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Vera V, Ashcroft J, Bennett J, Davies R. 231 Diagnostic Outcomes in Suspected Appendicitis Before and During the COVID-19 Pandemic. Br J Surg 2022. [PMCID: PMC9383475 DOI: 10.1093/bjs/znac039.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Routine operative treatment of appendicitis was temporarily interrupted during the COVID-19 pandemic. Non-operative management in suspected appendicitis makes a definitive diagnosis difficult. This study investigated diagnostic outcomes of suspected appendicitis patients before and during COVID-19. Method A retrospective review of patients aged 16–45 undergoing treatment for suspected appendicitis pre-COVID-19 (1st January 2019–1st January 2020) and during the COVID-19 pandemic (1st March 2020 to 31st June 2020) was performed. Patients were followed up for one year (31st June 2021) to explore diagnostic outcomes. Results At one year follow up, 206 patients were identified in the pre-COVID-19 cohort with 100% (n = 206) undergoing an appendicectomy. On histopathological examination 77.2% (n = 159) had appendicitis; 10.7% (n = 22) another pathology; 2.9% (n = 6) neuroendocrine tumour. There were 62 patients in the COVID-19 cohort in which 79% (n = 49) underwent appendicectomy (56% (n = 35) immediate appendicectomy; 23% (n = 13) interval appendicectomy). On histopathological examination 61% (n = 38) had appendicitis; 13% (n = 8) another pathology; 5% (n = 3) neuroendocrine tumour. Of the remaining 13/62 patients, one had undergone a CT scan and colonoscopy for gastrointestinal symptoms demonstrating signs of chronic caecal inflammation treated conservatively. One underwent a CT scan alone for gastrointestinal symptoms finding no pathology. The remaining 11/62 patients had no further reported symptoms or diagnostics. Conclusions This study demonstrates that the risk of appendiceal malignancy and chronic inflammation is important in non-operative management of suspected appendicitis and establishing consistent follow up pathways is essential.
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Affiliation(s)
- V. Vera
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - J. Ashcroft
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - J. Bennett
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - R.J. Davies
- Addenbrookes Hospital, Cambridge, United Kingdom
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2
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Harvey A, Brown MEL, Byrne MHV, Ashcroft J, Wan JCM, Alexander L, Schindler N, Brassett C. 729 “I Don’t Feel Like I’m Learning How to Be A Doctor:” The Impact of Disruptions Due to Covid-19 On Professional Identity Formation in UK Medical Students. Br J Surg 2021. [PMCID: PMC8524597 DOI: 10.1093/bjs/znab259.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Professional identity formation (PIF) is a priority of medical training. Covid-19 caused disruption to medical education. We ask how this disruption impacted PIF through the lens of the activities performed – or not performed – by medical students during the first wave of the covid-19 pandemic, and perceptions of conflicts between activities. Method A pragmatic survey was distributed in spring 2020. Thematic analysis was performed of qualitative responses to two open questions. A social constructivist approach linked participants’ comments to PIF theory. Results We analysed 928 responses. Three themes surrounding students’ activities during covid-19 and their impact on identity were constructed: Conflict arose at the intersections between these themes. Students noted lack of clinical exposure was detrimental, implicitly recognising that aspects of PIF require the clinical environment. Participants were keen to volunteer but struggled with balancing academic work. Participants worried about risk to their households and the wider community and wanted their skills to add value in the clinical environment. Volunteers felt frustrated when they were unable to perform tasks aligning with their identity as a future doctor. An exception was participants who worked as interim FY1s, aligned with the role of an FY1. Conclusions Medical students feel a duty to help during crises. Conflict arises when different aspects of their identity demand different actions. Care must be taken to nurture PIF during periods of disruption.
