs after 4 Gy or after 2 Gy x 6 fractions, respectively. Differentially expressed genes (DEGs) were identified from RNA-seq data with DeSeq2 followed by pathway analysis with iPathwayGuide. RESULTS RT sensitivity was subtype independent in 16 BC cell lines, with SUM-159 radioresistant (SF 0.88) and ZR-75-1 radiosensitive (SF 0.29). There were 75 unique pathways that were significantly altered after RT in SUM-159 cells (53 pathways in vivo only, 36 pathways in vitro only, 14 both conditions; adjusted p-value < 0.05) and 85 unique pathways that were significantly altered after RT in ZR-75-1 cells (16 pathways in vivo only, 72 in vivo only, 3 both conditions; adjusted p-value < 0.05). Pathways that were significantly affected in both cell lines exclusively in the in vitro condition include canonical RT response pathways such as cell cycle, cellular senescence, and DNA replication, though the direction of DEGs were opposite in the two cell lines for each of these pathways. The IL-17 signaling pathway was significantly altered for both cell lines in vivo. Of the pathways that were significantly altered in both conditions for SUM-159 cells, inflammation, including chemokine signaling pathway and cytokine-cytokine receptor interaction, were among the most significant. Significantly more cytokines were upregulated following RT in vivo than in vitro. Cytokines were not upregulated in ZR-75-1 cells in vitro or in vivo. CONCLUSION Taken together, the significant changes in the IL-17 pathway and the upregulation of cytokines only in vivo indicate a potential of the tumor microenvironment in the in vivo condition that the in vitro condition lacks. Increased heterogeneity in vivo relative to in vitro may also explain the absence of several canonical RT response pathways in the in vivo conditions for each cell line. Notably, the opposite direction of DEG changes in the canonical RT response pathways between the 2 cell lines with disparate radiosensitivity levels may point to important biologic vulnerabilities that may be targeted in the resistant SUM-159 cells. Future studies are underway using additional BC cell lines and single-cell analysis to better understand RT response heterogeneity.
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Affiliation(s)
- B McBean
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - A R Michmerhuizen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - B Chandler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - L Lerner
- University of Michigan, Ann Arbor, MI
| | - C Ward
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - M Liu
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A P Boyle
- University of Michigan, Ann Arbor, MI
| | - C Speers
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Campbell CD, Ridge PC, McDonnell MJ, Ward C, Harrison MJ, Collins C, Rutherford RM. Recurrent Lung Injury Resulting From Unusual Cases of Aero-Digestive Disease. Dysphagia 2023; 38:1447-1448. [PMID: 36749391 DOI: 10.1007/s00455-023-10558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Affiliation(s)
- C D Campbell
- Department of Respiratory Medicine, University Hospital Galway, Galway, Ireland
| | - P C Ridge
- Department of Respiratory Medicine, University Hospital Galway, Galway, Ireland.
| | - M J McDonnell
- Department of Respiratory Medicine, University Hospital Galway, Galway, Ireland
| | - C Ward
- Department of Respiratory Medicine, Newcastle University, Newcastle, UK
| | - M J Harrison
- Department of Respiratory Medicine, University Hospital Galway, Galway, Ireland
| | - C Collins
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - R M Rutherford
- Department of Respiratory Medicine, University Hospital Galway, Galway, Ireland
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Pisano CE, McBean B, Michmerhuizen AR, Chandler B, Pesch A, Ward C, Jungles K, The S, Lyons J, Spratt DE, Pierce LJ, Speers C. Transcriptomic Analysis to Uncover the Mechanism of Radiosensitization of AR-Positive Triple Negative Breast Cancers with AR Inhibition. Int J Radiat Oncol Biol Phys 2023; 117:e255. [PMID: 37784986 DOI: 10.1016/j.ijrobp.2023.06.1202] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The androgen receptor (AR) has been shown to drive tumor growth in triple negative breast cancers (TNBC), and previous work demonstrated AR inhibition as a strategy for radiosensitization in AR-positive (AR+) TNBC. Despite its role in radioresistance, the mechanistic role of AR in response to radiation therapy (RT) remains unknown, as does the benefit of 2nd generation anti-androgens in this context. We hypothesized that all 2nd generation anti-AR therapy would radiosensitize similarly and that canonical AR transcriptional function was responsible for radioresistance in these models. MATERIALS/METHODS Radiosensitization was assessed using 2nd generation AR antagonists (apalutamide, enzalutamide, and darolutamide) using clonogenic survival assays in MDA-MB-453, SUM185, MFM-223, and MDA-MB-231 cells at 2-6Gy. Cellular fractionation experiments were performed and quantitated to determine the location of the AR protein in cells treated with AR agonists +/- RT. RNA Seq was performed and transcriptomic approaches were used (Advaita iPathway analysis) to investigate AR-mediated effects in response to RT. RESULTS Inhibition with the 2nd generation anti-androgens enzalutamide and apalutamide is sufficient to radiosensitize AR+ TNBC models (rER: 1.34-1.41); while darolutamide had no effect on radiosensitivity (rER: 0.96-1.11). Additionally, TNBC cells with low AR expression were not radiosensitized by AR inhibition with any drug (rER: 0.96-1.03). While stimulation with the synthetic androgen methyltrienolone R1881 is sufficient to induce nuclear translocation of AR in AR+ TNBC cells, AR inhibition with enzalutamide, apalutamide, or darolutamide blocked AR nuclear translocation under growth conditions with charcoal stripped serum or fetal bovine serum. When cells are treated with R1881+RT, nuclear translocation of AR was induced at similar or greater levels compared to R1881 alone in AR+ TNBC cells. Combination treatment of RT with enzalutamide in the presence of hormones reduced nuclear localization of AR (32-39% reduction) compared to RT alone. RNA-sequencing after RT identified transcriptional changes potentially regulated by AR+RT, including changes in the NHEJ pathway genes. Additionally, pathway analyses in these models demonstrated changes in the MAPK/ERK signaling pathway, among others, that may regulate RT resistance in AR+ TNBC models. CONCLUSION Most 2nd generation anti-androgens confer radiosensitization in AR+ TNBC models with cellular localization changes of AR noted after RT. The known structural differences amongst 2nd generation anti-androgens may account for differences in radiosensitization noted. Furthermore, AR-mediated radioresistance may be due, at least in part, to downstream MAPK/ERK signaling. This work builds on the mechanistic understanding of AR-mediated radioresistance in AR+ TNBC and may expose vulnerabilities to overcome resistance to combination treatment with AR inhibition and RT.
