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Morris E, Currie H. Surviving the last 25 years at work - The benefits of following the evidence………with a little persistence! Post Reprod Health 2024; 30:5-6. [PMID: 38386691 DOI: 10.1177/20533691241237111] [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: 02/24/2024]
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Currie H. Why menopause still matters. Post Reprod Health 2023; 29:123-124. [PMID: 37619964 DOI: 10.1177/20533691231198295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Heather Currie
- Editor-in-chief, Dumfries & Galloway Royal Infirmary, UK
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Morris E, Currie H. Streamlining women's health - The case for change. Post Reprod Health 2023; 29:61-62. [PMID: 37114531 DOI: 10.1177/20533691231173015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Edward Morris
- Editors-in-chief, Norfolk & Norwich University Hospital, UK
| | - Heather Currie
- Editors-in-chief, Dumfries & Galloway Royal Infirmary, Scotland
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Wedisinghe L, Sasieni P, Currie H, Baxter G. The impact of offering multiple cervical screening options to women whose screening was overdue in Dumfries and Galloway, Scotland. Prev Med Rep 2022; 29:101947. [PMID: 36161116 PMCID: PMC9502330 DOI: 10.1016/j.pmedr.2022.101947] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/27/2022] Open
Abstract
Most women who develop cancer have not been screened regularly. One in four women in Scotland, is overdue for cervical screening. Aim was to assess the impact of offering multiple cervical screening options to women whose screening is overdue. A prospective cohort study including all women whose screening was overdue, aged 30-60 years in Dumfries and Galloway in 2012. Potentially eligible women (n = 4146) were identified split into six groups. Women aged 30-55 years were allocated to three different groups. Group 1 (letter, n = 1246), Group 2 (letter and kit, n = 221), Group 3 (letter, n = 2031). Women aged 56-60 years were allocated to: Group 4 (letter, n = 292), Group 5 (letter and kit, n = 292) and Group 6 (control, n = 64). Women who self-collected a vaginal sample were requested to complete a questionnaire. The percentages of women responding were 24 % (21-26), 32 % (25-38), 16 % (14-18), 15 % (11-20) and 12 % (9-17) in groups 1 to 5 respectively, compared with 3 % (0-11) among controls. A significantly higher number of women (n = 383, 10 % of 3815) opted for self-sampling in comparison with undergoing a cervical screening test (CST) at the GP practice (n = 197, 5 %, x2 = 59.0, p < 0.0001). The Evalyn® Brush was well accepted (218/313 = 70 %) by those who requested self-sampling. Almost all (265/272 = 97 %) women who self-collected a vaginal sample said that if they had the option of self-sampling, they would regularly participate in future cervical screening. Offering more flexible screening options, self-sampling in particular, appears to increase cervical screening participation.
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Affiliation(s)
- L. Wedisinghe
- Department of Obstetrics and Gyanecology, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
| | - P. Sasieni
- School of Cancer and Pharmaceutical Sciences, King’s College London, Great Maze Pond, London SE1 9RT, United Kingdom
| | - H. Currie
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
| | - G. Baxter
- NHS Dumfries and Galloway, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, United Kingdom
- North Cumbria Integrated Care NHS Foundation Trust, Newtown Road, Carlisle CA2 7HY, United Kingdom
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Currie H, Lough C, Currie G, Bushong S, Bailey DL. Practical learning through radiation physics problem solving. Radiography (Lond) 2022; 28:981-990. [PMID: 35921730 DOI: 10.1016/j.radi.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/16/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The identification of unknown radionuclides is an authentic practical activity for students that provides the foundations for clinical problem solving, especially in the storage and management of radioactive waste. As different radionuclides have different half-lives, some of which are quite long, the storage of waste material has to accommodate the longest of these. Cross contamination requires a method of identifying the radionuclide samples in a mixed sample to safely and appropriately manage disposal. Similarly, identifying a single unknown sample of a radionuclide allows correct handling and disposal. METHODS Performing a systematic investigation of the physical properties of unknown radioactive samples is a rich learning opportunity to instil understanding of important physics principles among students in nuclear medicine. RESULTS This manuscript outlines an investigation developed that would allow students to identify single unknown radionuclides based on physical properties and identify the constituent radionuclides of a mixed sample using some additional mathematical curve stripping. CONCLUSION The processes and solutions are provided with real data and this practical activity can be replicated by students generating their own data. IMPLICATIONS FOR PRACTICE This paper provides a template and analysis/interpretation guideline for educators and clinicians to deepen understanding of foundation physics. Enhanced and deeper understanding are a vehicle for improved problem solving in clinical and research practice.
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Affiliation(s)
- H Currie
- College of Engineering and Computer Science, Australian National University, Canberra, Australia.
| | - C Lough
- The Riverina Anglican College, Wagga, Australia.
| | - G Currie
- School of Dentistry & Medical Sciences, Charles Sturt University, Wagga, Australia; Department of Radiology, Baylor College of Medicine, Houston, USA.
| | - S Bushong
- Department of Radiology, Baylor College of Medicine, Houston, USA.
| | - D L Bailey
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia.
