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Entezami M, Mustaqqim F, Morris E, Lim ESH, Prada JM, Paramasivam SJ. Effect of Human Activity and Presence on the Behavior of Long-Tailed Macaques ( Macaca fascicularis) in an Urban Tourism Site in Kuala Selangor, Malaysia. Animals (Basel) 2024; 14:1173. [PMID: 38672321 PMCID: PMC11047574 DOI: 10.3390/ani14081173] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The increasing overlap of resources between human and long-tailed macaque (Macaca fascicularis) (LTM) populations have escalated human-primate conflict. In Malaysia, LTMs are labeled as a 'pest' species due to the macaques' opportunistic nature. This study investigates the activity budget of LTMs in an urban tourism site and how human activities influence it. Observational data were collected from LTMs daily for a period of four months. The observed behaviors were compared across differing levels of human interaction, between different times of day, and between high, medium, and low human traffic zones. LTMs exhibited varying ecological behavior patterns when observed across zones of differing human traffic, e.g., higher inactivity when human presence is high. More concerning is the impact on these animals' welfare and group dynamics as the increase in interactions with humans takes place; we noted increased inactivity and reduced intra-group interaction. This study highlights the connection that LTMs make between human activity and sources of anthropogenic food. Only through understanding LTM interaction can the cause for human-primate conflict be better understood, and thus, more sustainable mitigation strategies can be generated.
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Affiliation(s)
- Mahbod Entezami
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Daphne Jackson Road, Guildford GU2 7AL, UK; (M.E.); (E.M.); (J.M.P.)
| | - Fiqri Mustaqqim
- School of Postgraduate Studies, Perdana University, Serdang 43400, Malaysia
| | - Elizabeth Morris
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Daphne Jackson Road, Guildford GU2 7AL, UK; (M.E.); (E.M.); (J.M.P.)
| | - Erin Swee Hua Lim
- Abu Dhabi Women’s College, Higher Colleges of Technology, Abu Dhabi 41012, United Arab Emirates;
- Centre for Research Excellence, Perdana University, Serdang 43400, Malaysia
| | - Joaquín M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Daphne Jackson Road, Guildford GU2 7AL, UK; (M.E.); (E.M.); (J.M.P.)
| | - Sharmini Julita Paramasivam
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Daphne Jackson Road, Guildford GU2 7AL, UK; (M.E.); (E.M.); (J.M.P.)
- Animal Neighbours Project, School of Veterinary Medicine, University of Surrey, Daphne Jackson Road, Guildford GU2 7AL, UK
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Buckell J, Mitchell CA, Fryer K, Newbert C, Brennan A, Joyce J, Jebb SA, Aveyard P, Guess N, Morris E. Identifying Preferred Features of Weight Loss Programs for Adults With or at Risk of Type 2 Diabetes: A Discrete Choice Experiment With 3,960 Adults in the U.K. Diabetes Care 2024; 47:739-746. [PMID: 38377531 DOI: 10.2337/dc23-2019] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To understand preferences for features of weight loss programs among adults with or at risk of type 2 diabetes in the U.K. RESEARCH DESIGN AND METHODS We conducted a discrete choice experiment with 3,960 U.K. adults living with overweight (n = 675 with type 2 diabetes). Preferences for seven characteristics of weight loss programs were analyzed. Simulations from choice models using the experimental data predicted uptake of available weight loss programs. Patient groups comprising those who have experience with weight loss programs, including from minority communities, informed the experimental design. RESULTS Preferences did not differ between individuals with and without type 2 diabetes. Preferences were strongest for type of diet. Healthy eating was most preferred relative to total diet replacement (odds ratio [OR] 2.24; 95% CI 2.04-2.44). Individual interventions were more popular than group interventions (OR 1.40; 95% CI 1.34-1.47). Participants preferred programs offering weight loss of 10-15 kg (OR 1.37; 95% CI 1.28-1.47) to those offering loss of 2-4 kg. Online content was preferred over in-person contact (OR 1.24; 95% CI 1.18-1.30). There were few differences in preferences by gender or ethnicity, although weight loss was more important to women than to men, and individuals from ethnic minority populations identified more with programs where others shared their characteristics. Modeling suggested that tailoring programs to individual preferences could increase participation by ∼17 percentage points (68% in relative terms). CONCLUSIONS Offering a range of weight loss programs targeting the preferred attributes of different patient groups could potentially encourage more people to participate in weight loss programs and support those living with overweight to reduce their weight.
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Affiliation(s)
- John Buckell
- Health Economics Research Centre, Oxford Population Health, University of Oxford, Oxford, U.K
| | - Caroline A Mitchell
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | - Kate Fryer
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | | | - Alan Brennan
- School of Medicine and Population Health, University of Sheffield, Sheffield, U.K
| | - Jack Joyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Susan A Jebb
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Paul Aveyard
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Nicola Guess
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
| | - Elizabeth Morris
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, U.K
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Hirsch L, Huang Y, Makse HA, Martinez DF, Hughes M, Eskreis-Winkler S, Pinker K, Morris E, Parra LC, Sutton EJ. [WITHDRAWN] Predicting breast cancer with AI for individual risk-adjusted MRI screening and early detection. ArXiv 2024:arXiv:2312.00067v2. [PMID: 38076513 PMCID: PMC10705586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
This paper has been withdrawn by Lukas Hirsch. Major revisions and rewriting in progress.
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Hartmann-Boyce J, Rees K, Onakpoya I, Otunla A, Morris E, Morgan J, Highton P, Suklan J, Curtis F, Goyder C, O'Mahoney L, James O, Sreejith N, Seidu S, Khunti K. An Update to the Overview of Reviews: Risks of and From SARS-COV-2 Infection and COVID-19 in People With Diabetes. Diabetes Care 2023; 46:e215-e216. [PMID: 37856358 DOI: 10.2337/dc23-1365] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
- University of Massachusetts Amherst, Amherst, MA
| | - Karen Rees
- Freelance systematic reviewer, Warwickshire, U.K
| | - Igho Onakpoya
- Department of Continuing Education, University of Oxford, Oxford, U.K
| | - Afolarin Otunla
- Medical Sciences Division, University of Oxford, Oxford, U.K
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, U.K
| | - Patrick Highton
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Jana Suklan
- National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, U.K
| | - Ffion Curtis
- Liverpool Reviews & Implementation Group (LRiG), University of Liverpool, Liverpool, U.K
| | - Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Lauren O'Mahoney
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Olivia James
- Medical Sciences Division, University of Oxford, Oxford, U.K
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
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Chanpong A, Morris E, Biassoni L, Easty M, Goodwin B, Lindley KJ, Rybak A, Eaton S, Thapar N, Borrelli O. Small Bowel Transit Scintigraphy in Children With Pediatric Intestinal Pseudo-Obstruction. Am J Gastroenterol 2023; 118:2267-2275. [PMID: 37351844 DOI: 10.14309/ajg.0000000000002373] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Objective evidence of small intestinal dysmotility is a key criterion for the diagnosis of pediatric intestinal pseudo-obstruction (PIPO). Small bowel scintigraphy (SBS) allows for objective measurement of small bowel transit (SBT), but limited data are available in children. We aimed to evaluate the utility of SBS in children suspected of gastrointestinal dysmotility. METHODS Patients undergoing gastric emptying studies for suspected foregut dysmotility, including PIPO, from 2016 to 2022 at 2 tertiary children's hospitals were recruited to an extended protocol of gastric emptying studies to allow for assessment of SBT. PIPO was classified based on antroduodenal manometry (ADM). SBT was compared between PIPO and non-PIPO patients. Scintigraphic parameters were assessed and correlated against ADM scores. RESULTS Fifty-nine patients (16 PIPO and 43 non-PIPO diagnoses) were included. SBS was performed with liquid and solid meals in 40 and 26 patients, respectively. As compared to the non-PIPO group, PIPO patients had a significantly lower median percentage of colonic filling at 6 hours, with both liquid (48% vs 83%) and solid tests (5% vs 65%). SBT in PIPO patients with myopathic involvement was significantly slower than in patients with neuropathic PIPO, both for liquid and solid meal. A significant correlation was found between solid SBT and ADM scores (r = -0.638, P = 0.036). DISCUSSION SBS provides a practically feasible assessment of small intestinal motility. It shows a potential utility to help diagnose and characterize PIPO. SBS seems most discriminative in PIPO patients with myopathic involvement. Studies in a larger pediatric population and across different ages are required.
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Affiliation(s)
- Atchariya Chanpong
- Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Gastroenterology, Hepatology, and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Elizabeth Morris
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
- Clinical Physics, Barts Health NHS Trust, London, United Kingdom
| | - Lorenzo Biassoni
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Marina Easty
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Bruce Goodwin
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keith J Lindley
- Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anna Rybak
- Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Simon Eaton
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nikhil Thapar
- Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom
- Stem Cells and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Gastroenterology, Hepatology, and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Center for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Osvaldo Borrelli
- Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom
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Choi K, Ayala L, Lierly R, Bustamante D, Cioppa-Fong B, Mead M, Mkroyan HJ, Morris E, Babajanyan I, Maryanov D. Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry. J Am Psychiatr Nurses Assoc 2023:10783903231171590. [PMID: 37853611 DOI: 10.1177/10783903231171590] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. AIMS The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. METHODS This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. RESULTS There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. CONCLUSION Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.
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Affiliation(s)
- Kristen Choi
- Kristen Choi, PhD, RN, FAAN, University of California, Los Angeles, Los Angeles, CA, USA; Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Leilanie Ayala
- Leilanie Ayala, PMHNP-BC, Sutter Center for Psychiatry, Sacramento, CA, USA; University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca Lierly
- Rebecca Lierly, PhD, Sutter Center for Psychiatry, Sacramento, CA, USA
| | - Daniela Bustamante
- Daniela Bustamante, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Benjamin Cioppa-Fong
- Benjamin Cioppa-Fong, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Meredith Mead
- Meredith Mead, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Hagop J Mkroyan
- Hagop J. Mkroyan, MSN, PMHNP-BC, Nutrix Care Partners, Los Angeles, CA, USA
| | - Elizabeth Morris
- Elizabeth Morris, PsyD, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Irina Babajanyan
- Irina Babajanyan, AMFT, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Daniel Maryanov
- Daniel Maryanov, MSN, RN, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
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Turner R, Quach H, Horvath N, Kerridge I, Lee E, Morris E, Kalff A, Khong T, Reynolds J, Spencer A. Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial. Br J Haematol 2023. [PMID: 37332079 DOI: 10.1111/bjh.18914] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m2 days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.
