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Pearce H, Hamilton D, Sharp L, Deane J, Kennedy M, O'Hara J. Routes to diagnosis of hypopharyngeal cancer: A single-centre experience. Clin Otolaryngol 2024. [PMID: 38515125 DOI: 10.1111/coa.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Helen Pearce
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - David Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Matthew Kennedy
- Department of Oral and Maxillofacial Surgery, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - James O'Hara
- Department of Otolaryngology-Head and Neck Surgery, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Bradley P, Deane J, O'Hara J, Kennedy M, Carrard VC, Cheong SC, Sharp L. Teledentistry may help in detecting oral cancers in current GP and dentist shortages. BMJ 2024; 384:q512. [PMID: 38428988 DOI: 10.1136/bmj.q512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
| | | | - James O'Hara
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Matt Kennedy
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Vinicius C Carrard
- School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Linda Sharp
- Newcastle University, Newcastle upon Tyne, UK
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Neilson LJ, Fitzgerald RC, Deane J, Debiram-Beecham I, Gulle H, Rees C, Sharp L. Patient experiences of Cytosponge: a qualitative study. Frontline Gastroenterol 2024; 15:28-34. [PMID: 38487563 PMCID: PMC10935513 DOI: 10.1136/flgastro-2023-102484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/28/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Cytosponge is a novel technology for oesophageal pathology diagnosis. Uses include diagnosis of Barrett's oesophagus and as a triage tool to prioritise upper gastrointestinal endoscopy. Patient experience is a key component of quality care. Previous work has developed endoscopy patient-reported experience measures. An appropriate tool to measure patient experience of Cytosponge is required. The aim of this work was to describe the patient experience of Cytosponge. Design/Method Individuals aged 18 years or over, who had undergone Cytosponge from September 2020 to March 2021, were invited to participate in a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken. Themes were organised into two overarching areas relating to patient experiences and patient perceptions of the test. Results 19 patients underwent interview (aged 37-80 years, 13 male). In terms of patient experiences of Cytosponge, five themes were identified: emotional reaction; expectations; environment and physical process; sensory experience; communication and information. All themes were present across all procedural phases, aside from sensory experience which was only present during the test. With regard to perception of the test, two major themes were identified: test novelty (encompassing patient awareness of the test and reaction to the new test) and trusting the test results. Conclusion Patients must remain central to novel technologies such as Cytosponge. Measuring patient experience is essential to achieve that. This study demonstrates five major themes which describe the patient experience of this procedure. These have been used to adapt the Newcastle ENDOPREM for use in Cytosponge.
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Affiliation(s)
- Laura Jane Neilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Rebecca C Fitzgerald
- Early Cancer Institute, University of Cambridge, Cambridge, UK
- Early Detection Programme, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Irene Debiram-Beecham
- Early Cancer Institute, University of Cambridge, Cambridge, UK
- Early Detection Programme, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Halime Gulle
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin Rees
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Ferguson JK, Chiu S, Oldmeadow C, Deane J, Munnoch S, Fraser N. VRE acquisition in hospital and its association with hospital antimicrobial usage -a non-linear analysis of an extended time series. Infect Dis Health 2023; 28:151-158. [PMID: 36803829 DOI: 10.1016/j.idh.2023.01.003] [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: 07/27/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Vancomycin resistant enterococci (VRE) have become endemic pathogens in many Australian hospitals causing significant morbidity. There are few observational studies that have evaluated the effect of antibiotic usage on VRE acquisition. This study examined VRE acquisition and its association with antimicrobial use. The setting was a NSW tertiary hospital with 800 beds over a 63 month period up to March 2020, straddling piperacillin-tazobactam (PT) shortages that occurred from in September 2017. METHODS The primary outcome was monthly inpatient hospital onset Vancomycin-resistant Enterococci (VRE) acquisitions. Multivariate adaptive regression splines (MARS) were used to estimate hypothetical thresholds, where antimicrobial use above threshold is associated with increased incidence of hospital onset VRE acquisition. Specific antimicrobials and categorised usage (broad, less broad and narrow spectrum) were modelled. RESULTS There were 846 hospital onset VRE detections over the study period. Hospital onset vanB and vanA VRE acquisitions fell significantly by 64% and 36% respectively after the PT shortage. MARS modelling indicated that PT usage was the only antibiotic found to exhibit a meaningful threshold. PT usage greater than 17.4 defined daily doses/1000 occupied bed-days (95%C I: 13.4, 20.5) was associated with higher onset of hospital VRE. CONCLUSIONS This paper highlights the large, sustained impact that reduced broad spectrum antimicrobial use had on VRE acquisition and showed that PT use in particular was a major driver with a relatively low threshold. It raises the question as to whether hospitals should be determining local antimicrobial usage targets based on direct evidence from local data analysed with non-linear methods.
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Affiliation(s)
- J K Ferguson
- John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, NSW, Australia.
| | - S Chiu
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - C Oldmeadow
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - J Deane
- Infection Prevention Service, Hunter New England Health Service, NSW, Australia
| | - S Munnoch
- Infection Prevention Service, Hunter New England Health Service, NSW, Australia
| | - N Fraser
- Hunter New England Population Health Unit, NSW, Australia
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Sharp L, Mentor K, Deane J, Watson E, Roberts KJ, Silva M, Phillips M, Siriwardena AK, Hammond J, Bradshaw A, Exley C, Pandanaboyana S. Assessing impact, needs and quality-of-life among informal carers of people with pancreatic cancer, a prospective study: the PAN-CARER study protocol. BMJ Open 2023; 13:e068178. [PMID: 37188466 DOI: 10.1136/bmjopen-2022-068178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Approximately 10 300 people are diagnosed with pancreatic cancer each year in the UK. The cancer and its treatment inflict a significant physical, functional and emotional burden on patients. Research suggests that patients have many ongoing needs for support and care, but that these needs are not met by existing services. Family members often step in to fill this gap and provide support and care during and after treatment. Research in other cancers shows that this informal caregiving can place a very heavy burden on carers. However, there are few studies in the international literature that have focused on informal carers in pancreatic cancer; none have been conducted in the UK. METHODS AND ANALYSIS Two complementary research methods will be utilised. First, a longitudinal quantitative study of 300 carers investigating, using validated questionnaires to assess the impact of caregiving (Caregiver Reaction Assessment), the unmet needs of carers (Supportive Care Needs Survey) and the quality-of-life (Short Form 12-item health survey), will be conducted. Second, qualitative interviews will be conducted with up to 30 carers to explore their experiences in more depth. Mixed-effects regression models will be applied to survey results to determine how impact, needs and quality-of-life vary over time, compare outcomes between carers of patients with operable and inoperable disease and identify social factors which affect outcomes. Interview data will undergo reflexive thematic analysis. ETHICS AND DISSEMINATION The protocol has been approved by the Health Research Authority of the UK (Ethical approval IRAS ID 309503). Findings will be published in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Keno Mentor
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- HPB and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Eila Watson
- Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - Keith J Roberts
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - John Hammond
- HPB and Transplant unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Alex Bradshaw
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sanjay Pandanaboyana
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- HPB and Transplant unit, Freeman Hospital, Newcastle upon Tyne, UK
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6
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Deane J, Norris R, O’Hara J, Patterson J, Sharp L. Who Presents Where? A Population-Based Analysis of Socio-Demographic Inequalities in Head and Neck Cancer Patients' Referral Routes. Int J Environ Res Public Health 2022; 19:16723. [PMID: 36554605 PMCID: PMC9779534 DOI: 10.3390/ijerph192416723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Head and neck cancers (HNC) are often late stage at diagnosis; stage is a major determinant of prognosis. The urgent cancer referral pathway (two week wait; 2WW) within England's National Health Service aims to reduce time to diagnosis. We investigated factors associated with HNC route to diagnosis. Data were obtained from the English population-based cancer registry on 66,411 primary invasive HNCs (ICD C01-14 and C31-32) diagnosed 2006-2014. Multivariable logistic regression determined the likelihood of different diagnosis routes by patients' demographic and clinical characteristics. Significant socio-demographic inequalities were observed. Emergency presentations declined over time and 2WW increased. Significant socio-demographic inequalities were observed. Non-white patients, aged over 65, residing in urban areas with advanced disease, were more likely to have emergency presentations. White males aged 55 and older with an oropharynx cancer were more likely to be diagnosed via 2WW. Higher levels of deprivation were associated with both emergency and 2WW routes. Dental referral was more likely in women, with oral cancers and lower stage disease. Despite the decline over time in emergency presentation and the increased use of 2WW, socio-demographic variation is evident in routes to diagnosis. Further work exploring the reasons for these inequalities, and the consequences for patients' care and outcomes, is urgently required.
