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Zhu K, Shelton J, Li C, Mendola P, Barnabei VM, Myneni AA, Giovino GA, Stevens R, Taylor RN, Niu Z, Mu L. Association between maternal cigarette smoking cessation and risk of preterm birth in Western New York. Paediatr Perinat Epidemiol 2024. [PMID: 38558461 DOI: 10.1111/ppe.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive. OBJECTIVES To examine the association of trimester-specific smoking cessation behaviours with PTB risk. METHODS We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI). RESULTS Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m2 (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30). CONCLUSION Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.
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Affiliation(s)
- Kexin Zhu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - James Shelton
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Chan Li
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Vanessa M Barnabei
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Rebeccah Stevens
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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Zhu K, Mendola P, Barnabei VM, Wang M, Hageman Blair R, Schwartz J, Shelton J, Lei L, Mu L. Association of prenatal exposure to PM 2.5 and NO 2 with gestational diabetes in Western New York. Environ Res 2024; 244:117873. [PMID: 38072106 DOI: 10.1016/j.envres.2023.117873] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Although many studies have examined the association between prenatal air pollution exposure and gestational diabetes (GDM), the relevant exposure windows remain inconclusive. We aim to examine the association between preconception and trimester-specific exposure to PM2.5 and NO2 and GDM risk and explore modifying effects of maternal age, pre-pregnancy body mass index (BMI), smoking, exercise during pregnancy, race and ethnicity, and neighborhood disadvantage. METHODS Analyses included 192,508 birth records of singletons born to women without pre-existing diabetes in Western New York, 2004-2016. Daily PM2.5 and NO2 at 1-km2 grids were estimated from ensemble-based models. We assigned each birth with exposures averaged in preconception and each trimester based on residential zip-codes. We used logistic regression to examine the associations and distributed lag models (DLMs) to explore the sensitive windows by month. Relative excess risk due to interaction (RERI) and multiplicative interaction terms were calculated. RESULTS GDM was associated with PM2.5 averaged in the first two trimesters (per 2.5 μg/m3: OR = 1.08, 95% CI: 1.01, 1.14) or from preconception to the second trimester (per 2.5 μg/m3: OR = 1.10, 95% CI: 1.03, 1.18). NO2 exposure during each averaging period was associated with GDM risk (per 10 ppb, preconception: OR = 1.10, 95% CI: 1.06, 1.14; first trimester: OR = 1.12, 95% CI: 1.08, 1.16; second trimester: OR = 1.10, 95% CI: 1.06, 1.14). In DLMs, sensitive windows were identified in the 5th and 6th gestational months for PM2.5 and one month before and three months after conception for NO2. Evidence of interaction was identified for pre-pregnancy BMI with PM2.5 (P-for-interaction = 0.023; RERI = 0.21, 95% CI: 0.10, 0.33) and with NO2 (P-for-interaction = 0.164; RERI = 0.16, 95% CI: 0.04, 0.27). CONCLUSION PM2.5 and NO2 exposure may increase GDM risk, and sensitive windows may be the late second trimester for PM2.5 and periconception for NO2. Women with higher pre-pregnancy BMI may be more susceptible to exposure effects.
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Affiliation(s)
- Kexin Zhu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Vanessa M Barnabei
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachael Hageman Blair
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James Shelton
- Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Lijian Lei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
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Kurek T, Picillo E, Shelton J, Griffith S, DeNagy J. HIV Pre-exposure Prophylaxis at Two Urban Obstetrics/Gynecology Clinics in Buffalo: Awareness and Attitudes Among Non-Hispanic Black vs. Latinx Patients. J Racial Ethn Health Disparities 2023; 10:2294-2301. [PMID: 36097312 DOI: 10.1007/s40615-022-01408-1] [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: 07/15/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Non-Hispanic Black and Latinx women are disproportionately affected by HIV when compared to the general population. This study evaluated awareness of and attitude towards PrEP, self-perceived HIV infection risk, and factors constituting high-risk behavior for HIV infection at two general OB/GYN clinics in Erie County, which exhibited a 31.6% increase in HIV cases from 2019 to 2020. METHODS One thousand twenty-five self-administered surveys were analyzed. RESULTS Of participants, 69.3% were non-Hispanic Black, 13.4% were Latinx, and 22.4% were White. There was no significant difference in awareness of or attitude toward PrEP between non-Hispanic Black and Latinx participants (p = 0.197, p = 0.467). Latinx participants exhibited the lowest awareness of PrEP compared with non-Hispanic Black and White participants (p = 0.002). CONCLUSIONS In our high-risk group, most participants had low self-perceived risk of HIV infection and low awareness of PrEP, and most were unwilling or unsure as to whether they would take PrEP. This calls attention to a need for improved counseling regarding PrEP and what constitutes risk of HIV infection at our general OB/GYN clinics, with a potential focus on Latinx individuals.
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Affiliation(s)
- Tamara Kurek
- Department of OB/GYN, University at Buffalo, 1001 Main St Buffalo, NY 14203, Buffalo, USA.
| | - Ellen Picillo
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - James Shelton
- Department of OB/GYN, University at Buffalo, Buffalo, NY, USA
| | | | - Joseph DeNagy
- Department of OB/GYN, Adventist Health White Memorial, Los Angeles, CA, USA
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Stevens R, Schiffman B, Justicia-Linde F, Shelton J. Postpartum contraception usage in immigrants compared with non-immigrants in Buffalo, NY. Sex Reprod Healthc 2023; 37:100897. [PMID: 37597273 DOI: 10.1016/j.srhc.2023.100897] [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: 02/28/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES The purpose of this study was to compare rates of postpartum contraception use in immigrant populations in Buffalo, NY compared with non-immigrant populations. The study also explores rates of specific birth control selection amongst those who did choose to employ postpartum contraception. STUDY DESIGN A retrospective chart review was conducted comparing the rate of postpartum contraceptive use in 132 immigrant individuals with that of 134 non-immigrant individuals, as measured by the documented intent or refusal to initiate any contraceptive method within the first three months postpartum. Patients were from clinics affiliated with the Women and Children's Hospital of Buffalo (WCHOB) who delivered during the years 2015-2016. The immigrant patients were chosen from the top ten immigrant countries of origin who delivered at WCHOB at the time. RESULTS After controlling for factors of maternal age, gestational age at time of delivery, and gravidity and parity, the immigrant group was more likely to decline postpartum contraception in the first three months postpartum compared with the non-immigrant group (25.8% vs 6.7%, p < 0.001). Immigrants were more likely to select a barrier method (p = 0.036) and decided to employ contraception more remotely from delivery when compared with non-immigrant individuals (p < 0.001). Amongst the immigrant cohort, there was no statistically significant difference in methods chosen based on broad geographic areas of origin. CONCLUSIONS Immigrant obstetric populations in Buffalo are less likely to employ postpartum contraception compared with non-immigrant populations. The factors influencing this are multifactorial; however, this information can inform care for both immigrant and non-immigrant patients.
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Affiliation(s)
- Rebeccah Stevens
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, Buffalo, NY, United States.
| | - Blakeley Schiffman
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, Buffalo, NY, United States.
| | - Faye Justicia-Linde
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, Buffalo, NY, United States.
| | - James Shelton
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, Buffalo, NY, United States.