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Affiliation(s)
- A Harvey
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - M E L Brown
- Hull York Medical School, Health Professions Education Unit, Hull York, United Kingdom
| | - M H V Byrne
- University of Oxford, Department of Urology, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery. Cambridge University Hospitals Trust, Cambridge, United Kingdom
| | - J C M Wan
- Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - L Alexander
- Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - N Schindler
- Norfolk and Norwich University Hospitals Foundation Trust, Paediatric Department, Norwich, United Kingdom
| | - C Brassett
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
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Grimmett C, Bates A, West M, Leggett S, Varkonyi-Sepp J, Campbell A, Davis J, Wootton S, Shaw C, Barlow R, Ashcroft J, Scott A, Moyes H, Hawkins L, Levett DZH, Williams F, Grocott MPW, Jack S. SafeFit Trial: virtual clinics to deliver a multimodal intervention to improve psychological and physical well-being in people with cancer. Protocol of a COVID-19 targeted non-randomised phase III trial. BMJ Open 2021; 11:e048175. [PMID: 34446487 PMCID: PMC8392740 DOI: 10.1136/bmjopen-2020-048175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The impact of the COVID-19 pandemic (caused by the SARS-CoV-2 virus) on individuals with cancer has been profound. It has led to increased anxiety, distress and deconditioning due to reduced physical activity. We aim to investigate whether SafeFit, a multimodal intervention of physical activity, nutrition and psychological support delivered virtually by cancer exercise specialists (CES), can improve physical and emotional functionings during the COVID-19 pandemic. METHODS AND ANALYSIS A phase III non-randomised intervention trial, target recruitment of 1050 adults with suspected or confirmed diagnosis of cancer. All recruited participants will receive the multimodal intervention delivered by CES for 6 months. Sessions will be delivered 1-to-1 using telephone/video conferencing consultations. CES will work with each participant to devise a personalised programme of (1) physical activity, (2) basic dietary advice and (3) psychological support, all underpinned by behaviour change support. PRIMARY OUTCOME Physical and emotional functioning as measured by the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ-C30). SECONDARY OUTCOMES overall quality of life measured by EORTC-QLQ-C30 and EQ-5D-5L, health economics, patient activation, self-efficacy to self-manage chronic disease, distress, impact of COVID-19 on emotional functioning, self-reported physical activity, functional capacity and nutrition. Adherence to the intervention will also be measured and a process evaluation conducted. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority (reference number 20/NW/0254). Results of this trial will be disseminated through publication of peer-reviewed articles, presentations at scientific conferences, and to the public and people with cancer in collaboration with our patient and public involvement representatives and partners. TRIAL REGISTRATION NUMBER NCT04425616.
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Affiliation(s)
- Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Andrew Bates
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Malcolm West
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samantha Leggett
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anna Campbell
- School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | | | - Stephen Wootton
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Cancer and Nutrition Collaboration, Southampton, UK
| | - Clare Shaw
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust, London, UK
| | - Rachael Barlow
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Joanna Ashcroft
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Scott
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Helen Moyes
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lesley Hawkins
- Critical Care/Anaesthesia and Perioperative Medicine Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Denny Z H Levett
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sandy Jack
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Byrne M, Ashcroft J, Alexander L, Wan J, Harvey A. 986 A Systematic Review of Medical Student Willingness to Volunteer and Preparedness for Pandemics and Disasters. Br J Surg 2021. [PMCID: PMC8135845 DOI: 10.1093/bjs/znab134.185] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction We aimed to identify motivators and barriers to volunteering during a disaster and knowledge and medical school curriculum of disaster and pandemic medicine. Method We systematically searched the literature on 28/6/2020, following PRISMA guidelines. Results A total of 37 studies met inclusion criteria including 11,168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%), and five evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD = 21.7%, n = 2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (P<.001). We identified a number of modifiable barriers which may contribute to this difference. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD = 15.1%, n = 2985). Conclusions There is a large number of students who are willing to volunteer during pandemics. However, they are likely to be under-prepared for these roles due to poor overall knowledge and limited teaching. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. Medical schools need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared for these roles.
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Affiliation(s)
- M Byrne
- University of Cambridge, Department of Surgery. Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery. Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - L Alexander
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - J Wan
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - A Harvey
- King's College London, London, United Kingdom
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5
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Byrne M, Ashcroft J, Wan J, Alexander L, Harvey A, Schindler N, Brassett C. 967 COVID READY Study: Cross-Sectional Survey of Medical Students Volunteering During the Coronavirus Pandemic (COVID-19) In the United Kingdom. Br J Surg 2021. [PMCID: PMC8135849 DOI: 10.1093/bjs/znab135.010] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction We aimed to identify the willingness, attitudes, and practice of medical students towards volunteering in a clinical capacity during the COVID-19 pandemic. Method We distributed a cross-sectional survey from 2/5/2020 to 14/6/2020 to all medical students at UK medical schools. Results A total of 1145 medical students from 36 medical schools completed the questionnaire. 82.7% of students were willing to volunteer, but only 34.3% had volunteered. The strongest predictors of willingness to volunteer on multiple linear regression were the beliefs that volunteering to work would benefit their medical education (estimate=0.35±0.03, adjusted P < 0.001) and that they would have a positive impact (estimate=0.33±0.03, adjusted P < 0.001). The majority of students were willing to take up a clinical role and were confident in having the necessary skills, but there was a discrepancy between the role’s students were comfortable performing and those they were assigned. Thematic analysis of the issue’s students would face when volunteering identified five themes: safety, professional practice, pressure to volunteer, finances and logistics, and education. Conclusions This study identifies areas for consideration from those responsible for workforce planning, healthcare provision, and student safety. We provide recommendations to facilitate a volunteering process that is safer for students, staff, and patients.