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Affiliation(s)
- C E Pisano
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - B McBean
- Department of Human Genetics, University of Michigan, Ann Arbor, MI
| | - A R Michmerhuizen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - B Chandler
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Pesch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - C Ward
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - K Jungles
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - S The
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - J Lyons
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - L J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - C Speers
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Young KS, Purves KL, Hübel C, Davies MR, Thompson KN, Bristow S, Krebs G, Danese A, Hirsch C, Parsons CE, Vassos E, Adey BN, Bright S, Hegemann L, Lee YT, Kalsi G, Monssen D, Mundy J, Peel AJ, Rayner C, Rogers HC, ter Kuile A, Ward C, York K, Lin Y, Palmos AB, Schmidt U, Veale D, Nicholson TR, Pollak TA, Stevelink SAM, Moukhtarian T, Martineau AR, Holt H, Maughan B, Al-Chalabi A, Chaudhuri KR, Richardson MP, Bradley JR, Chinnery PF, Kingston N, Papadia S, Stirrups KE, Linger R, Hotopf M, Eley TC, Breen G. Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK. Psychol Med 2023; 53:5428-5441. [PMID: 35879886 PMCID: PMC10482709 DOI: 10.1017/s0033291722002501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/12/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors. METHOD Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change. RESULTS Prospective symptom analyses showed small decreases in depression (PHQ-9: -0.43 points) and anxiety [generalised anxiety disorder scale - 7 items (GAD)-7: -0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status. CONCLUSIONS We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
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Affiliation(s)
- K. S. Young
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - K. L. Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - C. Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - M. R. Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - K. N. Thompson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - S. Bristow
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - G. Krebs
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - A. Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- National and Specialist CAMHS Trauma, Anxiety, and Depression Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - C. Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C. E. Parsons
- Interacting Minds Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - E. Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - B. N. Adey
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - S. Bright
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - L. Hegemann
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Y. T. Lee
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - G. Kalsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - D. Monssen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - J. Mundy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - A. J. Peel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - C. Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - H. C. Rogers
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - A. ter Kuile
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - C. Ward
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - K. York
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Y. Lin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - A. B. Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - U. Schmidt
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D. Veale
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - T. R. Nicholson
- South London and Maudsley NHS Foundation Trust, London, UK
- Section of Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - T. A. Pollak
- South London and Maudsley NHS Foundation Trust, London, UK
- Section of Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S. A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T. Moukhtarian
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - A. R. Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - H. Holt
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - B. Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - A. Al-Chalabi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K. Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Parkinson Foundation Centre of Excellence, King's College and King's College Hospital, London, UK
| | - M. P. Richardson
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J. R. Bradley
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - P. F. Chinnery
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Department of Clinical Neurosciences and MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - N. Kingston
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S. Papadia
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - K. E. Stirrups
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - R. Linger
- NIHR BioResource and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - M. Hotopf
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T. C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
| | - G. Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, UK
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6
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George MP, Germack HD, Goyal A, Ward C, Studer S, Panjabi S. Impact of the COVID-19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension-specific therapy in the United States of America: An observational study. Pulm Circ 2023; 13:e12283. [PMID: 37701141 PMCID: PMC10493079 DOI: 10.1002/pul2.12283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Regular expert follow-up, risk assessment, and early therapeutic intervention minimize worsening of pulmonary arterial hypertension (PAH). COVID-19 lockdown measures were challenging for chronic disease management. This retrospective, longitudinal analysis used US claims data (January 12, 2016 to September 11, 2021) for patients treated with PAH-specific medication to compare in-person outpatient and specialist visits, telemedicine visits, and PAH-related tests during 6-month assessment periods pre- and immediately post-COVID-19. Hospitalizations, costs, and outcomes were compared in patients with and without care disruptions (no in-person or telemedicine outpatient visits in immediate post-COVID-19 period). Patients in the immediate post-COVID-19 (N = 599) versus the pre-COVID-19 period (N = 598) had fewer in-person outpatient visits (mean 1.27 vs. 2.12) and in-person specialist visits (pulmonologist, 22.9% vs. 37.0% of patients; cardiologist, 27.5% vs. 33.8%); and more telemedicine visits (mean 0.45 vs. 0.02). In the immediate post-COVID-19 period, patients were less likely to have a PAH-related test versus the pre-COVID-19 period (incidence rate ratio: 0.700; 95% confidence interval: 0.615-0.797), including electrocardiograms (41.7% vs. 54.2%) and 6-minute walk distance tests (16.2% vs. 24.9%). In the immediate post-COVID-19 period, 48 patients had care disruptions and, in the following year, required more hospital days than those without care disruptions (N = 240) (median 10 vs. 5 days in total) and had higher overall hospitalization costs (median US$34,755 vs. US$20,090). Our findings support the need for minimizing care disruptions to potentially avoid incremental post-disruption healthcare utilization and costs among patients with serious chronic diseases such as PAH.
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Affiliation(s)
| | | | | | | | - Sean Studer
- Medical AffairsJanssen Pharmaceuticals US, Inc.TitusvilleNew JerseyUSA
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Okereke E, Smith H, Oguoma C, Oresanya O, Maxwell K, Anikwe C, Osuji LC, Ogazi O, Musa J, Rajab A, Shekarau E, Okoh F, Viganò E, Donovan L, Ward C, Baker K. Optimizing the role of 'lead mothers' in seasonal malaria chemoprevention (SMC) campaigns: formative research in Kano State, northern Nigeria. Malar J 2023; 22:13. [PMID: 36635665 PMCID: PMC9835293 DOI: 10.1186/s12936-023-04447-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Seasonal malaria chemoprevention (SMC) is a safe and effective intervention for preventing malaria in children under 5 years of age. Lead mothers are community health volunteers that help caregivers comply with monthly administration of anti-malarial drugs during SMC campaigns. The lead mother approach is used in several SMC implementing states across Nigeria, but there is lack of evidence about their roles and how effective they are. This study sought to better understand the current role of lead mothers, identify areas for improvement and ways to optimize the role of lead mothers during SMC campaigns. METHODS This paper reports the formative phase of a three-phased intervention development study. The formative phase involved semi-structured interviews with stakeholders from national, state, local government and community levels (n = 20). Thematic analysis was used to identify key themes, forming the basis of a subsequent co-design workshop with stakeholders routinely involved in SMC campaigns. RESULTS The findings of the formative phase converged around four overarching themes: skills and attributes required of lead mothers; factors that affect lead mother's roles; how lead mothers interact with Community Health Influencers Promoters Services (CHIPS) agents and re-imagining the role of lead mothers during SMC campaigns. CONCLUSION This formative work in Kano state indicates that through their strong connection to communities and unique relationship with caregivers, lead mothers can and do influence caregivers to adopt healthy behaviours during SMC campaigns. However, there is room for improvement in how they are recruited, trained and supervised. There is need to improve lead mothers' knowledge and skills through adequate training and supporting materials, so they can deliver targeted health messages to caregivers. Sustainability of the lead mother approach is at risk if policymakers do not find a way of transitioning their role into the existing community health worker infrastructure, for example by using CHIPs agents, and ensuring less reliance on external donor support.
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Affiliation(s)
| | - Helen Smith
- Independent Consultant, International Health Consulting Services Ltd, Merseyside, UK
| | | | | | | | | | | | | | | | - Ashiru Rajab
- Kano State Ministry of Health, Kano, Kano State Nigeria
| | | | - Festus Okoh
- National Malaria Elimination Programme, Abuja, Nigeria ,grid.434433.70000 0004 1764 1074Federal Ministry of Health, Abuja, Nigeria
| | - Erica Viganò
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK
| | - Laura Donovan
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK
| | - Charlotte Ward
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Baker
- grid.475304.10000 0004 6479 3388Malaria Consortium, London, UK ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Talaulikar D, Joshua D, Ho PJ, Gibson J, Quach H, Gibbs S, Ling S, Ward C, Augustson B, Trotman J, Harrison SJ, Tam CS, Chair SHV, Vietoria HQ, Viewria MP, Vietria AS, Viewria AK, Vietoria SG, Joshua D, Ho J, Ward C, Ling S, Molle P, Weber N, Horvath N, Zannettino A, Jase W, Lee C, Augustson B, Radesk D, Talaulikar D, Murphy N, Johnston A, Szabo F, Romer K, Chan H. Treatment of Patients with Waldenström Macroglobulinaemia: Clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2022; 53:599-609. [PMID: 36441109 DOI: 10.1111/imj.15980] [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: 06/10/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on use of other agents including BCL2 inhibitors and on treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia review the available evidence on the treatment of WM since the last publication in 2017 and provide specific recommendations to assist Australian clinicians in the management of this disease.
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Affiliation(s)
- Dipti Talaulikar
- ACT Pathology, Canberra Hospital Canberra Australia
- Australian National University Canberra Australia
| | - D Joshua
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - J. Gibson
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - H Quach
- St Vincent's Hospital, Fitzroy Victoria
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
| | - S Gibbs
- Department of Haematology Eastern Health Box Hill VIC
- Eastern Clinical Research Unit Monash University
| | - S Ling
- Liverpool Hospital Liverpool NSW
| | - C Ward
- Royal North Shore Hospital St Leonards NSW
| | - B Augustson
- Department of Haematology Sir Charles Gairdner Hospital Nedlands WA
| | - Judith Trotman
- University of Sydney Camperdown NSW
- Concord Repatriation General Hospital Concord NSW
| | - S J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne Vic
- Sir Peter MacCallum Dept of Oncology University of Melbourne, Parkville Vic
| | - Constantine S. Tam
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
- Alfred Hospital, Melbourne Victoria
- Central Clinical School, Monash University, Melbourne Victoria
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Brinson D, Ward C, Ford C, Begg A. Smokefree and vapefree streets: high levels of support from tourists, residents and businesses, implications for tourist-destination communities in New Zealand. N Z Med J 2022; 135:73-84. [PMID: 35999783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS To (a) evaluate the attitudes of local businesses, residents, and visitors regarding the trial of a voluntary smokefree and vapefree zone covering the central business streets of a popular tourist town in the South Island of New Zealand, and (b) observe smoking and vaping prevalence before and during the trial, to inform national and local smokefree environment advocacy work. METHODS The six-month smokefree and vapefree trial included an embedded mixed methods project evaluation to capture a range of stakeholder groups' views about the smokefree and vapefree zone. Data collection methods included face-to-face interviews, non-random pen and paper and online surveys, and observational scans. Qualitative data were analysed using a systematic iterative thematic approach, and simple descriptive quantitative analyses were applied to the survey data. RESULTS The analysis synthesised information from almost 1,000 respondents. A large majority of respondents supported smokefree and vapefree within the zone (visitors 84%; residents 67%; businesses 63%). A majority of responding visitors indicated that the same rules should apply to both smoking and vaping and that they would be either more likely or as likely to visit other tourist destinations in New Zealand if they had smokefree and vapefree zones. Implementing the initiative was associated with a reduction in the number of people visibly smoking and vaping within the zone. CONCLUSION The weight of evidence from the project evaluation points towards a net benefit both for individuals and for the community from implementing voluntary smokefree and vapefree zones in tourist destinations in New Zealand.
