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Nikolaou E, German EL, Howard A, Nabwera HM, Matope A, Robinson R, Shiham F, Liatsikos K, McNamara C, Kattera S, Carter K, Parry CM, Read JM, Allen SJ, Urban BC, Hawcutt DB, Hill H, Collins AM, Ferreira DM. Assessing the use of minimally invasive self-sampling at home for long-term monitoring of the microbiota within UK families. Sci Rep 2023; 13:18201. [PMID: 37875557 PMCID: PMC10598218 DOI: 10.1038/s41598-023-45574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/21/2023] [Indexed: 10/26/2023] Open
Abstract
Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies.
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Affiliation(s)
- E Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, 3050, Australia.
- Microbiology and Immunology Department, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia.
| | - E L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - A Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C McNamara
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Kattera
- Alder Hey Children's Hospital, Liverpool, UK
| | - K Carter
- Alder Hey Children's Hospital, Liverpool, UK
| | - C M Parry
- Alder Hey Children's Hospital, Liverpool, UK
| | - J M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - B C Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK
| | - D B Hawcutt
- Alder Hey Children's Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - H Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK.
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Robinson R, Kennerley Z. Hywel Dda University Health Board antimicrobial pharmacist input into implementation, clinical and outcome monitoring of outpatient parenteral antimicrobial therapy (OPAT). International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.053] [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: 12/05/2022]
Abstract
Abstract
Introduction
The finance team highlighted an increased spend on antibiotics used by the Acute Response Teams (ART) across Hywel Dda University Health Board (HDUHB). Antimicrobial pharmacists (AMPs) investigated the antibiotics issued to ART and their stock lists. A wide variety of antimicrobials including broad-spectrum, high-cost, and restricted antimicrobials were being prescribed as OPAT. A multi-disciplinary team (MDT) team was set up to implement and deliver good practice recommendations 1alongside providing care closer to home2.
Aim
To assess the number of patients accessing treatment through the service, evaluate uptake and adherence to OPAT guidelines, identify whether AMPs were having an impact on the service and evaluate patient outcomes.
Methods
The MDT included consultant microbiologists, AMPs, ART & infection control nurses, consultant anaesthetist and orthogeriatrician. A Standard Operating Procedure and guidelines were implemented. A data collection form was completed by nurses for each patient and monitored by AMPs. The data underwent descriptive statistical analysis. Ethical approval was not required for this service evaluation.
Results
The service saved 1685 bed days across two counties (Ceredigion and Carmarthenshire) over a 6-month period. Patients were treated with a variety of antimicrobial agents including ceftriaxone, ertapenem, teicoplanin and ceftazidime. Patients receiving OPAT received a clinical check by an AMP for clinical appropriateness, therapeutic drug monitoring and dosing according to blood results. AMPs undertook over 200 reviews, making 27 interventions, including advice on monitoring, when to take levels, bloods, or antibiotic choice. There were only 6 interventions on choice of antibiotic to include more stewardship wise options or options for reduced dosing frequency to increase the capacity of ART, highlighting good uptake and adherence to the guidelines. Outcome forms were collected for all 31 patients in Ceredigion 81% (26 patients) were cured of their infection. In 6% the treatment aim was not attained and required readmission, 6% had no information supplied, 3% were reviewed in clinic and switched to oral and 3% required readmission due to unrelated event.
Discussion/Conclusion
Collaboration within the MDT has led to an improvement in practice while delivering OPAT in HDUHB. Development of a working relationship between the ART nurses and AMPs has led to improved patient safety and monitoring whilst offering patients the opportunity to receive care closer to home. The availability of AMPs to provide answers and guidance in a timely manner to ART has made treatment in the community easier and safer. The guidelines launched at the beginning of the COVID-19 pandemic in an effort to reduce the number of patients occupying beds in secondary care however, this led to a reduced ability for education to be delivered on the guidelines compared to normal practice. Further work is needed to involve the Pembrokeshire team in the process and to increase awareness of the guidelines in both primary and secondary care. Discussions are also in place to investigate whether elastomeric devices offer better antimicrobial stewardship wise treatment options. The main limitation of this study is the inability to follow up long term outcomes.
References
1. Chapman A., Patel S., Horner C., Gilchrist M. and Seaton A. Outpatient parenteral antimicrobial therapy: updated recommendations from the UK. Journal of Antimicrobial Chemotherapy, Volume 74, Issue 11, November 2019, Pages 3125–3127, https://doi.org/10.1093/jac/dkz343
2. Welsh Government. A Healthier Wales: our Plan for Health and Social Care. 2021 A Healthier Wales (gov.wales)
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Barker S, Starr A, van der Lubbe J, Doughty A, Knorr G, Conn S, Lordsmith S, Owen L, Nederbragt A, Hemming S, Hall I, Levay L, Berke MA, Brentegani L, Caley T, Cartagena-Sierra A, Charles CD, Coenen JJ, Crespin JG, Franzese AM, Gruetzner J, Han X, Hines SKV, Jimenez Espejo FJ, Just J, Koutsodendris A, Kubota K, Lathika N, Norris RD, Periera Dos Santos T, Robinson R, Rolison JM, Simon MH, Tangunan D, Yamane M, Zhang H. Persistent influence of precession on northern ice sheet variability since the early Pleistocene. Science 2022; 376:961-967. [PMID: 35617392 DOI: 10.1126/science.abm4033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Prior to ~1 million years ago (Ma), variations in global ice volume were dominated by changes in obliquity; however, the role of precession remains unresolved. Using a record of North Atlantic ice rafting spanning the past 1.7 million years, we find that the onset of ice rafting within a given glacial cycle (reflecting ice sheet expansion) consistently occurred during times of decreasing obliquity whereas mass ice wasting (ablation) events were consistently tied to minima in precession. Furthermore, our results suggest that the ubiquitous association between precession-driven mass wasting events and glacial termination is a distinct feature of the mid to late Pleistocene. Before then (increasing), obliquity alone was sufficient to end a glacial cycle, before losing its dominant grip on deglaciation with the southward extension of Northern Hemisphere ice sheets since ~1 Ma.