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Affiliation(s)
- M Byrne
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
| | - J Ashcroft
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Wan
- University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Alexander
- University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Harvey
- King’s College London GKT School of Medical Education, London, United Kingdom
| | - N Schindler
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
- University of Cambridge, Institute of Continuing Education, Cambridge, United Kingdom
| | - C Brassett
- University of Cambridge, Department of Physiology, Development and Neuroscience, Cambridge, United Kingdom
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6
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Ashcroft J, Havers N, Seebacher-Tomas A, Plesci E, Goh S, Hudson V. 11 A Sequential Simulation Experience for Interim Foundation Doctors and Analysis of Preparedness to Practice Early. Br J Surg 2021. [PMCID: PMC8135804 DOI: 10.1093/bjs/znab135.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Covid-19 necessitated the early graduation of medical students to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. A sequential simulation session was implemented to improve and assess FiY1 preparedness towards approaching deteriorating patients. Method 12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward-based management, and acute deterioration. Participants interpreted investigations, performed examinations, created management plans, and escalated using a pager. Results There was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-simulation 4(4-4.75); p = 0.04) and paperwork (2(2-3.75) vs. 4(3.25-4.75); p = 0.03). Following four weeks of FiY1 participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-FiY1 4.5(4-5); p = 0.01), communication and teamworking (4(3.25-4.75) vs. 5(5-5.75); p = 0.01), and paperwork (2(2-3.75) vs. 5(5-5); p = 0.01). The FiY1 programme improved integration within teams and facilitated training whilst medical school placements left participants feeling apprehensive and unprepared to practice. Conclusions This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities, and responsibilities as that of the FiY1 programme.
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Affiliation(s)
- J Ashcroft
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Havers
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - E Plesci
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Goh
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - V Hudson
- Addenbrooke's Hospital, Cambridge, United Kingdom
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Ashcroft J, Murphy S, Laing TA, Durrani AJ, Roshan A. A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma. Ann R Coll Surg Engl 2021; 103:e98-e100. [PMID: 33645284 DOI: 10.1308/rcsann.2020.7038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstrated a large right sided pneumothorax with associated punctured right breast implant, a 'pneumocapsule' and extensive subcutaneous emphysema of the breast. This case highlights that the fibrous tissue capsule around a breast implant can function as an anatomical space in continuity with the thoracic cavity, masking the diagnosis of pneumothorax in penetrating trauma.
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Affiliation(s)
- J Ashcroft
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Murphy
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T A Laing
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A J Durrani
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Roshan
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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8
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Ashcroft J, Singh AA, Rooney S, Bennett J, Davies RJ. A single centre evaluation of risk prediction models and imaging modalities in acute appendicitis. Ann R Coll Surg Engl 2021; 103:203-207. [PMID: 33645277 DOI: 10.1308/rcsann.2020.7033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with suspected appendicitis remain a diagnostic challenge. The aim of this study was to validate risk prediction models, and to investigate diagnostic accuracy of ultrasonography and computed tomography (CT) in adults undergoing appendicectomy. METHODS A retrospective case review was performed of patients aged 16-45 years having an appendicectomy between January 2019 and January 2020 at a tertiary referral centre. Primary outcomes were the accuracy of a high risk appendicitis risk score and ultrasonography and CT imaging modalities compared with histological reports following appendicectomy. RESULTS A total of 206 patients (52% female) were included in the study. Removal of a histologically normal appendix was equally likely in men and women (13.1% vs 11.2% respectively, relative risk: 1.17, 95% confidence interval: 0.56-2.44, p=0.674). A high risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. Ultrasonography was reported as equivocal in 85.7% (18/21) of low risk women and 59.0% (23/39) of high risk women. CT correctly detected or excluded appendicitis in 75.0% (6/8) of low risk women and 88.5% (23/26) of high risk women. CONCLUSIONS This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.