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Stanczuk G, Currie H, Forson W, Baxter G, Lawrence J, Wilson A, Palmer T, Arbyn M, Cuschieri K. Clinical Performance of Triage Strategies for Hr-HPV-Positive Women; A Longitudinal Evaluation of Cytology, p16/K-67 Dual Stain Cytology, and HPV16/18 Genotyping. Cancer Epidemiol Biomarkers Prev 2022; 31:1492-1498. [PMID: 35511738 DOI: 10.1158/1055-9965.epi-21-1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/25/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We evaluated the longitudinal performance of three options: HPV16/18 genotyping (HPV16/18), cytology (LBC), and p16/Ki-67 dual stain cytology (DS) for the triage of high-risk Human Papillomavirus-positive (Hr-HPV+) women within the cervical screening program in Scotland. METHODS Data were derived from a cohort of Hr-HPV+ women (n = 385) who participated in PaVDaG (Papillomavirus Dumfries and Galloway) study. Performance of triage strategies for detecting high-grade disease was assessed at 3 (in women <50 years) or 5 years (in women >50 years). Sensitivity, specificity, PPV, and cNPV of each triage test were calculated for CIN2+ and CIN3+ when used singly or sequentially. RESULTS The sensitivity of LBC (≥ borderline), DS, and HPV 16/18 genotyping for the detection of CIN2+ was 62.7% (50.7-73.3), 77.7% (63.1-83.7), and 62.7% (50.7-73.3) with corresponding cNPVs of 10.9%, 8.4%, and 11.9%. The option with the highest sensitivity and lowest cNPV was HPV 16/18 genotyping followed by LBC of Hr-HPV other+ and then DS of the LBC negatives. This yielded sensitivity of 94.7% (86.2-98.3) and cNPV 2.7% for CIN2+. Triage performance was similar if women had tested Hr-HPV+ positive by vaginal self-sampling. CONCLUSIONS Two-step triage with HPV 16/18 genotyping before LBC (or DS) for Hr-HPV other+ women was associated with a lower risk of significant disease at follow-up compared with single triage approaches. IMPACT This study provides longitudinal performance data on triage strategies in Hr-HPV+ women and will be informative for the evolution of cervical screening programs that increasingly rely on molecular technologies.
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Affiliation(s)
- Grazyna Stanczuk
- Department of Obstetrics and Gynecology, Western Isles Hospital, Stornoway, United Kingdom.,Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather Currie
- Department of Obstetrics and Gynecology, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - William Forson
- Department of Obstetrics and Gynecology, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Gwendoline Baxter
- North Cumbria Integrated NHS Foundation Care Trust, Carlisle, United Kingdom
| | - James Lawrence
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Timothy Palmer
- Center for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.,Public Health Scotland, Glasgow, United Kingdom
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Center, Sciensano, Brussels.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Laws E, Currie H, Batra R. 748 HEARING AIDS AND GLASSES: BEDSIDE SIGNS PROMPT ASSESSMENT OF SENSORY NEEDS, AN AUDIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac034.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
It is widely acknowledged that older adults with hearing or visual impairment are at higher risk of developing delirium. The National Institute for Clinical Excellence (NICE) guideline for delirium prevention in the hospital setting emphasises the importance of considering sensory impairment in the clinical assessment of patients at risk of delirium, yet it is often overlooked. This audit aimed to determine doctors’ documentation of sensory needs in a geriatrics department and the effect of bedside signs on this documentation.
Method
This study analysed documentation for all patients on three elderly care wards. Pre-defined search terms relating to hearing, visual and cognitive impairment were used to analyse whether sensory needs were mentioned during the patients’ hospital stay to study date. After the first round of data collection, bedside signs to indicate whether patients have hearing aids or glasses were installed, complemented by ward teaching on sensory impairment and delirium. Documentation was re-audited using the same pre-defined search terms as in the first round.
Results
The first round of data collection included 71 patients with an average age of 79 years. Only 30% of patients had documentation regarding sensory needs (hearing and/or vision) and 49% were documented as having delirium and/or dementia. The second round of data collection was completed one month after intervention and included 71 patients with an average age of 82 years. After intervention of bedside signs and ward teaching, doctors’ documentation of sensory impairment increased by 81%.
Conclusion
Installing bedside signs to indicate whether patients have hearing aids or glasses has improved documentation of sensory impairment, in turn prompting its consideration in assessment and care of patients at risk of delirium.
