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Berry P, Kotha S. Challenge of achieving truly individualised informed consent in therapeutic endoscopy. Frontline Gastroenterol 2024; 15:183-189. [PMID: 38665798 PMCID: PMC11042451 DOI: 10.1136/flgastro-2023-102545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/24/2023] [Indexed: 04/28/2024] Open
Abstract
Objective Guidance covering informed consent in endoscopy has been refined in the UK following the obstetric case of Nadine Montgomery, and in light of updated General Medical Council guidance. All risks likely to be material to the patient must be explored, as well as alternatives to the procedure. Despite this, departments and endoscopists still struggle to meet the current standards. In this article, we explore the challenges encountered in achieving individualised consent in therapeutic endoscopy through real-life scenarios. Methods Five realistic therapeutic endoscopy (hepatobiliary) scenarios are described, followed by presentation of possible or ideal approaches, with references related to existing literature in this field. Results The vignettes allow consideration of how to approach difficult consent challenges, including anxiety and information overload, urgency during acute illness, failure to disclose the risk of death, the role of trainees and intraprocedural distress under conscious sedation. Conclusions The authors conclude that a high degree of transparency is required while obtaining consent for therapeutic endoscopy accompanied by full documentation, involvement of relatives in nearly all cases, and clarity around the presence of trainees who may handle the scope. A greater focus on upskilling trainees in the consent process for therapeutic endoscopy is required.
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Affiliation(s)
- Philip Berry
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
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2
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Berry P, Kotha S. The fundamental importance of exploring the risks alongside the benefits of artificial intelligence. J Hepatol 2024; 80:e223-e225. [PMID: 37454874 DOI: 10.1016/j.jhep.2023.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
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3
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Berry P, Kotha S. Letter to the Editor: The urgent need for consensus around organ donation after assisted dying. Liver Transpl 2023; 29:E44. [PMID: 37747289 DOI: 10.1097/lvt.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, UK
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4
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Berry P, Kotha S. Letter to the Editor: More questions than answers-Response to the POP-NEXT project. Hepatology 2023; 78:E37. [PMID: 37329170 DOI: 10.1097/hep.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Hepatology and Nutrition, Guy's and St Thomas NHS Foundation Trust, London, UK
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5
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Berry P, Kotha S, Demartino S, Tritto G. Improving compliance with the duty of candour: 5-year experience within an endoscopy department. Postgrad Med J 2023; 99:928-933. [PMID: 37141622 DOI: 10.1136/pmj-2022-141930] [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: 05/19/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIMS Duty of candour (DoC) is the requirement for timely and transparent disclosure after significant healthcare-related harm. We describe the experience of DoC following patient safety incidents (PSI) related to endoscopy, and offer reflections on improving compliance across other areas of clinical medicine. METHODS PSI notified on an electronic reporting system (DATIX) from January 2015 to June 2021 were identified. Details of the procedure, level of harm and evidence of both verbal and written DoC were collected and analysed. RESULTS 33 PSI were notified on DATIX. A verbal apology was documented in 23 cases (70%) and a written notification was offered or sent to in 20 (61%). Verbal apologies were timely, while written DoC was delayed. PSI reporting and verbal DoC increased over this period. Patients or families were invited to present questions for investigation in all 20 with written DoC. There were two claims for compensation during this period. CONCLUSION DoC remains challenging for clinicians and patient safety teams 8 years after its inception. Improved compliance requires promotion by clinical leaders and high levels of awareness among clinical and nursing staff, a culture of openness and importantly, sustained administrative support to ensure that downstream actions are not overlooked.
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Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sabina Demartino
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Giovanni Tritto
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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6
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Kotha S, Berry P. Multi-system IgG4-related disease: the value of positron emission tomography. BMJ Case Rep 2023; 16:16/6/e253909. [PMID: 37263677 DOI: 10.1136/bcr-2022-253909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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7
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Berry P, Kotha S. Letter: pre-emptive TIPSS and the risks of uncertainty. Aliment Pharmacol Ther 2023; 57:1358. [PMID: 37161627 DOI: 10.1111/apt.17522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Philip Berry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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8
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Mullally D, Kotha S, Mandour MO, Berry P. Luetic (syphilitic) hepatitis: the great imitator persists in the 21st century. BMJ Case Rep 2023; 16:16/5/e254330. [PMID: 37160377 PMCID: PMC10174013 DOI: 10.1136/bcr-2022-254330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
A male patient in his 20s was referred to the hepatology team with jaundice, pruritus and drenching night sweats. Investigations revealed an acute hepatitis with negative autoimmune and viral serology. Liver biopsy demonstrated severe pan-lobular hepatitis, and an extended diagnostic screen included a positive treponemal antibody test, with an RPR titre of 64, indicating active syphilis infection. He was treated with 2.4 million units of intramuscular benzathine penicillin as a single dose which led to complete resolution of the abnormal liver tests and symptoms. Diagnostic and management challenges, including the role of good history taking, appropriate investigations and role of multidisciplinary team, are discussed.
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Affiliation(s)
- Daniel Mullally
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mandour Omar Mandour
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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9
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Kotha S, Tritto G, Theocharidou E, Wong T, Wang B, Berry P. Achieving Improving Quality in Liver Services (IQILS) accreditation - lessons learned from one unit's experience. Clin Med (Lond) 2023; 23:213-218. [PMID: 37236795 PMCID: PMC11046494 DOI: 10.7861/clinmed.2022-0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In 2017 the Royal College of Physicians launched a voluntary accreditation process supported by British Association for the Study of the Liver (BASL) and the British Society of Gastroenterologists (BSG) to improve the quality and consistency of liver services across the UK and Ireland. This article describes the approach that we took and the challenges that we met on the way to achieving accreditation.
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Affiliation(s)
| | | | | | - Terry Wong
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bo Wang
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Dhanda A, Bodger K, Hood S, Henn C, Allison M, Amasiatu C, Burton R, Cramp M, Forrest E, Khetani M, MacGilchrist A, Masson S, Parker R, Sheron N, Simpson K, Vergis N, White M, Boyd A, Brind A, Joshi A, Rund A, Srivastava A, McCune A, Gartland A, Hudson B, Stableforth B, John C, Maxan E, Unitt E, Beetteridge F, Lewis H, Fellows H, Haq I, Patel J, Ryan J, Cobbold J, Pohl K, Raeburn K, Corless L, Johnston M, Subhani M, Shah N, Ali N, Rajoriya N, Bendall O, Saeed O, Berry P, Moodley P, Abdelbadiee S, Davies S, Kotha S, Ryder S, Verma S, Manship T, Kumar V, Haddadin Y. The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England. Aliment Pharmacol Ther 2023; 57:368-377. [PMID: 36397658 PMCID: PMC10099257 DOI: 10.1111/apt.17307] [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] [Received: 04/29/2022] [Revised: 05/19/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. AIM To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic. METHODS We applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. RESULTS Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. CONCLUSIONS The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality.
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Affiliation(s)
- Ashwin Dhanda
- University of Plymouth, Plymouth, UK.,South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Keith Bodger
- University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Hood
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Clive Henn
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Michael Allison
- Cambridge Liver Unit, Cambridge NIHR Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Chioma Amasiatu
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Robyn Burton
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Matthew Cramp
- University of Plymouth, Plymouth, UK.,South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Meetal Khetani
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | | | - Steven Masson
- Liver Unit, Newcastle Hospitals NHS Trust, Newcastle, UK
| | - Richard Parker
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Sheron
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
| | - Ken Simpson
- Liver Unit, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nikhil Vergis
- Imperial College London, London, UK.,Research and Development, GlaxoSmithKline (GSK), Hertfordshire, UK
| | - Martin White
- Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department for Health and Social Care, London, UK
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11
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Berry P, Kotha S, Zen Y, Papa S, El Menabawey T, Webster G, Joshi D, Heneghan M. Immune checkpoint inhibitor-related cholangiopathy: Novel clinicopathological description of a multi-centre cohort. Liver Int 2023; 43:147-154. [PMID: 35704341 DOI: 10.1111/liv.15340] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 06/12/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Cholestatic liver dysfunction is common in immune-related hepatitis (irH) during treatment with immune checkpoint inhibitors (CPI) for malignancy. We investigated the spectrum of bile duct injury and associated natural history in this cohort. METHOD Clinical, laboratory, radiological and histopathological data in patients with evidence of bile duct injury during CPI treatment from 2018 to 2020 was collected in three tertiary hospitals. RESULTS In this study, ten patients with confirmed bile duct disease were identified. Pembrolizumab was most commonly implicated (8/10). Median CPI cycles prior to bile duct injury was 6. Median alanine aminotransferase and alkaline phosphatase were 225 U/L and 1549 U/L respectively. Clinical jaundice was seen in 6/10 and radiological evidence of bile duct pathology in 8/10. Of five patients, who had liver biopsy, three cases (including two cases with normal MRCP) showed primary sclerosing cholangitis (PSC) like changes with periductal fibrosis. All patients were treated first-line with prednisolone following cessation of CPI, three with mycophenolate mofetil and one with tacrolimus, with clinical response in four patients. Five patients died after a mean follow-up of 27 weeks; cause of death was primarily related to progression of malignancy. CONCLUSION Within this heterogeneous cohort, we identified that CPI-related cholangiopathy responded poorly to immunosuppression and potentially progressed to bile duct loss. Thorough radiological and histological assessment is recommended, as identification of the cholangiopathy-associated phenotype may permit more informed advice regarding prognosis. Further data is required to determine detailed immunological characterisation in order to identify individuals at an increased risk of developing cholangiopathy.
