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Giles HV, Drayson MT, Kishore B, Pawlyn C, Kaiser M, Cook G, de Tute R, Owen RG, Cairns D, Menzies T, Davies FE, Morgan GJ, Pratt G, Jackson GH. Progression free survival of myeloma patients who become IFE-negative correlates with the detection of residual monoclonal free light chain (FLC) by mass spectrometry. Blood Cancer J 2024; 14:50. [PMID: 38499538 PMCID: PMC10948753 DOI: 10.1038/s41408-024-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024] Open
Abstract
Deeper responses are associated with improved survival in patients being treated for myeloma. However, the sensitivity of the current blood-based assays is limited. Historical studies suggested that normalisation of the serum free light chain (FLC) ratio in patients who were negative by immunofixation electrophoresis (IFE) was associated with improved outcomes. However, recently this has been called into question. Mass spectrometry (MS)-based FLC assessments may offer a superior methodology for the detection of monoclonal FLC due to greater sensitivity. To test this hypothesis, all available samples from patients who were IFE negative after treatment with carfilzomib and lenalidomide-based induction and autologous stem cell transplantation (ASCT) in the Myeloma XI trial underwent FLC-MS testing. FLC-MS response assessments from post-induction, day+100 post-ASCT and six months post-maintenance randomisation were compared to serum FLC assay results. Almost 40% of patients had discordant results and 28.7% of patients with a normal FLC ratio had residual monoclonal FLC detectable by FLC-MS. FLC-MS positivity was associated with reduced progression-free survival (PFS) but an abnormal FLC ratio was not. This study demonstrates that FLC-MS provides a superior methodology for the detection of residual monoclonal FLC with FLC-MS positivity identifying IFE-negative patients who are at higher risk of early progression.
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Affiliation(s)
- H V Giles
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- University of Birmingham, Birmingham, UK.
| | | | - B Kishore
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Pawlyn
- The Institute of Cancer Research, London and The Royal Marsden Hospital, London, UK
| | - M Kaiser
- The Institute of Cancer Research, London and The Royal Marsden Hospital, London, UK
| | - G Cook
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - R de Tute
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - R G Owen
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals Trust, Leeds, UK
| | - D Cairns
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - T Menzies
- Leeds Cancer Research UK Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - F E Davies
- Myeloma Research Program, Perlmutter Cancer, NYU Langone Health, New York, USA
| | - G J Morgan
- Myeloma Research Program, Perlmutter Cancer, NYU Langone Health, New York, USA
| | - G Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - G H Jackson
- Department of Haematology, University of Newcastle, Newcastle upon Tyne, UK
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Clough AR, Evans A, Graham V, Catterall J, Lakeman R, Gilroy J, Pratt G, Petrucci J, Orda U, Sehdev R, Thornton N, Das S, Yearsley G, Stone R. Emergency examination authorities in Queensland, Australia. Emerg Med Australas 2023; 35:731-738. [PMID: 36951038 DOI: 10.1111/1742-6723.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE In Queensland, where a person experiences a major disturbance in their mental capacity, and is at risk of serious harm to self and others, an emergency examination authority (EEA) authorises Queensland Police Service (QPS) and Queensland Ambulance Service (QAS) to detain and transport the person to an ED. In the ED, further detention for up to 12 h is authorised to allow the examination to be completed. Little published information describes these critical patient encounters. METHODS Queensland's Public Health Act (2005), amended in 2017, mandates the use of the approved EEA form. Data were extracted from a convenience sample of 942 EEAs including: (i) patient age, sex, address; (ii) free text descriptions by QPS and QAS officers of the person's behaviour and any serious risk of harm requiring urgent care; (iii) time examination period commenced; and (iv) outcome upon examination. RESULTS Of 942 EEA forms, 640 (68%) were retrieved at three 'larger central' hospitals and 302 (32%) at two 'smaller regional' hospitals in non-metropolitan Queensland. QPS initiated 342 (36%) and QAS 600 (64%) EEAs for 486 (52%) males, 453 (48%) females and two intersexes (<1%), aged from 9 to 85 years (median 29 years, 17% aged <18 years). EEAs commonly occurred on weekends (32%) and between 2300 and midnight (8%), characterised by 'drug and/or alcohol issues' (53%), 'self-harm' (40%), 'patient aggression' (25%) and multiple prior EEAs (23%). Although information was incomplete, most patients (78%, n = 419/534) required no inpatient admission. CONCLUSIONS EEAs furnish unique records for evaluating the impacts of Queensland's novel legislative reforms.
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Affiliation(s)
- Alan R Clough
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Angela Evans
- Queensland Police Service, Far Northern Region, Cairns, Queensland, Australia
| | - Veronica Graham
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Janet Catterall
- Library and Information Services, Division of Student Life, James Cook University, Cairns, Queensland, Australia
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - John Gilroy
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health, The University of Sydney, Sydney, New South Wales, Australia
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Joe Petrucci
- QLD and NT Neami National Cairns, Cairns, Queensland, Australia
| | - Ulrich Orda
- Emergency Medicine, North West Hospital and Health Service, Mount Isa, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Rajesh Sehdev
- Emergency Medicine, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Neale Thornton
- Emergency Medicine, Mackay Hospital and Health Service, Mackay, Queensland, Australia
| | - Sourav Das
- Statistics and Data Science, College of Science and Engineering, James Cook University, Cairns, Queensland, Australia
| | - Gillian Yearsley
- Northern Territory Primary Health Network, Darwin, Northern Territory, Australia
| | - Richard Stone
- Emergency Medicine, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Bernardes CM, Ekberg S, Birch S, Claus A, Bryant M, Meuter R, Isua J, Gray P, Kluver JP, Malacova E, Jones C, Houkamau K, Taylor M, Lin I, Pratt G. Yarning about pain: Evaluating communication training for health professionals at persistent pain services in Queensland, Australia. Br J Pain 2023; 17:306-319. [PMID: 37342393 PMCID: PMC10278454 DOI: 10.1177/20494637221149831] [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] [Indexed: 09/20/2023] Open
Abstract
Background Providing cultural education to health professionals is essential in improving the quality of care and outcomes for Aboriginal and Torres Strait Islander patients. This study reports the evaluation of a novel training workshop used as an intervention to improve communication with Aboriginal and Torres Strait Islander patients of persistent pain services. Methods In this single-arm intervention study, health professionals undertook a one-day workshop, which included cultural capability and communication skills training based on a clinical yarning framework. The workshop was delivered across three adult persistent pain clinics in Queensland. At the end of the training, participants completed a retrospective pre/post evaluation questionnaire (5 points Likert scale, 1 = very low to 5 = very high), to rate their perceived importance of communication training, their knowledge, ability and confidence to communicate effectively. Participants also rated their satisfaction with the training and suggested improvements for future trainings. Results Fifty-seven health professionals were trained (N = 57/111; 51% participation rate), 51 completed an evaluation questionnaire (n = 51/57; 90% response rate). Significant improvements in the perceived importance of communication training, knowledge, ability and confidence to effectively communicate with Aboriginal and Torres Strait Islander patients were identified (p < 0.001). The greatest increase was in the perceived confidence pre-training mean of 2.96 (SE = 0.11) to the post-training mean of 4.02 (SE = 0.09). Conclusion This patient-centred communication training, delivered through a novel model that combines cultural capability and the clinical yarning framework applied to the pain management setting, was highly acceptable and significantly improved participants' perceived competence. This method is transferrable to other health system sectors seeking to train their clinical workforce with culturally sensitive communication skills.
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Affiliation(s)
- Christina M Bernardes
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Stuart Ekberg
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Matthew Bryant
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Renata Meuter
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jermaine Isua
- Aboriginal and Torres Strait Islander Health Division, Cultural Capability Services, Queensland Health, Brisbane, QLD, Australia
| | - Paul Gray
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Joseph P Kluver
- Persistent Pain Clinic, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Eva Malacova
- Statistics Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Corey Jones
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kushla Houkamau
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Marayah Taylor
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health (WACRH), The University of Western Australia, Geraldton, WA, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Bernardes CM, Houkamau K, Lin I, Taylor M, Birch S, Claus A, Bryant M, Meuter R, Isua J, Gray P, Kluver JP, Jones C, Ekberg S, Pratt G. Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia. Front Pain Res (Lausanne) 2022; 3:1041968. [PMID: 36561982 PMCID: PMC9763606 DOI: 10.3389/fpain.2022.1041968] [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] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication. Methods This qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants. Results A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation. Conclusion Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.
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Affiliation(s)
- Christina Maresch Bernardes
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,Correspondence: Christina Maresch Bernardes
| | - Kushla Houkamau
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Ivan Lin
- WesternAustralian Center for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Marayah Taylor
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Stephen Birch
- Centre for Business and Economics of Health, Faculty of Business, St Lucia, QLD, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Matthew Bryant
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Renata Meuter
- School of Psychology and Counselling, Faculty of Health, Brisbane, QLD, Australia
| | - Jermaine Isua
- Aboriginal and Torres Strait Islander Health Division, Cultural Capability Services, Brisbane, QLD, Australia
| | - Paul Gray
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Joseph P Kluver
- Persistent Pain Clinic, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Corey Jones
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Stuart Ekberg
- School of Psychology and Counselling, Faculty of Health, Brisbane, QLD, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Vidgen ME, Cutler K, Bean J, Bunker D, Fowles LF, Healy L, Hondow G, Istiko SN, McInerney-Leo AM, Pratt G, Robins D, Waddell N, Evans E. Community input in a genomic health implementation program: Perspectives of a community advisory group. Front Genet 2022; 13:892475. [PMID: 35938017 PMCID: PMC9355292 DOI: 10.3389/fgene.2022.892475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Consumer and community engagement (CCE) in the implementation of genomics into health services and associated research is needed to ensure that changes benefit the affected patients. Queensland Genomics was a program to implement genomics into a public health service. We describe its Community Advisory Group’s (CAG) structure and function and provide recommendations based on the CAG members’ perspectives. The CAG provided advice to the Queensland Genomics program and its projects in an advisory capacity. The CAG was also resourced to develop and lead community-focused activities. Key enablers for CAG included; diversity of CAG members’ skills and experience, adequate resourcing, and the CAG’s ability to self-determine their direction. The CAG experienced limitations due to a lack of mechanisms to implement CCE in the Program’s projects. Here, we provide insights and commentary on this CAG, which will be useful for other initiatives seeking to undertake CCE in genomic research and health care.