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Affiliation(s)
- Jennifer Deane
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - Ruth Norris
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - James O’Hara
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
- Freeman Hospital, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne NE7 7DN, UK
| | - Joanne Patterson
- School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
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Menger F, Deane J, Patterson JM, Fisher P, O’Hara J, Sharp L. The nature and content of rumination for head and neck cancer survivors. Front Psychol 2022; 13:995187. [DOI: 10.3389/fpsyg.2022.995187] [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] [Received: 07/15/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHead and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors’ experiences of rumination.MethodsTwenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46–83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.ResultsFour themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).ConclusionThis study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.
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Neilson LJ, Fitzgerald RC, Deane J, Debiram-Beecham I, Sharp L, Rees CJ. Measuring patient experience of Cytosponge using the Newcastle ENDOPREM. Frontline Gastroenterol 2022; 14:355-356. [PMID: 37409338 DOI: 10.1136/flgastro-2022-102288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 08/31/2023] Open
Affiliation(s)
- Laura Jane Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca C Fitzgerald
- Early Cancer Institute, University of Cambridge, Cambridge, UK
- Early Detection Programme, CRUK Cambridge Centre, Cambridge, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Ronan NJ, Einarsson GG, Deane J, Fouhy F, Rea M, Hill C, Shanahan F, Elborn JS, Ross RP, McCarthy M, Murphy DM, Eustace JA, Mm T, Stanton C, Plant BJ. Modulation, microbiota and inflammation in the adult CF gut: A prospective study. J Cyst Fibros 2022; 21:837-843. [PMID: 35764510 DOI: 10.1016/j.jcf.2022.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cystic Fibrosis (CF) has prominent gastrointestinal and pancreatic manifestations. The aim of this study was to determine the effect of Cystic fibrosis transmembrane conductance regulator (CFTR) modulation on, gastrointestinal inflammation, pancreatic function and gut microbiota composition in people with cystic fibrosis (CF) and the G551D-CFTR mutation. METHODS Fourteen adult patients with the G551D-CFTR mutation were assessed clinically at baseline and for up to 1 year after treatment with ivacaftor. The change in gut inflammatory markers (calprotectin and lactoferrin), exocrine pancreatic status and gut microbiota composition and structure were assessed in stool samples. RESULTS There was no significant change in faecal calprotectin nor lactoferrin in patients with treatment while all patients remained severely pancreatic insufficient. There was no significant change in gut microbiota diversity and richness following treatment. CONCLUSION There was no significant change in gut inflammation after partial restoration of CFTR function with ivacaftor, suggesting that excess gut inflammation in CF is multi-factorial in aetiology. In this adult cohort, exocrine pancreatic function was irreversibly lost. Longer term follow-up may reveal more dynamic changes in the gut microbiota and possible restoration of CFTR function.
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Affiliation(s)
- N J Ronan
- Cork Adult CF Centre, Cork University Hospital, Wilton, Cork; HRB Clinical research facility, University College Cork
| | - G G Einarsson
- Halo Research Group, Queen's University Belfast, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine. School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, UK
| | - J Deane
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland; APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - F Fouhy
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland; APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - M Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland; APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - C Hill
- APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - F Shanahan
- APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - J S Elborn
- Halo Research Group, Queen's University Belfast, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine. School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, UK
| | - R P Ross
- APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland
| | - M McCarthy
- Cork Adult CF Centre, Cork University Hospital, Wilton, Cork
| | - D M Murphy
- Cork Adult CF Centre, Cork University Hospital, Wilton, Cork
| | - J A Eustace
- HRB Clinical research facility, University College Cork
| | - Tunney Mm
- Halo Research Group, Queen's University Belfast, Belfast, UK; School of Pharmacy, Queen's University Belfast, Belfast, UK; HRB Clinical research facility, University College Cork
| | - C Stanton
- Wellcome-Wolfson Institute for Experimental Medicine. School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast, Belfast, UK; Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - B J Plant
- Cork Adult CF Centre, Cork University Hospital, Wilton, Cork; HRB Clinical research facility, University College Cork; APC Microbiome Ireland, University College Cork, NUI, Cork, Ireland.
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Moschopoulou E, Deane J, Duncan M, Ismail SA, Moriarty S, Sarker SJ, White P, Korszun A. Measuring quality of life in people living with and beyond cancer in the UK. Support Care Cancer 2021; 29:6031-6038. [PMID: 33783624 PMCID: PMC8410707 DOI: 10.1007/s00520-021-06105-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to identify the most appropriate measure of quality of life (QoL) for patients living with and beyond cancer. Methods One hundred eighty-two people attending cancer clinics in Central London at various stages post-treatment, completed a series of QoL measures: FACT-G, EORTC QLQ-C30 , IOCv2 (positive and negative subscales) and WEMWBS, a wellbeing measure. These measures were chosen as the commonest measures used in previous research. Correlation tests were used to assess the association between scales. Participants were also asked about pertinence and ease of completion. Results There was a significant positive correlation between the four domain scores of the two health-related QoL measures (.32 ≤ r ≤ .72, P < .001), and a significant large negative correlation between these and the negative IOCv2 subscale scores (− .39 ≤ r ≤ − .63, P < .001). There was a significant moderate positive correlation between positive IOCv2 subscale and WEMWBS scores (r = .35, P < .001). However, neither the FACT-G nor the EORTC showed any significant correlation with the positive IOCv2 subscale. Participants rated all measures similarly with regards to pertinence and ease of use. Conclusion There was little to choose between FACT-G, EORTC, and the negative IOC scales, any of which may be used to measure QoL. However, the two IOCv2 subscales capture unique aspects of QoL compared to the other measures. The IOCv2 can be used to identify those cancer survivors who would benefit from interventions to improve their QoL and to target specific needs thereby providing more holistic and personalised care beyond cancer treatment.