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Affiliation(s)
- Philip Berry
- Department of Hepatology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Hepatology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Yoh Zen
- Department of Histopathology, King's College Hospital, London, UK
| | - Sophie Papa
- Department of Oncology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Tareq El Menabawey
- Department of hepato-biliary medicine, University college London Hospital, London, UK
| | - George Webster
- Department of hepato-biliary medicine, University college London Hospital, London, UK
| | - Deepak Joshi
- Department of Hepatology, King's college Hospital, London, UK
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12
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Kotha S, Berry P. The writing was on the wall: Decision making near the end of life in advanced liver disease. Progress in Palliative Care 2022. [DOI: 10.1080/09699260.2022.2067702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy’s and St Thomas’ Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy’s and St Thomas’ Foundation Trust, London, UK
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13
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Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
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14
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Kotha S, Zen Y, Berry P. Diagnostic, therapeutic and prognostic challenges in a jaundiced patient treated with a checkpoint inhibitor. Clin J Gastroenterol 2022; 15:446-450. [PMID: 35152370 DOI: 10.1007/s12328-022-01604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
Immune check point inhibitors (CPI) are now standard treatment for numerous metastatic malignancies. They are associated with hepatological adverse reactions, the most common of which is immune related hepatitis (irH). Bile duct injury is rarely described. We present the case of a 42 year old male with metastatic non-small cell lung cancer (NSCLC) treated with atezolizumab who developed severe liver dysfunction with biochemical and radiological features of a cholangiopathy. Establishing the final diagnosis proved exceptionally difficult due to multiple potential aetiologies. In this article the diagnostic, prognostic and management challenges including the role of liver biopsy, biliary drainage and immune suppression are explored. Cholangiopathy related to CPI is an emerging clinical entity that requires coordinated, expert care and further research.
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Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Hospital, Guy's and St Thomas' Foundation Trust, London, UK.
| | - Yoh Zen
- Department of Histopathology, King's College Hospital, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Hospital, Guy's and St Thomas' Foundation Trust, London, UK
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15
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Kotha S, Berry P. Multiple investigations for a very common disorder: Finding the right balance in NAFLD. J Hepatol 2021; 75:1501-1502. [PMID: 34228993 DOI: 10.1016/j.jhep.2021.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom.
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
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16
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Berry P, Kotha S. The under-recognised effects of serious endoscopic complications on practitioners. Lancet Gastroenterol Hepatol 2021; 6:978-980. [PMID: 34774150 DOI: 10.1016/s2468-1253(21)00341-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London SE1 7JD, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London SE1 7JD, UK.
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17
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Berry P, MacDonald M, Kotha S. Debilitating tremors in a patient with alcohol-related cirrhosis. Lancet Gastroenterol Hepatol 2021; 6:970. [PMID: 34626564 DOI: 10.1016/s2468-1253(21)00302-2] [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] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark MacDonald
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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18
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Berry P, Theocharidou E, Kotha S. Clinical utility of prognostic scores and models in decompensated liver disease. Journal of Liver Transplantation 2021. [DOI: 10.1016/j.liver.2021.100048] [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: 11/30/2022] Open
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19
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Alabsawy E, Serry Y, Kotha S, Berry P, Tritto G. Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism. BMJ Case Rep 2021; 14:e244805. [PMID: 34544714 PMCID: PMC8454452 DOI: 10.1136/bcr-2021-244805] [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] [Accepted: 09/07/2021] [Indexed: 11/04/2022] Open
Abstract
Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%-47%. Chronic liver disease has been described in patients with hypothalamic-pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.
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Affiliation(s)
- Eman Alabsawy
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yassen Serry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Giovanni Tritto
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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20
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Berry P, Kotha S, Tritto G, DeMartino S. A three-tiered approach to investigating patient safety incidents in endoscopy: 4-year experience in a teaching hospital. Endosc Int Open 2021; 9:E1188-E1195. [PMID: 34447862 PMCID: PMC8383084 DOI: 10.1055/a-1479-2556] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background and study aims Patient safety incidents (PSIs) in endoscopy, although infrequent, can lead to significant morbidity or mortality. There is no commonly agreed strategy to investigate PSIs. We describe a three-tiered approach to investigation to facilitate appropriate action, shared learning, and timely disclosure to patients as mandated in the UK health system by the Duty of Candor (DoC). Methods PSIs were identified prospectively over a 3-year, 7-month period in a large teaching hospital. Level of investigation was agreed by a group of three senior clinicians. Levels of investigation comprised: 1) rapid desktop review; 2) departmental "mini-root cause analysis" (mini-RCA, developed internally); and 3) hospital-level RCA or mortality review. Results Of 63006 procedures there were 73 reported cases of significant harm. Eleven resulted in death. Thirty PSIs were related to hepatobiliary endoscopy, 17 to lower gastrointestinal endoscopy, and 26 to upper gastrointestinal endoscopy. Hospital-level RCA was performed in six cases, mini-RCA/mortality review in 14, and 53 were examined by the endoscopy lead. Findings were presented in an endoscopy user group (EUG) meeting. There was learning in relation to informed consent, pre-procedural radiology reviews, pre-procedural treatment, escalation planning, teamwork and communication, preparation of equipment, and recognition of delayed complications. Open and honest communication with patients and relatives was facilitated. Conclusions The introduction of an endoscopy-tailored investigation tool, the mini-RCA, as part of a three-tiered approach, facilitated investigation, appropriate action, learning, and disclosure after PSIs.
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Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guyʼs and St Thomasʼ Foundation Trust, London, United Kingdom
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guyʼs and St Thomasʼ Foundation Trust, London, United Kingdom
| | - Giovanni Tritto
- Department of Gastroenterology, Guyʼs and St Thomasʼ Foundation Trust, London, United Kingdom
| | - Sabina DeMartino
- Department of Gastroenterology, Guyʼs and St Thomasʼ Foundation Trust, London, United Kingdom
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Kotha S, Berry P. Hepatic, pancreatic and renal manifestations of a ciliopathy. Hepatobiliary Pancreat Dis Int 2021; 20:394-395. [PMID: 33341400 DOI: 10.1016/j.hbpd.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/07/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, UK.
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, UK
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Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Usman Raja
- Department of Interventional Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Terry Wong
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
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Berry P. What became of the 'eyes and the ears'?: exploring the challenges to reporting poor quality of care among trainee medical staff. Postgrad Med J 2021; 97:695-700. [PMID: 37066753 DOI: 10.1136/postgradmedj-2021-140463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 01/25/2023]
Abstract
The importance of trainee medical staff in alerting Trusts to patient safety risks and low-quality care was established by the Francis Report, yet many remain hesitant about speaking up. Known barriers include lack of feedback, sceptical attitudes to the likelihood of change and fear of consequences. The author explores other factors including moral orientation in the workplace, role modelling by senior clinicians, discontinuity, 'normalisation of deviance', human reactions to burnout/moral injury, loyalty and the spectrum of motivation. The issues of absent feedback and fear are discussed in detail. Challenges met by those receiving reports are also described, such as how to collate soft intelligence, putting concerns into context (the 'bigger picture') and stewardship of resources. Initiatives to encourage reporting of trainees' concerns such as speak up guardians, 'Speak Up for Safety' campaign and simulation training are described. A proposal to embed proactive intelligence-gathering arrangements is presented.