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Affiliation(s)
- Miranda E. Vidgen
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Correspondence: Miranda E. Vidgen, ; Nicola Waddell,
| | - Katrina Cutler
- Queensland Genomics, Herston, QLD, Australia
- Health Translation Queensland, Herston, QLD, Australia
| | - Jessica Bean
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | - David Bunker
- Queensland Genomics, Herston, QLD, Australia
- Health Translation Queensland, Herston, QLD, Australia
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | - Lindsay F. Fowles
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Louise Healy
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | - Gary Hondow
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | | | - Aideen M. McInerney-Leo
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
- Dermatology Research Centre, University of Queensland Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | - Deborah Robins
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
- Correspondence: Miranda E. Vidgen, ; Nicola Waddell,
| | - Erin Evans
- Queensland Genomics Community Advisory Group, Brisbane, QLD, Australia
- Health Consumers Queensland, Brisbane, QLD, Australia
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Bernardes CM, Lin I, Birch S, Meuter R, Claus A, Bryant M, Isua J, Gray P, Kluver JP, Ekberg S, Pratt G. Study protocol: Clinical yarning, a communication training program for clinicians supporting aboriginal and Torres Strait Islander patients with persistent pain: A multicentre intervention feasibility study using mixed methods. Public Health in Practice 2022; 3:100221. [PMID: 36101752 PMCID: PMC9461225 DOI: 10.1016/j.puhip.2021.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives Ineffective communication between healthcare clinicians and Aboriginal and Torres Strait Islander patients with persistent pain is a significant barrier to optimal pain management. This manuscript is a study protocol and describes the development and evaluation methods of a tailored, culturally-informed training program, to improve clinicians’ communication with patients. Study design This is a single-arm, multicentre (2 metropolitan and 1 regional persistent pain service) intervention feasibility study that will be evaluated using mixed methods. Methods A communication training program will be developed informed by qualitative interviews with key stakeholders, and adapt the patient-centred ‘clinical yarning’ framework for the Queensland context. Evaluation of the effectiveness of the training will involve the analysis of quantitative data collected at three study sites over a 12-month period. At the patient level, communication experience will be rated at differing times of the training rollout to reflect participants' experience of communication either prior to or following the treating clinician attending the communication training. At the clinician level, evaluation of the training program will be based on changes of ratings in the importance of training, knowledge, ability and confidence to communicate with Aboriginal and Torres Strait Islander patients; satisfaction, acceptance and relevance to their clinical practice. This study will be grounded in the needs and preferences of communication of Aboriginal and Torres Strait Islander people living with pain. Conclusion It is hypothesized that the patient-centred intervention will have immediate benefits for patients, improving patient experience of care. This research will focus on an area of unmet need in addressing persistent pain.
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Tay W, Giles H, Wright N, Afzal M, Birtwistle J, Berlanga O, North S, Drayson M, Pratt G, Wallis G, Harding S. T043 Exent mass spectrometry allows early identification of multiclonal MGUS compared to electrophoretic methods. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vidgen ME, Fowles LF, Istiko SN, Evans E, Cutler K, Sullivan K, Bean J, Healy L, Hondow G, McInerney-Leo AM, Pratt G, Robins D, Best S, Finlay K, Ramarao-Milne P, Waddell N. Evaluation of a Genetics Education Program for Health Interpreters: A Pilot Study. Front Genet 2022; 12:771892. [PMID: 35186003 PMCID: PMC8850313 DOI: 10.3389/fgene.2021.771892] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Health Interpreters enable effective communication between health practitioners and patients with limited knowledge of the predominant language. This study developed and evaluated a training session introducing Health Interpreters to genetics. The online training was delivered multiple times as a single 2-h session comprising lectures and activities. Participants completed questionnaires (pre-, post-, and 6-months follow-up) to assess the impact of training on knowledge, attitude, self-efficacy, and self-reported practice behaviour. Questionnaires were analysed using descriptive statistics, Fisher’s Exact, or independent t-test. In total, 118 interpreters participated in the training sessions. Respondent knowledge improved, with gains maintained at 6-months (p < 0.01). There were no changes in self-efficacy, and attitudes. Training did not change self-reported practice behaviour, but there was notable pre-existing variability in participants’ methods of managing unknown genetic words. Most respondents agreed that training was useful (93%) and relevant (79%) to their work. More respondents reported learning more from the case study activity (86%) than the group activity (58%). Health Interpreters found the training acceptable and demonstrated sustained improvement in knowledge of genetic concepts. Increased delivery of this training and associated research is needed to assess findings in a larger cohort and to measure the impact on patients.
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Affiliation(s)
- Miranda E. Vidgen
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- *Correspondence: Miranda E. Vidgen,
| | - Lindsay F. Fowles
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Satrio Nindyo Istiko
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Erin Evans
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Health Consumers Queensland, Brisbane, QLD, Australia
| | - Katrina Cutler
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Kate Sullivan
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Jessica Bean
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Healy
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Gary Hondow
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Deborah Robins
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Macquarie University, Sydney, NSW, Australia
| | - Keri Finlay
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Genetic Support Network of Victoria, Melbourne, VIC, Australia
| | - Priya Ramarao-Milne
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
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Kaladharan S, Vidgen ME, Pearson JV, Donoghue VK, Whiteman DC, Waddell N, Pratt G. Ask the people: developing guidelines for genomic research with Aboriginal and Torres Strait Islander peoples. BMJ Glob Health 2021; 6:bmjgh-2021-007259. [PMID: 34732514 PMCID: PMC8572381 DOI: 10.1136/bmjgh-2021-007259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 01/07/2023] Open
Abstract
In health and medical research, guidelines are a set of statements and recommendations, whereby experts or stakeholders assess published literature to generate practical advice for a specific audience. This emphasis on guidelines development with expert consultation and published literature is not practical or inclusive when working in disciplines with minimal data and addressing issues that concern under-represented communities. Here we describe the process used for developing guidelines for the conduct of genomic research projects in partnership with Aboriginal and Torres Strait Islander peoples. A new technology with individual and community level ethical and social implications, and First Nations peoples with cultural and community expectations for research. We developed the guidelines through a consultation process that used participatory action research to engage with various stakeholders during multiple rounds of tailored activities. The end product, ‘Genomic Partnerships: Guidelines for Genomics Research with Aboriginal and Torres Strait Islander peoples of Queensland’ reflects the needs of the end-users and perspectives of the Aboriginal and Torres Strait Islander peoples, communities and organisations that participated. Through this process, we have identified recommendations for developing guidelines with other under-represented communities.
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Affiliation(s)
- Sid Kaladharan
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Nambour General Hospital, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Miranda E Vidgen
- Medical Genomics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - John V Pearson
- Genome Informatics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Victoria K Donoghue
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia
| | - David C Whiteman
- Cancer Control, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nicola Waddell
- Medical Genomics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
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Clough AR, Evans A, Grant K, Graham V, Catterall J, Lakeman R, Gilroy J, Pratt G, Petrucci J, Stone R. Recent amendments to Queensland legislation make mental health presentations to hospital emergency departments more difficult to scrutinise. Emerg Med Australas 2021; 34:130-133. [PMID: 34643039 DOI: 10.1111/1742-6723.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
The Queensland Police Service (QPS) and Queensland Ambulance Service may detain and transport persons experiencing major disturbances in their mental capacity to an ED for urgent care. Queensland's new mental health legislation (March 2017) makes this legal intervention difficult to scrutinise. For a large non-metropolitan region, QPS records for emergency examination orders (EEOs) and emergency examination authorities (EEAs) were compared with annual reports of Queensland's Director of Mental Health and Chief Psychiatrist. From 2009-2010 to March 2017, QPS-registered EEOs totalled 12 903 while annual reports attributed 9441 to QPS (27% fewer). From March 2017 to 2019-2020, QPS-registered EEAs totalled 6887. Annual reports declared 1803 EEAs in total for this period, without distinguishing those registered by QPS from the Queensland Ambulance Service. Past year proportions of EEOs, however, indicate perhaps ~1100 originated with QPS (84% fewer). Information crucial for considered emergency mental healthcare responses for thousands of people is no longer readily available.
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Affiliation(s)
- Alan R Clough
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Angela Evans
- Queensland Police Service, Far Northern Region, Cairns, Queensland, Australia
| | - Kristy Grant
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Veronica Graham
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Janet Catterall
- Library and Information Services, James Cook University Library, Cairns, Queensland, Australia
| | - Richard Lakeman
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - John Gilroy
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Joe Petrucci
- QLD and NT Neami National Cairns, Cairns, Queensland, Australia
| | - Richard Stone
- Emergency Department, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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11
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Parry H, McIlroy G, Bruton R, Ali M, Stephens C, Damery S, Otter A, McSkeane T, Rolfe H, Faustini S, Wall N, Hillmen P, Pratt G, Paneesha S, Zuo J, Richter A, Moss P. Antibody responses after first and second Covid-19 vaccination in patients with chronic lymphocytic leukaemia. Blood Cancer J 2021; 11:136. [PMID: 34330895 PMCID: PMC8323747 DOI: 10.1038/s41408-021-00528-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10-12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody Formation/drug effects
- BNT162 Vaccine
- COVID-19/blood
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19 Vaccines/administration & dosage
- COVID-19 Vaccines/immunology
- Female
- Humans
- Immunization, Secondary
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
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Affiliation(s)
- H Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - G McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - R Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - M Ali
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - C Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - S Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Otter
- National infection Service, Public Health England, Porton Down, Salisbury, SP4 OJG, UK
| | - T McSkeane
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - H Rolfe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, B15 2TT, Birmingham, UK
| | - S Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - N Wall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Hillmen
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - G Pratt
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - S Paneesha
- Birmingham Heartlands Hospital, University Hospitals Birmingham, Bordesley Green East, B9 5SS, Birmingham, UK
| | - J Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - A Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - P Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2TH, UK.
