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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Test Yourself question: Incidental hip lesion on PET-CT. Skeletal Radiol 2024; 53:1195-1197. [PMID: 38032363 DOI: 10.1007/s00256-023-04532-z] [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] [Received: 10/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Correction to: Test Yourself question: Incidental hip lesion on PET‑CT. Skeletal Radiol 2024; 53:1199. [PMID: 38095687 DOI: 10.1007/s00256-023-04540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Gavvala SN, Jenko N, Stevenson J, Shirodkar K, Vaiyapuri S, Botchu R. Test yourself answer: incidental hip lesion on PET-CT. Skeletal Radiol 2024; 53:1229-1231. [PMID: 38063891 DOI: 10.1007/s00256-023-04530-1] [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] [Received: 10/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Sai Niharika Gavvala
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - N Jenko
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - J Stevenson
- Department of Orthopedic Oncology, Royal Orthopedic Hospital, Birmingham, UK
| | - K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - S Vaiyapuri
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
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Shihabul Hassan M, Stevenson J, Gandikota G, Veeratterapillay A, Bhamidipaty K, Botchu R. Current updates in MSK infection imaging: A narrative review. J Clin Orthop Trauma 2024; 51:102396. [PMID: 38585385 PMCID: PMC10998214 DOI: 10.1016/j.jcot.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.
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Affiliation(s)
- M. Shihabul Hassan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J. Stevenson
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | - G. Gandikota
- Department of Radiology, University of North Carolina, USA
| | | | | | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Orchard L, Van M, Abbas J, Malik R, Stevenson J, Tolley N. Mixed-reality technology for clinical communication: objective assessment of the HoloLens 2 as a clinical communication device in a simulated on-call scenario. J Laryngol Otol 2023; 137:1165-1169. [PMID: 36992658 DOI: 10.1017/s0022215123000531] [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] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario. METHOD This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively. RESULTS Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision. CONCLUSION This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.
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Affiliation(s)
- L Orchard
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - M Van
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
| | - J Abbas
- Human Factors Academy, Manchester University NHS Trust, University of Manchester, Manchester, UK
| | - R Malik
- Medical School, Imperial College London, London, UK
| | - J Stevenson
- Infomation Technology, Imperial College Healthcare NHS Trust, London, UK
| | - N Tolley
- Department of ENT Surgery, St Mary's Hospital, Praed St, London, UK
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6
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Stevenson J. Prevention and treatment of osteoporosis in women. Post Reprod Health 2023; 29:11-14. [PMID: 36357006 PMCID: PMC10009319 DOI: 10.1177/20533691221139902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- John Stevenson
- National Heart and Lung Institute, 90897Imperial College London, Royal Brompton Hospital, London, UK
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- National Heart and Lung Institute, 90897Imperial College London, Royal Brompton Hospital, London, UK
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Stolzenberg L, Huang A, Usman M, Koch A, Stevenson J, Kihara C, Seale J. Rheumatoid Arthritis-Linked Artificial Joint Infections Leading to Amputations. Cureus 2023; 15:e35622. [PMID: 37007351 PMCID: PMC10065365 DOI: 10.7759/cureus.35622] [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: 02/01/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common autoimmune condition that can rarely cause more serious complications, such as permanent joint damage or infection, and may pose a significant additional risk during certain routine procedures. One major consequence of RA is that it can lead to serious and permanent joint damage requiring arthroplasty. Additionally, RA is a known cause of infection, with orthopedic prosthetic joint infections (PJIs) being documented. We explore one such serious case of a patient with long-term RA and a left knee joint replacement who presented to the emergency room with a serious PJI. History revealed that he repeatedly was affected by infections and had an extensive and severe clinical course, including nine revision surgeries. After a physical examination, imaging was performed, which further supported the diagnosis of joint infection. Considering the extensive number of attempts to salvage the joint, clinicians decided an above-knee amputation was necessary. This case highlights the fact that RA both increases the need for orthopedic arthroplasties and the risk of complications from these procedures, complicating clinical decision-making for physicians. Additionally, this patient had other underlying medical conditions and social habits that may have contributed to his severe clinical course, and we hope to explore these, discuss possible methods of modifying them, and assist clinicians in not only better treating similar patients but also emphasizing the importance of further developing standardized predictive algorithms and scoring tools.
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Ali K, Mensah E, McDermott A, Stevenson J, Hamer V, Parekh N, Schiff R, Nyangoma S, Fowler-Davis S, Cammen T, Davies JG, Rajkumar C. 1285 IMPLEMENTATION OF A MEDICINE MANAGEMENT PLAN TO REDUCE MEDICATION-RELATED HARM IN OLDER PEOPLE POST-HOSPITAL DISCHARGE - AN RCT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.061] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Medication-related harm (MRH) events are increasing among older adults especially in the 8-weeks after hospital discharge. The Discharge Medical Service (DMS), a UK initiative, aims to reduce post-discharge MRH. In this study, we will compare the clinical, economic, and service outcomes of the DMS.
Method
Using a randomised control trial design, 682 older adults ≥ 65years due for hospital-discharge will be recruited. Participants will be randomized to either intervention arm (medicine management plan (MMP) and DMS), or control arm (DMS only) using a 1:1 stratification. The MMP includes patient and carer education about MRH, copy of discharge medications, and MRH risk score calculated using a validated prediction tool (1). Data collection includes patient clinical and social demographics, and admission and discharge medications. At 8-weeks post discharge, study pharmacist will verify MRH through patient telephone interview, and review of patients’ GP records.
Data Analysis
Univariate analysis will be done for baseline variables comparing the intervention and control arms. Variables known to be associated with MRH will be described by the randomisation groups. Further multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the two arms and modelled to provide national estimates. Qualitative data from focus group interviews at participating hospital sites will explore practitioners’ understanding and acceptance of the DMS and MMP.
Conclusion
This study will inform the use of a validated MRH risk prediction tool, and provide a clinical, and economic evaluation of the DMS and MMP in the NHS. The study has ethics approval and is adopted in the national ageing research portfolio. We are seeking additional sites.
Reference
1. Parekh N, Ali K, Davies JG et al. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Quality and Safety 2020; 29: 142–53.
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Affiliation(s)
- K Ali
- Brighton and Sussex Medical School
| | | | | | | | | | - N Parekh
- Brighton and Sussex Medical School
| | - R Schiff
- Guys and St Thomas’s NHS Foundation
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Antony A, Stevenson J, Trimble T, Block J. Perspective: A Proposed Diagnostic and Treatment Algorithm for Management of Lumbar Spinal Stenosis: An Integrated Team Approach. Pain Physician 2022; 25:E1467-E1474. [PMID: 36608018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Newly-introduced minimally invasive interventions have filled a gap between conservative care and open surgical procedures in the treatment and management of lumbar spinal stenosis (LSS), allowing expanded access to patient care. This spectrum of care involves an important interplay between advanced practice providers, interventional pain physicians, and spine surgeons. OBJECTIVES Using an integrated team approach starting with history taking; static and dynamic imaging; and conservative care, we developed a simple, understandable clinical algorithm that serves as a foundation for physicians to confidently make objective decisions regarding diagnosing and treating LSS throughout the entire clinical course of the condition. We believe this could potentially lead to more efficient and effective care for patients suffering from LSS with neurogenic claudication. METHODS A decision tree approach was utilized with "either/or" choices at each branch or node in the algorithm. Activities are divided into examination procedures and corresponding treatment interventions. Symptom and radiographic severity grading as well as assessing clinical status employed published validated standards. Commensurate treatment choices were selected based on published LSS-specific clinical practice guidelines and/or meta-analyses. RESULTS This algorithm recommends a systematic rule set for LSS diagnostic and treatment options. Initially, LSS symptom severity is graded based on the patient's pain relief with spinal flexion. This is correlated with radiographic severity assessment graded as mild, moderate, or severe. Radiographic severity combined with dynamic imaging prescribes a choice of treatment options and a risk/benefit discussion with the patient. These options include conservative management, minimally invasive methods such as interspinous process decompression, and more invasive surgical procedures such as laminectomy for increasing grades of radiographic severity. LIMITATIONS Understanding that each patient with LSS is managed on a case-by-case basis, the treatment options recommended by this algorithm should be considered "soft guidance." As such, integrated team/patient consultation is recommended to ensure maximum clinical benefit. A risk/benefit assessment and discussion should be performed with each individual patient. CONCLUSIONS Our proposed algorithm offers an easy-to-use clinical tool and general foundation for identifying, evaluating, and treating patients with intermittent neurogenic claudication associated with LSS.