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Affiliation(s)
- J Ashcroft
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - A A Singh
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - S Rooney
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - J Bennett
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - R J Davies
- Cambridge University Hospitals NHS Foundation Trust, UK
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Bryan J, Ashcroft J, Hudson VE, Wong KY. Unusual presentation of appendicitis as soft tissue infection of the thigh. J Surg Case Rep 2021; 2021:rjaa505. [PMID: 33447356 PMCID: PMC7794021 DOI: 10.1093/jscr/rjaa505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/10/2020] [Indexed: 11/14/2022] Open
Abstract
Appendicitis remains one of the most common causes of abdominal pain across the world typically presenting with right iliac fossa pain, fever and nausea or vomiting. We describe an unusual case of appendicitis presenting as a soft tissue infection of the thigh, thereby causing a delayed diagnosis from presentation. We discuss the pathophysiological process behind soft tissue infections caused by appendicitis and highlight investigation and management strategies to ensure prompt treatment to reduce patient mortality.
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Affiliation(s)
- J Bryan
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - J Ashcroft
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - V E Hudson
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - K Y Wong
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Patel R, Ashcroft J, Darzi A, Singh H, Leff DR. Neuroenhancement in surgeons: benefits, risks and ethical dilemmas. Br J Surg 2020; 107:946-950. [DOI: 10.1002/bjs.11601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance-enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice.
Methods
Use of transcranial direct-current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed.
Results
Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot-tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation.
Conclusion
Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.
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Affiliation(s)
- R Patel
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - J Ashcroft
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - H Singh
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
| | - D R Leff
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, Queen Elizabeth the Queen Mother Building, Praed Street, London W2 1NY, UK
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Ashcroft J, Patel R, Singh H, Woods A, Darzi A, Leff D. P135 Transcranial Direct Current Stimulation (tDCS) to improve surgical technical skills acquisition. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Knowles C, DunneJ. D, Ashcroft J, Byrne J, Rigby C, Byrne C, Jones L, Fenwick S. Prehab matters - a prehabilitation service for cancer patients undergoing major abdominal surgery. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Ashcroft J, Badran D, Balasubramanian R, Barkeji M. Informing the consent process: chronic groin pain after open inguinal hernia repair. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.477] [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: 11/29/2022]
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Hechmati G, Cure S, Gouépo A, Hoefeler H, Lorusso V, Lüftner D, Duran I, Garzon-Rodriguez C, Ashcroft J, Wei R, Ghelani P, Bahl A. Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study. J Med Econ 2013; 16:691-700. [PMID: 23441975 DOI: 10.3111/13696998.2013.779921] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Patients with bone metastases often experience skeletal-related events (SREs: radiation or surgery to bone, pathologic fracture, and spinal cord compression). This study examined health resource utilization and costs associated with SREs. METHODS Data presented are from the European cohort (Germany, Italy, Spain, and the UK) of patients with solid tumours enrolled in a multi-national, prospective, observational study in patients with solid tumours or multiple myeloma. Patients with Eastern Cooperative Oncology Group score 0-2 and life expectancy ≥6 months, who experienced an SRE up to 97 days before enrolment, were eligible. Health resource utilization associated with SREs (including number/length of inpatient stays, numbers of procedures and outpatient visits) were collected through chart review for up to 97 days before enrolment and prospectively during follow-up. Country-specific cost calculations were performed. RESULTS In total, 478 eligible patients contributed 893 SREs to this analysis. Radiation to bone occurred most frequently (66% of total). Spinal cord compression (7%) and surgery to bone (10%) were the least common events, but most likely to require inpatient stays. The most costly SREs were also spinal cord compression (mean per SRE across countries, €4884-€12,082) and surgery to bone (€3348-€9407). Inpatient stays were the main cost drivers. LIMITATIONS Health resource utilization used to calculate the costs associated with SREs may have been under-estimated as a result of exclusion of patients with low performance status or life expectancy; unavailable information and exclusion of resource consumption associated with pain. Thus, the estimate of associated costs is likely to be conservative. CONCLUSIONS SREs result in considerable health resource utilization, imposing a substantial financial burden driven by inpatient stays. Treatments that prevent/delay SREs may help ease this burden, thereby providing cost savings across European healthcare systems.