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12
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Westerland O, Drinkwater KJ, Parikh J, Streetly M, Pratt G, Goh V, Howlett DC. Imaging in myeloma: a Royal College of Radiologists national survey of current imaging practice. Clin Radiol 2021; 76:820-828. [PMID: 34187681 DOI: 10.1016/j.crad.2021.05.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate current national imaging practice in myeloma with reference to National Institute for Health and Care Excellence (NICE) guidelines (NG35, 2016) and compare results with an initial survey conducted in 2017 (61 participating sites). MATERIALS AND METHODS All UK radiology departments treating myeloma patients and with a Royal College of Radiologists (RCR) Audit Lead were invited to participate. Data were collected using an online questionnaire. Descriptive statistics were performed. RESULTS One hundred and fourteen hospitals supplied data (54% return rate). Skeletal survey (SS) remains the most-commonly performed first-line imaging test for suspected/confirmed myeloma or plasmacytoma (39%, 45/114 hospitals), followed by whole-body magnetic resonance imaging (WBMRI) (27%, 31/114) and whole-body computed tomography (WBCT) (19%, 22/114). Integrated positron-emission tomography/CT (PET/CT) was first-line in 14% (16/114). The NICE recommended initial investigation, WBMRI, is currently offered in 27% of surveyed hospitals (<10% in 2017). Ongoing challenges to implementing WBMRI include scanner availability, financial constraints, reporting time, and radiologist training. CONCLUSION Despite NICE recommendations regarding WBMRI in diagnosis/follow-up of myeloma, SS (poor sensitivity and specificity) remains the most commonly performed first-line test. Radiologists, haematologists, and patients should continue to emphasise the superiority and benefit of modern and more accurate imaging, such that they are prioritised in clinical service planning.
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Affiliation(s)
- O Westerland
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K J Drinkwater
- Directorate of Professional Practice, Royal College of Radiologists, London, UK.
| | - J Parikh
- Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Streetly
- Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Pratt
- Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - V Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Clinical Imaging and Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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Lopez‐Olivo MA, Zogala RJ, des Bordes J, Zamora NV, Christensen R, Rai D, Goel N, Carmona L, Pratt G, Strand V, Suarez‐Almazor ME. Outcomes Reported in Prospective Long‐Term Observational Studies and Registries of Patients With Rheumatoid Arthritis Worldwide: An Outcome Measures in Rheumatology Systematic Review. Arthritis Care Res (Hoboken) 2021; 73:649-657. [DOI: 10.1002/acr.24163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/28/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | | | - Robin Christensen
- Bispebjerg and Frederiksberg Hospital Copenhagen and University of Southern Denmark and Odense University Hospital Odense Denmark
| | - Davesh Rai
- University of Texas MD Anderson Cancer Center Houston
| | - Niti Goel
- Duke University School of Medicine Durham North Carolina
| | | | - Gregory Pratt
- University of Texas MD Anderson Cancer Center Houston
| | - Vibeke Strand
- Stanford University School of Medicine Palo Alto California
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14
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Bernardes CM, Clark PJ, Brown C, Stuart K, Pratt G, Toombs M, Hartel G, Powell EE, Valery PC. Disparities in Unmet Needs in Indigenous and Non-Indigenous Australians with Cirrhosis: An Exploratory Study. Patient Prefer Adherence 2021; 15:2649-2658. [PMID: 34853510 PMCID: PMC8628121 DOI: 10.2147/ppa.s341566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Understanding and responding to the supportive care needs of people with cirrhosis is essential to quality care. Indigenous Australians, Aboriginal and Torres Strait Islander people, are overrepresented amongst patients with cirrhosis. This study documented the nature and extent of supportive care needs of Indigenous Australians with cirrhosis, in comparison with non-Indigenous Australians. PATIENTS AND METHODS The supportive care needs of adult patients diagnosed with cirrhosis attending public hospitals in Queensland were assessed through the Supportive Needs Assessment tool for Cirrhosis (SNAC). Patients indicated how much additional help they needed on four subscales: 1. psychosocial issues; 2. practical and physical needs; 3. information needs; and 4. lifestyle changes. We examined the rate of moderate-to-high unmet needs based on Indigenous status (Poisson regression; incidence rate ratio (IRR)). RESULTS Indigenous (n=20) and non-Indigenous (n=438) patients included in the study had similar sociodemographic and clinical characteristics except for a lower educational level among Indigenous patients (p<0.01). Most Indigenous patients (85.0%) reported having moderate-to-high unmet needs with at least one item in the SNAC tool. Following adjustment for key sociodemographic and clinical factors, Indigenous patients had a greater rate of moderate-to-high unmet needs overall (IRR=1.5, 95% CI 1.31-1.72; p<0.001), and specifically for psychosocial issues (IRR=1.7, 95% CI 1.39-2.15; p<0.001), and practical and physical needs subscales (IRR=1.5, 95% CI 1.22-1.83; p<0.001), compared to non-Indigenous patients. CONCLUSION Indigenous Australians with cirrhosis more frequently had moderate-to-high unmet supportive care needs than non-Indigenous patients. Specific targeting of culturally appropriate supportive care for psychosocial, practical and physical needs may optimize cirrhosis care and improve the quality of life for Indigenous Australians with cirrhosis.
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Affiliation(s)
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Cath Brown
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Katherine Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Correspondence: Patricia C Valery Tel +61 07 3362 0376 Email
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15
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Wallingford CK, Cutler K, Istiko SN, Fowles LF, Lamb R, Bean J, Healy L, Hondow G, Pratt G, Vidgen ME, Waddell N, Evans E, Bunker D, McInerney-Leo AM. Queensland Consumers' Awareness and Understanding of Clinical Genetics Services. Front Genet 2020; 11:537743. [PMID: 33193608 PMCID: PMC7593610 DOI: 10.3389/fgene.2020.537743] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
As genetic testing becomes increasingly utilized in health care, consumer awareness and understanding is critical. Both are reported to be low in Australia, though there are limited studies to date. A consumer survey assessed perceived knowledge, awareness and attitudes toward genetic medicine, prior to consumers’ genomics forums in Queensland in 2018 and 2019. Data was analyzed using t-test and Mann-Whitney U tests analysis to detect any associations between sociodemographic factors and familiarity or attitudes. This highly educated and experienced health consumer cohort reported they were significantly more familiar with the healthcare system generally than genetic medicine specifically (p < 0.0001). Consumers perceived that genetic testing would be significantly more important in the future than it is currently (p < 0.00001). Consumers agreed that genetic testing should be promoted (91.4%), made available (100%), better funded (94.2%), and offered to all pregnant women (81.6%). The preferred learning modality about genetics was internet sites (62.7%) followed by talks/presentations (30.8%). Benefits of genetic testing, reported in qualitative responses, included the potential for additional information to promote personal control and improve healthcare. Perceived concerns included ethical implications (including privacy and discrimination), and current limitations of science, knowledge and/or practice. This study demonstrates that even knowledgeable consumers have little familiarity with genetic medicine but are optimistic about its potential benefits. Ethical concerns, particularly concerns regarding genetic discrimination should inform legislation and policy. Consumers are supportive of online resources in increasing genomic literacy.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, The University of Queensland Diamantina Institute, University of Queensland, Brisbane, QLD, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | | | - Lindsay F Fowles
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Rachel Lamb
- Queensland Genomics, Brisbane, QLD, Australia
| | | | | | - Gary Hondow
- Queensland Genomics, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Erin Evans
- Queensland Genomics, Brisbane, QLD, Australia
| | | | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
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16
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Lopez-Olivo MA, Pratt G, Suarez-Almazor ME, Colmegna I, Karpes AR, Ruyu Qi S, Zamora NV, Sharma R. Reply. Arthritis Care Res (Hoboken) 2020; 72:1828-1829. [PMID: 32961036 DOI: 10.1002/acr.24456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Maria A Lopez-Olivo
- The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Gregory Pratt
- The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | | | | | - Aliza R Karpes
- University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States
| | | | - Natalia V Zamora
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Robin Sharma
- Nassau University Medical Center, East Meadow, New York, United States
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17
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Lopez-Olivo MA, Colmegna I, Karpes Matusevich AR, Qi SR, Zamora NV, Sharma R, Pratt G, Suarez-Almazor ME. Systematic Review of Recommendations on the Use of Disease-Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis and Cancer. Arthritis Care Res (Hoboken) 2020; 72:309-318. [PMID: 30821928 DOI: 10.1002/acr.23865] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate consensus recommendations regarding management of rheumatoid arthritis (RA) in patients with cancer. METHODS We searched electronic databases, guideline registries, and relevant web sites for cancer-specific recommendations on RA management. Reviewers independently selected and appraised the recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. We identified similarities and discrepancies among recommendations. RESULTS Of 4,077 unique citations, 39 recommendations were identified, of which half described their consensus process. Average scores for the AGREE II domains ranged from 33% to 87%. Cancer risk in RA was addressed in 79% of recommendations, with acknowledgement of increased overall cancer risk. Recommendations did not agree on the safety of using disease-modifying antirheumatic drugs (DMARDs) in RA patients with cancer, except for the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma. Most recommendations agreed that RA treatment should be stopped and re-evaluated with a new diagnosis of cancer. Recommendations for patients with a history of cancer differed depending on the drug, cancer type, and time since cancer diagnosis. Few recommendations addressed all issues. CONCLUSION Recommendations for the treatment of RA in patients with cancer often fail to meet expected methodologic criteria. There was agreement on the need for caution when prescribing DMARDs to these patients. However, several areas continue to lack consensus, and given the paucity of evidence, there is an urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer.