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Affiliation(s)
- R Turner
- Alfred Health, Melbourne, Victoria, Australia
| | - H Quach
- St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
| | - N Horvath
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Kerridge
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - E Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - E Morris
- Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Kalff
- Alfred Health, Melbourne, Victoria, Australia
| | - T Khong
- Alfred Health, Melbourne, Victoria, Australia
| | - J Reynolds
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - A Spencer
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
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Blankenburg M, Sánchez-Collado I, Soyemi BO, Åkerborg Ö, Caleyachetty A, Harris J, Morris E, Newstead G, Lobig F. Economic evaluation of supplemental breast cancer screening modalities to mammography or digital breast tomosynthesis in women with heterogeneously and extremely dense breasts and average or intermediate breast cancer risk in US healthcare. J Med Econ 2023:1-22. [PMID: 37278659 DOI: 10.1080/13696998.2023.2222035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the cost effectiveness of supplemental breast imaging modalities for women with heterogeneously and extremely dense breasts and average or intermediate risk of breast cancer (BC) in the USA, and analyze capacity requirements for supplemental magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM). METHODS Clinical and economic outcomes for supplemental imaging modalities including full- and abbreviated-protocol MRI (Fp-MRI, Ab-MRI), CEM, and ultrasound (U/S) as add-on to x-ray mammography (XM) or digital breast tomosynthesis (DBT), were compared to XM or DBT alone, in a decision tree linked to a Markov chain validated by comparison with a microsimulation analysis. A Delphi panel supplemented model input parameters from the literature. A capacity model evaluated the number of additional daily scans and scanners required for Fp-MRI and CEM. RESULTS Compared to XM or DBT alone, all supplemental imaging protocols were cost effective. Both Fp- and Ab-MRI, and to a lesser extent CEM and U/S, yielded superior clinical outcomes to XM or DBT. Compared to XM alone, U/S and Ab-MRI had the lowest incremental cost-effectiveness ratios (ICER). For U/S, the ICER was $23,394 for the average-risk population and $13,241 for the intermediate-risk population. For CEM, the ICER was $38,423 and $23,772, respectively. For the extremely dense subpopulation with intermediate risk, supplemental screening requirements could be accommodated by conducting one Fp-MRI scan per day per existing general scanner. CONCLUSIONS While ultrasound had the lowest ICER, MRI and CEM demonstrated the best clinical outcomes, compared to XM or DBT alone for women with dense breasts and intermediate and high risk. Existing MRI scanner capacity has the potential to meet most of the supplemental screening needs of this population.
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Affiliation(s)
| | | | | | | | | | | | - Elizabeth Morris
- Department of Radiology, University of California Davis, Sacramento, CA, USA
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Scragg J, Morris E, Wane S, Noreik M, Jerome D, Yu LM, Galal U, Dyson P, Tan GD, Fox R, Breeze P, Thomas C, Jebb SA, Aveyard P. Dietary approaches to the management of type 2 diabetes (DIAMOND) in primary care: A protocol for a cluster randomised trial. Contemp Clin Trials 2023; 129:107199. [PMID: 37094737 DOI: 10.1016/j.cct.2023.107199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION There is strong evidence that type 2 diabetes (T2D) remission can be achieved by adopting a low-energy diet achieved through total dietary replacement products. There is promising evidence that low-carbohydrate diets can achieve remission of T2D. The Dietary Approaches to the Management of type 2 Diabetes (DIAMOND) programme combines both approaches in a behaviourally informed low-energy, low-carbohydrate diet for people with T2D, delivered by nurses in primary care. This trial compares the effectiveness of the DIAMOND programme to usual care in inducing remission of T2D and in reducing risk of cardiovascular disease. METHODS AND ANALYSIS We aim to recruit 508 people in 56 practices with T2D diagnosed within 6 years, who are demographically representative of the UK population. We will allocate general practices, based on ethnicity and socioeconomic status, to provide usual care for diabetes or offer the DIAMOND programme. Participants in practices offering DIAMOND will see the nurse seven times over 6 months. At baseline, 6 months, and 1 year we will measure weight, blood pressure, HbA1c, lipid profile and risk of fatty liver disease. The primary outcome is diabetes remission at 1 year, defined as HbA1c < 48 mmol/mol and off glucose-lowering medication for at least 6 months. Thereafter, we will assess whether people resume treatment for diabetes and the incidence of microvascular and macrovascular disease through the National Diabetes Audit. Data will be analysed using mixed-effects generalised linear models. This study has been approved by the National Health Service Health Research Authority Research Ethics Committee (Ref: 22/EM/0074). TRIAL REGISTRATION NUMBER ISRCTN46961767.
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Affiliation(s)
- Jadine Scragg
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Sarah Wane
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Michaela Noreik
- Hochschule Niederrhein, Fachbereich Oecotrophologie, University of Applied Sciences, UK
| | - Derek Jerome
- PPI representative, the DIAMOND study, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Primary Care- Clinical trials unit, University of Oxford, Oxford, UK
| | - Ushma Galal
- Primary Care- Clinical trials unit, University of Oxford, Oxford, UK
| | - Pamela Dyson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Garry D Tan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robin Fox
- Bicester Health Centre, Bicester, UK
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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11
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Lobig F, Caleyachetty A, Forrester L, Morris E, Newstead G, Harris J, Blankenburg M. Performance of Supplemental Imaging Modalities for Breast Cancer in Women With Dense Breasts: Findings From an Umbrella Review and Primary Studies Analysis. Clin Breast Cancer 2023:S1526-8209(23)00088-5. [PMID: 37202338 DOI: 10.1016/j.clbc.2023.04.003] [Citation(s) in RCA: 1] [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] [Received: 11/25/2022] [Revised: 02/28/2023] [Accepted: 04/14/2023] [Indexed: 05/20/2023]
Abstract
Breast cancer screening performance of supplemental imaging modalities by breast density and breast cancer risk has not been widely studied, and the optimal choice of modality for women with dense breasts remains unclear in clinical practice and guidelines. This systematic review aimed to assess breast cancer screening performance of supplemental imaging modalities for women with dense breasts, by breast cancer risk. Systematic reviews (SRs) in 2000 to 2021, and primary studies in 2019 to 2021, on outcomes of supplemental screening modalities (digital breast tomography [DBT], MRI (full/abbreviated protocol), contrast enhanced mammography (CEM), ultrasound (hand-held [HHUS]/automated [ABUS]) in women with dense breasts (BI-RADS C&D) were identified. None of the SRs analyzed outcomes by cancer risk. Meta-analysis of the primary studies was not feasible due to lack of studies (MRI, CEM, DBT) or methodological heterogeneity (ultrasound); therefore, findings were summarized narratively. For average risk, a single MRI trial reported a superior screening performance (higher cancer detection rate [CDR] and lower interval cancer rate [ICR]) compared to HHUS, ABUS and DBT. For intermediate risk, ultrasound was the only modality assessed, but accuracy estimates ranged widely. For mixed risk, a single CEM study reported the highest CDR, but included a high proportion of women with intermediate risk. This systematic review does not allow a complete comparison of supplemental screening modalities for dense breast populations by breast cancer risk. However, the data suggest that MRI and CEM might generally offer superior screening performance versus other modalities. Further studies of screening modalities are urgently required.
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Affiliation(s)
| | | | | | - Elizabeth Morris
- University of California Davis, Department of Radiology, Sacramento, CA 95817, USA
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12
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Manduca S, Mabud T, Liu S, Taslakian B, Morris E, Kulkarni K. Abstract No. 146 Effect of Embolic Particle Size on Outcomes of Uterine Artery Embolization for Mixed Adenomyosis/Fibroids: Are Smaller Particles Needed? J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.199] [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: 02/26/2023] Open
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13
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Slomp C, Morris E, Hippman C, Inglis A, Carrion P, Batallones R, Andrighetti H, Albert A, Austin J. Relationships Between Maternal Perinatal Mood, Sex of Infant, and Disappointment with Sex of Infant in a North American Sample. Matern Child Health J 2023; 27:297-306. [PMID: 36602647 DOI: 10.1007/s10995-022-03583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Little is known about the relationships between sex of infant, disappointment with sex of infant, and risk for perinatal depression, particularly in societies where the nature of parental sex preference is thought to be "balanced" between male and female offspring. We sought to explore relationships between these variables in a North American population. METHODS In this exploratory study, we used data from a large Canadian prospective longitudinal study in which data were collected at up to four timepoints: during pregnancy, and at 1 week, 1 month and 3 months postpartum. Data about sex of infant, maternal preference for, and disappointment in sex of infant were recorded at the first possible timepoint; while at each postpartum timepoint infant fussiness and EPDS scores were recorded. We performed a mixed-effects linear regression to evaluate relationships between these variables. RESULTS In our sample of N = 207 women, EPDS scores were higher for mothers of male versus female infants, and independently associated with infant fussiness. There was no interaction between sex of infant and maternal disappointment, or between maternal disappointment and EPDS scores. CONCLUSIONS Mothers of male infants may have slightly more depressive symptoms than mothers of female infants regardless of maternal preference for, or disappointment in sex of infant; sex-specific biological risk factors for PPD should be explored.
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Affiliation(s)
- C Slomp
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - E Morris
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - C Hippman
- BC Women's Health Research Institute, Vancouver, BC, Canada
| | - A Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - P Carrion
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - R Batallones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - H Andrighetti
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - A Albert
- BC Women's Health Research Institute, Vancouver, BC, Canada
| | - J Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. .,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada. .,UBC Departments of Psychiatry and Medical Genetics, Rm A3-127, 3Rd Floor, Translational Lab Building, 938 W28th Ave, Vancouver, BC, V5Z 4H4, Canada.