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Affiliation(s)
- Philip Berry
- Gastroenterology, Hepatology and Nutrition, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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24
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Affiliation(s)
- Philip Berry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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25
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Berry P, Kotha S. Crying wolf: the danger of recurrent intentional foreign body ingestion. Frontline Gastroenterol 2021; 13:266. [PMID: 35493620 PMCID: PMC8996105 DOI: 10.1136/flgastro-2021-101888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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26
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D'errico F, Kotha S, Wong T, Berry P. Unexpected liver imaging during severe COVID-19 infection. Frontline Gastroenterol 2021; 13:178-179. [PMID: 35291718 PMCID: PMC8098289 DOI: 10.1136/flgastro-2021-101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Francesca D'errico
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Terry Wong
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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27
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Affiliation(s)
- Sailish Honap
- IBD Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Eva Sticova
- Institute of Liver Studies, King's College London, London, UK
| | - Eleni Theocharidou
- Department of Hepatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Department of Hepatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter M Irving
- IBD Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Mark A Samaan
- IBD Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Department of Hepatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ravindran S, Matharoo M, Shaw T, Robinson E, Choy M, Berry P, O'Donohue J, Healey CJ, Coleman M, Thomas-Gibson S. 'Case of the month': a novel way to learn from endoscopy-related patient safety incidents. Frontline Gastroenterol 2020; 12:636-643. [PMID: 34917321 PMCID: PMC8640437 DOI: 10.1136/flgastro-2020-101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Accepted: 09/11/2020] [Indexed: 02/04/2023] Open
Abstract
Patient safety incidents (PSIs) are unintended or unexpected incidents which can or do lead to patient harm. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) acknowledges that PSIs should be reviewed by endoscopy services and learning shared among staff. It is recognised that more could be done to promote shared learning as outlined by the JAG 'Improving Safety and Reducing Error in Endoscopy' strategy. The 'Case of the month' series aims to provide a broad selection of cases and subsequent learning that can be shared among services and their workforce. This review focuses on five case vignettes that highlight a variety of PSIs in endoscopy. A structured approach, based on incident analysis methodology, is applied to each case to categorise PSIs and develop learning points. Learning is directed toward the individual, team and healthcare organisation. A selection of methods to disseminate learning at local, regional and national levels are also described.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Manmeet Matharoo
- Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Tim Shaw
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Emma Robinson
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Matthew Choy
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, Austin Academic Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Philip Berry
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - John O'Donohue
- Department of Gastroenterology, University Hospital Lewisham, London, London, UK
| | - Chris J Healey
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
- Gastroenterology and Hepatology Services, Airedale NHS Foundation Trust, Keighley, UK
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
- Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Siwan Thomas-Gibson
- Department of Surgery and Cancer, Imperial College London, London, UK
- Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
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Laurent A, Ferron C, Berry P, Soudier B, Georgelin B, Gaspard S, Berdougo F, Rush E, Lombrail P. Valuing experiential knowledge in health promotion: a new method to build up knowledge in France. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.420] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
Effectiveness analyses of health promotion (HP) interventions (HPI) abound nowadays in France, but few research details how HPI work, nor explains how practitioners can translate conclusive evidence from the literature into action. Furthermore, large amounts of experiential knowledge remain untapped and undervalued. To close these gaps, a national multidisciplinary committee, comprising public officials, academics and practitioners, has worked since 2016 at designing a new method to build up knowledge in HP.
CEKHP
The method aims at Capitalizing, collecting and circulating Experiential Knowledge in HP (CEKHP).
Committee members first investigated methods used in other countries to synthesize and share practical evidence, then drafted and experimented CEKHP in 11 different settings to test its relevance and applicability.
Results
Key components of CEKHP are: 1/CEKHP consists in in-depth semi-structured interviews and offers a guideline template adjustable for various contexts and multiple public health issues (behaviors, environments, etc.); 2/a trained outsider, mastering 7 core competencies, must conduct CEKHP; 3/CEKHP includes a framework for reporting key mechanisms that influence HPI outcomes. Detailed mechanisms include: context, partnerships, key steps, barriers and levers, ethics, theoretical foundations (intervention models, evidence-based literature, etc.), transferability. A guidebook and a toolkit are published in 2020. CEKHP successfully disseminates within the French HP community. It is currently used as the main data collection tool in a research project investigating health promoting sports clubs (PROCeSS) and in a practice-focused project documenting tobacco prevention (DCAP).
Lessons
Practitioners benefit from access to knowledge on how HPI work. CEKHP offers new tools to value and disseminate experiential knowledge. Given that policymakers increasingly prioritize funding in France on documented HPI, providing such tools and training is crucial.
Key messages
CEKHP offers a new method in the French context that has proven fruitful in various settings, for various public health issues, and can be useful to practitioners and researchers alike. Building up experiential knowledge with and for practitioners can be effective at both documenting practices and helping them gain new skills and better understanding of their interventions.
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Affiliation(s)
- A Laurent
- Société Française de Santé Publique, Laxou, France
| | | | - P Berry
- Le Réverbère, Nantes, France
| | - B Soudier
- Société Française de Santé Publique, Laxou, France
| | - B Georgelin
- Société Française de Santé Publique, Laxou, France
| | - S Gaspard
- Société Française de Santé Publique, Laxou, France
| | - F Berdougo
- Société Française de Santé Publique, Laxou, France
| | - E Rush
- Société Française de Santé Publique, Laxou, France
| | - P Lombrail
- Société Française de Santé Publique, Laxou, France
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Porcherie M, Laurent A, Ferron C, Berry P, Soudier B, Georgelin B, Gaspard S, Berdougo F, Lombrail P. Joining forces to build up knowledge in health promotion: lessons from a French coalition initiative. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.218] [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: 11/12/2022] Open
Abstract
Abstract
Issue
French public health authorities increasingly rationalize access to public funding, favoring evidence-based programs. Health Promotion (HP) interventions are especially urged to prove their efficiency in this context. To tackle this issue, HP practitioners hold experiential knowledge (EK) that proves useful to assess both the complexity and efficiency of HP interventions. United by this conviction in a multidisciplinary coalition, HP experts from various backgrounds came together five years ago to promote Experiential Knowledge in HP (EKHP) in France.
A national committee to promote EKHP
670 HP practitioners were surveyed in 2016. Results reported vast amounts of under-documented and often untapped field expertise in HP and numerous obstacles regarding access to scientific literature or systematic reviews. Consequently, the coalition launched a National Committee for EKHP, meeting 5 times a year since 2016. Members of 6 national HP organizations, of 4 regional HP institutes, national and local public health administrators, researchers, consultants and field workers participate. Steered by the French Society for Public Health and the National Federation for Health Education and Promotion, the committee devised a threefold action plan: 1/ advocate EKHP in all relevant institutional spaces, 2/ develop tools for EKHP, 3/ mobilize for EKHP at the local level.
Results
The committee designed a method for capitalizing, collecting and circulating EK and published in 2020 a guidebook and a toolkit. French Public Health authorities agreed to share EK nationwide on their online portal. Dissemination within the French HP community has started, through the committee members' networks, and will be amplified with a training program launched in 2021 at the National School of Public Health.
Lessons
Attention must be brought to HP practitioners’ experiential knowledge, both to recognize HP practitioners' expertise and to help improve the understanding of how HP interventions work.
Key messages
Experiential knowledge in HP remains undervalued and untapped in France. Dedicated practitioners, policymakers and researchers formed a multidisciplinary committee to promote and disseminate EKHP. A multilevel strategy combining advocacy and tool building can be effective at promoting experiential knowledge. A multidisciplinary coalition provided the necessary context-specific levers in France.
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Affiliation(s)
- M Porcherie
- EHESP, Rennes, France
- ARENES - UMR CNRS 6051, Université de Rennes - CNRS, Rennes, France
| | - A Laurent
- Société Française de Santé Publique, Laxou, France
| | | | - P Berry
- Le Réverbère, Nantes, France
| | - B Soudier
- Société Française de Santé Publique, Laxou, France
| | - B Georgelin
- Société Française de Santé Publique, Laxou, France
| | - S Gaspard
- Société Française de Santé Publique, Laxou, France
| | - F Berdougo
- Société Française de Santé Publique, Laxou, France
| | - P Lombrail
- Société Française de Santé Publique, Laxou, France
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Ingraham C, Carey A, Vernon M, Berry P. Deaf-Blind Clients and Vocational Rehabilitation: Practical Guidelines for Counselors. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9408800207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents suggestions and proved effective strategies for determining the eligibility of, conducting diagnostic workups for, and providing vocational rehabilitation services to deaf-blind individuals. It emphasizes that the optimal rehabilitation process for such clients begins before the clients transfer from educational programs.
