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Townsley H, Gahir J, Russell TW, Greenwood D, Carr EJ, Dyke M, Adams L, Miah M, Clayton B, Smith C, Miranda M, Mears HV, Bailey C, Black JRM, Fowler AS, Crawford M, Wilkinson K, Hutchinson M, Harvey R, O’Reilly N, Kelly G, Goldstone R, Beale R, Papineni P, Corrah T, Gilson R, Caidan S, Nicod J, Gamblin S, Kassiotis G, Libri V, Williams B, Gandhi S, Kucharski AJ, Swanton C, Bauer DLV, Wall EC. COVID-19 in non-hospitalised adults caused by either SARS-CoV-2 sub-variants Omicron BA.1, BA.2, BA.4/5 or Delta associates with similar illness duration, symptom severity and viral kinetics, irrespective of vaccination history. PLoS One 2024; 19:e0294897. [PMID: 38512960 PMCID: PMC10956747 DOI: 10.1371/journal.pone.0294897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/11/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND SARS-CoV-2 variant Omicron rapidly evolved over 2022, causing three waves of infection due to sub-variants BA.1, BA.2 and BA.4/5. We sought to characterise symptoms and viral loads over the course of COVID-19 infection with these sub-variants in otherwise-healthy, vaccinated, non-hospitalised adults, and compared data to infections with the preceding Delta variant of concern (VOC). METHODS In a prospective, observational cohort study, healthy vaccinated UK adults who reported a positive polymerase chain reaction (PCR) or lateral flow test, self-swabbed on alternate weekdays until day 10. We compared participant-reported symptoms and viral load trajectories between infections caused by VOCs Delta and Omicron (sub-variants BA.1, BA.2 or BA.4/5), and tested for relationships between vaccine dose, symptoms and PCR cycle threshold (Ct) as a proxy for viral load using Chi-squared (χ2) and Wilcoxon tests. RESULTS 563 infection episodes were reported among 491 participants. Across infection episodes, there was little variation in symptom burden (4 [IQR 3-5] symptoms) and duration (8 [IQR 6-11] days). Whilst symptom profiles differed among infections caused by Delta compared to Omicron sub-variants, symptom profiles were similar between Omicron sub-variants. Anosmia was reported more frequently in Delta infections after 2 doses compared with Omicron sub-variant infections after 3 doses, for example: 42% (25/60) of participants with Delta infection compared to 9% (6/67) with Omicron BA.4/5 (χ2 P < 0.001; OR 7.3 [95% CI 2.7-19.4]). Fever was less common with Delta (20/60 participants; 33%) than Omicron BA.4/5 (39/67; 58%; χ2 P = 0.008; OR 0.4 [CI 0.2-0.7]). Amongst infections with an Omicron sub-variants, symptoms of coryza, fatigue, cough and myalgia predominated. Viral load trajectories and peaks did not differ between Delta, and Omicron, irrespective of symptom severity (including asymptomatic participants), VOC or vaccination status. PCR Ct values were negatively associated with time since vaccination in participants infected with BA.1 (β = -0.05 (CI -0.10-0.01); P = 0.031); however, this trend was not observed in BA.2 or BA.4/5 infections. CONCLUSION Our study emphasises both the changing symptom profile of COVID-19 infections in the Omicron era, and ongoing transmission risk of Omicron sub-variants in vaccinated adults. TRIAL REGISTRATION NCT04750356.
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Affiliation(s)
- Hermaleigh Townsley
- The Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
| | - Joshua Gahir
- The Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
| | - Timothy W. Russell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Matala Dyke
- The Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
| | - Lorin Adams
- Worldwide Influenza Centre, The Francis Crick Institute, London, United Kingdom
| | - Murad Miah
- The Francis Crick Institute, London, United Kingdom
| | | | - Callie Smith
- The Francis Crick Institute, London, United Kingdom
| | | | | | - Chris Bailey
- The Francis Crick Institute, London, United Kingdom
| | - James R. M. Black
- The Francis Crick Institute, London, United Kingdom
- University College London, London, United Kingdom
| | | | | | | | | | - Ruth Harvey
- The Francis Crick Institute, London, United Kingdom
- Worldwide Influenza Centre, The Francis Crick Institute, London, United Kingdom
| | | | - Gavin Kelly
- The Francis Crick Institute, London, United Kingdom
| | | | - Rupert Beale
- The Francis Crick Institute, London, United Kingdom
- University College London, London, United Kingdom
- Genotype-to-Phenotype UK National Virology Consortium (G2P-UK)
| | | | - Tumena Corrah
- London Northwest University Healthcare NHS Trust, London, United Kingdom
| | - Richard Gilson
- Camden and North West London NHS Community Trust, London, United Kingdom
| | - Simon Caidan
- The Francis Crick Institute, London, United Kingdom
| | - Jerome Nicod
- The Francis Crick Institute, London, United Kingdom
| | | | - George Kassiotis
- The Francis Crick Institute, London, United Kingdom
- Department of Infectious Disease, St Mary’s Hospital, Imperial College London, London, United Kingdom
| | - Vincenzo Libri
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
- Worldwide Influenza Centre, The Francis Crick Institute, London, United Kingdom
| | - Bryan Williams
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
- Worldwide Influenza Centre, The Francis Crick Institute, London, United Kingdom
| | - Sonia Gandhi
- The Francis Crick Institute, London, United Kingdom
- University College London, London, United Kingdom
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles Swanton
- The Francis Crick Institute, London, United Kingdom
- University College London, London, United Kingdom
| | - David L. V. Bauer
- The Francis Crick Institute, London, United Kingdom
- Genotype-to-Phenotype UK National Virology Consortium (G2P-UK)
| | - Emma C. Wall
- The Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
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Drahman A, Ngee-Soon SL, Crawford M. Prophylactic alpha-blockade for prevention of post-operative urinary retention after inguinal hernia repair: a systematic review and meta-analysis. Hernia 2023; 27:1351-1361. [PMID: 36952050 DOI: 10.1007/s10029-023-02764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The rate of post-operative urinary retention (POUR) in inguinal hernia repairs (IHR) is estimated to be approximately 5.9% to 38% worldwide. Currently, there are minimal studies on the prophylaxis of POUR after IHR. Pre-operative administration of alpha-blockers such as (but not limited to) Tamsulosin, Prazosin and Alfuzosin has shown promising results in the prevention of POUR in patients undergoing IHR. This study aims to determine the effectiveness of prophylactic alpha-blockade in the prevention of POUR after IHR. METHODS This study reports the findings of a systematic review and meta-analysis. Randomised controlled trials (RCTs) using prophylactic alpha-blockade for the prevention of POUR after open and/or laparoscopic IHR in patients aged more than 18 years in all sex groups were included. Multiple databases were searched from inception to October 2021 using the PRISMA flow diagram. Data were extracted and analysed to include eligibility criteria, comparator, intervention, study and participant characteristics. Studies excluded were non-RCT studies and patients with known urinary tract disorders such as benign prostate hypertrophy, urinary incontinence and cancer of the bladder or prostate. Subgroup analyses were also conducted. All effect measures of each data were odds ratio with 95% confidence interval. All studies were pooled using the dichotomous random effects Mantel-Haenszel statistical mode and I2 was used to assess heterogeneity. Publication bias was detected using the Cochrane risk-of-bias tool for randomised trials (RoB-2) involving two independent reviewers. RESULTS A total of eight RCTs were identified which provided adequate numeric data for incorporation into the meta-analysis. Overall, administration of pre-operative alpha-blocker prior to IHR did not prevent POUR (95% CI 1.20 (0.96-1.49), I2: 34%). Subgroup analysis comparing pre-operative use of prophylactic alpha-blocker in open versus laparoscopic IHR has shown statistically significant reduction of POUR prevention in the laparoscopic group (95% CI 0.66 (0.47-0.92)), I2: 43%). The older age group benefited from pre-operative alpha-blocker use with reduced incidence of POUR post-IHR (95% CI 0.14 (0.08, 0.23), I2: 0%)). Gender did not affect the difference of incidence of POUR post-IHR despite pre-operative alpha-blockers (95% CI 0.62 (0.27, 1.44)), I2: 53%)). CONCLUSION Overall, this meta-analysis has shown that administration of prophylactic alpha-blockers did not prevent POUR. However, there was statistically significant reduction of POUR in patients undergoing laparoscopic IHR as compared to open, as well as in older patients (age more than 60 years) after administration of pre-operative alpha-blocker. Hence, the use of pre-operative alpha-blocker especially in older patients should be considered and more RCTs should be undertaken.