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Al-Aqeel M, Adlan A, Stevenson J. 626 What Is the Influence of Negative Pressure Wound Therapy (NPWT) on High-Risk Wounds in Pelvic Oncology? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.381] [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: 11/06/2022]
Abstract
Abstract
Aim
Hindquarter amputation (HQA) has a high incidence of postoperative wound complications. We aim to use the HQA procedure as a model to investigate the potential advantages of negative pressure wound therapy (NPWT) on wound healing complications in high-risk pelvic oncology wounds.
Method
We conducted a retrospective analysis of all patients undergoing hindquarter amputation at a single tertiary centre between January 2009 and November 2020. Patients were divided into groups who had and hadn't undergone neoadjuvant radiotherapy (RT) to the pelvic tumour.
Results
One hundred six patients were included in the study. 43.4% had NPWT. There was no difference in the incidence of reoperation in the patient group without neo-adjuvant RT between NPWT and conventional dressings (odds ratio [OR], 1.01; p=0.983, 95% confidence interval [CI], 0.365–2.8). However, the use of NPWT decreased the incidence of reoperation among the patients who had NPWT who had received radiotherapy [OR], 0.087; p=0.033, 95% CI, 0.009–0.818). The incidence of wound complications has declined with the increasing use of NPWT between 2009–2020.
Conclusions
The application of NPWT reduces the incidence of wound complications in high-risk pelvic oncology wounds. We demonstrated a reduction in the incidence of reoperation due to wound complications in patients who received NPWT following HQA.
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Affiliation(s)
- M Al-Aqeel
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - A Adlan
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
| | - J Stevenson
- Royal Orthopaedic Hospital , Birmingham , United Kingdom
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Ortega Franco A, Adamson-Raieste A, Rahman R, Pihlak R, Peters N, Scott JA, Aruketty S, Thomson C, Dransfield S, Henshaw A, Ward A, Cutts T, Carter L, Thistlethwaite F, Cook N, Graham D, Stevenson J, Krebs M. 44P Value of comprehensive genomic profiling in pre-screening patients for NTRK fusion in STARTRK2 trial: Single centre experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2040] [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: 11/28/2022] Open
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12
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Sinclair C, Schnobrich M, Stevenson J, Kouba J. 108 A preliminary investigation of anti-Müllerian hormone as a biomarker for fertility in mares. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103571] [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: 10/21/2022]
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13
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Shaw RJ, Yang Q, Barnes A, Hatch D, Crowley MJ, Vorderstrasse A, Vaughn J, Diane A, Lewinski AA, Jiang M, Stevenson J, Steinberg D. Self-monitoring diabetes with multiple mobile health devices. J Am Med Inform Assoc 2021; 27:667-676. [PMID: 32134447 DOI: 10.1093/jamia/ocaa007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the use of multiple mobile health technologies to generate and transmit data from diverse patients with type 2 diabetes mellitus (T2DM) in between clinic visits. We examined the data to identify patterns that describe characteristics of patients for clinical insights. METHODS We enrolled 60 adults with T2DM from a US healthcare system to participate in a 6-month longitudinal feasibility trial. Patient weight, physical activity, and blood glucose were self-monitored via devices provided at baseline. Patients also responded to biweekly medication adherence text message surveys. Data were aggregated in near real-time. Measures of feasibility assessing total engagement in device submissions and survey completion over the 6 months of observation were calculated. RESULTS It was feasible for participants from different socioeconomic, educational, and racial backgrounds to use and track relevant diabetes-related data from multiple mobile health devices for at least 6 months. Both the transmission and engagement of the data revealed notable patterns and varied by patient characteristics. DISCUSSION Using multiple mobile health tools allowed us to derive clinical insights from diverse patients with diabetes. The ubiquitous adoption of smartphones across racial, educational, and socioeconomic populations and the integration of data from mobile health devices into electronic health records present an opportunity to develop new models of care delivery for patients with T2DM that may promote equity as well.
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Affiliation(s)
- Ryan J Shaw
- School of Nursing, Duke University, Durham, North Carolina, USA.,Center for Applied Genomics & Precision Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Q Yang
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A Barnes
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - D Hatch
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - M J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina, USA
| | - A Vorderstrasse
- College of Nursing, New York University, New York, New York, USA
| | - J Vaughn
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A Diane
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - A A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - M Jiang
- Department of Biostatistics & Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA
| | - J Stevenson
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - D Steinberg
- School of Nursing, Duke University, Durham, North Carolina, USA
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Mclachlan S, Chakravorty M, Odone J, Stevenson J, Minshul J, Schiff R. 28 Medication Compliance Aids and Acute Hospitals. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
An estimated 64 million Medication Compliance Aids (MCAs) are dispensed by pharmacies in England each year as a method of reasonable adjustment to improve medication adherence (NICE 2009) and support medicines administration by carers (RPS 2013). Complexities exist when implementing medication changes for patients using MCAs, particularly at hospital discharge or outpatient appointments, where practices seem to vary. This National Survey is the first to determine the current policy and service provision of MCAs by acute hospitals in England.
Methods
An electronic survey was emailed to Chief Pharmacists via the Regional Medicines Information Services in Spring 2019. Initial non-responders were contacted by email and telephone.
Results
51% (73/144) of acute hospital trusts in England responded. 77% (56/73) dispensed medication in MCAs at discharge. Of these, 62.5% would initiate MCAs and 61% supplied a different length of MCA vs non-MCA prescription (see table).
41 hospitals had designated staff completing MCAs. The median time to complete an MCA was 59.5 minutes (range 10–200). The median time from prescription receipt in pharmacy to MCA arrival on ward was 144.5 minutes (range 60–1,440).
Of the 17 hospitals not providing MCAs, the majority would, upon discharge, contact the community pharmacy that provided the MCA pre-admission to update any medication changes and request the provision of a new supply of medicines.
Conclusion
Despite the ubiquitous nature of the MCA, there is no standard approach to the supply of these devices from acute hospitals across England. When hospitals do provide MCAs their preparation is time consuming, often requiring additional staff. A national approach to MCAs might help patients and carers, and reduce medication-related problems and costs.
