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Grant M, McCarthy D, Kearney C, Collins A, Sundararajan V, Rhee J, Philip J, Emery J. Primary care usage at the end of life: a retrospective cohort study of cancer patients using linked primary and hospital care data. Support Care Cancer 2024; 32:273. [PMID: 38587665 PMCID: PMC11001688 DOI: 10.1007/s00520-024-08458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Health service use is most intensive in the final year of a person's life, with 80% of this expenditure occurring in hospital. Close involvement of primary care services has been promoted to enhance quality end-of-life care that is appropriate to the needs of patients. However, the relationship between primary care involvement and patients' use of hospital care is not well described. This study aims to examine primary care use in the last year of life for cancer patients and its relationship to hospital usage. METHODS Retrospective cohort study in Victoria, Australia, using linked routine care data from primary care, hospital and death certificates. Patients were included who died related to cancer between 2008 and 2017. RESULTS A total of 758 patients were included, of whom 88% (n = 667) visited primary care during the last 6 months (median 9.1 consultations). In the last month of life, 45% of patients were prescribed opioids, and 3% had imaging requested. Patients who received home visits (13%) or anticipatory medications (15%) had less than half the median bed days in the last 3 months (4 vs 9 days, p < 0.001, 5 vs 10 days, p = 0.001) and 1 month of life (0 vs 2 days, p = 0.002, 0 vs 3 days, p < 0.001), and reduced emergency department presentations (32% vs 46%, p = 0.006, 31% vs 47% p < 0.001) in the final month. CONCLUSION This study identifies two important primary care processes-home visits and anticipatory medication-associated with reduced hospital usage and intervention at the end of life.
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Affiliation(s)
- M Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia.
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia.
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands.
| | - D McCarthy
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - C Kearney
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - A Collins
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - V Sundararajan
- La Trobe University, Public Health, Melbourne, Australia
| | - J Rhee
- Discipline of General Practice, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - J Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - J Emery
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands
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2
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Speir M, Tye H, Gottschalk TA, Simpson DS, Djajawi TM, Deo P, Ambrose RL, Conos SA, Emery J, Abraham G, Pascoe A, Hughes SA, Weir A, Hawkins ED, Kong I, Herold MJ, Pearson JS, Lalaoui N, Naderer T, Vince JE, Lawlor KE. A1 is induced by pathogen ligands to limit myeloid cell death and NLRP3 inflammasome activation. EMBO Rep 2023; 24:e56865. [PMID: 37846472 PMCID: PMC10626451 DOI: 10.15252/embr.202356865] [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: 01/23/2023] [Revised: 09/09/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
Programmed cell death pathways play an important role in innate immune responses to infection. Activation of intrinsic apoptosis promotes infected cell clearance; however, comparatively little is known about how this mode of cell death is regulated during infections and whether it can induce inflammation. Here, we identify that the pro-survival BCL-2 family member, A1, controls activation of the essential intrinsic apoptotic effectors BAX/BAK in macrophages and monocytes following bacterial lipopolysaccharide (LPS) sensing. We show that, due to its tight transcriptional and post-translational regulation, A1 acts as a molecular rheostat to regulate BAX/BAK-dependent apoptosis and the subsequent NLRP3 inflammasome-dependent and inflammasome-independent maturation of the inflammatory cytokine IL-1β. Furthermore, induction of A1 expression in inflammatory monocytes limits cell death modalities and IL-1β activation triggered by Neisseria gonorrhoeae-derived outer membrane vesicles (NOMVs). Consequently, A1-deficient mice exhibit heightened IL-1β production in response to NOMV injection. These findings reveal that bacteria can induce A1 expression to delay myeloid cell death and inflammatory responses, which has implications for the development of host-directed antimicrobial therapeutics.
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3
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Tran LS, Ying L, D'Costa K, Wray-McCann G, Kerr G, Le L, Allison CC, Ferrand J, Chaudhry H, Emery J, De Paoli A, Colon N, Creed S, Kaparakis-Liaskos M, Como J, Dowling JK, Johanesen PA, Kufer TA, Pedersen JS, Mansell A, Philpott DJ, Elgass KD, Abud HE, Nachbur U, Croker BA, Masters SL, Ferrero RL. NOD1 mediates interleukin-18 processing in epithelial cells responding to Helicobacter pylori infection in mice. Nat Commun 2023; 14:3804. [PMID: 37365163 DOI: 10.1038/s41467-023-39487-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
The interleukin-1 family members, IL-1β and IL-18, are processed into their biologically active forms by multi-protein complexes, known as inflammasomes. Although the inflammasome pathways that mediate IL-1β processing in myeloid cells have been defined, those involved in IL-18 processing, particularly in non-myeloid cells, are still not well understood. Here we report that the host defence molecule NOD1 regulates IL-18 processing in mouse epithelial cells in response to the mucosal pathogen, Helicobacter pylori. Specifically, NOD1 in epithelial cells mediates IL-18 processing and maturation via interactions with caspase-1, instead of the canonical inflammasome pathway involving RIPK2, NF-κB, NLRP3 and ASC. NOD1 activation and IL-18 then help maintain epithelial homoeostasis to mediate protection against pre-neoplastic changes induced by gastric H. pylori infection in vivo. Our findings thus demonstrate a function for NOD1 in epithelial cell production of bioactive IL-18 and protection against H. pylori-induced pathology.
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Affiliation(s)
- L S Tran
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Melbourne, VIC, Australia
| | - L Ying
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Melbourne, VIC, Australia
| | - K D'Costa
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - G Wray-McCann
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - G Kerr
- Department of Anatomy and Developmental Biology, Development and Stem Cells Program, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - L Le
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - C C Allison
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - J Ferrand
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - H Chaudhry
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - J Emery
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Melbourne, VIC, Australia
| | - A De Paoli
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - N Colon
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - S Creed
- Monash Micro Imaging, Monash University, Melbourne, VIC, Australia
| | - M Kaparakis-Liaskos
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - J Como
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - J K Dowling
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - P A Johanesen
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - T A Kufer
- Department of Immunology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | | | - A Mansell
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Molecular and Translational Science, Monash University, Melbourne, VIC, Australia
| | - D J Philpott
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - K D Elgass
- Monash Micro Imaging, Monash University, Melbourne, VIC, Australia
| | - H E Abud
- Department of Anatomy and Developmental Biology, Development and Stem Cells Program, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - U Nachbur
- Cell Signalling and Cell Death Division, WEHI, Melbourne, VIC, Australia
| | - B A Croker
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Inflammation Division, WEHI, Melbourne, VIC, Australia
| | - S L Masters
- Inflammation Division, WEHI, Melbourne, VIC, Australia
| | - R L Ferrero
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia.
- Inflammation Division, WEHI, Melbourne, VIC, Australia.