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Affiliation(s)
- A Drahman
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia.
| | - S L Ngee-Soon
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, 2050, Australia
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Turner A, Jones A, Ong J, Tu A, Crawford M. The effects of Cognitive Behaviour Therapy for insomnia and Continuous Positive Airway Pressure on neurocognitive functioning in individuals with comorbid insomnia and sleep apnea (COMISA). Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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6
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Kawasaki S, Hwang G, Buckner K, Francis E, Huffnagle S, Kraschnewski J, Vulgamore P, Lucas A, Barbour J, Crawford M, Thomas L, Fuller M, Meyers J, Swartzentruber G, Levine R. Collaborative health systems ECHO: The use of a tele-education platform to facilitate communication and collaboration with recipients of state targeted response funds in Pennsylvania. Subst Abuse 2022; 43:892-900. [PMID: 35192446 PMCID: PMC9627399 DOI: 10.1080/08897077.2021.2007519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The opioid epidemic continues to erode communities across Pennsylvania (PA). Federal and PA state programs developed grants to establish Hub and Spoke programs for the expansion of medications for opioid use disorders (MOUD). Employing the telementoring platform Project ECHO (Extension for Community Health Outcomes), Penn State Health engaged the other seven grant awardees in a Collaborative Health Systems (CHS) ECHO. We conducted key informant interviews to better understand impact of the CHS ECHO on health systems collaboration and opioid crisis efforts. Methods: For eight one-hour sessions, each awardee presented their unique strategies, challenges, and opportunities. Using REDCap, program characteristics, such as number of waivered prescribers and number of patients served were collected at baseline. After completion of the sessions, key informant interviews were conducted to assess the impact of CHS ECHO on awardee's programs. Results: Analysis of key informant interviews revealed important themes to address opioid crisis efforts, including the need for strategic and proactive program reevaluation and the convenience of collaborative peer learning networks. Participants expressed benefits of the CHS ECHO including allowing space for discussion of challenges and best practices and facilitating conversation on collaborative targeted advocacy and systems-level improvements. Participants further reported bolstered motivation and confidence. Conclusions: Utilizing Project ECHO provided a bidirectional platform of learning and support that created important connections between institutions working to combat the opioid epidemic. CHS ECHO was a unique opportunity for productive and convenient peer learning across external partners. Open dialogue developed during CHS ECHO can continue to direct systems-levels improvements that benefit individual and population outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - L Thomas
- The Wright Center for Community Health
| | | | - J Meyers
- UPMC Center for High Value Health Care
| | | | - R Levine
- Pennsylvania Department of Health
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7
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Fendler A, Au L, Shepherd STC, Byrne F, Cerrone M, Boos LA, Rzeniewicz K, Gordon W, Shum B, Gerard CL, Ward B, Xie W, Schmitt AM, Joharatnam-Hogan N, Cornish GH, Pule M, Mekkaoui L, Ng KW, Carlyle E, Edmonds K, Rosario LD, Sarker S, Lingard K, Mangwende M, Holt L, Ahmod H, Stone R, Gomes C, Flynn HR, Agua-Doce A, Hobson P, Caidan S, Howell M, Wu M, Goldstone R, Crawford M, Cubitt L, Patel H, Gavrielides M, Nye E, Snijders AP, MacRae JI, Nicod J, Gronthoud F, Shea RL, Messiou C, Cunningham D, Chau I, Starling N, Turner N, Welsh L, van As N, Jones RL, Droney J, Banerjee S, Tatham KC, Jhanji S, O'Brien M, Curtis O, Harrington K, Bhide S, Bazin J, Robinson A, Stephenson C, Slattery T, Khan Y, Tippu Z, Leslie I, Gennatas S, Okines A, Reid A, Young K, Furness AJS, Pickering L, Gandhi S, Gamblin S, Swanton C, Nicholson E, Kumar S, Yousaf N, Wilkinson KA, Swerdlow A, Harvey R, Kassiotis G, Larkin J, Wilkinson RJ, Turajlic S. Functional antibody and T cell immunity following SARS-CoV-2 infection, including by variants of concern, in patients with cancer: the CAPTURE study. Nat Cancer 2021; 2:1321-1337. [PMID: 35121900 DOI: 10.1038/s43018-021-00275-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/17/2021] [Indexed: 12/13/2022]
Abstract
Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study, integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2 positive, 94 were symptomatic and 2 died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies and 82% had neutralizing antibodies against wild type SARS-CoV-2, whereas neutralizing antibody titers against the Alpha, Beta and Delta variants were substantially reduced. S1-reactive antibody levels decreased in 13% of patients, whereas neutralizing antibody titers remained stable for up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment specific, but presented compensatory cellular responses, further supported by clinical recovery in all but one patient. Overall, these findings advance the understanding of the nature and duration of the immune response to SARS-CoV-2 in patients with cancer.
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Affiliation(s)
- Annika Fendler
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Lewis Au
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Scott T C Shepherd
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fiona Byrne
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Maddalena Cerrone
- Tuberculosis Laboratory, The Francis Crick Institute, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Laura Amanda Boos
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - William Gordon
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Benjamin Shum
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Camille L Gerard
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Barry Ward
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Wenyi Xie
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Andreas M Schmitt
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Georgina H Cornish
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, UK
| | - Martin Pule
- Department of Haematology, University College London Cancer Institute, London, UK
- Autolus Ltd., London, UK
| | | | - Kevin W Ng
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, UK
| | - Eleanor Carlyle
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Kim Edmonds
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Lyra Del Rosario
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Sarah Sarker
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Karla Lingard
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mary Mangwende
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Lucy Holt
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Hamid Ahmod
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Richard Stone
- Experimental Histopathology Laboratory, The Francis Crick Institute, London, UK
| | - Camila Gomes
- Experimental Histopathology Laboratory, The Francis Crick Institute, London, UK
| | - Helen R Flynn
- Mass Spectrometry Proteomics Science Technology Platform, The Francis Crick Institute, London, UK
| | - Ana Agua-Doce
- Flow Cytometry Scientific Technology Platform, The Francis Crick Institute, London, UK
| | - Philip Hobson
- Flow Cytometry Scientific Technology Platform, The Francis Crick Institute, London, UK
| | - Simon Caidan
- Safety, Health and Sustainability, The Francis Crick Institute, London, UK
| | - Michael Howell
- High Throughput Screening Laboratory, The Francis Crick Institute, London, UK
| | - Mary Wu
- High Throughput Screening Laboratory, The Francis Crick Institute, London, UK
| | - Robert Goldstone
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Margaret Crawford
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Laura Cubitt
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Harshil Patel
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - Mike Gavrielides
- Scientific Computing Scientific Technology Platform, The Francis Crick Institute, London, UK
| | - Emma Nye
- Experimental Histopathology Laboratory, The Francis Crick Institute, London, UK
| | - Ambrosius P Snijders
- Mass Spectrometry Proteomics Science Technology Platform, The Francis Crick Institute, London, UK
| | - James I MacRae
- Metabolomics Scientific Technology Platform, The Francis Crick Institute, London, UK
| | - Jerome Nicod
- Advanced Sequencing Facility, The Francis Crick Institute, London, UK
| | - Firza Gronthoud
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Robyn L Shea
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London, UK
- Translational Cancer Biochemistry Laboratory, The Institute of Cancer Research, London, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - David Cunningham
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, London, UK
| | - Ian Chau
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, London, UK
| | - Naureen Starling
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, London, UK
| | - Nicholas Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Liam Welsh
- Neuro-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicholas van As
- Clinical Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Joanne Droney
- Palliative Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Kate C Tatham
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shaman Jhanji
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mary O'Brien
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Olivia Curtis
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
| | - Jessica Bazin
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Anna Robinson
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Tim Slattery
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Yasir Khan
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Zayd Tippu
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Isla Leslie
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Spyridon Gennatas
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Medical Oncology, Guy's Hospital, London, UK
| | - Alicia Okines
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alison Reid
- Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Kate Young
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew J S Furness
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Lisa Pickering
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Sonia Gandhi
- Neurodegeneration Biology Laboratory, The Francis Crick Institute, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Steve Gamblin
- Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- University College London Cancer Institute, London, UK
| | - Emma Nicholson
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Sacheen Kumar
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, London, UK
| | - Nadia Yousaf
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Katalin A Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, UK
- Wellcome Center for Infectious Disease Research in Africa, University Cape Town, Cape Town, Republic of South Africa
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Ruth Harvey
- Worldwide Influenza Centre, The Francis Crick Institute, London, UK
| | - George Kassiotis
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, UK
| | - James Larkin
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Robert J Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
- Wellcome Center for Infectious Disease Research in Africa, University Cape Town, Cape Town, Republic of South Africa
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK.
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8
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Fendler A, Au L, Shepherd ST, Byrne F, Cerrone M, Boos LA, Rzeniewicz K, Gordon W, Shum B, Gerard CL, Ward B, Xie W, Schmitt AM, Joharatnam-Hogan N, Cornish GH, Pule M, Mekkaoui L, Ng KW, Carlyle E, Edmonds K, Del Rosario L, Sarker S, Lingard K, Mangwende M, Holt L, Ahmod H, Stone R, Gomes C, Flynn HR, Agua-Doce A, Hobson P, Caidan S, Howell M, Wu M, Goldstone R, Crawford M, Cubitt L, Patel H, Gavrielides M, Nye E, Snijders AP, MacRae JI, Nicod J, Gronthoud F, Shea RL, Messiou C, Cunningham D, Chau I, Starling N, Turner N, Welsh L, van As N, Jones RL, Droney J, Banerjee S, Tatham KC, Jhanji S, O’Brien M, Curtis O, Harrington K, Bhide S, Bazin J, Robinson A, Stephenson C, Slattery T, Khan Y, Tippu Z, Leslie I, Gennatas S, Okines A, Reid A, Young K, Furness AJ, Pickering L, Gandhi S, Gamblin S, Swanton C, Nicholson E, Kumar S, Yousaf N, Wilkinson KA, Swerdlow A, Harvey R, Kassiotis G, Larkin J, Wilkinson RJ, Turajlic S. Functional antibody and T-cell immunity following SARS-CoV-2 infection, including by variants of concern, in patients with cancer: the CAPTURE study. Res Sq 2021:rs.3.rs-916427. [PMID: 34580668 PMCID: PMC8475970 DOI: 10.21203/rs.3.rs-916427/v1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with cancer have higher COVID-19 morbidity and mortality. Here we present the prospective CAPTURE study (NCT03226886) integrating longitudinal immune profiling with clinical annotation. Of 357 patients with cancer, 118 were SARS-CoV-2-positive, 94 were symptomatic and 2 patients died of COVID-19. In this cohort, 83% patients had S1-reactive antibodies, 82% had neutralizing antibodies against WT, whereas neutralizing antibody titers (NAbT) against the Alpha, Beta, and Delta variants were substantially reduced. Whereas S1-reactive antibody levels decreased in 13% of patients, NAbT remained stable up to 329 days. Patients also had detectable SARS-CoV-2-specific T cells and CD4+ responses correlating with S1-reactive antibody levels, although patients with hematological malignancies had impaired immune responses that were disease and treatment-specific, but presented compensatory cellular responses, further supported by clinical. Overall, these findings advance the understanding of the nature and duration of immune response to SARS-CoV-2 in patients with cancer.