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14
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Karandikar A, Solberg A, Fung A, Lee AY, Farooq A, Taylor AC, Oliveira A, Narayan A, Senter A, Majid A, Tong A, McGrath AL, Malik A, Brown AL, Roberts A, Fleischer A, Vettiyil B, Zigmund B, Park B, Curran B, Henry C, Jaimes C, Connolly C, Robson C, Meltzer CC, Phillips CH, Dove C, Glastonbury C, Pomeranz C, Kirsch CFE, Burgan CM, Scher C, Tomblinson C, Fuss C, Santillan C, Daye D, Brown DB, Young DJ, Kopans D, Vargas D, Martin D, Thompson D, Jordan DW, Shatzkes D, Sun D, Mastrodicasa D, Smith E, Korngold E, Dibble EH, Arleo EK, Hecht EM, Morris E, Maltin EP, Cooke EA, Schwartz ES, Lehrman E, Sodagari F, Shah F, Doo FX, Rigiroli F, Vilanilam GK, Landinez G, Kim GGY, Rahbar H, Choi H, Bandesha H, Ojeda-Fournier H, Ikuta I, Dragojevic I, Schroeder JLT, Ivanidze J, Katzen JT, Chiang J, Nguyen J, Robinson JD, Broder JC, Kemp J, Weaver JS, Conyers JM, Robbins JB, Leschied JR, Wen J, Park J, Mongan J, Perchik J, Barbero JPM, Jacob J, Ledbetter K, Macura KJ, Maturen KE, Frederick-Dyer K, Dodelzon K, Cort K, Kisling K, Babagbemi K, McGill KC, Chang KJ, Feigin K, Winsor KS, Seifert K, Patel K, Porter KK, Foley KM, Patel-Lippmann K, McIntosh LJ, Padilla L, Groner L, Harry LM, Ladd LM, Wang L, Spalluto LB, Mahesh M, Marx MV, Sugi MD, Sammer MBK, Sun M, Barkovich MJ, Miller MJ, Vella M, Davis MA, Englander MJ, Durst M, Oumano M, Wood MJ, McBee MP, Fischbein NJ, Kovalchuk N, Lall N, Eclov N, Madhuripan N, Ariaratnam NS, Vincoff NS, Kothary N, Yahyavi-Firouz-Abadi N, Brook OR, Glenn OA, Woodard PK, Mazaheri P, Rhyner P, Eby PR, Raghu P, Gerson RF, Patel R, Gutierrez RL, Gebhard R, Andreotti RF, Masum R, Woods R, Mandava S, Harrington SG, Parikh S, Chu S, Arora SS, Meyers SM, Prabhu S, Shams S, Pittman S, Patel SN, Payne S, Hetts SW, Hijaz TA, Chapman T, Loehfelm TW, Juang T, Clark TJ, Potigailo V, Shah V, Planz V, Kalia V, DeMartini W, Dillon WP, Gupta Y, Koethe Y, Hartley-Blossom Z, Wang ZJ, McGinty G, Haramati A, Allen LM, Germaine P. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clin Imaging 2023; 93:117-121. [PMID: 36064645 DOI: 10.1016/j.clinimag.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alice Fung
- Oregon Health & Science University (OHSU), United States of America
| | - Amie Y Lee
- University of California, San Francisco, United States of America
| | | | - Amy C Taylor
- University of Virginia, Charlottesville, VA, United States of America
| | | | - Anand Narayan
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States of America
| | | | | | | | | | | | | | - Anne Roberts
- University of California San Diego, United States of America
| | | | | | - Beth Zigmund
- Larner College of Medicine at University of Vermont, United States of America
| | - Brian Park
- Oregon Health & Science University (OHSU), United States of America
| | - Bruce Curran
- Virginia Commonwealth University Health System, United States of America
| | - Cameron Henry
- Vanderbilt University Medical Center, United States of America
| | - Camilo Jaimes
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cara Connolly
- Vanderbilt University Medical Center, United States of America
| | - Caroline Robson
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Carolyn C Meltzer
- Keck School of Medicine of the University of Southern California, United States of America
| | | | - Christine Dove
- Vanderbilt University Medical Center, United States of America
| | | | | | | | | | - Courtney Scher
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Cristina Fuss
- Oregon Health & Science University (OHSU), United States of America
| | | | - Dania Daye
- Massachusetts General Hospital/Harvard Medical School, United States of America
| | - Daniel B Brown
- Vanderbilt University Medical Center, United States of America
| | - Daniel J Young
- Oregon Health & Science University (OHSU), United States of America
| | | | | | - Dann Martin
- Vanderbilt University Medical Center, United States of America
| | | | - David W Jordan
- University Hospitals Cleveland Medical Center & Case Western Reserve University, United States of America
| | | | - Derek Sun
- University of California, San Francisco, United States of America
| | | | | | - Elena Korngold
- Oregon Health & Science University (OHSU), United States of America
| | - Elizabeth H Dibble
- The Warren Alpert Medical School of Brown University, United States of America
| | | | | | | | | | - Erin A Cooke
- Vanderbilt University Medical Center, United States of America
| | - Erin Simon Schwartz
- Perelman School of Medicine, University of Pennsylvania, United States of America
| | | | - Faezeh Sodagari
- Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Faisal Shah
- Radiology Partners, United States of America
| | | | | | - George K Vilanilam
- Dept of Radiology, University of Arkansas for Medical Sciences, United States of America
| | - Gina Landinez
- University of California, San Francisco, United States of America
| | | | - Habib Rahbar
- University of Washington, United States of America
| | - Hailey Choi
- University of California, San Francisco, United States of America
| | | | | | - Ichiro Ikuta
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | | | | | | | - Jason Chiang
- Ronald Reagan UCLA Medical Center, United States of America
| | - Jeffers Nguyen
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | - Jennifer C Broder
- Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Jennifer Kemp
- University of Colorado School of Medicine, United States of America
| | | | | | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, United States of America
| | | | - Jessica Wen
- Stanford University, United States of America
| | - Jocelyn Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | | | - Jordan Perchik
- University of Alabama at Birmingham, United States of America
| | | | - Jubin Jacob
- St Lawrence Radiology, United States of America
| | | | | | | | | | | | | | - Kelly Kisling
- University of California San Diego, United States of America
| | | | | | | | | | | | - Kimberly Seifert
- Stanford University School of Medicine, United States of America
| | - Kirang Patel
- University of Texas Southwestern Medical Center, United States of America
| | - Kristin K Porter
- University of Alabama at Birmingham Hospital, United States of America
| | | | | | | | - Laura Padilla
- University of California San Diego, United States of America
| | | | - Lauren M Harry
- Indiana University School of Medicine, United States of America
| | - Lauren M Ladd
- Indiana University School of Medicine, United States of America
| | - Lisa Wang
- Oregon Health & Science University (OHSU), United States of America
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, United States of America
| | - M Mahesh
- Johns Hopkins University School of Medicine, United States of America
| | | | - Mark D Sugi
- University of California, San Francisco, United States of America
| | | | - Maryellen Sun
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | | | | | - Maya Vella
- University of California, San Francisco, United States of America
| | | | | | | | - Michael Oumano
- Rhode Island Hospital (Brown University), Providence, RI, United States of America
| | - Monica J Wood
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | - Morgan P McBee
- Medical University of South Carolina, United States of America
| | | | | | - Neil Lall
- Emory University, Atlanta, GA, United States of America
| | - Neville Eclov
- Duke University, Durham, NC, United States of America
| | | | | | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Nishita Kothary
- Stanford University School of Medicine, United States of America
| | | | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Orit A Glenn
- University of California, San Francisco, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America
| | | | - Peter R Eby
- Virginia Mason Franciscan Health, United States of America
| | - Preethi Raghu
- University of California, San Francisco, United States of America
| | - Rachel F Gerson
- Northwest Radiologists, Inc, PS, Bellingham, WA, United States of America
| | - Rina Patel
- University of California, San Francisco, United States of America
| | | | - Robyn Gebhard
- The Ohio State University, Columbus, OH, United States of America
| | | | - Rukya Masum
- The Ohio State University, Columbus, OH, United States of America
| | - Ryan Woods
- University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabala Mandava
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Samir Parikh
- Henry Ford Health, Jackson, MI, United States of America
| | - Sammy Chu
- University of Washington (Seattle, WA), United States of America
| | | | - Sandra M Meyers
- University of California San Diego, United States of America
| | - Sanjay Prabhu
- Boston Children's Hospital, United States of America
| | | | - Sarah Pittman
- Stanford University School of Medicine, United States of America
| | | | | | - Steven W Hetts
- University of California, San Francisco, United States of America
| | - Tarek A Hijaz
- Northwestern Memorial Hospital/Feinberg School of Medicine of Northwestern University, Chicago, IL, United States of America
| | - Teresa Chapman
- University of Washington (Seattle, WA), United States of America
| | - Thomas W Loehfelm
- University of California, Davis, Sacramento, CA, United States of America
| | | | | | | | - Vinil Shah
- University of California, San Francisco, United States of America
| | - Virginia Planz
- Vanderbilt University Medical Center, United States of America
| | - Vivek Kalia
- Texas Scottish Rite for Children Hospital, United States of America
| | - Wendy DeMartini
- Stanford University School of Medicine, United States of America
| | - William P Dillon
- University of California, San Francisco, United States of America
| | - Yasha Gupta
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Yilun Koethe
- Oregon Health & Science University (OHSU), United States of America
| | | | - Zhen Jane Wang
- University of California, San Francisco, United States of America
| | | | - Adina Haramati
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laveil M Allen
- Vanderbilt University Medical Center, United States of America
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15
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Morris E, Perumalla S, Stiers C, Gross K. Rice protein concentrate is a well-accepted, highly digestible protein source for adult cats. Front Vet Sci 2023; 10:1168659. [PMID: 37187925 PMCID: PMC10175793 DOI: 10.3389/fvets.2023.1168659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction The use of rice protein concentrate (RPC) as a protein source in cat food is uncommon. Therefore, this study aimed to determine the acceptability and digestibility of foods formulated to contain increasing levels of RPC to support its inclusion in foods for adult (non-gravid, non-lactating) cats. Methods Increasing levels of RPC (0, 7, 14, and 28%) were formulated into test foods fed to 24 cats in a Latin square design with 15-day periods and no washout between periods. Food intake and fecal scores were measured to determine the acceptability of test foods. Fecal output was measured on days 11-15. Food and fecal samples from day 15 of each period were analyzed for nutrient composition to calculate the macronutrient digestibility of the test foods. Analysis of variance and orthogonal contrasts were used to assess the effects of RPC inclusion on food intake, fecal output, fecal scores, and macronutrient digestibility. Results The results showed that as-fed (AF), dry matter (DM), and gross energy (GE) intake increased with increasing RPC levels (p > 0.05). Fecal output, both as-is and DM, was unaffected by RPC inclusion (p > 0.05); however, fecal scores increased linearly with increasing RPC inclusion (p < 0.001). Furthermore, true protein and apparent DM, GE, and carbohydrate (NFE) digestibility increased linearly with RPC inclusion (p < 0.05). Apparent fat digestibility was high for all test foods but was unaffected by RPC inclusion (p = 0.690). Discussion Overall, the inclusion of RPC was well-accepted, improved fecal characteristics, and increased the apparent and true macronutrient digestibility compared to the control. Therefore, this study demonstrated that RPC can serve as a high-quality and acceptable protein source for adult cats.