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Affiliation(s)
- S Mclachlan
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - M Chakravorty
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - J Odone
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
| | - J Stevenson
- Institute of Pharmaceutical Science, King’s College London
- Pharmacy Department, Guy’s and St. Thomas’ NHS Foundation Trust
| | - J Minshul
- London Medicines Information Service, NHS Specialist Pharmacy
| | - R Schiff
- Department of Ageing and Health, Guy’s and St Thomas’ NHS Foundation Trust
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15
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Rao S, Arnold S, Carbone D, Salgia R, Tsao A, Niu J, Aggarwal C, Dragnev K, Awad M, Gainor J, Gubens M, Velcheti V, Telliho L, Akala O, Chartash E, Stevenson J. P75.03 KEYNOTE-U01: A Phase 2 Umbrella Study of Investigational Agents Plus Pembrolizumab-Based Therapy for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1037] [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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16
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Tsoi K, Tan D, Stevenson J, Evans S, Jeys L, Botchu R. Indeterminate pulmonary nodules are not associated with worse overall survival in Ewing Sarcoma. J Clin Orthop Trauma 2021; 16:58-64. [PMID: 33717939 PMCID: PMC7920159 DOI: 10.1016/j.jcot.2020.12.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Lung metastases are a negative prognostic factor in Ewing sarcoma, however, the incidence and significance of sub-centimetre pulmonary nodules at diagnosis is unclear. The aims of this study were to (1): determine the incidence of indeterminate pulmonary nodules (IPNs) in patients diagnosed with Ewing sarcoma (2); establish the impact of IPNs on overall and metastasis-free survival and (3) identify patient, oncological and radiological factors that correlate with poorer prognosis in patients that present with IPNs on their staging chest CT. MATERIALS & METHODS Between 2008 and 2016, 173 patients with a first presentation of Ewing sarcoma of bone were retrospectively identified from an institutional database. Staging and follow-up chest CTs for all patients with IPN were reviewed by a senior radiologist. Clinical and radiologic course were examined to determine overall- and metastasis-free survival for IPN patients and to identify demographic, oncological or nodule-specific features that predict which IPN represent true lung metastases. RESULTS Following radiologic re-review, IPN were found in 8.7% of patients. Overall survival for IPN patients was comparable to those with a normal staging chest CT (2-year overall survival of 73.3% [95% CI 43.6-89] and 89.4% [95% CI 81.6-94], respectively; p = 0.34) and was significantly better than for patients with clear metastases (46.0% [95% CI 31.9-59]; p < 0.0001). Similarly, there was no difference in metastasis-free survival between 'No Metastases' and 'IPN' patients (p = 0.16). Lung metastases developed in 40% of IPN patients at a median 9.6 months. Reduction of nodule size on neoadjuvant chemotherapy was associated with worse overall survival in IPN patients (p = 0.0084). CONCLUSION IPN are not uncommon in patients diagnosed with Ewing sarcoma. In this study, we were unable to detect a difference in overall- or metastasis-free survival between patients with IPN at diagnosis and patients with normal staging chest CTs.
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Affiliation(s)
- K.M. Tsoi
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - D. Tan
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Stevenson
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK,Aston University Medical School, Birmingham, UK
| | - S. Evans
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
| | - L.M. Jeys
- Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK,Aston University Medical School, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK,Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Dykema J, Stevenson J, Assad N, Kniss C, Taylor CA. Effects of Sequential Prepaid Incentives on Response Rates, Data Quality, Sample Representativeness, and Costs in a Mail Survey of Physicians. Eval Health Prof 2020; 44:235-244. [PMID: 32924566 DOI: 10.1177/0163278720958186] [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] [Indexed: 11/16/2022]
Abstract
While collecting high quality data from physicians is critical, response rates for physician surveys are frequently low. A proven method for increasing response in mail surveys is to provide a small, prepaid monetary incentive in the initial mailing. More recently, researchers have begun experimenting with adding a second cash incentive in a follow-up contact in order to increase participation among more reluctant respondents. To assess the effects of sequential incentives on response rates, data quality, sample representativeness, and costs, physicians (N = 1,500) were randomly assigned to treatments that crossed the amount of a first ($5 or $10) and second ($0, $5, or $10) incentive to form the following groups: Group $5/$5; Group $5/$10; Group $10/$0; Group $10/$5; and Group $10/$10. Overall, second incentives were associated with higher response rates and lower costs per completed survey, and while they had no effect on item nonresponse, they increased sample representativeness.
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Affiliation(s)
- Jennifer Dykema
- University of Wisconsin Survey Center, 5228University of Wisconsin-Madison, WI, USA.,Department of Sociology, 5228University of Wisconsin-Madison, WI, USA
| | - John Stevenson
- University of Wisconsin Survey Center, 5228University of Wisconsin-Madison, WI, USA
| | - Nadia Assad
- University of Wisconsin Survey Center, 5228University of Wisconsin-Madison, WI, USA
| | - Chad Kniss
- University of Wisconsin Survey Center, 5228University of Wisconsin-Madison, WI, USA
| | - Catherine A Taylor
- Department of Global Community Health and Behavioral Sciences, 5783Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Reardon CL, Hafer R, Langheim FJP, Lee ER, McDonald JM, Peterson MJ, Stevenson J, Walaszek A. A Quality Improvement Curriculum for Psychiatry Residents. MedEdPORTAL 2020; 16:10870. [PMID: 32051851 PMCID: PMC7012317 DOI: 10.15766/mep_2374-8265.10870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/07/2019] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Quality improvement (QI) is an increasingly important aspect of health care and residency education. There is relatively little research describing QI curricula for residents in psychiatry. Although QI curricula have been published in MedEdPORTAL, the current resource represents the first such curriculum specific to psychiatry residents. This resource aims to present a QI curriculum for psychiatry residents. METHODS The University of Wisconsin psychiatry residency program implemented a QI curriculum for our PGY 3 psychiatry residents in 2010. The initial version of the curriculum has undergone marked changes over the ensuing years, reflecting feedback received from learners and faculty instructors, as well as ongoing review of the literature, to ascertain best practices in this area of medical education. Steps taken have included faculty training, development of evaluation forms, and implementation of elements to increase accountability for successful, sustainable project development. RESULTS During the 8 completed years of this curriculum, 77 PGY 3 psychiatry residents have completed it. The Quality Improvement Knowledge Application Tool adapted for psychiatry was completed by PGY 3 residents in advance of and upon completion of the curriculum for the first 2 years of the curriculum; results demonstrated a significant improvement in scores as a measurement of QI knowledge and skills. Thirty-one of 32 resident teams (97%) have implemented a QI project. DISCUSSION Our QI curriculum for PGY 3 psychiatry residents has been successful in equipping residents with QI knowledge and having them implement QI projects.