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Affiliation(s)
- Elisavet Moschopoulou
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, UK
| | - Morvwen Duncan
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Sharif A Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sophie Moriarty
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Shah-Jalal Sarker
- Research Department of Medical Education, UCL Medical School, UCL, London, UK
| | - Peter White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Ania Korszun
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Deane J, Fouhy F, Ronan NJ, Daly M, Fleming C, Eustace JA, Shanahan F, Flanagan ET, Dupont L, Harrison MJ, Haworth CS, Floto A, Rea MC, Ross RP, Stanton C, Plant BJ. A multicentre analysis of Clostridium difficile in persons with Cystic Fibrosis demonstrates that carriage may be transient and highly variable with respect to strain and level. J Infect 2021; 82:363-370. [PMID: 33444699 DOI: 10.1016/j.jinf.2020.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Clostridium difficile has been reported to occur in the gastrointestinal tract of 50% of Cystic Fibrosis (CF) subjects, however, clinical C. difficile infection (CDI) is a rare occurrence in this cohort despite the presence of toxigenic and hypervirulent ribotypes. Here, we present the first longitudinal, multicentre analysis of C. difficile prevalence among adult CF subjects. METHODOLOGY Faecal samples were collected from adults with CF (selected based on confirmed Pseudomonas aeruginosa pulmonary colonisation) from Ireland, UK and Belgium as part of the CFMATTERS clinical research trial (grant No. 603038) and from non-CF controls. Faecal samples were collected on enrolment, at three monthly intervals, during pulmonary exacerbation and three months post exacerbation. C. difficile was isolated from faecal samples by ethanol shocking followed by culturing on cycloserine cefoxitin egg yolk agar. Isolates were characterised in terms of ribotype, toxin type and antibiotic susceptibility to antibiotics routinely used in the treatment of CDI (metronidazole and vancomycin) and those implicated in induction of CDI (ciprofloxacin and moxifloxacin). RESULTS Prevalence of C. difficile among CF subjects in the three sites was similar ranging from 47% to 50% at baseline, while the healthy control cohort had a carriage rate of 7.1%. Including subjects who were positive for C. difficile at any time point there was a higher carriage rate of 71.4%, 66.7% and 63.2% in Ireland, UK, and Belgium, respectively. Ribotyping of 80 isolates from 45 CF persons, over multiple time points revealed 23 distinct ribotypes with two ribotypes (046 and 078) shared by all centres. The proportion of toxigenic isolates varied across the sites, ranging from 66.7% in Ireland to 52.9% in Belgium and 100% in the UK. Antibiotic susceptibility rates to vancomycin, metronidazole, ciprofloxacin and moxifloxacin was 100%, 97.5%, 1.3% and 63.8%, respectively. CONCLUSIONS This study demonstrates the highest carriage rate of C. difficile to date in a CF cohort. Longitudinal data show that C. difficile can be a transient inhabitant of the CF gut, changing both in terms of strain and excretion rates.
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Affiliation(s)
- Jennifer Deane
- Teagasc Food Research Centre, Moorepark, Fermoy, Co., Cork, Ireland; HRB Clinical Research Facility, University College Cork, Cork, Ireland; School of Microbiology, University College Cork, Cork, Ireland
| | - Fiona Fouhy
- Teagasc Food Research Centre, Moorepark, Fermoy, Co., Cork, Ireland; APC Microbiome Ireland, Cork, Ireland
| | - Nicola J Ronan
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - Mary Daly
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - Claire Fleming
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - Joseph A Eustace
- HRB Clinical Research Facility, University College Cork, Cork, Ireland
| | | | - Evelyn T Flanagan
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | | | - Michael J Harrison
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge United Kingdom
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge United Kingdom
| | - Andres Floto
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge United Kingdom; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary C Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, Co., Cork, Ireland; APC Microbiome Ireland, Cork, Ireland
| | | | | | - Barry J Plant
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland.
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Bartley D, Panchasarp R, Bowen S, Deane J, Ferguson JK. How accurately is hospital acquired pneumonia documented for the correct assignment of a hospital acquired complication (HAC)? Infect Dis Health 2020; 26:67-71. [PMID: 33071209 DOI: 10.1016/j.idh.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2016, the Australian Commission on Safety and Quality in Healthcare (ACSQHC) released a list of 16 categories of potentially preventable, high impact hospital-acquired complications (HAC) identified by using administrative coded data (ACD). An important category are hospital-acquired infections (HAI). Within this category, hospital-acquired pneumonia (HAP) is among the most frequent complications documented. There are no published studies concerning the current ACSQHC approach to HAI surveillance using ACD and no pneumonia-specific ACD studies reported from Australia. Published work indicates that ACD detection of HAP has low a sensitivity and positive predictive value (PPV). The current study was designed to examine whether coders correctly reflected the documentation of HAP that was present in the medical record and also evaluated the medical documentation that was present. METHODS One hundred patients with ACD encoded HAP were selected for review, drawn from admissions to 2 Hunter New England Health hospitals during 2017. Patient records and the eMR were reviewed by two medical officers to assess medical and radiological documentation of pneumonia. The district coding manager reviewed the accuracy of coding of a subset of 23 cases where medical review had not located documented evidence of HAP. RESULTS Of the 100 reviewed cases, the median patient age was 75 years (range 0-95 years) with 3% under 16 years of age. Twenty one were intensive care-associated of which 13 were associated with ventilation. In 23 cases the documentation was disputed and a secondary review took place - the coding manager confirmed coding changes in 14 of these 23 cases. CONCLUSIONS This study found that administrative coded data of HAP, utilizing the ACSQHC method reliably reflected the available documentation with a PPV of 86% (95% binomial exact confidence interval 77-92%), much higher than documented by previous ACD studies. The actual documentation of pneumonia by medical staff frequently used the non-specific term 'lower respiratory infection (LRTI)' which we recommend to be avoided. Radiological confirmation was absent in one third of cases. We recommend the adoption of a medical note template checklist for HAP to prompt clinicians with the accepted diagnostic criteria. We also recommend documenting a reason as to why any antibiotic has been commenced in a hospitalized patient in accord with the ACSQHC Antimicrobial Stewardship Clinical Care Standard.
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Affiliation(s)
- D Bartley
- HNE Health, Newcastle, NSW, 2305, Australia
| | | | - S Bowen
- HNE Health, Tamworth, NSW, 2340, Australia
| | - J Deane
- Infection Prevention Service, HNE Health, Newcastle, NSW, 2305, Australia
| | - J K Ferguson
- Infection Prevention Service, HNE Health, Newcastle, NSW, 2305, Australia; University of Newcastle, NSW, Australia.
