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Bennett KH, Khor BY, Hughes S, Patel AJ. A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis. Clin Radiol 2024; 79:413-419. [PMID: 38378386 DOI: 10.1016/j.crad.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years. MATERIALS AND METHODS A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports. RESULTS One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm2, and lesion volume ranged from 8-18,380 mm3; lesion area ranged from 1-45mm2 and lesion volume ranged from 11-17,800 mm3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis. CONCLUSIONS No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease.
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Affiliation(s)
- K H Bennett
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - B Y Khor
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - S Hughes
- Department of Nuclear Medicine and Radiology, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - A J Patel
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK; Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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2
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Spelman T, Herring WL, Acosta C, Hyde R, Jokubaitis VG, Pucci E, Lugaresi A, Laureys G, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Ozakbas S, Alroughani R, Kalincik T, Duquette P, Girard M, Petersen T, Patti F, Csepany T, Granella F, Grand'Maison F, Ferraro D, Karabudak R, Jose Sa M, Trojano M, van Pesch V, Van Wijmeersch B, Cartechini E, McCombe P, Gerlach O, Spitaleri D, Rozsa C, Hodgkinson S, Bergamaschi R, Gouider R, Soysal A, Castillo-Triviño, Prevost J, Garber J, de Gans K, Ampapa R, Simo M, Sanchez-Menoyo JL, Iuliano G, Sas A, van der Walt A, John N, Gray O, Hughes S, De Luca G, Onofrj M, Buzzard K, Skibina O, Terzi M, Slee M, Solaro C, Oreja-Guevara, Ramo-Tello C, Fragoso Y, Shaygannejad V, Moore F, Rajda C, Aguera Morales E, Butzkueven H. Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom. J Med Econ 2024; 27:109-125. [PMID: 38085684 DOI: 10.1080/13696998.2023.2293379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
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Affiliation(s)
- T Spelman
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - W L Herring
- Health Economics, RTI Health Solutions, NC, USA
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - C Acosta
- Value and Access, Biogen, Baar, Switzerland
| | - R Hyde
- Medical, Biogen, Baar, Switzerland
| | - V G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - E Pucci
- Neurology Unit, AST-Fermo, Fermo, Italy
| | - A Lugaresi
- Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - T Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Duquette
- CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | - T Petersen
- Aarhus University Hospital, Arhus C, Denmark
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Italy
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - M Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - M Trojano
- School of Medicine, University of Bari, Bari, Italy
| | - V van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Belgium
| | - B Van Wijmeersch
- University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
| | | | - P McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - O Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - C Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - S Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - R Gouider
- Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Castillo-Triviño
- Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain
| | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | - J Garber
- Westmead Hospital, Sydney, Australia
| | - K de Gans
- Groene Hart Ziekenhuis, Gouda, Netherlands
| | - R Ampapa
- Nemocnice Jihlava, Jihlava, Czech Republic
| | - M Simo
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - J L Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
- Biocruces-Bizkaia Health Research Institute, Spain
| | - G Iuliano
- Ospedali Riuniti di Salerno, Salerno, Italy
| | - A Sas
- Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
| | - A van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - N John
- Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - O Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | - S Hughes
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G De Luca
- MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - K Buzzard
- Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - O Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - M Slee
- Flinders University, Adelaide, Australia
| | - C Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitation, ML Novarese Hospital Moncrivello
| | - Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
| | - C Ramo-Tello
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Y Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - F Moore
- Department of Neurology, McGill University, Montreal, Canada
| | - C Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - E Aguera Morales
- Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Solovyeva O, Dimairo M, Weir C, de Bono J, Bedding A, Chan AW, Espinasse A, Evans T, Hee S, Hopewell S, Hughes S, Jaki T, Kightley A, Lee S, Mander A, Patel D, Rantell K, Rekowski J, Ursino M, Yap C. 79MO Developing international consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: The DEFINE (DosE FIndiNg Extensions) study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100937] [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: 04/05/2023] Open
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Olivier FAB, Hilsenstein V, Weerasinghe H, Weir A, Hughes S, Crawford S, Vince JE, Hickey MJ, Traven A. The escape of Candida albicans from macrophages is enabled by the fungal toxin candidalysin and two host cell death pathways. Cell Rep 2022; 40:111374. [PMID: 36130496 DOI: 10.1016/j.celrep.2022.111374] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
The egress of Candida hyphae from macrophages facilitates immune evasion, but it also alerts macrophages to infection and triggers inflammation. To better define the mechanisms, here we develop an imaging assay to directly and dynamically quantify hyphal escape and correlate it to macrophage responses. The assay reveals that Candida escapes by using two pore-forming proteins to permeabilize macrophage membranes: the fungal toxin candidalysin and Nlrp3 inflammasome-activated Gasdermin D. Candidalysin plays a major role in escape, with Nlrp3 and Gasdermin D-dependent and -independent contributions. The inactivation of Nlrp3 does not reduce hyphal escape, and we identify ETosis via macrophage extracellular trap formation as an additional pathway facilitating hyphal escape. Suppressing hyphal escape does not reduce fungal loads, but it does reduce inflammatory activation. Our findings explain how Candida escapes from macrophages by using three strategies: permeabilizing macrophage membranes via candidalysin and engaging two host cell death pathways, Gasdermin D-mediated pyroptosis and ETosis.