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Affiliation(s)
- David Brinson
- Public Health Analyst, Community & Public Health, Canterbury District Health Board, Christchurch
| | - Charlotte Ward
- Public Health Analyst, Community & Public Health, Canterbury District Health Board, Christchurch
| | - Cheryl Ford
- Health Promotion Advisor, Cancer Society of New Zealand Canterbury-West Coast Division Inc., Christchurch
| | - Annabel Begg
- Public Health Specialist, Community & Public Health, Canterbury District Health Board, Christchurch
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Oresanya O, Phillips A, Okereke E, Ahmadu A, Ibinaiye T, Marasciulo M, Ward C, Adesoro O, Mohammed R, Nikau J, Isokpunwu CO, Inname MA, Counihan H, Baker K, Maxwell K, Smith H. Co-implementing vitamin A supplementation with seasonal malaria chemoprevention in Sokoto State, Nigeria: a feasibility and acceptability study. BMC Health Serv Res 2022; 22:871. [PMID: 35791014 PMCID: PMC9258179 DOI: 10.1186/s12913-022-08264-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/20/2021] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bi-annual high dose vitamin A supplements administered to children aged 6–59 months can significantly reduce child mortality, but vitamin A supplementation (VAS) coverage is low in Nigeria. The World Health Organization recommends that VAS be integrated into other public health programmes which are aimed at improving child survival. Seasonal malaria chemoprevention (SMC) provides a ready platform for VAS integration to improve health outcomes. This study explored the feasibility and acceptability of integrating VAS with SMC in one local government area in Sokoto State. Methods A concurrent QUAN-QUAL mixed methods study was used to assess the feasibility and acceptability of co-implementing VAS with SMC in one LGA of Sokoto state. Existing SMC implementation tools and job aids were revised and SMC and VAS were delivered using a door-to-door approach. VAS and SMC coverage were subsequently assessed using questionnaires administered to 188 and 197 households at baseline and endline respectively. The qualitative component involved key informant interviews and focus group discussions with policymakers, programme officials and technical partners to explore feasibility and acceptability. Thematic analysis was carried out on the qualitative data. Results At endline, the proportion of children who received at least one dose of VAS in the last six months increased significantly from 2 to 59% (p < 0.001). There were no adverse effects on the coverage of SMC delivery with 70% eligible children reached at baseline, increasing to 76% (p = 0.412) at endline. There was no significant change (p = 0.264) in the quality of SMC, measured by proportion of children receiving their first dose as directly observed treatment (DOT), at baseline (54%) compared to endline (68%). The qualitative findings are presented as two overarching themes relating to feasibility and acceptability of the integrated VAS-SMC strategy, and within each, a series of sub-themes describe study participants’ views of important considerations in implementing the strategy. Conclusion This study showed that it is feasible and acceptable to integrate VAS with SMC delivery in areas of high seasonal malaria transmission such as northern Nigeria, where SMC campaigns are implemented. SMC-VAS integrated campaigns can significantly increase vitamin A coverage but more research is required to demonstrate the feasibility of this integration in different settings and on a larger scale.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jamilu Nikau
- National Malaria Elimination Programme, Abuja, Nigeria
| | | | | | | | - Kevin Baker
- Malaria Consortium United Kingdom, London, UK
| | | | - Helen Smith
- Malaria Consortium United Kingdom, London, UK
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11
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Bourke S, Palmer E, Echevarria C, Anderson A, Doe S, Brodlie M, Ward C. P200 The prevalence of laryngopharyngeal reflux and sino-nasal symptoms in adults with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Ward C, Tsvetanova Z, O'Keane C, O'Mahony D. A case of multiple metastases from a primary renal solitary fibrous tumour; The uncertain long road. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100163] [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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13
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Ward C, Phillips A, Oresanya O, Olisenekwu G, Arogunade E, Moukénet A, Beakgoubé H, De Paul Allambademel V, Compaoré CS, Traoré A, Ouedraogo JB, Compaoré YD, Zongo I, Donovan L, Decola MA, Smith H, Baker K. Delivery of seasonal malaria chemoprevention with enhanced infection prevention and control measures during the COVID-19 pandemic in Nigeria, Burkina Faso and Chad: a cross-sectional study. Malar J 2022; 21:103. [PMID: 35331248 PMCID: PMC8943494 DOI: 10.1186/s12936-022-04091-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Seasonal malaria chemoprevention (SMC) is a WHO-recommended intervention for children aged 3–59 months living in areas of high malaria transmission to provide protection against malaria during the rainy season. Operational guidelines were developed, based on WHO guidance, to support countries to mitigate the risk of coronavirus disease 2019 (COVID-19) transmission within communities and among community distributors when delivering SMC. Methods A cross-sectional study to determine adherence to infection prevention and control (IPC) measures during two distribution cycles of SMC in Nigeria, Chad and Burkina Faso. Community distributors were observed receiving equipment and delivering SMC. Adherence across six domains was calculated as the proportion of indications in which the community distributor performed the correct action. Focus group discussions were conducted with community distributors to understand their perceptions of the IPC measures and barriers and facilitators to adherence. Results Data collectors observed community distributors in Nigeria (n = 259), Burkina Faso (n = 252) and Chad (n = 266) receiving IPC equipment and delivering SMC. Adherence to IPC indications varied. In all three countries, adherence to mask use was the highest (ranging from 73.3% in Nigeria to 86.9% in Burkina Faso). Adherence to hand hygiene for at least 30 s was low (ranging from 3.6% in Nigeria to 10.3% in Burkina Faso) but increased substantially when excluding the length of time spent hand washing (ranging from 36.7% in Nigeria to 61.4% in Burkina Faso). Adherence to safe distancing in the compound ranged from 5.4% in Chad to 16.4% in Nigeria. In Burkina Faso and Chad, where disinfection wipes widely available compliance with disinfection of blister packs for SMC was low (17.4% in Burkina Faso and 16.9% in Chad). Community distributors generally found the IPC measures acceptable, however there were barriers to optimal hand hygiene practices, cultural norms made social distancing difficult to adhere to and caregivers needed assistance to administer the first dose of SMC. Conclusion Adherence to IPC measures for SMC delivery during the COVID-19 pandemic varied across domains of IPC, but was largely insufficient, particularly for hand hygiene and safe distancing. Improvements in provision of protective equipment, early community engagement and adaptations to make IPC measures more feasible to implement could increase adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04091-z.
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Affiliation(s)
- Charlotte Ward
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Helen Smith
- International Health Consulting Services Ltd, Wirral, UK
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Brennan M, McDonnell MJ, Harrison MJ, Duignan N, O’Regan A, Murphy DM, Ward C, Rutherford RM. Antimicrobial therapies for prevention of recurrent acute exacerbations of COPD (AECOPD): beyond the guidelines. Respir Res 2022; 23:58. [PMID: 35287677 PMCID: PMC8919139 DOI: 10.1186/s12931-022-01947-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/04/2022] [Indexed: 12/19/2022] Open
Abstract
Background Unfortunately, many COPD patients continue to exacerbate despite good adherence to GOLD Class D recommended therapy. Acute exacerbations lead to an increase in symptoms, decline in lung function and increased mortality rate. The purpose of this review is to do a literature search for any prophylactic anti-microbial treatment trials in GOLD class D patients who ‘failed’ recommended therapy and discuss the role of COPD phenotypes, lung and gut microbiota and co-morbidities in developing a tailored approach to anti-microbial therapies for high frequency exacerbators. Main text There is a paucity of large, well-conducted studies in the published literature to date. Factors such as single-centre, study design, lack of well-defined controls, insufficient patient numbers enrolled and short follow-up periods were significant limiting factors in numerous studies. One placebo-controlled study involving more than 1000 patients, who had 2 or more moderate exacerbations in the previous year, demonstrated a non-significant reduction in exacerbations of 19% with 5 day course of moxifloxacillin repeated at 8 week intervals. In Pseudomonas aeruginosa (Pa) colonised COPD patients, inhaled antimicrobial therapy using tobramycin, colistin and gentamicin resulted in significant reductions in exacerbation frequency. Viruses were found to frequently cause acute exacerbations in COPD (AECOPD), either as the primary infecting agent or as a co-factor. However, other, than the influenza vaccination, there were no trials of anti-viral therapies that resulted in a positive effect on reducing AECOPD. Identifying clinical phenotypes and co-existing conditions that impact on exacerbation frequency and severity is essential to provide individualised treatment with targeted therapies. The role of the lung and gut microbiome is increasingly recognised and identification of pathogenic bacteria will likely play an important role in personalised antimicrobial therapies. Conclusion Antimicrobial therapeutic options in patients who continue to exacerbate despite adherence to guidelines-directed therapy are limited. Phenotyping patients, identification of co-existing conditions and assessment of the microbiome is key to individualising antimicrobial therapy. Given the impact of viruses on AECOPD, anti-viral therapeutic agents and targeted anti-viral vaccinations should be the focus of future research studies.