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Affiliation(s)
- Claudia L. Reardon
- Associate Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health
| | - Roderick Hafer
- Clinical Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health
| | | | - Elliot R. Lee
- Clinical Adjunct Assistant Professor, Mendota Mental Health Institute
| | | | - Michael J. Peterson
- Associate Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health
| | - John Stevenson
- Associate Director for Research Services, University of Wisconsin Survey Center
| | - Art Walaszek
- Professor, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health
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Lutz CS, Fink RV, Cloud AJ, Stevenson J, Kim D, Fiebelkorn AP. Factors associated with perceptions of influenza vaccine safety and effectiveness among adults, United States, 2017-2018. Vaccine 2019; 38:1393-1401. [PMID: 31883808 DOI: 10.1016/j.vaccine.2019.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Annual vaccination against seasonal influenza is widely recognized as the primary intervention method in preventing morbidity and mortality from influenza, but coverage among adults is suboptimal in the United States. Safety and effectiveness perceptions regarding vaccines are consistently cited as factors that influence adults' decisions to accept or reject vaccination. Therefore, we conducted this analysis in order to understand sociodemographic, attitude, and knowledge factors associated with these perceptions for influenza vaccine among adults in three different age groups. METHODS Probability-based Internet panel surveys using nationally representative samples of adults aged ≥19 years in the United States were conducted during February-March of 2017 and 2018. We asked respondents if they believed the influenza vaccine was safe and effective. We calculated prevalence ratios using chi-square and pairwise t-tests to determine associations between safety and effectiveness beliefs and sociodemographic variables for adults aged 19-49, 50-64, and ≥65 years. RESULTS Survey completion rates were 58.2% (2017) and 57.2% (2018); we analyzed 4597 combined responses. Overall, most adults reported the influenza vaccine was safe (86.3%) and effective (73.0%). However, fewer younger adults reported positive perceptions compared with older age groups. Respondents who believed the vaccine was safe also reported it was effective. CONCLUSIONS Generally, adults perceived the influenza vaccine as safe and effective. Considering this, any improvements to these perceptions would likely be minor and have a limited effect on coverage. Future research to understand why, despite positive perceptions, adults are still choosing to forego the vaccine may be informative.
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Affiliation(s)
- Chelsea S Lutz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, United States; Oak Ridge Institute for Science and Education, United States Department of Energy, Washington, DC, United States; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Rebecca V Fink
- Westat, Rockville, MD, United States; Abt Associates, Cambridge, MA, United States.
| | - Ann J Cloud
- Abt Associates, Cambridge, MA, United States.
| | - John Stevenson
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David Kim
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Vaccines, Office of Infectious Disease and HIV/AIDS, Office of Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC, United States.
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Southam S, Ayub M, Krebs M, Rothwell D, Graham D, Stevenson J. Application of variant interpretation software to decipher pathogenicity of mutations for a molecular tumour board (MTB). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.037] [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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21
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Murphy L, Laurent J, Mathews K, Stevenson J, Thiele S, Vissing J, Walter M, Woods L, Straub V. P.389Global FKRP registry. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.551] [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: 11/15/2022]
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22
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Randall A, Stevenson J, Heaney S, Notaras S, Hoffman A, Choi P, Brown M, Sud K. SUN-103 PREVALENCE OF MALNUTRITION & NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.500] [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: 11/16/2022] Open
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RANDALL A, Stevenson J, Heaney S, Notaras S, Hoffman A, Choi P, Brown M, Sud K. SUN-102 NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Nandra R, Matharu G, Stevenson J, Parry M, Grimer R, Jeys L. Long-term outcomes after an initial experience of computer-navigated resection of primary pelvic and sacral bone tumours. Bone Joint J 2019; 101-B:484-490. [PMID: 30929483 DOI: 10.1302/0301-620x.101b4.bjj-2018-0981.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. Patients and Methods This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, using computer navigation, between 2010 and 2012. The mean age of the patients at the time of presentation was 51 years (10 to 77). The rates of local recurrence and mortality were calculated using the Kaplan–Meier method. Results Bone resection margins were all clear and there were no bony recurrences. At a mean follow-up for all patients of 59 months (12 to 93), eight patients (34.8%) developed soft-tissue local recurrence, with a cumulative rate of local recurrence at six-years of 35.1% (95% confidence interval (CI) 19.3 to 58.1). The cumulative all-cause rate of mortality at six-years was 26.1% (95% CI 12.7 to 49.1). Conclusion Despite the positive early experience with navigated-assisted resection, local recurrence rates remain high. With increasing knowledge of the size of soft-tissue margins required to reduce local recurrence and the close proximity of native structures in the pelvis, we advise against compromising resection to preserve function, and encourage surgeons to reduce local recurrence by prioritizing wide resection margins of the tumour. Cite this article: Bone Joint J 2019;101-B:484–490.
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Affiliation(s)
- R. Nandra
- West Midlands Deanery, Birmingham, UK
| | | | - J. Stevenson
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - M. Parry
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - R. Grimer
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - L. Jeys
- The Royal Orthopaedic Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
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Gunatillake T, Chui A, Fitzpatrick E, Ignjatovic V, Monagle P, Whitelock J, Zanten D, Eijsink J, Borg A, Stevenson J, Brennecke SP, Erwich JJHM, Said JM, Murthi P. Decreased placental glypican expression is associated with human fetal growth restriction. Placenta 2018; 76:6-9. [PMID: 30803713 DOI: 10.1016/j.placenta.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/21/2016] [Revised: 12/05/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
Placental mediated fetal growth restriction (FGR) is a leading cause of perinatal morbidity and mortality. Heparan sulphate proteoglycans (HSPG) are highly expressed in placentae and regulate haemostasis. We hypothesise that altered expression of HSPGs, glypicans (GPC) may contribute to the development of FGR and small-for-gestational-age (SGA). GPC expression was determined in first-trimester chorionic villous samples collected from women with later SGA pregnancies and in placentae from third-trimester FGR and gestation-matched uncomplicated pregnancies. The expression of both GPC1 and GPC3 were significantly reduced in first-trimester SGA as well as in the third-trimester FGR placentae compared to controls. This is the first study to report a relationship between altered placental GPC expression and subsequent development of SGA/FGR.
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Affiliation(s)
- T Gunatillake
- Department of Obstetrics and Gynaecology, The University of Melbourne, Sunshine Hospital, St Albans, 3021, Australia.