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Affiliation(s)
- C.L. Ingraham
- East Central Region, Helen Keller National Center, 6801 Kenilworth Avenue, Suite 100, Riverdale, MD 20737
| | - A. Carey
- Deaf and deaf-blind, West Virginia Division of Rehabilitation Services, 202 Timber Trail Road, Charleston, WV 25304
| | - M. Vernon
- Western Maryland College, 37 Ridge Road, Westminster, MD 21157
| | - P. Berry
- Deaf-Blind Services, Virginia Department for the Visually Handicapped, 397 Azalea Avenue, Richmond, VA 23227
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Touma Z, Hoskin B, Atkinson C, Bell D, Massey O, Lofland JH, Berry P, Karyekar C, Costenbader K. SAT0213 IMPACT OF FLARES ON HEALTHCARE RESOURCE USAGE AND PROS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The effect of flares on healthcare resource usage and patient-reported outcome scores in SLE patients is not well quantified.Objectives:To understand how flares impact healthcare resource utilization (HCRU) and patient-reported outcomes amongst an international real-world dataset of SLE patients.Methods:The Adelphi Real World 2015 Lupus Disease Specific Programme (DSP) is a cross-sectional study of 263 rheumatologists in the US and EU5. Rheumatologists were asked to complete patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; the same patients were asked to complete patient self-completion (PSC) forms describing how SLE affected them. PRFs collected data pertaining to the patient’s diagnosis, disease history, current clinical outcomes, treatment and management history. PSCs collected similar data and included patient-reported outcome measures (PROs) to assess humanistic burden. Propensity score matching was used to assess differences in HCRU and health status between SLE patients who had flared (physician defined) in the last 12 months and those who had not. Matching variables were patient ethnicity, time since diagnosis, and severity at diagnosis. Data were extracted from 1278 PRFs, and 591 PSCs. Propensity score matching was carried out on two matched groups of 408 patients.Results:Demographic data are reported in Table 1. Propensity score matching showed patients who flared in the last 12 months experienced significantly greater hospitalizations, visits to the ER, and total HCP consults in the last 12 months. Significantly greater drug burden lower physician and patient satisfaction, lower EQ-5D score (worse health status), lower FACIT Fatigue score (greater fatigue), and greater overall work impairment (Table 2) were also observed.Table 1.Demographic dataVariableFlared in last 12 monthsNot flared in the last 12 monthsMean age (years)41.842.4% Female86.087.0% White/Caucasian66.276.3Mean years diagnosed5.95.4Table 2.Propensity score matching resultsOutcome variableFlared meanNot flared meanCoefficient95% CIp-valueHospitalisations in last 12 months24.267.630.17[0.12 – 0.21]<0.001Emergency department visits in last 12 months20.834.190.17[0.12 – 0.21]<0.001Number of tests in last 12 months46.4938.907.59[3.74 – 11.44]<0.001Number of current medications2.762.190.57[0.43 – 0.72]<0.001Physician satisfied64.4686.63-0.22[-0.28 – -0.17]<0.001Patient satisfied69.2985.09-0.16[-0.24 – -0.08]<0.001EQ-5D-3L0.720.83-0.11[-0.15 – -0.07]<0.001FACIT Fatigue30.0636.48-6.42[-8.5 – -4.3]<0.001WPAI overall percentage work impairment42.7430.2312.5[7.51 – 17.50]<0.001Conclusion:The analysis of international real-world data confirmed that SLE patients who flared in the last year represent a greater burden on healthcare resource and demonstrate significantly worse health status, greater fatigue, lower patient and physician satisfaction and greater overall work impairment compared with non-flaring patients. There is a need for more effective treatments in this patient population to reduce patient and healthcare burden.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, Olivia Massey Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Berry P, Burrows K, Hall R, Gater A, Bradley H, Ward A, Tolley C, Delong P, Hsia EC. AB1332-HPR ASSESSING THE PATIENT EXPERIENCE OF LUPUS NEPHRITIS: DEVELOPMENT OF A CONCEPTUAL MODEL AND REVIEW OF EXISTING PATIENT-REPORTED OUTCOME (PRO) MEASURES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lupus nephritis (LN) is an autoimmune disease characterized by inflammation of the kidneys as a result of systemic lupus erythematosus (SLE). Approximately 50% of SLE patients will develop LN, which is considered to be one of the most severe manifestations of SLE and the leading cause of morbidity and mortality in SLE. While there is ample existing evidence on disease experience and PROs used in extra-renal SLE, little research has been done in LN. Qualitative interviews with patients can help identify concepts that are both important and relevant to the patient. In order to effectively evaluate treatment benefit, it is critical that PRO measures used to assess such concepts and define clinical trial endpoints are fit for purpose and have strong evidence of content validity in the specific context of use.Objectives:The objective of this study was to understand the patient experience of LN and to identify and characterize the signs and symptoms of LN and their impact on health-related quality of life (HRQoL) through the development of a disease-specific conceptual model. This model was then used to evaluate the content validity of existing PRO measures available for use in LN.Methods:A structured literature search was conducted in Medline, Embase and PsycINFO to identify qualitative research articles documenting the patient experience of LN. PRO measures developed or commonly used to assess patient experiences of LN were also identified. Semi-structured concept elicitation interviews were conducted with 15 adult patients in the US with a clinician-confirmed diagnosis of LN (defined in accordance with established clinical guidelines). Supplementary qualitative data were also collected from a review of publicly available online blogs/forums. Findings were used to inform the development of a conceptual model detailing the impact of LN signs, symptoms and HRQoL and evaluate the validity of existing measures used within LN.Results:Searches revealed a paucity of qualitative research conducted with LN patients, supporting the need for prospective research in LN. Consistent with existing literature in SLE, the core signs and symptoms identified from the qualitative literature review, interviews and blog/forum review included joint pain, fatigue, joint stiffness, swelling (particularly in the extremities) and skin rashes. LN patients also reported urinary frequency, urgency, foamy urine and blood in their urine. Disease impact on physical functioning, activities of daily living, emotions, social life, work/finances and sleep were reported. PRO measures commonly used to evaluate patient experiences in LN included the SF-36, LupusQOL, LupusPRO, SLE Symptom Checklist, KDQoL and KSQ. Conceptual mapping of instruments against the newly developed conceptual model (Figure 1) highlighted that no single measure provides a comprehensive assessment of all symptoms/impact important to LN patients. Furthermore, items are largely focused on impact of symptoms with few items on symptom severity.Figure 1.Conceptual model of lupus nephritis symptoms and associated impactsConclusion:The presentation of signs and symptoms in LN patients appears similar to those reported in extra-renal SLE populations, with the addition of swelling and urinary symptoms. Qualitative research with LN patients guided the development of a comprehensive LN conceptual model outlining the disease experience from the patients’ perspective. These insights can be useful to inform PRO measurement strategies for clinical trials in LN.Acknowledgments:With thanks to Dr. Betty Diamond and Dr. David Wofsy for their collaboration and helpful insightsDisclosure of Interests:Pamela Berry Employee of: Janssen, Kate Burrows Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Rebecca Hall Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract., Adam Gater Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Helena Bradley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Amy Ward Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Chloe Tolley Consultant of: Adelphi Values a health outcomes research company commissioned by Janssen to conduct the research reported in this abstract, Patricia Delong Employee of: Janssen, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC