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15
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Traore A, Donovan L, Sawadogo B, Ward C, Smith H, Rassi C, Counihan H, Johansson J, Richardson S, Savadogo JR, Baker K. Extending seasonal malaria chemoprevention to five cycles: a pilot study of feasibility and acceptability in Mangodara district, Burkina Faso. BMC Public Health 2022; 22:442. [PMID: 35247990 PMCID: PMC8897918 DOI: 10.1186/s12889-022-12741-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Seasonal malaria chemoprevention (SMC) involves administering antimalarial drugs at monthly intervals during the high malaria transmission period to children aged 3 to 59 months as recommended by the World Health Organization. Typically, a full SMC course is administered over four monthly cycles from July to October, coinciding with the rainy season. However, an analysis of rainfall patterns suggest that the malaria transmission season is longer and starting as early as June in the south of Burkina Faso, leading to a rise in cases prior to the first cycle. This study assessed the acceptability and feasibility of extending SMC from four to five cycles to coincide with the earlier rainy season in Mangodara health district.
Methods
The mixed-methods study was conducted between July and November 2019. Quantitative data were collected through end-of-cycle and end-of-round household surveys to determine the effect of the additional cycle on the coverage of SMC in Mangodara. The data were then compared with 22 other districts where SMC was implemented by Malaria Consortium. Eight focus group discussions were conducted with caregivers and community distributors and 11 key informant interviews with community, programme and national-level stakeholders. These aimed to determine perceptions of the acceptability and feasibility of extending SMC to five cycles.
Results
The extension was perceived as acceptable by caregivers, community distributors and stakeholders due to the positive impact on the health of children under five. However, many community distributors expressed concern over the feasibility, mainly due to the clash with farming activities in June. Stakeholders highlighted the need for more evidence on the impact of the additional cycle on parasite resistance prior to scale-up. End-of-cycle survey data showed no difference in coverage between five SMC cycles in Mangodara and four cycles in the 22 comparison districts.
Conclusions
The additional cycle should begin early in the day in order to not coincide with the agricultural activities of community distributors. Continuous sensitisation at community level is critical for the sustainability of SMC and acceptance of an additional cycle, which should actively engage male caregivers. Providing additional support in proportion to the increased workload from a fifth cycle, including timely remuneration, is critical to avoid the demotivation of community distributors. Further studies are required to understand the effectiveness, including cost-effectiveness, of tailoring SMC according to the rainy season. Understanding the impact of an additional cycle on parasite resistance to SPAQ is critical to address key informants’ concerns around the deviation from the current four-cycle policy recommendation.
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Moukénet A, Donovan L, Honoré B, Baker K, Smith H, Richardson S, Ward C. Extending Delivery of Seasonal Malaria Chemoprevention to Children Aged 5-10 Years in Chad: A Mixed-Methods Study. Glob Health Sci Pract 2022; 10:e2100161. [PMID: 35294375 PMCID: PMC8885336 DOI: 10.9745/ghsp-d-21-00161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND To prevent malaria among children aged 3-59 months in areas with high seasonal transmission, seasonal malaria chemoprevention (SMC) is recommended. In Chad, there is evidence of SMC administration to children aged older than 5 years (referred to as "leakage"). This study aimed to understand the reasons for leakage and explore the feasibility and acceptability of extending the delivery of SMC to children aged 5-10 years in Chad. METHODS We conducted a mixed-methods study in Massaguet health district with a cross-sectional survey to determine SMC coverage for children aged up to 10 years after SMC cycles 1 and 3 (n=90 and n=100 caregivers surveyed, respectively) and at the end of cycle 4 (n=101 caregivers surveyed). We conducted 14 key informant interviews at the national and district level and 8 focus group discussions with community distributors and caregivers. RESULTS In the compounds surveyed, there were no children aged 5-10 years in cycle 1. In cycles 3 (n=1 children) and 4 (n=16 children), there was 100% (95% confidence interval [CI]=2.5, 100.0) and 62.5% (95% CI=35.4, 84.8) coverage of SMC in children aged 5-10 years, respectively. Extension of SMC to older children was considered acceptable, but there were concerns about feasibility and ensuring the sustainability of the current program in children aged 3-59 months. Key informants acknowledged the need to secure additional funding to pilot SMC in older age groups and were uncertain about the impact of the current SMC program at scale. CONCLUSION Key informants considered extending SMC to children aged 5-10 years acceptable but did not deem it a current priority. They expressed an urgent need to address leakage and reinforce both the sustainability and quality of the current SMC program.
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Affiliation(s)
| | | | | | | | - Helen Smith
- Independent consultant, International Health Consulting Services Ltd., United Kingdom
| | | | - Charlotte Ward
- London School of Hygiene and Tropical Medicine, United Kingdom.
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Moukénet A, de Cola MA, Ward C, Beakgoubé H, Baker K, Donovan L, Laoukolé J, Richardson S. Health management information system (HMIS) data quality and associated factors in Massaguet district, Chad. BMC Med Inform Decis Mak 2021; 21:326. [PMID: 34809622 PMCID: PMC8609810 DOI: 10.1186/s12911-021-01684-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background Quality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad. Methods A cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January–December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy. Results Health centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32–48.19) and 5– < 15 years (OR: 6.64, 95% CI 1.38–32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years. Conclusion Data completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01684-7.
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Affiliation(s)
- Azoukalné Moukénet
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Monica Anna de Cola
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Charlotte Ward
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Honoré Beakgoubé
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | | | - Sol Richardson
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
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Ward C, Taylor M, Keeney C, Brown K. 281 The Impact of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Best A, Singh P, Ward C, Vitale C, Oliver M, Idris L, Poulston A. The impact of varying class sizes on epidemic spread in a university population. R Soc Open Sci 2021; 8:210712. [PMID: 34150319 PMCID: PMC8206692 DOI: 10.1098/rsos.210712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/14/2021] [Indexed: 05/09/2023]
Abstract
A common non-pharmaceutical intervention (NPI) during the COVID-19 pandemic has been group size limits. Furthermore, educational settings of schools and universities have either fully closed or reduced their class sizes. As countries begin to reopen classrooms, a key question will be how large classes can be while still preventing local outbreaks of disease. Here, we develop and analyse a simple, stochastic epidemiological model where individuals (considered as students) live in fixed households and are assigned to a fixed class for daily lessons. We compare key measures of the epidemic-the peak infected, the total infected by day 180 and the calculated R 0-as the size of class is varied. We find that class sizes of 10 could largely restrict outbreaks and often had overlapping inter-quartile ranges with our most cautious case of classes of five. However, class sizes of 30 or more often result in large epidemics. Reducing the class size from 40 to 10 can reduce R 0 by over 30%, as well as significantly reducing the numbers infected. Intermediate class sizes show considerable variation, with the total infected varying by as much as from 10% to 80% for the same class size. We show that additional in-class NPIs can limit the epidemic still further, but that reducing class sizes appears to have a larger effect on the epidemic. We do not specifically tailor our model for COVID-19, but our results stress the importance of small class sizes for preventing large outbreaks of infectious disease.