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Affiliation(s)
- E Laws
- Department of Geriatrics, Queen Elizabeth Hospital, Birmingham
| | - H Currie
- Department of Geriatrics, Queen Elizabeth Hospital, Birmingham
| | - R Batra
- Department of Ophthalmology, Queen Elizabeth Hospital, Birmingham
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Stanczuk GA, Currie H, Forson W, Baxter G, Lawrence J, Wilson A, Palmer T, Arbyn M, Cuschieri K. Self-sampling as the principal modality for population based cervical screening: Five-year follow-up of the PaVDaG study. Int J Cancer 2021; 150:1350-1356. [PMID: 34850395 PMCID: PMC9300001 DOI: 10.1002/ijc.33888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023]
Abstract
Self-sampling provides a powerful means to engage women in cervical screening. In the original Papillomavirus Dumfries and Galloway study (PaVDaG), we demonstrated cross-sectional similarity of high-risk human papillomavirus (Hr-HPV) testing on self-taken vaginal vs clinician-taken samples for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+). Few data exist on the longitudinal performance of self-sampling; we present longitudinal outcomes of PaVDaG. Routinely screened women provided a self-taken and a clinician-collected sample. Ninety-one percent of 5136 women from the original cohort completed a further screening round. Sensitivity, specificity, positive predictive value and complement of the negative predictive value of the Hr-HPV test on self-samples for detection of CIN2+ and CIN3+ up-to 5 years after testing were determined. Additionally, clinical accuracy of Hr-HPV testing on vaginal and clinician-collected samples was assessed. A total of 183 CIN2+ and 102 CIN3+ lesions were diagnosed during follow-up. Risk of CIN2+ and CIN3+ following an Hr-HPV negative self-sample was 0.6% and 0.2%, respectively, for up to 5 years after testing. The relative sensitivity for CIN3+ and specificity for ≤CIN1 of Hr-HPV testing on self-taken specimens was slightly lower vs clinician-collected samples: 0.95 (95% CI: 0.90-0.99; PMcN = .0625) and 0.98 (95% CI: 0.95-1.00; PMcN = <.0000), respectively. The low risk of CIN2+ in women with Hr-HPV-self-sample(s) suggests, that the 3 to 5-year recall interval implemented in several cervical screening settings, based on clinician-taken samples, may be safe for self-samples. Future assessment will show if "universal" 5-year screening is appropriate for programs based on self-sampling.
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Affiliation(s)
- Grazyna A Stanczuk
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK.,Global Health Academy, University of Edinburgh, Edinburgh, UK
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - William Forson
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | | | - James Lawrence
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, UK
| | - Timothy Palmer
- Department of Pathology, University of Edinburgh, Edinburgh, UK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, Brussels, Belgium.,Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
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Currie H. Managing menopausal symptoms-hormone replacement therapy is not the only option! Post Reprod Health 2021; 27:183-184. [PMID: 34797184 DOI: 10.1177/20533691211063191] [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: 11/16/2022]
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Abstract
Menopause is a major life event affecting all women in a variety of ways, both short and long term. All women should have access to accurate information, available in all forms and through all recognised sources. All healthcare professionals should have a basic understanding of the menopause and know where to signpost women for advice, support and treatment whenever appropriate. Every primary care team should have at least one nominated healthcare professional with a special interest and knowledge in menopause. All healthcare professionals with a special interest in menopause should have access to British Menopause Society Menopause Specialists for advice, support, onward referral and leadership of multidisciplinary education. With the introduction of the comprehensive British Menopause Society Principles and Practice of Menopause Care programme, the society is recognised throughout the UK as the leading provider of certificated menopause and post reproductive health education and training for healthcare professionals. Restrictions imposed by the coronavirus pandemic have been a springboard for the British Menopause Society to bring innovations to the services provided for our membership and for healthcare professionals throughout the UK.
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Abstract
Objective To provide a greater understanding of the expectations, symptoms and impact of the menopause among women and their partners. Study design Three online surveys were conducted among women aged ≥45 years with menopause symptoms (currently or within previous 10 years). Two questionnaires focussed on symptoms and treatments and were conducted before (Survey 1, 2015; n = 1000) and after (Survey 2, 2016, n = 1000) publication of the National Institute for Health and Care Excellence (NICE) menopause guidelines. Survey 3 (2017) focussed on the psychosocial impact of the menopause and was also conducted among partners (women n = 650; partners n = 350). Results Women experienced an average of seven symptoms; 42% reported them to be worse than expected. Approximately one-fifth of women were not expecting common symptoms, such as sleep disturbance and cognitive problems, and were uncertain how long symptoms could last. A significant proportion of women reported negative effects on work and relationships. There was a reluctance to talk openly about the menopause or consult a healthcare professional (HCP). Partners expressed a desire to provide support but were unsure how to do so. Often women felt isolated and 41% considered the information and support available to them was insufficient. Only 3% of women were aware of the NICE guidelines but the majority (66%) were interested in learning more. Conclusions These findings underscore the knowledge gaps and lack of support for women impacted by the menopause. Improved HCP training and education is required to ensure that high-quality menopause support can be accessed as standard.