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Affiliation(s)
- Stephen Barker
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - Aidan Starr
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - Jeroen van der Lubbe
- Department of Earth Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Alice Doughty
- School of Earth and Climate Sciences, University of Maine, Orono, ME, USA
| | | | - Stephen Conn
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - Sian Lordsmith
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - Lindsey Owen
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | | | - Sidney Hemming
- Lamont-Doherty Earth Observatory, Columbia University, New York, NY, USA
| | - Ian Hall
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK
| | - Leah Levay
- International Ocean Discovery Program, Texas A&M University, College Station, TX, USA
| | | | - M A Berke
- Department of Civil Engineering & Geological Sciences, University of Notre Dame, USA
| | - L Brentegani
- Earth and Environmental Sciences, University of Technology Queensland, Australia
| | - T Caley
- EPOC, UMR CNRS 5805, University of Bordeaux, France
| | - A Cartagena-Sierra
- Department of Civil Engineering & Geological Sciences, University of Notre Dame, USA
| | - C D Charles
- Scripps Institution of Oceanography, University of California, USA
| | - J J Coenen
- Department of Geology, Northern Illinois University, USA
| | - J G Crespin
- EPOC, UMR CNRS 5805, University of Bordeaux, France
| | - A M Franzese
- School of Earth and Environmental Sciences, Hostos Community College (CUNY), USA
| | - J Gruetzner
- Geosciences, Alfred-Wegener-Institut for Polar and Marine Research, Germany
| | - X Han
- Second Institute of Oceanography, Key Laboratory of Submarine Science, China
| | - S K V Hines
- Woods Hole Oceanographic Institution, Woods Hole, USA
| | - F J Jimenez Espejo
- Institute of Biogeosciences, Japan Agency for Marine-Earth Science and Technology (JAMSTEC), Japan
| | - J Just
- Geologisches Institut, Universität Kõln, Germany
| | - A Koutsodendris
- Institute of Earth Sciences, University of Heidelberg, Germany
| | - K Kubota
- Research Institute for Marine Geodynamics, Japan Agency for Marine-Earth Science and Technology, Japan
| | - N Lathika
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Goa, India
| | - R D Norris
- Scripps Institution of Oceanography, University of California, USA
| | | | - R Robinson
- Graduate School of Oceanography, University of Rhode Island, USA
| | | | | | - D Tangunan
- School of Earth and Environmental Sciences, Cardiff University, UK
| | - M Yamane
- Institute for Space-Earth Environmental Research, Nagoya University, Japan
| | - H Zhang
- School of Ecology and Environmental Science, Yunnan University, China
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Robinson R, Haviland JS. Understanding Statistical Significance and Avoiding Common Pitfalls. Clin Oncol (R Coll Radiol) 2021; 33:804-806. [PMID: 34215450 DOI: 10.1016/j.clon.2021.06.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 01/21/2023]
Affiliation(s)
- R Robinson
- Institute of Cancer Research, London, UK; Royal Marsden Hospital NHS Foundation Trust, London, UK
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Robinson R, Roxanis I, Sobhani F, Zormpas-Petridis K, Steel H, Anbalagan S, Sommer A, Gothard L, Khan A, MacNeill F, Melcher A, Yuan Y, Somaiah N. PO-1085 Longitudinal assessment of immune infiltrate in breast cancer treated with neoadjuvant radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Silverman S, Schepman P, Rice JB, Beck C, White A, Thakkar S, Johnson M, Robinson R, Emir B. POS0283 TREATMENT PATTERNS AND CLINICAL CHARACTERISTICS OF PATIENTS WITH OSTEOARTHRITIS OF THE HIP AND/OR KNEE TREATED WITH TRADITIONAL NSAIDS VS COX-2S: A REAL-WORLD STUDY OF COMMERCIALLY-INSURED PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2175] [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:The 2019 American College of Rheumatology (ACR) guidelines strongly recommend oral nonsteroidal anti-inflammatory drugs (NSAIDs) for management of hip and knee osteoarthritis (OA) and strongly recommend topical NSAIDs for knee OA. There are, however, important safety considerations with NSAIDs in terms of increased rates of gastrointestinal, cardiovascular, and renal events. Given these risks, it is important to understand the characteristics and drug utilization of the patients who start treatment on these different treatments (i.e., traditional NSAIDs [tNSAIDs] and cyclooxygenase-2 inhibitors [COX-2s]).Objectives:The goal of this research was to describe and compare baseline characteristics of commercially-insured patients diagnosed with OA of the hip and/or knee who started treatment on different types of NSAIDs (i.e., oral tNSAIDs, topical tNSAIDs, and COX-2s).Methods:The Optum Healthcare Solutions, Inc. claims database (1/2012-3/2017) was used to identify patients ≥18 years old, with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of oral tNSAIDs, topical tNSAIDs, or COX-2s during the one-year follow up period. The index date was defined as the first prescription after the first OA diagnosis. Patients were assigned to cohorts based on the type of NSAID prescribed on index date. Patients were required to be continuously-enrolled six months before (baseline period) and 36 months after (follow-up period) the index date. Demographic and clinical characteristics including age, sex, comorbidities, and healthcare resource use (HRU) were summarized during baseline. Drug utilization characteristics including days supply and number of prescriptions for the different NSAIDs types were summarized during follow-up period.Results:Data for 23,796 patients were analyzed: 18,100 patients received oral tNSAIDs, 4,825 received COX-2s, and 871 topical tNSAIDs. Patients who initiated treatment on oral tNSAIDs were the youngest (mean age of 60.6 vs. 64.6 for COX-2s and 65.0 for topical tNSAIDs) and topical tNSAIDs had the highest proportion of female patients (71% vs. 62% for oral tNSAIDs and 63% for COX-2s). The topical tNSAIDs cohort had the highest presence of chronic kidney disease (2.6% vs. 1.0% and 1.5% for oral tNSAIDs and COX-2s, respectively) and congestive heart failure (2.5% vs. 0.8% and 1.7% for oral tNSAIDs and COX-2s, respectively) at baseline. In terms of HRU during baseline, topical tNSAIDs had the most patients with emergency department visits (20.8% vs. 16.7% in both COX-2s and oral tNSAIDs), and COX-2 had the most patients with inpatient visits (18.1% vs. 15.4% for topical tNSAIDs and 11.8% for oral tNSAIDs). Oral tNSAIDs had the lowest total all-cause cost ($6,504), and the topical tNSAIDs cohort had the highest costs ($8,455), but fairly comparable with COX-2s ($8,289). During follow-up, oral tNSAIDs patients stayed mostly on oral tNSAIDs as less than 15% of oral tNSAIDs patients later had a prescription for COX-2s or topical tNSAIDs. 37% of COX-2 patients and 56% of topical tNSAIDs patients later took oral tNSAIDs. Topical tNSAIDs patients had an average of 184.4 days of supply for topical tNSAIDs yet also extensively used oral NSAIDs during follow-up (average days of supply for oral tNSAIDs was 315.5 days and for COX-2s was 383.5 days).Conclusion:This study suggests that patients with more complex comorbidity profiles, including higher rates of adverse effects, often start pharmacological treatment with topical tNSAIDs. However, patients who start treatment with topical tNSAIDs switch to other types of NSAIDs; oral tNSAIDs were the most frequently prescribed treatment across the cohorts. Thus, despite the safety concerns with oral tNSAIDs and COX-2s, patients are still placed on these treatments to manage their OA pain. There is a need for new innovative treatments as there is currently a lack of other options.Disclosure of Interests:Stuart Silverman Consultant of: Stuart Silverman is a paid consultant to Pfizer and Eli Lilly and Company in connection with this study, Patricia Schepman Shareholder of: Patricia Schepman is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, James B Rice Consultant of: Brad Rice is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Craig Beck Shareholder of: Craig Beck is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, Alan White Consultant of: Alan White is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Sheena Thakkar Shareholder of: Sheena Thakkar is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer, Michaela Johnson Consultant of: Michaela Johnson is an employee of Analysis Group, who were paid consultants to Pfizer and Eli Lilly and Company for this study, Rebecca Robinson Shareholder of: Rebecca Robinson is an employee and minor stockholder of Eli Lilly and Company, Employee of: Eli Lilly and Company, Birol Emir Shareholder of: Birol Emir is an employee of Pfizer with stock and/or stock options, Employee of: Pfizer
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Sadosky A, Schepman P, Thakkar S, Robinson R, Beck C. AB0035 A REVIEW OF THE CLINICAL AND ECONOMIC BURDEN OF OSTEOARTHRITIS PAIN BY SEVERITY IN THE UNITED STATES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.534] [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 development of new therapies to treat symptomatic osteoarthritis (OA) often requires targeting patient subgroups such as mild and/or moderate and/or severe. Multiple assessments for pain are used in clinical and research settings, yet to quantify patient burden with increasing pain severity it is important to understand the potential variability in outcomes based on definitions of severity used1.Objectives:The objective of this study was to examine studies in the published literature that report the burden of OA pain by severity to assess similarities and/or differences across study methodologies and outcomes.Methods:A targeted literature review of PubMed and Google Scholar was conducted January 2021 and included search terms: osteoarthritis, severity, United States (US), burden, quality of life, medication/treatment, and healthcare resource utilization. The search was limited to the English language, full-text articles, and no restriction on publication date. Results included a recent study of the burden of symptomatic OA pain respondents by severity level in the US2,3. Over 100 publication titles were reviewed. Comparison of findings was descriptive in nature.Results:Nine publications were identified representing 7 unique studies, 6 being patient