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13
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Amenyah SD, Ward M, McMahon A, Deane J, McNulty H, Hughes C, Strain JJ, Horigan G, Purvis J, Walsh CP, Lees-Murdock DJ. DNA methylation of hypertension-related genes and effect of riboflavin supplementation in adults stratified by genotype for the MTHFR C677T polymorphism. Int J Cardiol 2020; 322:233-239. [PMID: 32920065 DOI: 10.1016/j.ijcard.2020.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/05/2020] [Accepted: 09/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The interaction between genetic, epigenetic and environmental factors plays an important role in the aetiology of hypertension. GWAS and observational studies link the C677T polymorphism in methylenetetrahydrofolate reductase (MTHFR) with hypertension, while riboflavin, the MTHFR cofactor, has been shown to reduce blood pressure and global DNA methylation in homozygous (TT genotype) individuals. It is currently unclear whether riboflavin modulates DNA methylation of other hypertension-related genes. OBJECTIVES To compare DNA methylation of hypertension-related genes in adults stratified by MTHFR genotype and effect of riboflavin intervention in adults with the variant MTHFR 677TT genotype. METHOD Pyrosequencing was carried out for hypertension-related genes (ACE, AGTR1, GCK, GNA12, IGF2, MMP9 and NOS3) in blood samples from participants in previous trials (CC, n = 40; TT, n = 40). The effect of intervention with riboflavin (1.6 mg/d for16 weeks) or placebo on DNA methylation was investigated in adults with the variant MTHFR 677TT genotype (n = 80). RESULTS Individuals with the MTHFR 677TT v CC genotype had significantly higher average DNA methylation at NOS3 (+1.66%, P = 0.044). In response to riboflavin supplementation in TT individuals, there was an increase in average DNA methylation at IGF2 (+1.09%, P = 0.019) and a decrease at ACE (-0.44%, P = 0.021) in females only. Specific CpG sites were hypomethylated in GNA12 and hypermethylated in AGTR1. CONCLUSION This study provides the first RCT evidence that riboflavin alters DNA methylation of hypertension-related genes in adults with the MTHFR 677TT genotype, providing some insight into mechanisms linking hypertension with the genotype-specific response of BP to riboflavin.
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Affiliation(s)
- Sophia D Amenyah
- Genomic Medicine Research Group, Ulster University, Coleraine BT52 1SA, N. Ireland, UK; Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Amy McMahon
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Jennifer Deane
- Genomic Medicine Research Group, Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Catherine Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Geraldine Horigan
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - John Purvis
- Department of Cardiology, Altnagelvin Area Hospital, BT47 6SB, N. Ireland, UK
| | - Colum P Walsh
- Genomic Medicine Research Group, Ulster University, Coleraine BT52 1SA, N. Ireland, UK
| | - Diane J Lees-Murdock
- Genomic Medicine Research Group, Ulster University, Coleraine BT52 1SA, N. Ireland, UK.
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Amenyah SD, McMahon A, Ward M, Deane J, McNulty H, Hughes CF, Strain JJ, Horigan G, Purvis J, Walsh CP, Lees-Murdock DJ. Riboflavin supplementation alters global and gene-specific DNA methylation in adults with the MTHFR 677 TT genotype. Biochimie 2020; 173:17-26. [PMID: 32334045 DOI: 10.1016/j.biochi.2020.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
DNA methylation is important in regulating gene expression and genomic stability while aberrant DNA methylation is associated with disease. Riboflavin (FAD) is a cofactor for methylenetetrahydrofolate reductase (MTHFR), a critical enzyme in folate recycling, which generates methyl groups for homocysteine remethylation to methionine, the pre-cursor to the universal methyl donor S-adenosylmethionine (SAM). A polymorphism (C677T) in MTHFR results in decreased MTHFR activity and increased homocysteine concentration. Previous studies demonstrated that riboflavin modulates this phenotype in homozygous adults (MTHFR 677 TT genotype), however, DNA methylation was not considered. This study examined DNA methylation, globally and at key MTHFR regulatory sites, in adults stratified by MTHFR genotype and the effect of riboflavin supplementation on DNA methylation in individuals with the 677 TT genotype. Samples were accessed from participants, screened for the MTHFR C677T polymorphism, who participated in observational (n = 80) and targeted riboflavin (1.6 mg/day) RCTs (n = 80). DNA methylation at LINE-1 and key regulatory regions of the MTHFR locus were analysed by pyrosequencing in peripheral blood leukocytes. LINE-1 (+1.6%; p = 0.011) and MTHFR south shelf (+4.7%, p < 0.001) were significantly hypermethylated in individuals with the MTHFR 677 TT compared to CC genotype. Riboflavin supplementation resulted in decreased global methylation, albeit only significant at one CpG. A significant reduction in DNA methylation at the MTHFR north shore (-1.2%, p < 0.001) was also observed in TT adults following intervention with riboflavin. This provides the first RCT evidence that DNA methylation may be modulated by riboflavin in adults with the MTHFR 677 TT genotype.
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Affiliation(s)
- Sophia D Amenyah
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, United Kingdom; Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Amy McMahon
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Jennifer Deane
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Geraldine Horigan
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - John Purvis
- Department of Cardiology, Altnagelvin Area Hospital, Londonderry, Northern Ireland, United Kingdom
| | - Colum P Walsh
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Diane J Lees-Murdock
- Genomic Medicine Research Group, Ulster University, Coleraine, Northern Ireland, United Kingdom.
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Amenyah SD, Hughes CF, Ward M, Rosborough S, Deane J, Thursby SJ, Walsh CP, Kok DE, Strain JJ, McNulty H, Lees-Murdock DJ. Influence of nutrients involved in one-carbon metabolism on DNA methylation in adults—a systematic review and meta-analysis. Nutr Rev 2020; 78:647-666. [DOI: 10.1093/nutrit/nuz094] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Context
Aberrant DNA methylation is linked to various diseases. The supply of methyl groups for methylation reactions is mediated by S-adenosylmethionine, which depends on the availability of folate and related B vitamins.
Objectives
To investigate the influence of key nutrients involved in 1-carbon metabolism on DNA methylation in adults.
Data sources
Systematic literature searches were conducted in the Cochrane Library, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, and Web of Science databases. Studies that met the inclusion criteria and were published in English were included.
Data extraction
The first author, study design, sample size, population characteristics, type and duration of intervention, tissue type or cells analyzed, molecular techniques, and DNA methylation outcomes.
Data synthesis
A meta-analysis of randomized, controlled trials (RCTs) was conducted to investigate the effect of 1-carbon metabolism nutrients on global DNA methylation. Functional analysis and visualization were performed using BioVenn software.
Results
From a total of 2620 papers screened by title, 53 studies met the inclusion criteria. Qualitative analysis indicated significant associations between 1-carbon metabolism nutrients and DNA methylation. In meta-analysis of RCTs stratified by method of laboratory analysis, supplementation with folic acid alone or in combination with vitamin B12 significantly increased global DNA methylation in studies using liquid chromatography–mass spectrometry, which had markedly lower heterogeneity (n = 3; Z = 3.31; P = 0.0009; I2 = 0%) in comparison to other methods. Functional analysis highlighted a subset of 12 differentially methylated regions that were significantly related to folate and vitamin B12 biomarkers.
Conclusion
This study supports significant associations between 1-carbon metabolism nutrients and DNA methylation. However, standardization of DNA methylation techniques is recommended to reduce heterogeneity and facilitate comparison across studies.
Systematic Review registration
PROSPERO registration number: CRD42018091898.