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Lloyd M, Currie H, Paneerselvam H, Edwards S, Beaman N, Jenkin R. 107YIELD OF CT BRAIN SCANS IN VERY ELDERLY PATIENTS WITH ACUTE CONFUSION: A RETROSPECTIVE STUDY AT A DISTRICT GENERAL HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy203.02] [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: 11/12/2022] Open
Affiliation(s)
- M Lloyd
- Hereford County Hospital, Wye Valley Trust
| | - H Currie
- Hereford County Hospital, Wye Valley Trust
| | | | - S Edwards
- Hereford County Hospital, Wye Valley Trust
| | - N Beaman
- Hereford County Hospital, Wye Valley Trust
| | - R Jenkin
- Hereford County Hospital, Wye Valley Trust
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Benghiat H, Sanghera P, Stange D, Nightingale P, Hartley A, O'Reilly MW, Nundall N, Currie H, Ali M, Cruickshank G, Spooner D, Toogood A. Dexamethasone-related adrenal insufficiency in patients with brain and skull base tumours. Support Care Cancer 2018; 26:4031-4038. [PMID: 29858690 DOI: 10.1007/s00520-018-4264-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/10/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE This study aimed to evaluate the prevalence of glucocorticoid-induced adrenal insufficiency in a cohort of patients with brain and skull base tumours and to identify factors which may predict its occurrence. METHODS Patients with brain or skull base tumours attending for a short synacthen test (SST) (adrenocorticotropin hormone (ACTH) stimulation test) at a single institution over a 3-year period were retrospectively identified. Baseline demographics and dexamethasone exposure were examined. Only patients with dexamethasone exposure were included in the final analysis looking at the primary end point of SST failure. Fisher's exact test, Student's t test, Mann-Whitney test and the Kendall's tau-b test were used to evaluate the influence of age, gender, diagnosis and mean pituitary radiation dose on the primary endpoint. Receiver operating characteristic (ROC) curves were generated to explore the impact of duration and total exposure to dexamethasone on likelihood of SST failure. RESULTS Thirty-one of 51 patients with previous dexamethasone exposure failed their first SST (61%). No significant relationship was demonstrated between age, gender, diagnosis or mean pituitary radiation dose and SST failure. Duration of and total exposure to dexamethasone were significantly associated with SST failure (p = 0.001 and p = 0.007, respectively). ROC curves generated values of 78 days and 171 mg days to give a sensitivity of 94 and 97%, respectively, to detect SST failure. CONCLUSIONS Duration of dexamethasone use and total exposure predict for adrenal insufficiency in patients with brain and skull base tumours. Values derived from this study may be useful to identify patients at higher risk of adrenal suppression who require empirical hydrocortisone pending formal testing of the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- H Benghiat
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - D Stange
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - P Nightingale
- Wolfson Computer Laboratory, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - M W O'Reilly
- Department of Endocrinology and Late Effects, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - N Nundall
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - H Currie
- Department of Endocrinology and Late Effects, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - M Ali
- Department of Endocrinology and Late Effects, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - G Cruickshank
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - D Spooner
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - A Toogood
- Department of Endocrinology and Late Effects, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
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Simpson P, Currie H, Morris E. Neurokinin 3 receptor antagonism - Is this the end of HRT? Post Reprod Health 2018; 24:61-62. [PMID: 29925302 DOI: 10.1177/2053369118780657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Stanczuk GA, Baxter GJ, Currie H, Forson W, Lawrence JR, Cuschieri K, Wilson A, Patterson L, Govan L, Black J, Palmer T, Arbyn M. Defining Optimal Triage Strategies for hrHPV Screen-Positive Women-An Evaluation of HPV 16/18 Genotyping, Cytology, and p16/Ki-67 Cytoimmunochemistry. Cancer Epidemiol Biomarkers Prev 2017; 26:1629-1635. [PMID: 28887297 DOI: 10.1158/1055-9965.epi-17-0534] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/20/2017] [Accepted: 09/01/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Several options for the triage of high-risk HPV screen-positive (hrHPV+) women were assessed.Methods: This study incorporated CIN2+ cases and controls, all of whom tested hrHPV+ and whose results of liquid-based cytology (LBC), HPV16/18 genotyping, and p16/Ki67 cytoimmunochemistry were available. Sensitivity and specificity for the CIN2+ of these triage tests were evaluated.Results: Absolute sensitivities of HPV 16/18 typing, LBC, and p16/Ki-67 cytoimmunochemistry for CIN2+ detection were 61.7%, 68.3%, and 85.0% for women with hrHPV+ clinician-taken samples. Respective specificities were 70.5%, 89.1%, and 76.7%. The absolute accuracy of the triage tests was similar for women with a hrHPV+ self-sample. P16/Ki-67 cyto-immunochemistry was significantly more sensitive than LBC although significantly less specific.Conclusions: All three single-test triage options, if positive, exceed the threshold of 20% risk at which colposcopy would be indicated. However, none of them conferred a post-test probability of CIN2+ <2%; which would permit routine recall. P16/Ki-67 cytoimmunochemistry on HPV16/18 negative women had a post-test probability of CIN2+ of 1.7% and 0.6% if also LBC negative.Impact: This is one of the few studies to directly compare the performance of triage strategies of hrHPV+ women, in isolation and combinations. It is the only study assessing triage strategies in women who test hrHPV+ in self-taken vaginal samples. A combined triage option that incorporated HPV 16/18 typing prior to p16/ki-67 cytoimmunochemistry in HPV 16/18-negative women yielded a post-test probability of CIN2+ of >20%, whereas women who tested negative had a probability of CIN2+ of <2%. Cancer Epidemiol Biomarkers Prev; 26(11); 1629-35. ©2017 AACR.
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Affiliation(s)
- Grazyna A Stanczuk
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom.