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Ying L, Liu P, Ding Z, Wray‐McCann G, Emery J, Colon N, Le LHM, Tran LS, Xu P, Yu L, Philpott DJ, Tu Y, Cheah DMZ, Cheng CL, Lim ST, Ong CK, Ferrero RL. Anti-CD40L therapy prevents the formation of precursor lesions to gastric B-cell MALT lymphoma in a mouse model. J Pathol 2023; 259:402-414. [PMID: 36640261 PMCID: PMC10952994 DOI: 10.1002/path.6053] [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: 08/01/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is a B-cell tumour that develops over many decades in the stomachs of individuals with chronic Helicobacter pylori infection. We developed a new mouse model of human gastric MALT lymphoma in which mice with a myeloid-specific deletion of the innate immune molecule, Nlrc5, develop precursor B-cell lesions to MALT lymphoma at only 3 months post-Helicobacter infection versus 9-24 months in existing models. The gastric B-cell lesions in the Nlrc5 knockout mice had the histopathological features of the human disease, notably lymphoepithelial-like lesions, centrocyte-like cells, and were infiltrated by dendritic cells (DCs), macrophages, and T-cells (CD4+ , CD8+ and Foxp3+ ). Mouse and human gastric tissues contained immune cells expressing immune checkpoint receptor programmed death 1 (PD-1) and its ligand PD-L1, indicating an immunosuppressive tissue microenvironment. We next determined whether CD40L, overexpressed in a range of B-cell malignancies, may be a potential drug target for the treatment of gastric MALT lymphoma. Importantly, we showed that the administration of anti-CD40L antibody either coincident with or after establishment of Helicobacter infection prevented gastric B-cell lesions in mice, when compared with the control antibody treatment. Mice administered the CD40L antibody also had significantly reduced numbers of gastric DCs, CD8+ and Foxp3+ T-cells, as well as decreased gastric expression of B-cell lymphoma genes. These findings validate the potential of CD40L as a therapeutic target in the treatment of human gastric B-cell MALT lymphoma. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Le Ying
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
- Department of Molecular and Translational ScienceMonash UniversityClaytonVICAustralia
| | - Phoebe Liu
- Department of ImmunologyUniversity of TorontoTorontoONCanada
| | - Zhoujie Ding
- Department of Immunology and Pathology, Central Clinical SchoolMonash UniversityClaytonVICAustralia
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetSolnaSweden
| | - Georgie Wray‐McCann
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
| | - Jack Emery
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
| | - Nina Colon
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
| | - Lena HM Le
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
| | - Le Son Tran
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
| | - Ping Xu
- Department of Tea ScienceZhejiang UniversityHangzhouPR China
| | - Liang Yu
- Department of General Surgery, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiPR China
| | - Dana J Philpott
- Department of ImmunologyUniversity of TorontoTorontoONCanada
| | - Yugang Tu
- Cell Signaling Technology, Inc.DanversMAUSA
| | - Daryl MZ Cheah
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular ResearchNational Cancer Centre SingaporeSingaporeSingapore
| | - Chee L Cheng
- Department of PathologySingapore General HospitalSingaporeSingapore
| | - Soon T Lim
- Division of Medical OncologyNational Cancer Centre SingaporeSingaporeSingapore
- SingHealth Duke‐NUS Blood Cancer CentreSingaporeSingapore
- Office of EducationDuke‐NUS Medical SchoolSingaporeSingapore
| | - Choon K Ong
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular ResearchNational Cancer Centre SingaporeSingaporeSingapore
- Cancer and Stem Cell Biology ProgramDuke‐NUS Medical SchoolSingaporeSingapore
- Genome Institute of SingaporeSingaporeSingapore
| | - Richard L Ferrero
- Centre for Innate Immunity and Infectious DiseasesHudson Institute of Medical ResearchClaytonVICAustralia
- Department of Molecular and Translational ScienceMonash UniversityClaytonVICAustralia
- Biomedicine Discovery Institute, Department of MicrobiologyMonash UniversityClaytonVICAustralia
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5
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Garcia-Esperon C, Ostman C, Walker FR, Chew B, Edwards S, Emery J, Bendall J, Alanati K, Dunkerton S, Starling de Barros R, Amin M, Gangadharan S, Lillicrap T, Parsons M, Levi CR, Spratt NJ. The Hunter-8 scale prehospital triage workflow for identification of large vessel occlusion and brain haemorrhage. PREHOSP EMERG CARE 2022:1-7. [PMID: 36053543 DOI: 10.1080/10903127.2022.2120134] [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] [Indexed: 10/14/2022]
Abstract
ObjectiveThe Hunter-8 prehospital stroke scale predicts large vessel occlusion in hyperacute ischemic stroke patients (LVO) at hospital admission. We wished to test its performance in the hands of paramedics as part of a prehospital triage algorithm. We aimed to determine a) the proportion of patients identified by the Hunter-8 algorithm, receiving reperfusion therapies, b) whether a call to stroke team improved this, and c) performance for LVO detection using an expanded LVO definition.MethodsA prehospital workflow combining pre-morbid functional status, time from symptom onset, and the Hunter-8 scale was implemented from July 2019. A telephone call to the stroke team was prompted for potential treatment candidates. Classic LVO was defined as a proximal middle cerebral artery (MCA-M1), terminal internal carotid artery, or tandem occlusion. Extended LVO added proximal MCA-M2 and basilar occlusions.ResultsFrom July 2019 to April 2021, there were 363 Hunter-8 activations, 320 analysed: 181 (56.6%) had confirmed ischemic strokes, 13 (4.1%) transient ischemic attack, 91 (28.5%) stroke mimics, and 35 (10.9%) intracranial haemorrhage. Fifty-two patients (16.3%) received reperfusion therapies, 35 with Hunter-8 ≥ 8. The stroke doctor changed the final destination for 76 patients (23.7%), and five received reperfusion therapies. The AUCs for classic and extended LVO were 0.73 (95% CI 0.66-0.79) and 0.72 (95% CI 0.65-0.77), respectively.ConclusionThe Hunter-8 workflow resulted in 28.7% of confirmed ischemic stroke patients receiving reperfusion therapies, with no secondary transfers to the comprehensive stroke centre. The role of communication with stroke team needs to be further explored.
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Affiliation(s)
- C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - C Ostman
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia
| | - F R Walker
- College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Bla Chew
- Department of Neurology, John Hunter Hospital, Australia
| | - S Edwards
- New South Wales Ambulance, Rozelle, Australia
| | - J Emery
- New South Wales Ambulance, Rozelle, Australia
| | - J Bendall
- Department of Neurology, John Hunter Hospital, Australia.,New South Wales Ambulance, Rozelle, Australia
| | - K Alanati
- Department of Neurology, John Hunter Hospital, Australia
| | - S Dunkerton
- Department of Neurology, John Hunter Hospital, Australia
| | | | - M Amin
- Department of Neurology, John Hunter Hospital, Australia
| | - S Gangadharan
- Department of Neurology, John Hunter Hospital, Australia
| | - T Lillicrap
- Hunter Medical Research Institute, Newcastle, Australia
| | - M Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,University of New South Wales South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - C R Levi
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - N J Spratt
- Department of Neurology, John Hunter Hospital, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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6
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Jones OT, Matin RN, van der Schaar M, Prathivadi Bhayankaram K, Ranmuthu CKI, Islam MS, Behiyat D, Boscott R, Calanzani N, Emery J, Williams HC, Walter FM. Artificial intelligence and machine learning algorithms for early detection of skin cancer in community and primary care settings: a systematic review. The Lancet Digital Health 2022; 4:e466-e476. [DOI: 10.1016/s2589-7500(22)00023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/29/2021] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
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7
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Zhang J, Oberoi J, Karnchanachari N, Druce P, Drosdowsky A, Ijzerman M, Emery J. P09.01 Waiting Time and Lung Cancer Outcomes: Association and Methodological Results From a Systematic Review of Systematic and Scoping Reviews. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Roseleur J, Gonzalez-Chica DA, Emery J, Stocks NP. Skin checks and skin cancer diagnosis in Australian general practice before and during the COVID-19 pandemic, 2011-2020. Br J Dermatol 2021; 185:853-855. [PMID: 34009666 PMCID: PMC8239661 DOI: 10.1111/bjd.20494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 12/19/2022]
Affiliation(s)
- J Roseleur
- Discipline of General Practice, Adelaide Medical School, Adelaide, SA, Australia
| | - D A Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, Adelaide, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - J Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - N P Stocks
- Discipline of General Practice, Adelaide Medical School, Adelaide, SA, Australia
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9
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Wall J, Avaiusini L, Goodrich C, Emery J, Latimer A, Utarnachitt R. 389TF Targeted Cross-Over Education for Flight Nurses in Transition from Dedicated Pediatric and Adult Teams to Generalist Flight Teams. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Deo P, Chow SH, Han ML, Speir M, Huang C, Schittenhelm RB, Dhital S, Emery J, Li J, Kile BT, Vince JE, Lawlor KE, Naderer T. Mitochondrial dysfunction caused by outer membrane vesicles from Gram-negative bacteria activates intrinsic apoptosis and inflammation. Nat Microbiol 2020; 5:1418-1427. [PMID: 32807891 DOI: 10.1038/s41564-020-0773-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
Sensing of microbes activates the innate immune system, depending on functional mitochondria. However, pathogenic bacteria inhibit mitochondrial activity by delivering toxins via outer membrane vesicles (OMVs). How macrophages respond to pathogenic microbes that target mitochondria remains unclear. Here, we show that macrophages exposed to OMVs from Neisseria gonorrhoeae, uropathogenic Escherichia coli and Pseudomonas aeruginosa induce mitochondrial apoptosis and NLRP3 inflammasome activation. OMVs and toxins that cause mitochondrial dysfunction trigger inhibition of host protein synthesis, which depletes the unstable BCL-2 family member MCL-1 and induces BAK-dependent mitochondrial apoptosis. In parallel with caspase-11-mediated pyroptosis, mitochondrial apoptosis and potassium ion efflux activate the NLRP3 inflammasome after OMV exposure in vitro. Importantly, in the in vivo setting, the activation and release of interleukin-1β in response to N. gonorrhoeae OMVs is regulated by mitochondrial apoptosis. Our data highlight how innate immune cells sense infections by monitoring mitochondrial health.