| | - A Chui
- Department of Obstetrics and Gynaecology, The University of Melbourne, Sunshine Hospital, St Albans, 3021, Australia
| | - E Fitzpatrick
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, 3052, Australia
| | - V Ignjatovic
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, 3052, Australia; Department of Clinical Haematology, Royal Children's Hospital, Parkville, 3052, Australia
| | - P Monagle
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, 3052, Australia; Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, 3052, Australia; Department of Clinical Haematology, Royal Children's Hospital, Parkville, 3052, Australia
| | - J Whitelock
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, Australia
| | - D Zanten
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J Eijsink
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A Borg
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, The Royal Women's Hospital, Parkville, 3052, Australia
| | - J Stevenson
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, The Royal Women's Hospital, Parkville, 3052, Australia
| | - S P Brennecke
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, The Royal Women's Hospital, Parkville, 3052, Australia
| | - J J H M Erwich
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J M Said
- Department of Obstetrics and Gynaecology, The University of Melbourne, Sunshine Hospital, St Albans, 3021, Australia; Maternal Fetal Medicine, Sunshine Hospital, Western Health, St Albans, 3021, Australia
| | - P Murthi
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, The Royal Women's Hospital, Parkville, 3052, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, 3052, Australia; Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168, Australia
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Rengan R, Mick R, Pryma D, Lin L, Plastaras J, Simone C, Gupta A, Evans T, Stevenson J, Langer C, Kucharczuk J, Friedberg J, Lam S, Patsch D, Hahn S, Maity A. Long-term Results of a Phase I/II Trial of Nelfinavir with Concurrent Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stevenson J, Howe C, Alexander G. A Cross-Sectional Study on MyPlate Awareness in Children 7-13 Years of Age. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.125] [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: 11/15/2022]
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28
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Stevenson J, Ayub M, Dransfield S, Shing E, Barley D, Dunne R, Westaway M, Landers D, Krebs M. PO-047 Etarget: a digital science solution to integrate clinical and genomic data for the manchester molecular tumour board (MTB). ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.580] [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] Open
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Argiris A, Lee JW, Stevenson J, Sulecki MG, Hugec V, Choong NW, Saltzman JN, Song W, Hansen RM, Evans TL, Ramalingam SS, Schiller JH. Phase II randomized trial of carboplatin, paclitaxel, bevacizumab with or without cixutumumab (IMC-A12) in patients with advanced non-squamous, non-small-cell lung cancer: a trial of the ECOG-ACRIN Cancer Research Group (E3508). Ann Oncol 2018; 28:3037-3043. [PMID: 28950351 DOI: 10.1093/annonc/mdx534] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/06/2023] Open
Abstract
Background Cixutumumab is a fully human IgG1 monoclonal antibody to the insulin-like growth factor type I receptor that can potentially reverse resistance and enhance the efficacy of chemotherapy. Methods Bevacizumab-eligible patients with stage IV or recurrent non-squamous, non-small-cell lung cancer and good performance status were randomized to receive standard doses of paclitaxel, carboplatin, and bevacizumab to a maximum of six cycles followed by bevacizumab maintenance (CPB) until progression (arm A) or CPB plus cixutumumab 6 mg/kg i.v. weekly (arm B). Results Of 175 patients randomized, 153 were eligible and treated (78 in arm A; 75 in arm B). The median progression-free survival was 5.8 months (95% CI 5.4-7.1) in arm A versus 7 months (95% CI 5.7-7.6) in arm B (P = 0.33); hazard ratio 0.92 (95% CI 0.65-1.31). Objective response was 46.2% versus 58.7% in arm A versus arm B (P = 0.15). The median overall survival was 16.2 months in arm A versus 16.1 months in arm B (P = 0.95). Grade 3/4 neutropenia and febrile neutropenia, thrombocytopenia, fatigue, and hyperglycemia were increased with cixutumumab. Conclusions The addition of cixutumumab to CPB increased toxicity without improving efficacy and is not recommended for further development in non-small-cell lung cancer. Both treatment groups had longer OS than historical controls which may be attributed to several factors, and emphasizes the value of a comparator arm in phase II trials. ClinicalTrials.gov Identifier NCT00955305.
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Affiliation(s)
- A Argiris
- Medical Oncology, Hygeia Hospital, Athens, Greece.,Medical Oncology, Thomas Jefferson University, Philadelphia
| | - J W Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston
| | - J Stevenson
- Medical Oncology, Cleveland Clinic Foundation, Cleveland
| | - M G Sulecki
- Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh
| | - V Hugec
- Medical Oncology, Minnesota Oncology, Minneapolis, Lake Elmo
| | | | - J N Saltzman
- Medical Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland
| | - W Song
- Pottstown Memor Reg Cancer Ctr, Pottstown
| | - R M Hansen
- Medical Oncology, Oconomowoc Memorial Hospital, Oconomowoc
| | - T L Evans
- Medical Oncology, University of Pennsylvania, Philadelphia
| | - S S Ramalingam
- The Winship Cancer Institute of Emory University, Atlanta
| | - J H Schiller
- Medical Oncology, The University of Texas Southwestern Medical Center, Dallas, USA
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Kirolos A, Waugh C, Templeton K, McCormick D, Othieno R, Willocks LJ, Stevenson J. Imported case of measles in a university setting leading to an outbreak of measles in Edinburgh, Scotland from September to December 2016. Epidemiol Infect 2018; 146:741-746. [PMID: 29564994 PMCID: PMC9134365 DOI: 10.1017/s0950268818000602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/19/2017] [Revised: 02/03/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022] Open
Abstract
In September 2016, an imported case of measles in Edinburgh in a university student resulted in a further 17 confirmed cases during October and November 2016. All cases were genotype D8 and were associated with a virus strain most commonly seen in South East Asia. Twelve of the 18 cases were staff or students at a university in Edinburgh and 17 cases had incomplete or unknown measles mumps rubella (MMR) vaccination status. The public health response included mass follow-up of all identified contacts, widespread communications throughout universities in Edinburgh and prompt vaccination clinics at affected campuses. Imported cases of measles pose a significant risk to university student cohorts who may be undervaccinated, include a large number of international students and have a highly mobile population. Public health departments should work closely with universities to promote MMR uptake and put in place mass vaccination plans to prevent rapidly spreading measles outbreaks in higher educational settings in future.
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Affiliation(s)
- A. Kirolos
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
| | - C. Waugh
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
| | - K. Templeton
- Department of Virology, National Health Service, Lothian, Royal Infirmary Edinburgh, Edinburgh, UK
| | - D. McCormick
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
| | - R. Othieno
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
| | - L. J. Willocks
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
| | - J. Stevenson
- National Health Service, Lothian, Directorate of Public Health and Health Policy, Edinburgh, UK
- National Health Service, Lothian, Incident Management Team for the Outbreak of Measles in Edinburgh 2016, Edinburgh, UK
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Feinberg L, Srinivasan A, Singh JK, Parry M, Stevenson J, Jeys L, Grimer R, Peart F, Warner R, Ford S, Gourevitch D, Hallissey M, Desai A. Impact of specialist management on survival from radiation-associated angiosarcoma of the breast. Br J Surg 2018; 105:401-409. [PMID: 29405251 DOI: 10.1002/bjs.10696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/26/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Radiation-associated angiosarcoma of the breast (RAAS) is a rare complication of adjuvant radiotherapy associated with poor survival. The British Sarcoma Group guidelines recommend that all angiosarcomas are referred to a sarcoma multidisciplinary team, although there is no recommendation that patients are managed within a sarcoma service. The aims of this study were to compare survival, complete excision rates and local recurrence rates of patients managed within a sarcoma service and those managed within local hospitals. METHODS All patients with RAAS referred to a regional sarcoma service between 1998 and 2015 were identified from prospective databases. Patient records, and radiology, pathology and operation notes were reviewed retrospectively. RESULTS Thirty-six patients were operated on with curative intent; 26 were managed by the sarcoma service (of whom 21 underwent radical excision of the irradiated field followed by chest wall reconstruction) and ten were managed locally. Median age was 69·5 (range 43-85) years. Disease-specific survival was significantly longer in patients managed by the sarcoma service than in those managed locally: median 91·1 (range 69·2-113·0) versus 48·8 (18·6-79·1) months respectively (P = 0·012). Overall survival rates were similar (P = 0·112). There was no difference in complete excision rate (18 of 26 in sarcoma service versus 5 of 10 in local services; P = 0·456), although the local recurrence rate was significantly lower among patients managed by the sarcoma service (9 of 26 versus 8 of 10; P = 0·015). CONCLUSION Specialist management of RAAS leads to fewer local recurrences and improved disease-specific survival. Early referral and management within specialist units is recommended.