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Affiliation(s)
| | | | | | | | | | - Robin Sharma
- University of Texas MD Anderson Cancer Center, Houston
| | - Gregory Pratt
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston
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18
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Affiliation(s)
- S Paneesha
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - G Pratt
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - H Parry
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
| | - P Moss
- Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, UK.,University of Birmingham, UK
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19
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Valery PC, Clark PJ, Pratt G, Bernardes CM, Hartel G, Toombs M, Irvine KM, Powell EE. Hospitalisation for cirrhosis in Australia: disparities in presentation and outcomes for Indigenous Australians. Int J Equity Health 2020; 19:27. [PMID: 32066438 PMCID: PMC7027067 DOI: 10.1186/s12939-020-1144-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background Indigenous Australians experience greater health disadvantage and have a higher prevalence of many chronic health conditions. Liver diseases leading to cirrhosis are among the most common contributor to the mortality gap between Indigenous and other Australian adults. However, no comparative data exist assessing differences in presentation and patient outcomes between Indigenous and non-Indigenous Australians hospitalised with cirrhosis. Methods Using data from the Hospital Admitted Patient Data Collection and the Death Registry, this retrospective, population-based, cohort study including all people hospitalised for cirrhosis in the state of Queensland during 2008–2017 examined rate of readmission (Poisson regression), cumulative survival (Kaplan–Meier), and assessed the differences in survival (Multivariable Cox regression) by Indigenous status. Predictor variables included demographic, health service characteristics and clinical data. Results We studied 779 Indigenous and 10,642 non-Indigenous patients with cirrhosis. A higher proportion of Indigenous patients were younger than 50 years (346 [44%] vs. 2063 [19%] non-Indigenous patients), lived in most disadvantaged areas (395 [51%) vs. 2728 [26%]), had alcohol-related cirrhosis (547 [70%] vs. 5041 [47%]), had ascites (314 [40%] vs. 3555 [33%), and presented to hospital via the Emergency Department (510 [68%] vs. 4790 [47%]). Indigenous patients had 3.04 times the rate of non-cirrhosis readmissions (95%CI 2.98–3.10), 1.35 times the rate of cirrhosis-related readmissions (95%CI 1.29–1.41), and lower overall survival (17% vs. 27%; unadjusted hazard ratio (HR) = 1.16 95%CI 1.06–1.27), compared to non-Indigenous patients. Most of the survival deficit was explained by Emergency Department presentation (adj-HR = 1.03 95%CI 0.93–1.13), and alcohol-related aetiology (adj-HR = 1.08 95%CI 0.99–1.19). The remaining survival deficit was influenced by the other clinico-demographic and health service factors (final adj-HR = 1.08 95%CI 0.96–1.20). Conclusions There was evidence of differential presentation, higher rates of readmissions, and poorer survival for Indigenous Australians with cirrhosis, compared to other Australians. The increased prevalence of Emergency Department presentation among Indigenous patients suggests missed opportunities for early intervention to prevent progressive cirrhosis complications and hospital readmissions.
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Affiliation(s)
- Patricia C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia. .,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Christina M Bernardes
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD, 4006, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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20
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Senko C, Moore J, Hay K, Lwin Z, Pratt G, Fong K, Hughes B. P1.18-14 The Prognostic Significance of Significant Weight Loss in Stage III NSCLC Undergoing Definitive CRT After FDG-PET Staging. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Blythe R, Pratt G. 26IMPACT OF COMPREHENSIVE GERIATRIC ASSESSMENT AND EARLY COMMUNICATION IN MORE DEBILITATED PATIENTS FOLLOWING STROKE. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Blythe
- Acute Stroke Unit, Sheffield Teaching Hospitals, Sheffield
| | - G Pratt
- Acute Stroke Unit, Sheffield Teaching Hospitals, Sheffield
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22
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Meiklejohn JA, Arley BD, Pratt G, Valery PC, Bernardes CM. 'We just don't talk about it': Aboriginal and Torres Strait Islander peoples' perceptions of cancer in regional Queensland. Rural Remote Health 2019; 19:4789. [PMID: 31137938 DOI: 10.22605/rrh4789] [Citation(s) in RCA: 5] [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] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Disparities in cancer outcomes between Indigenous and non-Indigenous people are well reported. Some Australian Indigenous communities' beliefs about cancer may influence health behaviours, support for those with cancer and ,ultimately, treatment outcomes. This project was instigated by request of a cultural adviser from a regional Queensland community and aims to make community perceptions of cancer visible, facilitate development of resources representing these perceptions and briefly evaluate the project from the community's perspective. METHODS The project was guided by qualitative, participatory and visual research methodology. Community participation was engaged by identifying community champions who helped recruit interested community members and continued project momentum. The project was defined and driven by community, and a consensus decision making approach was used to select resources or activities to represent community perceptions of cancer and raise cancer awareness. Qualitative data were collected from yarning groups at two community forums and subsequent group sessions to explore and define community perceptions of cancer. Informed consent was obtained prior to audio-taped yarning groups. Data were also included from publicly available interviews broadcast on radio and television. All data about community perceptions of cancer and of the project were thematically analysed. Photovoice using cameras was the visual method chosen to capture images and stories representing community cancer beliefs. RESULTS Three main themes were derived from thematic analysis of data collected about community perceptions of cancer, identified by participants as important to improving cancer outcomes: (1) silence in the community, (2) support is important for survivorship and (3) awareness of cancer and the importance of sharing positive stories. A consensus decision-making approach resulted in the community choosing two resources to stimulate community discussion about cancer, raise awareness and reduce stigma. These were creating a community quilt, with each quilt square representing community perceptions of cancer, and producing a community calendar, with messages promoting healthy behaviours and cancer screening. The overall project was viewed as valuable for facilitating and improving the conversation about cancer with family, friends, the broader community and health professionals. Group sessions were considered important for providing a shared, safe space for support, for asking health related questions and as an instigator to share cancer related knowledge and stories with others. CONCLUSION Silence around cancer may influence awareness and discussion about cancer, screening participation and help-seeking behaviour in this community. In this project, engaging with the community created a safe space for conversation around a previously taboo topic, which could lead to improved screening and help seeking behaviour. The role of primary health care in reducing health disparities by partnering with community to conduct awareness and prevention activities and by providing culturally appropriate care for Indigenous people is emphasised.
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Affiliation(s)
- Judith A Meiklejohn
- Orange Sky Australia, Remote and Indigenous Services Program, Brisbane, Queensland, Australia
| | - Brian D Arley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland, Australia
| | - Christina M Bernardes
- QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland, Australia
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23
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Yap A, Lopez-Olivo MA, Dubowitz J, Pratt G, Hiller J, Gottumukkala V, Sloan E, Riedel B, Schier R. Effect of beta-blockers on cancer recurrence and survival: a meta-analysis of epidemiological and perioperative studies. Br J Anaesth 2018; 121:45-57. [PMID: 29935594 DOI: 10.1016/j.bja.2018.03.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 11/07/2017] [Revised: 03/05/2018] [Accepted: 03/30/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The biological perturbation associated with psychological and surgical stress is implicated in cancer recurrence. Preclinical evidence suggests that beta-blockers can be protective against cancer progression. We undertook a meta-analysis of epidemiological and perioperative clinical studies to investigate the association between beta-blocker use and cancer recurrence (CR), disease-free survival (DFS), and overall survival (OS). METHODS Databases were searched until September 2017, reported hazard ratios (HRs) pooled, and 95% confidence intervals (CIs) calculated. Comparative studies examining the effect of beta-blockers (selective and non-selective) on cancer outcomes were included. The Newcastle Ottawa Scale was used to assess methodological quality and bias. RESULTS Of the 27 included studies, nine evaluated the incidental use of non-selective beta-blockers, and ten were perioperative studies. Beta-blocker use had no effect on CR. Within subgroups of cancer, melanoma was associated with improved DFS (HR 0.03, 95% CI 0.01-0.17) and OS (HR 0.04, 95% CI 0.00-0.38), while endometrial cancer had an associated reduction in DFS (HR 1.40, 95% CI 1.10-1.80) and OS (HR 1.50, 95% CI 1.12-2.00). There was also reduced OS seen with head and neck and prostate cancer. Non-selective beta-blocker use was associated with improved DFS and OS in ovarian cancer, improved DFS in melanoma, but reduced OS in lung cancer. Perioperative studies showed similar variable effects across cancer types, albeit from a limited data pool. CONCLUSION Beta-blocker use had no evident effect on CR. The beneficial effect of beta-blockers on DFS and OS in the epidemiological or perioperative setting remains variable, tumour-specific, and of low-level evidence at present.