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Affiliation(s)
- Françios A B Olivier
- Infection Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800 VIC, Australia; Centre to Impact AMR, Monash University, Clayton, VIC 3800, Australia
| | | | - Harshini Weerasinghe
- Infection Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800 VIC, Australia; Centre to Impact AMR, Monash University, Clayton, VIC 3800, Australia
| | - Ashley Weir
- The Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Parkville, VIC 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sebastian Hughes
- The Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Parkville, VIC 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Simon Crawford
- Monash Ramaciotti Centre for Cryo-Electron Microscopy, Monash University, Clayton, VIC 3800, Australia
| | - James E Vince
- The Walter and Eliza Hall Institute of Medical Research, University of Melbourne, Parkville, VIC 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Michael J Hickey
- Monash Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC 3168, Australia
| | - Ana Traven
- Infection Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800 VIC, Australia; Centre to Impact AMR, Monash University, Clayton, VIC 3800, Australia.
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van Boxel J, Darraz O, van Duursen M, Lamoree M, Hughes S. P06-06 Toxicological effects of polystyrene nanoparticles on the nematode Caenorhabditis elegans: A predictive model for human toxicity of microplastics. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.324] [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: 11/17/2022]
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Counter C, Owen R, Sinha S, Muthusamy A, Drage M, Callaghan C, Elker D, Harper S, Sutherland A, Van Dellen D, Johnson P, Manas D, Shaw J, Forsythe J, Wilson C, Hughes S, Casey J, White S. O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era. Br J Surg 2022; 109:znac242.007. [PMCID: PMC9384530 DOI: 10.1093/bjs/znac242.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Methods Results Conclusion Take-home message
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Affiliation(s)
| | - R Owen
- NHSBT Pancreas Advisory Group
| | - S Sinha
- NHSBT Pancreas Advisory Group
| | | | - M Drage
- NHSBT Pancreas Advisory Group
| | | | - D Elker
- NHSBT Pancreas Advisory Group
| | | | | | | | | | - D Manas
- NHSBT Pancreas Advisory Group
| | - J Shaw
- NHSBT Pancreas Advisory Group
| | | | | | | | - J Casey
- NHSBT Pancreas Advisory Group
| | - S White
- NHSBT Pancreas Advisory Group
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7
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Ratcliffe H, Tiley KS, Andrews N, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley P, Galiza EP, Faust SN, Hughes S, Murray CS, Roderick M, Shackley F, Oddie SJ, Lees T, Turner DPJ, Raman M, Owens S, Turner P, Cockerill H, Lopez Bernal J, Linley E, Borrow R, Brown K, Ramsay ME, Voysey M, Snape MD. Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021. Arch Dis Child 2022; 108:archdischild-2022-324375. [PMID: 35858775 PMCID: PMC9887370 DOI: 10.1136/archdischild-2022-324375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER NCT04061382.
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Affiliation(s)
| | - K S Tiley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - I Vichos
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - E Morey
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - N L Douglas
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - S Marinou
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder Aley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eva P Galiza
- St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saul N Faust
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Hughes
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Clare S Murray
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Respiratory Group, University of Manchester, Manchester, UK
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fiona Shackley
- Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - Tim Lees
- Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D P J Turner
- School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Raman
- Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Turner
- Section of Paediatrics, Imperial College London, London, UK
| | - H Cockerill
- Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
| | - J Lopez Bernal
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - E Linley
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Kevin Brown
- Virus Reference Department, Public Health England, Colindale, UK
| | - Mary Elizabeth Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - M Voysey
- Department of Paediatrics, University of Oxford, Oxford, UK
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Smith E, Hegde G, Czyz M, Hughes S, Haleem S, Grainger M, James SL, Botchu R. A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know? Indian J Radiol Imaging 2022; 32:205-212. [PMID: 35924121 PMCID: PMC9340175 DOI: 10.1055/s-0042-1744162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
AbstractEn bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.