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Affiliation(s)
- Pankaj Deo
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Seong H Chow
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mei-Ling Han
- Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Mary Speir
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Cheng Huang
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Monash Biomedical Proteomics and Metabolomics Facility, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Ralf B Schittenhelm
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Monash Biomedical Proteomics and Metabolomics Facility, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Subhash Dhital
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Jack Emery
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Jian Li
- Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Benjamin T Kile
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - James E Vince
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Kate E Lawlor
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Thomas Naderer
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
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11
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Usher-Smith JA, Harshfield A, Saunders CL, Sharp SJ, Emery J, Walter FM, Muir K, Griffin SJ. Correction: External validation of risk prediction models for incident colorectal cancer using UK Biobank. Br J Cancer 2020; 122:1572-1575. [PMID: 32203217 PMCID: PMC7217758 DOI: 10.1038/s41416-020-0767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - A Harshfield
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - C L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - S J Sharp
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - J Emery
- Department of General Practice, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, VIC, 3010, Australia
| | - F M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - K Muir
- Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - S J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK.,MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
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12
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Mazza D, Lin X, Emery J, Walter F, Young J, Barnes D, Mitchell P, Brijnath B, Martin A, O’Byrne K. MA22.06 Longer Lung Cancer Time Intervals Amongst Culturally and Linguistically Diverse Patient Than Anglo-Australian Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.686] [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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Abstract
OBJECTIVE Most skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians (PCPs). However, when used by untrained clinicians, accuracy may be no better than visual inspection. This study aimed to undertake a systematic review of literature reporting use of dermoscopy to triage suspicious skin lesions in primary care settings, and challenges for implementation. DESIGN A systematic literature review and narrative synthesis. DATA SOURCES We searched MEDLINE, Cochrane Central, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS bibliographic databases from 1 January 1990 to 31 December 2017, without language restrictions. INCLUSION CRITERIA Studies including assessment of dermoscopy accuracy, acceptability to patients and PCPs, training requirements, and cost-effectiveness of dermoscopy modes in primary care, including trials, diagnostic accuracy and acceptability studies. RESULTS 23 studies met the review criteria, representing 49 769 lesions and 3708 PCPs, all from high-income countries. There was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity therefore made meta-analysis unfeasible; the data were synthesised through narrative review. Dermoscopy, with appropriate training, was associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals. Teledermoscopy-based referral systems improved triage accuracy. Only three studies examined cost-effectiveness; hence, there was insufficient evidence to draw conclusions. Costs, training and time requirements were considered important implementation barriers. Patient satisfaction was seldom assessed. Computer-aided dermoscopy and other technological advances have not yet been tested in primary care. CONCLUSIONS Dermoscopy could help PCPs triage suspicious lesions for biopsy, urgent referral or reassurance. However, it will be important to establish further evidence on minimum training requirements to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care. TRIAL REGISTRATION NUMBER CRD42018091395.
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Affiliation(s)
- O T Jones
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - L C Jurascheck
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A van Melle
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S Hickman
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - N P Burrows
- Addenbrooke's Hospital Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P N Hall
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Emery
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - F M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
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14
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Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM. Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol 2019; 33:1706-1712. [PMID: 30977937 PMCID: PMC6767170 DOI: 10.1111/jdv.15614] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
Background Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. Objectives To determine views on, and use of, dermoscopy by dermatology‐interested general practitioners (GPs). Methods An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. Results A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one‐fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face‐to‐face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. Conclusions UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost‐effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.
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Affiliation(s)
- O T Jones
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - M Utukuri
- Clinical School, University of Cambridge, Cambridge, UK
| | - M M Pannebakker
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - J Emery
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Faculty of Medicine, Dentistry and Health Science, Department of General Practice and the Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - F M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Faculty of Medicine, Dentistry and Health Science, Department of General Practice and the Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
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15
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Bergin R, Emery J, Bollard R, Falborg A, Jensen H, Weller D, Menon U, Vedsted P, Thomas R, Whitfield K, White V. Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10700] [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: 11/20/2022] Open
Abstract
Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.
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Affiliation(s)
- R. Bergin
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - J. Emery
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Bollard
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - A. Falborg
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - H. Jensen
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - D. Weller
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - U. Menon
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - P. Vedsted
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Thomas
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - K. Whitfield
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - V. White
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
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16
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Licqurish S, Pattuwage L, Chima S, Qama A, Emery J. Interventions for Maximizing Quality Communication in Cancer Care: A Systematic Review of Systematic Reviews. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.48000] [Citation(s) in RCA: 2] [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] [Indexed: 11/20/2022] Open
Abstract
Background: Clinician communication has shown to influence cancer patients' perception of care and satisfaction. Effective communication is therefore a critical aspect of patient-centered care. Health services should be implementing evidence-based communication interventions to improve the provision of cancer care to patients. Aim: We conducted a systematic review of the literature with the aim to identify effective communication strategies and/or interventions to improve clinician-patient communication. Methods: Five electronic databases (MEDLINE, Embase, PsycINFO, the Cochrane Library and CINAHL Plus) were searched for relevant citations from 2005 until October 2015 using search terms related to “cancer”, “information” and “communication”. Titles and abstracts were evaluated by two independent reviewers. Selected full text publications were assessed against the eligibility criteria. Quality was assessed using the AMSTAR guidelines and GRADE. Due to the enormity of the literature, only systematic reviews were included. Results: The database search yielded 2934 unique citations, of which 198 full texts were retrieved. After applying the inclusion and exclusion criteria, 41 systematic reviews were included. The included studies were broadly categorized under six major themes: e-health, technological and telephone-based interventions (n=9); patient education and tools (n=5); communication training (n=9); education interventions to improve cancer pain (n=6); tools to facilitate patients' participation in care/decision making (n=8); nurse delivered interventions (n=6). Conclusion: There are an enormous number of studies of communication interventions for cancer patients. The quality of the evidence to support some of these interventions is low; whereas other interventions have stronger evidence of effectiveness. Therefore, health services and clinicians should carefully consider which interventions they choose to implement. The recommendations from this review will assist clinicians and health services to choose evidence-based interventions which can improve care provision and/or patient outcomes.
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Affiliation(s)
- S. Licqurish
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - L. Pattuwage
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - S. Chima
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - A. Qama
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - J. Emery
- University of Melbourne Centre for Cancer Research, Victoria, Australia
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17
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Emery J, Smith K, Shibaoka M, Barrett M. Upskilling the Primary Care Workforce in Cancer Survivorship. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.61500] [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: 11/20/2022] Open
Abstract
Introduction/background: There is a rapidly increasing population of people living with and beyond cancer due to ageing and improvements in detection and treatment. This has impacted on the complexity of the primary care practitioners' role in managing cancer survivorship. The Massive Open Online Course (MOOC) was developed to address this need for a sustainable education model. Aim/Objectives: The Cancer Survivorship for Primary Care Practitioners program aims to enhance the knowledge and skills in the transition of survivors from oncology treatment into shared care. The Victorian Comprehensive Cancer Centre's (VCCC) goal was to develop a freely accessible, relevant, flexible, evidence based and sustainable resource for a global audience. Methods: Aimed at primary healthcare practitioners including general practitioners, nurses (general practice nurses, community nurses and nurse practitioners) and allied health professionals; the program was developed to adhere to best practice survivorship care in the areas of: survivorship fundamentals; communication and coordination of care; promoting self-management, psychosocial and community-based support; surveillance, long term and late effects; and new and emergent technologies. The MOOC is contextualised in the narrative of a patient story and includes a series of real patient stories, interactive presentations, interviews, readings, online discussions, quizzes and peer reviewed assessments. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program. An online survey will be distributed to all participants before and after their completion of the program. Paired tests will be conducted and compared for the participant craft groups that attend the MOOC. We will measure the effect of participation in either the MOOC and/or workshop on confidence, knowledge and intention to change practice. Results: A description of the sustainable MOOC delivery model and evaluation results from the first cohort will be presented. Conclusion: The program will deliver an innovative and sustainable professional development opportunity for PCPs in response to the evolving population health landscape. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program.