and/or healthcare provider surveys. Two studies focused on OA severity: the remaining 5 stratified patients by pain severity, and all but 2 of the 5 identified and confirmed pain as OA-related. Pain measures included numeric rating scales (generic 0-10, Western Ontario and McMaster Universities Arthritis Index [WOMAC] NRS 3.1), visual analog scales (generic 0-100, Short-Form McGill Pain Questionnaire Visual Analog Scale [SF-MPQ-VAS]) or Pain Interference with Activities (PIA) scale derived from the 12-Item Short Form Health Survey [SF-12v2] developed for the Medical Outcomes Study, with recall periods varying from 48 hours to 7 days to 4 weeks. Only one study exclusively assessed symptomatic patients only i.e., patients with pain scores of 0 were excluded; the remainder compared cohorts of no/mild pain with increasing severity cohorts. Four of the 7 studies examined pairwise differences among mild, moderate, and severe patients (1 study vs. a non-OA cohort); 2 compared no/mild vs. moderate-to-severe OA pain and 1 study compared mild to moderate-to-severe OA pain. For most outcomes examined like clinical comorbidities, quality of life, and healthcare resource utilization, increasing burden was observed with increasing OA and/or pain severity despite study variability.Conclusion:Pain severity levels represent an important and distinguishing factor that contributes to health outcomes in OA patients in the US. Considerable heterogeneity across studies may impact how OA pain is defined, perceived by patients, and treated. Selecting appropriate OA pain severity assessments, including cut-points, may contribute to the successful monitoring of outcomes or comparisons of therapies to manage symptomatic OA pain, especially those that target specific pain severity subgroups.References:[1]Hawker GA, Mian S, Kendzerska T et al. Arthritis Care and Research. 2011; 63(11):S240-S252.[2]Schepman P, Robinson RL, Thakkar S, et al. International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Virtual Annual Meeting; May 2020.[3]Schepman P, Thakkar S, Robinson RL, et al. PAINWeek 2020 Virtual Meeting; September 2020.Disclosure of Interests:Alesia Sadosky Shareholder of: Own stock in Pfizer Inc, Consultant of: I am an employee with the consulting firm Apperture Health, Employee of: I am retired from Pfizer Inc, Patricia Schepman Shareholder of: Owns shares in Pfizer Inc, Employee of: Employee of Pfizer Inc, Sheena Thakkar Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc, Rebecca Robinson Shareholder of: Owns shares of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Craig Beck Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc
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Graham J, Novosat T, Sun H, Piper B, Boscarino J, Duboski V, Kern M, Wright E, Robinson R, Casey E, Beck C, Hall J, Schepman P. POS1089 ASSOCIATION BETWEEN PAIN SEVERITY AND HEALTHCARE UTILIZATION IN AN OSTEOARTHRITIS POPULATION: AN 18-YEAR RETROSPECTIVE COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.523] [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:Osteoarthritis (OA) is a common disease that varies in severity among patients. A standardized definition to classify patients into different severity levels is lacking, however, due to the disease’s complex pathogenesis and presentation. Prior studies have shown associations between pain severity and higher healthcare resource utilization (HRU) and costs. We investigated an association between pain severity and higher healthcare resource utilization by examining the use of specific OA-related treatments across pain intensity levels in a large, integrated health system’s OA population over an 18-year period.Objectives:Our aim was to compare use of medications and other treatments among OA patients experiencing mild, moderate, or severe pain.Methods:This was a retrospective study of electronic health records from 2001 to 2018 at Geisinger, an integrated health system in Pennsylvania. Patients were included with a diagnosis code for OA (ICD-9: 715.*, ICD-10 M15-19) on a problem list or encounter or an OA-specific procedure (hip or knee replacement, arthroscopy or injection). We examined pain scores (0-10 scale, with 10 being worst pain) taken after the first OA diagnosis date and defined pain episodes starting on the pain score’s date and lasting for 90 days. If a new pain score was measured before 90 days elapsed, the episode was extended for an additional 90 days, with this process repeated as necessary. Each episode was categorized as mild (pain score 0-3), moderate (4-6), or severe (7-10) based on initial score, and patients could contribute multiple episodes to the analysis. Descriptive statistics were used to quantify treatment utilization during each patients’ mild, moderate and severe episodes. Percentages of patients who had any use of 10 medication types (tramadol, non-tramadol opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), injectable corticosteroids, acetaminophen, salicylates, duloxetine, homeopathic medications, other topical medications, and other over-the-counter (OTC) medications were compared across pain episode types. Percentages of patients with knee or hip surgeries, spine or joint imaging procedures (x-ray, computed tomography or magnetic resonance) and consults to OA-related care (pain management, orthopedics or physical medicine and rehabilitation) were also compared. All analyses used logistic regression with p-values <0.05 considered significant.Results:We identified 290,897 patients with OA, representing 34% of the health system population in 2018; 58% were female with mean age of 49 years and mean BMI of 30.5 kg/m2. A total of 801,144 pain episodes were defined, with 75% of patients having at least one pain score. The two most frequently occurring pain scores were 0 (17%) and 5 (13%), and pain episodes were classified as 43% mild, 32% moderate and 25% severe. Significantly higher percentages of patients used certain medication types (NSAIDs, injectable corticosteroids, non-tramadol opioid, duloxetine) in both moderate and severe pain episodes as compared to mild episodes, but other medication types were less likely to be used as pain severity increased (acetaminophen, salicylates, homeopathic medications, other OTC medications). Knee or hip surgeries, imaging, and consults to OA-related specialists were all consistently significantly more likely to occur in patients during moderate or severe pain episodes versus mild episodes (relative risk ratios of 1.76, 1.25 and 1.35 for moderate vs mild, respectively, and 2.00, 1.44 and 1.46 for severe vs mild, all p-values <0.05).Conclusion:While pain is generally recognized to be a subjective measure that could be influenced by other unmeasured factors and can be confounded with treatment effectiveness, it is nevertheless the primary symptom of OA. It is important to understand the relationship between pain intensity and treatment utilization, and our results support an overall association between pain and utilization but provide new details on the extent to which it depends on specific utilization type.Acknowledgements:Pfizer and Eli Lilly and Company for sponsoring this study.Disclosure of Interests:Jove Graham Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Tonia Novosat Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Haiyan Sun Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Brian Piper Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Joseph Boscarino Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Vanessa Duboski Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Melissa Kern Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Eric Wright Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Rebecca Robinson Shareholder of: Eli Lilly & Co., Employee of: Eli Lilly & Co., Edward Casey Shareholder of: Pfizer, Inc., Paid instructor for: As an employee of Pfizer, Inc. this is part of my role., Employee of: Pfizer, Inc., Craig Beck Shareholder of: Pfizer, Inc., Employee of: Pfizer, Inc., Jerry Hall Shareholder of: Eli Lilly & Co., Employee of: Eli Lilly & Co., Patricia Schepman Shareholder of: Pfizer, Inc., Employee of: Pfizer, Inc.
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Demetri GD, Luke JJ, Hollebecque A, Powderly JD, Spira AI, Subbiah V, Naumovski L, Chen C, Fang H, Lai DW, Yue H, Polepally AR, Purcell JW, Robinson R, Sharma P, Allison JP, Tolcher A, Villalobos VM. First-in-Human Phase I Study of ABBV-085, an Antibody-Drug Conjugate Targeting LRRC15, in Sarcomas and Other Advanced Solid Tumors. Clin Cancer Res 2021; 27:3556-3566. [PMID: 33820780 DOI: 10.1158/1078-0432.ccr-20-4513] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Leucine-rich repeat containing 15 (LRRC15) is expressed on stromal fibroblasts in the tumor microenvironment of multiple solid tumor types and may represent an interesting target for therapy, particularly in patients with sarcomas where LRRC15 is also expressed by malignant cells. ABBV-085 is a monomethyl auristatin-E antibody-drug conjugate that targets LRRC15 and showed antineoplastic efficacy in preclinical experiments. Herein, we report findings of ABBV-085 monotherapy or combination therapy in adult patients with sarcomas and other advanced solid tumors. PATIENTS AND METHODS This first-in-human phase I study (NCT02565758) assessed ABBV-085 safety, pharmacokinetics/pharmacodynamics, and preliminary antitumor activity. The study consisted of two parts: dose escalation and dose expansion. ABBV-085 was administered by intravenous infusion at 0.3 to 6.0 mg/kg every 14 days. RESULTS In total, 85 patients were enrolled; 45 patients received the recommended expansion dose of 3.6 mg/kg ABBV-085 monotherapy, including 10 with osteosarcoma and 10 with undifferentiated pleomorphic sarcoma (UPS). Most common treatment-related adverse events were fatigue, nausea, and decreased appetite. The overall response rate for patients with osteosarcoma/UPS treated at 3.6 mg/kg was 20%, including four confirmed partial responses. No monotherapy responses were observed for other advanced cancers treated at 3.6 mg/kg. One patient treated with ABBV-085 plus gemcitabine achieved partial response. CONCLUSIONS ABBV-085 appeared safe and tolerable at a dose of 3.6 mg/kg every 14 days, with preliminary antitumor activity noted in patients with osteosarcoma and UPS. Given the high unmet need in these orphan malignancies, further investigation into targeting LRRC15 in these sarcomas may be warranted.