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Affiliation(s)
- Alex Best
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Prerna Singh
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Charlotte Ward
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Caterina Vitale
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Megan Oliver
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Laminu Idris
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
| | - Alison Poulston
- School of Mathematics and Statistics, University of Sheffield, Sheffield S3 7RH, UK
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20
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Stratil AS, Ward C, Habte T, Maurel A, Antson M, Naydenova E, Baker K. Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in Children under Five with Cough and/or Difficulty Breathing. J Trop Pediatr 2021; 67:6297970. [PMID: 34124753 PMCID: PMC8201841 DOI: 10.1093/tropej/fmab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Manual assessment of respiratory rate (RR) in children is unreliable, but remains the main method to diagnose pneumonia in low-resource settings. While automated RR counters offer a potential solution, there is currently no gold standard to validate these diagnostic aids. A video-based reference tool is proposed that allows users to annotate breaths and distortions including movement periods, allowing the exclusion of distortions from the computation of RR measures similar to how new diagnostic aids account for distortions automatically. This study evaluated the interrater agreement and acceptability of the new reference tool. METHODS Annotations were based on previously recorded reference videos of children under five years old with cough and/or difficulty breathing (n = 50). Five randomly selected medical experts from a panel of ten annotated each video. RR measures (breaths per minute, bpm) were computed as the number of annotated certain breaths divided by the length of calm periods after removing annotated distorted periods. RESULTS Reviewers showed good interrater agreement on continuous RR {standard error of measurement (SEM) [4.8 (95%CI 4.4-5.3)]} and substantial agreement on classification of fast breathing (Fleiss kappa, κ 0.71). Agreement was lowest in the youngest age group [< 2 months: SEM 6.2 (5.4-7.4) bpm, κ 0.48; 2-11 months: 4.7 (4.0-5.8) bpm, κ 0.84; 12-59 months: 2.6 (2.2-3.1) bpm, κ 0.8]. Reviewers found the functionalities of the tool helpful in annotating breaths, but remained uncertain about the validity of their annotations. CONCLUSIONS Before the new tool can be considered a reference standard for RR assessments, interrater agreement in children younger than 2 months must be improved.
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Affiliation(s)
- Ann-Sophie Stratil
- Malaria Consortium, E2 9DA, London, UK,Correspondence: Ann-Sophie Stratil, Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK. E-mail
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21
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Baker K, Ward C, Maurel A, de Cola MA, Smith H, Getachew D, Habte T, McWhorter C, LaBarre P, Karlstrom J, Ameha A, Tariku A, Black J, Bassat Q, Källander K. Usability and acceptability of a multimodal respiratory rate and pulse oximeter device in case management of children with symptoms of pneumonia: A cross-sectional study in Ethiopia. Acta Paediatr 2021; 110:1620-1632. [PMID: 33220086 PMCID: PMC8246879 DOI: 10.1111/apa.15682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
Aim Pneumonia is the leading infectious cause of death among children under five globally. Many pneumonia deaths result from inappropriate treatment due to misdiagnosis of signs and symptoms. This study aims to identify whether health extension workers (HEWs) in Ethiopia, using an automated multimodal device (Masimo Rad‐G), adhere to required guidelines while assessing and classifying under five children with cough or difficulty breathing and to understand device acceptability. Methods A cross‐sectional study was conducted in three districts of Southern Nations, Nationalities, and Peoples' Region, Ethiopia. Between September and December 2018, 133 HEWs were directly observed using Rad‐G while conducting 599 sick child consultations. Usability was measured as adherence to the World Health Organization requirements to assess fast breathing and device manufacturer instructions for use. Acceptability was assessed using semi‐structured interviews with HEWs, first‐level health facility workers and caregivers. Results Adherence using the Rad‐G routinely for 2 months was 85.3% (95% CI 80.2, 89.3). Health workers and caregivers stated a preference for Rad‐G. Users highlighted a number of device design issues. Conclusion While demonstrating high levels of acceptability and usability, the device modifications to consider include better probe fit, improved user interface with exclusive age categories and simplified classification outcomes.
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Affiliation(s)
- Kevin Baker
- Malaria Consortium London UK
- Department of Global Public Health Karolinska Institutet Solna Sweden
| | | | | | | | | | | | | | | | | | | | | | | | - Jim Black
- Nossal Institute for Global Health Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
| | - Quique Bassat
- ISGlobal Hospital Clínic ‐ Universitat de Barcelona Barcelona Spain
- Centro de Investigação em Saúde de Manhiça (CISM) Maputo Mozambique
- ICREA Barcelona Spain
- Paediatric Infectious Diseases Unit Paediatrics Department Hospital Sant Joan de Déu (University of Barcelona) Barcelona Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) Madrid Spain
| | - Karin Källander
- Malaria Consortium London UK
- Department of Global Public Health Karolinska Institutet Solna Sweden
- Programme Division UNICEF New York NY USA
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22
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Counihan H, Baba E, Oresanya O, Adesoro O, Hamzat Y, Marks S, Ward C, Gimba P, Qazi SA, Källander K. One-arm safety intervention study on community case management of chest indrawing pneumonia in children in Nigeria - a study protocol. Glob Health Action 2021; 13:1775368. [PMID: 32856569 PMCID: PMC7480438 DOI: 10.1080/16549716.2020.1775368] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Current recommendations within integrated community case management (iCCM) programmes advise community health workers (CHWs) to refer cases of chest indrawing pneumonia to health facilities for treatment, but many children die due to delays or non-compliance with referral advice. Recent revision of World Health Organization (WHO) pneumonia guidelines and integrated management of childhood illness chart booklet recommend oral amoxicillin for treatment of lower chest indrawing (LCI) pneumonia on an outpatient basis. However, these guidelines did not recommend its use by CHWs as part of iCCM, due to insufficient evidence regarding safety. We present a protocol for a one-arm safety intervention study aimed at increasing access to treatment of pneumonia by training CHWs, locally referred to as Community Oriented Resource Persons (CORPs) in Nigeria. The primary objective was to assess if CORPs could safely and appropriately manage LCI pneumonia in 2-59 month old children, and refer children with danger signs. The primary outcomes were the proportion of children 2-59 months with LCI pneumonia who were managed appropriately by CORPs and the clinical treatment failure within 6 days of LCI pneumonia. Secondary outcomes included proportion of children with LCI followed up by CORPs on day 3; caregiver adherence to treatment for chest indrawing, acceptability and satisfaction of both CORP and caregivers on the mode of treatment, including caregiver adherence to treatment; and clinical relapse of pneumonia between day 7 to 14 among children whose signs of pneumonia disappeared by day 6. Approximately 308 children 2-59 months of age with LCI pneumonia would be needed for this safety intervention study.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation , Geneva, Switzerland
| | - Karin Källander
- Malaria Consortium , London, UK.,Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden
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23
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Rigaud B, Anderson B, Cazoulat G, Yu Z, Soderberg J, Samuelsson E, Ward C, Svensson S, Taku N, Lofman F, Venkatesan A, Klopp A, Brock K. Automatic Segmentation Using Deep Learning for Online Dose Optimization During Adaptive Radiotherapy of Cervical Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ward C, Cauchy P, Garcia P, Frampton J, Esteban MA, Volpe G. Author Correction: High WBP5 expression correlates with elevation of HOX genes levels and is associated with inferior survival in patients with acute myeloid leukaemia. Sci Rep 2020; 10:13109. [PMID: 32733008 PMCID: PMC7391628 DOI: 10.1038/s41598-020-70049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- C Ward
- Key Laboratory of Regenerative Biology, Joint School of Life Sciences, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, and Guangzhou Medical University, Guangzhou, China.,Laboratory of RNA, Chromatin and Human Disease, Guangzhou, 510530, China.,Key Laboratory of Regenerative Biology and Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - P Cauchy
- Max Planck Institute of Immunobiology and Epigenetics, 79108, Freiburg, Germany
| | - P Garcia
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Frampton
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - M A Esteban
- Key Laboratory of Regenerative Biology, Joint School of Life Sciences, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, and Guangzhou Medical University, Guangzhou, China.,Laboratory of RNA, Chromatin and Human Disease, Guangzhou, 510530, China.,Key Laboratory of Regenerative Biology and Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China.,Institute for Stem Cells and Regeneration, Chinese Academy of Sciences, Beijing, 100101, China
| | - G Volpe
- Key Laboratory of Regenerative Biology, Joint School of Life Sciences, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, and Guangzhou Medical University, Guangzhou, China. .,Laboratory of RNA, Chromatin and Human Disease, Guangzhou, 510530, China. .,Key Laboratory of Regenerative Biology and Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China. .,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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25
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Ward C, Baker K, Smith H, Maurel A, Getachew D, Habte T, McWhorter C, LaBarre P, Karlstrom J, Black J, Bassat Q, Ameha A, Tariku A, Petzold M, Källander K. Usability and acceptability of an automated respiratory rate counter to assess children for symptoms of pneumonia: A cross-sectional study in Ethiopia. Acta Paediatr 2020; 109:1196-1206. [PMID: 31638714 PMCID: PMC7317341 DOI: 10.1111/apa.15074] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
AIM Manually counting respiratory rate (RR) is commonly practiced by community health workers to detect fast breathing, an important sign of childhood pneumonia. Correctly counting and classifying breaths manually is challenging, often leading to inappropriate treatment. This study aimed to determine the usability of a new automated RR counter (ChARM) by health extension workers (HEWs), and its acceptability to HEWs, first-level health facility workers (FLHFWs) and caregivers in Ethiopia. METHODS A cross-sectional study was conducted in one region of Ethiopia between May and August 2018. A total of 131 HEWs were directly observed conducting 262 sick child consultations after training and 337 after 2 months. Usability was measured as adherence to the WHO requirements to assess fast breathing and device manufacturer instructions for use (IFU). Acceptability was measured through semi-structured interviews. RESULTS After 2 months, HEWs were shown to adhere to the requirements in 74.6% consultations; an increase of 18.6% after training (P < .001). ChARM is acceptable to users and caregivers, with HEWs suggesting that ChARM increased client flow and stating a willingness to use ChARM in future. CONCLUSION Further research on the performance, cost-effectiveness and implementation of this device is warranted to inform policy decisions in countries with a high childhood pneumonia burden.