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Affiliation(s)
- J. Emery
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - K. Smith
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - M. Shibaoka
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - M. Barrett
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
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18
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Licqurish S, Huynh M, Qama A, Emery J. Improving Cancer Outcomes for Vietnamese Speaking Migrants: A Mixed Methods Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.59000] [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: 11/20/2022] Open
Abstract
Background: Prompt diagnosis of symptomatic cancer has been shown to improve survival and quality of life. The time from noticing a bodily change and seeking medical help has been termed the 'symptom appraisal interval'. The processes people undertake during symptom appraisal are impacted by numerous factors, including culture. Aim: We aimed to explore culturally specific factors that impact symptom appraisal and help seeking for a cancer diagnosis in Vietnamese-speaking Australians and to develop a culturally relevant community-based symptom awareness campaign. Methods: We used a mixed methods approach to survey and interview people who had not experienced cancer and interviewed people with a recent diagnosis of cancer. We also tested campaign materials in focus groups and interviews with community members. Results: 28 people participated in the interview study and 65 completed surveys. We found poor symptom recognition and a prevailing Taoist or traditional Eastern model of health and illness. There was also a strong emphasis on being healthy for your family and fatalistic beliefs. Home remedies and Eastern medicine were commonly used for cancer symptom management and the people with cancer were shocked at their cancer diagnosis. Conclusion: The study findings were used to tailor a symptom awareness campaign for Vietnamese speaking communities to raise awareness of cancer symptoms and to prompt people to discuss symptoms with family and their general practitioner sooner to facilitate timely diagnosis and better outcomes.
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Affiliation(s)
- S. Licqurish
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - M. Huynh
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - A. Qama
- University of Melbourne Centre for Cancer Research, Victoria, Australia
| | - J. Emery
- University of Melbourne Centre for Cancer Research, Victoria, Australia
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19
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Usher-Smith JA, Harshfield A, Saunders CL, Sharp SJ, Emery J, Walter FM, Muir K, Griffin SJ. External validation of risk prediction models for incident colorectal cancer using UK Biobank. Br J Cancer 2018; 118:750-759. [PMID: 29381683 PMCID: PMC5846069 DOI: 10.1038/bjc.2017.463] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to compare and externally validate risk scores developed to predict incident colorectal cancer (CRC) that include variables routinely available or easily obtainable via self-completed questionnaire. METHODS External validation of fourteen risk models from a previous systematic review in 373 112 men and women within the UK Biobank cohort with 5-year follow-up, no prior history of CRC and data for incidence of CRC through linkage to national cancer registries. RESULTS There were 1719 (0.46%) cases of incident CRC. The performance of the risk models varied substantially. In men, the QCancer10 model and models by Tao, Driver and Ma all had an area under the receiver operating characteristic curve (AUC) between 0.67 and 0.70. Discrimination was lower in women: the QCancer10, Wells, Tao, Guesmi and Ma models were the best performing with AUCs between 0.63 and 0.66. Assessment of calibration was possible for six models in men and women. All would require country-specific recalibration if estimates of absolute risks were to be given to individuals. CONCLUSIONS Several risk models based on easily obtainable data have relatively good discrimination in a UK population. Modelling studies are now required to estimate the potential health benefits and cost-effectiveness of implementing stratified risk-based CRC screening.
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Affiliation(s)
- J A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - A Harshfield
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - C L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - S J Sharp
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - J Emery
- Department of General Practice, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, VIC 3010, Australia
| | - F M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - K Muir
- Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - S J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
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20
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Phillips KA, Lo L, Bressel M, Collins IM, Emery J, Weideman P, Keogh L, Steel E, Bickerstaffe A, Mann GB, Trainer A, Hopper JL, Antoniou AC, Cuzick J, Butow P. Abstract P4-11-02: Acceptability and usability of iPrevent, a web-based decision support tool for assessment and management of breast cancer risk. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-11-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: iPrevent estimates an individual's personal BC risk, using either the IBIS or BOADICEA algorithms, and provides tailored risk management information on screening, lifestyle modifications, risk-reducing surgery and risk-reducing medication. It is designed to be used collaboratively by women and their clinicians. The purpose of this pre-implementation pilot study was to assess the clinical usability and acceptability of the iPrevent prototype, and to identify barriers to clinical implementation. Exploratory aims investigated patients' BC worry, anxiety, risk perception and knowledge before and after using iPrevent. Methods: Eligible clinicians worked in primary care (PC), breast surgical (BS) or genetics clinics (GC). Their female patients were eligible if aged 18-70 years with no personal cancer history. Clinicians were familiarized with iPrevent using hypothetical cases, then actor scenarios, and lastly iPrevent was trialed with patients. All participants completed the System Usability Scale (SUS) and an acceptability questionnaire 2 weeks after using iPrevent. Patients also completed the Lerman BC Worry Scale, Spielberger State-Trait Anxiety Inventory, and BC risk perception and prevention knowledge questionnaires before and 2 weeks after using the tool. Data were summarized using descriptive statistics. Results: 63 participants comprising 20 clinicians (median age 47 years, 8 PC, 6 BS, 6 GC) and 43 patients (median age 38 years, 16% high risk, 51% moderate risk, 33% average risk) were recruited. Usability was rated above average (SUS score >68) by most clinicians (68%) and patients (76%). Most (79% of clinicians, 81% of patients) agreed iPrevent was 'easy to use', although 10 (53%) clinicians and 10 (27%) patients reported that it was too long. Most clinicians (84%) and patients (86%) found iPrevent 'very' or 'somewhat' helpful. 89% of participants reported that iPrevent provided the right amount of information. 5% reported to 'rarely' or 'not at all' worry about BC before iPrevent, and 29% after use. 25% of patients reported less impact of worrying about BC after iPrevent, 47% were unchanged and 28% reported more impact of worrying about BC after iPrevent use. State anxiety remained the same. 87% of patients correctly reported their risk category after using iPrevent® compared with 40% before. BC prevention knowledge improved for most questions. Conclusions: iPrevent has high usability and acceptability. Exploratory analyses suggest that iPrevent may also improve patients' BC risk perception and knowledge without adversely affecting anxiety or BC worry. Because concerns about length could be a barrier to implementation, data entry has been abbreviated in the modified version of iPrevent that will be publically available.
Citation Format: Phillips K-A, Lo L, Bressel M, Collins IM, Emery J, Weideman P, Keogh L, Steel E, Bickerstaffe A, Mann GB, Trainer A, Hopper JL, Antoniou AC, Cuzick J, Butow P. Acceptability and usability of iPrevent, a web-based decision support tool for assessment and management of breast cancer risk [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-02.
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Affiliation(s)
- K-A Phillips
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - L Lo
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - M Bressel
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - IM Collins
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - J Emery
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - P Weideman
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - L Keogh
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - E Steel
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - A Bickerstaffe
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - GB Mann
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - A Trainer
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - JL Hopper
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - AC Antoniou
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - J Cuzick
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
| | - P Butow
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Deakin University, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; University of Cambridge; Queen Mary University of London; University of Sydney
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Coulson AS, Glasspool DW, Emery J, Fox J. RAGs: A Novel Approach to Computerized Genetic Risk Assessment and Decision Support from Pedigrees. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
To assist general practitioners in evaluating patients’ genetic risk of cancer on the basis of family history data.
Methods:
A new computer application, RAGs (Risk Assessment in Genetics), has been developed to help doctors create graphical family trees and assess the genetic risk of breast and colorectal cancer. RAGs possesses two features that distinguish it from similar software: (i) a user-centred design, which takes into account the requirements of the doctor-patient encounter; (ii) effective and accessible risk reporting by employing qualitative evidence for or against increased risk, which is more easily understood than numerical probabilities. The system allows any rule-based genetic risk guideline to be implemented, and may be readily modified to cater for the varying degrees of information required by different specialists.