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Affiliation(s)
- Annika Fendler
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Equal contribution
| | - Lewis Au
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Equal contribution
| | - Scott T.C. Shepherd
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Equal contribution
| | - Fiona Byrne
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Maddalena Cerrone
- Tuberculosis Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Department of Infectious Disease, Imperial College London, W12 0NN, UK
| | - Laura Amanda Boos
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Karolina Rzeniewicz
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - William Gordon
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Ben Shum
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Camille L. Gerard
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Barry Ward
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Wenyi Xie
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Andreas M. Schmitt
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | | | - Georgina H. Cornish
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Martin Pule
- Research Department of Haematology at University College London Cancer Institute, WC1E 6DD, London, UK
- Autolus Limited, The MediaWorks, 191 Wood Lane, London, W12 7F
| | - Leila Mekkaoui
- Autolus Limited, The MediaWorks, 191 Wood Lane, London, W12 7F
| | - Kevin W. Ng
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Eleanor Carlyle
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kim Edmonds
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Lyra Del Rosario
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Sarah Sarker
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Karla Lingard
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Mary Mangwende
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Lucy Holt
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Hamid Ahmod
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Richard Stone
- Autolus Limited, The MediaWorks, 191 Wood Lane, London, W12 7F
| | - Camila Gomes
- Autolus Limited, The MediaWorks, 191 Wood Lane, London, W12 7F
| | - Helen R. Flynn
- Mass Spectrometry Proteomics Science Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - Ana Agua-Doce
- Flow Cytometry Scientific Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - Philip Hobson
- Flow Cytometry Scientific Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - Simon Caidan
- Safety, Health & Sustainability, The Francis Crick Institute, London, NW1 1AT, UK
| | - Michael Howell
- High Throughput Screening Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Mary Wu
- High Throughput Screening Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Robert Goldstone
- Advanced Sequencing Facility, The Francis Crick Institute, London, NW1 1AT, UK
| | - Margaret Crawford
- Advanced Sequencing Facility, The Francis Crick Institute, London, NW1 1AT, UK
| | - Laura Cubitt
- Advanced Sequencing Facility, The Francis Crick Institute, London, NW1 1AT, UK
| | - Harshil Patel
- Department of Bioinformatics and Biostatistics, The Francis Crick Institute, London, UK
| | - Mike Gavrielides
- Scientific Computing Scientific Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - Emma Nye
- Experimental Histopathology Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Ambrosius P Snijders
- Mass Spectrometry Proteomics Science Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - James I MacRae
- Metabolomics Scientific Technology Platform, The Francis Crick Institute, London, NW1 1AT, UK
| | - Jerome Nicod
- Advanced Sequencing Facility, The Francis Crick Institute, London, NW1 1AT, UK
| | - Firza Gronthoud
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London, NW1 1AT, UK
| | - Robyn L. Shea
- Department of Pathology, The Royal Marsden NHS Foundation Trust, London, NW1 1AT, UK
- Translational Cancer Biochemistry Laboratory, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - David Cunningham
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey SM2 5PT
| | - Ian Chau
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey SM2 5PT
| | - Naureen Starling
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey SM2 5PT
| | - Nicholas Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Liam Welsh
- Neuro-oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Nicholas van As
- Clinical Oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, SW3 6JJ, UK
| | - Joanne Droney
- Palliative Medicine, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kate C. Tatham
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Shaman Jhanji
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Mary O’Brien
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Olivia Curtis
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Targeted Therapy Team, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Shreerang Bhide
- Head and Neck, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Jessica Bazin
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Anna Robinson
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Clemency Stephenson
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tim Slattery
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Yasir Khan
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Zayd Tippu
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Isla Leslie
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Spyridon Gennatas
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Department of Medical Oncology, 14th Floor, Great Maze Pond Road, Tower Wing, Guy’s Hospital, London SE1 9RY, UK
| | - Alicia Okines
- Breast Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Alison Reid
- Uro-oncology unit, The Royal Marsden NHS Foundation Trust, Surrey, SM2 5PT
| | - Kate Young
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Andrew J.S. Furness
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Lisa Pickering
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Sonia Gandhi
- Neurodegeneration Biology Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG
| | - Steve Gamblin
- Structural Biology of Disease Processes Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- University College London Cancer Institute, London WC1E 6DD, UK
| | - Emma Nicholson
- Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Sacheen Kumar
- Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, London and Surrey SM2 5PT
| | - Nadia Yousaf
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
- Acute Oncology Service, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Katalin A. Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Wellcome Center for Infectious Disease Research in Africa, University Cape Town, Observatory 7925, Republic of South Africa
| | - Anthony Swerdlow
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, London, SW7 3RP, UK
| | - Ruth Harvey
- Worldwide Influenza Centre, The Francis Crick Institute, London, NW1 1AT, UK
| | - George Kassiotis
- Retroviral Immunology Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
| | - James Larkin
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Robert J. Wilkinson
- Tuberculosis Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Department of Infectious Disease, Imperial College London, W12 0NN, UK
- Wellcome Center for Infectious Disease Research in Africa, University Cape Town, Observatory 7925, Republic of South Africa
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, NW1 1AT, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
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9
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Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer H. Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over eight years: randomised controlled trial - CORRIGENDUM. Psychol Med 2021; 51:1723. [PMID: 32489159 DOI: 10.1017/s0033291720001932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2022]
Affiliation(s)
- P Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - D Wang
- Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Crawford
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Dupont
- Central Northwest London Foundation NHS Trust, London, UK
| | - S Cooper
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Nourmand
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - V Lazarevic
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - A Philip
- South London and Maudsley NHS Foundation Trust, London, UK
| | - H Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
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10
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Tyrer P, Wang D, Crawford M, Dupont S, Cooper S, Nourmand S, Lazarevic V, Philip A, Tyrer H. Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial. Psychol Med 2021; 51:1714-1722. [PMID: 32174296 DOI: 10.1017/s003329172000046x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
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Affiliation(s)
- P Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - D Wang
- Department of Statistics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Crawford
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Dupont
- Central Northwest London Foundation NHS Trust, London, UK
| | - S Cooper
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - S Nourmand
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - V Lazarevic
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
| | - A Philip
- South London and Maudsley NHS Foundation Trust, London, UK
| | - H Tyrer
- Centre for Mental Health, Faculty of Medicine, Imperial College, London, UK
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11
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Johnson D, Crawford M, Cooper T, Claeys Bouuaert C, Keeney S, Llorente B, Garcia V, Neale MJ. Concerted cutting by Spo11 illuminates meiotic DNA break mechanics. Nature 2021; 594:572-576. [PMID: 34108687 PMCID: PMC7611867 DOI: 10.1038/s41586-021-03389-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 02/24/2021] [Indexed: 02/05/2023]
Abstract
Genetic recombination arises during meiosis through the repair of DNA double-strand breaks (DSBs) that are created by Spo11, a topoisomerase-like protein1,2. Spo11 DSBs form preferentially in nucleosome-depleted regions termed hotspots3,4, yet how Spo11 engages with its DNA substrate to catalyse DNA cleavage is poorly understood. Although most recombination events are initiated by a single Spo11 cut, here we show in Saccharomyces cerevisiae that hyperlocalized, concerted Spo11 DSBs separated by 33 to more than 100 base pairs also form, which we term 'double cuts'. Notably, the lengths of double cuts vary with a periodicity of 10.5 base pairs, which is conserved in yeast and mice. This finding suggests a model in which the orientation of adjacent Spo11 molecules is fixed relative to the DNA helix-a proposal supported by the in vitro DNA-binding properties of the Spo11 core complex. Deep sequencing of meiotic progeny identifies recombination scars that are consistent with repair initiated from gaps generated by adjacent Spo11 DSBs. Collectively, these results revise our present understanding of the mechanics of Spo11-DSB formation and expand on the original concepts of gap repair during meiosis to include DNA gaps that are generated by Spo11 itself.
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Affiliation(s)
- Dominic Johnson
- Genome Damage and Stability Centre, University of Sussex, Brighton, UK
| | - Margaret Crawford
- Genome Damage and Stability Centre, University of Sussex, Brighton, UK
| | - Tim Cooper
- Genome Damage and Stability Centre, University of Sussex, Brighton, UK
| | - Corentin Claeys Bouuaert
- Howard Hughes Medical Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Louvain Institute of Biomolecular Science and Technology, Louvain-la-Neuve, Belgium
| | - Scott Keeney
- Howard Hughes Medical Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bertrand Llorente
- Cancer Research Centre of Marseille, CNRS, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Valerie Garcia
- Genome Damage and Stability Centre, University of Sussex, Brighton, UK.
- Cancer Research Centre of Marseille, CNRS, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.
| | - Matthew J Neale
- Genome Damage and Stability Centre, University of Sussex, Brighton, UK.
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12
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Buck MD, Poirier EZ, Cardoso A, Frederico B, Canton J, Barrell S, Beale R, Byrne R, Caidan S, Crawford M, Cubitt L, Gandhi S, Goldstone R, Grant PR, Gulati K, Hindmarsh S, Howell M, Hubank M, Instrell R, Jiang M, Kassiotis G, Lu WT, MacRae JI, Martini I, Miller D, Moore D, Nastouli E, Nicod J, Nightingale L, Olsen J, Oomatia A, O'Reilly N, Rideg A, Song OR, Strange A, Swanton C, Turajlic S, Wu M, Reis e Sousa C. SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay. Wellcome Open Res 2021; 6:9. [PMID: 34095506 PMCID: PMC8170534 DOI: 10.12688/wellcomeopenres.16517.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
The ongoing pandemic of SARS-CoV-2 calls for rapid and cost-effective methods to accurately identify infected individuals. The vast majority of patient samples is assessed for viral RNA presence by RT-qPCR. Our biomedical research institute, in collaboration between partner hospitals and an accredited clinical diagnostic laboratory, established a diagnostic testing pipeline that has reported on more than 252,000 RT-qPCR results since its commencement at the beginning of April 2020. However, due to ongoing demand and competition for critical resources, alternative testing strategies were sought. In this work, we present a clinically-validated procedure for high-throughput SARS-CoV-2 detection by RT-LAMP that is robust, reliable, repeatable, specific, and inexpensive.