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Affiliation(s)
- Sophia D Amenyah
- Genomic Medicine Research Group, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Samuel Rosborough
- Genomic Medicine Research Group, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Jennifer Deane
- Genomic Medicine Research Group, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Sara-Jayne Thursby
- Genomic Medicine Research Group, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Colum P Walsh
- Genomic Medicine Research Group, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
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Duncan M, Moschopoulou E, Herrington E, Deane J, Roylance R, Jones L, Bourke L, Morgan A, Chalder T, Thaha MA, Taylor SC, Korszun A, White PD, Bhui K. Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open 2017; 7:e015860. [PMID: 29187408 PMCID: PMC5719270 DOI: 10.1136/bmjopen-2017-015860] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Over two million people in the UK are living with and beyond cancer. A third report diminished quality of life. DESIGN A review of published systematic reviews to identify effective non-pharmacological interventions to improve the quality of life of cancer survivors. DATA SOURCES Databases searched until May 2017 included PubMed, Cochrane Central, EMBASE, MEDLINE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. STUDY SELECTION Published systematic reviews of randomised trials of non-pharmacological interventions for people living with and beyond cancer were included; included reviews targeted patients aged over 18. All participants had already received a cancer diagnosis. Interventions located in any healthcare setting, home or online were included. Reviews of alternative therapies or those non-English reports were excluded. Two researchers independently assessed titles, abstracts and the full text of papers, and independently extracted the data. OUTCOMES The primary outcome of interest was any measure of global (overall) quality of life. ANALYTICAL METHODS Quality assessment assessing methdological quality of systematic reviews (AMSTAR) and narrative synthesis, evaluating effectiveness of non-pharmacological interventions and their components. RESULTS Of 14 430 unique titles, 21 were included in the review of reviews. There was little overlap in the primary papers across these reviews. Thirteen reviews covered mixed tumour groups, seven focused on breast cancer and one focused on prostate cancer. Face-to-face interventions were often combined with online, telephone and paper-based reading materials. Interventions included physical, psychological or behavioural, multidimensional rehabilitation and online approaches. Yoga specifically, physical exercise more generally, cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) programmes showed benefit in terms of quality of life. CONCLUSIONS Exercise-based interventions were effective in the short (less than 3-8 months) and long term. CBT and MBSR also showed benefits, especially in the short term. The evidence for multidisciplinary, online and educational interventions was equivocal.
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Affiliation(s)
- Morvwen Duncan
- Academic Psychological Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elisavet Moschopoulou
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eldrid Herrington
- Blizard Institute, National Bowel Research Centre, Queen Mary University of London, London, UK
- Department of Colorectal Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jennifer Deane
- Academic Psychological Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rebecca Roylance
- University College Hospitals, NHS Foundation Trust and UCLH Biomedical Research Centre, London, UK
| | - Louise Jones
- Marie Curie Palliative Research Department, Division of Psychiatry, University College Medical School, London, UK
| | - Liam Bourke
- Cancer Research Group, Sheffield Hallam University, Sheffield, UK
- Health & Wellbeing, Sheffield Hallam University, Sheffield
| | - Adrienne Morgan
- Centre for Tumour Biology, Barts Cancer Institute – Queen Mary University of London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King’s College London, Denmark Hill, King’s College, London, UK
| | - Mohamed A Thaha
- Blizard Institute, National Bowel Research Centre, Queen Mary University of London, London, UK
- Department of Colorectal Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stephanie C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Ania Korszun
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter D. White
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Konidaris VE, Tsaousis KT, Al-Hubeshy Z, Pieri K, Deane J, Empeslidis T. Clinical real-world results of switching treatment from ranibizumab to aflibercept in patients with diabetic macular oedema. Eye (Lond) 2017. [PMID: 28622326 DOI: 10.1038/eye.2017.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- V E Konidaris
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - K T Tsaousis
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Z Al-Hubeshy
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - K Pieri
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - J Deane
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - T Empeslidis
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
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Fouhy F, Ronan N, McCarthy Y, Arooj P, Daly M, Flanagan E, Deane J, O'Sullivan O, Murphy K, Fleming C, McCarthy M, Shortt C, Eustace J, Shanahan F, Rea M, Ross R, Floto R, Harrison M, Haworth C, Dupont L, Stanton C, Plant B. WS03.3 A longitudinal, multi-centre investigation into the gut microbiota of adult CF patients – the CFMATTERS perspective. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Duncan M, Deane J, White PD, Ridge D, Roylance R, Korszun A, Chalder T, Bhui KS, Thaha MA, Bourke L. A survey to determine usual care after cancer treatment within the United Kingdom national health service. BMC Cancer 2017; 17:186. [PMID: 28284185 PMCID: PMC5346235 DOI: 10.1186/s12885-017-3172-1] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 03/04/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Approximately one third of cancer survivors in the United Kingdom face ongoing and debilitating psychological and physical symptoms related to poor quality of life. Very little is known about current post-cancer treatment services. METHODS Oncology healthcare professionals (HCPs) were invited to take part in a survey, which gathered both quantitative and free text data about the content and delivery of cancer aftercare and patient needs. Analysis involved descriptive statistics and content analysis. RESULTS There were 163 complete responses from 278 survey participants; 70% of NHS acute trusts provided data. HCPs views on patient post-cancer treatment needs were most frequently: fear of recurrence (95%), fatigue (94%), changes in physical capabilities (89%), anxiety (89%) and depression (88%). A median number of 2 aftercare sessions were provided (interquartile range: 1,4) lasting between 30 and 60 min. Usually these were provided face-to-face and intermittently by a HCP. However, sessions did not necessarily address the issues HCPs asserted as important. Themes from free-text responses highlighted inconsistencies in care, uncertain funding for services and omission of some evidence based approaches. CONCLUSION Provision of post-cancer treatment follow-up care is neither universal nor consistent in the NHS, nor does it address needs HCPs identified as most important.
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Affiliation(s)
- M Duncan
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - J Deane
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - P D White
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - D Ridge
- Department of Psychology, University of Westminster, London, UK
| | - R Roylance
- University College Hospitals London, London, UK
| | - A Korszun
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Chalder
- Institute of Psychiatry, King's College London, London, UK
| | - K S Bhui
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M A Thaha
- National Bowel Research Centre, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - L Bourke
- Sheffield Hallam University, Office A121, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
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Sugito S, Deane J, Diu P, Mylabathula S. Single Rural Referral Hospital Experience with Computed Tomography Coronary Angiogram for Evaluation of Low-to-Intermediate Risk Coronary Artery Disease. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.122] [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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Kelly JR, Borre Y, O' Brien C, Patterson E, El Aidy S, Deane J, Kennedy PJ, Beers S, Scott K, Moloney G, Hoban AE, Scott L, Fitzgerald P, Ross P, Stanton C, Clarke G, Cryan JF, Dinan TG. Transferring the blues: Depression-associated gut microbiota induces neurobehavioural changes in the rat. J Psychiatr Res 2016; 82:109-18. [PMID: 27491067 DOI: 10.1016/j.jpsychires.2016.07.019] [Citation(s) in RCA: 923] [Impact Index Per Article: 115.4] [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: 04/27/2016] [Revised: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 12/14/2022]
Abstract
The gut microbiota interacts with the host via neuroimmune, neuroendocrine and neural pathways. These pathways are components of the brain-gut-microbiota axis and preclinical evidence suggests that the microbiota can recruit this bidirectional communication system to modulate brain development, function and behaviour. The pathophysiology of depression involves neuroimmune-neuroendocrine dysregulation. However, the extent to which changes in gut microbiota composition and function mediate the dysregulation of these pathways is unknown. Thirty four patients with major depression and 33 matched healthy controls were recruited. Cytokines, CRP, Salivary Cortisol and plasma Lipopolysaccharide binding protein were determined by ELISA. Plasma tryptophan and kynurenine were determined by HPLC. Fecal samples were collected for 16s rRNA sequencing. A Fecal Microbiota transplantation was prepared from a sub group of depressed patients and controls and transferred by oral gavage to a microbiota-deficient rat model. We demonstrate that depression is associated with decreased gut microbiota richness and diversity. Fecal microbiota transplantation from depressed patients to microbiota-depleted rats can induce behavioural and physiological features characteristic of depression in the recipient animals, including anhedonia and anxiety-like behaviours, as well as alterations in tryptophan metabolism. This suggests that the gut microbiota may play a causal role in the development of features of depression and may provide a tractable target in the treatment and prevention of this disorder.