Results:
RAGs permits fast, accurate data entry, and results in more appropriate management decisions than those made via other techniques. In addition, RAGs enables both the clinician and the patient to understand how it arrives at its conclusions, since the use of qualitative evidence allows the program to provide explanations for its reasoning.
Conclusions:
The RAGs system promises to help practitioners be more effective gatekeepers to genetic services. It may empower doctors both to make an informed choice when deciding to refer patients who are at increased genetic risk of breast or colorectal cancer, and to reassure those who are at low risk.
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Rankin N, York S, Trevena L, Emery J, Sundaresan P, Beale P, Zielinski R, Vinod S, Shaw T. P3.13-038 The RoaDmaP Study: Feasibility of Implementing a Primary Care Intervention for Referral of Potential Lung Cancer Cases to Specialist Care. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bergin R, Emery J, Bollard R, White V. How rural and urban patients in Australia with colorectal or breast cancer experience choice of treatment provider: A qualitative study. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28144993 DOI: 10.1111/ecc.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/01/2016] [Indexed: 12/21/2022]
Abstract
Modern healthcare systems promote patient choice of cancer treatment provider, but little is known about how place of residence influences decision-making. This research explored how rural and urban patients with breast or colorectal cancer experience choice of cancer treatment provider in Victoria, Australia. Realist thematic analysis of 43 semi-structured telephone interviews identified little active participation in decision-making regardless of area of residence or cancer diagnosis. Perceptions of choice were impacted by urgency for treatment, insurance status and access to providers, a key issue for rural patients. All patients wanted high quality care, but needed to trust health professional's recommendations. Rural patients experienced more complex decision-making, balancing a range of social factors with perceptions about quality of accessible care. Further research into variation in quality of care and complex cancer pathways for rural and urban cancer patients is warranted to inform choices and enhance patient-centred care.
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Affiliation(s)
- R Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia.,Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - J Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - R Bollard
- Division of Surgery, Ballarat Health Services, Ballarat, Vic., Australia
| | - V White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic., Australia
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Arvizo C, Emery J, Uy-Kroh MJ. Laparoscopic Essure Removal and Review of Anatomy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Licqurish S, Phillipson L, Chiang P, Walker J, Walter F, Emery J. Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27515153 DOI: 10.1111/ecc.12556] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
Abstract
People from ethnic minorities often experience poorer cancer outcomes, possibly due to later presentation to healthcare and later diagnosis. We aimed to identify common cancer beliefs in minority populations in developed countries, which can affect symptom appraisal and help seeking for symptomatic cancer. Our systematic review found 15 relevant qualitative studies, located in the United Kingdom (six), United States (five), Australia (two) and Canada (two) of African, African-American, Asian, Arabic, Hispanic and Latino minority groups. We conducted a meta-synthesis that found specific emotional reactions to cancer, knowledge and beliefs and interactions with healthcare services as contributing factors in help seeking for a cancer diagnosis. These findings may be useful to inform the development of interventions to facilitate cancer diagnosis in minority populations.
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Affiliation(s)
- S Licqurish
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - L Phillipson
- Centre for Health Initiatives, University of Wollongong, Wollongong, NSW, Australia
| | - P Chiang
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - J Walker
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - F Walter
- Department of Public Health and Primary Care, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - J Emery
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
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Hall N, Birt L, Banks J, Emery J, Mills K, Johnson M, Rubin GP, Hamilton W, Walter FM. Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study. BMJ Open 2015; 5:e008448. [PMID: 26453591 PMCID: PMC4606388 DOI: 10.1136/bmjopen-2015-008448] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Timely diagnosis of colorectal cancer is important to improve survival. This study explored symptom appraisal and help-seeking among patients referred to specialist services with symptoms of colorectal cancer. DESIGN Qualitative in-depth interview study. SETTING AND PARTICIPANTS Participants were recruited on referral to gastroenterology clinics (North East and East of England); interviews were conducted soon after referral. We purposively sampled participants to ensure a range of accounts in terms of age, sex, diagnosis and geographical location. METHODS Data collection and analysis were underpinned by the Model of Pathways to Treatment. Framework analysis was used to explore the data within and across cases, focusing on patient beliefs and experiences, disease factors and healthcare influences. RESULTS 40 participants were interviewed (aged 43-87 years, 17 women, 18 diagnosed with colorectal cancer). Patients diagnosed with and without colorectal cancer had similar symptom pathways. We found a range of interacting and often competing biopsychosocial, contextual and cultural influences on the way in which people recognised, interpreted and acted on their symptoms. People attempted to 'maintain normality' through finding benign explanations for their symptoms. Bodily changes were appraised within the context of usual bowel patterns, comorbidities and life events, and decisions to seek help were made in relation to expectations about the course of symptoms. The 'private nature' of colorectal cancer symptoms could affect both their identification and discussions with others including healthcare professionals. Within the context of the National Health Service, people needed to legitimise appropriate use of healthcare services and avoid being thought of as wasting doctors' time. CONCLUSIONS Findings provide guidance for awareness campaigns on reducing stigma around appraising and discussing bowel movements, and the importance of intermittent and non-specific symptoms. Altering perceptions about the appropriate use of health services could have a beneficial effect on time to presentation.
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Affiliation(s)
- N Hall
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - L Birt
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - J Banks
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - J Emery
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - K Mills
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | | | - G P Rubin
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - W Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - F M Walter
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
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Ward SV, Dowty JG, Webster RJ, Cadby G, Glasson EJ, Heyworth JS, Emery J, Cole JM, Millward MJ, Wood FM, Palmer LJ. The aggregation of early-onset melanoma in young Western Australian families. Cancer Epidemiol 2015; 39:346-52. [PMID: 25843692 DOI: 10.1016/j.canep.2015.03.007] [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: 10/27/2014] [Revised: 02/11/2015] [Accepted: 03/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have examined the familial aggregation of melanoma or its co-aggregation with other cancers using whole-population based designs. This study aimed to investigate aggregation patterns in young Western Australian families, using population-based linked health data to identify individuals born in Western Australia between 1974 and 2007, their known relatives, and all incident cancer diagnoses within the resulting 1,506,961 individuals. METHODS Cox proportional hazards regression models were used to compare the risk of melanoma for first-degree relatives of melanoma cases to that for first-degree relatives of controls, with bootstrapping used to account for correlations within families. The risk of (i) developing melanoma based on the number of first-degree relatives with other cancers, and (ii) developing non-melanoma cancers based on the number of first-degree relatives diagnosed with melanoma was also investigated. RESULTS First-degree relatives of melanoma cases had a significantly greater incidence of melanoma than first-degree relatives of individuals not affected with melanoma (Hazard Ratio (HR)=3.58, 95% bootstrap confidence interval (CI): 2.43-5.43). Sensitivity analyses produced a higher hazard ratio estimate when restricted to melanoma cases diagnosed before 40 years of age (HR=3.77, bootstrap 95% CI: 2.49-6.39) and a lower estimate when only later-onset cases (>40 years) were considered (HR=2.45, bootstrap 95% CI: 1.23-4.82). No significant evidence was found for co-aggregation between melanoma and any other cancers. CONCLUSIONS Results indicated a strong familial basis of melanoma, with the higher than expected hazard ratio observed likely to reflect early-age at onset cases in this young cohort, supported by the results of the sensitivity analyses. Exploratory analyses suggested that the determinants of melanoma causing the observed aggregation within families may be independent of other malignancies, although these analyses were limited by the young age of the sample. Determining familial aggregation patterns will provide valuable knowledge regarding improved clinical risk prediction and the underlying biological mechanisms of melanoma and other cancers.