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Affiliation(s)
- Elizabeth Morris
- Hill’s Pet Nutrition, Inc., Topeka, KS, United States
- *Correspondence: Elizabeth Morris,
| | | | - Cheryl Stiers
- Hill’s Pet Nutrition, Inc., Topeka, KS, United States
| | - Kathy Gross
- Department of Animal Science & Industry Adjunct Faculty, Kansas State University, Manhattan, KS, United States
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Pilleron S, Maringe C, Morris E, Leyrat C. Immortal time bias in older vs. younger age groups. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00414-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Morris E, Perumalla S, Gross K. PSXI-5 Digestibility and Acceptability of Foods Containing Increasing Content of Rice Protein Concentrate fed to Adult Cats. J Anim Sci 2022. [DOI: 10.1093/jas/skac247.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The use of rice protein concentrate (RPC) as a protein source in cat food is not common. Therefore, the purpose of this study was to determine the acceptability and digestibility of foods formulated to contain increasing content of RPC to support its inclusion in foods for adult (non-gestational, non-lactational) cats. Increasing RPC (0, 7, 14, and 28%) were formulated into test foods fed to 24 cats in a Latin Square design with 15-day periods and no washout between periods. Food intake and fecal scores were measured to determine acceptability of test foods. Food intake and fecal output were measured on days 11-15; food and fecal samples from day 15 of each period were analyzed for nutrient composition to calculate macronutrient digestibility of the test foods. Analysis of variance and orthogonal contrasts were utilized to assess the effect of RPC inclusion on food intake, fecal output, fecal scores, and macronutrient digestibility. As-fed, dry matter (DM), and gross energy intake increased with increasing RPC inclusion (P = 0.040, 0.017, and 0.040, respectively). Fecal output, both as-is and DM, was unaffected by RPC inclusion (P = 0.267 and 0.685, respectively); however, fecal scores increased linearly with increasing RPC inclusion (P < 0.001). Rice protein concentrate inclusion in test foods linearly increased digestibility of all macronutrients (P < 0.050) except for apparent fat digestibility, which was unaffected by RPC inclusion (P = 0.690). This study demonstrated that RPC can serve as a high-quality, acceptable protein source in foods fed to adult cats. Overall, the inclusion of RPC was well accepted, improved fecal characteristics, and increased apparent and true macronutrient digestibility compared to control.
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18
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Hanna CR, Lemmon E, Hall PS, Ennis H, Morris E, McLoone P, Boyd KA, Jones RJ. Cancer Trial Impact: Understanding Implementation of the Short Course Oncology Treatment (SCOT) Trial Findings in colorectal cancer at a National Level. Clin Oncol (R Coll Radiol) 2022; 34:554-560. [PMID: 35370039 DOI: 10.1016/j.clon.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/29/2021] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS The Short Course Oncology Treatment (SCOT) trial indicated that 3 months of adjuvant doublet chemotherapy was non-inferior to 6 months of treatment for patients with colorectal cancer, with considerably less toxicity. The SCOT trial results were disseminated in June 2017. The aim of this study was to understand if SCOT trial findings were implemented in Scotland. MATERIALS AND METHODS A retrospective analysis was carried out on a dataset derived from a source population of 5.4 million people. Eligible patients were those with stage II or III colorectal cancer who received adjuvant chemotherapy. Logistic regression was applied to understand the extent of practice change to a 3-month adjuvant chemotherapy duration after the SCOT trial results were disseminated. Interrupted time series analysis was used to visualise differences in prescribing trends before and after June 2017 for the overall cohort, and by SCOT trial eligibility. RESULTS In total, 2310 patients were included in the study; 1957 and 353 treated pre- and post-June 2017, respectively. The median treatment duration decreased from 21 weeks (interquartile range 14-24) prior to June 2017 to 12 weeks (interquartile range 12-21 weeks) after June 2017 (P < 0.001). The proportion of patients receiving over 3 months of adjuvant treatment decreased from 75% to 42% (P < 0.001). This change was most noticeable for patients who met the SCOT trial eligibility criteria, and specifically for those with low-risk stage III disease and those treated with capecitabine and oxaliplatin (CAPOX). Although practice change occurred in all locations, there were differences between regions that could be explained by pre-SCOT trial prescribing trends. DISCUSSION A significant change in chemotherapy prescribing occurred after dissemination of the SCOT trial results. National, real-world data can be used to capture the extent of implementation of clinical trial results. In this case, implementation was aligned with clinical trial subgroup findings. This type of analysis could be conducted to evaluate the impact of other clinical trials.
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Affiliation(s)
- C R Hanna
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| | - E Lemmon
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - P S Hall
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - H Ennis
- Edinburgh Health Economics, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - P McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - K A Boyd
- Health Economics & Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R J Jones
- CRUK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Rochira I, Chanpong A, Biassoni L, Easty M, Morris E, Saliakellis E, Lindley K, Thapar N, Rybak A, Borrelli O. Transpyloric propagation and liquid gastric emptying in children with foregut dysmotility. Neurogastroenterol Motil 2022; 34:e14334. [PMID: 35254724 DOI: 10.1111/nmo.14334] [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: 03/16/2021] [Revised: 09/14/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Gastric emptying (GE) requires precise antropyloroduodenal coordination for effective transpyloric flow, the mechanisms of which are still unclear. We aimed to correlate gastric antral function assessed by antroduodenal manometry (ADM) with GE scintigraphy (GES) for liquid feeds in children with suspected gastrointestinal dysmotility. METHODS Children who underwent both ADM and GES over a five-year period were reviewed. ADM tracings were re-analyzed to assess antral frequency, amplitude, and motility index (MI) pre-prandially and postprandially. Transpyloric propagation (TPP) was defined as antegrade propagated antral activity preceding duodenal phase III of the migrating motor complex (MMC). TPP was defined as "poor" if occurring in <50% of all presented duodenal phases III. For GES, regions of interest over the whole stomach, fundus, and antrum were drawn to calculate GE half-time (GE-T1/2 ) and retention rate (RR) in each region at 1 and 2 h. RESULTS Forty-seven children (median age: 7.0 years) were included. Twenty-two had PIPO, 14 functional GI disorders, and 11 gastroparesis. Children with poor TPP had longer GE-T1/2 (113.0 vs 66.5 min, p = 0.028), higher RR of the whole stomach and fundus at 1 h (79.5% vs 63.5%, p = 0.038; 60.0% vs 41.0%, p = 0.022, respectively) and 2 h (51.0% vs 10.5%, p = 0.005; 36.0% vs 6.5%, p = 0.004, respectively). The pre-prandial antral amplitude of contractions inversely correlated with GE-T1/2 , RR of the whole stomach, and fundus at 2 h. CONCLUSIONS TPP during phase III of the MMC correlated with gastric emptying of liquid and its assessment on ADM might predict abnormalities in postprandial gastric function.
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Affiliation(s)
- Ilaria Rochira
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK.,Department of Paediatrics, Children's Hospital, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Atchariya Chanpong
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK.,Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Stem cell and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lorenzo Biassoni
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Marina Easty
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Elizabeth Morris
- Nuclear Medicine Unit, Department of Radiology, Great Ormond Street Hospital for Children, London, UK.,Nuclear Medicine Physics, Clinical Physics, Barts Health NHS Trust, London, UK
| | - Efstratios Saliakellis
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Keith Lindley
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Nikhil Thapar
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK.,Stem cell and Regenerative Medicine, UCL Great Ormond Street Institute of Child Health, London, UK.,Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anna Rybak
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Osvaldo Borrelli
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
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Khalil A, Samara A, O'Brien P, Morris E, Draycott T, Lees C, Ladhani S. Monkeypox and pregnancy: what do obstetricians need to know? Ultrasound Obstet Gynecol 2022; 60:22-27. [PMID: 35652380 DOI: 10.1002/uog.24968] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Samara
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - T Draycott
- The Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, UK
| | - C Lees
- Imperial College London, London, UK
| | - S Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
- Immunisation and Countermeasures Division, Public Health, England
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
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Khosravi P, Sutton EJ, Jee J, Dalfonso T, Fong CJ, Rose D, Da Silva EM, Kohli A, Ho DJ, Ahmed MS, Martinez D, Begum A, Zakszewski E, Aukerman A, Tazi Y, Pinker-Domenig K, Eskreis-Winkler S, Khan AJ, Brogi E, Morris E, Chandarlapaty S, Plitas G, Powell S, Morrow M, Norton L, Gao J, Robson M, Zhang H, Shah S, Razavi P. Abstract 1928: Prediction of neoadjuvant treatment outcomes with multimodal data integration in breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1928] [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
Neoadjuvant chemotherapy (NAC) is the standard of care for selected patients with high-risk early-stage breast cancer with pathologic complete response (pCR) being the most prominent predictor of favorable outcomes. Here, we sought to study the predictive capacity of integrating orthogonal diagnostic measures on predicting pCR relative to standard clinicopathologic features.
We developed a computational model integrating radiology and pathology images, and tumor genomics to automatically predict pCR from multimodal data. We present an interim analysis on a cohort of 957 patients with at least one available pre-NAC data modality. The baseline AUC for pCR prediction by a trained and tested logistic regression model on 857 patients using standard clinicopathologic features including receptor subtype, demographic information, and stage was 0.77. MR images were input into a convolutional neural network (CNN) and a radiomics model.
The trained CNN and radiomics models using selected images of 576 patients with pre-NAC MR images achieved AUCs of 0.65 and 0.60 on 164 hold-out test cases, respectively.
We trained a multiple instance learning-based weakly supervised learning (MIL-WSL) model using 537,762 extracted tiles from whole slide images (WSI) of digital histopathology scans from 522 patients. The MIL-WSL model achieved AUC of 0.63 for pCR prediction on a hold-out test set of pre-NAC biopsies from 239 patients. A feature based classifier trained on 76 cases using tumor genomic features such as mutational burden, microsatellite instability, fraction genome altered, ploidy, purity, mutation and copy number alterations in selected genes achieved an AUC of 0.72 on 83 hold-out test cases.