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Affiliation(s)
| | - Kevin Baker
- Malaria ConsortiumLondonUK
- Department of Public Health SciencesKarolinska InstitutetSolnaSweden
| | | | | | | | | | | | | | | | - Jim Black
- FREO2 Foundation LtdMelbourneAustralia
| | - Quique Bassat
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ICREABarcelonaSpain
- Pediatric Infectious Diseases UnitPediatrics DepartmentHospital Sant Joan de Déu (University of Barcelona)BarcelonaSpain
| | | | | | - Max Petzold
- School of Public Health and Community MedicineInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | - Karin Källander
- Malaria ConsortiumLondonUK
- Department of Public Health SciencesKarolinska InstitutetSolnaSweden
- Programme DivisionUNICEFNew YorkNYUSA
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26
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Källander K, Ward C, Smith H, Bhattarai R, KC A, Timsina D, Lamichhane B, Maurel A, Ram Shrestha P, Baral S, McWhorter C, LaBarre P, de Cola MA, Baker K. Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal. Acta Paediatr 2020; 109:1207-1220. [PMID: 31762072 PMCID: PMC7318335 DOI: 10.1111/apa.15108] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023]
Abstract
AIM Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal. METHODS A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews. RESULTS FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned. CONCLUSION Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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Affiliation(s)
- Karin Källander
- Malaria Consortium London UK
- Programme Division Health Section UNICEF New York NY USA
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
| | | | | | | | - Ashish KC
- Health & Nutrition Section UNICEF Nepal Kathmandu Nepal
- Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden
| | | | - Bikash Lamichhane
- Department of Health Services Ministry of Health & Population Kathmandu Nepal
| | | | | | | | - Cindy McWhorter
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | - Paul LaBarre
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | | | - Kevin Baker
- Malaria Consortium London UK
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
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27
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Ward C, Baker K, Marks S, Getachew D, Habte T, McWhorter C, Labarre P, Howard-Brand J, Miller NP, Tarekegn H, Deribessa SJ, Petzold M, Kallander K. Determining the Agreement Between an Automated Respiratory Rate Counter and a Reference Standard for Detecting Symptoms of Pneumonia in Children: Protocol for a Cross-Sectional Study in Ethiopia. JMIR Res Protoc 2020; 9:e16531. [PMID: 32238340 PMCID: PMC7163412 DOI: 10.2196/16531] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Acute respiratory infections (ARIs), primarily pneumonia, are the leading infectious cause of under-5 mortality worldwide. Manually counting respiratory rate (RR) for 60 seconds using an ARI timer is commonly practiced by community health workers to detect fast breathing, an important sign of pneumonia. However, correctly counting breaths manually and classifying the RR is challenging, often leading to inappropriate treatment. A potential solution is to introduce RR counters, which count and classify RR automatically. Objective This study aims to determine how the RR count of an Automated Respiratory Infection Diagnostic Aid (ARIDA) agrees with the count of an expert panel of pediatricians counting RR by reviewing a video of the child’s chest for 60 seconds (reference standard), for children aged younger than 5 years with cough and/or difficult breathing. Methods A cross-sectional study aiming to enroll 290 children aged 0 to 59 months presenting to pediatric in- and outpatient departments at a teaching hospital in Addis Ababa, Ethiopia, was conducted. Enrollment occurred between April and May 2017. Once enrolled, children participated in at least one of three types of RR evaluations: (1) agreement—measure the RR count of an ARIDA in comparison with the reference standard, (2) consistency—measure the agreement between two ARIDA devices strapped to one child, and (3) RR fluctuation—measure RR count variability over time after ARIDA attachment as measured by a manual count. The agreement and consistency of expert clinicians (ECs) counting RR for the same child with the Mark 2 ARI timer for 60 seconds was also measured in comparison with the reference standard. Results Primary outcomes were (1) mean difference between the ARIDA and reference standard RR count (agreement) and (2) mean difference between RR counts obtained by two ARIDA devices started simultaneously (consistency). Conclusions Study strengths included the design allowing for comparison between both ARIDA and the EC with the reference standard RR count. A limitation is that exactly the same set of breaths were not compared between ARIDA and the reference standard since ARIDA can take longer than 60 seconds to count RR. Also, manual RR counting, even when aided by a video of the child’s chest movements, is subject to human error and can result in low interrater reliability. Further work is needed to reach global consensus on the most appropriate reference standard and an acceptable level of agreement to provide ministries of health with evidence to make an informed decision on whether to scale up new automated RR counters. Trial Registration ClinicalTrials.gov NCT03067558; https://clinicaltrials.gov/ct2/show/NCT03067558 International Registered Report Identifier (IRRID) RR1-10.2196/16531
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Affiliation(s)
| | - Kevin Baker
- Malaria Consortium, London, United Kingdom.,Department of Public Health Sciences, Karolinska Institutet, Solnavägen, Sweden
| | | | | | | | - Cindy McWhorter
- United Nations Children's Fund Supply Division, Copenhagen, Denmark
| | - Paul Labarre
- United Nations Children's Fund Supply Division, Copenhagen, Denmark
| | | | - Nathan P Miller
- United Nations Children's Fund Programme Division, New York, NY, United States
| | - Hayalnesh Tarekegn
- United Nations Children's Fund Programme Division, New York, NY, United States
| | | | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karin Kallander
- Malaria Consortium, London, United Kingdom.,Department of Public Health Sciences, Karolinska Institutet, Solnavägen, Sweden.,United Nations Children's Fund Programme Division, New York, NY, United States
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28
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Baker K, Maurel A, Ward C, Getachew D, Habte T, McWhorter C, LaBarre P, Karlström J, Petzold M, Källander K. Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal. JMIR Res Protoc 2020; 9:e14405. [PMID: 32224491 PMCID: PMC7154937 DOI: 10.2196/14405] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background Manually counting a child’s respiratory rate (RR) for 60 seconds using an acute respiratory infection timer is the World Health Organization (WHO) recommended method for detecting fast breathing as a sign of pneumonia. However, counting the RR is challenging and misclassification of an observed rate is common, often leading to inappropriate treatment. To address this gap, the acute respiratory infection diagnostic aid (ARIDA) project was initiated in response to a call for better pneumonia diagnostic aids and aimed to identify and assess automated RR counters for classifying fast breathing pneumonia when used by front-line health workers in resource-limited community settings and health facilities. The Children’s Automated Respiration Monitor (ChARM), an automated RR diagnostic aid using accelerometer technology developed by Koninklijke Philips NV, and the Rad-G, a multimodal RR diagnostic and pulse oximeter developed by Masimo, were the two devices tested in these studies conducted in the Southern Nations, Nationalities, and Peoples’ Region in Ethiopia and in the Karnali region in Nepal. Objective In these studies, we aimed to understand the usability of two new automated RR diagnostic aids for community health workers (CHWs; health extension workers [Ethiopia] and female community health volunteers [Nepal]) and their acceptability to CHWs in Ethiopia and Nepal, first-level health facility workers (FLHFWs) in Ethiopia only, and caregivers in both Ethiopia and Nepal. Methods This was a prospective, cross-sectional study with a mixed methods design. CHWs and FLHFWs were trained to use both devices and provided with refresher training on all WHO requirements to assess fast breathing. Immediately after training, CHWs were observed using ARIDA on two children. Routine pneumonia case management consultations for children aged 5 years and younger and the device used for these consultations between the first and second consultations were recorded by CHWs in their patient log books. CHWs were observed a second time after 2 months. Semistructured interviews were also conducted with CHWs, FLHFWs, and caregivers. The proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA and adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months will be calculated. Qualitative data from semistructured interviews will be analyzed using a thematic framework approach. Results The ARIDA project was funded in November 2015, and data collection was conducted between April and December 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions This is the first time the usability and acceptability of automated RR counters in low-resource settings have been evaluated. Outcomes will be relevant for policy makers and are important for future research of this new class of diagnostic aids for the management of children with suspected pneumonia. International Registered Report Identifier (IRRID) DERR1-10.2196/14405