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Affiliation(s)
| | | | - Ana Cardoso
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | - Sam Barrell
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Rupert Beale
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Simon Caidan
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Laura Cubitt
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Sonia Gandhi
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | | | | | | | | | | | - Michael Hubank
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
- The Institute of Cancer Research, London, SW7 3RP, UK
| | | | - Ming Jiang
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Wei-Ting Lu
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | | | - David Moore
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | - Eleni Nastouli
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
- University College London GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Jerome Nicod
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | | | | | - Anett Rideg
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Ok-Ryul Song
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Amy Strange
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Charles Swanton
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | - Samra Turajlic
- The Francis Crick Institute, London, NW1 1AT, UK
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
| | - Mary Wu
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - The Crick COVID-19 Consortium
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
- Healh Service Laboratories, London, WC1H 9AX, UK
- New England Biolabs, Ipswich, MA, USA
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
- The Institute of Cancer Research, London, SW7 3RP, UK
- The Royal Free Hospital, London, NW3 2QG, UK
- University College London GOS Institute of Child Health, London, WC1N 1EH, UK
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13
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Monserrat J, Morales Torres C, Richardson L, Wilson TS, Patel H, Domart MC, Horswell S, Song OR, Jiang M, Crawford M, Bui M, Dalal Y, Scaffidi P. Disruption of the MSL complex inhibits tumour maintenance by exacerbating chromosomal instability. Nat Cell Biol 2021; 23:401-412. [PMID: 33837287 PMCID: PMC7610593 DOI: 10.1038/s41556-021-00657-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/26/2021] [Indexed: 02/01/2023]
Abstract
Rewiring of cellular programmes in malignant cells generates cancer-specific vulnerabilities. Here, using an unbiased screening strategy aimed at identifying non-essential genes required by tumour cells to sustain unlimited proliferative capacity, we identify the male-specific lethal (MSL) acetyltransferase complex as a vulnerability of genetically unstable cancers. We find that disruption of the MSL complex and consequent loss of the associated H4K16ac mark do not substantially alter transcriptional programmes but compromise chromosome integrity and promote chromosomal instability (CIN) that progressively exhausts the proliferative potential of cancer cells through a p53-independent mechanism. This effect is dependent on pre-existing genomic instability, and normal cells are insensitive to MSL disruption. Using cell- and patient-derived xenografts from multiple cancer types, we show that excessive CIN induced by MSL disruption inhibits tumour maintenance. Our findings suggest that targeting MSL may be a valuable means to increase CIN beyond the level tolerated by cancer cells without inducing severe adverse effects in normal tissues.
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Affiliation(s)
- Josep Monserrat
- Cancer Epigenetics Laboratory, Francis Crick Institute, London, UK
| | | | | | | | - Harshil Patel
- Bioinformatics and Biostatistics, Francis Crick Institute, London, UK
| | | | - Stuart Horswell
- Bioinformatics and Biostatistics, Francis Crick Institute, London, UK
| | - Ok-Ryul Song
- High Throughput Screening, Francis Crick Institute, London, UK
| | - Ming Jiang
- High Throughput Screening, Francis Crick Institute, London, UK
| | | | - Minh Bui
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yamini Dalal
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paola Scaffidi
- Cancer Epigenetics Laboratory, Francis Crick Institute, London, UK.
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14
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Hood C, Morris A, Corrado O, Swanson E, Bourke L, Crawford M, Quirk A, Doxford H. 116 Impact of COVID 19 Pandemic on Hospital Care For People with Dementia—Feedback From Hospital Leads and Carers. Age Ageing 2021. [PMCID: PMC7989599 DOI: 10.1093/ageing/afab030.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The National Audit of Dementia (NAD) is funded by the Healthcare Quality Improvement Partnership to collect data from acute general hospital in England and Wales. In June 2020 NAD circulated optional surveys to leads for dementia in acute hospitals and carers asking about the impact of the pandemic on the organisation and provision of hospital care. Methods Anonymous survey links were sent to hospital dementia leads directly and circulated to carers of people with dementia via social media and representative organisations. Dementia Leads’ questions included whether they and/or their team had been redeployed during the pandemic and whether wards had access to specialist services. Carers’ questions included whether patients’ needs were discussed, whether they were permitted to visit/how this was communicated, any measures to facilitate communication with their loved ones, and whether they were updated about progress and discharge. Results 53 dementia hospital leads completed the questionnaire. 32% had been redeployed to other clinical areas during the pandemic, 45% said the same for members of the dementia team. Specialist support for people with dementia on both Covid and Non-Covid wards was significantly compromised. 32 carers completed the questionnaire. 48% were not asked about the needs of the patient they cared for, 90% not allowed to visit, 43% were not given any explanation about visiting and 48% not given support to keep in touch with their loved one. Conclusions Clinical priorities inevitably meant redeployment of dementia specialist staff, and changes to visiting. However, continuation of specialist support is a requirement for people with dementia admitted to hospital. Liaison with carers/families must be a priority, including facilitating remote support. Hospitals should take note of NHS guidance permitting carer visits to support a person with dementia experiencing distress.
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Affiliation(s)
- C Hood
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - A Morris
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - O Corrado
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - E Swanson
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - L Bourke
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - M Crawford
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - A Quirk
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
| | - H Doxford
- National Audit of Dementia (NAD) Programme Manager; NAD Deputy Programme Manager; NAD Lead Physician; NAD Nurse Adviser; NAD Project Officer; Director of CCQI RCPsych; Head of Clinical Audit and Research RCPsych; Alzheimer's Society AmbassadorProfessor of Mental Health Research Imperial College, London
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15
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Crawford M, Johnson M, Klein IJ, Hames KC, Norman GJ. Including Continuous Glucose Monitoring to Provide Personalized Glycemic Profiles as Part of a Pilot Worksite Health Screening. J Diabetes Sci Technol 2021; 15:515-516. [PMID: 33095028 PMCID: PMC8256063 DOI: 10.1177/1932296820966630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | - Gregory J. Norman
- Dexcom, Inc., San Diego CA, USA
- Gregory J. Norman, PhD, Dexcom, Inc., 6340 Sequence
Drive, San Diego, CA 92121, USA.
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16
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Buck MD, Poirier EZ, Cardoso A, Frederico B, Canton J, Barrell S, Beale R, Byrne R, Caidan S, Crawford M, Cubitt L, Gandhi S, Goldstone R, Grant PR, Gulati K, Hindmarsh S, Howell M, Hubank M, Instrell R, Jiang M, Kassiotis G, Lu WT, MacRae JI, Martini I, Miller D, Moore D, Nastouli E, Nicod J, Nightingale L, Olsen J, Oomatia A, O'Reilly N, Rideg A, Song OR, Strange A, Swanton C, Turajlic S, Wu M, Reis e Sousa C. SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay. Wellcome Open Res 2021; 6:9. [PMID: 34095506 PMCID: PMC8170534 DOI: 10.12688/wellcomeopenres.16517.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 09/01/2023] Open
Abstract
The ongoing pandemic of SARS-CoV-2 calls for rapid and cost-effective methods to accurately identify infected individuals. The vast majority of patient samples is assessed for viral RNA presence by RT-qPCR. Our biomedical research institute, in collaboration between partner hospitals and an accredited clinical diagnostic laboratory, established a diagnostic testing pipeline that has reported on more than 252,000 RT-qPCR results since its commencement at the beginning of April 2020. However, due to ongoing demand and competition for critical resources, alternative testing strategies were sought. In this work, we present a clinically-validated procedure for high-throughput SARS-CoV-2 detection by RT-LAMP in 25 minutes that is robust, reliable, repeatable, sensitive, specific, and inexpensive.