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Kempton JA, Brighton CH, France LA, KleinHeerenbrink M, Miñano S, Shelton J, Taylor GK. Visual versus visual-inertial guidance in hawks pursuing terrestrial targets. J R Soc Interface 2023; 20:20230071. [PMID: 37312497 DOI: 10.1098/rsif.2023.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The aerial interception behaviour of falcons is well modelled by a guidance law called proportional navigation, which commands steering at a rate proportional to the angular rate of the line-of-sight from predator to prey. Because the line-of-sight rate is defined in an inertial frame of reference, proportional navigation must be implemented using visual-inertial sensor fusion. By contrast, the aerial pursuit behaviour of hawks chasing terrestrial targets is better modelled by a mixed guidance law combining information on the line-of-sight rate with information on the deviation angle between the attacker's velocity and the line-of-sight. Here we ask whether this behaviour may be controlled using visual information alone. We use high-speed motion capture to record n = 228 flights from N = 4 Harris' hawks Parabuteo unicinctus, and show that proportional navigation and mixed guidance both model their trajectories well. The mixed guidance law also models the data closely when visual-inertial information on the line-of-sight rate is replaced by visual information on the motion of the target relative to its background. Although the visual-inertial form of the mixed guidance law provides the closest fit, all three guidance laws provide an adequate phenomenological model of the behavioural data, whilst making different predictions on the physiological pathways involved.
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Affiliation(s)
- James A Kempton
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
| | | | - Lydia A France
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
| | | | - Sofia Miñano
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
| | - James Shelton
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
| | - Graham K Taylor
- Department of Biology, University of Oxford, Oxford OX1 3SZ, UK
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Nims S, Sullivan M, Shelton J, Lardy M, Gallo M, Szczepanski J. Association between initial prenatal blood pressure and development of hypertensive disorders. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.686] [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: 01/09/2023]
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Shelton J, McCall M, Strickland M. A216 WHEN CANCER CASTS THE FIRST STONE: A CASE REPORT OF GALLBLADDER CANCER PRESENTING AS GALLSTONE ILEUS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859188 DOI: 10.1093/jcag/gwab049.215] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Gallstone ileus is a rare cause of mechanical bowel obstruction. It occurs when a biliary stone passes through a cholecystoenteric fistula and becomes impacted in the bowel lumen, most commonly at the terminal ileum or ileocecal valve. Gallbladder cancer is rare and often has a poor prognosis. Many patients present with advanced-stage disease and only 10% of patients are candidates for surgical resection. Early research has shown there is an increased incidence of gallbladder cancer among patients with gallstone ileus. To date, this relationship remains poorly understood. Aims To present a case of an elderly female whose gallbladder cancer presented after causing a cholecystoenteric fistula and gallstone ileus. Methods A retrospective review of a single patient case. Results Our patient was a 78-year-old female with a background history of hypertension, iron-deficiency anemia, osteoporosis, and treated bilateral breast cancer. She initially presented with acute cholecystitis, complicated by a concurrent pulmonary embolism. Given her need for systemic anticoagulation, she was treated non-operatively with antibiotics and an outpatient cholecystectomy was planned. She returned to hospital eight months later reporting two days of nausea and vomiting. A repeat CT scan showed a cholecystoduodenal fistula with a 3.5cm x 2.6cm gallstone impacted 20cm from the ileocecal valve. A laparoscopic-assisted enterolithotomy was performed and her postoperative course was uneventful. One month later, a CT scan was organized by her family physician to follow-up on incidental liver lesions. While the liver lesions were deemed benign, there was new lobulated soft tissue within the gallbladder, measuring 4.8cm x 4.7cm x 6.2cm, suspicious for a primary gallbladder malignancy. A follow-up MRI confirmed an intraluminal mass with direct invasion into hepatic segment III as well as marked segment III intrahepatic biliary dilatation. Endoscopy to the duodenum and cholecystoduodenal fistula was performed with a biopsy confirming gallbladder adenocarcinoma. She underwent an open radical cholecystectomy, left hepatic lobectomy, antrectomy, resection of 1st portion of duodenum, and reconstruction with a Roux-en-Y gastrojejunostomy. Final pathology and staging confirmed a pT3pN0M0 adenocarcinoma of the gallbladder with a fistula tract within the cancer extending to the duodenum. She was then referred to a cancer center to complete a six-month course of adjuvant chemotherapy with capecitabine. Conclusions Gallstone ileus is a cause of mechanical bowel obstruction and rarely, it can be the first presentation of gallbladder cancer. Gallbladder cancer has a poor prognosis with many patients presenting with late-stage disease. As a result, we recommend the consideration of post-enterolithotomy imaging in select patients to evaluate for evidence of malignancy. Funding Agencies None
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Affiliation(s)
- J Shelton
- University of Alberta Department of Medicine, Edmonton, AB, Canada
| | - M McCall
- University of Alberta Department of Surgery, Edmonton, AB, Canada
| | - M Strickland
- University of Alberta Department of Surgery, Edmonton, AB, Canada
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Shelton J, Dorman S, Kim Y, Thorpe P, Narayan B, Gollogly J. Circular frames without x-ray - lessons learned regarding radiation exposure during tibial deformity correction from Low & Middle Income Countries? Trop Doct 2022; 52:253-257. [PMID: 34994249 DOI: 10.1177/00494755211043309] [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: 11/15/2022]
Abstract
Circular frames are a successful way of treating difficult fractures and non-unions. At our institution (CSC) in Phnom Penh, Cambodia, our method differs from developed healthcare systems in that we do not use x-ray to site the frames. A retrospective cohort study was performed between CSC and a UK LRS unit. Demographics, diagnosis, frame type, pre- and post-op deformity, proximal and distal construct alignment comparative to the tibia, and time to union or failure. 70 patients in total were identified and were randomly selected from a hospital in UK. Demographics & deformity were similar and failed to reach significant difference on testing: union rate 70% v. 82%, time to union 9.8 v. 8.5 months, and radiation exposure mean 0 v. 74 cGy/cm2 (range 6.4-326.7). These are startlingly homogenous results considering the differing resources available. We believe that ring fixators are a viable treatment method in austere environments where image intensifiers are unavailable, and demand no unnecessary radiation exposure.
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Affiliation(s)
- James Shelton
- Children's Surgical Centre, Route 6A, Khan Ruseykeo, Chroy Changvar, Phnom Penh, Cambodia
| | - Sara Dorman
- Children's Surgical Centre, Route 6A, Khan Ruseykeo, Chroy Changvar, Phnom Penh, Cambodia
| | - Yinna Kim
- Children's Surgical Centre, Route 6A, Khan Ruseykeo, Chroy Changvar, Phnom Penh, Cambodia
| | - Phillipa Thorpe
- 4595Liverpool University Hospitals NHS Foundation Trust, Broadgreen Hospital, Thomas Drive, Liverpool, L14 3LB
| | - Badri Narayan
- 4595Liverpool University Hospitals NHS Foundation Trust, Broadgreen Hospital, Thomas Drive, Liverpool, L14 3LB
| | - Jim Gollogly
- Children's Surgical Centre, Route 6A, Khan Ruseykeo, Chroy Changvar, Phnom Penh, Cambodia
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Shelton J, Dorman S, Long K, Oy H, Ngiep O, Gollogly J. Total hip arthroplasty in Cambodia - Our experience of two hundred and fifty six consecutive total hip arthroplasties in a low-income country & the challenge of service delivery in this setting. Trop Doct 2022; 52:246-252. [PMID: 34986051 DOI: 10.1177/00494755211047670] [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: 11/16/2022]
Abstract
The Children's Surgical Centre has performed 256 THAs since 2007, We aim to assess the outcome of arthroplasty in a LMIC. Primary outcome: all cause of re-operation, Secondary outcome: any other complication. A retrospective review of all consecutive THA since 2007 was conducted. Electronic and physical case notes were reviewed. Statistical analysis was performed using MedCalc. 256 THA. Mean age: 43, gender M2:1F. Common pathologies include (1) AVN (44%), (2) OA (11%) and (3) DDH (11%). Revision rate 13%. Time to revision was 2.8 years (0-9). Common revision reasons: (1) stem fracture (5.8%), (2) aseptic loosening (4.8%) and (3) infection (2.7%). Complications were identified in 85 patients (33.2%). Common complications included (1) aseptic loosening (10.5%) (2) stem fracture (5.8%) and (3) dislocation (5.8%). Patients at CSC benefit from THA, the complication rates at CSC are declining suggesting the apex of the 'learning curve' has passed. Cheap poorly manufactured implants continue to cause catastrophic failure.