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Touma Z, Hoskin B, Atkinson C, Bell D, Massey O, Lofland JH, Berry P, Karyekar C, Costenbader K. THU0246 DIAGNOSTIC CLUSTER PROFILING OF PATIENTS IN A REAL-WORLD DATA SET WITH SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Previous systemic lupus erythematosus (SLE) studies have identified potential clusters of SLE clinical manifestations post diagnosis.Objectives:To describe the presentation of SLE at diagnosis across different cohorts of patients and describe management and outcomes after diagnosis within clusters.Methods:Cross-sectional study of 263 rheumatologists in the US and EU5. Data were collected from the Adelphi Real World 2015 Lupus Disease Specific Programme. Rheumatologists completed patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; these patients completed patient self-completion (PSC) forms describing how SLE affected them. PRF data includes patient’s characteristics and management history. PSCs focused on similar data collection, including patient reported outcome measures on the humanistic burden. Age at diagnosis, symptoms at diagnosis, organ involvement at diagnosis, and severity at diagnosis were used as covariates in a latent cluster analysis.Results:Data were extracted from 1376 PRFs. Cluster analysis resulted in up to 6 clusters, and disease understanding led to the selection of a 4-cluster solution.Cluster 1 displayed the mildest disease, characterised by joint involvement, while cluster 2 displayed more skin involvement in conjunction with joint. Cluster 3 were characterised by renal involvement and cluster 4 had skin and joint involvement, but also high constitutional and haematological involvement at diagnosis (Table 1).Table 1Cluster analysisClustersOrgan involvement at diagnosis, n (%)Overall(n=1304)1(n=210)2(n=493)3(n=162)4(n=439)p-valueMusculoskeletal1145 (87.8)174 (82.9)444 (90.1)134 (82.7)393 (89.5)0.0065Mucocutaneous898 (68.9)5 (2.4)397 (80.5)95 (58.6)401 (91.3)<0.0001Neuropsychiatric87 (6.7)19 (9.0)9 (1.8)16 (9.9)43 (9.8)<0.0001Cardiorespiratory176 (13.5)36 (17.1)14 (2.8)22 (13.6)104 (23.7)<0.0001Gastrointestinal44 (3.4)8 (3.0)14 (2.8)8 (4.9)14 (3.2)0.6115Opthalmic47 (3.6)020 (4.1)10 (6.2)17 (3.9)0.0102Renal213 (16.6)15 (7.1)9 (1.8)162 (100)27 (6.2)<0.0001Constitutional425 (32.6)45 (21.4)89 (18.1)55 (34.0)236 (53.8)<0.0001Haematological452 (34.7)64 (30.5)22 (4.5)80 (49.4(286 (65.1)<0.0001Severity at diagnosis, n (%)Mild209 (16.0)55 (26.2)99 (20.1)1 (0.6)54 (12.3)<0.0001Moderate806 (61.8)122 (58.1)324 (65.7)75 (46.3)285 (64.9)Severe289 (22.2)33 (15.7)70 (14.2)86 (53.1)100 (22.8)Significant between-cluster differences were observed when comparing outcomes; cluster 4 have been diagnosed longest (mean weeks diagnosed 354.6 v. 1: 232.6, 2: 228.7, 3: 338.2, p<0.0001). Cluster 3 consulted more in the last 12 months (mean number of visits 7.9 vs. 1: 5.7, 2: 6.3, 4: 7.6).Significant differences were also observed between clusters in relation to current treatment proportions: corticosteroid (highest cluster 3: 78.4%), immunosuppressant (highest cluster 3: 75.3%), biologic DMARD (highest cluster 4: 17.8%) and antidepressant (highest cluster 4: 4.1%).Conclusion:This study demonstrates the heterogeneity of SLE at diagnosis and highlights four distinct presentations of the disease at diagnosis. Significant proportions of patients present with advanced disease, these clusters go on to present the greatest burden demonstrating the need for better diagnostic tools and novel earlier intervention.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, Olivia Massey Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Touma Z, Hoskin B, Atkinson C, Bell D, Pike J, Lofland JH, Berry P, Karyekar C, Costenbader K. AB1170 THE IMPACT OF HIGH DISEASE ACTIVITY AS MEASURED BY SLEDAI AND DRUG BURDEN-ON HEALTHCARE UTILIZATION, QUALITY OF LIFE AND WORK PRODUCTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Although there is abundant literature on healthcare utilization in SLE patients, the impact of disease activity in SLE patients is not well understood.Objectives:To quantify the impact of disease activity, as measured by SLEDAI score and drug burden, in SLE patients on health care resource utilization (HCRU), health related quality of life (HRQoL) and work productivity (WP).Methods:Data were collected from a cross-sectional survey of 754 rheumatologists in US and EU5 from the Adelphi Real World 2010/2013/2015 Lupus Disease Specific Programmes (DSP). Physicians were asked to complete patient record forms (PRFs) for the next 5 prospectively consulting SLE patients; the same patients were asked to complete patient self-completion (PSC) forms describing how SLE affected them. PRFs collected data pertaining to the patient’s diagnosis, disease history, current clinical outcomes, treatment and management history. PSCs focused on similar data collection and included patient reported outcome measures (PROs). Propensity score matching was used to assess differences in HCRU and PRO scores between SLE patients who had a low disease activity and those who had a high disease activity. Low disease activity was defined as a SLEDAI score of ≤4, a steroid dose of <7.5mg/day, and not on immunosuppressant or biologic. High disease activity was a SLEDAI score of >4, or on an immunosuppressant, biologic, or steroid dose of >7.5mg/day. Patients were matched on age, sex, and ethnicity.Results:Data was extracted from 1278 PRFs, and 591 PSCs. Using the estimated propensity score each low disease activity patient (n=44) was matched with a high disease activity patient (n=1187). Using 1:1 matching, with replacement and allowing for ties, matching resulted in 414 high disease activity patients being used as matches for 44 low disease activity patients. Demographic data are reported in Table 1. Patients with a low disease activity were significantly less likely to be currently flaring, lower number of flares in last 12 months, less likely to have been hospitalized in the last 12 months, had fewer consultations in the last 12 months, reported better HrQoL (EQ5D), more favourable levels of fatigue (FACIT), and lower work impairment (WPAI). (Table 2).Table 1.Demographic dataVariableLow disease activityHigh disease activityMean age (years)38.140.0% Female90.788.2% White/Caucasian76.767.7Mean years diagnosed5.55.0Table 1.Propensity score matching resultsOutcome variableLow activity meanHigh activity meanCoefficient95% CIp-valueFlared in the last 12 months11.6337.97-0.26[-0.38 – -0.14]<0.001Number of flares in last 12 months0.210.70-0.49[-0.72 - -0.26]<0.001Hospitalised in last 12 months4.6514.98-0.10[-0.17 – -0.04]0.001Number of consults in last 12 months2.843.52-0.68[-1.19 – -0.17]0.009EQ-5D-3L0.780.880.10[0.03 – 0.17]0.004FACIT Fatigue34.6839.865.19[0.80 – 9.57]0.02WPAI overall percentage work impairment14.4245.35-30.93[-45.32 – -16.54]<0.001Conclusion:Systemic lupus erythematosus patients with lower levels of disease activity are less burdensome to the healthcare system and experience a significantly better HRQoL and lower levels of productivity impairment. There is a need to establish a universal definition of low disease activity as a treatment goal to benefit patient quality of life and reduce HCRU.Study funded by Johnson and Johnson.Disclosure of Interests:Zahi Touma Consultant of: Consultant for Janssen, Ben Hoskin Consultant of: Consultant for Janssen, Christian Atkinson Consultant of: Consultant for Janssen, David Bell Consultant of: Janssen, James Pike Consultant of: Janssen, Jennifer H. Lofland Employee of: Janssen, Pamela Berry Employee of: Janssen, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca
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Lee MJ, Berry P, D'Errico F, Miquel R, Kulasegaram R. A case of rilpivirine drug-induced liver injury. Sex Transm Infect 2020; 96:618-619. [PMID: 31974214 DOI: 10.1136/sextrans-2019-054336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ming Jie Lee
- Harrison Wing Department, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology and Hepatology, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Francesca D'Errico
- Department of Gastroenterology and Hepatology, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
| | - Rosa Miquel
- Liver Histopathology Laboratory, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranjababu Kulasegaram
- Harrison Wing Department, Guy's and St Thomas Hospital NHS Foundation Trust, London, UK
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Kotha S, Griffin N, Berry P. A Mauritian Patient with Weight Loss and Diarrhea. Gastroenterology 2020; 158:e12-e13. [PMID: 31376389 DOI: 10.1053/j.gastro.2019.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, UK.
| | - Nyree Griffin
- Department of Radiology, Guy's and St Thomas' Foundation Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, UK
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Kotha S, Berry P, Webster G, Wong T. Cholangioscopic management of proximally migrated biliary stent using a novel through-the-cholangioscope snare. Endoscopy 2020; 52:E5-E6. [PMID: 31398740 DOI: 10.1055/a-0977-2488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/10/2022]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - George Webster
- Department of Pancreaticobiliary Medicine, University College London, London, United Kingdom
| | - Terry Wong
- Department of Gastroenterology, Guy's and St Thomas' Hospital, London, United Kingdom
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Laurent A, Ferron C, Lombrail P, Berry P, Frattini MO, Berdougo F, Rusch E. How to build and share an experiential knowledge in public health? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Health promotion stakeholders are encouraged to base their intervention strategies on evidence. However, the evidence produced by public health research is outcome-based and provides little information on “how to act?” It is necessary to complete this evidence with experiential data constituting an evidence of a different nature, answering questions about organizations, skills and tools mobilized to achieve the results, and valuing skilled actors’ knowledge and good practice.