We then combined unimodal radiology, histopathology, and genomic predictions in a deterministic manner. This multimodal combination on an independent 68-patient test set achieved an AUC of 0.84, indicating increased power to resolve pCR than any modality alone, and over clinicopathologic baseline.
Together, we present approaches to train models end-to-end using tensor fusion networks and attention-gating combined with MIL. Automated multimodal methods are here shown to improve prediction over established clinical parameters alone, motivating our ongoing efforts to refine and improve the model so as to achieve higher levels of efficiency. We anticipate these interim results will be further improved through refinement of input features and increasing the number of patients included in the final validation cohort.
Citation Format: Pegah Khosravi, Elizabeth J. Sutton, Justin Jee, Timothy Dalfonso, Christopher J. Fong, Doori Rose, Edaise M. Da Silva, Armaan Kohli, David Joon Ho, Mehnaj S. Ahmed, Danny Martinez, Anika Begum, Elizabeth Zakszewski, Andrew Aukerman, Yanis Tazi, Katja Pinker-Domenig, Sarah Eskreis-Winkler, Atif J. Khan, Edi Brogi, Elizabeth Morris, Sarat Chandarlapaty, George Plitas, Simon Powell, Monica Morrow, Larry Norton, Jianjiong Gao, Mark Robson, Hong Zhang, Sohrab Shah, Pedram Razavi, MSK-MIND Consortium. Prediction of neoadjuvant treatment outcomes with multimodal data integration in breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1928.
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Affiliation(s)
| | | | - Justin Jee
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Doori Rose
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Armaan Kohli
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Joon Ho
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Anika Begum
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Yanis Tazi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Atif J. Khan
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - George Plitas
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Simon Powell
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larry Norton
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jianjiong Gao
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Robson
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hong Zhang
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sohrab Shah
- 1Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pedram Razavi
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Taslakian B, Mabud T, Attur M, Samuels J, Alaia E, Morris E, Sista A. Abstract No. 350 Genicular artery embolization for treatment of knee osteoarthritis: interim analysis of a prospective pilot trial including effect on serum osteoarthritis-associated biomarkers. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.431] [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: 10/18/2022] Open
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Pilleron S, Franks K, Wang Z, Morris E, Dodwell D. Chemotherapy use and outcomes in patients with stage III or IV small-cell lung cancer in relation to age: An analysis of the English Systemic Anti-Cancer Treatment (SACT) dataset. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pilleron S, Franks K, Wang Z, Morris E, Dodwell D. Chemotherapy in patients with stage III and IV non-small cell lung cancer (NSCLC) above and below the age of 75 in England: an analysis of the SACT dataset. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Van den Bruel A, Verbakel J, Wang K, Fleming S, Holtman G, Glogowska M, Morris E, Edwards G, Abakar Ismail F, Curtis K, Goetz J, Barnes G, Slivkova R, Nesbitt C, Aslam S, Swift E, Williams H, Hayward G. Non-contact infrared thermometers compared with current approaches in primary care for children aged 5 years and under: a method comparison study. Health Technol Assess 2021; 24:1-28. [PMID: 33111663 DOI: 10.3310/hta24530] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. OBJECTIVES The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. DESIGN Method comparison study with a nested qualitative study. SETTING Primary care in Oxfordshire. PARTICIPANTS Children aged ≤ 5 years attending with an acute illness. INTERVENTIONS Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. MAIN OUTCOME MEASURES The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. RESULTS A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79-3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by -0.14 °C (95% confidence interval -0.21 to -0.06 °C) on average with the lower limit of agreement being -1.57 °C (95% confidence interval -1.69 to -1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by -0.16 °C (95% confidence interval -0.23 to -0.09 °C) on average, with the lower limit of agreement being -1.54 °C (95% confidence interval -1.66 to -1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was -0.04 °C (95% confidence interval -0.07 to -0.01 °C); the lower limit was -0.56 °C (95% confidence interval -0.60 to -0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval -0.02 to 0.04 °C); the lower limit was -0.60 °C (95% confidence interval -0.65 to -0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. LIMITATIONS A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. CONCLUSIONS The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. FUTURE WORK Better methods for peripheral temperature measurement that agree well with central thermometry are needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN15413321. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Academic Centre for Primary Care, University of Leuven, Leuven, Belgium
| | - Jan Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Academic Centre for Primary Care, University of Leuven, Leuven, Belgium
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gea Holtman
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fatene Abakar Ismail
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn Curtis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Goetz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Grace Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ralitsa Slivkova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Nesbitt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suhail Aslam
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ealish Swift
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harriet Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Smith ME, Hardman JC, Mehta N, Jones GH, Mandavia R, Anderson C, Khan M, Abdelaziz A, Al-Dulaimy B, Amin N, Anmolsingh R, Anwar B, Bance M, Belfield K, Bhutta M, Buchanan R, Chandrasekharan D, Chu M, Chundu S, Conroy K, Crundwell G, Daniel M, Daniels J, De S, Dobbs S, Doshi J, Farr M, Ferdous T, Fragkouli E, Freeman S, Ghosh S, Gosnell E, Hannan SA, Heward E, Javed F, John D, Nicholls H, Kasbekar AV, Khan H, Khan H, Khwaja S, Kotecha B, Krishnan M, Kumar N, Lamb T, Lancer H, Manjaly JG, Martinez Del Pero M, McClenaghan F, Milinis K, Mistry N, Mohammed H, Morris E, Morris-Jones S, Padee J, Pal S, Patel S, Pericleous A, Qayyum A, Rouhani M, Saeed H, Santhiyapillai M, Seymour K, Sharma S, Siau R, Singh A, Stapleton E, Stephenson K, Stynes G, Subramanian B, Summerfield N, Swords C, Trinidade A, Tse A, Twumasi E, Ubhi H, Unadkat S, Vijendren A, Wasson J, Watson G, Williams G, Wilson J, Yao A, Youssef A, Lloyd SKW, Tysome JR. Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development. PLoS One 2021; 16:e0251395. [PMID: 33989313 PMCID: PMC8121300 DOI: 10.1371/journal.pone.0251395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING Stakeholders from the United Kingdom. SUBJECTS AND METHODS Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.
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Affiliation(s)
| | - John C Hardman
- The Royal Marsden Hospital London, London, United Kingdom
| | - Nishchay Mehta
- Royal National ENT Hospital London, London, United Kingdom
| | - Gareth H Jones
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | - Rishi Mandavia
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Maha Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Nikul Amin
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Bilal Anwar
- Salford Royal Hospital, Salford, United Kingdom
| | - Manohar Bance
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Katherine Belfield
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mahmood Bhutta
- Brighton Sussex University Hospitals, Brighton, United Kingdom
| | | | | | - Michael Chu
- Health Education North West, Manchester, United Kingdom
| | | | - Katherine Conroy
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gemma Crundwell
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Mat Daniel
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jessica Daniels
- Tameside and Glossop NHS Integrated Care Trust, Ashton-under-Lyne, United Kingdom
| | - Sujata De
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sian Dobbs
- Health Education North West, Manchester, United Kingdom
| | - Jayesh Doshi
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Matthew Farr
- University of Sheffield, Sheffield, United Kingdom
| | - Tanjinah Ferdous
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Eleni Fragkouli
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | | | - Samit Ghosh
- Pennine Acute Trust, Manchester, United Kingdom
| | - Emma Gosnell
- Royal Bolton Hospital, Farnworth, United Kingdom
| | - S Alam Hannan
- Royal National ENT Hospital London, London, United Kingdom
| | - Elliot Heward
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Faisal Javed
- Heartlands Hospital Birmingham, Birmingham, United Kingdom
| | - Deepa John
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Anand V Kasbekar
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Haroon Khan
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hammad Khan
- Royal Preston Hospital, Fulwood, United Kingdom
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Bhik Kotecha
- Nuffield Health Brentwood Hospital, Brentwood, United Kingdom
| | | | - Nirmal Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Tamara Lamb
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hannah Lancer
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | | | - Kristijonas Milinis
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Nina Mistry
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Hassan Mohammed
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, United Kingdom
| | - Stephen Morris-Jones
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jessica Padee
- University of Manchester, Manchester, United Kingdom
| | - Surojit Pal
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Sanjay Patel
- Aintree University Hospitals Liverpool, Liverpool, United Kingdom
| | | | - Asad Qayyum
- North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
| | - Maral Rouhani
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haroon Saeed
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Kay Seymour
- Barts Health NHS Trust, London, United Kingdom
| | - Sunil Sharma
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard Siau
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Arvind Singh
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Emma Stapleton
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Gill Stynes
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Neil Summerfield
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Aaron Trinidade
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom
| | - Antonia Tse
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Emmanuel Twumasi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Harmony Ubhi
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Samit Unadkat
- Royal National ENT Hospital London, London, United Kingdom
| | | | - Joe Wasson
- East Kent Hospitals NHS Foundation Trust, Canterbury, United Kingdom
| | - Glen Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Janet Wilson
- Newcastle Upon Tyne University Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | | | - Ahmed Youssef
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon K W Lloyd
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Koutoukidis DA, Morris E, Henry JA, Shammoon Y, Zimmerman M, Michalopoulou M, Jebb SA, Aveyard P. What proportion of people have a follow-up biopsy in randomized trials of treatments for non-alcoholic steatohepatitis?: A systematic review and meta-analysis. PLoS One 2021; 16:e0250385. [PMID: 33882107 PMCID: PMC8059856 DOI: 10.1371/journal.pone.0250385] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background and aim Trials of treatments for non-alcoholic steatohepatitis require endpoint assessment with liver biopsies. Previous large-scale trials have calculated their sample size expecting high retention but on average did not achieve this. We aimed to quantify the proportion of participants with a valid follow-up biopsy. Methods We conducted a systematic review of MEDLINE and Embase until May 2020 and included randomized clinical trials of any intervention in non-alcoholic steatohepatitis with at least 1-year follow-up. We were guided by Cochrane methods to run a meta-analysis with generalized linear mixed models with random effects. Results Forty-one trials (n = 6,695) were included. The proportion of participants with a valid follow-up biopsy was 82% (95%CI: 78%-86%, I2 = 92%). There was no evidence of a difference by location, trial length, or by allocated treatment group. Reasons for missing follow-up biopsies were, in ranked order, related to participants (95 per 1,000 participants (95%CI: 69–129, I2 = 92%), medical factors, protocol, trial conduct, and other/unclear. Biopsy-related serious adverse events occurred in 16 per 1,000 participants (95% CI: 8–33, I2 = 54%). No biopsy-related deaths were reported. Conclusions The proportion of participants with a valid follow-up biopsy in therapeutic trials in non-alcoholic steatohepatitis is on average 82%, with around 1 in 10 participants declining a follow-up biopsy. These findings can inform adequately-powered trials.