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Affiliation(s)
- J Shelton
- Kadoorie International fellow, The Children's Surgical Centre, Phnom Penh, Cambodia
| | - S Dorman
- Kadoorie International fellow, The Children's Surgical Centre, Phnom Penh, Cambodia
| | - K Long
- Attending Surgeons, The Children's Surgical Centre, Phnom Penh, Cambodia
| | - H Oy
- Attending Surgeons, The Children's Surgical Centre, Phnom Penh, Cambodia
| | - O Ngiep
- Attending Surgeons, The Children's Surgical Centre, Phnom Penh, Cambodia
| | - J Gollogly
- CEO of CSC, The Children's Surgical Centre, Phnom Penh, Cambodia
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Tian S, Kazzi B, Mccook A, Switchenko J, Stokes W, Shelton J, Kahn S, Carlisle J, Steuer C, Owonikoko T, Ramalingam S, Bradley J, Higgins K. FP08.01 Lung Stereotactic Body Radiation Therapy for Treatment of Oligoprogressive and Oligorecurrent Metastatic Disease: A Multi-Center Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shelton J, Raviraj S. A Case Report: Hepatic artery pseudoaneurysm causing life-threatening haemobilia. Int J Surg Case Rep 2021; 86:106350. [PMID: 34482204 PMCID: PMC8426515 DOI: 10.1016/j.ijscr.2021.106350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction & importance Hepatic artery aneurysms (HAA) are rare and it accounts 20% of all visceral artery aneurysms. Commonly HAAs are autopsy findings, but rupture and bleeding carrying significant morbidity and can manifest as haemobilia. Case presentation A 63-year-old Sri Lankan male presented with severe melaena upper abdominal pain and features of obstructive jaundice was found to have a giant pseudoaneurysm at the right hepatic artery with the possible arterio-biliary fistula. The etiology for the pseudoaneurysm was not identified. Despite massive transfusion, the patient died before the endovascular intervention. Clinical discussion Atherosclerosis is the leading cause of HAA formation but can be associated with connective tissue disorders and arteritis. Most of the HAA are asymptomatic. Aneurysms can be managed with surgical or endovascular interventions. Conclusion Life-threatening haemobilia is a notorious complication of the rapture of HAA into the biliary system. The incidents of hepatic artery aneurysms and pseudoaneurysms due to percutaneous transhepatic interventions and minimal invasive hepatobiliary surgeries are in the rising trend. Nonleaking VAA can be best treated with endovascular treatment. The knowledge on this topic is important for the early detection and intervention of this rare entity. Massive Gastrointestinal bleeding can be haemobilia. Rupture of vascular aneurysms into the biliary system can cause severe haemobilia. Incidents of Hepatic artery aneurysms due to minimal invasive transhepatic procedures are in a rising trend. Non-leaking Visceral artery aneurysms can be managed best with Endovascular treatment.
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Affiliation(s)
- J Shelton
- General Surgery, Teaching Hospital Jaffna, Sri Lanka.
| | - S Raviraj
- University Surgical Unit, Teaching Hospital Jaffna, Sri Lanka
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Micheletti SJ, Bryc K, Ancona Esselmann SG, Freyman WA, Moreno ME, Poznik GD, Shastri AJ, Beleza S, Mountain JL, Agee M, Aslibekyan S, Auton A, Bell R, Clark S, Das S, Elson S, Fletez-Brant K, Fontanillas P, Gandhi P, Heilbron K, Hicks B, Hinds D, Huber K, Jewett E, Jiang Y, Kleinman A, Lin K, Litterman N, McCreight J, McIntyre M, McManus K, Mozaffari S, Nandakumar P, Noblin L, Northover C, O’Connell J, Petrakovitz A, Pitts S, Shelton J, Shringarpure S, Tian C, Tung J, Tunney R, Vacic V, Wang X, Zare A. Genetic Consequences of the Transatlantic Slave Trade in the Americas. Am J Hum Genet 2020; 107:265-277. [PMID: 32707084 PMCID: PMC7413858 DOI: 10.1016/j.ajhg.2020.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023] Open
Abstract
According to historical records of transatlantic slavery, traders forcibly deported an estimated 12.5 million people from ports along the Atlantic coastline of Africa between the 16th and 19th centuries, with global impacts reaching to the present day, more than a century and a half after slavery's abolition. Such records have fueled a broad understanding of the forced migration from Africa to the Americas yet remain underexplored in concert with genetic data. Here, we analyzed genotype array data from 50,281 research participants, which-combined with historical shipping documents-illustrate that the current genetic landscape of the Americas is largely concordant with expectations derived from documentation of slave voyages. For instance, genetic connections between people in slave trading regions of Africa and disembarkation regions of the Americas generally mirror the proportion of individuals forcibly moved between those regions. While some discordances can be explained by additional records of deportations within the Americas, other discordances yield insights into variable survival rates and timing of arrival of enslaved people from specific regions of Africa. Furthermore, the greater contribution of African women to the gene pool compared to African men varies across the Americas, consistent with literature documenting regional differences in slavery practices. This investigation of the transatlantic slave trade, which is broad in scope in terms of both datasets and analyses, establishes genetic links between individuals in the Americas and populations across Atlantic Africa, yielding a more comprehensive understanding of the African roots of peoples of the Americas.
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Dumpa V, Avulakunta I, Shelton J, Yu T, Lakshminrusimha S. Induction of labor and early-onset Sepsis guidelines: impact on NICU admissions in Erie County, NY. Matern Health Neonatol Perinatol 2019; 5:19. [PMID: 31844538 PMCID: PMC6894216 DOI: 10.1186/s40748-019-0114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks’ postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study. Methods This is a population-based retrospective comparison of all live births and NICU admissions in Erie County, NY between pre-and post-ACOG IOL guideline epochs (2005–2008 vs. 2011–2014). Information on early-term, full/late/post-term births and NICU admissions was obtained. A detailed chart analysis of indications for admission to the Regional Perinatal Center was performed. Results During the 2005–2008 epoch, early-term births constituted 27% (11,968/44,617) of live births. The NICU admission rate was higher for early-term births (1134/11968 = 9.5%) compared to full/late/post-term (1493/27541 = 5.4%). In the 2011–2014 epoch, early-term births decreased to 23% (10,286/44,575) of live births. However, NICU admissions for early-term (1072/10286 = 10.4%) and full/late/post-term births (1892/29508 = 6.4%) did not decrease partly due to asymptomatic infants exposed to maternal chorioamnionitis admitted for empiric antibiotic therapy as per revised early-onset sepsis guidelines. Conclusions ACOG recommendations against elective IOL or cesarean delivery < 39 weeks PMA were rapidly translated to clinical practice and decreased early-term births in Erie County, NY. This decrease did not translate to reduced NICU admissions partly due to increased NICU admissions for empiric antibiotic therapy.