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Affiliation(s)
- S V Ward
- Centre for Genetic Origins of Health and Disease, The University of Western Australia, Crawley, Western Australia, Australia.
| | - J G Dowty
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - R J Webster
- Laboratory for Cancer Medicine, Harry Perkins Institute for Medical Research and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, Australia
| | - G Cadby
- Centre for Genetic Origins of Health and Disease, The University of Western Australia, Crawley, Western Australia, Australia
| | - E J Glasson
- Telethon Kids Institute, Subiaco, Western Australia, Australia
| | - J S Heyworth
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - J Emery
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - J M Cole
- St John of God Dermatology, St John of God Health Care, Subiaco, Perth, Western Australia, Australia
| | - M J Millward
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - F M Wood
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia; Fiona Wood Foundation, Telstra Burns Reconstruction and Rehabilitation Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - L J Palmer
- Joanna Briggs Institute and School of Translational Health Science, University of Adelaide, Adelaide, South Australia, Australia
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Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, Dobson C, Rintoul RC, Hamilton W, Emery J. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer 2015; 112 Suppl 1:S6-13. [PMID: 25734397 PMCID: PMC4385970 DOI: 10.1038/bjc.2015.30] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis. METHODS Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage. RESULTS Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003). CONCLUSIONS Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.
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Affiliation(s)
- F M Walter
- 1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - G Rubin
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - C Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - H C Morris
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - N Hall
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - K Mills
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - C Dobson
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE, UK
| | - W Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - J Emery
- 1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia [3] Department of General Practice, University of Western Australia, Perth, Western Australia, Australia
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 614] [Impact Index Per Article: 68.2] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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Martyn M, Anderson V, Archibald A, Carter R, Cohen J, Delatycki M, Donath S, Emery J, Halliday J, Hill M, Sheffield L, Slater H, Tassone F, Younie S, Metcalfe S. Offering fragile X syndrome carrier screening: a prospective mixed-methods observational study comparing carrier screening of pregnant and non-pregnant women in the general population. BMJ Open 2013; 3:e003660. [PMID: 24022395 PMCID: PMC3773647 DOI: 10.1136/bmjopen-2013-003660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Fragile X syndrome (FXS) is the leading cause of inherited intellectual and developmental disability. Policy development relating to carrier screening programmes for FXS requires input from large studies examining not only test uptake but also psychosocial aspects. This study will compare carrier screening in pregnant and non-pregnant populations, examining informed decision-making, psychosocial issues and health economics. METHODS AND ANALYSIS Pregnant and non-pregnant women are being recruited from general practices and obstetric services. Women receive study information either in person or through clinic mail outs. Women are provided pretest counselling by a genetic counsellor and make a decision about testing in their own time. Data are being collected from two questionnaires: one completed at the time of making the decision about testing and the second 1 month later. Additional data are gathered through qualitative interviews conducted at several time points with a subset of participating women, including all women with a positive test result, and with staff from recruiting clinics. A minimum sample size of 500 women/group has been calculated to give us 88% power to detect a 10% difference in test uptake and 87% power to detect a 10% difference in informed choice between the pregnant and non-pregnant groups. Questionnaire data will be analysed using descriptive statistics and multivariate logistic regression models. Interview data will be thematically analysed. Willingness-to-pay and cost effectiveness analyses will also be performed. Recruitment started in July 2009 and data collection will be completed by December 2013. ETHICS AND DISSEMINATION Ethics approval has been granted by the Universities of Melbourne and Western Australia and by recruiting clinics, where required. Results will be reported in peer-reviewed publications, conference presentations and through a website http://www.fragilexscreening.net.au. The results of this study will make a significant contribution to discussions about the wider introduction of population carrier screening for FXS.
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Affiliation(s)
- M Martyn
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol 2012; 18:45-65. [PMID: 22536840 DOI: 10.1111/j.2044-8287.2012.02077.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studying and understanding pathways to diagnosis and treatment is vital for the development of successful interventions to encourage early detection, presentation, and diagnosis. An existing framework posited to describe the decisional and behavioural processes that occur prior to treatment (Andersen et al.'s General Model of Total Patient Delay) does not appear to match the complex and dynamic nature of the pathways into and through the health care system or provide a clear framework for research. Therefore a revised descriptive framework, the Model of Pathways to Treatment, has been proposed. PURPOSE This paper presents the concepts and definitions of the Model of Pathways to Treatment and specifies how the model can encompass existing psychological theory, with particular focus on the Appraisal and Help-seeking intervals. The potential and direction for future work is also discussed. STATEMENT OF CONTRIBUTION WHAT IS ALREADY KNOWN ON THIS SUBJECT?: • The use of theory is often lacking in existing research into delays in presentation, diagnosis and treatment of illness. WHAT DOES THIS STUDY ADD?: • A detailed account of the concepts and definitions of a revised framework: the Model of Pathways to Treatment. • Specification of how the Model of Pathways to Treatment can encompass existing psychological theory such as the Common Sense Model of Illness Self-regulation and Social Cognitive Theory.
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Affiliation(s)
- S E Scott
- Unit of Social & Behavioural Sciences, Dental Institute, King's College London, UK.
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Weller D, Vedsted P, Rubin G, Walter FM, Emery J, Scott S, Campbell C, Andersen RS, Hamilton W, Olesen F, Rose P, Nafees S, van Rijswijk E, Hiom S, Muth C, Beyer M, Neal RD. The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. Br J Cancer 2012; 106:1262-7. [PMID: 22415239 PMCID: PMC3314787 DOI: 10.1038/bjc.2012.68] [Citation(s) in RCA: 517] [Impact Index Per Article: 43.1] [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] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/13/2012] [Accepted: 02/14/2012] [Indexed: 02/07/2023] Open
Abstract
Early diagnosis is a key factor in improving the outcomes of cancer patients. A greater understanding of the pre-diagnostic patient pathways is vital yet, at present, research in this field lacks consistent definitions and methods. As a consequence much early diagnosis research is difficult to interpret. A consensus group was formed with the aim of producing guidance and a checklist for early cancer-diagnosis researchers. A consensus conference approach combined with nominal group techniques was used. The work was supported by a systematic review of early diagnosis literature, focussing on existing instruments used to measure time points and intervals in early cancer-diagnosis research. A series of recommendations for definitions and methodological approaches is presented. This is complemented by a checklist that early diagnosis researchers can use when designing and conducting studies in this field. The Aarhus checklist is a resource for early cancer-diagnosis research that should promote greater precision and transparency in both definitions and methods. Further work will examine whether the checklist can be readily adopted by researchers, and feedback on the guidance will be used in future updates.
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Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
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Watts G, Bell D, Kirk A, Barbour R, Southwell L, Juniper A, Burrows S, Emery J. Assessment of Familial Hypercholesterolaemia in a Regional Community in Western Australia: Comparison Between Primary Care and Specialist Centre. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mai Q, Holman D, Sanfilippo F, Emery J. P2-168 Mental illness related disparities in potentially preventable hospitalisations: a population-base cohort study from 1990 to 2006. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mai Q, Holman D, Sanfilippo F, Emery J, Preen D. P2-167 Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study in Western Australia from 1990 to 2006. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gibson D, Moorin R, Preen D, Emery J, Holman D. P2-96 Can increasing physician fee-for-service payments improve service regularity in elderly patients with chronic disease? Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.31] [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: 11/04/2022]
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Mai Q, Holman D, Sanfilippo F, Emery J. P2-169 Do mental health clients lack access to general practitioner services? Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Greving MP, Belcher PE, Diehnelt CW, Gonzalez-Moa MJ, Emery J, Fu J, Johnston SA, Woodbury NW. Thermodynamic additivity of sequence variations: an algorithm for creating high affinity peptides without large libraries or structural information. PLoS One 2010; 5:e15432. [PMID: 21085650 PMCID: PMC2978705 DOI: 10.1371/journal.pone.0015432] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 09/21/2010] [Indexed: 12/23/2022] Open
Abstract
Background There is a significant need for affinity reagents with high target affinity/specificity that can be developed rapidly and inexpensively. Existing affinity reagent development approaches, including protein mutagenesis, directed evolution, and fragment-based design utilize large libraries and/or require structural information thereby adding time and expense. Until now, no systematic approach to affinity reagent development existed that could produce nanomolar affinity from small chemically synthesized peptide libraries without the aid of structural information. Methodology/Principal Findings Based on the principle of additivity, we have developed an algorithm for generating high affinity peptide ligands. In this algorithm, point-variations in a lead sequence are screened and combined in a systematic manner to achieve additive binding energies. To demonstrate this approach, low-affinity lead peptides for multiple protein targets were identified from sparse random sequence space and optimized to high affinity in just two chemical steps. In one example, a TNF-α binding peptide with Kd = 90 nM and high target specificity was generated. The changes in binding energy associated with each variation were generally additive upon combining variations, validating the basis of the algorithm. Interestingly, cooperativity between point-variations was not observed, and in a few specific cases, combinations were less than energetically additive. Conclusions/Significance By using this additivity algorithm, peptide ligands with high affinity for protein targets were generated. With this algorithm, one of the highest affinity TNF-α binding peptides reported to date was produced. Most importantly, high affinity was achieved from small, chemically-synthesized libraries without the need for structural information at any time during the process. This is significantly different than protein mutagenesis, directed evolution, or fragment-based design approaches, which rely on large libraries and/or structural guidance. With this algorithm, high affinity/specificity peptide ligands can be developed rapidly, inexpensively, and in an entirely chemical manner.