| | - Gwen J Baxter
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - William Forson
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - James R Lawrence
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Lynne Patterson
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Lynn Govan
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Janice Black
- Department of Pathology, Monklands Hospital, Airdrie, United Kingdom
| | - Tim Palmer
- Department of Pathology, NHS Highland, Inverness, United Kingdom
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Simpson P, Currie H, Short H, Morris E. Signs of recovery … appropriate menopause care being made a priority? Post Reprod Health 2017; 23:99-100. [PMID: 28931360 DOI: 10.1177/2053369117727898] [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: 06/07/2023]
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Currie H, Abernethy K, Gray S. British Menopause Society vision for menopause care in the UK: Endorsed by Royal College of General Practitioners, Faculty of Sexual and Reproductive Health, Royal College of Nursing, and Royal College of Obstetricians and Gynaecologists. Post Reprod Health 2017; 23:105-109. [PMID: 28670956 DOI: 10.1177/2053369117717207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Sarah Gray
- Dumfries and Galloway Royal Infirmary, Dumfries, UK
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- Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Currie H, Morris E, Simpson P. Guidelines, guidelines, guidelines! Post Reprod Health 2016; 22:107-108. [PMID: 27614345 DOI: 10.1177/2053369116666210] [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: 06/06/2023]
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Abstract
The Internet was born in 1969; it was originally developed so that computers could share information on research and development in the scientific and military fields. The original Internet consisted of four university computers networked in the United States. Email became available two years later. The infant Internet initially required complex computing knowledge to be used. However, this was all to change with the development of the World Wide Web in the early 1990s, which made the Internet much more widely accessible. The Internet has since grown at a phenomenal rate and has evolved into a global communications tool. It is by nature anarchic, in that it is an unrestricted broadcast medium. Although this lack of censorship is a strength, it is also a weakness. The quality of information available on the Web is variable and discernment is required. With the growth of e-health, medicine and its allied specialties are faced with the challenges of providing their services in a novel way while maintaining the first principle of medicine, primum non nocere (first, do no harm). This provision of e-health care is in its infancy and this review explores issues arising from the use of the Internet as a medium for organizing menopausal health care in the third millennium.
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Cumming GP, Herald J, Moncur R, Currie H, Lee AJ. Women's attitudes to hormone replacement therapy, alternative therapy and sexual health: a web-based survey. ACTA ACUST UNITED AC 2016; 13:79-83. [PMID: 17540139 DOI: 10.1258/175404507780796424] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective. To survey women's views on hormone replacement therapy (HRT), alternative therapies and sexual health using the Internet. Study design and main outcome measures. Three questionnaires were offered on a UK, patient-tailored, independent, clinician-led dedicated menopause website. They covered HRT, alternative therapies and sexual health. The anonymous responses of the users of the website were analysed. Results. There were 1026, 1072 and 1002 responses for the HRT, alternative therapies and sexual health questionnaires, respectively. On the first, 75% of respondents were in favour of HRT; 36% felt media reports of the risks of HRT had been exaggerated and 73% of women did not know enough about HRT to make informed choices. In relation to alternative therapies, 85% of respondents felt they did not know enough to make informed choices, 71% received no advice before starting an alternative therapy and 69% were unaware of possible interactions. Ninety-five per cent would try alternative therapies before HRT in the belief that they were more natural and 68% were prepared to pay more than £10 a month for such therapies. On the questionnaire on sexual health, 88% of respondents indicated that they believed an active sex life was important. Fifty-three per cent recorded that they experienced dyspareunia, but 51% of women hid their symptoms and 31% made excuses to avoid intercourse; 54% felt their confidence had been adversely affected. Only 20% had discussed their symptoms with health professionals and only 12% were using prescribed treatment. Conclusions. Online questionnaires are a useful means to obtain data. Our surveys raised several issues, including the observations that the majority of women said they did not know enough about HRT and alternative therapies to make informed choices. There appeared to be many women with vaginal symptoms who had not spoken with a health professional and therefore were untreated.
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Affiliation(s)
- Grant P Cumming
- Department of Obstetrics & Gynaecology, Dr Gray's Hospital, Elgin, UK.
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Stanczuk G, Baxter G, Currie H, Lawrence J, Cuschieri K, Wilson A, Arbyn M. Clinical validation of hrHPV testing on vaginal and urine self-samples in primary cervical screening (cross-sectional results from the Papillomavirus Dumfries and Galloway-PaVDaG study). BMJ Open 2016; 6:e010660. [PMID: 27113237 PMCID: PMC4854001 DOI: 10.1136/bmjopen-2015-010660] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 11/24/2022] Open
Abstract
OBJECTIVES Papillomavirus Dumfries and Galloway (PaVDaG) assessed the performance of a high-risk human papillomavirus (hrHPV) PCR-based assay to detect high-grade cervical intraepithelial neoplasia (CIN2+) in self-collected vaginal and urine samples. SETTING Women attending routine cervical screening in primary care. PARTICIPANTS 5318 women aged 20-60 years provided self-collected random urine and vaginal samples for hrHPV testing and a clinician-collected liquid-based cytology (LBC) sample for cytology and hrHPV testing. INTERVENTIONS HrHPV testing. All samples were tested for hrHPV using the PCR-based cobas 4800 assay. Colposcopy was offered to women with high-grade or repeated borderline/low-grade cytological abnormalities; also to those who were LBC negative but hrHPV 16/18 positive. PRIMARY AND SECONDARY OUTCOME MEASURES The self-tests' absolute sensitivity and specificity for CIN2+ were assessed on all biospecimens; also, their relative sensitivity and specificity compared with clinician-taken samples. Interlaboratory and intralaboratory performance of the hrHPV assay in self-collected samples was also established. RESULTS HrHPV prevalence was 14.7%, 16.6% and 11.6% in cervical, vaginal and urine samples, respectively. Sensitivity for detecting CIN2+ was 97.7% (95% to 100%), 94.6% (90.7% to 98.5%) and 63.1% (54.6% to 71.7%) for cervical, vaginal and urine hrHPV detection, respectively. The corresponding specificities were 87.3% (86.4% to 88.2%), 85.4% (84.4% to 86.3%) and 89.8% (89.0% to 90.7%). There was a 38% (24% to 57%) higher HPV detection rate in vaginal self-samples from women over 50 years compared with those ≤29 years. Relative sensitivity and specificity of hrHPV positivity for the detection of CIN2+ in vaginal versus cervical samples were 0.97 (0.94 to 1.00) and 0.98 (0.97 to 0.99); urine versus cervical comparisons were 0.53 (0.42 to 0.67) and 1.03 (1.02 to 1.04). The intralaboratory and interlaboratory agreement for hrHPV positivity in self-samples was high (κ values 0.98 (0.96 to 0.99) and 0.94 (0.92 to 0.97) for vaginal samples and 0.95 (0.93 to 0.98) and 0.90 (0.87 to 0.94) for urine samples). CONCLUSIONS The sensitivity of self-collected vaginal samples for the detection of CIN2+ was similar to that of cervical samples and justifies consideration of this sample for primary screening.