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Affiliation(s)
- A Yap
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Princess Margaret Hospital, Perth, WA, Australia.
| | - M A Lopez-Olivo
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - J Dubowitz
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - G Pratt
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - J Hiller
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Parkville, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - V Gottumukkala
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - E Sloan
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Cousins Center for PNI, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Parkville, VIC, Australia
| | - R Schier
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
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24
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Richer S, Huntjens B, Pratt S, Rutledge G, Perry B, Novil S, Pratt G. Is macular pigment spatial profile a clinical biomarker in children of AMD parents? Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Richer
- Eye Clinic 112e; Captain James A Lovell Federal Health Care Center; North Chicago IL USA
| | - B. Huntjens
- Applied Vision Research Centre; School of Health Sciences; City University of London; London UK
| | - S. Pratt
- Scripps Clinical Research Service; Scripps Health / Scripps Memorial Hospital; Scripps Mericos Eye Institute; La Jolla CA USA
| | - G. Rutledge
- Ecology and Evolutionary Biology; University of California; Irvine CA USA
| | - B. Perry
- Ophthalmology; University of Iowa; Iowa City IA USA
| | - S. Novil
- Eye Clinic; Captain James A Lovell Federal Health Care Center; North Chicago IL USA
| | - G. Pratt
- Ophthalmology; Steven Pratt- MD Private Practice; La Jolla CA USA
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25
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Pan X, Lopez-Olivo MA, Song J, Pratt G, Suarez-Almazor ME. Systematic review of the methodological quality of controlled trials evaluating Chinese herbal medicine in patients with rheumatoid arthritis. BMJ Open 2017; 7:e013242. [PMID: 28249848 PMCID: PMC5353312 DOI: 10.1136/bmjopen-2016-013242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES We appraised the methodological and reporting quality of randomised controlled clinical trials (RCTs) evaluating the efficacy and safety of Chinese herbal medicine (CHM) in patients with rheumatoid arthritis (RA). DESIGN For this systematic review, electronic databases were searched from inception until June 2015. The search was limited to humans and non-case report studies, but was not limited by language, year of publication or type of publication. Two independent reviewers selected RCTs, evaluating CHM in RA (herbals and decoctions). Descriptive statistics were used to report on risk of bias and their adherence to reporting standards. Multivariable logistic regression analysis was performed to determine study characteristics associated with high or unclear risk of bias. RESULTS Out of 2342 unique citations, we selected 119 RCTs including 18 919 patients: 10 108 patients received CHM alone and 6550 received one of 11 treatment combinations. A high risk of bias was observed across all domains: 21% had a high risk for selection bias (11% from sequence generation and 30% from allocation concealment), 85% for performance bias, 89% for detection bias, 4% for attrition bias and 40% for reporting bias. In multivariable analysis, fewer authors were associated with selection bias (allocation concealment), performance bias and attrition bias, and earlier year of publication and funding source not reported or disclosed were associated with selection bias (sequence generation). Studies published in non-English language were associated with reporting bias. Poor adherence to recommended reporting standards (<60% of the studies not providing sufficient information) was observed in 11 of the 23 sections evaluated. LIMITATIONS Study quality and data extraction were performed by one reviewer and cross-checked by a second reviewer. Translation to English was performed by one reviewer in 85% of the included studies. CONCLUSIONS Studies evaluating CHM often fail to meet expected methodological criteria, and high-quality evidence is lacking.
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Affiliation(s)
- Xin Pan
- Department of Rheumatology, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maria A Lopez-Olivo
- Department of General Internal Medicine, Rheumatology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gregory Pratt
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Rheumatology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Abstract
In February 2016, the National Institute for Health and Care Excellence (NICE) published guidelines on multiple myeloma. NICE have published numerous guidelines relating to haematology, but this was the first guideline focusing on a single haematological malignancy. The purpose of this review was to highlight the recommendations made in the guideline and the implications for the management of patients in the UK and also internationally. In addition, we review the NICE process and highlight issues around current guideline development.
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Affiliation(s)
- G Pratt
- Haematology, Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T C Morris
- Haematology, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
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27
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Jones JR, Cairns DA, Gregory WM, Collett C, Pawlyn C, Sigsworth R, Striha A, Henderson R, Kaiser MF, Jenner M, Cook G, Russell NH, Williams C, Pratt G, Kishore B, Lindsay J, Drayson MT, Davies FE, Boyd KD, Owen RG, Jackson GH, Morgan GJ. Second malignancies in the context of lenalidomide treatment: an analysis of 2732 myeloma patients enrolled to the Myeloma XI trial. Blood Cancer J 2016; 6:e506. [PMID: 27935580 PMCID: PMC5223149 DOI: 10.1038/bcj.2016.114] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 09/02/2016] [Accepted: 10/24/2016] [Indexed: 12/26/2022] Open
Abstract
We have carried out the largest randomised trial to date of newly diagnosed myeloma patients, in which lenalidomide has been used as an induction and maintenance treatment option and here report its impact on second primary malignancy (SPM) incidence and pathology. After review, 104 SPMs were confirmed in 96 of 2732 trial patients. The cumulative incidence of SPM was 0.7% (95% confidence interval (CI) 0.4–1.0%), 2.3% (95% CI 1.6–2.7%) and 3.8% (95% CI 2.9–4.6%) at 1, 2 and 3 years, respectively. Patients receiving maintenance lenalidomide had a significantly higher SPM incidence overall (P=0.011). Age is a risk factor with the highest SPM incidence observed in transplant non-eligible patients aged >74 years receiving lenalidomide maintenance. The 3-year cumulative incidence in this group was 17.3% (95% CI 8.2–26.4%), compared with 6.5% (95% CI 0.2–12.9%) in observation only patients (P=0.049). There was a low overall incidence of haematological SPM (0.5%). The higher SPM incidence in patients receiving lenalidomide maintenance therapy, especially in advanced age, warrants ongoing monitoring although the benefit on survival is likely to outweigh risk.
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Affiliation(s)
- J R Jones
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - W M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Pawlyn
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Sigsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - A Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - R Henderson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M F Kaiser
- The Institute of Cancer Research, London, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - M Jenner
- Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Cook
- University of Leeds, Leeds, UK
| | - N H Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - C Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - G Pratt
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - B Kishore
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J Lindsay
- Department of Haematology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - M T Drayson
- Clinical Immunology, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - F E Davies
- The Institute of Cancer Research, London, UK.,The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K D Boyd
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - G H Jackson
- Department of Haematology, Newcastle University, Newcastle, UK
| | - G J Morgan
- The Institute of Cancer Research, London, UK.,The Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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28
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Ludwig C, Williams DS, Bartlett DB, Essex SJ, McNee G, Allwood JW, Jewell E, Barkhuisen A, Parry H, Anandram S, Nicolson P, Gardener C, Seymour F, Basu S, Dunn WB, Moss PAH, Pratt G, Tennant DA. Alterations in bone marrow metabolism are an early and consistent feature during the development of MGUS and multiple myeloma. Blood Cancer J 2015; 5:e359. [PMID: 26473531 PMCID: PMC4635194 DOI: 10.1038/bcj.2015.85] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- C Ludwig
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D S Williams
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - D B Bartlett
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S J Essex
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G McNee
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J W Allwood
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - E Jewell
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - A Barkhuisen
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - H Parry
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Anandram
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - P Nicolson
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - C Gardener
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - F Seymour
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - S Basu
- Department of Haematology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - W B Dunn
- School of Biosciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - P A H Moss
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G Pratt
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - D A Tennant
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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29
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Parry HM, Damery S, Mudondo NP, Hazlewood P, McSkeane T, Aung S, Murray J, Pratt G, Moss P, Milligan DW. Primary care management of early stage chronic lymphocytic leukaemia is safe and effective. QJM 2015; 108:789-94. [PMID: 25638788 PMCID: PMC4586947 DOI: 10.1093/qjmed/hcv017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 10/01/2014] [Revised: 12/18/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukaemia (CLL) is the commonest leukaemia in western society. Most patients are detected incidentally at an early stage and require 'watch and wait' follow-up. In the UK, management of Stage A0 CLL varies with some centres advising regular outpatient haematology follow-up, whereas others recommend management within primary care. The safety and effectiveness of these two management options are currently unknown. METHODS An observational retrospective cohort study in outpatient Haematology clinics at Queen Elizabeth Hospital Birmingham (QEH) and Birmingham Heartlands Hospital (BHH) and primary care practices in West Midlands, UK. All patients diagnosed with stable stage A0 CLL since 2002 at BHH or QEH were identified. At BHH, patients were discharged to primary care follow-up, whilst QEH patients remained under haematology for follow-up. Evidence of disease progression, need for treatment and overall mortality was documented. RESULTS Two hundred and forty-six Stage A0 CLL patients were identified. One hundred and five (43%) patients were discharged to primary care, whilst 141 (57%) patients were followed up in haematology outpatient clinics. No difference in mortality or need for treatment was found between the two groups. Of those discharged, 93 (66%) remained in primary care. CONCLUSION The management of stable-stage A0 CLL within primary or secondary care leads to equivalent clinical outcomes. The prevalence of early-stage CLL is expected to increase with the ageing population and management within primary care should be considered as a potentially effective approach.