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Affiliation(s)
- Kevin Baker
- Malaria Consortium, London, United Kingdom.,Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | - Cindy McWhorter
- United Nations Children's Fund Supply Division, Copenhagen, Denmark
| | - Paul LaBarre
- United Nations Children's Fund Supply Division, Copenhagen, Denmark
| | - Jonas Karlström
- United Nations Children's Fund Supply Division, Copenhagen, Denmark
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Källander
- Malaria Consortium, London, United Kingdom.,Karolinska Institute, Stockholm, Sweden.,United Nations Children's Fund Programme Division, New York, NY, United States
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Brennan M, McDonnell MJ, Ward C, Alamer A, Duignan N, Rutherford RM. Bronchiectasis in the Elderly—a Disease That Has Not Gone Away. Curr Geri Rep 2020. [DOI: 10.1007/s13670-020-00315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kott K, Morel-Kopp M, Vernon S, Takagi Y, Di Bartolo B, Ward C, Figtree G. 347 Global Tests of Haemostatic Function can Detect Imbalances in Coagulation Pathways in Male Patients With Subclinical Coronary Artery Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.354] [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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Pinato D, Cole T, Bengsch B, Tait P, Sayed A, Abomeli F, Gramenitskaya D, Allara E, Thomas R, Ward C, Wong C, Akarca A, Miguens Blanco J, Marafioti T, Marchesi J, Sharma R. A phase Ib study of pembrolizumab following trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): PETAL. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Piccini I, Chéret J, Ghatak S, Alam M, Hardman J, Erdmann H, Jimenez F, Ward C, Paus R, Bertolini M. 599 PPARg signaling modulation protects from hair follicle bulge stem cell damage and cyclophosphamide-induced hair follicle cytotoxicity. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lopez E, Jimenez F, Bertolini M, Alam M, Ward C, Cheret J, Westgate G, Rinaldi F, Paus R. 181 Topical Sandalore®, a specific OR2AT4-stimulating odorant, ameliorates telogen effluvium: Randomized, double-blinded, placebo-controlled trial. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gardner A, Haq I, Verdon B, Mavin E, Saint-Criq V, Gray M, Ward C, Gulbins E, Brodlie M. WS08-5 Acid ceramidase as a potential therapeutic target in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haq I, Gardner A, Saint-Criq V, Verdon B, Jiwa K, Ward C, Gray M, Brodlie M. P033 Nasal epithelial cells as an experimental model in cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30328-5] [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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Berry D, Broglio K, Ward C, Sahin D, Nielsen T, Mattiello F, McGlothlin A, Wendelberger B, Foster M, Nowakowski G, Kostakoglu L. PET-CR AS A SURROGATE FOR SURVIVAL OUTCOMES IN DLBCL: A LITERATURE BASED META-ANALYSIS. Hematol Oncol 2019. [DOI: 10.1002/hon.59_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D.A. Berry
- Biostatistics; M.D. Anderson Cancer Center; Houston TX United States
| | - K.R. Broglio
- Biostatistics; Berry Consultants, LLC; Austin United States
| | - C. Ward
- PDBB; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - D. Sahin
- PDO; F. Hoffmann-La Roche Ltd., BASEL; Switzerland
| | - T. Nielsen
- PDO; F. Hoffmann-La Roche Ltd., BASEL; Switzerland
| | - F. Mattiello
- PDBB; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | | | | | - M. Foster
- Biostatistics; Berry Consultants, LLC; Austin United States
| | - G.S. Nowakowski
- Lymphoma Group; Mayo Clinic Rochester; Rochester United States
| | - L. Kostakoglu
- Radiology; Icahn School of Medicine at Mount Sinai; NY United States
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Bertolini M, Jimenez F, Lopez E, Alam M, Ward C, Chéret J, Westgate G, Rinaldi F, Paus R. 609 Topical Sandalore®, a specific OR2AT4-stimulating odorant, ameliorates female telogen effluvium: Randomized, double-blinded, placebo-controlled clinical trial. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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38
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Piccini I, Chéret J, Ghatak S, Alam M, Hardmann J, Erdmann H, Jimenez F, Ward C, Paus R, Bertolini M. 909 PPARγ stimulation protects from cyclophosphamide-induced hair follicle cytotoxicity and bulge stem cell damage. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Meehan J, Gray M, Turnbull AK, Martinez-Perez C, Bonello M, Ward C, Langdon SP, McLaughlin S, MacLennan M, Dixon JM, Wills J, Quinn N, Finich AJ, von Kriegsheim A, Cameron D, Kunkler IH, Murray A, Argyle D. Abstract P3-12-24: Tumor-secreted predictive biomarkers of response to radiotherapy in breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-12-24] [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: 11/16/2022]
Abstract
Abstract
Background:In breast cancer (BC), radiotherapy (RT) is used adjuvantly to prevent recurrence and also in the palliative setting. Clinical signs of RT response are often not apparent for several weeks post-treatment and we currently lack tools to predict or monitor tumor response to RT early during treatment. The aim was to identify tumor-secreted biomarkers whose release reflects response to RT, which could be monitored during treatment in the blood or intratumorally by an implantable biosensor, currently under development within the Implantable Microsystems for Personalised Anti-Cancer Therapy (IMPACT) program.
Methods: A series of experiments assessed the effect of different radiation doses (2-10Gy) on 3 human BC cell lines – MDA-MB-231 (ER-), MCF-7 (ER+) and HBL-100 (ER-) –, 1 canine breast cancer and 2 sheep lung cancer lines. Culture media was collected from each dose experiment at a range of post-radiation time-points (1-24 hours). Proteins were isolated from collected media for secretome mass spectrometry (MS) analysis. A subset of treatment/time conditions were repeated in the same BC cell lines and radioresistant (RR) derivatives from which RNA was extracted and analysed using Lexogen QuantSeq for whole-genome transcriptomics.In-lab candidate biomarker validation was carried out using immuhistochemistry (IHC), immunofluorescence (IF) and western blotting (WB) using validated antibodies. Levels of candidate biomarkers were also assessed in normal and untreated BC tissues using IHC. ELISA-based methods are currently under investigation for detection of the lead candidate biomarkers in the blood of large animal cancer models treated with RT.
Results: Biomarker discovery using the MS data revealed 4 promising candidates: EIF3G, SEC24C, YBX3 and TK1. These are released from BC and animal cancer cells sensitive to radiation in a dose-dependent manner 24 hours after treatment. Analysis of the transcriptomic data showed an 8-fold higher expression of the genes encoding the 4 candidates in the radio-sensitive parental cell lines compared to the RR cell lines. IF and WB confirmed lower intracellular expression of the 4 proteins in RR cells compared to the parental lines. WB of collected culture media confirmed release of each of the 4 candidates 24 hours after a 2Gy dose of radiation in only the parental lines. GAPDH was not found in these media samples, demonstrating that protein release was not due to cell lysis.
Conclusions:
· We have identified 4 promising biomarkers which are released from cancer cells sensitive to RT and not released from RR derivatives.
· All 4 candidates are released 24 hours after a 2Gy radiation dose, which fits with the current clinical dosing schedule where radiation is administered at 24 hour intervals. Ongoing work will elucidate if these biomarkers can be reliably detected in blood or intratumorally using implantable biosensors.
· There are currently no validated predictive tools to monitor RT response during treatment. If successfully validated, these biomarkers could have a clinical role in personalising RT dosing schedules and durations for solid tumors in the neoadjuvant and palliative setting, thus optimising treatment and preventing the administration of ineffective RT and its associated side effects.
Citation Format: Meehan J, Gray M, Turnbull AK, Martinez-Perez C, Bonello M, Ward C, Langdon SP, McLaughlin S, MacLennan M, Dixon JM, Wills J, Quinn N, Finich AJ, von Kriegsheim A, Cameron D, Kunkler IH, Murray A, Argyle D. Tumor-secreted predictive biomarkers of response to radiotherapy in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-24.