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Affiliation(s)
- Grazyna Stanczuk
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
- Global Health Academy, University of Edinburgh, Edinburgh, UK
| | - Gwendoline Baxter
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - James Lawrence
- Research and Development Support Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Allan Wilson
- Department of Pathology, Monklands Hospital, Airdrie, UK
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Abstract
The menopause should be diagnosed based on age, menstrual history and clinical symptoms, and as such, follicle stimulating hormone testing may be considered inappropriate when diagnosing the menopause or peri-menopause in women aged 45 and over. As part of a demand optimisation programme, the number of follicle stimulating hormone tests requested to diagnose the menopause in this age group was quantified and educational interventions were implemented to reduce inappropriate testing. The number of follicle stimulating hormone tests requested to diagnose the menopause in women aged 45 and over was successfully and sustainably reduced.
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Affiliation(s)
- Jac Williams
- Jac Williams is not affiliated with any specific department
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Adele Foster
- Microbiology Department, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Julia Anderson
- Blood Sciences Department, Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Constantine GD, Graham S, Clerinx C, Bernick BA, Krassan M, Mirkin S, Currie H. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health 2016; 22:112-22. [PMID: 26895640 PMCID: PMC5019289 DOI: 10.1177/2053369116632439] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective To assess women’s behaviours and attitudes regarding the treatment of menopausal symptoms in five European countries. Study design Women aged ≥45 years in France, Germany, Italy, Spain, and the United Kingdom participated in an internet survey. Completers were those who reported menopausal symptoms and had treated their symptoms. Women were equally stratified by age (45–54 years, 55–64 years, ≥65 years). Main outcome measures Behaviours, attitudes, and experiences regarding treatment of menopausal symptoms. Results Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. Hot flushes, the most common symptom, decreased with age but remained prevalent after age 64. Roughly 75% of women who sought relief consulted a physician, mostly a gynaecologist or a general practitioner (GP) as in the United Kingdom. The decision to seek treatment was influenced by age, number, and severity of symptoms. Approximately 79% visiting a physician received prescription therapy. Of the women who received non-hormone therapy (HT) treatment instead of HT: patients refused HT (20–44%), physicians did not discuss HT (32–46%), or advised against HT (24–43%). Women in the United Kingdom were most familiar with and favorable to HT. Interest in a new HT (34–50%) was higher than use (19–28%). Conclusions Menopausal symptoms are common, persistent, and bothersome, but many fail to seek treatment. Sources and types of treatment vary among age groups and countries. Education regarding women’s attitudes toward treatment should be provided to those physicians who treat menopausal symptoms in each country.
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Affiliation(s)
| | | | | | | | | | | | - Heather Currie
- Department of Obstetrics and Gynecology, Dumfries & Galloway Royal Infirmary, Dumfries, UK
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Currie H, Morris E. Editorial. The 25th Anniversary of the BMS. Post Reprod Health 2015; 21:43-44. [PMID: 26071610 DOI: 10.1177/2053369115590113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
OBJECTIVE To survey women's views on HRT and alternative therapies and make comparisons with 2007 data. STUDY DESIGN A questionnaire on a UK patient-tailored independent clinician-led website with anonymous responses analysed using descriptive statistics. MAIN OUTCOME MEASURES Answers to survey questions in 2007 and 2014. RESULTS A total of 1476 responses from 33 countries were obtained. Almost 70% of respondents had used/would consider using HRT. Over the last 5 years, 27.7% felt that their views had changed for the better. Most obtained information from health professionals or the Internet. About 51.1% felt that their family doctor did not recognise the importance of the menopause with one-third feeling resistance to being offered HRT. Compared to 2007, significantly more women were aware of the different risks associated with different types of HRT. More women were able to respond positively to the question asking whether or not they felt able to make an informed choice regarding HRT/alternative therapies. CONCLUSIONS There has been negativity and confusion regarding HRT management since the beginning of the millennium. Our findings suggest that we, as health professionals, continue to let our patients down with poor provision of information, inaccurate or wrong information, or access to the right care. The cost of this is women living with preventable sequelae associated with the menopausal transition with a consequent adverse impact on health and the health economy. The importance of the menopause consultation as part of a life course approach is highlighted as well as the emerging discipline of Health Web Science.