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Affiliation(s)
- L Feinberg
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Srinivasan
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J K Singh
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - F Peart
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Warner
- Department of Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ford
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Gourevitch
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Hallissey
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Desai
- Midland Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Willey C, Fede J, Stevenson J, Hayward A, Kogut S, Fournier H, Padbury J. Clinical and Translational Research in Rhode Island: Results of a Needs Assessment Survey. R I Med J (2013) 2018; 101:21-25. [PMID: 29393306 PMCID: PMC6053046] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Advance-Clinical and Translational Research (CTR) program was established in Rhode Island in May of 2016 with an IDeA Program Infrastructure award to collaborating institutions: Brown University, the University of Rhode Island, with the Lifespan, Care New England and Providence VA Medical Center healthcare institutions and the Rhode Island Quality Institute. To support programmatic planning, the Tracking and Evaluation Key Component Activity (KCA) of Advance-CTR developed and implemented a needs assessment survey to identify the obstacles to clinical and translational research at the participating institutions. We describe the methods used and the responses, which identified needs for study design and data analysis support. Support for project development, pilot funding and grants administration showed significant variation, depending on the affiliation of the respondent. The results of the survey are discussed in the context of Rhode Island's significant opportunities to support and develop the capabilities of scientists who engage in translational research. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].
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Affiliation(s)
- Cynthia Willey
- Department of Pharmacy Practice, University of Rhode Island, Kingston, RI 02881,
| | - Jacquelyn Fede
- Department of Pharmacy Practice, University of Rhode Island, Kingston, RI 02881,
| | - John Stevenson
- Department of Psychology, University of Rhode Island, Kingston, RI 02881,
| | | | - Stephen Kogut
- Department of Pharmacy Practice, University of Rhode Island, Kingston, RI 02881, , Office: 401 874-5370; Fax: 401 874-2741
| | - Heather Fournier
- Advance-CTR, Brown University, Division of Biology & Medicine, 233 Richmond Street, Providence, RI 02912,
| | - James Padbury
- William and Mary Oh-William and Elsa Zopfi Professor of Pediatrics for Perinatal Research; Professor of Pediatrics, Principal Investigator, Advance-CTR, Alpert Medical School, Brown University,
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Herd P, Schaeffer NC, DiLoreto K, Jacques K, Stevenson J, Rey F, Roan C. The Influence of Social Conditions Across the Life Course on the Human Gut Microbiota: A Pilot Project With the Wisconsin Longitudinal Study. J Gerontol B Psychol Sci Soc Sci 2017; 73:124-133. [PMID: 28444239 PMCID: PMC5926979 DOI: 10.1093/geronb/gbx029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/03/2017] [Indexed: 02/06/2023] Open
Abstract
Objective To test the feasibility of collecting and integrating data on the gut microbiome into one of the most comprehensive longitudinal studies of aging and health, the Wisconsin Longitudinal Study (WLS). The long-term goal of this integration is to clarify the contribution of social conditions in shaping the composition of the gut microbiota late in life. Research on the microbiome, which is considered to be of parallel importance to human health as the human genome, has been hindered by human studies with nonrandomly selected samples and with limited data on social conditions over the life course. Methods No existing population-based longitudinal study had collected fecal specimens. Consequently, we created an in-person protocol to collect stool specimens from a subgroup of WLS participants. Results We collected 429 stool specimens, yielding a 74% response rate and one of the largest human samples to date. Discussion The addition of data on the gut microbiome to the WLS-and to other population based longitudinal studies of aging-is feasible, under the right conditions, and can generate innovative research on the relationship between social conditions and the gut microbiome.
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Affiliation(s)
- Pamela Herd
- Lafollette School of Public Affairs, University of Wisconsin-Madison
| | | | - Kerryann DiLoreto
- Lafollette School of Public Affairs, University of Wisconsin-Madison
| | - Karen Jacques
- Lafollette School of Public Affairs, University of Wisconsin-Madison
| | - John Stevenson
- Lafollette School of Public Affairs, University of Wisconsin-Madison
| | - Federico Rey
- Lafollette School of Public Affairs, University of Wisconsin-Madison
| | - Carol Roan
- Lafollette School of Public Affairs, University of Wisconsin-Madison
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Kirolos A, Mark K, Waugh C, Shetty J, McCallum A, Templeton K, Stevenson J. Cluster of acute flaccid paralysis in children following enterovirus D68 infection in Scotland. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - K Mark
- NHS Lothian, Edinburgh, UK
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Velcheti V, Bordeaux J, Dakappagari N, Pennell N, Stevenson J, Khunger M, Kim J, Schalper K, Rimm D. MA 13.03 Quantitative Spatial Profiling of PD-1/PD-L1 Interaction Predicts Response to Adjuvant Chemotherapy Non–Small-Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Introduction The aim of this study was to identify patients with malignant hand lesions, establish the proportions of those that were metastases and review their clinical course. Methods A retrospective search of a prospective tumour database was carried out to identify all patients treated at our unit with hand metastases. Patient demographics were recorded including site of primary malignancy, region of the hand involved, management of their metastasis and clinical outcome. Results Overall, 149 patients were identified with a malignant tumour of the hand. Ten had a metastatic lesion. There were 3 women and 7 men with a median age of 68 years (range: 28-91 years) at presentation. All presented with non-mechanical hand pain while four had pain and swelling. The median interval from symptom onset to diagnosis was eight weeks. The minimum follow-up duration was four months. Three patients had no history of malignancy. Of the remaining seven patients, three had other known metastases. Six patients underwent solely palliative radiotherapy. Three patients had amputation. One was treated with surgical excision and radiotherapy. One had an amputation and axillary node clearance. All but one patient had died by the time of the latest follow-up appointment. The median time to death following identification of acrometastases was 18 months. Sites of primary disease were skin (n=4), lung (n=3), kidney (n=2) and neuroendocrine system (n=1). The thumb was the most commonly affected location. Conclusions This study demonstrates that patients presenting with non-mechanical hand pain should be considered to have a malignant process until proved otherwise, particularly in patients with thumb symptoms and a history of prior malignancy.
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Affiliation(s)
- G Morris
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - S Evans
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - J Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - A Kotecha
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - M Parry
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - L Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
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Abstract
Introduction Malignant osseous foot tumours are uncommon. Their oncological outcomes have been poorly documented in the literature so far. The aim of this study was to establish the incidence and to evaluate the oncological outcomes of such patients. Methods Our large orthopaedic oncology database was used to review 70 malignant osseous foot tumour patients. Results The age at diagnosis of malignant osseous foot tumours demonstrated a bimodal distribution peaking in the second and eighth decades of life. Overall, 55 primary malignant bone tumours of the foot (79%) were identified. The median duration from onset of symptoms to diagnosis was 52 weeks (interquartile range [IQR]: 17-104). Eight primary tumours (15%) underwent an accidental excision (ie intralesional excision of a malignant bone tumour where some of the tumour has been left behind, also known as a 'whoops procedure') prior to referral to our unit. Forty-six patients (84%) underwent surgery overall and thirteen of these developed recurrence or metastases. Seven of eight patients with a previous accidental excision underwent amputation. Fifteen osseous metastatic foot lesions were identified. The median length of foot symptoms to diagnosis was 24 weeks (IQR: 20-36 weeks). The median time to death following diagnosis of osseous foot metastases was 20.1 months (IQR: 11.3-27.8 months). Conclusions A high index of suspicion and awareness of clinical features of malignant osseous foot tumours are both essential to avoid diagnostic delays. Amputation is associated with a respectable outcome for patients who have undergone previous accidental excisions.