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Affiliation(s)
- Matthew P. Greving
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Paul E. Belcher
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Chris W. Diehnelt
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Maria J. Gonzalez-Moa
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Jack Emery
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Jinglin Fu
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Stephen Albert Johnston
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
- School of Life Sciences, Arizona State University, Tempe, Arizona, United States of America
| | - Neal W. Woodbury
- Center for BioOptical Nanotechnology and Center for Innovations in Medicine, The Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
- Department of Chemistry and Biochemistry, Arizona State University, Tempe, Arizona, United States of America
- * E-mail:
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Menzies SW, Emery J, Staples M, Davies S, McAvoy B, Fletcher J, Shahid KR, Reid G, Avramidis M, Ward AM, Burton RC, Elwood JM. Impact of dermoscopy and short-term sequential digital dermoscopy imaging for the management of pigmented lesions in primary care: a sequential intervention trial. Br J Dermatol 2009; 161:1270-7. [PMID: 19747359 DOI: 10.1111/j.1365-2133.2009.09374.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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Abstract
The development and evaluation of computer decision support for the assessment of cancer genetic risk in primary care is reported with two series of studies described: the RAGs (Risk Assessment in Genetics) studies and the GRAIDS (Genetic Risk Assessment in an Intranet and Decision Support) Trial. In the GRAIDS Trial, 45 general practices in Eastern England have been recruited and randomised. Comparison practices attend an educational session and receive clinical guidelines about familial breast and colorectal cancer. In the intervention practices a lead clinician is trained in cancer genetics and use of the GRAIDS software. The GRAIDS software is a simple pedigree-drawing program that implements clinical guidelines for familial breast and colorectal cancer and presents individualised information about breast cancer risk in a range of formats. Outcome measures of the trial include: frequency of software use, practitioners' attitudes towards the software, total number of referrals to secondary care about familial cancer and the proportion that meet regional referral criteria, and a patient-centred measure of informed decision making. The family history will become an increasingly important tool in primary care to assess genetic risk. This research evaluates an approach to support high-quality advice about cancer genetics in primary care which could be applied more broadly as our understanding of complex disease genetics increases.
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Affiliation(s)
- J Emery
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Australia.
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Salkus T, Kazakevičius E, Kežionis A, Dindune A, Kanepe Z, Ronis J, Emery J, Boulant A, Bohnke O, Orliukas AF. Peculiarities of ionic transport in Li(1.3)Al(0.15)Y(0.15)Ti(1.7)(PO(4))(3) ceramics. J Phys Condens Matter 2009; 21:185502. [PMID: 21825465 DOI: 10.1088/0953-8984/21/18/185502] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A powder of Li(1.3)Al(0.15)Y(0.15)Ti(1.7)(PO(4))(3) has been synthesized by solid state reaction. The powder was a single phase material and had rhombohedral symmetry (space group [Formula: see text]) with six formula units in the unit cell. Impedance spectra of Li(1.3)Al(0.15)Y(0.15)Ti(1.7)(PO(4))(3) ceramics were recorded in the frequency range from 10(6) to 1.2 × 10(9) Hz and temperature range from 300 to 600 K. Two relaxation type dispersions of electrical quantities in the frequency range were found. The dispersion regions are presumably related to the ionic transport processes in bulk and grain boundaries of the ceramics. The activation energy of the conductivity of the bulk and the activation energy of the characteristic relaxation frequency, at which the dispersion sets in, has the same value of 0.25 eV. The only contribution of the mobility of Li(+) ions defines the temperature dependence of the bulk conductivity in the investigated temperature range. The values of ε(') may be related to the contributions of the polarization of the fast ionic migration, vibrations of the lattice and electronic polarization. Nuclear magnetic resonance (NMR) investigation shows that the T(1) of (7)Li and (6)Li at room temperature are 6 ms and 2 s respectively. This result confirms that the relaxation of the (7)Li nucleus occurs through quadrupolar fluctuations although the relaxation of the (6)Li nucleus occurs via dipolar fluctuations. Furthermore, the T(1) minimum allows us to evidence a motion with a characteristic frequency in the range of the Larmor frequency.
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Affiliation(s)
- T Salkus
- Department of Physics, Vilnius University, Sauletekio aleja 9/3, LT-10222, Vilnius, Lithuania
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Metcalfe S, Bittles A, O’Leary P, Emery J. Australia: Public Health Genomics. Public Health Genomics 2008; 12:121-8. [DOI: 10.1159/000160666] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 07/16/2008] [Indexed: 11/19/2022] Open
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Allen VM, Weaver H, Ridley AM, Harris JA, Sharma M, Emery J, Sparks N, Lewis M, Edge S. Sources and spread of thermophilic Campylobacter spp. during partial depopulation of broiler chicken flocks. J Food Prot 2008; 71:264-70. [PMID: 18326174 DOI: 10.4315/0362-028x-71.2.264] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The practice of partial depopulation or thinning (early removal of a portion of birds from a commercial broiler flock) is a reported risk factor for Campylobacter colonization of residual birds because of the difficulty in maintaining biosecurity during the thinning process. The effect of this practice was studied in detail for 51 target flocks, each at a different growing farm belonging to one of seven major poultry companies throughout the United Kingdom. On 21 of these farms, the target flock was already colonized by Campylobacter, and at slaughter all cecal samples examined were positive, with a mean of 8 log CFU/g. An additional 27 flocks became positive within 2 to 6 days of the start of thinning and had similarly high levels of cecal carriage at slaughter. Just before the thinning process, Campylobacter was isolated frequently from the farm driveways, transport vehicles, equipment, and personnel. Strains from seven farms on which flocks became colonized after thinning were examined by pulsed-field gel electrophoresis typing. An association was found between strains occurring at specific sampling sites and those isolated subsequently from the thinned flocks. The results indicated that particular strains had spread from one farm to another when the farms were jointly owned by the same company and employed the same bird-catching teams and/or vehicles. These results highlight the need for better hygiene control in relation to catching equipment and personnel and more effective cleaning and disinfection of vehicles and bird-transport crates.
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Affiliation(s)
- V M Allen
- Department of Clinical Veterinary Science, University of Bristol, Langford, North Somerset BS40 5DU, UK.
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Emery J, Morris H, Goodchild R, Fanshawe T, Prevost AT, Bobrow M, Kinmonth AL. The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care. Br J Cancer 2007; 97:486-93. [PMID: 17700548 PMCID: PMC2360348 DOI: 10.1038/sj.bjc.6603897] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The objective was to evaluate the effect of an assessment strategy using the computer decision support system (the GRAIDS software), on the management of familial cancer risk in British general practice in comparison with best current practice. The design included cluster randomised controlled trial, and involved forty-five general practice teams in East Anglia, UK. Randomised to GRAIDS (Genetic Risk Assessment on the Internet with Decision Support) support (intervention n=23) or comparison (n=22). Training in the new assessment strategy and access to the GRAIDS software (GRAIDS arm) was conducted, compared with an educational session and guidelines about managing familial breast and colorectal cancer risk (comparison) were mailed. Outcomes were measured at practice, practitioner and patient levels. The primary outcome measure, at practice level, was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines. Other measures included practitioner confidence in managing familial cancer (GRAIDS arm only) and, in patients: cancer worry, risk perception and knowledge about familial cancer. There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practices (mean 6.2 and 3.2 referrals per 10 000 registered patients per year; mean difference 3.0 referrals; 95% confidence interval (CI) 1.2–4.8; P=0.001); referrals from GRAIDS practices were more likely to be consistent with referral guidelines (odds ratio (OR)=5.2; 95% CI 1.7–15.8, P=0.006). Patients referred from GRAIDS practices had lower cancer worry scores at the point of referral (mean difference −1.44 95% CI −2.64 to −0.23, P=0.02). There were no differences in patient knowledge about familial cancer. The intervention increased GPs' confidence in managing familial cancer. Compared with education and mailed guidelines, assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk, improved practitioner confidence and had no adverse psychological effects in patients. Trials are registered under N0181144343 in the UK National Research Register.