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Affiliation(s)
- E. Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - G. Hegde
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Czyz
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Hughes
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Grainger
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. L. James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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9
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McKee JD, Spence RW, Hughes S, Gray O, Campbell J, Droogan A, McDonnell GV. 094 Measuring neutralising antibodies (NAbs) to interferon-beta (IFNB) for multiple sclerosis (MS): a neglected practice? J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.419] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine frequency of testing for NAbs to IFNB in our MS population and adherence to international (EFNS) guidelines.BackgroundIFNB was the first approved MS disease modifying therapy (DMT). NAbs diminish efficacy regarding relapse rate, lesion load and disease progression.MethodsIn August 2019, the Northern Ireland (NI) DMT database was interrogated for patients currently or previously receiving IFNB. The NI Electronic Care Record and regional laboratory database were reviewed to verify if NAb testing ever undertaken, results, outcomes of positive results and reasons for treatment cessation.Results488 patients were currently on IFNB, 21.6% of the DMT population (IFNB1a intramuscularly - 210, pegylated IFNB1a - 71, IFNB1a subcutaneously - 175, IFNB1b subcutaneously - 32). Overall, 20.1% had NAbs checked (11.2% positive). Additionally, 288 patients had ceased treatment in the past 13 years, 273 having available records, 32 (11.7%) with NAb testing including 7 (21.9%) testing positive. 62/273 patients had discontinued due to relapse or disease progression - only 9 (14.5%) of these had ever had NAbs checked.ConclusionsThese data suggest that guidelines are poorly observed in this population. Improved testing could identify potential treatment failures earlier, avoiding adverse outcomes and facilitating more effective DMT decision making.jonmckee@doctors.org.uk72
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10
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Englezou C, Hayton T, Chelvarajah R, Hughes S, Sawlani V, Shirley C, McCorry D. 154 Crossed cerebellar diaschisis in refractory epilepsy. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.183] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCrossed cerebellar diaschisis is the unilateral depression in functional activity of the cerebel- lar hemisphere, caused by a controlateral supratentorial lesion. The phenomenon arises from disruption of neuronal connections between the cerebrum and the cerebellum.Case reportWe present the case of a 42 year old woman with refractory epilepsy since early childhood. Her epilepsy is characterised by focal seizures with no impairment of awareness, and bilateral tonic- clonic seizures. She is currently on triple therapy with topiramate, gabapentin, and lacosamide. Seizure frequency varies with events occurring at least twice a week. MRI brain showed left mesial sclerosis, and PET CT demonstrated marked reduction in glucose uptake in the left temporal lobe, as well as reduction in uptake in the right cerebellar hemisphere. Scalp videotelemetry captured her events and demonstrated onset from the left fronto-temporal region.DiscussionThe epileptogenic focus was localised to the left fronto-temporal region. The PET CT demon- strated the phenomenon of crossed cerebellar diaschisis. It has been said that the phenomenon shows reversibility, but it is a poor prognostic factor, and it could result in cerebellar atrophy.englezou.chr@gmail.com
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11
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Khanra D, Calvert P, Wright P, Hughes S, Mahida S, Hall M, Todd D, Gupta D, Luther V. Differentiating border-zone tissue from post-infarct scar using ripple mapping during VT ablation. Europace 2022. [DOI: 10.1093/europace/euac053.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Areas of post-infarct ventricular scar and border-zone slow conduction are often highlighted on a bipolar voltage map with generalized values 0.5mV–1.5mV. The true voltage that differentiates regions of conducting from non-conducting tissue is unknown. Ripple Mapping (RM)displays allows conducting tissue to be seen as areas supporting Ripple activation, and non-conducting tissue as areas devoid of Ripple activation.
Purpose
We describe application of Ripple Maps to differentiate areas of scar from conducting tissue during ischemic VT ablation.
Methods
Dense bipolar voltage maps were created (Pentaray catheter, pacing 80-100bpm) and presented as a single value (e.g. 0.5mV-0.5mV) to binarize the color display (red and purple). RMs were superimposed on the voltage map and played above a pre-set noise threshold (>0.05mV). The voltage map mV limit was sequentially reduced ("border-zone threshold") until only those areas devoid of Ripple bars appeared red. The surrounding border-zone supporting ripple activation thus appeared purple. We performed off-line analysis of border-zone voltage thresholds from a series of RM guided VT ablations.