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Affiliation(s)
- G Hechmati
- Health Economics, Amgen (Europe) GmbH, Zug, Switzerland.
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Lüftner D, Lorusso V, Duran I, Hechmati G, Garzon-Rodriguez C, Ashcroft J, Bahl A, Ghelani P, Wei R, Thomas E, Hoefeler H. P4-16-09: Health Resource Utilization (HRU) Associated with Skeletal-Related Events (SREs) in Advanced Breast Cancer Patients with Bone Metastases: Results from a Prospective Multinational Observational Study. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-16-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Patients with advanced breast cancer and bone metastases suffer from skeletal complications (SREs, defined as spinal cord compression [SCC], surgery to bone [SB], pathologic fracture [PF] or radiation to bone [RB]). Planning future resource requirements and estimating the value of new treatment options requires prospective data on the health resource burden. However, there is a lack of these data in the literature.
Materials and Methods Patients had bone metastases secondary to advanced breast cancer and were eligible to be included in the study if they had: at least one SRE within 90 days prior to enrolment; life expectancy >6 months; ECOG≤2. HRU (number and length of inpatient hospitalizations, outpatient visits, emergency room visits, number of procedures, etc) associated with SREs was collected retrospectively for 90 days prior to enrolment and prospectively for up to 18–21 months. Attribution of HRU to each SRE was determined independently by the investigators. This pooled European analysis includes data for breast cancer patients from centers in Germany, Italy, Spain and UK.
Results A total of 223 eligible patients with breast cancer and bone metastases were enrolled from the four countries. A total of 118 of 457 SREs (25.8%) were associated with inpatient stays with a mean duration of 18.2 (SD=15.7) days per inpatient stay (for the total 125 stays; a single SRE could contribute multiple hospitalizations). The length of inpatient stays varied by facility (i.e., oncology, radiation, surgical) and SRE type. The most common SRE requiring hospitalization was SB (42 of 54 events [77.8%]) with 45 inpatient stays requiring an average length of stay of 15.1 (SD=16.8) days. The least common SRE requiring hospitalization, RB (27 of 279 events [9.7%]), was still associated with 23 inpatient stays with an average of 16.7 (SD=12.4) days per inpatient stay. A total of 342 SREs (74.8%) required an outpatient visit and 159 (34.8%) required >5 visits. As expected, RB was associated with the highest number of outpatient visits (239 of 279 [85.7%] SREs). SB and PF were associated with fewer outpatient visits with 23 of 54 (42.6%) of 54 SREs and 66 of 105 (62.9%) SREs requiring a visit, respectively. 22 of 457 (4.8%) SREs were associated with an emergency room visit.
Discussion SREs can lead to lengthy hospitalizations and numerous outpatient visits. Neither pain requiring opioid use nor changes in cancer therapy to treat bone pain were reported as SREs, although they may have led to additional inpatient and outpatient visits. Thus, HRU estimated in this study likely underestimates overall HRU associated with SREs in advanced breast cancer patients. Relatively low utilization of emergency room visits reported here may be due to emergency care provided directly by the specialist oncology unit or the patient visiting a different institution. Preventing SREs in advanced breast cancer patients may help to reduce the financial burden to the European healthcare systems.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-16-09.