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14
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White B, Nordin A, Fry A, Ahmad A, McPhail S, Roe C, Rous B, Smittenaar R, Shelton J. Geographic variation in the use of lymphadenectomy and external-beam radiotherapy for endometrial cancer: a cross-sectional analysis of population-based data. BJOG 2019; 126:1456-1465. [PMID: 31449731 DOI: 10.1111/1471-0528.15914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To quantify geographic variation in the use of lymphadenectomy and/or external-beam radiotherapy (EBRT) for endometrial cancer in England. DESIGN Cross-sectional analysis of population-based data. SETTING English cancer registry data, linked to chemotherapy, radiotherapy and hospital episodes statistics data. POPULATION Twenty-two thousand four hundred and eighty-three women with endometrial cancer presenting without clinical or radiological evidence of distant metastatic spread, diagnosed in England from 2013 to 2016. METHODS Proportions of patients receiving lymphadenectomy and/or EBRT were compared across 19 Cancer Alliances, to identify variations in clinical practice. Two separate logistic regression models assessed the impact on variation of adjustment for tumour and patient characteristics. MAIN OUTCOME MEASURES Receipt of lymphadenectomy, receipt of EBRT. RESULTS There was substantial variation by Cancer Alliance in the adjusted proportion of women with endometrial cancer receiving lymphadenectomy (range 5% [95% CI 4-6%] to 48% [95% CI 45-52%]) and EBRT (range 10% [95% CI 7-12%] to 31% [95% CI 28-33%]), after adjusting for variation in pathological grade, age, comorbidities, deprivation, ethnic group and (EBRT only) FIGO stage. Different approaches to clinical practice were identified; (i) one Cancer Alliance had significantly higher than average lymphadenectomy and significantly lower than average EBRT use, (ii) three had high use of both lymphadenectomy and EBRT, (iii) one had low lymphadenectomy use and high EBRT use, and (iv) three had low use of both lymphadenectomy and EBRT. CONCLUSIONS Lymphadenectomy is probably used to triage for EBRT when lymphadenectomy use is high and EBRT use is low. This is probably a result of variation in local endometrial cancer management guidelines, suggesting that UK recommendations should be clarified. TWEETABLE ABSTRACT There is geographic variation in England in the use of lymphadenectomy and radiotherapy to treat endometrial cancer.
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Affiliation(s)
- B White
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Nordin
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,East Kent Hospitals University Foundation NHS Trust, Queen Elizabeth The Queen Mother Hospital, Margate, UK
| | - A Fry
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Ahmad
- Cancer Research UK, London, UK
| | - S McPhail
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - C Roe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - B Rous
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - R Smittenaar
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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15
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Singh S, Haung J, Rivas D, Gemelli T, Weiler M, Tassin T, Chung E, Goetsch S, Shelton J, Richardson J, Schneider J, Mammen P. P.131Cytoglobin modulates skeletal muscle regeneration by targeting canonical Wnt signaling. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.187] [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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16
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Tian S, Switchenko J, Patel P, Shelton J, Kahn S, Pillai R, Steuer C, Owonikoko T, Behera M, Curran W, Higgins K. MA01.02 Lung Stereotactic Body Radiotherapy and Concurrent Immunotherapy: A Multi-Center Safety and Toxicity Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.494] [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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17
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Shelton J, Dorman S, Doorgakant A, Wood E. How well do we reduce ankle fractures intra-operatively: A retrospective 1 year review using Pettrone's criteria. Foot (Edinb) 2019; 40:46-53. [PMID: 31085446 DOI: 10.1016/j.foot.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ankle ORIF is a common orthopaedic procedure. Assessment of the reduction is often performed by 'eyeballing' the intra-operative images. AIMS This study aimed to assess the radiographic reduction of all ankle fracture ORIFs at COCH over a 1-year period using Pettrone's criteria METHOD: Using the trauma database at the COCH all patients admitted for ankle ORIF over a 1 year period (n = 284) were identified. Each patient was retrospectively reviewed, duplicates or non-ankle fractures excluded and data collected on: patient demographics, Lauge-Hansen classification, time from injury to theatre, level of primary surgeon, type of fixation, reduction of medial, lateral or posterior malleolar reduction, syndesmosis reduction, date and satisfaction at last clinic appointment and complications. RESULTS After exclusions 187 patients were included in the study. The average age of patients was 49 years old (14-93). The most common Lauge-Hansen fracture classifications were SER (51.6% (98)) and PER (29.9% (57)). Registrars were first surgeon in 49.7% (93) of cases. 80% (111 of 139) of medial malleoli were reduced, 90% of lateral malleoli were reduced 11% (21) had residual talar shift. The syndesmosis was reduced in 76.4% (143) of cases. 19% (36) had further operations. There were 35 major complications in 25 (13.4%) patients. Not all malposition of fracture fixation were in the same ankles, 34.2% (64) ankle ORIFs had residual deformity after being fixed. CONCLUSION The implications of this study are very important. The authors aim to raise awareness of Pettrone's radiographic criteria of a successful ORIF of the ankle and subsequently improve the mal-reduction rate of post-fixation ankle ORIF.
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Affiliation(s)
- James Shelton
- Health Education North West (Mersey Sector), Summers Road, Liverpool, L3 4BL, UK.
| | - Sara Dorman
- Health Education North West (Mersey Sector), Summers Road, Liverpool, L3 4BL, UK
| | - Ashtin Doorgakant
- Health Education North West (Mersey Sector), Summers Road, Liverpool, L3 4BL, UK
| | - Edward Wood
- Department of Trauma & Orthopaedics, Countess of Chester Hospital, Chester, CH2 1UL, UK
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18
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Johnson C, Caputo R, Karwin C, Murgia S, Ritz S, Shelton J. Search for Gamma-ray Emission from p-wave Dark Matter Annihilation in the Galactic Center. Phys Rev D 2019; 99:10.1103/PhysRevD.99.103007. [PMID: 31535060 PMCID: PMC6749172 DOI: 10.1103/physrevd.99.103007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Indirect searches for dark matter through Standard Model products of its annihilation generally assume a cross-section which is dominated by a term independent of velocity (s-wave annihilation). However, in many DM models an s-wave annihilation cross-section is absent or helicity suppressed. To reproduce the correct DM relic density in these models, the leading term in the cross section is proportional to the DM velocity squared (p-wave annihilation). Indirect detection of such p-wave DM is difficult because the average velocities of DM in galaxies today are orders of magnitude slower than the DM velocity at the time of decoupling from the primordial thermal plasma, thus suppressing the annihilation cross-section today by some five orders of magnitude relative to its value at freeze out. Thus p-wave DM is out of reach of traditional searches for DM annihilations in the Galactic halo. Near the region of influence of a central supermassive black hole, such as Sgr A*, however, DM can form a localized over-density known as a "spike". In such spikes the DM is predicted to be both concentrated in space and accelerated to higher velocities, thereby allowing the γ-ray signature from its annihilation to potentially be detectable above the background. We use the Fermi Large Area Telescope to search for the γ-ray signature of p-wave annihilating DM from a spike around Sgr A* in the energy range 10 GeV-600 GeV. Such a signal would appear as a point source and would have a sharp line or box-like spectral features difficult to mimic with standard astrophysical processes, indicating a DM origin. We find no significant excess of γ rays in this range, and we place upper limits on the flux in γ-ray boxes originating from the Galactic Center. This result, the first of its kind, is interpreted in the context of different models of the DM density near Sgr A*.
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Affiliation(s)
- C. Johnson
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, CA 95064, USA
| | - R. Caputo
- Center for Research and Exploration in Space Science and Technology (CRESST) and NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - C. Karwin
- Physics Department, University of California at Irvine, Irvine, CA
| | - S. Murgia
- Physics Department, University of California at Irvine, Irvine, CA
| | - S. Ritz
- Santa Cruz Institute for Particle Physics, Department of Physics and Department of Astronomy and Astrophysics, University of California at Santa Cruz, Santa Cruz, CA 95064, USA
| | | | - J. Shelton
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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19
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Agbemenu K, Auerbach S, Murshid NS, Shelton J, Amutah-Onukagha N. Reproductive Health Outcomes in African Refugee Women: A Comparative Study. J Womens Health (Larchmt) 2019; 28:785-793. [PMID: 30767694 DOI: 10.1089/jwh.2018.7314] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women. Methods: A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal-Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant. Results: From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks (p < 0.001), fewer preterm births (p < 0.001), fewer low birth weight infants (p < 0.001), and higher rates of vaginal deliveries (p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care (p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups (p < 0.001). Conclusions: The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups.