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Affiliation(s)
| | - S Damery
- School of Primary Care Clinical Sciences
| | - N P Mudondo
- School of Medicine and Dentistry, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK
| | | | | | - S Aung
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
| | - J Murray
- Centre for Clinical Haematology, Morris House, Queen Elizabeth Hospital, Birmingham, West Midlands B15 2TH, UK
| | - G Pratt
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
| | | | - D W Milligan
- Centre for Haematology and Stem Cell Transplantation, Heart of England NHS Foundation Trust, Birmingham, West Midlands B9 5SS, UK and
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30
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Sava GP, Speedy HE, Di Bernardo MC, Dyer MJS, Holroyd A, Sunter NJ, Marr H, Mansouri L, Deaglio S, Karabon L, Frydecka I, Jamroziak K, Woszczyk D, Juliusson G, Smedby KE, Jayne S, Majid A, Wang Y, Dearden C, Hall AG, Mainou-Fowler T, Jackson GH, Summerfield G, Harris RJ, Pettitt AR, Allsup DJ, Bailey JR, Pratt G, Pepper C, Fegan C, Rosenquist R, Catovsky D, Allan JM, Houlston RS. Common variation at 12q24.13 (OAS3) influences chronic lymphocytic leukemia risk. Leukemia 2015; 29:748-51. [PMID: 25363670 PMCID: PMC4360210 DOI: 10.1038/leu.2014.311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
MESH Headings
- 2',5'-Oligoadenylate Synthetase/genetics
- Alleles
- Case-Control Studies
- Chromosome Mapping
- Chromosomes, Human, Pair 12/chemistry
- Gene Frequency
- Genetic Loci
- Genetic Predisposition to Disease
- Genome-Wide Association Study
- Humans
- Introns
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Odds Ratio
- Polymorphism, Single Nucleotide
- Risk
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Affiliation(s)
- G P Sava
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - H E Speedy
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - M C Di Bernardo
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - M J S Dyer
- The Ernest and Helen Scott Haematological Research Institute, Department of Biochemistry and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - A Holroyd
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - N J Sunter
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - H Marr
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - L Mansouri
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - S Deaglio
- Department of Medical Sciences and Human Genetics Foundation, University of Turin, Turin, Italy
| | - L Karabon
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
- Department and Clinic of Urology, Wroclaw Medical University, Wroclaw, Poland
| | - I Frydecka
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - K Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - D Woszczyk
- Department of Haematology, State Hospital, Opole, Poland
| | - G Juliusson
- Lund Strategic Research Center for Stem Cell Biology and Cell Therapy, Hematology and Transplantation, Lund University, Lund, Sweden
| | - K E Smedby
- Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - S Jayne
- The Ernest and Helen Scott Haematological Research Institute, Department of Biochemistry and Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | - A Majid
- Medical Research Council Toxicology Unit, Leicester University, Leicester, UK
| | - Y Wang
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - C Dearden
- Haemato-Oncology, Division of Pathology, The Institute of Cancer Research, Sutton, UK
| | - A G Hall
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - T Mainou-Fowler
- Haematological Sciences, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G H Jackson
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Summerfield
- Department of Haematology, Queen Elizabeth Hospital, Gateshead, Newcastle upon Tyne, UK
| | - R J Harris
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - A R Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - D J Allsup
- Department of Haematology, Hull Royal Infirmary, Hull, UK
| | - J R Bailey
- Hull York Medical School and University of Hull, Hull, UK
| | - G Pratt
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | - C Fegan
- Cardiff and Vale National Health Service Trust, Heath Park, Cardiff, UK
| | - R Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - D Catovsky
- Haemato-Oncology, Division of Pathology, The Institute of Cancer Research, Sutton, UK
| | - J M Allan
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - R S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
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31
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Pepper C, Buggins AGS, Jones CH, Walsby EJ, Forconi F, Pratt G, Devereux S, Stevenson FK, Fegan C. Phenotypic heterogeneity in IGHV-mutated CLL patients has prognostic impact and identifies a subset with increased sensitivity to BTK and PI3Kδ inhibition. Leukemia 2014; 29:744-7. [PMID: 25349153 PMCID: PMC4360209 DOI: 10.1038/leu.2014.308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C Pepper
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A G S Buggins
- Department of Haematology, King's College London, London, UK
| | - C H Jones
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - E J Walsby
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - F Forconi
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - G Pratt
- CRUK Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Devereux
- Department of Haematology, King's College London, London, UK
| | - F K Stevenson
- Cancer Sciences Unit, CRUK Clinical Centre, University of Southampton, Southampton, UK
| | - C Fegan
- Cardiff CLL Research Group, Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Rabin N, Lai M, Pratt G, Morgan G, Snowden J, Bird J, Cook G, Bowcock S, Owen R, Yong K, Wechalaker A, Low E, Davies F. United Kingdom Myeloma Forum position statement on the use of consolidation and maintenance treatment in myeloma. Int J Lab Hematol 2014; 36:665-75. [DOI: 10.1111/ijlh.12205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. Rabin
- Department of Haematology; University College London Hospitals; London UK
| | | | - G. Pratt
- Department of Haematology; Birmingham Hertlands Hospital; Birmingham UK
| | - G. Morgan
- Haemato-oncology; Royal Marsden Hospital; London UK
| | - J. Snowden
- Department of Haematology; Sheffield Teaching Hospitals; Sheffield UK
| | - J. Bird
- Department of Haematology; University Hospitals Bristol; Bristol UK
| | - G. Cook
- St James's Institute of Oncology; Leeds Teaching Hospitals Trust; Leeds UK
| | - S. Bowcock
- Department of Haematology; Princess Royal Hospital; Orpington Kent UK
| | - R. Owen
- St James's Institute of Oncology; Leeds Teaching Hospitals Trust; Leeds UK
| | - K. Yong
- Department of Haematology; University College London Hospitals; London UK
| | - A. Wechalaker
- Centre for Amyloidosis and Acute Phase Proteins; Royal Free Hospital; London UK
| | | | - F. Davies
- Haemato-oncology; Royal Marsden Hospital; London UK
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Burmeister A, Assi LK, Ferro CJ, Hughes RG, Barnett AH, Bellary S, Cockwell P, Pratt G, Hutchison CA. The relationship between high-sensitivity CRP and polyclonal Free Light Chains as markers of inflammation in chronic disease. Int J Lab Hematol 2013; 36:415-24. [DOI: 10.1111/ijlh.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Burmeister
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- The Binding Site Group Ltd; Birmingham UK
| | - L. K. Assi
- The Binding Site Group Ltd; Birmingham UK
| | - C. J. Ferro
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | | | - A. H. Barnett
- University of Birmingham; Birmingham UK
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
| | - S. Bellary
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
- Aston University; Birmingham UK
| | - P. Cockwell
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | - G. Pratt
- Department of Haematology; Heart of England NHS Trust; Birmingham UK
| | - C. A. Hutchison
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
- Hawke's Bay District Health Board; Hawke's Bay New Zealand
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Lopez-Olivo MA, Pratt G, Palla SL, Salahudeen A. Rasburicase in tumor lysis syndrome of the adult: a systematic review and meta-analysis. Am J Kidney Dis 2013; 62:481-92. [PMID: 23684124 DOI: 10.1053/j.ajkd.2013.02.378] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/14/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND The use of rasburicase has been evaluated extensively in children, but not in adults. We review the current literature to evaluate its effect on adults. STUDY DESIGN Systematic review and meta-analysis. SETTING & POPULATION Adults receiving rasburicase for tumor lysis syndrome (TLS). SELECTION CRITERIA FOR STUDIES Electronic databases, regulatory documents, and websites were searched up to August 7, 2012. Reference lists of published articles were examined for additional relevant references. Any controlled trial or observational studies (controlled before and after) were included. Studies considering children only or mixing data for children and adults were excluded. INTERVENTION Rasburicase for TLS. OUTCOMES The primary outcome was TLS development. Secondary outcomes included percentage of patients improving, total adverse events, acute kidney failure, deaths, and serum uric acid and creatinine levels. RESULTS 21 studies (24 publications) reported data for 1,261 adult patients, 768 receiving rasburicase for either the treatment or prophylaxis of TLS; these comprised 4 controlled trials and 17 observational studies. No statistically significant differences in clinical TLS development were observed in the controlled trials between the rasburicase and control groups. For the observational studies, 7.4% of patients developed clinical TLS after rasburicase (95% CI, 1.7%-16.7%), 93.4% of patients achieved normalized serum uric acid levels after rasburicase treatment (95% CI, 91.7%-94.6%), 4.4% developed acute kidney injury (95% CI, 3.0%-6.0%), and 2.6% died (95% CI, 0.95%-5.0%). The mean reduction in serum uric acid levels ranged from 5.3-12.8 mg/dL, and for serum creatinine levels, from 0.10-2.1 mg/dL. LIMITATIONS Controlled trials differed in outcomes reported; meta-analysis was not performed. CONCLUSIONS Rasburicase is effective in reducing serum uric acid levels in adults with TLS but at a significant cost, and evidence currently is lacking in adults to report whether rasburicase use improves clinical outcomes compared with other alternatives. Until new evidence is available, use of rasburicase may be limited to adult patients with a high risk of TLS.
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Affiliation(s)
- Maria A Lopez-Olivo
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Pratt G, Bowcock S, Lai M, Bell S, Bird J, D'Sa S, Cavenagh J, Cook G, Morgan G, Owen R, Snowden JA, Yong K, Davies F. United Kingdom Myeloma Forum (UKMF) position statement on the use of bendamustine in myeloma. Int J Lab Hematol 2013; 36:20-8. [PMID: 23615178 DOI: 10.1111/ijlh.12097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/25/2013] [Indexed: 11/29/2022]
Abstract
Bendamustine is a unique bifunctional alkylating agent with promising activity in myeloma. Despite the increasing number of studies demonstrating its efficacy in both the upfront and relapse settings, including patients with renal insufficiency, the optimal use of bendamustine, in terms of dosage, schedule and combination with other agents, has yet to be defined. It is currently licensed for use as frontline treatment with prednisolone for patients with myeloma who are unsuitable for transplantation and who are contraindicated for thalidomide and bortezomib. Studies in relapsed/refractory patients are currently ongoing with other combinations. Given the increasing data to date, the UK Myeloma Forum believes that bendamustine with steroids alone or in combination with a novel agent could be considered for patients with multiply relapsed myeloma. This document provides guidance for the use of bendamustine for patients with myeloma until the results of definitive studies are available.