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Affiliation(s)
- J Emery
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, 328 Stirling Highway, Claremont, Western Australia 6010, Australia.
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Emery J, Dacheux N, Clavier N. Investigation in hydrated thorium phosphates by NMR I-relation proton phosphorus. Solid State Nucl Magn Reson 2006; 30:29-44. [PMID: 16500089 DOI: 10.1016/j.ssnmr.2005.12.004] [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] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 12/30/2005] [Indexed: 05/06/2023]
Abstract
The relations between (1)H and (31)P nuclei are investigated by multinuclear and multidimensional nuclear magnetic resonance (NMR) spectroscopy in order to obtain structural information along the transformation of the thorium phosphate hydrogen phosphate hydrate (TPHPH) into the thorium phosphate diphosphate (TPD) when heating. The raw sample obtained at 120 degrees C was heated at 300, 400, 600, 800 or 1100 degrees C and then studied at room temperature. Single acquisition on (1)H and (31)P nuclei, cross-polarization (CP) at the magical angle spinning, Lee-Golburg homonuclear decoupling in two-dimensional experiments, rotational echo double resonance (REDOR and CP-REDOR) and heteronuclear correlation (HETCOR) were performed. These experiments contribute to evidence the differences between the raw sample and that heated. Indeed, above 300 degrees C, hydrogen phosphate groups (HPO(4)) are completely condensed as diphosphate entities (P(2)O(7)). These results confirm that the TPHPH is successively transformed into a low-temperature form of the TPD (called alpha-TPD), then into its well-known beta-form above 950 degrees C.
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Affiliation(s)
- J Emery
- Laboratoire de Physique de l'Etat Condensé, UMR 6087 CNRS, Université du Maine, Avenue O. Messiaen 72085 Le Mans Cedex 9, France.
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Farquhar MC, Barclay SIG, Earl H, Grande GE, Emery J, Crawford RAF. Barriers to effective communication across the primary/secondary interface: examples from the ovarian cancer patient journey (a qualitative study). Eur J Cancer Care (Engl) 2006; 14:359-66. [PMID: 16098121 DOI: 10.1111/j.1365-2354.2005.00596.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 11/28/2022]
Abstract
Effective communication across the primary/secondary interface is vital for the planning and delivery of appropriate patient care throughout the cancer patient journey. This study describes GPs' views of the communication issues across the primary/secondary interface in relation to ovarian cancer patients using qualitative interviews with purposively sampled general practitioners (GPs) and an audit of hospital medical records of 30 deceased ovarian cancer patients. Issues raised by the GPs related to the content and format of communications, but of most concern was the tardiness. The time lag between dictation and typing letters ranged from 0 to 27 days, with a delay of up to 8 days for signing before transit through various mail systems to the GP. Three stages in the patient journey were characterized by particular issues: (1) in the pre-diagnostic and diagnostic stage was a need for prompt information regarding the results of tests and diagnoses, and clearer guidance on the use of tests and fast-track referrals; (2) in the active treatment phase, when GPs could lose touch with their patients, they needed effective communication in order to provide moral support and crisis management; and (3) when oncology withdrew and the focus of care switched back to the community for the terminal phase, GPs needed information to enable them to pick up the baton of care. There is a need to develop and evaluate interventions aimed at improving the content and speed of communications between secondary and primary care. Such interventions are likely to be complex and might include the greater use of telephone or fax for more selected communications, a review of secretarial support, the use of email, the development of GP designed proformas, the feasibility of patient/carer letter delivery options, nurse-led communication, universal electronic patient records, or a revisiting of the patient-held record.
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Affiliation(s)
- M C Farquhar
- Department of Palliative Care and Policy, King's College London, Weston Education Centre, Cutcombe Road, Denmark Hill, London, UK.
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Cadet E, Capron D, Perez AS, Crépin SN, Arlot S, Ducroix JP, Dautréaux M, Fardellone P, Leflon P, Merryweather-Clarke AT, Livesey KJ, Pointon JJ, Rose P, Harcourt J, Emery J, Sueur JM, Feyt R, Robson KJH, Rochette J. A targeted approach significantly increases the identification rate of patients with undiagnosed haemochromatosis. J Intern Med 2003; 253:217-24. [PMID: 12542563 DOI: 10.1046/j.1365-2796.2003.01094.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the optimal means of identifying patients with undiagnosed haemochromatosis. DESIGN Case-control study where cases are defined by the presence of specific clinical diagnoses or symptoms. SETTING Primary care patients were recruited from three Oxfordshire practices and secondary care patients were recruited from those patients attending specialist clinics in Amiens University Hospital. SUBJECTS A total of 569 patients recruited via hospital clinics and 60 primary care patients (recruited from 4022 consultations) presenting with the following haemochromatosis associated conditions, diabetes, arthralgia/chronic fatigue, osteoporosis or arthropathy were studied. The control group, a total of 991 healthy volunteers, were recruited through a Health Appraisal Centre. Patients and controls were included in the study if they or their family members had not previously been diagnosed with hereditary haemochromatosis. MAIN OUTCOME MEASURES Serum ferritin concentration, transferrin saturation (Tsat) and presence of HFE mutations, C282Y and H63D. The check-up in controls consisted of a questionnaire, clinical examination, biochemical tests and screening for the presence of the C282Y and H63D mutations. RESULTS Patient groups presenting with unstable diabetes or chronic fatigue and arthralgia together with a raised serum ferritin concentration showed an enrichment in the haemochromatosis-associated genotype HH/YY, odds ratio (OR) = 40.1, confidence interval (CI) = 8.0-202.1 and OR = 103, CI = 22.9-469.7, respectively. CONCLUSION Patients presenting to hospital clinics with haemochromatosis associated conditions should be screened biochemically for iron overload. Only those with a serum ferritin >300 microg L-1 or Tsat >40% should subsequently go on to be genotyped for HFE mutations. The patients at greatest risk of having undiagnosed haemochromatosis are those presenting with unstable diabetes, or fatigue and/or arthralgia in the absence of any other explanation.
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Affiliation(s)
- E Cadet
- Services de Génétique Médicale, CHU d'Amiens, Faculté de Médecine & Université Jules Verne de Picardie, 3 rue des Louvels, 80036 Amiens, France
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Buzaré JY, Silly G, Emery J, Boccaccio G, Rouault E. Solid-state13C-NMR investigations of crosslinked structure modifications in elastomers during heating treatment. J Appl Polym Sci 2002. [DOI: 10.1002/app.11656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Glasspool DW, Fox J, Coulson AS, Emery J. Risk assessment in genetics: a semi-quantitative approach. Stud Health Technol Inform 2002; 84:459-63. [PMID: 11604782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Public awareness of genetic predisposition to diseases such as breast cancer threatens to put severe strain on genetics services. Computer-based decision support for general practitioners (GPs) has the potential to reduce unnecessary referrals, but issues of communicating about levels of risk and uncertainty must be addressed. An argumentation logic formalism can subsume both traditional probability theory and more qualitative, reason-based approaches to communicating uncertainty, and we propose that qualitative, argument-based presentation will make uncertainty information more accessible and comprehensible to both patient and GP. We describe software that uses an argumentation approach to assess genetic risk during a GP consultation and provide referral advice along with detailed qualitative explanations for its advice. The software was evaluated in real-life GP consultations in which actors played patients concerned about genetic risk, and in use by GPs evaluating simulated cases. Significant improvement in accuracy of assessment and appropriateness of referrals was found. GPs viewed the software and the qualitative reporting approach highly favourably.
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Affiliation(s)
- D W Glasspool
- Advanced Computation Laboratory, Imperial Cancer Research Fund, London, England.
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