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Affiliation(s)
- Kafuli Agbemenu
- 1 School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Samantha Auerbach
- 1 School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Nadine Shaanta Murshid
- 2 School of Social Work, The State University of New York (SUNY), University at Buffalo, Amherst, New York
| | - James Shelton
- 3 Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Ndidiamaka Amutah-Onukagha
- 4 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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20
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Mazzucco D, Wiseman D, Hanzlik J, Diamond M, Richardson J, Evers B, Shelton J. An Evaluation of the Zip-Stitch Vaginal Cuff Closure System in a Chronic Canine Ovariohysterectomy Model. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Pearson C, Fraser J, Shelton J. Using English National Cancer Registration and Linked Health Datasets to Assess Variation in Diagnostic Pathway Length for Colorectal and Lung Cancer Patients by Stage and Route to Diagnosis. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.62700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding factors that contribute to longer diagnostic pathways is important to improve efficiency of these pathways and can provide evidence for the implementation of the forthcoming 28-day Faster Diagnostic Standard (FDS) in England. This analysis uses linked national cancer registrations and other health datasets to define diagnostic pathway length and examine variation by route to diagnosis (RtD), stage and patient characteristics for colorectal and lung cancer patients. Aim: To achieve a more in-depth understanding of the diagnostic pathway for colorectal and lung cancer patients and identify particular factors associated with longer diagnostic pathways. Methods: English cancer registrations (2014 & 2015) diagnosed with colorectal and lung cancers (C18-20, C33-34) were linked to the hospital episode statistics, diagnostic imaging dataset, cancer waiting times and RtD data. Patients with multiple diagnoses or unknown RtD were excluded. To construct the pathway length, a start date was derived by defining the earliest relevant event (referral into/appointment in secondary care or diagnostic procedure) from available datasets in the 6 months prediagnosis. The pathway length was determined for each cancer site separately, by stage, RtD and patient characteristic. Regression analysis produced odds ratios (OR) of having a longer diagnostic pathway while controlling for other factors, including age, sex, comorbidities and deprivation. The longer pathway was defined as longer than the median days per cancer site. Results: Of 64,320 colorectal and 71,526 lung patients included, 99.5% and 99.8% respectively had at least one relevant first event recorded. The median pathway length (days) was 26 (IQR 11-56) for colorectal and 35 for lung (15-83). Pathway length decreased significantly with later stage (stage 1-4 - colorectal: 35 to 20, lung: 75 to 25) with significant variation also by presentation route and comorbidity score. Regression analysis showed that, after adjustment for other factors (including stage), patients on a GP referral route had an increased odds of a long pathway compared with the two week wait route (an urgent GP referral with a suspicion of cancer) (colorectal aOR: 4.5, lung aOR: 2.5). Patients diagnosed via emergency presentation route, which are predominantly late stage, had the shortest pathway length and reduced ORs of having a longer diagnostic pathway (colorectal aOR: 0.2, lung aOR: 0.4). Certain patient characteristics are also associated with longer diagnostic pathway length. Conclusion: There is substantial variation in diagnostic pathway length by stage and route for both sites and in many cases these pathways exceeded 28-days (colorectal: 45.3%, lung: 56.4%). Vague symptoms, comorbidities and other patient characteristics may make cancer more difficult to diagnose. Factors associated with longer waits could support the creation of targeted initiatives to reduce the diagnostic pathway length.
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22
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Zhou Y, Mendonca S, Abel G, Hamilton W, Walter F, Johnson S, Shelton J, Elliss-Brookes L, McPhail S, Lyratzopoulos G. Variation in 'Fast-Track' Referrals for Suspected Cancer by Patient Characteristic and Cancer Diagnosis: Evidence From 670,000 Patients With Cancers of 35 Different Sites. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.45100] [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: In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. Methods: We examined data from 669,220 patients with 35 cancers diagnosed 2006-2010 following either fast-track or nonfast track primary-to-secondary care referrals using a bespoke English dataset, the 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristics and cancer diagnosis and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. Results: There were large variations in the odds of fast-track referral by cancer ( P < 0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35 respectively, using rectal cancer as reference); while patients with brain cancer and leukemias least likely (adjusted odds ratios 0.05 and 0.09 respectively for brain cancer and acute myeloid leukemia). There were sex, age and deprivation differences in the odds of fast-track referral ( P < 0.013), which varied in their size and direction for patients with different cancers ( P < 0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. Conclusion: Fast-track referrals are less likely for cancers characterized by nonspecific presenting symptoms and patients belonging to low incidence demographic strata. Interventions beyond clinical guidelines for “alarm” symptoms are needed to improve diagnostic timeliness.
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Affiliation(s)
- Y. Zhou
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - S. Mendonca
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - G. Abel
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - W. Hamilton
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - F. Walter
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - S. Johnson
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - J. Shelton
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - L. Elliss-Brookes
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - S. McPhail
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
| | - G. Lyratzopoulos
- University of Cambridge, Department of Public Health and Primary Care, Cambridge, United Kingdom,
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Brown K, Rumgay H, Dunlop C, Ryan M, Quartly F, Cox A, Deas A, Elliss-Brookes L, Gavin A, Hounsome L, Huws D, Ormiston-Smith N, Shelton J, White C, Parkin D. What Proportion of Cancers in the UK and Its Constituent Countries Could Be Prevented? An Updated Analysis. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.34800] [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: Understanding population-level exposure to cancer risk factors is vital when devising risk-reduction policies. By reducing exposure to cancer risk factors, many cancers could be prevented. But what impact on cancer incidence do these risk factors have? And what proportion of cancers could be prevented if these risk factors are avoided? Aim: The aim of this analysis was to update the estimates of the number and proportion of theoretically preventable cancers in the UK to reflect the changing behavior as assessed in representative national surveys, and new epidemiologic evidence. Separate estimates were also calculated for England, Wales, Scotland, and Northern Ireland because prevalence of risk factor exposure varies between them. Methods: Population attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. Results: Around four in ten (38%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (39%) than UK females (37%). Comparing UK countries, the attributable proportion for persons was highest in Scotland (41%) and lowest in England (37%). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight and obesity, accounting for 15% and 6%, respectively, of all cases in the UK in 2015. Conclusion: Around four in ten (38%) cancer cases in the UK could be prevented. Tobacco and obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to reduce the level of harm associated with exposure or reduce exposure levels - both approaches may be effective in preventing cancer. The variation in PAFs between UK countries is affected by sociodemographic differences which drive differences in exposure to theoretically avoidable 'lifestyle' factors. PAFs at UK country level have not been available previously and they should be used by policymakers in the devolved nations to develop more targeted public health measures. This analysis demonstrates the importance of nationally representative exposure prevalence data and cancer registration in informing evidence-based public health policy.
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Affiliation(s)
- K. Brown
- Cancer Research UK, London, United Kingdom
| | - H. Rumgay
- Cancer Research UK, London, United Kingdom
| | - C. Dunlop
- Cancer Research UK, London, United Kingdom
| | - M. Ryan
- Cancer Research UK, London, United Kingdom
| | - F. Quartly
- Cancer Research UK, London, United Kingdom
| | - A. Cox
- Cancer Research UK, London, United Kingdom
| | - A. Deas
- Cancer Research UK, London, United Kingdom
| | | | - A. Gavin
- Cancer Research UK, London, United Kingdom
| | | | - D. Huws
- Cancer Research UK, London, United Kingdom
| | | | - J. Shelton
- Cancer Research UK, London, United Kingdom
| | - C. White
- Cancer Research UK, London, United Kingdom
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Zhou Y, Mendonca SC, Abel GA, Hamilton W, Walter FM, Johnson S, Shelton J, Elliss-Brookes L, McPhail S, Lyratzopoulos G. Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites. Br J Cancer 2018; 118:24-31. [PMID: 29182609 PMCID: PMC5765227 DOI: 10.1038/bjc.2017.381] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/16/2017] [Accepted: 09/26/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. METHODS We examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. RESULTS There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. CONCLUSIONS Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness.