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Affiliation(s)
- George D Demetri
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute; Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts.
| | - Jason J Luke
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Antoine Hollebecque
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - John D Powderly
- Carolina BioOncology Institute, Huntersville, North Carolina
| | | | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louie Naumovski
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Chris Chen
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Hua Fang
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Dominic W Lai
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Huibin Yue
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | | | - James W Purcell
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Randy Robinson
- Oncology Early Development, AbbVie Inc., Redwood City, California
| | - Padmanee Sharma
- Department of Immunology, MD Anderson Cancer Center, Houston, Texas
| | - James P Allison
- Department of Immunology, MD Anderson Cancer Center, Houston, Texas
| | - Anthony Tolcher
- South Texas Accelerated Research Therapeutics (START), San Antonio, Texas
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Tarrant B, Quinn E, Robinson R, Poulsen M, Fuller L, Snell G, Thompson B, Button B, Holland A. Postoperative, Inpatient Rehabilitation after Lung Transplant Evaluation (PIRATE): A Feasibility Randomized Controlled Trial. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Makin S, Hudson L, Robinson R, Riley MR, Murphy D. Control of three gastrointestinal illness outbreaks in a British Role 1 facility in Afghanistan: a primary care perspective. BMJ Mil Health 2020; 168:200-205. [PMID: 32636232 DOI: 10.1136/bmjmilitary-2020-001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2019, Camp Qargha (QAA), a British-led multinational military camp in Kabul, had three of the largest outbreaks of gastrointestinal illness (GI) experienced by the British Military since 2003. This paper discusses the incidence, the response of the British-led Role 1 (R1) medical treatment facility, identifies potential causative and exacerbating factors, and explains the control measures initiated. METHOD GI in QAA results in local and UK military-wide data collection including in the form of local GI questionnaires, FMed85 forms and EpiNATO returns. The data from these was used to identify trends during and after outbreaks and produce environmental health (EH) and local outbreak reports. RESULTS Overall, among the outbreaks 56% of stool samples tested positive for norovirus. In each outbreak incidence peaked within the first 3 days, and hardened multiperson rooms were worst affected. 206 patient presentations occurred during the three outbreaks, 706 working days were lost in isolation, with QAA shut down while in quarantine for 27 days. DISCUSSION Significant strain was placed on QAA and the R1. Causative factors may include close interaction with the local national (LN) population, a high population density and accommodation being limited by specific national infrastructure protocols in an operational environment. CONCLUSION Early recognition of GI, positive standard operating procedures and good hygiene habits are essential to prevent the spread of GI such as norovirus. An early awareness of LN population illness patterns will allow the R1 and command to be better prepared for outbreaks in the future.
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Affiliation(s)
- Seth Makin
- RMAS, Army Medical Services, Camberley, Surrey, UK
| | - L Hudson
- RMAS, Army Medical Services, Camberley, Surrey, UK
| | - R Robinson
- Royal Australian Army Nursing Corps, Bonegilla, Victoria, Australia
| | - M R Riley
- RMAS, Army Medical Services, Camberley, Surrey, UK
| | - D Murphy
- RMAS, Army Medical Services, Camberley, Surrey, UK
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Robinson R, FitzMaurice T, Shaw M, Dawood S, Nazareth D, Walshaw M. P219 Symkevi: real-world experience in an ill cohort at an adult cystic fibrosis centre. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Button B, Poulsen M, Robinson R, Burge A, Fuller L. ePS1.09 Urinary incontinence in women and men with end stage chronic lung disease before and after lung transplantation. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Silverman S, Rice J, White A, Le N, Somma M, Beck C, Robinson R, Schepman P. FRI0423 CLINICAL BURDEN OF TREATING COMMERCIALLY-INSURED OSTEOARTHRITIS PATIENTS WITH PRESCRIPTION NSAIDS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3716] [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:Prescription NSAIDs/Cox-2s (“NSAIDs”) are commonly prescribed by physicians to treat patients with chronic pain, and much is known about the potential negative outcomes associated with their use1. Such negative outcomes include gastrointestinal (“GI”) issues and hepatorenal toxicity.1In addition, CV risk of Cox-2s has not been completely clarified.1,2However, less is known about the extent to which these outcomes are pervasive and problematic in specific patient populations such as those diagnosed with osteoarthritis (“OA”).Objectives:The goal of this research is to assess the clinical burden of commercially-insured patients diagnosed with OA of the hip and/or knee before and after treatment with prescription NSAIDs, in a large, national database in recent years.Methods:The Optum Healthcare Solutions, Inc. data (1/2012-3/2017) were used to identify patients ≥18 years old with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of NSAIDs during the three-year period from first prescription (index date) after their first OA diagnosis. Patients were required to be continuously-enrolled during the six months before (baseline period) and 36 months after (follow-up period) the index date. Selected clinical outcomes such as GI issues, CV events, and renal toxicity were compared between the baseline and follow-up periods. Costs and resource use were normalized to account for differential duration in analytic time periods.Results:Data for 22,435 patients (60.8% as female, with an average age of 62) with hip and/or knee OA were analyzed. On average, patients were prescribed NSAIDs for 489 days during the follow-up period. From the baseline period to follow-up period, negative clinical outcomes associated with GI issues increased by 393% (1.5% v 7.5%), driven by a 667% (0.3% v 2.3%) increase in acute GI hemorrhages. Additionally, negative clinical outcomes associated with CV events increased by 73% (40.7% v 70.6%), largely due to a 600% (0.3% v 2.1%) increase in acute myocardial infarction. Lastly, negative clinical outcomes associated with renal toxicity increased by 433% (1.5% v 8.0%), with a 740% (0.5% v 4.2%) increase in acute renal failure being the most substantial.Conclusion:These findings suggest that prescribing of NSAIDs among OA patients is associated with an increase in negative clinical outcomes. This suggests that new treatment options other than NSAIDs should be evaluated.References:[1]van Laar M, et al. Pain treatment in arthritis-related pain: beyond NSAIDs.Open Rheumatol J. 2012;6:320–330.[2]Nissen SE, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis.NEJM2016;2519-2529.Disclosure of Interests:Stuart Silverman Consultant of: Pfizer and Eli Lilly for this project., Speakers bureau: Amgen, Radius, James Rice Consultant of: Pfizer and Eli Lilly have funded this project., Alan White Consultant of: Pfizer and Eli Lilly have funded this project., Nguyen Le Consultant of: Pfizer and Eli Lilly have funded this project., Michael Somma Consultant of: Eli Lilly and Pfizer have funded this project., Craig Beck Shareholder of: Pfizer, Employee of: Pfizer, Rebecca Robinson Shareholder of: Eli Lilly, Employee of: Eli Lilly, Patricia Schepman Shareholder of: Pfizer, Employee of: Pfizer
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Carneiro BA, Bestvina CM, Shmueli ES, Gan HK, Beck JT, Robinson R, Fischer JS, Wong A, Ansell PJ, Jin JY, Naumovski L, Papadopoulos KP. Phase I study of the antibody-drug conjugate ABBV-321 in patients with non-small cell lung cancer and squamous head and neck cancer with overexpression of the epidermal growth factor receptor. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps3649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3649 Background: ABBV-321 (serclutamab talirine) is an epidermal growth factor receptor (EGFR)-targeted antibody-drug conjugate that consists of a humanized immunoglobulin G1 anti-EGFR monoclonal antibody conjugated to a pyrrolobenzodiazepine (PBD) dimer via a maleimidocaproyl-valine-alanine linker. Once bound, ABBV-321 is internalized, the maleimidocaproyl-valine-alanine linker undergoes proteolytic cleavage, and the cytotoxic PBD is released, causing DNA cross-links and cell death. Preclinical studies have shown cytotoxicity in numerous human xenograft and patient (pt)-derived tumor models. This first-in-human trial is assessing the safety, pharmacokinetic (PK), and preliminary antitumor activity of ABBV-321 in pts with advanced solid tumor types likely to exhibit elevated levels of EGFR. Methods: This is a 2-part, multicenter phase 1 study (NCT03234712) of ABBV-321 monotherapy in pts (≥18 years; Eastern Cooperative Oncology Group performance status 0–1) with advanced solid tumors associated with overexpression of EGFR. EGFR overexpression will be determined by centralized testing using an RNA-based assay. Primary objectives of the completed part 1 (dose escalation) were to determine the maximum tolerated dose (MTD)/recommended phase 2 dose (RP2D) of ABBV-321 and assess the PK and toxicity and safety profile; part 2 (dose expansion) will evaluate safety and PK profile at the RP2D in specific cohorts (NSCLC and HNSCC). Secondary objectives include assessment of preliminary antitumor activity. Pts will receive escalating doses of ABBV-321 until the MTD/RP2D is determined. Dose-limiting toxicities will be assessed during the first cycle of dosing. Adverse events (AEs) will be evaluated per National Cancer Institute Common Terminology Criteria for AEs (version 4.03). Blood samples for PK analysis (ABBV-321, total antibody, unconjugated PBD) will be collected at designated time points throughout the study. The multinational trial is active, with the first pt screened on 1 Feb 2018. The dose-escalation phase has been completed; screening and enrollment for the expansion phase of the study in NSCLC and HNSCC is underway. Clinical trial information: NCT03234712 .