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Affiliation(s)
| | | | - Ana Cardoso
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | - Sam Barrell
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Rupert Beale
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Simon Caidan
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Laura Cubitt
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Sonia Gandhi
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | | | | | | | | | | | - Michael Hubank
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
- The Institute of Cancer Research, London, SW7 3RP, UK
| | | | - Ming Jiang
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - Wei-Ting Lu
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | | | - David Moore
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | - Eleni Nastouli
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
- University College London GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Jerome Nicod
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | | | | | | | - Anett Rideg
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Ok-Ryul Song
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Amy Strange
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Charles Swanton
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
| | - Samra Turajlic
- The Francis Crick Institute, London, NW1 1AT, UK
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
| | - Mary Wu
- The Francis Crick Institute, London, NW1 1AT, UK
| | | | - The Crick COVID-19 Consortium
- The Francis Crick Institute, London, NW1 1AT, UK
- University College London, London, WC1E 6BT, UK
- University College London Hospitals NHS Trust, London, NW1 2PG, UK
- Healh Service Laboratories, London, WC1H 9AX, UK
- New England Biolabs, Ipswich, MA, USA
- The Royal Marsden Hospital, Sutton, SM2 5NG, UK
- The Institute of Cancer Research, London, SW7 3RP, UK
- The Royal Free Hospital, London, NW3 2QG, UK
- University College London GOS Institute of Child Health, London, WC1N 1EH, UK
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17
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Aitken J, Ambrose K, Barrell S, Beale R, Bineva-Todd G, Biswas D, Byrne R, Caidan S, Cherepanov P, Churchward L, Clark G, Crawford M, Cubitt L, Dearing V, Earl C, Edwards A, Ekin C, Fidanis E, Gaiba A, Gamblin S, Gandhi S, Goldman J, Goldstone R, Grant PR, Greco M, Heaney J, Hindmarsh S, Houlihan CF, Howell M, Hubank M, Hughes D, Instrell R, Jackson D, Jamal-Hanjani M, Jiang M, Johnson M, Jones L, Kanu N, Kassiotis G, Kirk S, Kjaer S, Levett A, Levett L, Levi M, Lu WT, MacRae JI, Matthews J, McCoy LE, Moore C, Moore D, Nastouli E, Nicod J, Nightingale L, Olsen J, O'Reilly N, Pabari A, Papayannopoulos V, Patel N, Peat N, Pollitt M, Ratcliffe P, Reis e Sousa C, Rosa A, Rosenthal R, Roustan C, Rowan A, Shin GY, Snell DM, Song OR, Spyer MJ, Strange A, Swanton C, Turner JMA, Turner M, Wack A, Walker PA, Ward S, Wong WK, Wright J, Wu M. Author Correction: Scalable and robust SARS-CoV-2 testing in an academic center. Nat Biotechnol 2020; 38:1000. [PMID: 32681136 PMCID: PMC7366556 DOI: 10.1038/s41587-020-0623-z] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
| | | | | | - Rupert Beale
- The Francis Crick Institute, London, UK
- University College London, London, UK
| | | | | | | | | | | | - Laura Churchward
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - Chris Ekin
- Health Services Laboratories, London, UK
| | | | | | | | - Sonia Gandhi
- The Francis Crick Institute, London, UK.
- University College London, London, UK.
- University College London Hospitals, NHS Foundation Trust, London, UK.
| | | | | | | | | | - Judith Heaney
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | - Michael Hubank
- The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, Surrey, UK
| | | | | | | | - Mariam Jamal-Hanjani
- University College London, London, UK
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | - Marcel Levi
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | - David Moore
- University College London, London, UK
- University College London Hospitals, NHS Foundation Trust, London, UK
| | - Eleni Nastouli
- University College London Hospitals, NHS Foundation Trust, London, UK.
- University College London GOS Institute of Child Health, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gee Yen Shin
- University College London Hospitals, NHS Foundation Trust, London, UK
- Health Services Laboratories, London, UK
| | | | | | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK.
- University College London, London, UK.
- University College London Hospitals, NHS Foundation Trust, London, UK.
| | | | | | | | | | - Sophia Ward
- The Francis Crick Institute, London, UK
- University College London, London, UK
| | - Wai Keong Wong
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | - Mary Wu
- The Francis Crick Institute, London, UK
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18
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Aitken J, Ambrose K, Barrell S, Beale R, Bineva-Todd G, Biswas D, Byrne R, Caidan S, Cherepanov P, Churchward L, Clark G, Crawford M, Cubitt L, Dearing V, Earl C, Edwards A, Ekin C, Fidanis E, Gaiba A, Gamblin S, Gandhi S, Goldman J, Goldstone R, Grant PR, Greco M, Heaney J, Hindmarsh S, Houlihan CF, Howell M, Hubank M, Hughes D, Instrell R, Jackson D, Jamal-Hanjani M, Jiang M, Johnson M, Jones L, Kanu N, Kassiotis G, Kirk S, Kjaer S, Levett A, Levett L, Levi M, Lu WT, MacRae JI, Matthews J, McCoy LE, Moore C, Moore D, Nastouli E, Nicod J, Nightingale L, Olsen J, O'Reilly N, Pabari A, Papayannopoulos V, Patel N, Peat N, Pollitt M, Ratcliffe P, Reis e Sousa C, Rosa A, Rosenthal R, Roustan C, Rowan A, Shin GY, Snell DM, Song OR, Spyer MJ, Strange A, Swanton C, Turner JMA, Turner M, Wack A, Walker PA, Ward S, Wong WK, Wright J, Wu M. Scalable and robust SARS-CoV-2 testing in an academic center. Nat Biotechnol 2020; 38:927-931. [PMID: 32555528 DOI: 10.1038/s41587-020-0588-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | - Rupert Beale
- The Francis Crick Institute, London, UK
- University College London, London, UK
| | | | | | | | | | | | - Laura Churchward
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - Chris Ekin
- Health Services Laboratories, London, UK
| | | | | | | | - Sonia Gandhi
- The Francis Crick Institute, London, UK.
- University College London, London, UK.
- University College London Hospitals, NHS Foundation Trust, London, UK.
| | | | | | | | | | - Judith Heaney
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | - Michael Hubank
- The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, Surrey, UK
| | | | | | | | - Mariam Jamal-Hanjani
- University College London, London, UK
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | - Marcel Levi
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | | | | | | | | | - David Moore
- University College London, London, UK
- University College London Hospitals, NHS Foundation Trust, London, UK
| | - Eleni Nastouli
- University College London Hospitals, NHS Foundation Trust, London, UK.
- University College London GOS Institute of Child Health, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gee Yen Shin
- University College London Hospitals, NHS Foundation Trust, London, UK
- Health Services Laboratories, London, UK
| | | | | | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK.
- University College London, London, UK.
- University College London Hospitals, NHS Foundation Trust, London, UK.
| | | | | | | | | | - Sophia Ward
- The Francis Crick Institute, London, UK
- University College London, London, UK
| | - Wai Keong Wong
- University College London Hospitals, NHS Foundation Trust, London, UK
| | | | - Mary Wu
- The Francis Crick Institute, London, UK
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19
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Carr M, Stocks A, Mallett R, Konkoly K, Freegard M, Hicks A, Crawford M, Pigeon W, Schredl M, Bradshaw C. 0112 Lucid Dreaming Associated with Positive Waking Mood. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.110] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Lucid dreaming (being aware that one is dreaming) is typically a positive experience that may enhance positive mood even after waking. There is concern, however, that lucid dreaming may interfere with sleep quality. In the current experiment, participants practiced common lucid dream induction techniques over the course of a week, and kept a daily sleep and dream diary. The study objective was to assess relationships between dream lucidity and subjective sleep quality, dream emotional content, and subsequent waking mood.
Methods
There were 32 participants aged 19–33 in this open label, single arm study (mean=22.63±3.48; 6 males, 24 females). All participants completed a sleep and dream diary for 7 days that included scaled items (1–7 scale) concerning subjective sleep quality, negative and positive emotional intensity of a dream (if recalled). Participants also completed a 19-item lucidity questionnaire, and the Positive and Negative Affect Schedule. Average scores for the week were computed for all measures and Pearson’s correlations conducted between lucidity and all other measures. Participants with no dream recall (n=5) were excluded. Within-subjects analyses were undertaken by selecting each participant’s highest and lowest lucidity night (n=22; 5 participants with only minimum lucidity excluded).
Results
Positive correlations were found between lucidity and dream positive emotion (r=.490, n=27, p=.009) and positive waking mood (r=.638, n=27, p<.001); there were no other significant correlations (all p>.1). Higher lucidity was associated with more positive dream content (t(21)= -3.214, p=.004) and positive waking mood (t(25)=-4.568, p<.001); no other significant differences were observed.
Conclusion
These data indicate that lucidity is associated with positive dreams and waking mood, with no detriment to self-reported sleep quality. The findings provide preliminary support of lucid dreaming as an intervention to improve wellbeing and mood in the short term.
Support
N/A
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Affiliation(s)
- M Carr
- University of Rochester, Rochester, NY
| | - A Stocks
- Swansea University, Swansea, UNITED KINGDOM
| | - R Mallett
- University of Texas at Austin, Austin, TX
| | - K Konkoly
- Northwestern University, Evanston, IL
| | - M Freegard
- Swansea University, Swansea, UNITED KINGDOM
| | - A Hicks
- Swansea University, Swansea, UNITED KINGDOM
| | - M Crawford
- Swansea University, Swansea, UNITED KINGDOM
| | - W Pigeon
- University of Rochester, Rochester, NY
| | - M Schredl
- Central Institute of Mental Health, Mannehim, GERMANY
| | - C Bradshaw
- Swansea University, Swansea, UNITED KINGDOM
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20
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Scott B, Crawford M, Slavish D, Messman B, Wardle-Pinkston S, Dietch J, Kelly K, Ruggero C, Taylor D. 0398 Demographic Differences in the Degree of Discrepancy Between Sleep Diary and Actigraphy Measures of Sleep. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.395] [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
The accurate estimation of sleep is critical for understanding who is most at risk for sleep disorders and associated disease outcomes. Individuals who overestimate sleep disturbances may be at increased risk for insomnia. A few studies have shown demographic differences in the accuracy of sleep estimation when comparing subjective and objective measures; however, the previous literature is inconsistent and focuses primarily on older adults. We sought to replicate these studies in a large sample of nurses using 14 days of sleep diary and actigraphy measures.
Methods
Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a larger study. Participants completed 14 days of actigraphy and sleep diaries to prospectively assess total sleep time (TST) and sleep efficiency (SE). Discrepancy between diary and actigraphy measures was calculated by subtracting actigraphy measures from diary measures. Linear regression was used to examine how age, race (0 = race other than white, 1 = white), gender (1 = male, 2 = female), ethnicity (1= non-Hispanic/Latinx, 2 = Hispanic/Latinx) predicted degree of sleep discrepancy.
Results
The average discrepancy between diary and actigraphy TST was 30.29 minutes (SD = 29.28), and the average discrepancy between diary and actigraphy SE was 4.16% (SD = 5.66). Race and ethnicity did not predict amount of TST or SE discrepancy. However, younger individuals had more discrepancy in both TST (b = -0.48, p < .001) and SE (b = -0.09, p < .001). Men also had a greater discrepancy in both TST (b = -10.90, p < .05) and SE (b = -2.56, p < .05).