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Affiliation(s)
- Y Zhou
- Cambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort’s Causeway, Cambridge CB1 8RN, UK
| | - S C Mendonca
- Cambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort’s Causeway, Cambridge CB1 8RN, UK
| | - G A Abel
- University of Exeter Medical School (Primary Care), Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK
| | - W Hamilton
- University of Exeter Medical School (Primary Care), Smeall Building, St Luke’s Campus, Exeter EX1 2LU, UK
| | - F M Walter
- Cambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort’s Causeway, Cambridge CB1 8RN, UK
| | - S Johnson
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - J Shelton
- Cancer Research UK, Angel Building 407 St John Street, London EC1V 4AD, UK
| | - L Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - S McPhail
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - G Lyratzopoulos
- Cambridge Centre for Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort’s Causeway, Cambridge CB1 8RN, UK
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Schlueter R, Siu A, Shelton J, Lee MJ. Routine screening for Chlamydia trachomatis and Neisseria gonorrhoeae in first trimester abortion. J Infect Public Health 2017; 11:584-585. [PMID: 29146429 DOI: 10.1016/j.jiph.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/13/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022] Open
Abstract
Currently no recommendation exists to collect genital culture for Chlamydia trachomatis and Neisseria gonorrhoeae at diagnosis of spontaneous abortion. A retrospective cross sectional study was performed to identify first trimester abortions with concurrent genital culture collection in an emergency room setting. The results were compared to most current 2015 Center for Disease Control (CDC) statistics. Among women aged 15-24 the rate of C. trachomatis was increased to 20.0% and greater than CDC rate of 6.7% (RR 2.97, p<0.0001). No positive screens for C. trachomatis were found above age 30 and the study rate of N. gonorrhoeae was not significantly elevated. Younger women presenting for miscarriage have high prevalence of C. trachomatis in comparison to 2015 CDC statistics. Routine genital culture could be recommended at diagnosis of first trimester spontaneous abortion.
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Affiliation(s)
- Ryan Schlueter
- University of Hawaii, Department of Maternal and Fetal Medicine, United States.
| | - Andrea Siu
- Hawaii Pacific Health Research Institute, United States.
| | - James Shelton
- University of Buffalo, Department of Obstetrics and Gynecology, United States.
| | - Men-Jean Lee
- University of Hawaii, Department of Maternal and Fetal Medicine, United States.
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Higgins K, Pillai R, Chen Z, Zhang C, Patel P, Pakkala S, Shelton J, Force S, Fernandez F, Steuer C, Owonikoko T, Ramalingam S, Bradley J, Curran W. P1.08-003 Concomitant Chemotherapy and Radiotherapy with SBRT Boost for Unresectable, Stage III Non-Small Cell Lung Cancer: A Phase I Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.966] [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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Abstract
Radial head dislocations are common in children who fall onto outstretched hands. We present a case of medial radial head dislocation without a concomitant ulna fracture in a 14-year-old girl and the long-term sequelae of the injury.
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Affiliation(s)
- J Shelton
- Countess of Chester Hospital NHS Foundation Trust, Chester, and The Royal Manchester Children's Hospital , Manchester , UK
| | - M Nixon
- Countess of Chester Hospital NHS Foundation Trust, Chester, and The Royal Manchester Children's Hospital , Manchester , UK
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Abstract
Background Cubital tunnel decompression is a commonly undertaken upper limb procedure. Most studies compare the different techniques of decompression; however, only a few have specifically investigated the outcome of ulnar nerve decompression. Aim The aim of this study was to investigate the outcome of ulnar nerve decompression following cubital tunnel syndrome. Methods and results A total of 174 ulnar nerve decompression cases were identified from the upper limb surgery database with complete data available for 136 cases. Simple decompression was performed in 110 (80.88%) cases, and in 26 (19.12%), anterior subcutaneous transposition was also supplemented. These operations were performed at three different hospitals by surgeons of different levels of experience. The most common cause of cubital tunnel syndrome was idiopathic. The outcome was satisfactory in 86% of cases. No obvious association was demonstrated between the outcome of surgery and duration of symptoms, presence of co-morbidities or the type of surgery performed. Conclusion This is the largest outcome analysis of the results of ulnar nerve decompression at the elbow. Good results following nerve decompression were attained in 86% of cases without any significant effect of duration of symptoms or co-morbidities on the outcome of surgery. It is hoped that the findings of the current study will help general practitioners, junior doctors and surgeons in their management and pre-operative consultation with patients having cubital tunnel syndrome.
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Affiliation(s)
- A Jariwala
- Consultant Upper Limb and Trauma Surgeon Ninewells Hospital and Medical School, UK
| | - N Bansal
- Research Fellow, University Department of Orthopaedic and Trauma Surgery, TORT Centre, Ninewells Hospital and Medical School, UK
| | - GM Nicol
- Speciality Registrar, Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, UK
| | - J Shelton
- CT2, Department of Trauma & Orthopaedics, Macclesfield District General Hospital, UK
| | - CA Wigderowitz
- Senior Clinical Lecturer, University Department of Orthopaedic and Trauma Surgery, TORT Centre, Ninewells Hospital and Medical School
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Abel GA, Shelton J, Johnson S, Elliss-Brookes L, Lyratzopoulos G. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. Br J Cancer 2015; 112 Suppl 1:S129-36. [PMID: 25734396 PMCID: PMC4385986 DOI: 10.1038/bjc.2015.52] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer. METHODS Data from the Routes to Diagnosis project on 749,645 patients (2006-2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined. RESULTS The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39-1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32-0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35-44- vs 65-74-year-olds, 2.01; 95% CI 1.76-2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin's lymphoma (e.g., melanoma specific odds ratio in 35-44- vs 65-74-year-olds, 0.20; 95% CI 0.12-0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers. CONCLUSIONS Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.
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Affiliation(s)
- G A Abel
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - J Shelton
- Care Quality Commission, Finsbury Tower, 103–105 Bunhill Row, London EC1Y 8TG, UK
- National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK
| | - S Johnson
- National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK
| | - L Elliss-Brookes
- National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK
| | - G Lyratzopoulos
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
- National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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Rubin G, Gildea C, Wild S, Shelton J, Ablett-Spence I. Assessing the impact of an English national initiative for early cancer diagnosis in primary care. Br J Cancer 2015; 112 Suppl 1:S57-64. [PMID: 25734381 PMCID: PMC4385977 DOI: 10.1038/bjc.2015.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Cancer Networks Supporting Primary Care programme was a National Health Service (NHS) initiative in England between 2011 and 2013 that aimed to better understand and improve referral practices for suspected cancer. METHODS A mixed methods evaluation using semi-structured interviews with purposefully sampled key stakeholders and an analysis of Cancer Waiting Times and Hospital Episode Statistics data for all 8179 practices in England were undertaken. We compared periods before (2009/10) and at the end (2012/13) of the initiative for practices taking up any one of four specified quality improvement initiatives expected to change referral practice in the short to medium term and those that did not. RESULTS Overall, 38% of general practices were involved in at least one of four quality improvement activities (clinical audit, significant event analysis, use of risk assessment tools and development of practice plans). Against an overall 29% increase in urgent cancer referrals between 2009/10 and 2012/13, these practices had a significantly higher increase in referral rate, with reduced between-practice variation. There were no significant differences between the two groups in conversion, detection or emergency presentation rates. Key features of successful implementation at practice and network level reported by participants included leadership, organisational culture and physician involvement. Concurrent health service reforms created organisational uncertainty and limited the programme's effectiveness. CONCLUSIONS Specific primary care initiatives promoted by cancer networks had an additional and positive impact on urgent referrals for suspected cancer. Successful engagement with the programmes depended on effective and well-supported leadership by cancer networks and their general practitioner (GP) leads.