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Affiliation(s)
| | | | | | | | - Amanda J Lee
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Stanczuk GA, Currie H, Baxter G, Foster A, Gibson L, Graham C, Cuschieri K. Cobas 4800 HPV detection in the cervical, vaginal and urine samples of women with high-grade CIN before and after treatment. J Clin Pathol 2015; 68:567-70. [PMID: 25878328 DOI: 10.1136/jclinpath-2014-202851] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/29/2015] [Indexed: 11/03/2022]
Abstract
AIMS To assess the performance of a clinically validated human papillomavirus (HPV) test (the Cobas 4800 HPV test) in urine and self-taken vaginal specimens within a colposcopy population and to assess HPV prevalence before and after treatment across the different biospecimens. METHODS A total of 100 women attending a colposcopy clinic provided three biospecimens (a clinician-taken liquid-based cytology sample (LBC), a self-taken vaginal sample and a urine sample) for HPV testing. HPV prevalence and concordance was compared across the biospecimens and clinical performance relative to the detection of cervical intraepithelial neoplasia (CIN)2+ and CIN3+ was assessed. A total of 39 women retuned at 6 months for a post-treatment follow-up appointment, and HPV concordance in all biospecimens was measured relative to their original HPV status. RESULTS 65 cases of CIN2+ were detected in the baseline population; sensitivity for CIN2+ was 92% (82 to 97) for the vaginal and the LBC sample and 80.0 (68% to 88%) for the urine sample. In the follow-up (post treatment) population, women were twice as likely to be HPV positive in their urine or vaginal sample compared with the equivalent LBC sample. CONCLUSIONS Vaginal and LBC samples showed very similar performance for the detection of CIN2+ in this population using the Cobas HPV test; further validation of these findings in screening contexts will be of value. Self-taken samples may have less utility in a 'test of cure' setting-given the higher prevalence of HPV relative to LBC.
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Affiliation(s)
- Grazyna A Stanczuk
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Heather Currie
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Gwen Baxter
- Department of Research and Development, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Adele Foster
- Department of Microbiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Lindsay Gibson
- Department of Microbiology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Catriona Graham
- Wellcome Trust Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
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Currie H, Morris E. Education for all … again! Post Reprod Health 2015; 21:3. [PMID: 25802139 DOI: 10.1177/2053369115576649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Palacios S, Currie H, Mikkola TS, Dragon E. Perspective on prescribing conjugated estrogens/bazedoxifene for estrogen-deficiency symptoms of menopause: a practical guide. Maturitas 2015; 80:435-40. [PMID: 25684082 DOI: 10.1016/j.maturitas.2015.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 01/19/2023]
Abstract
Current guidelines recommend that hormone therapy (HT) in postmenopausal women with a uterus include a progestin to protect against endometrial hyperplasia. However, many concerns relating to HT use appear to be related to the progestin component, including cardiovascular risk, breast stimulation, and irregular vaginal bleeding. Conjugated estrogens (CE) combined with the selective estrogen receptor modulator bazedoxifene (BZA) is a new progestin-free HT option for alleviating estrogen deficiency symptoms in postmenopausal women with a uterus for whom treatment with progestin-containing therapy is not appropriate. Five double-blind, randomized, placebo-controlled, phase 3 studies, known as the Selective estrogens, Menopause, And Response to Therapy (SMART) trials have investigated the efficacy of CE/BZA for relieving vasomotor symptoms (VMS), and effect on bone mass, as well as endometrial and breast safety in postmenopausal women. In a 12-week study, CE 0.45 mg/BZA 20 mg significantly reduced the number and severity of hot flushes compared with placebo at weeks 4 and 12. Unlike estrogen-progestin therapy (EPT), CE 0.45 mg/BZA 20 mg did not increase breast density compared with placebo. In clinical trials up to 2 years, CE/BZA had a favorable tolerability profile, demonstrated by amenorrhea rates similar to placebo. Vascular disorders including venous thromboembolic events (pulmonary embolism, retinal vein thrombosis, deep vein thrombosis, and thrombophlebitis) were rare events, occurring in less than 1 per 1000 patients. CE/BZA was associated with significantly higher incidences of amenorrhea and lower incidences of bleeding compared with CE/medroxyprogesterone acetate in 2 comparative trials. Therefore, CE 0.45 mg/BZA 20mg provides an effective, well-tolerated, progestin-free alternative to EPT for postmenopausal women with a uterus.