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Affiliation(s)
- J Meehan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M Gray
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - AK Turnbull
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - C Martinez-Perez
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M Bonello
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - C Ward
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - SP Langdon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - S McLaughlin
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - M MacLennan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - JM Dixon
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - J Wills
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - N Quinn
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - AJ Finich
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - A von Kriegsheim
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - D Cameron
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - IH Kunkler
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - A Murray
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - D Argyle
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Institute of Sensors, Signals and Systems, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, United Kingdom; Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom; School of Engineering, Faraday Building, King's Buildings, University of Edinburgh, Edinburgh, United Kingdom; The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
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Abstract
Background: Preventable hospital readmissions are costly and erode the quality of care delivery.
Few efforts to incorporate the patient perspectives and social factors associated with
readmission preventability exist. Objective: To identify patient perceptions and social barriers to care related to readmission. Methods: Prospective cohort study of 202 respondents readmitted within 30 days of hospital
discharge from 2 inpatient adult medicine units at Massachusetts General Hospital,
Boston, Massachusetts between January 2012 and January 2016. Results: Few participants indicated that their readmission was due to unattainable health care
after discharge. Almost half indicated that they needed more general assistance to stay
well outside the hospital. Those reporting a barrier related to at least 2 measures of
social determinants of health were more likely to have preventable readmissions (34% vs
17%, P = .006). Participants with a history of homelessness or
substance use disorder were more likely to have preventable readmissions (44% vs 20%,
P = .04 and 32% vs 18%, P = .03, respectively). Conclusion: Strengthening nonmedical support systems and general social policy may be required to
reduce preventable readmissions.
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Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Charlotte Ward
- Center for Healthcare Studies, Northwestern University, Chicago, IL, USA.,Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Anne Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Karen Donelan
- Harvard Medical School, Boston, MA, USA.,Mongan Institute for Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Wexler
- Harvard Medical School, Boston, MA, USA.,MGH Diabetes Center, Boston, MA, USA
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Veerappan S, Lee-Tannock A, Ward C, Gooi A. Foetal Outcomes after HLHS Diagnosis: A 10 year Queensland Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Raue M, Miller J, Ward C, Brady S, D’Ambrosio L, Ellis D, Felts A, Coughlin JF. STAYING SOCIAL: SOCIOEMOTIONAL CONNECTIONS AND MEANING-MAKING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Raue
- Massachusetts Institute of Technology AgeLab, Cambridge, Massachusetts, United States
| | - J Miller
- Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA
| | - C Ward
- Massachusetts Institute of Technology AgeLab, Cambridge MA, USA
| | - S Brady
- Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA
| | - L D’Ambrosio
- Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA
| | - D Ellis
- Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA
| | - A Felts
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
| | - J F Coughlin
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
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Brady S, Miller J, Ward C, Raue M, D’Ambroiso L, Ellis D, Felts A, Coughlin JF. MAINTAINING INDEPENDENCE: HEALTH, DISABILITY, AND STAYING IN-SHAPE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Brady
- Massachusetts Institute of Technology AgeLab, Cambridge, Massachusetts, United States
| | - J Miller
- Massachusetts Institute of Technology AgeLab, Cambridge MA, USA
| | - C Ward
- Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA
| | - M Raue
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
| | - L D’Ambroiso
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
| | - D Ellis
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
| | - A Felts
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
| | - J F Coughlin
- Massachusetts Insititute of Technology, AgeLab, Cambridge, MA, USA
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Iyer S, Shah S, Ward C, Stains J, Folker E, Lovering R. NUCLEAR DYNAMICS AND CYTOSKELETAL COUPLING ARE ALTERED IN MURINE AGING SKELETAL MUSCLE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Iyer
- Department of Orthopaedics
| | - S Shah
- Departments of Orthopaedic Surgery and Bioengineering
| | - C Ward
- Department of Orthopaedics
| | | | | | - R Lovering
- Departments of Orthopaedics and Physiology
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Aston SJ, Reade S, Petersen B, Ward C, Duffy A, Nsutebu E. Extraordinary virtual multidisciplinary team meetings - a novel forum for the coordinated care of patients with -complex conditions within a secondary care setting. Future Healthc J 2018; 5:218-223. [PMID: 31098570 PMCID: PMC6502590 DOI: 10.7861/futurehosp.5-3-218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multidisciplinary team (MDT) meetings are increasingly regarded as best practice for the successful management of chronic disease. However, for patients with undiagnosed illnesses, multiple interacting comorbidities or other complex needs that fall outside the remit of disease-specific MDTs or the scope of expertise of individual clinicians, there is often no suitable forum at which to discuss their care to develop a coordinated plan for management. We developed and piloted a new forum for interspecialty discussion and collaboration, an extraordinary virtual MDT, to enable clinicians to arrange an urgent meeting of all involved parties in response to challenging clinical scenarios. Here, we share our experience of implementing this innovation and suggest how this novel forum for coordinated care could be further developed to improve the integration, timeliness and quality of healthcare delivery for patients with complex needs.
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Affiliation(s)
- Stephen J Aston
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, and Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Barbara Petersen
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Anthony Duffy
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Emmanuel Nsutebu
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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McDonnell M, O'Toole D, Ward C, Pearson J, Lordan J, De Soyza A, Loebinger M, Chalmers J, Laffey J, Rutherford R. A qualitative synthesis of gastro-oesophageal reflux in bronchiectasis: Current understanding and future risk. Respir Med 2018; 141:132-143. [DOI: 10.1016/j.rmed.2018.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/17/2018] [Accepted: 06/29/2018] [Indexed: 12/15/2022]
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Dyer G, Brice L, Schifter M, Gilroy N, Kabir M, Hertzberg M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Huang G, Hogg M, Brown L, Tan J, Ward C, Kerridge I. Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia. Aust Dent J 2018; 63:312-319. [PMID: 29878377 DOI: 10.1111/adj.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group. METHODS Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments. RESULTS Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team. CONCLUSION Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.
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Affiliation(s)
- G Dyer
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - L Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - M Schifter
- Westmead Centre for Oral Health, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - N Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - M Kabir
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - M Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - M Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - S R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J Moore
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - D Gottlieb
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - G Huang
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - M Hogg
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - L Brown
- Department of Haematology, Calvary Mater, Newcastle, New South Wales, Australia
| | - J Tan
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - C Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - I Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Haq I, Gardner A, Saint-Criq V, Thomas M, Townshend J, Ben-Hamida M, O'brien C, Ward C, Gray M, Brodlie M. WS15.4 First functional characterisation of the R751L CFTR mutation using an ex vivo primary airway epithelial cell culture model. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-17] [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: 11/16/2022]
Abstract
Abstract
Background
Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.
Methods
We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.
Results
111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.
Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic Age at diagnosis3636(25-49)36(21-44)0.31Stage I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80
Conclusions
PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.
Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-17.
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Affiliation(s)
- L Prior
- Cancer Trials Ireland, Dublin, Ireland
| | - M Teo
- Cancer Trials Ireland, Dublin, Ireland
| | - M Greally
- Cancer Trials Ireland, Dublin, Ireland
| | - C Ward
- Cancer Trials Ireland, Dublin, Ireland
| | - C O'Leary
- Cancer Trials Ireland, Dublin, Ireland
| | - R Aslam
- Cancer Trials Ireland, Dublin, Ireland
| | - W Darwish
- Cancer Trials Ireland, Dublin, Ireland
| | - N Ahmed
- Cancer Trials Ireland, Dublin, Ireland
| | - G Watson
- Cancer Trials Ireland, Dublin, Ireland
| | - D Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - L Kiely
- Cancer Trials Ireland, Dublin, Ireland
| | - A Hassan
- Cancer Trials Ireland, Dublin, Ireland
| | - J Gleeson
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Lim
- Cancer Trials Ireland, Dublin, Ireland
| | - H Murray
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Westrup
- Cancer Trials Ireland, Dublin, Ireland
| | | | - G Leonard
- Cancer Trials Ireland, Dublin, Ireland
| | - L Grogan
- Cancer Trials Ireland, Dublin, Ireland
| | | | - A Horgan
- Cancer Trials Ireland, Dublin, Ireland
| | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - R Gupta
- Cancer Trials Ireland, Dublin, Ireland
| | - M Keane
- Cancer Trials Ireland, Dublin, Ireland
| | - K Duffy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Kennedy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Higgins
- Cancer Trials Ireland, Dublin, Ireland
| | - C Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - D Carney
- Cancer Trials Ireland, Dublin, Ireland
| | - G Gullo
- Cancer Trials Ireland, Dublin, Ireland
| | - J Crown
- Cancer Trials Ireland, Dublin, Ireland
| | - J Walshe
- Cancer Trials Ireland, Dublin, Ireland
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