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Affiliation(s)
- G Rubin
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK
| | - C Gildea
- PHE Knowledge and Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - S Wild
- PHE Knowledge and Intelligence Team (East Midlands), 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - J Shelton
- Care Quality Commission, 103-105 Bunhill Row, London EC1Y 8TG, UK
| | - I Ablett-Spence
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK
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Papp KA, Barber K, Bissonnette R, Bourcier M, Lynde CW, Poulin Y, Shelton J, Garces K, Toole J, Poulin-Costello M. Improvements in patient-reported outcomes in patients with psoriasis receiving etanercept plus topical therapies: results from REFINE. J Eur Acad Dermatol Venereol 2015; 29:1555-61. [PMID: 25611084 PMCID: PMC5024053 DOI: 10.1111/jdv.12934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022]
Abstract
Background The REFINE study examined the efficacy and safety of adding topical corticosteroid therapy to etanercept when stepping down from the initial dose of etanercept to the maintenance dose. Clinical responses were shown to be similar in patients who remained on etanercept 50 mg twice weekly (BIW) and those who received etanercept 50 mg once weekly (QW) plus topical therapies through week 24. Objective The purpose of this analysis was to evaluate the effect of treatment on health‐related quality of life (HRQoL) for patients in REFINE. Methods All patients received etanercept 50 mg BIW for 12 weeks and were then randomized to etanercept 50 mg BIW or etanercept 50 mg QW plus topical corticosteroid as required to clear through week 24. HRQoL measures included the Dermatology Life Quality Index (DLQI), Treatment Satisfaction Questionnaire for Medication (TSQM) and the Economic Implications of Psoriasis Patient Questionnaire. No comparative testing was performed for this descriptive analysis. Missing data were imputed using the last observation carried forward. Results For 287 randomized patients (144 etanercept; 143 etanercept plus topical), the mean change [standard deviation (SD)] in DLQI from baseline to week 24 was 10.7 (7.8) for etanercept and 9.9 (6.9) for etanercept plus topical. Mean change (SD) in TSQM effectiveness, convenience, side‐effects and global satisfaction was 27.1 (36.1), 14.8 (25.9), −0.7 (22.0) and 26.7 (32.5) for the etanercept arm and 32.5 (40.3), 18.5 (29.0), 1.3 (19.4) and 28.4 (35.9) for etanercept plus topical. Economic implications, including healthcare visits, employment status, work productivity, ability to perform daily activities and out‐of‐pocket expenses were similar between treatment arms. Conclusion At week 24 of REFINE, measures of HRQoL were numerically similar in patients who stayed on etanercept 50 mg BIW and patients who received etanercept 50 mg QW plus topical therapies.
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Affiliation(s)
- K A Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - K Barber
- Kirk Barber Research, Calgary, AB, Canada
| | | | | | - C W Lynde
- Lynde Centre for Dermatology, Markham, ON, Canada
| | - Y Poulin
- Centre Dermatologique du Quebec Metropolitain, Quebec, QC, Canada
| | - J Shelton
- Amgen Canada Inc., Mississauga, ON, Canada
| | - K Garces
- Amgen Canada Inc., Mississauga, ON, Canada
| | - J Toole
- University of Manitoba, Winnipeg, MB, Canada
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Papp KA, Barber K, Bissonnette R, Bourcier M, Lynde CW, Poulin Y, Shelton J, Toole J, Vieira A, Poulin-Costello M. A Randomized, blinded assessor study to Evaluate the efFIcacy and safety of etanercept 50 mg once weekly plus as Needed topical agent vs. Etanercept 50 mg twice weekly in patients with moderate to severe plaque psoriasis (REFINE). J Eur Acad Dermatol Venereol 2014; 29:361-366. [PMID: 24980988 PMCID: PMC4340046 DOI: 10.1111/jdv.12555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 04/16/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Topical corticosteroids are used with systemic therapies for treatment of plaque psoriasis, but data from randomized clinical trials to document efficacy of combination therapy are lacking. OBJECTIVE To evaluate efficacy and safety of adding topical corticosteroid therapy from the time that etanercept dosage is reduced from initial label dose [50 mg twice weekly (BIW)] to maintenance dose [50 mg once weekly (QW)]. METHODS In this phase 3b, multicentre, randomized, open-label study, patients with moderate-to-severe plaque psoriasis received etanercept 50 mg BIW for 12 weeks, and then were randomized to etanercept 50 mg BIW or 50 mg QW plus topical agent as needed to achieve static physician global assessment (sPGA) status of clear for 12 weeks. Endpoints included percentage change in Psoriasis Area and Severity Index (PASI) score from week 12 to week 24 (primary endpoint); proportion of patients achieving 50% improvement in (PASI 50), PASI 75 and PASI 90; patients achieving sPGA of clear/almost clear; and change in affected body surface area (BSA). RESULTS Mean difference [95% confidence interval (CI)] between etanercept arm (n = 140) and etanercept plus topical arm (n = 142) in change in PASI score from week 12 to week 24 was 16.2% (-3.5%, 35.8%). PASI response rates were similar between groups. Percentage (95% CI) of patients achieving sPGA status of clear/almost clear was 40.6% (32.5%, 48.6%) and 45.8% (37.6%, 54.0%) at week 12 for patients in etanercept and etanercept plus topical arms, respectively, and 53.5% (45.3%, 61.7%) and 45.4% (37.2%, 53.6%) at week 24. Difference (95% CI) between groups in change in affected BSA from week 12 to week 24 was 4.9% (-23.4%, 33.2%). CONCLUSION Patients who received etanercept 50 mg QW at week 12 plus as-needed topical therapy and those who stayed on etanercept 50 mg BIW maintained clinical response through week 24 with no notable differences in PASI responses.
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Affiliation(s)
- K A Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - K Barber
- Kirk Barber Research, Calgary, AB, Canada
| | | | | | - C W Lynde
- Lynde Centre for Dermatology, Markham, ON, Canada
| | - Y Poulin
- Centre Dermatologique du Quebec Metropolitain, Quebec, QC, Canada
| | - J Shelton
- Amgen Canada Inc., Mississauga, ON, Canada
| | - J Toole
- University of Manitoba and Probity Medical Research, Winnipeg, MB, Canada
| | - A Vieira
- Amgen Canada Inc., Mississauga, ON, Canada
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Affiliation(s)
- James Shelton
- Clinical Skills Department; Ninewells Hospital & Medical School; Dundee UK
| | - Sara Dorman
- Clinical Skills Department; Ninewells Hospital & Medical School; Dundee UK
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Schlueter R, Liu C, Crimmins S, Patel B, Shelton J, Shaman M. 524: Routine screening for Chlamydia trachomatis and Neisseria gonorrhea in patients with first trimester abortion. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.557] [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
IMPORTANCE Full-term neonates born between 37 and 41 weeks' gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies based on mode of delivery has pointed toward increased morbidity associated with early-term cesarean section births (37-38 weeks) compared with term neonates (39-41 weeks). OBJECTIVE To compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service. DESIGN, SETTING, AND PARTICIPANTS Retrospective population-based 3-year birth cohort study (January 1, 2006-December 31, 2008) at all major birth hospitals in Erie County, New York. All full-term live births comprised the birth cohort; this information was obtained from the hospitals' perinatal databases, and data pertaining to NICU or neonatology service admissions were extracted from individual medical records. EXPOSURE Gestational age of early term (37(0/7)-38(6/7) weeks) vs term (39(0/7)-41(0/7) weeks). MAIN OUTCOMES AND MEASURES Admission to the NICU or neonatology service. RESULTS There were 33,488 live births during the 3-year period, of which 29,741 had a gestational age between 37 and 41 weeks. Of all live births, 9031 (27.0%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycemia (4.9% vs 2.5%; adjusted odds ratio [OR], 1.92), NICU or neonatology service admission (8.8% vs 5.3%; adjusted OR, 1.64), need for respiratory support (2.0% vs 1.1%; adjusted OR, 1.93), requirement for intravenous fluids (7.5% vs 4.4%; adjusted OR, 1.68), treatment with intravenous antibiotics (2.6% vs 1.6%; adjusted OR, 1.62), and mechanical ventilation or intubation (0.6% vs 0.1%; adjusted OR, 4.57). Delivery by cesarean section was common among early-term births (38.4%) and increased the risk for NICU or neonatology service admission (12.2%) and morbidity (7.5%) compared with term births. Among vaginal deliveries, early-term neonates (6.8%) had a significantly higher rate of NICU or neonatology service admission compared with term neonates (4.4%). CONCLUSIONS AND RELEVANCE Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.