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Affiliation(s)
- John R Kelly
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Yuliya Borre
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Ciaran O' Brien
- APC Microbiome Institute, University College Cork, Cork, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Elaine Patterson
- APC Microbiome Institute, University College Cork, Cork, Ireland; Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Sahar El Aidy
- APC Microbiome Institute, University College Cork, Cork, Ireland; Groningen Biomolecular Sciences and Biotechnology Institute, University of Groningen, Groningen, The Netherlands
| | - Jennifer Deane
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Paul J Kennedy
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Sasja Beers
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Karen Scott
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Gerard Moloney
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Alan E Hoban
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Lucinda Scott
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | | | - Paul Ross
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | | | - Gerard Clarke
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland.
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Konidaris V, Gorgoli K, Burgula S, Deane J, Banerjee S, Empeslidis T. Treatment outcome of switching from ranibizumab to aflibercept in patients with central retinal vein occlusion. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0316] [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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Traczewski MM, Deane J, Sahm D, Brown SD, Chesnel L. Impact of Variations in Test Method Parameters on In Vitro Activity of Surotomycin against Clostridium difficile and Surotomycin Quality Control Limits for Broth Microdilution and Agar Dilution Susceptibility Testing. J Clin Microbiol 2016; 54:749-53. [PMID: 26677246 PMCID: PMC4767964 DOI: 10.1128/jcm.02881-15] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/06/2015] [Indexed: 11/20/2022] Open
Abstract
Test parameter variations were evaluated for their effects on surotomycin MICs. Calcium concentration was the only variable that influenced MICs; therefore, 50 μg/ml (standard for lipopeptide testing) is recommended. Quality control ranges for Clostridium difficile (0.12 to 1 μg/ml) and Eggerthella lenta (broth, 1 to 4 μg/ml; agar, 1 to 8 μg/ml) were approved by the Clinical and Laboratory Standards Institute based on these data.
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Affiliation(s)
| | | | | | - Steven D Brown
- Clinical Microbiology Institute, Wilsonville, Oregon, USA
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Lyell M, Simmonds J, Deane J. Physiotherapists’ knowledge and management of adults with hypermobility and Joint Hypermobility Syndrome in the UK: a nationwide online survey. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Griva K, Deane J, Rixon L, Shahab L, Newman SP. SP342THE DIFFERENTIAL COURSE OF NEUROCOGNITIVE FUNCTIONING IN DIALYSIS AND TRANSPLANTATION - A SIX YEAR PROSPECTIVE STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv192.08] [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: 11/12/2022] Open
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Fouhy F, Deane J, Rea MC, O’Sullivan Ó, Ross RP, O’Callaghan G, Plant BJ, Stanton C. The effects of freezing on faecal microbiota as determined using MiSeq sequencing and culture-based investigations. PLoS One 2015; 10:e0119355. [PMID: 25748176 PMCID: PMC4352061 DOI: 10.1371/journal.pone.0119355] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/14/2015] [Indexed: 12/14/2022] Open
Abstract
Background High-throughput sequencing has enabled detailed insights into complex microbial environments, including the human gut microbiota. The accuracy of the sequencing data however, is reliant upon appropriate storage of the samples prior to DNA extraction. The aim of this study was to conduct the first MiSeq sequencing investigation into the effects of faecal storage on the microbiota, compared to fresh samples. Culture-based analysis was also completed. Methods Seven faecal samples were collected from healthy adults. Samples were separated into fresh (DNA extracted immediately), snap frozen on dry ice and frozen for 7 days at -80°C prior to DNA extraction or samples frozen at -80°C for 7 days before DNA extraction. Sequencing was completed on the Illumina MiSeq platform. Culturing of total aerobes, anaerobes and bifidobacteria was also completed. Results No significant differences at phylum or family levels between the treatment groups occurred. At genus level only Faecalibacterium and Leuconostoc were significantly different in the fresh samples compared to the snap frozen group (p = 0.0298; p = 0.0330 respectively). Diversity analysis indicated that samples clustered based on the individual donor, rather than by storage group. No significant differences occurred in the culture-based analysis between the fresh, snap or -80°C frozen samples. Conclusions Using the MiSeq platform coupled with culture-based analysis, this study highlighted that limited significant changes in microbiota occur following rapid freezing of faecal samples prior to DNA extraction. Thus, rapid freezing of samples prior to DNA extraction and culturing, preserves the integrity of the microbiota.
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Affiliation(s)
- Fiona Fouhy
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
| | - Jennifer Deane
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
- HRB Clinical Research Facility, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
| | - Mary C. Rea
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
- Alimentary Pharmabiotic Centre, Cork, Ireland
| | - Órla O’Sullivan
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
- Alimentary Pharmabiotic Centre, Cork, Ireland
| | - R. Paul Ross
- College of Science, Engineering and Food Science (SEFS), University College Cork, Cork, Ireland
| | - Grace O’Callaghan
- HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Alimentary Pharmabiotic Centre, Cork, Ireland
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - Barry J. Plant
- HRB Clinical Research Facility, University College Cork, Cork, Ireland
- Alimentary Pharmabiotic Centre, Cork, Ireland
- Cork Adult Cystic Fibrosis Centre, University College Cork, Cork University Hospital, Wilton, Cork, Ireland
| | - Catherine Stanton
- Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, Ireland
- Alimentary Pharmabiotic Centre, Cork, Ireland
- * E-mail:
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Sahm DF, Deane J, Bien PA, Locke JB, Zuill DE, Shaw KJ, Bartizal KF. Results of the Surveillance of Tedizolid Activity and Resistance Program: in vitro susceptibility of Gram-positive pathogens collected in 2011 and 2012 from the United States and Europe. Diagn Microbiol Infect Dis 2015; 81:112-8. [DOI: 10.1016/j.diagmicrobio.2014.08.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
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Abstract