Results
10 consecutive patients (LVEF 32.3±7.5%) with remote myocardial infarction underwent VT ablation (median 19days (IQR 8-33) since last VT). Bipolar voltage mapping (5873±2841 points, median shell area 224cm2), revealed voltages<0.5mV covered a median 11% (IQR 7-17%) of the shell. The border-zone voltage threshold was median 0.2mV (range 0.12mV - 0.3mV). Non-conducting tissue below this value covered only median 5% (IQR 3-7%) of the entire shell. VT was mappable in 4 patients, and the isthmus was bordered by tissue below the same border-zone threshold as found in normal rhythm. The border-zone was homogenized with ablation(40-50W, median 29 mins (IQR 22-33), and clinical VT was non-inducible in all, and 9 pts (91%) remain sustained VT-free at median 90-day follow-up (IQR 23-139), 2-weeks blanking period).
Picture 1 presents an infero-lateral LV infarct collected in an RV paced rhythm (7340points) and displayed at conventional bipolar voltage settings 0.5-1.5mV. Tissue with voltages<0.5mV appear red and cover 30% of the total area. In this case, this border-zone voltage threshold was defined as 0.25mV. Non-conducting tissue, seen as areas devoid of ripple bars below this value, now appeared as red, and covered only 11% of the total area. Picture 2 demonstrates the morphologies of 4 poorly tolerated induced VTs during this case. Each had near perfect pacemaps to the exit sites of border-zone tissue defined using this approach, and were targets for ablation resulting in complete non-inducibility and no VT recurrence in early follow-up.
Conclusion
The bipolar voltage that differentiates putative scar from bordering conducting tissue is unique to each patient, and far lower than 0.5mV-1.5mV. RM presents a practical approach to visualize the border-zone activation to guide ablation.
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Affiliation(s)
- D Khanra
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Calvert
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Mahida
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Todd
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - V Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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12
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Elumalai T, Portner R, Mariam N, Young T, Hughes S, Wickramasinghe K, Bhana R, Jayaprakash K, Sabar M, Hudson A, Hoskin P, Mistry H, Choudhury A. MO-0555 Radiotherapy for node-positive prostate cancer correlates with improved survival. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02389-1] [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: 11/30/2022]
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13
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Simpson DS, Pang J, Weir A, Kong IY, Fritsch M, Rashidi M, Cooney JP, Davidson KC, Speir M, Djajawi TM, Hughes S, Mackiewicz L, Dayton M, Anderton H, Doerflinger M, Deng Y, Huang AS, Conos SA, Tye H, Chow SH, Rahman A, Norton RS, Naderer T, Nicholson SE, Burgio G, Man SM, Groom JR, Herold MJ, Hawkins ED, Lawlor KE, Strasser A, Silke J, Pellegrini M, Kashkar H, Feltham R, Vince JE. Interferon-γ primes macrophages for pathogen ligand-induced killing via a caspase-8 and mitochondrial cell death pathway. Immunity 2022; 55:423-441.e9. [PMID: 35139355 PMCID: PMC8822620 DOI: 10.1016/j.immuni.2022.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/19/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
Cell death plays an important role during pathogen infections. Here, we report that interferon-γ (IFNγ) sensitizes macrophages to Toll-like receptor (TLR)-induced death that requires macrophage-intrinsic death ligands and caspase-8 enzymatic activity, which trigger the mitochondrial apoptotic effectors, BAX and BAK. The pro-apoptotic caspase-8 substrate BID was dispensable for BAX and BAK activation. Instead, caspase-8 reduced pro-survival BCL-2 transcription and increased inducible nitric oxide synthase (iNOS), thus facilitating BAX and BAK signaling. IFNγ-primed, TLR-induced macrophage killing required iNOS, which licensed apoptotic caspase-8 activity and reduced the BAX and BAK inhibitors, A1 and MCL-1. The deletion of iNOS or caspase-8 limited SARS-CoV-2-induced disease in mice, while caspase-8 caused lethality independent of iNOS in a model of hemophagocytic lymphohistiocytosis. These findings reveal that iNOS selectively licenses programmed cell death, which may explain how nitric oxide impacts disease severity in SARS-CoV-2 infection and other iNOS-associated inflammatory conditions.