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Affiliation(s)
- P Yang
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - S Evans
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - N Bali
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - A Ramasamy
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - R Evans
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - J Stevenson
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - L Jeys
- Professor of Health and Life Sciences, Aston University , UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
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Stevenson J. Hormones and the heart, what's new. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.330] [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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Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
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Affiliation(s)
- L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK; School of Health and Life Sciences, Aston University, Birmingham, UK.
| | - G Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
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Pitkin J, Rees MCP, Gray S, Lumsden MA, Marsden J, Stevenson J, Williamson J. Managing the menopause: British Menopause Society Council consensus statement on hormone replacement therapy. ACTA ACUST UNITED AC 2016; 11:152-6. [PMID: 16354459 DOI: 10.1258/136218005775544354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The British Menopause Society Council aims to help health professionals inform and advise women about the menopause. This guidance regarding estrogen-based hormone replacement therapy (HRT), including tibolone, which is classified in the British National Formulary as HRT, responds to the results and analysis of the randomized Women's Health Initiative studies and the observational Million Women Study. Treatment choice should be based on up-to-date information and targeted to individual women's needs. HRT still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.
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Affiliation(s)
- Joan Pitkin
- The British Menopause Society, 4-6 Eton Place, Marlow, Buckinghamshire SL7 2QA, UK
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Abstract
The British Menopause Society Council aims to help health professionals to inform and advise women about the menopause. The oestrogen plus progestogen arm of the Women's Health Initiative was stopped in July 2002. This guidance regarding hormone replacement therapy (HRT) use responds to the results and analysis that have been published since then, as well as the Million Women Study published in August 2003. Because there are few effective alternatives to HRT for vasomotor and urogenital symptoms, oestrogen-based treatments still have a major role. HRT is also most effective for the prevention of osteoporosis. Unopposed oestrogens are contraindicated in women with an intact uterus, and hence a range of oestrogen and progestogen combinations, with differing routes of delivery, now exists under the title of "HRT". Treatment choice should be based on up to date information and targeted to individual women's needs. Hormone replacement still offers the potential for benefit to outweigh harm, providing the appropriate regimen has been instigated in terms of dose, route and combination.
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Affiliation(s)
- Joan Pitkin
- Menopause Clinical & Research Unit, Division of Women & Children, Northwick Park & St Marks Hospital, Watford Road Harrow, Mddlx, UK
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Stevenson J, Kwon A, Scalia G. How Good is Stroke Volume Calculation by the Doppler Continuity Method? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.546] [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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Abstract
The authors use the development of one individualized mental health outcome measure, the Major Problem Rating System, to examine psychometric problems for instruments tailored to individual patients. A 280-item computer interview taken by the patient at the outset of treatment solves some reliability and validity problems by standardizing the menu from which a unique set ofproblems is derived Follow-up improvement ratings are made only for baseline-identifiedproblems. Decisions in the design of an individualized measure, testretest reliability, patterns of internal relationships among subscales, and external relationships with other outcome measures are provided.
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Danial J, Ballard-Smith S, Horsburgh C, Crombie C, Ovens A, Templeton KE, Hardie A, Cameron F, Harvey L, Stevenson J, Johannessen I. Lessons learned from a prolonged and costly norovirus outbreak at a Scottish medicine of the elderly hospital: case study. J Hosp Infect 2016; 93:127-34. [PMID: 27005281 DOI: 10.1016/j.jhin.2016.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Norovirus outbreaks are a major burden for healthcare facilities globally. AIM Lessons learned to inform an action plan to improve facilities as well as responses to norovirus within the medicine of the elderly (MoE) hospital as well as other NHS (National Health Service) Lothian facilities. METHODS This study investigated the impact of a prolonged outbreak at an MoE hospital in one of the 14 Scottish health boards between February and March 2013. FINDINGS In all, 143 patients (14.80 cases per 1000 inpatient bed-days) and 30 healthcare staff (3.10 cases per 1000 inpatient bed-days) were affected clinically and 63 patients were confirmed virologically. Restricting new admissions to affected units resulted in 1192 lost bed-days. The cost due to lost bed-days in addition to staff absence and management of the outbreak was estimated at £341,534 for this incident alone. At certain points during the outbreak, the whole facility was closed with resulting major impact on the health board's acute care hospitals. CONCLUSION Due to the outbreak, new measures were implemented for the first time within NHS Lothian that included floor-by-floor (instead of individual) ward closures, enhanced cleaning with chlorine-based products throughout the hospital, reduction in bed capacity with enhanced bed-spacing and interruption to direct admissions from the Board's general practice surgeries, and temporary suspension of visitors to affected areas. Together with regular communication to staff, patients, relatives, and the public throughout the outbreak and good engagement of staff groups in management of the incident, the outbreak was gradually brought under control.
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Affiliation(s)
- J Danial
- Infection Prevention and Control Team, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - S Ballard-Smith
- NHS Lothian Directorate of Nursing, Waverley Gate, Edinburgh, UK
| | - C Horsburgh
- Infection Prevention and Control Team, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C Crombie
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Ovens
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K E Templeton
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hardie
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - F Cameron
- Infection Prevention and Control Team, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Harvey
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Stevenson
- NHS Lothian Public Health, Waverley Gate, Edinburgh, UK
| | - I Johannessen
- Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
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Cai L, Stevenson J, Peng C, Xin R, Rastogi R, Liu K, Geng X, Gao Z, Ji X, Rafols JA, Ji Z, Ding Y. Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia. Neuroscience 2016; 318:45-57. [PMID: 26794589 DOI: 10.1016/j.neuroscience.2016.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Normobaric oxygen (NBO), ethanol (EtOH), and therapeutic hypothermia (TH) delivered alone or in combination have neuroprotective properties after acute stroke. We used an autologous thromboembolic rat stroke model to assess the additive effects of these treatments for reducing the deleterious effects of hyperglycolysis post-stroke in which reperfusion is induced with recombinant tissue plasminogen activator (rt-PA). METHODS Sprague-Dawley rats were subjected to middle cerebral artery (MCA) occlusion with an autologous embolus. One hour after occlusion, rt-PA was administered alone or with NBO (60%), EtOH (1.0 g/kg), TH (33 °C), either singly or in combination. Infarct volume and neurological deficit were assessed at 24h after rt-PA-induced reperfusion with or without other treatments. The extent of hyperglycolysis, as determined by cerebral glucose and lactate levels was evaluated at 3 and 24h after rt-PA administration. At the same time points, expressions of glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), phosphofructokinase1 (PFK-1), and lactate dehydrogenase were (LDH) measured by Western blotting. RESULTS Following rt-PA in rats with thromboembolic stroke, NBO combined with TH or EtOH most effectively decreased infarct volume and neurological deficit. As compared to rt-PA alone, EtOH or TH but not NBO monotherapies significantly reduced post-stroke hyperglycolysis. The increased utilization of glucose and production of lactate post-stroke was prevented most effectively when NBO was combined with either EtOH or TH after reperfusion with rt-PA, as shown by the significantly decreased Glut1, Glut3, PFK-1, and LDH levels. CONCLUSIONS In a rat thromboembolic stroke model, both EtOH and TH used individually offer neuroprotection after the administration of rt-PA. While NBO monotherapy does not appear to be effective, it significantly potentiates the efficacy of EtOH and TH. The similar neuroprotection and underlying mechanisms pertaining to the attenuation of hyperglycolysis provided by EtOH or TH in combination with NBO suggest a possibility of substituting EtOH for TH. Thus a combination of NBO and EtOH, which are widely available and easily used, could become a novel and effective neuroprotective strategy in the clinical setting.