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Affiliation(s)
| | | | | | - Hui Kong Gan
- Olivia Newton-John Cancer Research Institute, Victoria, NSW, Australia
| | | | - Randy Robinson
- Oncology Early Development, AbbVie Inc., Redwood City, CA
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Robinson R, Barber K, Jones G, Blakey J, Burhan H. Exploring the relationship between generalised anxiety/depression scales and asthma-specific quality of life/control questionnaires in a specialist asthma clinic. J Asthma 2020; 58:912-920. [PMID: 32186425 DOI: 10.1080/02770903.2020.1744640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Psychological issues are common in patients with chronic disabling diseases such as asthma. National guidance recommends that specialist asthma clinic attendees should complete questionnaires screening for psychological comorbidities. However, completing these in addition to asthma specific questionnaires can be burdensome. In order to investigate whether anxiety and depression questionnaires can be used in a targeted manner, this study investigates the correlation between the respective scores. We hypothesize that there is correlation between asthma-specific and anxiety/depression questionnaire scores. METHODS Three-hundred individuals with poorly controlled asthma attending a specialist clinic were asked to complete Asthma Control Questionnaire (ACQ), mini-Asthma Quality of Life Questionnaire (mini-AQLQ), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaires (PHQ-9). A Pearson correlation coefficient was generated and area under ROC and confusion matrices were used to assess correlation. RESULTS 49% and 47% of patients completing the GAD-7 or PHQ-9 questionnaires, respectively had scores above the screening level for co-morbid anxiety and depression. Additional questionnaires were often incomplete (GAD-7 = 150 and PHQ-9 = 140). GAD-7 and PHQ-9 correlated with ACQ and mini-AQLQ (all p = <0.001, r values 0.53-0.65). Asthma-specific questionnaire scores were predictive of GAD-7 and PHQ-9 scores (AUCs of 0.78 to 0.84). 75% of patients with a mini-AQLQ score of <3 met the threshold GAD-7 and PHQ-9 score of 10. CONCLUSIONS ACQ and mini-AQLQ correlate with GAD-7 and PHQ-9 amongst specialist asthma clinic attendees. A mini-AQLQ >3 suggests patients are unlikely to have anxiety or depression. These findings could be used to identify patients requiring formal screening for psychological co-morbidity.
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Affiliation(s)
- R Robinson
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - K Barber
- Respiratory Medicine, Countess of Chester Hospital, Chester, UK
| | - G Jones
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - J Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Curtin University Medical School, Perth, Australia
| | - H Burhan
- Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, UK
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Fuller L, Poulsen M, Button B, Robinson R, Snell G, Burge A. Urinary Incontinence - Incidence, Associations and Effect of Lung Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Demetri GD, Luke JJ, Hollebecque A, Powderly JD, Spira AI, Subbiah V, Lai DW, Yue H, Kasichayanula S, Gulbranson S, Purcell J, Myzak M, Robinson R, Villalobos VM, Tolcher AW. First-in-human phase 1 study of ABBV-085, an antibody-drug conjugate (ADC) targeting LRRC15, in sarcomas and other advanced solid tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3004 Background: ABBV-085 is an ADC (conjugated to monomethyl auristatin E, drug:antibody ratio of 2:1) directed against leucine-rich repeat containing 15 (LRRC15), a type 1 transmembrane protein highly expressed on the surface of sarcomas and cancer-associated fibroblasts in stroma of many other cancers. ABBV-085 induced antitumor activity in both in vitro and xenograft models of sarcoma. This phase 1, first-in-human, 2-part study assessed the safety/tolerability of ABBV-085 in patients (pts) with advanced solid tumors (NCT02565758). Methods: Eligible pts (≥18 yr; advanced solid tumors) received ABBV-085 intravenously in a 3+3 dose-escalation (DE) design; 0.3- to 4.8-mg/kg doses every 2 wk (8 cohorts). Pharmacokinetics (PK) were assessed in cycle 1 and cycle 3. Results: As of Dec 2018, 78 pts were enrolled in monotherapy DE and dose-expansion (EXP) cohorts (≤2.7 mg/kg, n = 21; 3.6 mg/kg, n = 45; 4.2 mg/kg, n = 6; 4.8 mg/kg, n = 6); median age: 58 yr (range 21–84); median treatment (Tx) duration: 6.2 wk (range 0.3–54.4). Overall, 77 (98.7%) pts reported ≥1 Tx-emergent adverse events (TEAEs). Fatigue (48.7%) was most common; 19 (24.4%) pts reported grade 1/2 blurred vision (reversible on study discontinuation). Grade ≥3 TEAEs were reported in 56 (71.8%) pts; anemia (14.1%) was the most common. Dose-limiting toxicities occurred at 3.6 mg/kg (n = 1; anemia), 4.2 mg/kg (n = 1; hypertriglyceridemia), and 4.8 mg/kg (n = 2; ileus and nausea); 3.6 mg/kg was chosen as the recommended phase 1b dose (RP1bD). PK exhibited dose-proportional increase in the area under the curve after single-dose administration; half-life was 2.84 days at the RP1bD. Of the 27 sarcoma pts (DE [n = 8]/EXP [n = 19] cohorts; undifferentiated pleomorphic sarcoma [n = 10], osteosarcoma [n = 10], and other sarcomas [n = 7]) treated at the RP1bD, 4 (14.8%) had confirmed partial response (PR; 2 [7.4%] unconfirmed), 8 (29.6%) had stable disease, 11 (40.7%) had progressive disease; 2 (7.4%) were not evaluable. The median duration of response (confirmed responders) was 7.6 mo (95% CI: 5.6–9.2). Updated safety and efficacy data will be reported. Conclusions: ABBV-085 was well tolerated with durable PR observed in pts with advanced sarcomas. Clinical trial information: NCT02565758.
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Affiliation(s)
- George D. Demetri
- Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA
| | | | | | | | | | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dominic W. Lai
- Oncology Early Development, AbbVie Inc., Redwood City, CA
| | - Huibin Yue
- Oncology Early Development, AbbVie Inc., Redwood City, CA
| | | | | | - James Purcell
- Oncology Early Development, AbbVie Inc., Redwood City, CA
| | - Melinda Myzak
- Oncology Early Development, AbbVie Inc., Redwood City, CA
| | - Randy Robinson
- Oncology Early Development, AbbVie Inc., Redwood City, CA
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Fuller L, Whitford H, Cristiano Y, Robinson R, Steward R, Poulsen M, Shi W, Snell G. What Happens to Frailty in the First Year after Lung Transplantation? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Bourn M, Robinson R, Innocenti F, Scheutz C. Regulating landfills using measured methane emissions: An English perspective. Waste Manag 2019; 87:860-869. [PMID: 29937100 DOI: 10.1016/j.wasman.2018.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
Methane emissions from landfills are an important source of greenhouse gases in the UK and worldwide. This paper considers how measurements of methane emissions could be used to regulate landfills in England in order to reduce the contribution of landfilling to climate change. The paper presents the results of a number of UK studies undertaken to quantify methane emissions from landfills. The methods used have included the DIAL (Differential Absorption Lidar) technique and a tracer gas dispersion method. A method based on aerial measurements has been developed. Methane emission rates were measured at 15 biodegradable waste landfills. All of the landfills where measurements took place had an active landfill gas extraction system. A methane collection index (MCI) is calculated for each landfill using the ratio of the methane collection rate to the sum of the collection and emission rates. The values of the index in the campaigns reported here ranged from 0.28 to 0.90. The modern operational landfills surveyed achieved MCI values with a much narrower range of between 0.64 and 0.90 with an average of 0.76. This has demonstrated that it is possible for these landfills to collect a high proportion of the landfill gas. A proposed approach is presented for regulating landfills using the measured MCI. This would involve an annual measurement campaign to quantify the methane emissions and the use of the data provided by these surveys to develop an achievable but challenging MCI limit. A limit value of 0.75 for the MCI is used to illustrate the approach. An MCI that falls below the limit would trigger actions to reduce the methane emissions from the landfill.