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Affiliation(s)
- Shaon Sengupta
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hall W, Hardy C, Colbert L, Fisher S, Kooby D, Adsay V, Shelton J, Maithel S, Landry J, Yu D. Chromodomain Helicase DNA Binding Protein 5 (CHD5) Is Associated With Improved Overall Survival in Patients Undergoing Adjuvant Therapy for Resected Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lavin TE, Nielsen BD, Zingsheim JN, O'Connor-Robison CI, Link JE, Hill GM, Shelton J. Effects of phytase supplementation in mature horses fed alfalfa hay and pelleted concentrate diets. J Anim Sci 2013; 91:1719-27. [DOI: 10.2527/jas.2012-5081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T. E. Lavin
- Department of Animal Science, Michigan State University, East Lansing 48824
| | - B. D. Nielsen
- Department of Animal Science, Michigan State University, East Lansing 48824
| | - J. N. Zingsheim
- Department of Animal Science, Michigan State University, East Lansing 48824
| | | | - J. E. Link
- Department of Animal Science, Michigan State University, East Lansing 48824
| | - G. M. Hill
- Department of Animal Science, Michigan State University, East Lansing 48824
| | - J. Shelton
- Cargill Animal Nutrition, Elk River, MN 55330
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Papp K, Poulin Y, Vieira A, Shelton J, Poulin-Costello M. Disease characteristics in patients with and without psoriatic arthritis treated with etanercept. J Eur Acad Dermatol Venereol 2013; 28:581-9. [DOI: 10.1111/jdv.12138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/15/2013] [Indexed: 12/12/2022]
Affiliation(s)
- K. Papp
- Probity Medical Research; 135 Union Street East Waterloo ON N2J 1C4 Canada
| | - Y. Poulin
- Centre Dermatologique du Quebec Metropolitain; Quebec Canada
| | - A. Vieira
- Amgen Canada Inc.; Mississauga ON Canada
| | - J. Shelton
- Amgen Canada Inc.; Mississauga ON Canada
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Papp K, Poulin Y, Vieira A, Shelton J, Poulin-Costello M. Différences de gravité du psoriasis chez des sujets atteints ou non de rhumatisme psoriasique et traités par l’étanercept. Ann Dermatol Venereol 2012. [DOI: 10.1016/j.annder.2012.10.520] [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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Pantazides B, Hardy C, Gandhi K, Landry J, Shelton J, Maithel S, El-Rayes B, Kowalski J, Yu D. A Synthetic Lethal Screen Identifies Genes That Mediate Gemcitabine Resistance in Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, Richards M. Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. Br J Cancer 2012; 107:1220-6. [PMID: 22996611 PMCID: PMC3494426 DOI: 10.1038/bjc.2012.408] [Citation(s) in RCA: 369] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/06/2012] [Accepted: 08/15/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis. METHODS Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006-2008, is categorised into one of eight 'Routes to Diagnosis'. RESULTS Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival. CONCLUSION Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis.
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Affiliation(s)
- L Elliss-Brookes
- Avon, Somerset, and Wiltshire Cancer Services, South Plaza, Marlborough Street, Bristol BS1 3NX, UK
| | - S McPhail
- National Cancer Intelligence Network, 18th Floor, Portland House, Bressenden Place, London SW1E 5RS, UK
| | - A Ives
- South West Public Health Observatory, Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK
| | - M Greenslade
- South West Public Health Observatory, Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK
| | - J Shelton
- National Cancer Intelligence Network, 18th Floor, Portland House, Bressenden Place, London SW1E 5RS, UK
| | - S Hiom
- Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - M Richards
- National Cancer Action Team, 18th Floor, Portland House, Bressenden Place, London SW1E 5RS, UK
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Gray RH, Shelton J, Serwadda D, Wawer MJ, Nalugoda F, Ssempiija V. The contribution of HIV-discordant relationships to new HIV infections. AIDS 2011. [DOI: 10.1097/qad.0b013e32834ad67f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 2011; 16:179-83. [DOI: 10.1007/s10029-011-0879-9] [Citation(s) in RCA: 487] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 08/04/2011] [Indexed: 12/16/2022]
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Sasieni PD, Shelton J, Ormiston-Smith N, Thomson CS, Silcocks PB. What is the lifetime risk of developing cancer?: the effect of adjusting for multiple primaries. Br J Cancer 2011; 105:460-5. [PMID: 21772332 PMCID: PMC3172907 DOI: 10.1038/bjc.2011.250] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/17/2011] [Accepted: 06/12/2011] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The 'lifetime risk' of cancer is generally estimated by combining current incidence rates with current all-cause mortality ('current probability' method) rather than by describing the experience of a birth cohort. As individuals may get more than one type of cancer, what is generally estimated is the average (mean) number of cancers over a lifetime. This is not the same as the probability of getting cancer. METHODS We describe a method for estimating lifetime risk that corrects for the inclusion of multiple primary cancers in the incidence rates routinely published by cancer registries. The new method applies cancer incidence rates to the estimated probability of being alive without a previous cancer. The new method is illustrated using data from the Scottish Cancer Registry and is compared with 'gold-standard' estimates that use (unpublished) data on first primaries. RESULTS The effect of this correction is to make the estimated 'lifetime risk' smaller. The new estimates are extremely similar to those obtained using incidence based on first primaries. The usual 'current probability' method considerably overestimates the lifetime risk of all cancers combined, although the correction for any single cancer site is minimal. CONCLUSION Estimation of the lifetime risk of cancer should either be based on first primaries or should use the new method.
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Affiliation(s)
- P D Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Bart's and The London School of Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
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Lowe M, Cavitt A, Shelton J, Maynard N, Crocker IR, Carlson GW, Delman KA, Lawson DH, Rizzo M. The prognostic utility of LDH and disease-specific graded prognostic assessment for melanoma brain metastases. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8590] [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: 11/20/2022] Open
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Shelton J, Kummerow K, Phillips S, Griffin M, Holzman M, Nealon W, Pinson C, Poulose B. An Urban-Rural Blight? Choledocholithiasis Presentation And Treatment. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.801] [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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Poulose B, Phillips S, Nealon W, Shelton J, Kummerow K, Penson D, Griffin M, Holzman M. Choledocholithiasis Management in Rural America: Health Disparity or Health Opportunity? J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shelton J, Phillips S, Arbogast P, Griffin M, Holzman M, Nealon W, Poulose B. Patient Safety In The Era Of The 80-Hour Work Week. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.584] [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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Schreibmann E, Shelton J, Rossi P, Master V, Jani A. Impact of Prostate Motion on Delivered Dose during Intensity Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1590] [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: 10/19/2022]
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