For two years, a group of 15 French organizations has been working on capitalization and sharing experiential knowledge. This work is part of the setting up of a national evidence platform. After a benchmarking phase, the group developed and tested a capitalization method which focuses on the collection and analysis of qualitative data and aims to explain the contexts and processes at work in the actions: knowledge and skills, strategies, perceived challenges and facilitating factors, key moments. The group also worked on the structure, content and use of a shareable document.
The test has shown the pedagogical interest of the method for the actors who were invited to develop a reflective thinking about their action, as well as the relevance of this method to build experiential knowledge. The ongoing group’s work concerns the dissemination of collected data. A practical guide for stakeholders is being finalised. The group is defining the selection process of the initiatives to be valued, in particular with regard to results that make sense for all stakeholders.
The main difficulty of the approach - its low level of recognition and entrenchment in public health - will be discussed during the presentation, as well as the necessity to ensure the legitimacy of this approach in a context where the notion of evidence is centered on quantitative data produced with an objective defined “a priori” and in a controlled context.
Key messages
This work opens the way for an original reflection in public health to build a shareable experiential knowledge, and to valorize and strengthen field actors’ practical expertise. This work has pedagogical, political, scientific and informational impacts. It contributes to knowledge transfer and provides self-training, a practical vision of policies, and questions for research.
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Yogev O, Almeida GS, Barker KT, George SL, Kwok C, Campbell J, Zarowiecki M, Kleftogiannis D, Smith LM, Hallsworth A, Berry P, Möcklinghoff T, Webber HT, Danielson LS, Buttery B, Calton EA, da Costa BM, Poon E, Jamin Y, Lise S, Veal GJ, Sebire N, Robinson SP, Anderson J, Chesler L. In Vivo Modeling of Chemoresistant Neuroblastoma Provides New Insights into Chemorefractory Disease and Metastasis. Cancer Res 2019; 79:5382-5393. [PMID: 31405846 DOI: 10.1158/0008-5472.can-18-2759] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 01/18/2019] [Revised: 06/27/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022]
Abstract
Neuroblastoma is a pediatric cancer that is frequently metastatic and resistant to conventional treatment. In part, a lack of natively metastatic, chemoresistant in vivo models has limited our insight into the development of aggressive disease. The Th-MYCN genetically engineered mouse model develops rapidly progressive chemosensitive neuroblastoma and lacks clinically relevant metastases. To study tumor progression in a context more reflective of clinical therapy, we delivered multicycle treatment with cyclophosphamide to Th-MYCN mice, individualizing therapy using MRI, to generate the Th-MYCN CPM32 model. These mice developed chemoresistance and spontaneous bone marrow metastases. Tumors exhibited an altered immune microenvironment with increased stroma and tumor-associated fibroblasts. Analysis of copy number aberrations revealed genomic changes characteristic of human MYCN-amplified neuroblastoma, specifically copy number gains at mouse chromosome 11, syntenic with gains on human chromosome 17q. RNA sequencing revealed enriched expression of genes associated with 17q gain and upregulation of genes associated with high-risk neuroblastoma, such as the cell-cycle regulator cyclin B1-interacting protein 1 (Ccnb1ip1) and thymidine kinase (TK1). The antiapoptotic, prometastatic JAK-STAT3 pathway was activated in chemoresistant tumors, and treatment with the JAK1/JAK2 inhibitor CYT387 reduced progression of chemoresistant tumors and increased survival. Our results highlight that under treatment conditions that mimic chemotherapy in human patients, Th-MYCN mice develop genomic, microenvironmental, and clinical features reminiscent of human chemorefractory disease. The Th-MYCN CPM32 model therefore is a useful tool to dissect in detail mechanisms that drive metastasis and chemoresistance, and highlights dysregulation of signaling pathways such as JAK-STAT3 that could be targeted to improve treatment of aggressive disease. SIGNIFICANCE: An in vivo mouse model of high-risk treatment-resistant neuroblastoma exhibits changes in the tumor microenvironment, widespread metastases, and sensitivity to JAK1/2 inhibition.
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Affiliation(s)
- Orli Yogev
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Gilberto S Almeida
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Karen T Barker
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Sally L George
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Colin Kwok
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - James Campbell
- CRUK-center Informatics Facility, The Institute of Cancer Research, London, United Kingdom
| | - Magdalena Zarowiecki
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- CRUK-center Informatics Facility, The Institute of Cancer Research, London, United Kingdom
| | | | - Laura M Smith
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Albert Hallsworth
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Till Möcklinghoff
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hannah T Webber
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Laura S Danielson
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Bliss Buttery
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Elizabeth A Calton
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Barbara M da Costa
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Evon Poon
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Yann Jamin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Stefano Lise
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Neil Sebire
- Paediatric and Development Pathology, Institute of Child Health, University College London, London, United Kingdom
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - John Anderson
- Cancer Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Louis Chesler
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.
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Jackson RK, Liebich M, Berry P, Errington J, Liu J, Parker C, Moppett J, Samarasinghe S, Hough R, Rowntree C, Goulden NJ, Vora A, Kearns PR, Saha V, Hempel G, Irving JAE, Veal GJ. Impact of dose and duration of therapy on dexamethasone pharmacokinetics in childhood acute lymphoblastic leukaemia-a report from the UKALL 2011 trial. Eur J Cancer 2019; 120:75-85. [PMID: 31499383 DOI: 10.1016/j.ejca.2019.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/23/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The use of dexamethasone in acute lymphoblastic leukaemia therapy contributes to short- and long-term toxicities. The UKALL 2011 randomised trial investigated whether a more intense dexamethasone dose (10 mg/m2/d x 14d, short vs 6 mg/m2/d x 28d, standard) would lead to a more rapid cytoreduction and reduced adverse effects associated with longer durations of steroids in induction. The impact of dose and duration on dexamethasone pharmacokinetics was investigated. METHODS Blood samples were obtained on one of the first three and last three days of induction dexamethasone dosing at time points up to 8 h after oral administration. Plasma dexamethasone levels were quantified in 1084 plasma samples obtained from 174 children and a population pharmacokinetic model developed. RESULTS Drug exposure varied significantly between patients, with a >12-fold variation in AUC0-12h values and a marked overlap in dexamethasone exposures between dose levels. Intuitively, AUC0-12h was significantly higher with short dosing (10 mg/m2/d), but cumulative exposure was significantly higher with standard dosing over 28 days, after a higher cumulative dose. Concomitant rasburicase administration was associated with a 60% higher dexamethasone clearance. Day 8 bone marrow response was comparable between dosing arms, but those with <5% blast count exhibited a greater mean dexamethasone exposure than those with >5%. No statistical differences were observed between arms in terms of steroid-related toxicity or minimal residual disease at the end of induction. CONCLUSION The potential significance of dexamethasone AUC0-12h on early response and higher cumulative exposure on the standard arm suggest that duration of therapy and exposure may be more important factors than absolute dose from a clinical pharmacology perspective.
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Affiliation(s)
- Rosanna K Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Martina Liebich
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Germany
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Julie Errington
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Jizhong Liu
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Catriona Parker
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - John Moppett
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, UK
| | - Sujith Samarasinghe
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | | | | | - Nick J Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Studies, University of Birmingham, UK
| | - Vaskar Saha
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Germany
| | - Julie A E Irving
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK.