STUDY QUESTION Does post-menopausal endometrium contain mesenchymal stem/stromal cells (MSC) that have adult stem cell properties and can be prospectively isolated from a biopsy? SUMMARY ANSWER Perivascular W5C5(+) cells isolated from post-menopausal endometrial biopsies displayed characteristic MSC properties of clonogenicity, multipotency and surface phenotype irrespective of whether the women were or were not pre-treated with estrogen to regenerate the endometrium. WHAT IS KNOWN ALREADY Recently MSCs have been identified in human premenopausal endometrium, and can be prospectively isolated using a single marker, W5C5/SUSD2. STUDY DESIGN, SIZE, DURATION Endometrial tissue of both the functional and basal layers, from 17 premenopausal (pre-MP) women, 19 post-menopausal (post-MP) women without hormonal treatment and 15 post-menopausal women on estrogen replacement therapy (post-MP+ E2), was collected through a prospective phase IV clinical trial over 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Post-menopausal women <65 years of age were treated with or without E2 for 6-8 weeks prior to tissue collection. Serum E2 levels were determined by estradiol immunoenzymatic assay. Endometrial tissue was obtained from women by biopsy (curettage) just prior to the hysterectomy. The effect of E2 on endometrial thickness and glandular and luminal epithelial height was determined using image analysis. Endometrial tissue was dissociated into single cell suspensions and MSC properties were examined in freshly isolated and short-term cultured, magnetic bead-purified W5C5(+) cells. MSC properties were assessed using clonogenicity, serial cloning, mesodermal differentiation in adipogenic, chondrogenic, osteogenic and myogenic induction culture media, and surface phenotype analysis by flow cytometry. Estrogen receptor α expression in W5C5(+) cells was examined using dual colour immunofluorescence. Vascularity was analysed using CD34 and alpha smooth muscle actin immunostaining and subsequent image analysis. MAIN RESULTS AND THE ROLE OF CHANCE A small population of stromal cells with MSC properties was purified with the W5C5 antibody from post-menopausal endometrium, whether atrophic from low circulating estrogen or regenerated from systemic estrogen treatment, similar to premenopausal endometrium. The MSC derived from post-menopausal endometrium treated with or without E2 fulfilled the minimum MSC criteria: clonogenicity, surface phenotype (CD29(+), CD44(+), CD73(+), CD105(+), CD140b(+), CD146(+)) and multipotency. The post-menopausal endometrial MSCs also showed comparable properties to premenopausal eMSC with respect to self-renewal in vitro and W5C5 expression. The W5C5(+) cells were located perivascularly as expected and did not express estrogen receptor α. LIMITATIONS, REASONS FOR CAUTION The properties of the MSC derived from post-menopausal endometrium were evaluated in vitro and their in vivo tissue reconstitution capacity has not been established as it has for premenopausal endometrial MSC. WIDER IMPLICATIONS OF THE FINDINGS The endometrium is an accessible source of MSC obtainable with minimum morbidity that could be used for future clinical applications as a cell-based therapy. This study shows that menopausal women can access their endometrial MSC by a simple biopsy for use in autologous therapies, particularly if their endometrium has been regenerated by short-term E2 treatment, provided they have an intact uterus and are not contraindicated for short-term E2 treatment. Endometrial MSC in post-menopausal women possess key MSC properties and are a promising source of MSC independent of a woman's age. STUDY FUNDING/COMPETING INTERESTS This study was supported by the National Health and Medical Research Council (NHMRC) of Australia grant (1021126) (C.E.G., A.R.) and Senior Research Fellowship (1042298) (C.E.G.), Australian Gynaecological Endoscopic Society grant (A.R.) , Monash International Postgraduate Research Scholarship (DU), Australian Stem Cell Centre, South East Melbourne Alliance for Regenerative Therapies and Australian Stem Cell Centre top up scholarships (DU) and Victorian Government's Operational Infrastructure Support Program. Competing interests: AR receives Preceptorship fees from AMS, advisory board fees and sponsored study from Astellas, and conducts investigator led studies sponsored by AMS and Boston Scientific for other projects. TRIAL REGISTRATION NUMBER CTNRN12610000563066.
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Affiliation(s)
- D Ulrich
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia Present address: Department of Obstetrics and Gynaecology, Medical University Graz, 8045 Graz, Austria
| | - K S Tan
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - J Deane
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - K Schwab
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - A Cheong
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - A Rosamilia
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - C E Gargett
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
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Empeslidis T, Tsaousis KT, Konidaris V, Pradeep A, Deane J. Multifocal chorioretinitis caused by Bartonella henselae: imaging findings of spectral domain optical coherence tomography during treatment with trimethoprim-sulfamethoxazole. Eye (Lond) 2014; 28:907-9. [PMID: 24763244 DOI: 10.1038/eye.2014.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- T Empeslidis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - K T Tsaousis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - V Konidaris
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - A Pradeep
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - J Deane
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
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Morrow BJ, Pillar CM, Deane J, Sahm DF, Lynch AS, Flamm RK, Peterson J, Davies TA. Activities of carbapenem and comparator agents against contemporary US Pseudomonas aeruginosa isolates from the CAPITAL surveillance program. Diagn Microbiol Infect Dis 2013; 75:412-6. [PMID: 23391609 DOI: 10.1016/j.diagmicrobio.2012.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
Antimicrobial susceptibilities of contemporary Pseudomonas aeruginosa clinical isolates were determined from the CAPITAL 2010 surveillance program. Isolates were collected from 100 sites throughout the USA and Puerto Rico, and included isolates representing a range of patient demographics and infection types. A total of 2722 isolates were tested for susceptibility to a broad spectrum of agents, with susceptibilities ranging from 98.8% for colistin to 74% for levofloxacin. Doripenem was the most active carbapenem agent, with 88.6% of isolates susceptible, in comparison with 78.1% and 84.6% for imipenem and meropenem, respectively. Lower respiratory tract isolates and isolates from the intensive care unit setting were the least susceptible overall. Resistance rates were typically highest in lower respiratory tract isolates, with the exception of urinary tract isolates, which displayed the highest resistance for levofloxacin. Overall, multidrug-resistant isolates comprised 14.8% of the total sample population.
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Master RN, Deane J, Opiela C, Sahm DF. Recent trends in resistance to cell envelope-active antibacterial agents among key bacterial pathogens. Ann N Y Acad Sci 2013; 1277:1-7. [DOI: 10.1111/nyas.12022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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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Claesson MJ, Jeffery IB, Conde S, Power SE, O'Connor EM, Cusack S, Harris HMB, Coakley M, Lakshminarayanan B, O'Sullivan O, Fitzgerald GF, Deane J, O'Connor M, Harnedy N, O'Connor K, O'Mahony D, van Sinderen D, Wallace M, Brennan L, Stanton C, Marchesi JR, Fitzgerald AP, Shanahan F, Hill C, Ross RP, O'Toole PW. Gut microbiota composition correlates with diet and health in the elderly. Nature 2012; 488:178-84. [PMID: 22797518 DOI: 10.1038/nature11319] [Citation(s) in RCA: 2064] [Impact Index Per Article: 172.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 06/14/2012] [Indexed: 02/06/2023]
Abstract
Alterations in intestinal microbiota composition are associated with several chronic conditions, including obesity and inflammatory diseases. The microbiota of older people displays greater inter-individual variation than that of younger adults. Here we show that the faecal microbiota composition from 178 elderly subjects formed groups, correlating with residence location in the community, day-hospital, rehabilitation or in long-term residential care. However, clustering of subjects by diet separated them by the same residence location and microbiota groupings. The separation of microbiota composition significantly correlated with measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water. The individual microbiota of people in long-stay care was significantly less diverse than that of community dwellers. Loss of community-associated microbiota correlated with increased frailty. Collectively, the data support a relationship between diet, microbiota and health status, and indicate a role for diet-driven microbiota alterations in varying rates of health decline upon ageing.