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Affiliation(s)
| | - Heather Currie
- NHS Dumfries & Galloway, Dumfries, Scotland, United Kingdom
| | | | - Erika Dragon
- Pfizer, Global Innovative Pharma, Europe, Paris, France
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Currie H, Morris E. Post Reproductive Health. Editorial. Post Reprod Health 2014; 20:85-86. [PMID: 25224670 DOI: 10.1177/2053369114550584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Currie H, Morris E. The future is NICE! Post Reprod Health 2014; 20:43-44. [PMID: 24939983 DOI: 10.1177/2053369114536509] [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: 06/03/2023]
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Morris E, Currie H. Dwindling Drugs: is there anything we can do? Menopause Int 2013; 19:1-2. [PMID: 23461876 DOI: 10.1177/1754045313478068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Morris E, Currie H. Ten years on and where are we now? Menopause Int 2012; 18:93. [PMID: 22903373 DOI: 10.1258/mi.2012.012031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Morris E, Currie H. HRT prescribing post WHI and MWS: What did you do? Would you do it again? Menopause Int 2012; 18:1. [PMID: 22337723 DOI: 10.1258/mi.2012.012004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Morris E, Currie H. The British Menopause Society: next steps 2011. Menopause Int 2011; 17:35-36. [PMID: 21693495 DOI: 10.1258/mi.2011.011018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Morris E, Currie H. The new NHS and what it will mean for the management of the menopause. Menopause Int 2011; 17:1-2. [PMID: 21427415 DOI: 10.1258/mi.2011.011005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Affiliation(s)
| | | | | | - Amanda J Lee
- Medical Statistics, Section of Population Health, University of Aberdeen
| | - Grant P Cumming
- Dr Gray's Hospital, Elgin; Honorary Senior Lecturer, University of Aberdeen; Honorary Professor, The University of the Highlands and Islands
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Morris E, Currie H. Spread the word! Menopause Int 2010; 16:47. [PMID: 20729491 DOI: 10.1258/mi.2010.010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Currie H. Paediatric and Adolescent Gynaecology for the MRCOG and Beyond. j fam plann reprod health care 2009. [DOI: 10.1783/147118909788708183] [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: 11/05/2022]
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Prescott SL, Wiltschut J, Taylor A, Westcott L, Jung W, Currie H, Dunstan JA. Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase. Allergy 2008; 63:1481-90. [PMID: 18925885 DOI: 10.1111/j.1398-9995.2008.01778.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously reported that a Lactobacillus acidophilus probiotic strain (LAFTI) L10/LAVRI-A1) given for the first 6 months of life increased the risk of allergen sensitization at 1 year of age. METHODS To assess the effects on subsequent allergic outcomes, 153 children from the initial prevention cohort (n = 178) were reviewed at 2.5 years of age. Clinical outcomes were assessed in relation to (i) probiotic supplementation; and (ii) immune function previously assessed at 6 months of age. RESULTS Supplementation with this probiotic did not reduce the risk of dermatitis at 2.5 years (31/74, 42%) compared with that in placebo group (25/76, 34%). There was no significant reduction in any other allergic disease or allergen sensitization. Inhalant sensitization at 2.5 years (n = 29) was associated with higher proportions of circulating CD4+ CD25+ regulatory T-cell populations (P = 0.005) and higher allergen-induced FOXP3 levels (P = 0.003) at 6 months. This was also seen in children with dermatitis. Children with dermatitis at 2.5 years also had significantly lower toll-like receptor 4 lipopolysaccharide responses at 6 months of age (IL-12 P = 0.04, IL-6 P = 0.039) and lower polyclonal (PHA) responses (IFN-gamma P = 0.005, IL-10 P = 0.001, and IL-6 P = 0.001). Children who had previously received the probiotic had fewer gastrointestinal infections in the preceding 18 months (P = 0.023). CONCLUSION The LAFTI L10 probiotic strain did not have any significant effect on allergy outcomes. Allergic children showed a number of early differences in immune function including altered regulatory T-cell markers and innate immune function.
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Affiliation(s)
- S L Prescott
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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Prescott SL, Wickens K, Westcott L, Jung W, Currie H, Black PN, Stanley TV, Mitchell EA, Fitzharris P, Siebers R, Wu L, Crane J. Supplementation with Lactobacillus rhamnosus or Bifidobacterium lactis probiotics in pregnancy increases cord blood interferon-gamma and breast milk transforming growth factor-beta and immunoglobin A detection. Clin Exp Allergy 2008; 38:1606-14. [PMID: 18631345 DOI: 10.1111/j.1365-2222.2008.03061.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study explored the effects of maternal probiotic supplementation on immune markers in cord blood (CB) and breast milk. METHODS CB plasma and breast milk samples were collected from a cohort of women who had received daily supplements of either 6 x 10(9) CFU/day Lactobacillus rhamnosus HN001 (n=34), 9 x 10(9) CFU/day Bifidobacterium lactis HN019 (n=35) or a placebo (n=36) beginning 2-5 weeks before delivery and continuing for 6 months in lactating women. CB plasma and breast milk (collected at 3-7 days, 3 months and 6 months postpartum) were assayed for cytokines (IL-13, IFN-gamma, IL-6, TNF-alpha, IL-10, TGF-beta1) and sCD14. Breast milk samples were also assayed for total IgA. RESULTS Neonates of mothers who received a probiotic had higher CB IFN-gamma levels (P=0.026), and a higher proportion had detectable blood IFN-gamma levels, compared with the placebo group (P=0.034), although levels were undetectable in many infants. While this pattern was evident for both probiotics, when examined separately only the L. rhamnosus HN001 group showed statistically significant higher IFN-gamma levels (P=0.030) compared with the placebo group. TGF-beta1 levels were higher in early breast milk (week 1) from the probiotic groups (P=0.028). This was evident for the B. lactis HN019 group (P=0.041) with a parallel trend in the L. rhamnosus HN001 group (P=0.075). Similar patterns were seen for breast milk IgA, which was more readily detected in breast milk from both the B. lactis HN019 (P=0.008) and the L. rhamnosus HN001 group (P=0.011). Neonatal plasma sCD14 levels were lower in the B. lactis HN019 group compared with the placebo group (P=0.041). CONCLUSION The findings suggest that supplementation with probiotics in pregnancy has the potential to influence fetal immune parameters as well as immunomodulatory factors in breast milk.
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Affiliation(s)
- S L Prescott
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
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