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Kotha S, Wong T, Berry P. Silent migration: unexpected finding at ERCP. Frontline Gastroenterol 2019; 10:438-439. [PMID: 31656572 PMCID: PMC6788268 DOI: 10.1136/flgastro-2019-101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Terry Wong
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Philip Berry
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
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Kotha S, Berry P. End-stage liver disease: critical care escalation or palliative care. Br J Hosp Med (Lond) 2019; 79:658. [PMID: 30418818 DOI: 10.12968/hmed.2018.79.11.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sreelakshmi Kotha
- Senior Hepatology Clinical Fellow, Department of Gastroenterology, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London
| | - Philip Berry
- Consultant Hepatologist, Department of Gastroenterology, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH
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Martinez-Soria N, McKenzie L, Draper J, Ptasinska A, Issa H, Potluri S, Blair HJ, Pickin A, Isa A, Chin PS, Tirtakusuma R, Coleman D, Nakjang S, Assi S, Forster V, Reza M, Law E, Berry P, Mueller D, Osborne C, Elder A, Bomken SN, Pal D, Allan JM, Veal GJ, Cockerill PN, Wichmann C, Vormoor J, Lacaud G, Bonifer C, Heidenreich O. The Oncogenic Transcription Factor RUNX1/ETO Corrupts Cell Cycle Regulation to Drive Leukemic Transformation. Cancer Cell 2019; 35:705. [PMID: 30991028 PMCID: PMC6472942 DOI: 10.1016/j.ccell.2019.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hepburn AC, Steele RE, Veeratterapillay R, Wilson L, Kounatidou EE, Barnard A, Berry P, Cassidy JR, Moad M, El-Sherif A, Gaughan L, Mills IG, Robson CN, Heer R. The induction of core pluripotency master regulators in cancers defines poor clinical outcomes and treatment resistance. Oncogene 2019; 38:4412-4424. [PMID: 30742096 PMCID: PMC6546609 DOI: 10.1038/s41388-019-0712-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/31/2022]
Abstract
Stem cell characteristics have been associated with treatment resistance and poor prognosis across many cancer types. The ability to induce and regulate the pathways that sustain these characteristic hallmarks of lethal cancers in a novel in vitro model would greatly enhance our understanding of cancer progression and treatment resistance. In this work, we present such a model, based simply on applying standard pluripotency/embryonic stem cell media alone. Core pluripotency stem cell master regulators (OCT4, SOX2 and NANOG) along with epithelial–mesenchymal transition (EMT) markers (Snail, Slug, vimentin and N-cadherin) were induced in human prostate, breast, lung, bladder, colorectal, and renal cancer cells. RNA sequencing revealed pathways activated by pluripotency inducing culture that were shared across all cancers examined. These pathways highlight a potential core mechanism of treatment resistance. With a focus on prostate cancer, the culture-based induction of core pluripotent stem cell regulators was shown to promote survival in castrate conditions—mimicking first line treatment resistance with hormonal therapies. This acquired phenotype was shown to be mediated through the upregulation of iodothyronine deiodinase DIO2, a critical modulator of the thyroid hormone signalling pathway. Subsequent inhibition of DIO2 was shown to supress expression of prostate specific antigen, the cardinal clinical biomarker of prostate cancer progression and highlighted a novel target for clinical translation in this otherwise fatal disease. This study identifies a new and widely accessible simple preclinical model to recreate and explore underpinning pathways of lethal disease and treatment resistance.
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Affiliation(s)
- A C Hepburn
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - R E Steele
- Prostate Cancer UK/Movember Centre of Excellence for Prostate Cancer, Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, BT9 7AE, UK
| | - R Veeratterapillay
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - L Wilson
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - E E Kounatidou
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - A Barnard
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - P Berry
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - J R Cassidy
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - M Moad
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - A El-Sherif
- Department of Pathology, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - L Gaughan
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - I G Mills
- Prostate Cancer UK/Movember Centre of Excellence for Prostate Cancer, Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, BT9 7AE, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK
| | - C N Robson
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - R Heer
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
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Chen L, Pastorino F, Berry P, Bonner J, Kirk C, Wood KM, Thomas HD, Zhao Y, Daga A, Veal GJ, Lunec J, Newell DR, Ponzoni M, Tweddle DA. Preclinical evaluation of the first intravenous small molecule MDM2 antagonist alone and in combination with temozolomide in neuroblastoma. Int J Cancer 2019; 144:3146-3159. [PMID: 30536898 PMCID: PMC6491995 DOI: 10.1002/ijc.32058] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
Abstract
High‐risk neuroblastoma, a predominantly TP53 wild‐type (wt) tumour, is incurable in >50% patients supporting the use of MDM2 antagonists as novel therapeutics. Idasanutlin (RG7388) shows in vitro synergy with chemotherapies used to treat neuroblastoma. This is the first study to evaluate the in vivo efficacy of the intravenous idasanutlin prodrug, RO6839921 (RG7775), both alone and in combination with temozolomide in TP53 wt orthotopic neuroblastoma models. Detection of active idasanutlin using liquid chromatography‐mass spectrometry and p53 pathway activation by ELISA assays and Western analysis showed peak plasma levels 1 h post‐treatment with maximal p53 pathway activation 3–6 h post‐treatment. RO6839921 and temozolomide, alone or in combination in mice implanted with TP53 wt SHSY5Y‐Luc and NB1691‐Luc cells showed that combined RO6839921 and temozolomide led to greater tumour growth inhibition and increase in survival compared to vehicle control. Overall, RO6839921 had a favourable pharmacokinetic profile consistent with intermittent dosing and was well tolerated alone and in combination. These preclinical studies support the further development of idasanutlin in combination with temozolomide in neuroblastoma in early phase clinical trials. What's new? Long‐term survival of high‐risk neuroblastoma patients currently averages than 50%. New therapies that both improve survival and reduce treatment toxicity are urgently needed. MDM2 antagonists are a novel class of anti‐cancer agents that stabilize the p53 pathway and lead to tumour suppression. In this preclinical study, the authors tested a prodrug of the MDM2 inhibitor idasanutlin in mice. They found that this compound inhibited tumour growth and increased survival, especially in combination with temozolomide. These results support the further development of idasanutlin plus temozolomide in clinical trials for neuroblastoma.
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Affiliation(s)
- Lindi Chen
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fabio Pastorino
- Laboratory of Experimental Therapy in Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jennifer Bonner
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Calum Kirk
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Katrina M Wood
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Huw D Thomas
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yan Zhao
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Antonio Daga
- Oncologia Cellulare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John Lunec
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David R Newell
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mirco Ponzoni
- Laboratory of Experimental Therapy in Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Deborah A Tweddle
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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47
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Martinez-Soria N, McKenzie L, Draper J, Ptasinska A, Issa H, Potluri S, Blair HJ, Pickin A, Isa A, Chin PS, Tirtakusuma R, Coleman D, Nakjang S, Assi S, Forster V, Reza M, Law E, Berry P, Mueller D, Osborne C, Elder A, Bomken SN, Pal D, Allan JM, Veal GJ, Cockerill PN, Wichmann C, Vormoor J, Lacaud G, Bonifer C, Heidenreich O. The Oncogenic Transcription Factor RUNX1/ETO Corrupts Cell Cycle Regulation to Drive Leukemic Transformation. Cancer Cell 2018; 34:626-642.e8. [PMID: 30300583 PMCID: PMC6179967 DOI: 10.1016/j.ccell.2018.08.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 11/29/2017] [Revised: 04/20/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
Oncogenic transcription factors such as the leukemic fusion protein RUNX1/ETO, which drives t(8;21) acute myeloid leukemia (AML), constitute cancer-specific but highly challenging therapeutic targets. We used epigenomic profiling data for an RNAi screen to interrogate the transcriptional network maintaining t(8;21) AML. This strategy identified Cyclin D2 (CCND2) as a crucial transmitter of RUNX1/ETO-driven leukemic propagation. RUNX1/ETO cooperates with AP-1 to drive CCND2 expression. Knockdown or pharmacological inhibition of CCND2 by an approved drug significantly impairs leukemic expansion of patient-derived AML cells and engraftment in immunodeficient murine hosts. Our data demonstrate that RUNX1/ETO maintains leukemia by promoting cell cycle progression and identifies G1 CCND-CDK complexes as promising therapeutic targets for treatment of RUNX1/ETO-driven AML.