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Affiliation(s)
- D Lüftner
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - V Lorusso
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - I Duran
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - G Hechmati
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - C Garzon-Rodriguez
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - J Ashcroft
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - A Bahl
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - P Ghelani
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - R Wei
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - E Thomas
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
| | - H Hoefeler
- 1Universitätsmedizin Berlin, Berlin, Germany; Oncology Institute ASL, Leece, Italy; Centro Integral Oncologico Clara Campal (CIOCC), Madrid, Spain; Amgen (Europe) GmbH, Zug, Switzerland; Instituto Catalan Oncologia ICO-IDIBELL, Barcelona, Spain; Pinderfields General Hospital, Wakefield, United Kingdom; University Hospitals Bristol, Bristol, United Kingdom; Ovatech Solutions, London, United Kingdom; Amgen Inc., So. San Francisco, CA; Forschungszentrum Ruhr, Witten, Germany
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Hoefeler H, Duran I, Hechmati G, Garzon-Rodriguez C, Lüftner D, Ashcroft J, Bahl A, Wei R, Thomas E, Lorusso V. 3613 POSTER Health Resource Utilization (HRU) Associated With Skeletal-related Events (SREs) by Tumour Type in Patients With Bone Metastases/lesions: European Analysis of a Prospective Multinational Observational Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Davies F, Morgan G, Wu P, Gregory W, Bell SE, Szubert A, Navarro Coy N, Drayson M, Owen RG, Feyler S, Ashcroft J, Ross F, Byrne J, Roddie H, Rudin C, Cook G, Jackson GH, Boyd K, Child JA. Are there benefits to long-term bisphosphonate treatment in multiple myeloma (MM)? Insights from temporal analyses of zoledronic acid (ZOL) versus clodronate (CLO) in the MRC Myeloma IX Trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8011] [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: 11/20/2022] Open
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Boyd K, Morgan G, Davies F, Wu P, Gregory W, Bell SE, Szubert A, Navarro Coy N, Drayson M, Owen RG, Feyler S, Ashcroft J, Ross F, Byrne J, Roddie H, Rudin C, Cook G, Jackson GH, Child JA. Does zoledronic acid (ZOL) reduce skeletal-related events (SREs) and improve progression-free survival (PFS) in patients (Pts) with multiple myeloma (MM) with or without bone disease? MRC myeloma IX study results. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bahl A, Hoefeler H, Duran I, Hechmati G, Garzon-Rodriguez C, Lueftner D, Ashcroft J, Wei R, Thomas E, Lorusso V. Health resource utilization (HRU) associated with skeletal-related events (SREs) in patients with bone metastases (BM): Results of a prospective multinational observational study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Morgan GJ, Davies F, Gregory W, Bell SE, Szubert A, Navarro Coy N, Drayson M, Owen RG, Feyler S, Ashcroft J, Ross F, Byrne J, Roddie H, Rudin C, Cook G, Jackson GH, Boyd K, Child JA, Wu P. Defining the biological subgroup of multiple myeloma patients which benefits maximally from the overall survival (OS) benefit associated with treatment with zoledronic acid (ZOL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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A. Lawson M, Ashcroft J, I. Croucher P. Bisphosphonate Therapy in the Treatment of Multiple Myeloma. Curr Pharm Des 2010; 16:3028-36. [DOI: 10.2174/138161210793563608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/12/2010] [Indexed: 11/22/2022]
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Terpos E, Sezer O, Croucher P, García-Sanz R, Boccadoro M, San Miguel J, Ashcroft J, Bladé J, Cavo M, Delforge M, Dimopoulos MA, Facon T, Macro M, Waage A, Sonneveld P. The use of bisphosphonates in multiple myeloma: recommendations of an expert panel on behalf of the European Myeloma Network. Ann Oncol 2009; 20:1303-17. [DOI: 10.1093/annonc/mdn796] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Abstract
OBJECTIVE To discover whether eating behaviour traits show continuity and stability over childhood. SUBJECTS/METHODS Mothers of 428 twin children from the Twins Early Development Study participated in a study of eating and weight in 1999 when the children were 4 years old. Families were contacted again in 2006 when the children were aged 10 years, with complete data on 322 children; a response rate of 75%. At both times, mothers completed the Child Eating Behaviour Questionnaire (CEBQ) for each child. Continuity was assessed with correlations between scores at the two time points, and stability by changes in mean scores over time. RESULTS For all CEBQ subscales, correlations between the two time points were highly significant (P-values <0.001). For satiety responsiveness, slowness in eating, food responsiveness, enjoyment of food, emotional overeating and food fussiness, correlations ranged from r=0.44 to 0.55, with lower continuity for emotional undereating (r=0.29). Over time, satiety responsiveness, slowness in eating, food fussiness, and emotional undereating decreased, while food responsiveness, enjoyment of food and emotional overeating increased. CONCLUSIONS Eating behaviours, including those associated with a tendency to overeat, emerge early in the developmental pathway and show levels of individual continuity comparable to stable personality traits. Appetitive traits related to higher satiety tended to decrease with maturation, while those associated with food responsiveness tended to increase. This pattern is consistent with strong tracking of body mass index alongside a progressive increase in the risk of obesity.