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Affiliation(s)
- G Pratt
- Haematology, Heart of England NHS Trust, Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | - S Bowcock
- Haematology, South London Healthcare NHS Trust, Haematology Kent, Kent, UK
| | - M Lai
- Myeloma UK, Edinburgh, UK
| | - S Bell
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - J Bird
- Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol, UK
| | - S D'Sa
- Department of Haematology, University College Hospital, London, UK
| | - J Cavenagh
- Department of Haematology, St. Bartholomew's Hospital, London, UK
| | - G Cook
- Department of Haematology, St. James's Institute of Oncology, Leeds, UK
| | - G Morgan
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
| | - R Owen
- Haematological Malignancy Diagnostic Service Laboratory, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Snowden
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK
| | - K Yong
- Department of Haematology, University College Hospital, London, UK
| | - F Davies
- Haemato-Oncology Unit, Royal Marsden Hospital, Sutton, UK
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Abstract
Screening for a monoclonal protein is a common part of the assessment of patients presenting with a renal injury. While in the settings of acute kidney injury, chronic kidney disease and proteinuria monoclonal proteins can be associated with significant pathologies such as cast nephropathy, amyloidosis, and light chain deposition disease, they can also be an unrelated finding. The purpose of this review is to provide the nephrologist with an update to the diagnostic assessment and risk stratification of monoclonal proteins to avoid unnecessary investigation and monitoring of those patients with low-risk monoclonal gammopathies.
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Piper KP, Karanth M, McLarnon A, Kalk E, Khan N, Murray J, Pratt G, Moss PAH. Chronic lymphocytic leukaemia cells drive the global CD4+ T cell repertoire towards a regulatory phenotype and leads to the accumulation of CD4+ forkhead box P3+ T cells. Clin Exp Immunol 2011; 166:154-63. [PMID: 21985361 DOI: 10.1111/j.1365-2249.2011.04466.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Advanced chronic lymphocytic leukaemia (CLL) is associated with profound immunodeficiency, including changes in T regulatory cells (T(regs)). We determined the pattern of expression of forkhead box P3 (FoxP3), CD25, CD27 and CD127 and showed that the frequency of CD4+ FoxP3+ T cells was increased in CLL patients (12% versus 8% in controls). This increase was seen only in advanced disease, with selective expansion of FoxP3-expressing cells in the CD4+ CD25(low) population, whereas the number of CD4+ CD25(high) FoxP3+ cells was unchanged. CD4+ CD25(low) cells showed reduced expression of CD127 and increased CD27, and this regulatory phenotype was also seen on all CD4 T cells subsets in CLL patients, irrespective of CD25 or FoxP3 expression. Incubation of CD4+ T cells with primary CLL tumours led to a sixfold increase in the expression of FoxP3 in CD4+ CD25- T cells. Patients undergoing treatment with fludarabine demonstrated a transient increase in the percentage of CD4+ FoxP3+ T cells, but this reduced to normal levels post-treatment. This work demonstrates that patients with CLL exhibit a systemic T cell dysregulation leading to the accumulation of CD4+ FoxP3+ T cells. This appears to be driven by interaction with malignant cells, and increased understanding of the mechanisms that are involved could provide novel avenues for treatment.
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Affiliation(s)
- K P Piper
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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Gursu M, Aydin Z, Karadag S, Uzun S, Ogul S, Kiris A, Doventas Y, Koldas M, Ozturk S, Kazancioglu R, Mandreoli M, Bellasi A, Baldrati L, Corradini M, Rigotti A, Russo G, David S, Malmusi G, DiNicolo' P, Orsi C, Zambianchi L, Caruso F, Poisetti P, Fabbri A, Santoro A, Barton Pai A, Grabe D, Eisele G, Hutchison CA, Bevins A, Lukacik P, Hughes RG, Pratt G, Viana JL, Bishop NC, Kosmadakis G, Bevington A, Clapp EL, Feehally J, Smith AC, Joki N, Hase H, Tanaka Y, Iwasaki M, Yamaka T, Shigematsu T, Dou L, Gondouin B, Cerini C, Duval-Sabatier A, Poitevin S, Dignat-George F, Burtey S, Brunet P, Carrasco F, Salvador F, Origaca C, Nogueira E, Silva N, Silva A, Sikole A, Trajceska L, Selim G, Gelev S, Dzekova P, Amitov V, Arsov S, Dalboni M, Cruz E, Manfredi S, Mouro M, Quinto M, Grabulosa C, Batista M, Cendoroglo M, Hirayama A, Matsui H, Nagano Y, Ueda A, Aoyagi K, Owada S, Schepers E, Barreto D, Liabeuf S, Glorieux G, Eloot S, Barreto F, Massy Z, Vanholder R, Secara IF, Oleniuc M, Nistor I, Onofriescu M, Covic A, Aguerrevere S, Granada M, Bayes B, Pastor M, Sancho A, Bonal J, Canas L, Lauzurica R, Teixido J, Troya M, Romero R, Capitanini A, D'Alessandro C, Ferretti V, Petrone I, Pasquariello G, Cupisti A, Parastayeva MM, Berseneva ON, Kucher AG, Ivanova GT, Smirnov AV, Kayukov IG, Kayabasi H, Esmer S, Yilmaz Z, Kadiroglu AK, Yilmaz ME, Radic J, Kovacic V, Radic M, Ljutic D, Sain M, Karakan S, Sezer S, Tutal E, Ozdemir Acar FN, Bi G, Xing C, Chen R, Romero-Garcia A, Jacobo-Arias F, Martin del Campo F, Gonzalez-Espinoza L, Pazarin L, Cueto-Manzano AM, Panagoutsos S, Kriki P, Mourvati E, Tziakas D, Chalikias G, Stakos D, Apostolakis S, Tsigalou C, Gioka T, Konstantinides S, Vargemezis V, Nascimento M, Hayashi S, Seeberger A, Yamamoto T, Qureshi AR, Lind B, Riella M, Brodin LA, Lindholm B, Meier P, Menne J, Kruger K, Mooren FC, Weissmann N, Seimetz M, Haller H, Gusev E, Solomatina L, Zhuravleva J, Striker G, Uribarri J, Cai W, Goodman S, Pyzik R, Grosjean F, Vlassara H, So A, Gimona A, Kiechle T, Shpilsky A, Schlesinger N. Malnutrition & inflammation in CKD 1-5. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Gorbea C, Pratt G, Ustrell V, Bell R, Sahasrabudhe S, Hughes RE, Rechsteiner M. A protein interaction network for Ecm29 links the 26 S proteasome to molecular motors and endosomal components. J Biol Chem 2010; 285:31616-33. [PMID: 20682791 DOI: 10.1074/jbc.m110.154120] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Ecm29 is a 200-kDa HEAT repeat protein that binds the 26 S proteasome. Genome-wide two-hybrid screens and mass spectrometry have identified molecular motors, endosomal components, and ubiquitin-proteasome factors as Ecm29-interacting proteins. The C-terminal half of human Ecm29 binds myosins and kinesins; its N-terminal region binds the endocytic proteins, Vps11, Rab11-FIP4, and rabaptin. Whereas full-length FLAG-Ecm29, its C-terminal half, and a small central fragment of Ecm29 remain bound to glycerol-gradient-separated 26 S proteasomes, the N-terminal half of Ecm29 does not. Confocal microscopy showed that Ecm-26 S proteasomes are present on flotillin-positive endosomes, but they are virtually absent from caveolin- and clathrin-decorated endosomes. Expression of the small central fragment of Ecm29 markedly reduces proteasome association with flotillin-positive endosomes. Identification of regions within Ecm29 capable of binding molecular motors, endosomal proteins, and the 26 S proteasome supports the hypothesis that Ecm29 serves as an adaptor for coupling 26 S proteasomes to specific cellular compartments.
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Affiliation(s)
- Carlos Gorbea
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah 84112, USA
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40
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Gorbea C, Makar KA, Pauschinger M, Pratt G, Bersola JLF, Varela J, David RM, Banks L, Huang CH, Li H, Schultheiss HP, Towbin JA, Vallejo JG, Bowles NE. A role for Toll-like receptor 3 variants in host susceptibility to enteroviral myocarditis and dilated cardiomyopathy. J Biol Chem 2010; 285:23208-23. [PMID: 20472559 DOI: 10.1074/jbc.m109.047464] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The innate antiviral response is mediated, at least in part, by Toll-like receptors (TLRs). TLR3 signaling is activated in response to viral infection, and the absence of TLR3 in mice significantly increases mortality after infection with enteroviruses that cause myocarditis and/or dilated cardiomyopathy. We screened TLR3 in patients diagnosed with enteroviral myocarditis/cardiomyopathy and identified a rare variant in one patient as well as a significantly increased occurrence of a common polymorphism compared with controls. Expression of either variant resulted in significantly reduced TLR3-mediated signaling after stimulation with synthetic double-stranded RNA. Furthermore, Coxsackievirus B3 infection of cell lines expressing mutated TLR3 abrogated activation of the type I interferon pathway, leading to increased viral replication. TLR3-mediated type I interferon signaling required cellular autophagy and was suppressed by 3-methyladenine and bafilomycin A1, by inhibitors of lysosomal proteolysis, and by reduced expression of Beclin 1, Atg5, or microtubule-associated protein 1 light chain 3beta (MAP1LC3beta). However, TLR3-mediated signaling was restored upon exogenous expression of Beclin 1 or a variant MAP1LC3beta fusion protein refractory to RNA interference. These data suggest that individuals harboring these variants may have a blunted innate immune response to enteroviral infection, leading to reduced viral clearance and an increased risk of cardiac pathology.