Conclusion
Men and younger individuals had greater discrepancies between diary and actigraphy measures of sleep. This is in contrast to some previous research showing that elderly women tend to display greater discrepancies between subjective and objective measures of sleep. It is essential that future research explore the discrepancies between subjective and objective measures of sleep in larger and more demographically diverse samples. Establishing a better understanding of this relationship is crucial, as it may have significant implications for the diagnosis and treatment of insomnia.
Support
NIH/NIAID R01AI128359-01
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Affiliation(s)
- B Scott
- Department of Psychology, University of North Texas, Denton, TX
| | - M Crawford
- Department of Psychology, University of North Texas, Denton, TX
| | - D Slavish
- Department of Psychology, University of North Texas, Denton, TX
| | - B Messman
- Department of Psychology, University of North Texas, Denton, TX
| | | | - J Dietch
- War Related Illness and Injury Study Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA
| | - K Kelly
- Department of Psychology, University of North Texas, Denton, TX
| | - C Ruggero
- Department of Psychology, University of North Texas, Denton, TX
| | - D Taylor
- Department of Psychology, University of Arizona, Tucson, AZ
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21
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Barnicot K, Crawford M. Conclusions and questions from a non-randomised comparison of routine clinical services implementing different treatment models for borderline personality disorder. Psychol Med 2019; 49:2812-2814. [PMID: 31551098 DOI: 10.1017/s0033291719002447] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K Barnicot
- Department of Medicine, Imperial College London, Centre for Psychiatry, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - M Crawford
- Department of Medicine, Imperial College London, Centre for Psychiatry, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
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22
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Vallières A, Pappathomas A, Araújo T, Crawford M, Garnier S. Who is seeking help for sleep? a clinical profile of patients in a sleep psychology clinic. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Crawford M, Salanitro M, Vallières A, Carr M, Rees H, Norris E, Bradshaw C, Blagrove M. Both good and poor sleepers overestimate wakefulness after waking from a nap: impact of sleep inertia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.224] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Laroche D, Nolin P, Delage J, Crawford M, Vallières A. Adherence to the quarter-hour rule for insomnia: is time perception affected by sleep inertia? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.590] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Curran LA, Nah G, Crawford M, Parikh NI. 2286Clinical correlates and outcomes of methamphetamine-associated cardiovascular disease among hospitalised patients in California. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Methamphetamine abuse is a growing public health crisis, affecting an estimated 33 millions users worldwide. It is associated with the development of several cardiac pathologies, however the incidence and predictors of cardiovascular disease among methamphetamine users remains unclear.
Purpose
We aim to describe the clinical characteristics of methamphetamine users identified from a large cohort of hospitalised patients. Through comparison of methamphetamine users who develop cardiovascular disease (CVD) with those who do not, we aim to identify predictors of these cardiac conditions.
Methods
We studied the clinical and sociodemographic characteristics (via ICD-9 codes) of methamphetamine users using a database of hospitalised patients in California, captured by the Healthcare Cost and Utilization Project (HCUP) between 2005–2011. We used Cox proportional hazards model for incidence of methamphetamine-associated cardiac pathologies (pulmonary hypertension, congestive heart failure, stroke and myocardial infarction) among methamphetamine users.
Results
Amongst 20,249,026 persons in HCUP, we identified n=66,199 patients as methamphetamine users. Methamphetamine users were younger (33±11.6 years) and more frequently male (63.3%) when compared to non-users (45±19.5 years, 44.4% male). They were also more likely to smoke (26% vs 4%) and concurrently abuse alcohol (7% vs 1%).
Methamphetamine use was associated with a 32% increased risk of CVD (HR 1.32, CI 1.26–1.38); higher than those who abuse alcohol (HR 1.28, CI 1.27–1.38), but lower than in those who abuse cocaine (HR 1.47, CI 1.40–1.54), when compared to non-users. Of the 4 CVD types studied, methamphetamine use was most strongly associated with the development of congestive heart failure (HR 1.53) and pulmonary hypertension (HR 1.42). Whilst male gender (HR 1.73) was a significant predictor of myocardial infarction among methamphetamine users, female gender was not found to be a significant risk factor for the development of any of the studied pathologies. Chronic Kidney Disease (HR 2.38, CI 1.74–3.25) and hypertension (HR 2.26, CI 2.03–2.51) were the risk factors most strongly associated with development of CVD among methamphetamine users.
A Kaplan-Meier plot was constructed (figure 1), comparing the time-to-event for development of CVD among users of either methamphetamine, alcohol or cocaine, with non-users. Methamphetamine and cocaine users both had a higher incidence of CVD after 5 years, when compared to those who abuse alcohol only.
Conclusions
Methamphetamine users are at increased risk of CVD when compared to the general hospitalised population. They have a similar risk of CVD as users of cocaine and a higher risk than those who abuse alcohol. Whilst male gender appears to be a risk factor for myocardial infarction among methamphetamine users, there was no significant association found between female gender and the development of CVD in this population.
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Affiliation(s)
- L A Curran
- University of California San Francisco, San Francisco, United States of America
| | - G Nah
- University of California San Francisco, San Francisco, United States of America
| | - M Crawford
- University of California San Francisco, San Francisco, United States of America
| | - N I Parikh
- University of California San Francisco, San Francisco, United States of America
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26
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Crawford M, Burns R, Cooper S, Mackay T. Hereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia. Int J Obstet Anesth 2018; 33:84-86. [DOI: 10.1016/j.ijoa.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
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27
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Abstract
Despite the widespread belief that the involvement of users and carers in the training of psychiatrists would provide a valuable addition to the training process, it is clear that many trainees do not receive this input as part of their current teaching. This article explores some of the questions and concerns that all those parties involved have raised and draws on the experience of users, carers and psychiatrists to address some of these issues and promote the further development of this practice.
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28
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Gutierrez A, Reid C, Crawford M, Cheetham K, Dzugalo A, Parsi M, Penman A, Noronha N, Galindez D, O'Flynn R, Coffey M. Pooled data analysis of the safety and tolerability of intravenous pelareorep in combination with chemotherapy in 500 + cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Abstract
With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.
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Affiliation(s)
- Marko Bukur
- Division of Trauma and Surgical Critical Care, Delray Medical Center, Delray Beach, Florida
- Division of Trauma and Surgical Critical Care, Broward General Medical Center, Fort Lauderdale, Florida
- Herbert Wertheim College of Medicine, Florida International University, University Park, Florida
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Joshua Simon
- Department of Surgery, Larkin Community Hospital, South Miami, Florida
| | - Joseph Catino
- Division of Trauma and Surgical Critical Care, Delray Medical Center, Delray Beach, Florida
- Division of Trauma and Surgical Critical Care, Broward General Medical Center, Fort Lauderdale, Florida
| | - Margaret Crawford
- Division of Trauma and Surgical Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Ivan Puente
- Division of Trauma and Surgical Critical Care, Delray Medical Center, Delray Beach, Florida
- Division of Trauma and Surgical Critical Care, Broward General Medical Center, Fort Lauderdale, Florida
- Herbert Wertheim College of Medicine, Florida International University, University Park, Florida
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Fahim Habib
- Division of Trauma and Surgical Critical Care, Broward General Medical Center, Fort Lauderdale, Florida
- Herbert Wertheim College of Medicine, Florida International University, University Park, Florida
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30
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McCaughan GW, Crawford M, Sandroussi C, Koorey DJ, Bowen DG, Shackel NA, Strasser SI. Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when? Intern Med J 2017; 46:404-12. [PMID: 27062203 DOI: 10.1111/imj.13025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023]
Abstract
In 2015, there are a few absolute contraindications to liver transplantation. In adult patients, survival post-liver transplant is excellent, with 1-year survival rate >90% and 5-year survival rates >80% and predicted median allograft survival beyond 20 years. Patients with a Child-Turcotte Pugh score ≥9 or a model for end-stage liver disease (MELD) score >15 should be referred for liver transplantation, with patients who have a MELD score >17 showing a 1-year survival benefit with liver transplantation. A careful selection of hepatocellular cancer patients results in excellent outcomes, while consideration of extra-hepatic disease (reversible vs irreversible) and social support structures are crucial to patient assessment. Alcoholic liver disease remains a challenge, and the potential to cure hepatitis C virus infection together with the emerging issue of non-alcoholic fatty liver disease-associated chronic liver failure will change the landscape of the who in the years ahead. The when will continue to be determined largely by the severity of liver disease based on the MELD score for the foreseeable future.
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Affiliation(s)
- G W McCaughan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia
| | - M Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C Sandroussi
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - D J Koorey
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - D G Bowen
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia
| | - N A Shackel
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia
| | - S I Strasser
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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31
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Pulitano C, Rogan C, Sandroussi C, Verran D, McCaughan GW, Waugh R, Crawford M. Percutaneous Retroperitoneal Splenorenal Shunt for Symptomatic Portal Vein Thrombosis After Liver Transplantation. Am J Transplant 2015; 15:2261-4. [PMID: 25980940 DOI: 10.1111/ajt.13243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 09/23/2014] [Revised: 01/25/2015] [Accepted: 01/25/2015] [Indexed: 01/25/2023]
Abstract
Acute or recurrent bleeding from ectopic varices is a potentially life-threatening condition in rare patients with extrahepatic complete portal vein thrombosis (PVT) after liver transplantation (LT). In this setting, the role of interventional radiology is very limited and surgical shunts, in particular splenorenal shunts are usually used, despite the high associated mortality. We present the first reports of the clinical use of a new minimally invasive technique, percutaneous retroperitoneal splenorenal shunt (PRESS), in two LT recipients with life-threatening variceal hemorrhage secondary to PVT. Both patients had a successful PRESS using a transplenic approach with resolution of bleeding, avoiding the need for a potentially complicated laparotomy. The PRESS procedure is a useful addition to the interventional armamentarium that can be used in cases unsuitable for surgical shunt, and refractory to endoscopic management. In the future, this technique may be an alternative to surgical shunts as the standard procedure in patients with extra-hepatic PVT, just as the transjugular intrahepatic portosystemic shunt (TIPS) procedure has become for the management of portal hypertension in the absence of PVT. Longer-term follow-up will be needed to establish the long-term success of this procedure.