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Affiliation(s)
- Natalia Martinez-Soria
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Lynsey McKenzie
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Julia Draper
- Cancer Research UK Manchester Institute, Manchester M20 4GJ, UK
| | - Anetta Ptasinska
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Hasan Issa
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Sandeep Potluri
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Helen J Blair
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Anna Pickin
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Asmida Isa
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Paulynn Suyin Chin
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Ricky Tirtakusuma
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Daniel Coleman
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sirintra Nakjang
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Salam Assi
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Victoria Forster
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Mojgan Reza
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Ed Law
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Philip Berry
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Dorothee Mueller
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Cameron Osborne
- Department of Medical & Molecular Genetics, King's College London, London SE1 9RT, UK
| | - Alex Elder
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Simon N Bomken
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - Deepali Pal
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK
| | - James M Allan
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Gareth J Veal
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Peter N Cockerill
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Christian Wichmann
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilian University Hospital, Munich 80539, Germany
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK; Princess Maxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands
| | - Georges Lacaud
- Cancer Research UK Manchester Institute, Manchester M20 4GJ, UK
| | - Constanze Bonifer
- Institute for Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Olaf Heidenreich
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Brewery Lane, Newcastle upon Tyne NE1 7RU, UK; Princess Maxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands.
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48
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Fischer-Huchzermeyer S, Chikobava L, Stahn V, Zangarini M, Berry P, Veal GJ, Senner V, Mautner VF, Harder A. Testing ATRA and MEK inhibitor PD0325901 effectiveness in a nude mouse model for human MPNST xenografts. BMC Res Notes 2018; 11:520. [PMID: 30055648 PMCID: PMC6064132 DOI: 10.1186/s13104-018-3630-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/20/2018] [Indexed: 01/29/2023] Open
Abstract
Objective Malignant peripheral nerve sheath tumors (MPNST) are aggressive sarcomas characterized by high recurrence rates and early metastases. These tumors arise more frequently within neurofibromatosis type 1 (NF1) and present with resistance during standard chemotherapy leading to increased mortality and morbidity in those patients. In vitro all-trans retinoic acid (ATRA) and MEK inhibitors (MEKi) were shown to inhibit tumor proliferation, especially when applied in combination. Therefore, we established a nude mouse model to investigate if treatment of xenografts derived from NF1 associated S462 and T265 MPNST cells respond to ATRA and the MEKi PD0325901. Results We demonstrated that human NF1 associated MPNST derived from S462 but not T265 cells form solid subcutaneous tumors in Foxn1 nude mice but not in Balb/c, SHO or Shorn mice. We verified a characteristic staining pattern of human MPNST xenografts by immunohistochemistry. Therapeutic effects of ATRA and/or MEKi PD0325901 on growth of S462 MPNST xenografts in Foxn1 nude mice were not demonstrated in vitro, as we did not observe significant suppression of MPNST growth compared with placebo treatment. Electronic supplementary material The online version of this article (10.1186/s13104-018-3630-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Levan Chikobava
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Verena Stahn
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Monique Zangarini
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Volker Senner
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Victor F Mautner
- Clinics and Polyclinics of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Harder
- Institute of Neuropathology, University Hospital Münster, Münster, Germany. .,Institute of Pathology, Health Care Center, Brandenburg Hospital, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
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49
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Coulthard SA, McGarrity S, Sahota K, Berry P, Redfern CPF. Three Faces of Mercaptopurine Cytotoxicity In Vitro: Methylation, Nucleotide Homeostasis, and Deoxythioguanosine in DNA. Drug Metab Dispos 2018; 46:1191-1199. [PMID: 29884651 DOI: 10.1124/dmd.118.081844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/01/2018] [Indexed: 11/22/2022] Open
Abstract
Mercaptopurine (MP) is a cytotoxic thiopurine important for the treatment of cancer and autoimmune diseases. MP and other thiopurine drugs undergo extensive intracellular metabolism, but the mechanisms of action are poorly characterized. In particular, it is unknown how different metabolites contribute to cytotoxicity and incorporation of thiopurine bases into DNA. The aim of this study was to ask whether cytotoxicity results from the incorporation of thioguanosine nucleotides into DNA, an alternative thiopurine metabolite, or a combination of factors. Therefore, we measured the cytotoxicity, metabolism, and incorporation of thioguanosine into DNA in response to MP or MP metabolites. Thiopurine metabolites varied in cytotoxicity, with methyl-thioinosine-mono-phosphate and thioguanosine-tri-phosphate the most toxic, and the methyl-thioguanosine nucleotides the least. We show, using liquid chromatography-tandem mass spectrometry, how different metabolites may perturb biochemical pathways, particularly disrupting guanosine nucleotide homeostasis, that may contribute to the mechanism of action of thiopurines. Although there was no correlation between metabolite cytotoxicity and the levels of 6-methylthioinosine-mono-phosphate or thioguanosine incorporation into DNA as individual factors, a combined analysis suggested that these factors together had a major influence on cytotoxicity. This study emphasizes the importance of enzymes of nucleotide homeostasis, methylation, and demethylation in thiopurine effects. These results will facilitate the development of dynamic biochemical models of thiopurine biochemistry that will improve our understanding of mechanisms of action in relevant target tissues.
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Affiliation(s)
- Sally A Coulthard
- Northern Institute of Cancer Research (S.A.C., S.M., P.B., C.P.F.R.) and Institute of Cellular Medicine (S.A.C., K.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah McGarrity
- Northern Institute of Cancer Research (S.A.C., S.M., P.B., C.P.F.R.) and Institute of Cellular Medicine (S.A.C., K.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kalvin Sahota
- Northern Institute of Cancer Research (S.A.C., S.M., P.B., C.P.F.R.) and Institute of Cellular Medicine (S.A.C., K.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip Berry
- Northern Institute of Cancer Research (S.A.C., S.M., P.B., C.P.F.R.) and Institute of Cellular Medicine (S.A.C., K.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Chris P F Redfern
- Northern Institute of Cancer Research (S.A.C., S.M., P.B., C.P.F.R.) and Institute of Cellular Medicine (S.A.C., K.S.), Newcastle University, Newcastle upon Tyne, United Kingdom
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50
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Mathias SD, Berry P, De Vries J, Pascoe K, Colwell HH, Chang DJ, Askanase AD. Patient experience in systemic lupus erythematosus: development of novel patient-reported symptom and patient-reported impact measures. J Patient Rep Outcomes 2018; 2:11. [PMID: 29757295 PMCID: PMC5934913 DOI: 10.1186/s41687-018-0028-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 02/08/2017] [Accepted: 10/04/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Comprehensive assessment of systemic lupus erythematosus (SLE) and its treatment requires patient-reported outcome (PRO) measures to capture impacts and fluctuating symptoms. The objective of this study was to develop PROs, in accordance with the Food and Drug Administration (FDA) PRO Guidance, to assess fluctuations in SLE symptoms and its impact. METHODS Following independent review board approval, six US rheumatology practices recruited patients with SLE to participate in concept elicitation (CE) interviews, in order to identify important SLE symptoms and their impacts. The SLE Symptom Severity Diary (SSD) and SLE Impact Questionnaire (SIQ) were drafted based on CE interview results and clinician input. The PROs were revised based on patient feedback from cognitive debriefing (CD) interviews, clinician feedback, and a translatability assessment. RESULTS Forty-one patients completed CE interviews. Commonly-reported symptoms included fatigue (98%), joint pain (93%), and rash (88%). The most frequently reported impact was difficulty with chores/housework (61%). Eighteen patients completed CD interviews. The PROs were considered comprehensive, clear, and relevant.The SSD contains 17 items assessing energy/vitality, joint and muscle pain/stiffness/swelling, flu-like symptoms, cognition, numbness/tingling, skin symptoms and hair loss using an 11-point numeric response scale and a 24-h recall period (with the exception of hair loss). It also evaluates steroid status and dose. The SIQ contains 50 items, uses a 5-point Likert scale and a 7-day recall period, to assess disease impacts including patients' ability to make plans, work, and physical/social/emotional functioning. CONCLUSION The SSD and SIQ are comprehensive SLE-specific PROs developed in accordance with the FDA PRO Guidance. Following assessment of their measurement properties, they may be useful in clinical studies and clinical practice to measure fluctuations in, and the impact of, symptoms in patients with SLE.
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Affiliation(s)
- S. D. Mathias
- Health Outcomes Solutions, PO Box 2343, Winter Park, FL 32790 USA
| | - P. Berry
- GlaxoSmithKline, Philadelphia, PA USA
| | | | | | - H. H. Colwell
- Health Outcomes Solutions, PO Box 2343, Winter Park, FL 32790 USA
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