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Affiliation(s)
- M Bourn
- Environment Agency, Horizon House, Deanery Road, Bristol BS1 5AH, United Kingdom.
| | - R Robinson
- National Physical Laboratory (NPL), Hampton Road, Teddington, Middlesex TW11 0LW, United Kingdom
| | - F Innocenti
- National Physical Laboratory (NPL), Hampton Road, Teddington, Middlesex TW11 0LW, United Kingdom
| | - C Scheutz
- Department of Environmental Engineering, Technical University of Denmark, Bygningstorvet, Building 115, DK-2800 Kongens Lyngby, Denmark
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Robinson R, Rhodes H, Fairweather A. Reducing home enteral feed wastage and associated cost saving by an established adult home enteral nutrition team. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Lavan L, Kyriazis G, Mbiabjeu D, Gormley R, Hall S, Robinson R, Hodgson D. Day-case surgery is possible in the majority of men undergoing transurethral resection of the prostate – a report on over 1000 cases. Journal of Clinical Urology 2018. [DOI: 10.1177/2051415818786667] [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: 11/17/2022]
Abstract
Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively ( p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).
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Affiliation(s)
- L Lavan
- Department of Urology, Queen Alexandra Hospital, UK
| | - G Kyriazis
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Mbiabjeu
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Gormley
- Department of Urology, Queen Alexandra Hospital, UK
| | - S Hall
- Department of Urology, Queen Alexandra Hospital, UK
| | - R Robinson
- Department of Urology, Queen Alexandra Hospital, UK
| | - D Hodgson
- Department of Urology, Queen Alexandra Hospital, UK
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Feher MD, Rampling MW, Brown J, Robinson R, Richmond W, Cholerton S, Bain BJ, Sever PS. Acute changes in Atherogenic and Thrombogenic Factors with Cessation of Smoking. J R Soc Med 2018; 83:146-8. [PMID: 2325055 PMCID: PMC1292556 DOI: 10.1177/014107689008300306] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco smoking is associated with alterations in several factors considered to be important in the atherosclerotic process. Thirty chronic smokers were studied 2 weeks before and 2 weeks after complete tobacco withdrawal. Significant reductions in fibrinogen, haematocrit, plasma viscosity and whole blood viscosity as well as a significant increase in HDL-cholesterol were observed. As these factors are important in both atherogenesis and thrombogenesis, these observations may give insight into tobacco-induced atherosclerotic disease and may be responsible for the more rapid reduction in the incidence of cardiovascular disease that is believed to occur after stopped smoking.
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Affiliation(s)
- M D Feher
- Department of Clinical Pharmacology, St Mary's Hospital Medical School, London
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. 设立针对脱发(斑秃除外)预防、诊断和治疗的研究问题并安排优先顺序:脱发优先设定合作伙伴关系. Br J Dermatol 2018. [DOI: 10.1111/bjd.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. Establishing and prioritizing research questions for the prevention, diagnosis and treatment of hair loss (excluding alopecia areata): the Hair Loss Priority Setting Partnership. Br J Dermatol 2018. [DOI: 10.1111/bjd.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. Establishing and prioritizing research questions for the prevention, diagnosis and treatment of hair loss (excluding alopecia areata): the Hair Loss Priority Setting Partnership. Br J Dermatol 2018; 178:535-540. [DOI: 10.1111/bjd.15810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A. Macbeth
- Department of Dermatology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane Norwich NR4 7UY U.K
| | | | - A. Messenger
- Department of Dermatology; University of Sheffield; Royal Hallamshire Hospital; Sheffield U.K
| | - K. Moore-Millar
- Department of Design, Manufacturing and Engineering; University of Strathclyde; Glasgow U.K
| | | | - A. Shipman
- Department of Dermatology; Warwick Hospital; Warwick Warwickshire U.K
| | - J. Kassim
- Dermatology Centre; St Mary's Hospital; Portsmouth U.K
| | - J. Brockley
- Department of Dermatology; Cannock Chase Hospital; Cannock U.K
| | - W. Szczecinska
- Department of Dermatology; Heart of England NHS Foundation Trust Standard Institution; Birmingham U.K
| | - P. Farrant
- Department of Dermatology; Brighton and Sussex University Hospitals NHS Trust; Brighton U.K
| | - R. Robinson
- Department of Dermatology; Harrogate and District NHS Foundation Trust; Harrogate North Yorkshire U.K
| | | | | | | | - M. Harries
- The Dermatology Centre; University of Manchester; Salford Royal NHS Foundation Trust; Salford Greater Manchester U.K
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Bhoyrul B, Lindsay H, Robinson R, Stahlschmidt J, Palmer T, Edward S, Clark SM. Pili annulati in a case of Rothmund-Thomson syndrome with a novel frameshift mutation in RECQL4. J Eur Acad Dermatol Venereol 2017; 32:e221-e223. [PMID: 29224249 DOI: 10.1111/jdv.14742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B Bhoyrul
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
| | - H Lindsay
- Leeds Genetics Laboratory, St James's University Hospital, Beckett Street, Leeds, UK
| | - R Robinson
- Leeds Genetics Laboratory, St James's University Hospital, Beckett Street, Leeds, UK
| | - J Stahlschmidt
- Department of Histopathology, St James's University Hospital, Beckett Street, Leeds, Uk
| | - T Palmer
- Department of Histopathology, St James's University Hospital, Beckett Street, Leeds, Uk
| | - S Edward
- Department of Histopathology, St James's University Hospital, Beckett Street, Leeds, Uk
| | - S M Clark
- Department of Dermatology, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK
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Allison A, Robinson R, Jolliffe C, Taylor PM. Evaluation of the use of midazolam as a co-induction agent with ketamine for anaesthesia in sedated ponies undergoing field castration. Equine Vet J 2017; 50:321-326. [PMID: 28898439 DOI: 10.1111/evj.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 09/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are limited investigations comparing ketamine to a ketamine-midazolam co-induction. OBJECTIVES To compare quality and safety of general anaesthesia induced using ketamine alone with anaesthesia co-induced using ketamine and midazolam. STUDY DESIGN Randomised, double blinded, placebo controlled trial. METHODS After i.v. detomidine (20 μg/kg) thirty-eight ponies undergoing field castration received either 0.06 mg/kg (0.6 mL/50 kg) midazolam (group M) or 0.6 mL/50 kg placebo (group P) with 2.2 mg/kg ketamine i.v. for anaesthetic induction. Quality of anaesthetic induction, endotracheal intubation, surgical relaxation and recovery were scored using combinations of simple descriptive and visual analogue scales. Time of sedation, induction, start of endotracheal intubation, first movement, sternal recumbency and standing were recorded, as were time, number and total quantity of additional i.v. detomidine and ketamine injections. Cardiorespiratory variables were assessed every 5 min. Adverse effects were documented. Data were tested for normality and analysed with a mixed model ANOVA, Fisher's exact test, unpaired Students' t test and Wilcoxon Rank-sum as appropriate; P<0.05 was considered significant. RESULTS Group M had better scores for induction (P = 0.005), intubation (P<0.001) and surgical relaxation (P<0.001) and required fewer additional injections of detomidine and ketamine (P = 0.04). Time (minutes) from induction to first movement (P<0.001), sternal recumbency (P =< 0.001) and standing was longer (P = 0.05) in group M. Recoveries were uneventful with no difference in quality between groups (P = 0.78). MAIN LIMITATIONS Clinical study with noninvasive monitoring undertaken in field conditions. CONCLUSIONS Ketamine-midazolam co-induction compared to ketamine alone improved quality of induction, ease of intubation and muscle relaxation without impacting recovery quality.