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Affiliation(s)
- C Pulitano
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Centenary Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - C Rogan
- Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C Sandroussi
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - D Verran
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - G W McCaughan
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Centenary Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - R Waugh
- Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Crawford
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Selby NS, Crawford M, Tracy L, Reno JL, Pan W. In situ biaxial rotation at low-temperatures in high magnetic fields. Rev Sci Instrum 2014; 85:095116. [PMID: 25273781 DOI: 10.1063/1.4896100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the design, construction, and characterization of a biaxial sample rotation stage for use in a cryogenic system for orientation-dependent studies of anisotropic electronic transport phenomena at low temperatures and high magnetic fields. Our apparatus allows for continuous rotation of a sample about two axes, both independently and simultaneously.
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Affiliation(s)
- N S Selby
- Sandia National Labs, Albuquerque, New Mexico 87185, USA
| | - M Crawford
- Sandia National Labs, Albuquerque, New Mexico 87185, USA
| | | | - J L Reno
- Sandia National Labs, Albuquerque, New Mexico 87185, USA
| | - W Pan
- Sandia National Labs, Albuquerque, New Mexico 87185, USA
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Bonesi M, Minneman MP, Ensher J, Zabihian B, Sattmann H, Boschert P, Hoover E, Leitgeb RA, Crawford M, Drexler W. Akinetic all-semiconductor programmable swept-source at 1550 nm and 1310 nm with centimeters coherence length. Opt Express 2014; 22:2632-55. [PMID: 24663556 DOI: 10.1364/oe.22.002632] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
We demonstrate, for the first time, OCT imaging capabilities of a novel, akinetic (without any form of movement in the tuning mechanism), all-semiconductor, all-electronic tunable, compact and flexible swept source laser technology at 1550 nm and 1310 nm. To investigate its OCT performance, 2D and 3D ex vivo and in vivo OCT imaging was performed at different sweep rates, from 20 kHz up to 200 kHz, with different axial resolutions, about 10 µm to 20 µm, and at different coherence gate displacements, from zero delay to >17 cm. Laser source phase linearity and phase repeatability standard deviation of <2 mrad (<160 pm) were observed without external phase referencing, indicating that the laser operated close to the shot noise limit (~2 × factor); constant percentile wavelengths variations of sliding RIN and ortho RIN <0.2% could be demonstrated, ~5 times better as compared to other swept laser technologies.
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Byrnes PD, Crawford M, Sieh E. 'If this…, then…' - Resource allocation in a finite world. Aust Fam Physician 2013; 42:846-849. [PMID: 24324983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Tasks in general practice can be divided into three areas: acute care, planned secondary and tertiary prevention, and primary prevention. There is some evidence that the demands placed on practitioners by the second and third areas can decrease the time available for the first. OBJECTIVE To assess the work load of general practitioners and the evidence around benefit for effort, and suggest some strategies for making the most of available time. DISCUSSION Time wasting in general practice can be doctor-generated, role-generated or Medicare/government-generated. Doctor-generated time wasting includes doing things for which there is evidence of futility and may comprise investigations, screening and specific treatments. Appropriate workforce deployment can reduce role-generated time wasting. Medicare/government-generated waste occurs when there are financial incentives for health care providers to persist in activities with little evidence of benefit, or even evidence of no benefit. GPs need to actively plan to achieve a balance in providing care in the three areas of general practice.
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Affiliation(s)
- Patrick D Byrnes
- MBBS, FRACGP, is Senior Lecturer, Discipline of General Practice, University of Queensland and a general practitioner, Bundaberg, Queensland
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Crawford M. Audrey Finnegan. Assoc Med J 2013. [DOI: 10.1136/bmj.f4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bogdan C, Minhas T, Tuggey J, Crawford M, Milton R. 206 Impact of surgical attendance on referral for thoracic surgery. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Byrnes PD, Crawford M, Wong B. Are they safe in there? - patient safety and trainees in the practice. AUSTRALIAN FAMILY PHYSICIAN 2012; 41:26-29. [PMID: 22276280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Due to the projected increase of medical graduates and general practice registrars, a rapid increase in new trainers and practices is required. The resulting mix of relatively inexperienced trainers and trainees makes the examination of the important question of patient safety even more pertinent. OBJECTIVE To describe practical techniques that look beyond the door of the closed consulting room to detect unconscious incompetence in trainees. DISCUSSION Trainees can both be conscious of their incompetence and ask for help, or unconscious of their incompetence. Many articles have been written on teaching trainees who ask for help, but it is the trainee who does not ask for help who may be at most risk of serious problems, and therefore compromise patient safety. Formative assessment and feedback should be used to empower trainees as self-regulated learners. There are seven principles of good feedback practice that help develop self-regulation. This article provides practical teaching tips for supervisors in general practice.
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Affiliation(s)
- Patrick D Byrnes
- Discipline of General Practice, University of Queensland and a general practitioner, Bundaberg, Queensland.
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Prakoso E, Verran D, Dilworth P, Kyd G, Tang P, Tse C, Koorey DJ, Strasser SI, Stormon M, Shun A, Thomas G, Joseph D, Pleass H, Gallagher J, Allen R, Crawford M, McCaughan GW, Shackel NA. Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney. Intern Med J 2011; 40:619-25. [PMID: 20840212 DOI: 10.1111/j.1445-5994.2010.02277.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We aimed to describe the demand for liver transplantation (LTx) and patient outcomes on the waiting list at the Australian National Liver Transplantation Unit, Sydney over the last 20 years. METHODS We performed a retrospective analysis with the data divided into three eras: 1985-1993, 1994-2000 and 2001-2008. RESULTS The number of patients accepted for LTx increased from 320 to 372 and 548 (P < 0.001) with the number of LTx being performed increasing from 262 to 312 and 452 respectively (P < 0.001). The median adult recipient age increased from 45 to 48 and 52 years (P < 0.001) while it decreased in children from 4 to 2 and 1 years respectively (P = 0.001). In parallel, the deceased donor offers decreased from 1003 to 720 and 717 (P < 0.001). Methods to improve access to donor livers have been used with the use of split livers, extended criteria and non-heart beating donors, resulting in increased acceptance of deceased donor offers by 65% and 115% in the second and third eras when compared with the first era (P < 0.001). However, the adult median waiting time has increased from 23 to 41 and 120 days respectively (P < 0.001). This was associated with increased adult mortality on the waiting list from 23 to 40 and 122 respectively (P < 0.001). CONCLUSIONS Despite the increasing proportion of donor offers being used, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.
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Affiliation(s)
- E Prakoso
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, New South Wales, Australia
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Barnes P, Zhang XJ, Lovejoy M, Drummond T, Hjalmarson H, Crawford M, Shul R, Zolper J. Calculations of the Specific Resistance of Contacts to III-V Nitride Compounds. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-395-849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe present calculations of the specific contact resistance for metals to GaN. Our calculations include a correct determination of the Fermi level taking into account the effect of the degenerate doping levels, required in creating tunneling ohmic contacts. Using a recently reported improved WKB approximation suitable in representing the depletion width at the metal-semiconductor interface, and a two band k-p model for the effective masses, specific contact resistance was determined as a function of doping concentration. The specific contact resistance was calculated using the best data available for barrier heights, effective masses and dielectric coefficients for GaN. Because the barrier height at the metal-semiconductor interface has a very large effect on the contact resistance and the available data is sketchy or uncertain, the effect of varying the barrier height on the calculated specific contact resistance was investigated. Further, since the III-V nitrides are being considered for high temperature device applications, the specific contact resistance was also determined as a function of temperature.
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Crawford M. Budget Squeeze Causes Fission in Fusion Labs: Divisions have appeared among fusion researchers over the nation's fusion strategy; the timing of the next major machine and its potential impact on other research are at issue. Science 2010; 244:138-9. [PMID: 17835342 DOI: 10.1126/science.244.4901.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Crawford M. Landmark Ozone Treaty Negotiated: United Nations group works out plan to slow the erosion of the ozone layer; further action may be necessary to protect the planet. Science 2010; 237:1557. [PMID: 17834441 DOI: 10.1126/science.237.4822.1557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Crawford M. A $2.5-billion Acid rain plan. Science 2010; 235:1567b. [PMID: 17795581 DOI: 10.1126/science.235.4796.1567b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Byrnes P, McGoldrick C, Crawford M. Asthma Cycle of Care attendance - overcoming therapeutic inertia using an asthma clinic. Aust Fam Physician 2010; 39:318-320. [PMID: 20485720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The prevalence of asthma is high in Australia. Despite national guidelines recommending the use of an Asthma Action Plan only 22.5% of people with asthma had a plan in 2004-2005. METHODS To ascertain the effect on attendance for an annual Asthma Cycle of Care resulting in an Asthma Action Plan, a retrospective audit was conducted looking at the 4 years commencing July 2005 of an asthma clinic in a group general practice in Bundaberg, Queensland, of 1 year of active recruitment (via telephone) from a database, and subsequent 3 years of opportunistic recruitment using a 'no asthma plan - no repeat script' policy in conjunction with recall. The practice population in 2005 was 2941 standardised whole patient equivalents including 243 asthmatics on preventers. The main outcome measure was the number of patients completing an annual Asthma Cycle of Care. RESULTS Completion of an annual Asthma Cycle of Care increased from a baseline of 30% (preclinic starting) to 38% at year 1, 64% at year 2, fell back to 45% at year 3, and rose to 59% at end year 4, with nearly all cycles of care being completed via the asthma clinic. DISCUSSION Opportunistic recruitment addressing therapeutic inertia combined with recall may be more effective than active recruitment via telephone.