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Queenan AM, Pillar CM, Deane J, Sahm DF, Lynch AS, Flamm RK, Peterson J, Davies TA. Multidrug resistance among Acinetobacter spp. in the USA and activity profile of key agents: results from CAPITAL Surveillance 2010. Diagn Microbiol Infect Dis 2012; 73:267-70. [DOI: 10.1016/j.diagmicrobio.2012.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/23/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
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Jeffery IB, O'Toole PW, Öhman L, Claesson MJ, Deane J, Quigley EMM, Simrén M. An irritable bowel syndrome subtype defined by species-specific alterations in faecal microbiota. Gut 2012; 61:997-1006. [PMID: 22180058 DOI: 10.1136/gutjnl-2011-301501] [Citation(s) in RCA: 592] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that may be triggered by enteric pathogens and has also been linked to alterations in the microbiota and the host immune response. The authors performed a detailed analysis of the faecal microbiota in IBS and control subjects and correlated the findings with key clinical and physiological parameters. DESIGN The authors used pyrosequencing to determine faecal microbiota composition in 37 IBS patients (mean age 37 years; 26 female subjects; 15 diarrhoea-predominant IBS, 10 constipation-predominant IBS and 12 alternating-type IBS) and 20 age- and gender-matched controls. Gastrointestinal and psychological symptom severity and quality of life were evaluated with validated questionnaires and colonic transit time and rectal sensitivity were measured. RESULTS Associations detected between microbiota composition and clinical or physiological phenotypes included microbial signatures associated with colonic transit and levels of clinically significant depression in the disease. Clustering by microbiota composition revealed subgroups of IBS patients, one of which (n=15) showed normal-like microbiota composition compared with healthy controls. The other IBS samples (n=22) were defined by large microbiota-wide changes characterised by an increase of Firmicutes-associated taxa and a depletion of Bacteroidetes-related taxa. CONCLUSIONS Detailed microbiota analysis of a well-characterised cohort of IBS patients identified several clear associations with clinical data and a distinct subset of IBS patients with alterations in their microbiota that did not correspond to IBS subtypes, as defined by the Rome II criteria.
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Affiliation(s)
- Ian B Jeffery
- Department of Microbiology, University College Cork, Cork, Ireland
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Turner SJ, Dharmasena A, Deane J. Bilateral rubeosis iridis and rubeotic glaucoma due to peripheral occlusive vasculitis associated with multiple sclerosis. Ocul Immunol Inflamm 2011; 19:373-5. [PMID: 21895514 DOI: 10.3109/09273948.2011.602500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Multiple sclerosis is associated with iridocyclitis, intermediate uveitis, retinal periphlebitis, and optic neuritis. The periphlebitis is known to be rarely sight-threatening as a result of the sequelae of retinal neovascularization. CASE This is a rare case of bilateral rubeosis iridis and rubeotic glaucoma in the setting of a branch retinal vein occlusion, widespread peripheral periphlebitis, and angiographic peripheral closure associated with "clinically definite" multiple sclerosis. DISCUSSION The case illustrates the extreme end of the spectrum of peripheral retinal ischemia and neovascularization associated with demyelinating disease, which can present as rubeotic glaucoma. Such patients require a proactive approach to inflammation, neovascularization, and raised intraocular pressure, including systemic immunosuppression, photocoagulation, and augmented trabeculectomy, respectively. As with other causes of peripheral ischemia, a favorable visual outcome can often be achieved using this strategy.
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Affiliation(s)
- S J Turner
- Ophthalmology Department, Leicester Royal Infirmary , Infirmary Square, Leicester, UK.
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Abstract
Over the past decade, excessive sleepiness among children and adolescents has been identified as a major societal concern. Professionals working with pediatric groups must increasingly factor sleepiness into assessments of waking function. We define and discuss excessive sleepiness in children and adolescents and review available evidence regarding effects on behavior, mood, and performance. Findings for daytime sleepiness and subsequent impairment in these domains are classified as robust to unknown. Empirical evidence clearly indicates that children and adolescents experience significant daytime sleepiness as a result of inadequate or disturbed sleep. The specific effect of sleepiness on functional domains in pediatric groups are less well-studied, but existing data suggests that children are likely to experience impairment in behavioral, mood, and performance domains. However, such variables as developmental differences in the type and degree of impairment, the degree of sleep disturbance required to produce impairments, and potential risk and protective factors for the effects of sleepiness in children have yet to be described. Further research is clearly warranted, and we discuss important questions and methodological concerns to encourage inquiry in both clinical and experimental settings. Advice is offered with regard to screening for sleep problems and associated sleepiness with children and adolescents.
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Affiliation(s)
- Gahan Fallone
- Chronobiology and Sleep Research Laboratory, E.P. Bradley Hospital, Department of Psychiatry and Human Behavior, Brown Medical School, USA.
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Besarab A, Adams M, Amatucci S, Bowe D, Deane J, Ketchen K, Reynolds K, Tello A. Unraveling the realities of vascular access: the Network 11 experience. Adv Ren Replace Ther 2000; 7:S65-70. [PMID: 11053589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.
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Affiliation(s)
- A Besarab
- Renal Network of the Upper Midwest, Inc, ESRD Network 11, St. Paul, MN 55114, USA
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Pruett D, Deane J. The Internet and poverty: real help or real hype? Panos Briefing No. 28. World Hosp Health Serv 1999; 34:27-40. [PMID: 10387683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Governments, donors and development organisations are rushing to realise the benefits that Internet access promises in the fight against poverty. But are the benefits it has brought so far merely isolated examples or are they signs that a revolution is underway? Access to information is an essential condition of development. The Internet has prompted a change in development thinking and many donor and multilateral lending organisations are radically reshaping their policies for the new information age. But is the enthusiasm among donors for spending on Internet development diverting funds from more traditional forms of development assistance? In terms of its most adaptive component, the World Wide Web, the Internet is still only four years old. Real hype or real help? The jury is still out. Quite simply, it is still too soon to tell.
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Abstract
Two hundred and ten patients (231 eyes) had their cataract sections closed with 11/0 polyester suture material over a 4 year period. Their case sheets were assessed to determine the number of eyes from which sutures had been removed prior to discharge, and for what reasons these sutures were removed. Ninety-seven patients (107 eyes) with sutures left in situ were further assessed to determine whether they were suffering from any suture-related symptoms and examined to determine the degree of clinical biodegradation experienced by the sutures. Six of these sutures were removed for electron microscopic examination. Of the 231 eyes initially included, 61 sutures (26.4%) had been removed prior to discharge. None of the 107 sutures examined showed evidence of clinical biodegradation; this was confirmed by electron microscopic analysis which showed only minimal erosion of sutures even after 48 months in situ.
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Affiliation(s)
- A J King
- Department of Ophthalmology, Leicester Royal Infirmary, UK
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Deane J. CHLOROFORM IN MIDWIFERY. West J Med 1853. [DOI: 10.1136/bmj.s3-1.31.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Deane J. MECHANICAL SUPPORT IN PROLAPSUS ANI. West J Med 1853; 1:34-5. [DOI: 10.1136/bmj.s3-1.2.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Deane J. Case of Poisoning by Oxalic Acid. West J Med 1851; 15:344-6. [DOI: 10.1136/bmj.s1-15.13.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Deane J. Manslaughter from a Blow on the Head with the Fist, Causing Fracture of the Inner Table of the Skull. West J Med 1851. [DOI: 10.1136/bmj.s1-15.5.121-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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