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Affiliation(s)
- L Cai
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - J Stevenson
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - C Peng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - R Xin
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Radiology, Luhe Hospital, Capital Medical University, Beijing, China
| | - R Rastogi
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Liu
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - X Geng
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Gao
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - X Ji
- Cerebral Vascular Diseases Research Institute, Capital Medical University, Beijing, China
| | - J A Rafols
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Z Ji
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China.
| | - Y Ding
- China-America Institute of Neuroscience, Department of Neurology, Luhe Hospital, Capital Medical University, Beijing, China; Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
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Stevenson J. Managing First Stage Problems. Midwifery Today Int Midwife 2016:24-25. [PMID: 27192753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Sterman DH, Alley E, Friedberg J, Metzger S, Stevenson J, Moon E, Haas AR, Vachani A, Katz SI, Cheng G, Sun J, Heitjan DF, Litzky L, Cengel K, Simone CB, Culligan M, Culligan M, Albelda SM. Abstract B56: An immuno-gene therapy clinical trial evaluating in situ vaccination of malignant pleural mesothelioma with intrapleural delivery of adenovirus-interferon-alpha-2b in combination with chemotherapy. Cancer Immunol Res 2015. [DOI: 10.1158/2326-6074.tumimm14-b56] [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: “In situ vaccination” immune-gene therapy has the ability to induce broad, polyclonal anti-tumor responses directed by the patient's own immune system using standard “off the shelf” agents. In this trial, we activated endogenous tumor immunity by injection of an adenovirus expressing a Type I interferon into the pleural space of patients with malignant pleural mesothelioma (MM). Based on preclinical data showing synergy with chemotherapy, all patients then received standard systemic cytotoxic therapy.
Methods: Two doses of intrapleural administration of a replication-defective recombinant adenoviral vector containing the human interferon-alpha (hIFN-α2b) gene at a dose of 3x1011 viral particles were given concomitant with a 14-day course of high-dose cyclo-oxygenase-2 (COX-2) inhibitor (Celecoxib) to reduce side effects and to modify the tumor microenvironment by decreasing PGE- 2 levels. This was followed by standard first-line or second-line chemotherapy agents. Primary outcome measures were safety, overall best response rate, and survival. Bio-correlates were measured.
Results: Forty patients were treated in this study: 18 patients received first-line Pemetrexed-based chemotherapy; 7 patients who had previously received front-line Pemetrexed-based chemotherapy >6 months prior to enrollment received Pemetrexed-based second-line chemotherapy. Additionally, in the second-line chemotherapy arm, fifteen patients (n=15) received gemcitabine-based chemotherapy. Treatment was well tolerated and adverse events were comparable to historical controls. Follow-up chest CT scans demonstrated an overall response rate of 20% by Modified RECIST criteria and disease control rate (DCR) of 85% (partial and complete responses plus stable disease) at initial follow-up scan after the first two cycles of chemotherapy. Encouragingly, median survival for all patients with epithelial histology (including both first and second line) was 26 months (95% CI: 15-ND); median overall survival (MOS) for patients with non-epithelial histology (both first and second line) was 6.5 months (95% CI: 5.50 – ND). [See figure] Historical MOS with first line chemotherapy alone is 13.3 months. No clear predictors for response were identified including: baseline immunologic parameters (i.e. activated T cells or number of regulatory T cells); the presence of the immune-gene signature in their biopsies; peak levels of interferon in blood or pleural fluid; or induction of anti-tumor antibodies, activated T cells, or natural killer cells in peripheral blood.
Conclusions: The combination of intrapleural Ad.IFN-α2b vector, Celecoxib, and systemic chemotherapy proved safe in patients with unresectable malignant pleural mesothelioma. Overall survival rates were significantly higher than historical controls, particularly in the second-line groups. The results of this study support proceeding with a multi-center randomized clinical trial of chemo-immunogene therapy versus standard chemotherapy alone.
Citation Format: D. H. Sterman, E. Alley, J. Friedberg, S. Metzger, J. Stevenson, E. Moon, A. R. Haas, A. Vachani, S. I. Katz, G. Cheng, J. Sun, D. F. Heitjan, L. Litzky, K. Cengel, C. B. Simone, II, M. Culligan, M. Culligan, S. M. Albelda. An immuno-gene therapy clinical trial evaluating in situ vaccination of malignant pleural mesothelioma with intrapleural delivery of adenovirus-interferon-alpha-2b in combination with chemotherapy. [abstract]. In: Proceedings of the AACR Special Conference: Tumor Immunology and Immunotherapy: A New Chapter; December 1-4, 2014; Orlando, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2015;3(10 Suppl):Abstract nr B56.
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Affiliation(s)
| | - E. Alley
- University of Pennsylvania, Philadelphia, PA
| | | | - S. Metzger
- University of Pennsylvania, Philadelphia, PA
| | | | - E. Moon
- University of Pennsylvania, Philadelphia, PA
| | - A. R. Haas
- University of Pennsylvania, Philadelphia, PA
| | - A. Vachani
- University of Pennsylvania, Philadelphia, PA
| | - S. I. Katz
- University of Pennsylvania, Philadelphia, PA
| | - G. Cheng
- University of Pennsylvania, Philadelphia, PA
| | - J. Sun
- University of Pennsylvania, Philadelphia, PA
| | | | - L. Litzky
- University of Pennsylvania, Philadelphia, PA
| | - K. Cengel
- University of Pennsylvania, Philadelphia, PA
| | | | - M. Culligan
- University of Pennsylvania, Philadelphia, PA
| | - M. Culligan
- University of Pennsylvania, Philadelphia, PA
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Jennings CS, Jones J, Mead A, Connolly S, Kotseva K, Holden A, Fiumicelli G, Stevenson J, Hunjan M, Turner E, Wood DA. 025 Lifestyle and health related quality of life changes in coronary and high CVD risk patients and their partners attending the MYACTION integrated vascular prevention programme in the community. Heart 2015. [DOI: 10.1136/hrt.2010.195941.25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perry MEO, Taylor GP, Sabin CA, Conway K, Flanagan S, Dwyer E, Stevenson J, Mulka L, McKendry A, Williams E, Barbour A, Dermont S, Roedling S, Shah R, Anderson J, Rodgers M, Wood C, Sarner L, Hay P, Hawkins D, deRuiter A. Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates. HIV Med 2015. [PMID: 26200570 DOI: 10.1111/hiv.12277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r). METHODS A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared. RESULTS A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%). CONCLUSIONS Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.
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Affiliation(s)
- M E O Perry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G P Taylor
- Imperial College Healthcare NHS Trust, London, UK
| | - C A Sabin
- Research Department of Infection and Population Health, University College London, London, UK
| | - K Conway
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Flanagan
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - E Dwyer
- Croydon University Hospital NHS Trust, London, UK
| | - J Stevenson
- Croydon University Hospital NHS Trust, London, UK
| | - L Mulka
- Imperial College Healthcare NHS Trust, London, UK
| | - A McKendry
- The North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - S Dermont
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Roedling
- (Mortimer Market Centre) Central and North West London NHS Foundation Trust, London, UK
| | - R Shah
- Barnet and Chase Farm Hospital NHS Trust, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - M Rodgers
- Croydon University Hospital NHS Trust, London, UK
| | - C Wood
- The North Middlesex University Hospital NHS Trust, London, UK
| | - L Sarner
- Barts Health NHS Trust, London, UK
| | - P Hay
- St George's NHS Trust, London, UK
| | - D Hawkins
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A deRuiter
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
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