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Affiliation(s)
- Carlos Gorbea
- Department of Pediatrics (Division of Cardiology), University of Utah School of Medicine, Salt Lake City, Utah 84112, USA
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41
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Fishpool S, Owens D, Pratt G, Roblin D. Ensuring correct posture whilst using the microscope. Clin Otolaryngol 2010; 35:244-5. [DOI: 10.1111/j.1749-4486.2010.02115.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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42
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Delgado J, Pillai S, Phillips N, Brunet S, Pratt G, Briones J, Lovell R, Martino R, Ewing J, Sureda A, Milligan D, Sierra J. Does reduced-intensity allogeneic transplantation confer a survival advantage to patients with poor prognosis chronic lymphocytic leukaemia? A case–control retrospective analysis. Ann Oncol 2009; 20:2007-12. [DOI: 10.1093/annonc/mdp259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Pemberton NC, Paneesha S, Hiller L, Starczynski J, Hooper L, Pepper C, Pratt G, Fegan C. The SDF-1 G > A polymorphism at position 801 plays no role in multiple myeloma but may contribute to an inferior cause-specific survival in chronic lymphocytic leukemia. Leuk Lymphoma 2009; 47:1239-44. [PMID: 16923552 DOI: 10.1080/10428190600562112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The growth and circulation of B lymphocytes is largely under the control of bone marrow stromal cells, cytokines and chemokines. The gene responsible for the pivotal B cell growth factor, stromal derived factor-1 (SDF-1), has recently been shown to contain a single nucleotide polymorphism G > A at position 801 which leads to higher SDF-1 secretion. This polymorphism is common in the normal population and has been shown to play a potential role in the development of both HIV and non-HIV related non-Hodgkin's lymphoma. We therefore undertook a large single-centre study to ascertain its role in the pathogenesis of two other common B-cell malignancies, notably chronic lymphocytic leukemia (CLL- 197 patients) and multiple myeloma (126 patients). We show that the 801 G > A polymorphism plays no role in the incidence of multiple myeloma or CLL nor the outcome in multiple myeloma. By contrast, it trends towards an inferior cause-specific survival in CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cell Line, Tumor
- Chemokine CXCL12
- Chemokines, CXC/genetics
- Cohort Studies
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Multiple Myeloma/genetics
- Multiple Myeloma/mortality
- Polymorphism, Genetic
- Prognosis
- Receptors, CXCR4/genetics
- Treatment Outcome
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Affiliation(s)
- N C Pemberton
- Department of Haematology, Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham, UK
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44
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Abstract
e17540 Background: Cancer cachexia affects about 250,000 patients in the US worsening treatment outcome and quality of life. To evaluate the scholar contribution to cancer cachexia, we analyzed the cachexia literature and funding support. Methods: In May 2008, we conducted a search of the major databases Medline, Web of Sciences, and Scopus of all publications with MeSH heading “cachexia” or keywords “cachexia, cachectic, cachexic” since 1982, distinguishing “original research” from “review” articles. To examine the trend over time, we compared the publication rate in the field of cachexia to that of published manuscripts in reference fields (cancer, AIDS, Alzheimer's disease, and CHF). To study the federal funding for cachexia research, we examined the Computer Retrieval of Information on Scientific Projects database. Only descriptive statistical analysis was adopted because of the heterogeneity of methods. Results: We identified 1990 published manuscripts, 677 (34%) of which are “reviews”. Out of the 2,890 country of origin affiliations, the US is the lead contributor (N = 1,105; 38%). In the last 5 years, the ratio of “review” articles in cachexia increased significantly (49%), compared to cancer (17%), and science publications (8%). Unlike the of publications in reference fields, the increase in cachexia has been mostly due to the dominance of “review” articles (ratio of original/review of 0.928 in cachexia, versus 0.417 in CHF, 0.337 in Alzheimer and 0.206 in AIDS). Nevertheless, published cachexia articles in journals with high impact factors (IF ≥ 4.0) remains similar (8.49%) to that of science research (8.63%) with a predominance of “review’ articles. Only one in four published manuscripts (24%) acknowledged federal support. Cachexia research support by US federal agencies declined significantly in the last decade (with a peak of 161 awards in 1999 down to 40 in 2006), the NCI remains the leading funding agency (17%). Only 275 out of the total of 121,997 NCI- awards over 25 years (0.22%) were awarded to cachexia research, with a clear decline in the latest decade by 50% (0.14% vs. 0.29%). Conclusions: Advances in the field of original cancer cachexia research have been very limited, perhaps related to the lack of federal research funding support, which is on the decline. No significant financial relationships to disclose.
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Affiliation(s)
- F. S. Braiteh
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - G. Pratt
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Kurzrock
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - E. Bruera
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Abstract
Eukaryotic proteasomes have been reported to cleave only once within polyglutamine tracts and then only after the N-terminal glutamine (Venkatraman, P., Wetzel, R., Tanaka, M., Nukina, N., and Goldberg, A. L. (2004) Mol. Cell 14, 95-104). We have obtained results that directly conflict with that report. In the presence of the proteasome activator PA28gamma(K188E) human red cell proteasomes progressively degraded fluorescein-GGQ(10)RR or fluorescein-HPHQ(10)RR into small fragments as shown by size exclusion chromatography and mass spectrometry. MALDI-TOF mass spectrometry revealed that proteolytic products arose from cleavage after every glutamine in fluorescein-HPHQ(10)RR, and mass accuracy rules out deamidation of glutamine to glutamic acid as an explanation for peptide degradation. Moreover, degradation cannot be attributed to a contaminating protease because peptide hydrolysis was completely blocked by the proteasome-specific inhibitors, lactacystin and epoxomicin. We conclude that proteasomes cleave repetitively anywhere within a stretch of ten glutamine residues. Thus our results cast doubt on the idea that mammalian proteasomes cannot degrade glutamine-expanded regions within pathogenic polyQ-expanded proteins, such as Huntingtin.
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Affiliation(s)
- Gregory Pratt
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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46
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Ryan G, Martinelli G, Kuper-Hommel M, Tsang R, Pruneri G, Yuen K, Roos D, Lennard A, Devizzi L, Crabb S, Hossfeld D, Pratt G, Dell'Olio M, Choo SP, Bociek RG, Radford J, Lade S, Gianni AM, Zucca E, Cavalli F, Seymour JF. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2007; 19:233-41. [PMID: 17932394 DOI: 10.1093/annonc/mdm471] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [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
BACKGROUND Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes. PATIENTS AND METHODS A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003. RESULTS Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites. CONCLUSIONS The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
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Affiliation(s)
- G Ryan
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
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47
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Pepper C, Ward R, Lin TT, Brennan P, Starczynski J, Musson M, Rowntree C, Bentley P, Mills K, Pratt G, Fegan C. Highly purified CD38+ and CD38- sub-clones derived from the same chronic lymphocytic leukemia patient have distinct gene expression signatures despite their monoclonal origin. Leukemia 2007; 21:687-96. [PMID: 17287849 DOI: 10.1038/sj.leu.2404587] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CD38 expression is an important prognostic marker in chronic lymphocytic leukemia (CLL) with high levels of CD38 associated with shorter overall survival. In this study, we used gene expression profiling and protein analysis of highly purified cell-sorted CD38(+) and CD38(-) chronic lymphocytic leukemia cells to elucidate a molecular basis for the association between CD38 expression and inferior clinical outcome. Paired CD38(+) and CD38(-) CLL cells derived from the same patient were shown to be monoclonal by V(H) gene sequencing but despite this, CD38(+) CLL cells possessed a distinct gene expression profile when compared with their CD38(-) sub-clones. Importantly, CD38(+) CLL cells relatively over expressed vascular endothelial growth factor (VEGF) and appeared to preferentially utilize an internal autocrine VEGF survival loop. Elevated VEGF expression was associated with increased expression of the anti-apoptotic protein Mcl-1. Inhibition of VEGF receptor signaling also resulted in a reduction in cell viability. In contrast, exogenous VEGF caused a significant increase in CD38(-) CLL cell viability and a marked induction of Mcl-1; both effects were less obvious in CD38(+) CLL cells. Taken together, our data provide a biological rationale for the poor prognosis of CD38(+) CLL and indicate that both VEGF and Mcl-1 may prove to be useful therapeutic targets.
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MESH Headings
- ADP-ribosyl Cyclase 1/blood
- ADP-ribosyl Cyclase 1/deficiency
- ADP-ribosyl Cyclase 1/genetics
- Antigens, CD/blood
- Antigens, CD/genetics
- Gene Expression Regulation, Neoplastic
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Oligonucleotide Array Sequence Analysis
- Restriction Mapping
- Survival Analysis
- Vascular Endothelial Growth Factor A/genetics
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Affiliation(s)
- C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
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Pepper C, Brennan P, Alghazal S, Ward R, Pratt G, Starczynski J, Lin T, Rowntree C, Fegan C. CD38+ chronic lymphocytic leukaemia cells co-express high levels of ZAP-70 and are functionally distinct from their CD38- counter-parts. Leukemia 2006; 20:743-4. [PMID: 16452999 DOI: 10.1038/sj.leu.2404133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
MESH Headings
- ADP-ribosyl Cyclase 1/biosynthesis
- ADP-ribosyl Cyclase 1/genetics
- B-Lymphocytes/pathology
- Flow Cytometry
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocyte Count
- Signal Transduction
- ZAP-70 Protein-Tyrosine Kinase/biosynthesis
- ZAP-70 Protein-Tyrosine Kinase/genetics
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Gorbea C, Kaufmann AG, Pratt G, Rechsteiner M, Rogers SW. Multiple Forms of the 26S Proteasome-Associated Protein Ecm29 in the Mouse Brain. Isr J Chem 2006. [DOI: 10.1560/742p-et1j-8rlc-2jyv] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Indigenous hepatitis E is increasingly recognized in developed countries, where it may be a zoonosis. We describe the first case of transfusion-transmitted hepatitis E in the UK from a blood donor who had no history of recent travel abroad. Follow-up of the donor and recipients of the blood products was carried out using serological and molecular techniques. Acute hepatitis E was transmitted to one of two recipients. The infected patient would have received a larger volume of the donor's plasma. HEV subgenomic sequences carried by the donor and recipient were identical. This is the first case of post-transfusion hepatitis E in the UK. Secondary transmission of hepatitis E indigenous to a nonhyperendemic country may occur by blood transfusion. It is important that blood donors inform the transfusion service of all post-donation illnesses so that appropriate interventions can take place.
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Affiliation(s)
- E Boxall
- National Blood Service, Vincent Drive, Birmingham, UK.
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