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Affiliation(s)
- Patrick Byrnes
- Rural Clinical School, University of Queensland, Queensland, Australia.
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Blatter D, Crawford M, Young N. Abstract No. 187: Implantable needle guide for enhanced access and improved longevity of dialysis fistulae. J Vasc Interv Radiol 2010. [DOI: 10.1016/j.jvir.2009.12.347] [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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Sirohi B, A'Hern R, Coombes G, Bliss JM, Hickish T, Perren T, Crawford M, O'Brien M, Iveson T, Ebbs S, Skene A, Laing R, Smith IE. A randomised comparative trial of infusional ECisF versus conventional FEC as adjuvant chemotherapy in early breast cancer: the TRAFIC trial. Ann Oncol 2010; 21:1623-1629. [PMID: 20093351 DOI: 10.1093/annonc/mdp602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The epirubicin with cisplatin and infusional 5-fluorouracil (5-FU) (ECisF) regimen was found to be highly active in the treatment of metastatic breast cancer and as neoadjuvant therapy. The UK TRAFIC (trial of adjuvant 5-FU infusional chemotherapy) trial (CRUK/95/007) compared this schedule with 5-FU, epirubicin and cyclophosphamide (FEC60) as adjuvant therapy in patients with early breast cancer. METHODS In this multicentre, open-label, phase III randomised controlled trial, 349 women were randomly assigned to receive i.v. ECisF [epirubicin 60 mg/m(2), day 1, cisplatin 60 mg/m(2), day 1 and 5-FU 200 mg/m(2) by daily 24-h infusion (n = 172)] or FEC [5-FU 600 mg/m(2), day 1, epirubicin 60 mg/m(2), day 1 and cyclophosphamide 600 mg/m(2), day 1 (n = 177)]. Both treatments were delivered every 3 weeks for six cycles. The primary end point was relapse-free interval (RFI). TRAFIC is registered as an International Standard Randomised Controlled Trial (ISRCTN 83324925). RESULTS All randomised patients were included in the intent-to-treat population. With a median follow-up of 112 months, there was no significant difference in RFI between the treatment groups [hazard ratio 0.84 (95% confidence interval 0.60-1.19); P = 0.33]. Toxic effects were more frequent in patients allocated to ECisF. CONCLUSIONS While limited by size, TRAFIC has long follow-up. No evidence of a clinically worthwhile benefit for the infusional treatment compared with standard treatment was observed which would justify further investigation or widespread use.
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Affiliation(s)
- B Sirohi
- Department of Medical Oncology, Max Cancer Centre, Max Healthcare, New Delhi, India (formerly at The Royal Marsden NHS Foundation Trust)
| | - R A'Hern
- ICR Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, Surrey
| | - G Coombes
- ICR Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, Surrey
| | - J M Bliss
- ICR Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, Surrey
| | - T Hickish
- Department of Oncology and Centre for Postgraduate Medical Research and Education, Institute of Cancer Research Clinical Trials and Statistics Unit, Royal Bournemouth Hospital, Bournemouth
| | - T Perren
- Non-Surgical Oncology, Institute of Cancer Research Clinical Trials and Statistics Unit, St James's University Hospital, Leeds
| | - M Crawford
- Medical Oncology, Airedale General Hospital, Keighley
| | - M O'Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London & Sutton; Mid Kent Oncology Centre, Maidstone Hospital, Sutton, Surrey
| | - T Iveson
- Oncology Department, Pembroke Suite, Salisbury District Hospital, Salisbury
| | - S Ebbs
- Breast Unit, Mayday University Hospital, Croydon
| | - A Skene
- Department of Surgery, Institute of Cancer Research Clinical Trials and Statistics Unit, Royal Bournemouth Hospital, Bournemouth
| | - R Laing
- Department of Oncology, St Luke's Cancer Centre, Guildford, UK
| | - I E Smith
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London & Sutton.
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Tyrer P, Oliver-Africano P, Romeo R, Knapp M, Dickens S, Bouras N, Ahmed Z, Cooray S, Deb S, Murphy D, Hare M, Meade M, Reece B, Kramo K, Bhaumik S, Harley D, Regan A, Thomas D, Rao B, Karatela S, Lenôtre L, Watson J, Soni A, Crawford M, Eliahoo J, North B. Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID). Health Technol Assess 2009; 13:iii-iv, ix-xi, 1-54. [PMID: 19397849 DOI: 10.3310/hta13210] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE(S) To assess the effects and cost-effectiveness of haloperidol, risperidone and placebo on aggressive challenging behaviour in adults with intellectual disability. DESIGN A double-blind randomised controlled trial of two drugs and placebo administered in flexible dosage, with full, independent assessments of aggressive and aberrant behaviour, global improvement, carer burden, quality of life and adverse drug effects at baseline, 4, 12 and 26 weeks, and comparison of total care costs in the 6 months before and after randomisation. At 12 weeks, patients were given the option of leaving the trial or continuing until 26 weeks. Assessments of observed aggression were also carried out with key workers at weekly intervals throughout the trial. SETTING Patients were recruited from all those being treated by intellectual disability services in eight sites in England, one in Wales and one in Queensland, Australia. PARTICIPANTS Patients from all severity levels of intellectual disability; recruitment was extended to include those who may have been treated with neuroleptic drugs in the past. EXCLUSION CRITERIA treatment with depot neuroleptics/another form of injected neuroleptic medication within the last 3 months; continuous oral neuroleptic medication within the last week; those under a section of the Mental Health Act 1983 or Queensland Mental Health Act 2000. INTERVENTIONS Randomisation to treatment with haloperidol (a typical neuroleptic drug), risperidone (an atypical neuroleptic drug) or placebo using a permuted blocks procedure. Dosages were: haloperidol 1.25-5.0 mg daily; risperidone 0.5-2.0 mg daily. MAIN OUTCOME MEASURES Primary: reduction in aggressive episodes between baseline and 4 weeks using Modified Overt Aggression Scale. Secondary: Aberrant Behaviour Checklist; Uplift/Burden Scale; 40-item Quality of Life Questionnaire; Udvalg for Kliniske Undersøgelser scale; Clinical Global Impressions scale. Economic costs recorded using a modified version of Client Service Receipt Inventory for 6 months before and after randomisation. RESULTS There were considerable difficulties in recruitment because of ethical and consent doubts. Twenty-two clinicians recruited a total of 86 patients. Mean daily dosages were 1.07 mg rising to 1.78 mg for risperidone and 2.54 mg rising to 2.94 mg for haloperidol. Aggression declined dramatically with all three treatments by 4 weeks, with placebo showing the greatest reduction (79%, versus 57% for combined drugs) (p = 0.06). Placebo-treated patients showed no evidence of inferior response in comparison to patients receiving neuroleptic drugs. An additional study found that clinicians who had not participated in clinical trials before were less likely to recruit. Mean total cost of accommodation, services, informal care and treatment over the 6 months of the trial was 16,336 pounds for placebo, 17,626 pounds for haloperidol and 18,954 pounds for risperidone. CONCLUSIONS There were no significant important benefits conferred by treatment with risperidone or haloperidol, and treatment with these drugs was not cost-effective. While neuroleptic drugs may be of value in the treatment of aggressive behaviour in some patients with intellectual disability, the underlying pathology needs to be evaluated before these are given. The specific diagnostic indications for such treatment require further investigation. Prescription of low doses of neuroleptic drugs in intellectual disability on the grounds of greater responsiveness and greater liability to adverse effects also needs to be re-examined.
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Affiliation(s)
- P Tyrer
- Department of Psychological Medicine, Imperial College, London, UK
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Romeo R, Knapp M, Tyrer P, Crawford M, Oliver-Africano P. The treatment of challenging behaviour in intellectual disabilities: cost-effectiveness analysis. J Intellect Disabil Res 2009; 53:633-643. [PMID: 19460067 DOI: 10.1111/j.1365-2788.2009.01180.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Antipsychotic drugs are used in the routine treatment of adults with intellectual disabilities (ID) and challenging behaviour in the UK despite limited evidence of their effectiveness. There is no evidence on their cost-effectiveness. METHODS The relative cost-effectiveness of risperidone, haloperidol and placebo in treating individuals with an ID and challenging behaviour was compared from a societal perspective in a 26-week, double-blind, randomised controlled trial. Outcomes were changes in aggression and quality of life. Costs measured all service impacts and unpaid caregiver inputs. RESULTS After 26 weeks, patients randomised to placebo had lower costs compared with those in the risperidone and haloperidol treatment groups. Aggression was highest for patients treated with risperidone and lowest for patients treated with haloperidol; however, quality of life was lowest for patients treated with haloperidol and highest for patients treated with risperidone. CONCLUSION The treatment of challenging behaviour in ID with antipsychotic drugs is not a cost-effective option.
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Affiliation(s)
- R Romeo
- Centre for the Economics of Mental Health, King's College London, Institute of Psychiatry, London, UK.
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Armstrong D, Bridson J, Crawford M, Cronin S, Earley A, Ehrhardt P, Essex C, Gilbert R, Gooderham P, Hall M, Jackson S, Mathews B, McHugh K, Mok J, Murray D, Osman J, Payne H, Philips B, Puntis J, Ravi A, Rahman F, Rogahn D, Rowlands I, Samuels M, Speight N, Wheatley R, Williams C, Williams L. Professionals Against Child Abuse express support for David Southall. Lancet 2009; 373:2021. [PMID: 19524768 DOI: 10.1016/s0140-6736(09)61025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Damian Armstrong
- Professionals Against Child Abuse, c/o 7 Albany Close, Wombwell, Barnsley S73 8ER, UK
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