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Affiliation(s)
- J Ashcroft
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London, UK
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Rawstron AC, Fenton JA, Ashcroft J, English A, Jones RA, Richards SJ, Pratt G, Owen R, Davies FE, Child JA, Jack AS, Morgan G. The interleukin-6 receptor alpha-chain (CD126) is expressed by neoplastic but not normal plasma cells. Blood 2000; 96:3880-6. [PMID: 11090073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Interleukin-6 (IL-6) is reported to be central to the pathogenesis of myeloma, inducing proliferation and inhibiting apoptosis in neoplastic plasma cells. Therefore, abrogating IL-6 signaling is of therapeutic interest, particularly with the development of humanized anti-IL-6 receptor (IL-6R) antibodies. The use of such antibodies clinically requires an understanding of IL-6R expression on neoplastic cells, particularly in the cycling fraction. IL-6R expression levels were determined on plasma cells from patients with myeloma (n = 93) and with monoclonal gammopathy of undetermined significance (MGUS) or plasmacytoma (n = 66) and compared with the levels found on normal plasma cells (n = 11). In addition, 4-color flow cytometry was used to assess the differential expression by stage of differentiation and cell cycle status of the neoplastic plasma cells. IL-6R alpha chain (CD126) was not detectable in normal plasma cells, but was expressed in approximately 90% of patients with myeloma. In all groups, the expression levels showed a normal distribution. In patients with MGUS or plasmacytoma, neoplastic plasma cells expressed significantly higher levels of CD126 compared with phenotypically normal plasma cells from the same marrow. VLA-5(-) "immature" plasma cells showed the highest levels of CD126 expression, but "mature" VLA-5(+) myeloma plasma cells also overexpressed CD126 when compared with normal subjects. This study demonstrates that CD126 expression is restricted to neoplastic plasma cells, with little or no detectable expression by normal cells. Stromal cells in the bone marrow microenvironment do not induce the overexpression because neoplastic cells express higher levels of CD126 than normal plasma cells from the same bone marrow in individuals with MGUS. (Blood. 2000;96:3880-3886)
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Affiliation(s)
- A C Rawstron
- Haematological Malignancy Diagnostic Service, Department of Haematology, Leeds General Infirmary, Leeds, United Kingdom
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Abstract
This study was designed to determine normal variations in cutaneous blood content, red blood cell content and skin thickness in healthy human volunteers. The blood content (BC) of human skin and the velocity of red blood cells (RBV) has been comprehensively mapped over 30 anatomical sites in 28 volunteers between the age of 7 and 77 years using reflectance spectrophotometry (RFS) and laser Doppler (LD) techniques respectively. Total skin thickness, which may have a relationship with blood content, has been mapped at the same anatomical sites in six of the volunteers using two-dimensional array, 12 MHz ultrasound equipment. The major determinant of BC and RBV was found to be anatomical site. Regardless of age, gender or prior sun exposure, anatomical sites above the waist produced higher readings than below. BC and RBV were found to be dependent on age and gender at most sites with higher readings being observed in males and younger volunteers. The largest difference was seen in males under 55 years whose RFS readings above the waist were significantly higher than in older males or females of any age. Heavy prior sun exposure and skin thickness could not be demonstrated to impact on either RFS or LD readings independently of the effects of anatomical site, gender or age. In general, RFS and LD readings paralleled one another and correlated linearly at most anatomical sites. While RFS readings tended to decrease in the cranio-caudal direction, LD readings were relatively uniform across the body except for the head and groin where they were higher, and the abdomen where they were lower. The site-to-site variations in RFS readings observed in this study correspond well to capillary density variations noted in previous studies.
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Affiliation(s)
- P Simonen
- Department of Oncology, Kuopio University Hospital, Finland
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Ding W, Williams DR, Northcote P, Siegel MM, Tsao R, Ashcroft J, Morton GO, Alluri M, Abbanat D, Maiese WM. Pyrroindomycins, novel antibiotics produced by Streptomyces rugosporus sp. LL-42D005. I. Isolation and structure determination. J Antibiot (Tokyo) 1994; 47:1250-7. [PMID: 8002387 DOI: 10.7164/antibiotics.47.1250] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pyrroindomycins A and B were isolated from fermentations of culture LL-42D005, a strain of Streptomyces rugosporus. Pyrroindomycins possess potent antimicrobial activities against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci. Their structures have been determined by using 1- and 2-D NMR, mass spectroscopy and chemical degradations. Pyrroindomycins are the first natural products that contain the highly unsaturated pyrroloindole moiety.