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Affiliation(s)
- A Allison
- Animal Health Trust, Newmarket, Suffolk, UK
| | - R Robinson
- Animal Health Trust, Newmarket, Suffolk, UK
| | - C Jolliffe
- Animal Health Trust, Newmarket, Suffolk, UK
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Macbeth A, Tomlinson J, Messenger A, Moore-Millar K, Michaelides C, Shipman A, Kassim J, Brockley J, Szczecinska W, Farrant P, Robinson R, Rodgers J, Chambers J, Upadhyaya S, Harries M. Establishing and prioritizing research questions for the treatment of alopecia areata: the Alopecia Areata Priority Setting Partnership. Br J Dermatol 2017; 176:1316-1320. [DOI: 10.1111/bjd.15099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A.E. Macbeth
- Department of Dermatology; Norfolk and Norwich University Hospitals NHS Foundation Trust; Colney Lane; Norwich NR4 7UY U.K
| | | | - A.G. Messenger
- Dermatology; University of Sheffield; Royal Hallamshire Hospital; Sheffield U.K
| | - K. Moore-Millar
- Design, Manufacturing and Engineering; University of Strathclyde; Glasgow U.K
| | | | | | - J.M. Kassim
- Dermatology Centre; St Mary's Hospital; Portsmouth U.K
| | - J.R. Brockley
- Cannock Chase Hospital; The Royal Wolverhampton NHS Trust; Cannock U.K
| | - W. Szczecinska
- Dermatology Department; Solihull Hospital; Heart of England NHS Foundation Trust; Solihull U.K
| | - P. Farrant
- Department of Dermatology; Brighton and Sussex University Hospitals NHS Trust; Brighton U.K
| | - R. Robinson
- Harrogate and District NHS Foundation Trust; Harrogate U.K
| | | | | | | | - M.J. Harries
- The Dermatology Centre; University of Manchester; Salford Royal NHS Foundation Trust; Salford U.K
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Banda H, Robinson R, Thomson R, Squire SB, Mortimer K. The 'Practical Approach to Lung Health' in sub-Saharan Africa: a systematic review. Int J Tuberc Lung Dis 2017; 20:552-9. [PMID: 26970167 PMCID: PMC4784471 DOI: 10.5588/ijtld.15.0613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
SETTING: There is a high burden of respiratory disease in sub-Saharan Africa. To address this problem, the World Health Organization launched the ‘Practical approach to Lung Health’ (PAL), i.e., locally applicable integrated syndromic algorithms, to improve primary care management of these diseases. OBJECTIVE: To examine the evidence for the impact of PAL on the diagnosis and management of tuberculosis (TB) and other common respiratory problems in sub-Saharan Africa. DESIGN: A systematic review of MEDLINE (1998–2015), EMBASE (1998–2015) and CINAHL (1998–2015) was conducted to find trials evaluating PAL implementation in sub-Saharan Africa. RESULTS: Five studies were found, evaluating three PAL variations: PAL in South Africa (PALSA), PALSA with integrated human immunodeficiency virus treatment (PALSA PLUS) and PAL in Malawi using lay health workers (PALM/LHW). PALSA increased TB diagnosis (OR 1.72, 95%CI 1.04–2.85), as did PALSA PLUS (OR 1.25, 95%CI 1.01–1.55). Cure or completion rates in retreatment cases in PALSA and PALSA PLUS were significantly improved (OR 1.78, 95%CI 1.13–2.76). PALM/LHW, which examined TB treatment success, found no significant improvement (P = 0.578). CONCLUSION: The limited research performed shows that PAL can be effective in TB diagnosis and partial treatment success; however, more evidence is needed to assess its effects on other respiratory diseases, especially in wider sub-Saharan Africa.
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Affiliation(s)
- H Banda
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | - R Robinson
- Department of Clinical Sciences and Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Thomson
- Department of Clinical Sciences and Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S B Squire
- Department of Clinical Sciences and Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Department of Clinical Sciences and Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
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Porter SJ, DeArmitt CL, Robinson R, Kirby JP, Bott DC. The Surface Characterization of Polyacrylonitrile-based Carbon Fibres by Electrochemical Techniques. HIGH PERFORM POLYM 2016. [DOI: 10.1177/095400838900100107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carbon fibre surface properties have been studied by measuring the electrochemical behaviour of the hexacyano ferrate (III)/ferrate(II) couple using carbon fibre brush electrodes. Courtaulds Grafil polyacrylonitrile (PAN) based fibres have been studied that have been subjected to different extents of a proprietary wet oxidative surface treatment varying from 0 to 500% of the standard treatment. Analysis of the cyclic voltammograms gives information on the electroactive surface area, a parameter related to the conductivity perpendicular to the fibre surface and rate of electron transfer across the surface of the fibres. The electrochemical data are correlated with other surface properties such as the surface area determined by oxygen chemisorption, surface energy components and some adhesion parameters, such as interlaminar shear strength and critical fragment aspect ratio of epoxy matrix composites.
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Affiliation(s)
- S. J. Porter
- Courtaulds Research, Coventry, West Midlands CV6 5RS, UK
| | - C. L. DeArmitt
- Courtaulds Research, Coventry, West Midlands CV6 5RS, UK
| | - R. Robinson
- Courtaulds Research, Coventry, West Midlands CV6 5RS, UK
| | - J. P. Kirby
- Courtaulds Research, Coventry, West Midlands CV6 5RS, UK
| | - D. C. Bott
- Courtaulds Research, Coventry, West Midlands CV6 5RS, UK
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Abstract
The relationship between the Chair and Chief Executives of Health Authorities (and Boards) and NHS Trusts denote the managerial and political character of the NHS, creating an organizational apex with 'two at the top'. This article considers the nature of relationships between Chairs and Chief Executives in a variety of different NHS organizations according to two theoretical perspectives: role theory and negotiated order. Empirical evidence addresses the views of the roles of Chairs and Chief Executives, the content of their roles and the local and national factors which influence them (including critical incidents). Conclusions are drawn about the conceptualization of this crucial relationship in the NHS and also on the association between the Chair - Chief Executive relationship and organizational effectiveness.
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Affiliation(s)
- M Exworthy
- LSE Health, LSE, Houghton Street, London WC2A 2AE, UK.
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Schofield JK, Robinson R, Reeken S, Jackson R. National Institute for Health and Care Excellence melanoma guidelines: good news for patients but challenging to implement. Br J Dermatol 2016; 174:949-50. [PMID: 27206352 DOI: 10.1111/bjd.14587] [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: 11/30/2022]
Affiliation(s)
- J K Schofield
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, U.K..
| | - R Robinson
- Harrogate and District NHS Foundation Trust, Harrogate, U.K
| | - S Reeken
- Kingston Hospital NHS Foundation Trust, London, U.K
| | - R Jackson
- Patient Member, NICE Guideline Development Group
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Robinson R, Tait CD, Somov P, Lau MW, Sangar VK, Ramani VAC, Clarke NW. Estimated glomerular filtration rate is unreliable in detecting renal function loss during follow-up after cystectomy and urinary diversion. Int Urol Nephrol 2016; 48:511-5. [DOI: 10.1007/s11255-016-1216-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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LaRiviere M, McDougal M, Wang A, Syrop S, Robinson R, Lockhart A, Nguyen D, Gutekunst C, Crocker I, Gross R. Gene Therapy for Neuroprotection and Axon Regeneration Using a RhoA-Inhibitory C3 Transferase Transgene Adeno-Associated Viral Vector in a Rodent Optic Nerve Crush Model. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lavin SR, Sullivan KE, Wooley SC, Robinson R, Singh S, Stone K, Russell S, Valdes EV. Nutrient and plant secondary compound composition and iron-binding capacity in leaves and green stems of commonly used plant browse (Carolina willow; Salix caroliniana) fed to zoo-managed browsing herbivores. Zoo Biol 2015; 34:565-75. [PMID: 26335927 DOI: 10.1002/zoo.21244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 01/08/2023]
Abstract
Plant secondary compounds are diverse structurally, and associated biological effects can vary depending on multiple factors including chemical structure and reaction conditions. Phenolic compounds such as tannins can chelate dietary iron, and supplementation of animal species sensitive to iron overload with tannins may prevent/treat iron overload disorder. We assessed the nutrient and phenolic composition and iron-binding capacity of Carolina willow (Salix caroliniana), a plant fed to zoo-managed browsing herbivores. Based on studies in other plant species and the chemical structures of phenolic compounds, we hypothesized that the concentration of condensed tannins in willow would be inversely related to the concentration of phenolic glycosides and directly related to iron-binding capacity. Our results indicated that willow nutrient composition varied by year, season, and plant part, which could be taken into consideration when formulating animal diets. We also found that the predominant plant secondary compounds were condensed tannins with minimal phenolic glycosides. Instead of binding to iron, the willow leaf extracts reduced iron from the ferric to ferrous form, which may have prooxidative effects and increase the bioavailability of iron depending on animal species, gastrointestinal conditions, and whole animal processes. We recommend identifying alternative compounds that effectively chelate iron in vitro and conducting chelation therapy trials in vivo to assess potential effects on iron balance and overall animal health.