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Affiliation(s)
- Dimitrios A. Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John A. Henry
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yusra Shammoon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Zimmerman
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
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Tong H, Morris E, Jebb SA, Koutoukidis DA. Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care. BMC Fam Pract 2021; 22:65. [PMID: 33827433 PMCID: PMC8028812 DOI: 10.1186/s12875-021-01403-1] [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] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
Background Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations. Methods We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored. Results One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months. Conclusions The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01403-1.
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Affiliation(s)
- Heather Tong
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University, of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
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Morris E, Jebb SA, Oke J, Nickless A, Ahern A, Boyland E, Caterson ID, Halford J, Hauner H, Aveyard P. Effect of weight loss on cardiometabolic risk: observational analysis of two randomised controlled trials of community weight-loss programmes. Br J Gen Pract 2021; 71:e312-e319. [PMID: 33685923 PMCID: PMC7959667 DOI: 10.3399/bjgp20x714113] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend that clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, we lack individual level data quantifying the benefits of weight change for individuals to guide consultations in primary care. AIM To examine how weight change affects cardiometabolic risk factors, and to facilitate shared decision making between patients and clinicians regarding weight loss. DESIGN AND SETTING Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight-loss groups. METHOD Linear mixed effects regression modelling examining the association between weight change and change in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated haemoglobin (HbA1c), and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes, and hyperlipidaemia. RESULTS In total, 2041 participants had a mean (standard deviation) age of 50 (SD 13.5) years, mean baseline weight of 90.6 (14.8) kg and mean body mass index (BMI) of 32.7 (SD 4.1) kg/m2. Mean (SD) weight change was -4.3 (SD 6.0) kg. All outcome measures showed statistically significant improvements. Each 1 kg weight loss was associated with 0.4 mmHg reduction in SBP and 0.3 mmHg reduction in DBP, or 0.5 mmHg and 0.4 mmHg/kg respectively in people with hypertension. Each 1 kg weight loss was associated with 0.2 mmol/mol reduction in HbA1c, or 0.6 mmol/mol in people with diabetes. Effects on plasma lipids were negligible. CONCLUSION Weight loss achieved through referral to community weight-loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in BP and glucose regulation, especially in those at highest risk.
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Affiliation(s)
- Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford; Exploristics Ltd., Belfast, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ian D Caterson
- SoLES, University of Sydney, Boden Collaboration, Charles Perkins Centre, University of Sydney, Australia
| | - Jason Halford
- Psychology, University of Leeds, Leeds, UK; president of the European Association for the Study of Obesity
| | - Hans Hauner
- Chair of nutritional medicine and director of the Else Kröner-Fresenius-Centre of Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Relph S, Jardine J, Magee LA, von Dadelszen P, Morris E, Ross-Davie M, Draycott T, Khalil A. Authors' reply re: Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG 2021; 128:937-938. [PMID: 33550708 PMCID: PMC8013874 DOI: 10.1111/1471-0528.16639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Relph
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - J Jardine
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - E Morris
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - T Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - A Khalil
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
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Koutoukidis DA, Koshiaris C, Henry JA, Noreik M, Morris E, Manoharan I, Tudor K, Bodenham E, Dunnigan A, Jebb SA, Aveyard P. The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: A systematic review and meta-analysis. Metabolism 2021; 115:154455. [PMID: 33259835 DOI: 10.1016/j.metabol.2020.154455] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trials show that weight loss interventions improve biomarkers of non-alcoholic fatty liver disease (NAFLD), but it is unclear if a dose-response relationship exists. OBJECTIVE We aimed to quantify the dose-response relationship between the magnitude of weight loss and improvements in NAFLD. METHODS Nine databases and trial registries were searched until October 2020. Single-arm, non-randomized comparative, or randomized trials of weight loss interventions (behavioral weight loss programs [BWLPs], pharmacotherapy, or bariatric surgery) in people with NAFLD were eligible for inclusion if they reported an association between changes in weight and changes in blood, radiological, or histological biomarkers of liver disease. The review followed Cochrane methods and the risk of bias was assessed using the Newcastle-Ottawa scale. Pooled unstandardized b coefficients were calculated using random-effect meta-analyses. RESULTS Forty-three studies (BWMPs: 26, pharmacotherapy: 9, surgery: 8) with 2809 participants were included. The median follow-up was 6 (interquartile range: 6) months. The direction of effect was generally consistent but the estimates imprecise. Every 1 kg of weight lost was associated with a 0.83-unit (95% CI: 0.53 to 1.14, p < 0.0001, I2 = 92%, n = 18) reduction in alanine aminotransferase (U/L), a 0.56-unit (95% CI: 0.32 to 0.79, p < 0.0001, I2 = 68%, n = 11) reduction in aspartate transaminase (U/L), and a 0.77 percentage point (95% CI: 0.51 to 1.03, p < 0.0001, I2 = 72%, n = 11) reduction in steatosis assessed by radiology or histology. There was evidence of a dose-response relationship with liver inflammation, ballooning, and resolution of NAFLD or NASH, but limited evidence of a dose-response relationship with fibrosis or NAFLD activity score. On average, the risk of bias for selection and outcome was medium and low, respectively. CONCLUSION Clinically significant improvements in NAFLD are achieved even with modest weight loss, but greater weight loss is associated with greater improvements. Embedding support for formal weight loss programs as part of the care pathway for the treatment of NAFLD could reduce the burden of disease. PROSPERO CRD42018093676.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - John A Henry
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Michaela Noreik
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Indrani Manoharan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Kate Tudor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Emma Bodenham
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Anna Dunnigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; NIHR Oxford Biomedical Research Centre, Oxford OX2 6GG, UK.
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Morris E, Glogowska M, Ismail FA, Edwards G, Fleming S, Wang K, Verbakel JY, Van den Bruel A, Hayward G. Parents' concerns and beliefs about temperature measurement in children: a qualitative study. BMC Fam Pract 2021; 22:9. [PMID: 33413158 PMCID: PMC7791980 DOI: 10.1186/s12875-020-01355-y] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
Background Nearly 40% of parents with children aged 6 to 17 months consult a healthcare professional when their child has a high temperature. Clinical guidelines recommend temperature measurement in these children, but little is known about parents’ experiences of and beliefs about temperature measurement. This study aimed to explore parents’ concerns and beliefs about temperature measurement in children. Methods Semi-structured qualitative interviews were conducted from May 2017 to June 2018 with 21 parents of children aged 4 months to 5.5 years, who were purposively sampled from the METRIC study (a method comparison study comparing non-contact infrared thermometers to axillary and tympanic thermometers in acutely ill children). Data analysis followed a thematic approach. Results Parents described the importance of being able to detect fever, in particular high fevers, and how this then influenced their actions. The concept of “accuracy” was valued by parents but the aspects of performance which were felt to reflect accuracy varied. Parents used numerical values of temperature in four main ways: determining precision of the thermometer on repeat measures, detecting a “bad” fever, as an indication to administer antipyretics, or monitoring response to treatment. Family and social networks, the internet, and medical professionals and resources, were all key sources of advice for parents regarding fever, and guiding thermometer choice. Conclusions Temperature measurement in children has diagnostic value but can either empower, or cause anxiety and practical challenges for parents. This represents an opportunity for both improved communication between parents and healthcare professionals, and technological development, to support parents to manage febrile illness with greater confidence in the home. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01355-y.
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Affiliation(s)
- Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Fatene Abakar Ismail
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, 18 Alexandra Parade, Glasgow, G31 2ER, UK
| | - George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| | - Jan Y Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK.,Academic Centre for Primary Care, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 J, 3000, Leuven, Belgium
| | - Ann Van den Bruel
- Academic Centre for Primary Care, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 J, 3000, Leuven, Belgium
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
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Privitera L, Hales PW, Musleh L, Morris E, Sizer N, Barone G, Humphries P, Cross K, Biassoni L, Giuliani S. Comparison Between Diffusion-Weighted MRI and 123 I-mIBG Uptake in Primary High-Risk Neuroblastoma. J Magn Reson Imaging 2020; 53:1486-1497. [PMID: 33283381 PMCID: PMC8246892 DOI: 10.1002/jmri.27458] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023] Open
Abstract
Background High‐risk neuroblastoma (HR‐NB) has a variable response to preoperative chemotherapy. It is not possible to differentiate viable vs. nonviable residual tumor before surgery. Purpose To explore the association between apparent diffusion coefficient (ADC) values from diffusion‐weighted magnetic resonance imaging (DW‐MRI), 123I‐meta‐iodobenzyl‐guanidine (123I‐mIBG) uptake, and histology before and after chemotherapy. Study Type Retrospective. Subjects Forty patients with HR‐NB. Field Strength/Sequence 1.5T axial DW‐MRI (b = 0,1000 s/mm2) and T2‐weighted sequences. 123I‐mIBG scintigraphy planar imaging (all patients), with additional 123I‐mIBG single‐photon emission computed tomography / computerized tomography (SPECT/CT) imaging (15 patients). Assessment ADC maps and 123I‐mIBG SPECT/CT images were coregistered to the T2‐weighted images. 123I‐mIBG uptake was normalized with a tumor‐to‐liver count ratio (TLCR). Regions of interest (ROIs) for primary tumor volume and different intratumor subregions were drawn. The lower quartile ADC value (ADC25prc) was used over the entire tumor volume and the overall level of 123I‐mIBG uptake was graded into avidity groups. Statistical Tests Analysis of variance (ANOVA) and linear regression were used to compare ADC and MIBG values before and after treatment. Threshold values to classify tumors as viable/necrotic were obtained using ROC analysis of ADC and TLCR values. Results No significant difference in whole‐tumor ADC25prc values were found between different 123I‐mIBG avidity groups pre‐ (P = 0.31) or postchemotherapy (P = 0.35). In the “intratumor” analysis, 5/15 patients (prechemotherapy) and 0/14 patients (postchemotherapy) showed a significant correlation between ADC and TLCR values (P < 0.05). Increased tumor shrinkage was associated with lower pretreatment tumor ADC25prc values (P < 0.001); no association was found with pretreatment 123I‐mIBG avidity (P = 0.17). Completely nonviable tumors had significantly lower postchemotherapy ADC25prc values than tumors with >10% viable tumor (P < 0.05). Both pre‐ and posttreatment TLCR values were significantly higher in patients with >50% viable tumor than those with 10–50% viable tumor (P < 0.05). Data Conclusion 123I‐mIBG avidity and ADC values are complementary noninvasive biomarkers of therapeutic response in HR‐NB. Level of Evidence 4. Technical Efficacy Stage 3.