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Affiliation(s)
- W Ding
- Natural Products Research Section, American Cyanamid Company, Pearl River, New York 10965
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Ashcroft J. Rising to the challenge. Scope of practice. Nurs Times 1992; 88:30. [PMID: 1528767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ashcroft J, Live DH, Patel DJ, Cowburn D. Heteronuclear two-dimensional 15N- and 13C-NMR studies of DNA oligomers and their netropsin complexes using indirect proton detection. Biopolymers 1991; 31:45-55. [PMID: 1851045 DOI: 10.1002/bip.360310105] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heteronuclear multispin coherence proton-detected two-dimensional nmr spectroscopic experiments were used to obtain information on protonated carbons and nitrogens of the self-complementary d(G-G-T-A-T-A-C-C) and d(G-G-A-A-T-T-C-C) duplexes, with and without the drug netropsin dissolved in aqueous solution. Many correlations of protons coupled to 13C nuclei on the base and sugar rings of the octanucleotides were detected, allowing the carbon resonances to be assigned based on previous homonuclear proton two-dimensional nmr studies. Imino nitrogen assignments can also be made using the proton assignments from previous one-dimensional nuclear overhauser effect experiments. Imino nitrogen shifts may be useful indicators of changes in local hydrogen-bonding interactions to base-pair edges.
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Affiliation(s)
- J Ashcroft
- Rockefeller University, New York, New York 10021
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LaPlante SR, Boudreau EA, Zanatta N, Levy GC, Borer PN, Ashcroft J, Cowburn D. 13C NMR of the bases of three DNA oligonucleotide duplexes: assignment methods and structural features. Biochemistry 1988; 27:7902-9. [PMID: 3207718 DOI: 10.1021/bi00420a048] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Natural abundance 13C NMR spectra of three DNA oligomers have been obtained. Most of the base resonances are well resolved from one another. A combination of two independent methods was used in making assignments: a one-dimensional spectral comparison method and a two-dimensional proton-detected 1H-13C correlated experiment for the protonated carbons. There are large shielding changes (between 1.62 and -1.40 ppm) upon thermal dissociation of the duplex. The shapes of the chemical shift vs temperature curves are largely independent of sequence. The base carbon resonance frequencies are sensitive to hydrogen bonding, base stacking, sugar conformation, and changes in the glycosyl torsion angle.
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Affiliation(s)
- S R LaPlante
- NIH NMR and Data Processing Laboratory, Syracuse University, New York 13244-1200
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LaPlante SR, Ashcroft J, Cowburn D, Levy GC, Borer PN. 13C NMR assignments of the protonated carbons of [d(TAGCGCTA)]2 by two-dimensional proton-detected heteronuclear correlation. J Biomol Struct Dyn 1988; 5:1089-99. [PMID: 3271498 DOI: 10.1080/07391102.1988.10506450] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The resonances of the protonated carbons of [d(TAGCGCTA)]2 have been assigned by the two-dimensional proton-detected double-quantum heteronuclear correlation experiment [( 1H-13C]-DQCOSY). 13C-coupled and 13C-decoupled versions of the experiment were used. The assignment method is discussed in detail. The deoxyribose cross peaks segregate into five well-resolved regions, and the base cross peaks have distinct features that are helpful for assignments. The cross peaks from the 1H-13C pairs at the Cyd5, Ado2 and ThdCH3 base positions fall in separate regions of the spectrum from each other; they also are resolved from the closely spaced Ado8, Guo8, Cyd6 and Thd6. Additional parameters for distinction of the base signals are their differing J-coupling values and long-range coupling patterns.
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Affiliation(s)
- S R LaPlante
- NMR and Data Processing Laboratory NIH Resource, Syracuse University, New York 13244-1200
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Abstract
Experiments have been performed to simulate accidents which may occur during large-scale production of micro-organisms. Four types of accident, which were considered to be the most likely to result in the greatest hazard to health, were simulated using a bacterial model. The accidents were all concerned with faults occurring in the operation of the microbial fermenter. Gross contamination of surfaces occurred in all experiments, but only three types of accident produced a measurable aerosol.
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Ashcroft J. Nurses: rural health clinics. Opinion No. 32. Mo Nurse 1980; 49:4. [PMID: 6898834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ashcroft J. Computers in intensive care units. Nurs Mirror Midwives J 1974; 138:50-2. [PMID: 4496312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ashcroft J, Platt GS, Maidment BJ. The accuracy of the microtitre technique. Med Lab Technol 1971; 28:129-32. [PMID: 5557097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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