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Affiliation(s)
- S R Lavin
- Disney's Animal Kingdom, Lake Buena Vista, Florida.,Department of Animal Sciences, University of Florida, Gainesville, Florida
| | - K E Sullivan
- Disney's Animal Kingdom, Lake Buena Vista, Florida.,Department of Animal Sciences, University of Florida, Gainesville, Florida
| | - S C Wooley
- Department of Biolog, California State University, Stanislaus, California
| | - R Robinson
- Department of Biolog, California State University, Stanislaus, California
| | - S Singh
- Department of Biolog, California State University, Stanislaus, California
| | - K Stone
- Department of Biolog, California State University, Stanislaus, California
| | - S Russell
- Department of Biolog, California State University, Stanislaus, California
| | - E V Valdes
- Disney's Animal Kingdom, Lake Buena Vista, Florida.,Department of Animal Sciences, University of Florida, Gainesville, Florida.,Department of Animal and Poultry Science, University of Guelph, Ontario, Canada.,Department of Biology, University of Central Florida, Orlando, Florida
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Hellenbach M, Brown M, Karatzias T, Robinson R. Psychological interventions for women with intellectual disabilities and forensic care needs: a systematic review of the literature. J Intellect Disabil Res 2015; 59:319-331. [PMID: 24811918 DOI: 10.1111/jir.12133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Research evidence to date concerning offending by people with intellectual disabilities (ID) has concentrated on male perpetrators and little is known about their female counterparts. This systematic literature review examines evidence on psycho-social therapies for the female intellectually disabled population within healthcare forensic facilities. METHODS A search of health, psychology and social science databases was conducted, using a varying combination of search words to detect relevant literature for this review. Four studies published between 2001 and 2012 were identified for inclusion. Articles were organised and compared in relation to study characteristics, sample, kind of treatment, instruments used to measure treatment impact, and study findings. FINDINGS In total, four studies were identified that met the inclusion criteria. A range of Cognitive Behaviour Therapy (CBT)-orientated group interventions for people with learning disabilities were evaluated and in most studies improvements were reported in relation to reducing problem behaviour. Evidence that has been generated by the studies is, however, limited in its explanatory value because of study design and related methodological issues. CONCLUSIONS This review has identified a significant gap in relation to research-based therapies for women with ID and forensic care needs. In particular, more research is needed focusing on women with a dual diagnosis of ID and psychiatric disorder who present challenging or criminal behaviour.
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Affiliation(s)
- M Hellenbach
- Faculty of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK
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Ashmore D, Gittus M, Simpson R, Page C, Robinson R. Metal on metal (mom) hip arthroplasty: Radiological evaluation of the failing prosthesis. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Trop A, Robinson R. 4 The Impact of Emergency Medicine Residents on the Operational Efficiency in a Busy Level 1 Trauma Center Emergency Department. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tacker DH, Robinson R, Perrotta PL. Abbott ARCHITECT iPhenytoin assay versus similar assays for measuring free phenytoin concentrations. Lab Med 2014; 45:176-81. [PMID: 24869001 DOI: 10.1309/lm28b9dsrjcbcwwj] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To measure free phenytoin (FP) concentrations in filtered specimens using the Abbott ARCHITECT iPhenytoin assay and to compare results from this method with results from the Abbott TDx/FLx assays. METHODS We verified accuracy, analytic measurement range, and precision for FP measurements. For correlation and therapeutic interval studies, we used filtered calibrators, controls, proficiency-testing materials, and surplus clinical samples. After implementation, we determined proficiency testing results. RESULTS The analytic measurement range was 2.0 to 25.0 micromol/L. Quality control materials (6.1, 12.6, and 20.1 micromol/L) provided mean (SD) recoveries of 96.1 (5.0%), 99.2 (5.0%), and 99.3 (5.7%), respectively, and coefficients of variation of 5.2%, 5.0%, and 5.8%, respectively. Clinical specimens produced mean (SD) FP recovery levels of 103.7 (10.6%) (bias, 0.1 [0.3] micromol/L). Altering the FP therapeutic range (4.0-8.0 micromol/L) was unnecessary. Proficiency testing yielded consistently acceptable results. CONCLUSION Our accuracy, precision, and correlation results were similar for the TDx/FLx and ARCHITECT assays, which demonstrates that the ARCHITECT iPhenytoin assay is acceptable for clinical FP measurements.
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Gold R, Giovannoni G, Selmaj K, Havrdova E, Montalban X, Radue EW, Stefoski D, Robinson R, Riester K, Rana J, Elkins J, O'Neill G. Daclizumab high-yield process in relapsing-remitting multiple sclerosis (SELECT): a randomised, double-blind, placebo-controlled trial. Lancet 2013; 381:2167-75. [PMID: 23562009 DOI: 10.1016/s0140-6736(12)62190-4] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Daclizumab, a humanised monoclonal antibody, modulates interleukin-2 signalling by blocking the α subunit (CD25) of the interleukin-2 receptor. We assessed whether daclizumab high-yield process (HYP) would be effective when given as monotherapy for a 1 year treatment period in patients with relapsing-remitting multiple sclerosis. METHODS We did a randomised, double-blind, placebo-controlled trial at 76 centres in the Czech Republic, Germany, Hungary, India, Poland, Russia, Ukraine, Turkey, and the UK between Feb 15, 2008, and May 14, 2010. Patients aged 18-55 years with relapsing-remitting multiple sclerosis were randomly assigned (1:1:1), via a central interactive voice response system, to subcutaneous injections of daclizumab HYP 150 mg or 300 mg, or placebo, every 4 weeks for 52 weeks. Patients and study personnel were masked to treatment assignment, except for the site pharmacist who prepared the study drug for injection, but had no interaction with the patient. The primary endpoint was annualised relapse rate. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00390221. FINDINGS 204 patients were assigned to receive placebo, 208 to daclizumab HYP 150 mg, and 209 to daclizumab HYP 300 mg, of whom 188 (92%), 192 (92%), and 197 (94%), respectively, completed follow-up to week 52. The annualised relapse rate was lower for patients given daclizumab HYP 150 mg (0·21, 95% CI 0·16-0·29; 54% reduction, 95% CI 33-68%; p<0·0001) or 300 mg (0·23, 0·17-0·31, 50% reduction, 28-65%; p=0·00015) than for those given placebo (0·46, 0·37-0·57). More patients were relapse free in the daclizumab HYP 150 mg (81%) and 300 mg (80%) groups than in the placebo group (64%; p<0·0001 in the 150 mg group and p=0·0003 in the 300 mg group). 12 (6%) patients in the placebo group, 15 (7%) of those in the daclizumab 150 mg group, and 19 (9%) in the 300 mg group had serious adverse events excluding multiple sclerosis relapse. One patient given daclizumab HYP 150 mg who was recovering from a serious rash died because of local complication of a psoas abscess. INTERPRETATION Subcutaneous daclizumab HYP administered every 4 weeks led to clinically important effects on multiple sclerosis disease activity during 1 year of treatment. Our findings support the potential for daclizumab HYP to offer an additional treatment option for relapsing-remitting disease. FUNDING Biogen Idec and AbbVie Biotherapeutics Inc.
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Affiliation(s)
- Ralf Gold
- St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Robinson R, Nelson C, Kisling K, Fisher G, Kirsner S. SU-E-T-334: APBI Contralateral Breast Dose. Med Phys 2013. [DOI: 10.1118/1.4814768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Menzies D, McAndrew NA, Fowles H, Robinson R, Flood-Page P. P244 Assessing Training Value and Educational Supervision in SpR Posts. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robinson R, Brujin LI. Report on The ALS Association's drug discovery workshop. Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:81-4. [DOI: 10.3109/21678421.2012.734519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vondrak R, Robinson R. Inference of high-latitude ionization and conductivity from AE-C measurements of auroral electron fluxes. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/ja090ia08p07505] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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Cole M, Nair N, Cook J, VanDyke M, Cagle S, Robinson R, Robinson Z, Ray S. Escalation and De-Escalation Plan for Carbapenem-Resistant Gram Negative Organisms in Critical Care. Am J Infect Control 2012. [DOI: 10.1016/j.ajic.2012.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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48
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Gold R, Giovannoni G, Selmaj K, Havrdova E, Montalban X, Radue EW, Stefoski D, Robinson R, Riester K, Elkins J, O'Neill G. A Randomized, Double-Blind, Placebo-Controlled Study To Evaluate the Safety and Efficacy of Daclizumab HYP Monotherapy in Relapsing-Remitting Multiple Sclerosis: Primary Results of the SELECT Trial (S01.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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49
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Peng X, Robinson R, Mease P, Douglas F, Chen Y, Kroenke K, Williams D, Wohlreich M, McCarberg B. The long term evaluation of opioids in fibromyalgia treatment. The Journal of Pain 2012. [DOI: 10.1016/j.jpain.2012.01.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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