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Affiliation(s)
- Laura Privitera
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Patrick W Hales
- Developmental Imaging and Biophysics Section, University College London Great Ormond Street Insitute of Child Health, London, UK
| | - Layla Musleh
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Elizabeth Morris
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.,Nuclear Medicine Physics, Clinical Physics, Barts Health NHS Trust, London, UK
| | - Natalie Sizer
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.,Nuclear Medicine Physics, Clinical Physics, Barts Health NHS Trust, London, UK
| | - Giuseppe Barone
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Kate Cross
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Stefano Giuliani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
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Jardine J, Relph S, Magee LA, von Dadelszen P, Morris E, Ross-Davie M, Draycott T, Khalil A. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG 2020; 128:880-889. [PMID: 32992408 DOI: 10.1111/1471-0528.16547] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the modifications to maternity services across the UK, in response to the coronavirus disease 2019 (COVID-19) pandemic, in the context of the pandemic guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and NHS England. DESIGN National survey. SETTING UK maternity services during the COVID-19 pandemic. POPULATION OR SAMPLE Healthcare professionals working within maternity services. METHODS A national electronic survey was developed to investigate local modifications to general and specialist maternity care during the COVID-19 pandemic, in the context of the contemporaneous national pandemic guidance. After a pilot phase, the survey was distributed through professional networks by the RCOG and co-authors. The survey results were presented descriptively in tabular and graphic formats, with proportions compared using chi-square tests. MAIN OUTCOME MEASURES Service modifications made during the pandemic. RESULTS A total of 81 respondent sites, 42% of the 194 obstetric units in the UK, were included. They reported substantial and heterogeneous maternity service modifications. Seventy percent of units reported a reduction in antenatal appointments and 56% reported a reduction in postnatal appointments; 89% reported using remote consultation methods. A change to screening pathways for gestational diabetes mellitus was reported by 70%, and 59% had temporarily removed the offer of births at home or in a midwife-led unit. A reduction in emergency antenatal presentations was experienced by 86% of units. CONCLUSIONS This national survey documents the extensive impact of the COVID-19 pandemic on maternity services in the UK. More research is needed to understand the impact on maternity outcomes and experience. TWEETABLE ABSTRACT A national survey showed that UK maternity services were modified extensively and heterogeneously in response to COVID-19.
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Affiliation(s)
- J Jardine
- Royal College of Obstetricians and Gynaecologists, London, UK.,Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S Relph
- Royal College of Obstetricians and Gynaecologists, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - P von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - E Morris
- Royal College of Obstetricians and Gynaecologists, London, UK.,Norfolk and Norwich University Hospital, Norwich, UK
| | | | - T Draycott
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
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Spencer K, Hall P, Henry A, Velikova G, Whalley S, Birch R, Le Calvez K, Williams M, Morris E. PH-0522: Fractionation and early mortality in palliative radiotherapy across the English NHS. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00544-2] [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: 10/22/2022]
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Spencer K, Bojke C, Henry A, Velikova G, Morris E, Van der Linden Y, Van den Hout W, Hall P. OC-0079: Can SABR for painful bone metastases ever be cost-effective in the NHS? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00105-5] [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: 10/22/2022]
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Lin C, Joerger M, Grell P, Chiappori A, Leal T, Kasper S, Jerusalem G, Gonçalves A, Wolf J, De Braud F, de Jonge M, Otero J, Chhagan S, Cipolletta D, Morris E, Chowdhury N, Hurtado F, Tan D. Continuous vs intermittent adenosine 2A receptor (A2AR) inhibition in preclinical colon cancer (CC) models and in a Phase (Ph) II study of taminadenant (NIR178) + spartalizumab (PDR001) in patients (pts) with non-small cell lung cancer (NSCLC). Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31098-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Naranjo I, Gibss P, Sooknanan C, Logullo R, Saccarelli C, Morris E, Thakur S, Pinker K. Radiomics and Machine Learning with DWI for breast cancer diagnosis: Comparison with dynamic contrast enhanced and multiparametric MRI. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30557-8] [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: 11/28/2022]
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Hartmann-Boyce J, Morris E, Goyder C, Kinton J, Perring J, Nunan D, Mahtani K, Buse JB, Del Prato S, Ji L, Roussel R, Khunti K. Diabetes and COVID-19: Risks, Management, and Learnings From Other National Disasters. Diabetes Care 2020; 43:1695-1703. [PMID: 32546593 DOI: 10.2337/dc20-1192] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023]
Abstract
Evidence relating to the impact of COVID-19 in people with diabetes (PWD) is limited but continuing to emerge. PWD appear to be at increased risk of more severe COVID-19 infection, though evidence quantifying the risk is highly uncertain. The extent to which clinical and demographic factors moderate this relationship is unclear, though signals are emerging that link higher BMI and higher HbA1c to worse outcomes in PWD with COVID-19. As well as posing direct immediate risks to PWD, COVID-19 also risks contributing to worse diabetes outcomes due to disruptions caused by the pandemic, including stress and changes to routine care, diet, and physical activity. Countries have used various strategies to support PWD during this pandemic. There is a high potential for COVID-19 to exacerbate existing health disparities, and research and practice guidelines need to take this into account. Evidence on the management of long-term conditions during national emergencies suggests various ways to mitigate the risks presented by these events.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.
| | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Jade Kinton
- Medical Sciences Division, University of Oxford, Oxford, U.K
| | - James Perring
- Medical Sciences Division, University of Oxford, Oxford, U.K
| | - David Nunan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - Kamal Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | - Linong Ji
- Peking University Diabetes Center, Peking University People's Hospital, China
| | - Ronan Roussel
- Federation de Diabetologie, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,UFR de Médecine, Université de Paris, Paris, France
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
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Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Reply. Ultrasound Obstet Gynecol 2020; 56:122-123. [PMID: 32608568 DOI: 10.1002/uog.22112] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Demircioglu A, Grueneisen J, Ingenwerth M, Hoffmann O, Pinker-Domenig K, Morris E, Haubold J, Forsting M, Nensa F, Umutlu L. A rapid volume of interest-based approach of radiomics analysis of breast MRI for tumor decoding and phenotyping of breast cancer. PLoS One 2020; 15:e0234871. [PMID: 32589681 PMCID: PMC7319601 DOI: 10.1371/journal.pone.0234871] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background Recently, radiomics has emerged as a non-invasive, imaging-based tissue characterization method in multiple cancer types. One limitation for robust and reproducible analysis lies in the inter-reader variability of the tumor annotations, which can potentially cause differences in the extracted feature sets and results. In this study, the diagnostic potential of a rapid and clinically feasible VOI (Volume of Interest)-based approach to radiomics is investigated to assess MR-derived parameters for predicting molecular subtype, hormonal receptor status, Ki67- and HER2-Expression, metastasis of lymph nodes and lymph vessel involvement as well as grading in patients with breast cancer. Methods A total of 98 treatment-naïve patients (mean 59.7 years, range 28.0–89.4) with BI-RADS 5 and 6 lesions who underwent a dedicated breast MRI prior to therapy were retrospectively included in this study. The imaging protocol comprised dynamic contrast-enhanced T1-weighted imaging and T2-weighted imaging. Tumor annotations were obtained by drawing VOIs around the primary tumor lesions followed by thresholding. From each segmentation, 13.118 quantitative imaging features were extracted and analyzed with machine learning methods. Validation was performed by 5-fold cross-validation with 25 repeats. Results Predictions for molecular subtypes obtained AUCs of 0.75 (HER2-enriched), 0.73 (triple-negative), 0.65 (luminal A) and 0.69 (luminal B). Differentiating subtypes from one another was highest for HER2-enriched vs triple-negative (AUC 0.97), followed by luminal B vs triple-negative (0.86). Receptor status predictions for Estrogen Receptor (ER), Progesterone Receptor (PR) and Hormone receptor positivity yielded AUCs of 0.67, 0.69 and 0.69, while Ki67 and HER2 Expressions achieved 0.81 and 0.62. Involvement of the lymph vessels could be predicted with an AUC of 0.8, while lymph node metastasis yielded an AUC of 0.71. Models for grading performed similar with an AUC of 0.71 for Elston-Ellis grading and 0.74 for the histological grading. Conclusion Our preliminary results of a rapid approach to VOI-based tumor-annotations for radiomics provides comparable results to current publications with the perks of clinical suitability, enabling a comprehensive non-invasive platform for breast tumor decoding and phenotyping.
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Affiliation(s)
- Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marc Ingenwerth
- Department of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynaecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katja Pinker-Domenig
- Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Elizabeth Morris
- Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- * E-mail:
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Scully PR, Morris E, Patel KP, Treibel TA, Burniston M, Klotz E, Newton JD, Sabharwal N, Kelion A, Manisty C, Kennon S, Ozkor M, Mullen M, Hartman N, Elliott PM, Pugliese F, Hawkins PN, Moon JC, Menezes LJ. DPD Quantification in Cardiac Amyloidosis: A Novel Imaging Biomarker. JACC Cardiovasc Imaging 2020; 13:1353-1363. [PMID: 32498921 PMCID: PMC7264710 DOI: 10.1016/j.jcmg.2020.03.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 01/27/2020] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess whether single-photon emission computed tomography (SPECT/CT) quantification of bone scintigraphy would improve diagnostic accuracy and offer a means of quantifying amyloid burden. BACKGROUND Transthyretin-related cardiac amyloidosis is common and can be diagnosed noninvasively using bone scintigraphy; interpretation, however, relies on planar images. SPECT/CT imaging offers 3-dimensional visualization. METHODS This was a single-center, retrospective analysis of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scans reported using the Perugini grading system (0 = negative; 1 to 3 = increasingly positive). Conventional planar quantification techniques (heart/contralateral lung, and heart/whole-body retention ratios) were performed. Heart, adjacent vertebra, paraspinal muscle and liver peak standardized uptake values (SUVpeak) were recorded from SPECT/CT acquisitions. An SUV retention index was also calculated: (cardiac SUVpeak/vertebral SUVpeak) × paraspinal muscle SUVpeak. In a subgroup of patients, SPECT/CT quantification was compared with myocardial extracellular volume quantification by CT imaging (ECVCT). RESULTS A total of 100 DPD scans were analyzed (patient age 84 ± 9 years; 52% male): 40 were Perugini grade 0, 12 were grade 1, 41 were grade 2, and 7 were grade 3. Cardiac SUVpeak increased from grade 0 to grade 2; however, it plateaued between grades 2 and 3 (p < 0.001). Paraspinal muscle SUVpeak increased with grade (p < 0.001), whereas vertebral SUVpeak decreased (p < 0.001). The composite parameter of SUV retention index overcame the plateauing of the cardiac SUVpeak and increased across all grades (p < 0.001). Cardiac SUVpeak correlated well (r2 = 0.73; p < 0.001) with ECVCT. Both the cardiac SUVpeak and SUV retention index had excellent diagnostic accuracy (area under the curve [AUC]: 0.999). The heart to contralateral lung ratio performed the best of the planar quantification techniques (AUC: 0.987). CONCLUSIONS SPECT/CT quantification in DPD scintigraphy is possible and outperforms planar quantification techniques. Differentiation of Perugini grade 2 or 3 is confounded by soft tissue uptake, which can be overcome by a composite SUV retention index. This index can help in the diagnosis of cardiac amyloidosis and may offer a means of monitoring response to therapy.
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Affiliation(s)
- Paul R Scully
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Elizabeth Morris
- Clinical Physics, St. Bartholomew's Hospital, London, United Kingdom
| | - Kush P Patel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Thomas A Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Maria Burniston
- Clinical Physics, St. Bartholomew's Hospital, London, United Kingdom
| | | | - James D Newton
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Nikant Sabharwal
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew Kelion
- John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Muhiddin Ozkor
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Neil Hartman
- Nuclear Medicine, Abertawe Bro Morgannwg University HB, Swansea, United Kingdom
| | - Perry M Elliott
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; NIHR Barts Biomedical Research Centre, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Leon J Menezes
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Nuclear Medicine, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom.
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Affiliation(s)
- John A Henry
- Medical Sciences Division, University of Oxford, UK
| | | | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Maryamchik E, Kadauke S, Flower A, Barrett D, Ayello J, Harrison L, Morris E, Struhahn M, O'Donnell L, Lee D, Abu-Arja R, Johnson B, Talano J, Cairo M, Bunin N, Wang Y. Outcomes and Challenges of Manufacturing Virus-Specific Cytotoxic T-lymphocytes Using IFN-gamma Cytokine Capture System. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.092] [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: 11/16/2022]
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Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55:586-592. [PMID: 32180292 DOI: 10.1002/uog.22014] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 05/06/2023]
Abstract
OBJECTIVES There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy. METHODS Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. Data were extracted from relevant papers. This review has been used to develop guidelines with representatives of the Royal College of Paediatrics and Child Health (RCPCH) and RCOG who provided expert consensus on areas in which data were lacking. RESULTS From 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester. CONCLUSIONS Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to COVID-19. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55:586-592. [PMID: 32180292 DOI: 10.1101/2020.03.06.20032144] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 05/18/2023]
Abstract
OBJECTIVES There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy. METHODS Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. Data were extracted from relevant papers. This review has been used to develop guidelines with representatives of the Royal College of Paediatrics and Child Health (RCPCH) and RCOG who provided expert consensus on areas in which data were lacking. RESULTS From 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester. CONCLUSIONS Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to COVID-19. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
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Saphier N, Kondraciuk J, Morris E, Bernard-Davila B, Mango V. Preoperative Localization of Breast MRI Lesions: MRI-guided Marker Placement With Radioactive Seed Localization as an Alternative to MRI-guided Wire Localization. J Breast Imaging 2020; 2:250-258. [PMID: 33554114 DOI: 10.1093/jbi/wbaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 11/14/2022]
Abstract
Objective Preoperative MRI-guided wire localization (MWL) presents challenges to both the physician and patient. In this study, we examined the efficiency and outcome of MRI-guided marker placement followed by mammographic-guided radioactive seed localization (MMP/RSL) as an alternative localization method. The primary outcome parameter was pathology upon excision. The secondary outcome parameters were total procedure time and clinical indication for localization. Methods A retrospective review of a large tertiary cancer center's breast imaging database was performed. Records of 21 patients with MMP/RSL (24 markers) from August 2013 to January 2019 were compared with 34 patients receiving MWL (48 wires) from January 2016 to January 2019. Multiple factors, including age, prelocalization pathology, postsurgical pathology, concordance, re-excision rates, and total procedure time required for each technique, were compared. Univariate and descriptive statistical analyses were performed. Results Mean patient age in years (MMP/RSL = 54.1 ± 13.1, MWL = 55.1 ± 10.8, P = 0.389), time in MR scanner in minutes (MMP/RSL = 31.7 ± 12.0, MWL = 35.8 ± 13.1, P = 0.678), and postsurgical pathology malignancy rates (MMP/RSL = 71.4%, MWL = 65.7%, P = 0.7715) were similar without statistically significant differences. As expected, the mean total procedure time was slightly longer without a statistically significant difference (47.3 ± 19.8 min versus 35.8 ± 13.1 min, P = 0.922) for the MMP/RSL group. All patients in both groups underwent successful localization with 100% radiologic-pathology concordance. Re-excision rates were lower for the MMP/RSL group (9.5%) versus the MWL group (16.7%); however, they were not found to be statistically significant (P = 0.7104). Conclusion MMP/RSL is a feasible alternative to MWL and may alleviate many challenges presented by MWL. Further studies are needed.
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Affiliation(s)
- Nicole Saphier
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Jessica Kondraciuk
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Elizabeth Morris
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
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Morris E, Aveyard P, Dyson P, Noreik M, Bailey C, Fox R, Jerome D, Tan GD, Jebb SA. A food-based, low-energy, low-carbohydrate diet for people with type 2 diabetes in primary care: A randomized controlled feasibility trial. Diabetes Obes Metab 2020; 22:512-520. [PMID: 31709697 PMCID: PMC7079070 DOI: 10.1111/dom.13915] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 10/25/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 01/06/2023]
Abstract
AIM To examine the feasibility of a food-based, low-energy, low-carbohydrate diet with behavioural support delivered by practice nurses for patients with type 2 diabetes. MATERIALS AND METHODS People with type 2 diabetes and a body mass index (BMI) of ≥30 kg/m2 were randomized 2:1 to intervention or control (usual care) and assessed at 12 weeks. The intervention comprised an 800-1000 kcal/day, food-based, low-carbohydrate (<26% energy) diet for 8 weeks, followed by a 4-week weight maintenance period and four 15-20-minute appointments with a nurse. Primary outcomes were feasibility of recruitment, fidelity of intervention delivery and retention of participants at 12 weeks. Secondary outcomes included change in weight and HbA1c. Focus groups explored the intervention experience. RESULTS Forty-eight people were screened, 33 enrolled and 32 followed-up. Mean (±SD) weight loss in the intervention group was 9.5 kg (± 5.4 kg) compared with 2 kg (± 2.5 kg) in the control group (adjusted difference - 7.5 kg [-11.0 to -4.0, P < 0.001]). Mean reduction in HbA1c in the intervention group was 16.3 mmol/mol (± 13.3 mmol/mol) compared with 0.7 mmol/mol (±4.5 mmol/mol) in the control group (difference - 15.7 mmol/mol [-24.1 to -7.3, P < 0.001]). CONCLUSIONS It is feasible to recruit participants to a food-based, low-energy, low-carbohydrate intervention, for practice nurses to deliver the programme in primary care, and to retain participants in both groups. There is evidence of clinically significant short-term improvements in weight and glycaemic control.
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Affiliation(s)
- Elizabeth Morris
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- NIHR Biomedical Research CentreOxfordUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- NIHR Biomedical Research CentreOxfordUK
| | - Pamela Dyson
- NIHR Biomedical Research CentreOxfordUK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Michaela Noreik
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- NIHR Biomedical Research CentreOxfordUK
| | | | | | - Derek Jerome
- PPI representative, the DIAMOND studyUniversity of OxfordOxfordUK
| | - Garry D Tan
- NIHR Biomedical Research CentreOxfordUK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- NIHR Biomedical Research CentreOxfordUK
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Walker KF, Morris E, Plumb J, Gray J, Thornton JG, Daniels J. Universal testing for group B streptococcus during pregnancy: need for a randomised trial. BJOG 2020; 127:693. [DOI: 10.1111/1471-0528.16116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- KF Walker
- Division of Child Health, Obstetrics and Gynaecology School of Medicine University of Nottingham Nottingham UK
| | - E Morris
- Department of Obstetrics and Gynaecology Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - J Plumb
- Group B Strep Support Haywards Heath UK
| | - J Gray
- Department of Microbiology Birmingham Children's Hospital NHS Foundation Trust Birmingham UK
| | - JG Thornton
- Division of Child Health, Obstetrics and Gynaecology School of Medicine University of Nottingham Nottingham UK
| | - J Daniels
- Nottingham Clinical Trials Unit University of Nottingham Nottingham UK
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Abstract
There is increasing evidence that menopausal changes can have an impact on women’s cognition and potentially, the future development of dementia. In particular, the role of reduced levels of estrogen in postmenopausal changes has been linked to an increased risk of developing dementia in observational studies. Not surprisingly, this has led to several clinical trials investigating whether postmenopausal hormone replacement therapy can potentially delay/avoid cognitive changes and subsequently, the onset of dementia. However, the evidence of these trials has been mixed, with some showing positive effects while others show no or even negative effects. In the current review, we investigate this controversy further by reviewing the existing studies and trials in cognition and dementia. Based on the current evidence, we conclude that previous approaches may have used a mixture of women with different genetic risk factors for dementia which might explain these contradicting findings. Therefore, it is recommended that future interventional studies take a more personalised approach towards hormone replacement therapy use in postmenopausal women, by taking into account the women’s genetic status for dementia risk.
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Affiliation(s)
- S Pertesi
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - G Coughlan
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - E Morris
- Norfolk and Norwich University Hospital, Norwich, UK
| | - M Hornberger
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Suffolk Foundation Trust, Norwich, UK
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