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Affiliation(s)
- Daniel S. Simpson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jiyi Pang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia,College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Ashley Weir
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Isabella Y. Kong
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Melanie Fritsch
- Institute for Molecular Immunology, Centre for Molecular Medicine Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases, University of Cologne, Cologne, 50931, Germany
| | - Maryam Rashidi
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - James P. Cooney
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Kathryn C. Davidson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Mary Speir
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, VIC, 3168, Australia
| | - Tirta M. Djajawi
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, VIC, 3168, Australia
| | - Sebastian Hughes
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Liana Mackiewicz
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| | - Merle Dayton
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| | - Holly Anderton
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marcel Doerflinger
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Yexuan Deng
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Allan Shuai Huang
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Stephanie A. Conos
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, VIC, 3168, Australia
| | - Hazel Tye
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, VIC, 3168, Australia
| | - Seong H. Chow
- The Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia
| | - Arfatur Rahman
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Raymond S. Norton
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia,ARC Centre for Fragment-Based Design, Monash University, Parkville, VIC, 3052, Australia
| | - Thomas Naderer
- The Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia
| | - Sandra E. Nicholson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Gaetan Burgio
- Department of Immunology and Infectious Disease, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, 2601, Australia
| | - Si Ming Man
- Department of Immunology and Infectious Disease, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, 2601, Australia
| | - Joanna R. Groom
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marco J. Herold
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Edwin D. Hawkins
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Kate E. Lawlor
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Department of Molecular and Translational Science, Monash University, Clayton, VIC, 3168, Australia
| | - Andreas Strasser
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Silke
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Marc Pellegrini
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Hamid Kashkar
- Institute for Molecular Immunology, Centre for Molecular Medicine Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases, University of Cologne, Cologne, 50931, Germany
| | - Rebecca Feltham
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - James E. Vince
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia,The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia,Corresponding author
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14
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Cheon IS, Li C, Son YM, Goplen NP, Wu Y, Cassmann T, Wang Z, Wei X, Tang J, Li Y, Marlow H, Hughes S, Hammel L, Cox TM, Goddery E, Ayasoufi K, Weiskopf D, Boonyaratanakornkit J, Dong H, Li H, Chakraborty R, Johnson AJ, Edell E, Taylor JJ, Kaplan MH, Sette A, Bartholmai BJ, Kern R, Vassallo R, Sun J. Immune signatures underlying post-acute COVID-19 lung sequelae. Sci Immunol 2021; 6:eabk1741. [PMID: 34591653 DOI: 10.1126/sciimmunol.abk1741] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- I S Cheon
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - C Li
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y M Son
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - N P Goplen
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Wu
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - T Cassmann
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Z Wang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - X Wei
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - J Tang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - H Marlow
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - S Hughes
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - L Hammel
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - T M Cox
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - E Goddery
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - K Ayasoufi
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - D Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - J Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - H Dong
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - H Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - R Chakraborty
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - A J Johnson
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - E Edell
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - J J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - M H Kaplan
- Department of Microbiology and Immunology, Indiana University of School of Medicine, Indianapolis, IN 46202, USA
| | - A Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA.,Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - B J Bartholmai
- Department of Radiology, Mayo Clinic, Rochester, MN 5590, USA
| | - R Kern
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R Vassallo
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - J Sun
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.,Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.,Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA.,Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
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15
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Hughes S, Andracchio L, Fredkin K. 62: Patients’ greatest needs: A qualitative survey analysis of care team perspectives on greatest needs of patients. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01487-9] [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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16
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Dowd C, Lomas P, Harris E, Hughes S, Riley M. 65: Care center local collaborations: A survey analysis of care center perspectives on current relationships. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01490-9] [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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17
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Amarnani R, Hughes S, Morris-Jones R, Kanwar AJ, Bunker CB. Persistent facial discoid dermatosis successfully treated with topical calcipotriol. Clin Exp Dermatol 2021; 47:229-231. [PMID: 34648653 DOI: 10.1111/ced.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- R Amarnani
- Department of, Dermatology, University College London Hospital NHS Foundation Trust, London, UK
| | - S Hughes
- Department of, Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - R Morris-Jones
- Department of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C B Bunker
- Department of, Dermatology, University College London Hospital NHS Foundation Trust, London, UK
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18
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Choudri MJ, Tahir M, Haleem S, Hughes S. 1091 Assessment of Cauda Equina Syndrome Referrals to The Tertiary Spinal Service for Compliance with National Standards. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Urgent assessment/investigation and appropriate referral of Cauda Equina Syndrome (CES) is important in preventing morbidity and avoiding litigation. A recent GIRFT review outlined a series of guidelines on the management of patients with suspected CES. This audit aimed to assess whether CES referrals to a tertiary spinal service are compliant with GIRFT recommendations and SBNS/BASS guidelines.
Method
Retrospective review of an electronic referral system at a tertiary spinal centre over 4 months, examining CES referrals from surrounding peripheral hospitals. General Practice referrals were excluded. Data collected included patient demographics, symptoms/examination findings, timing of MRI and outcomes of the referral.
Results
A total of 48 referrals were included for analysis, mean age was 46.7 and 64% were female. 27% had no ‘red' or ‘yellow' flag signs/symptoms and were inappropriately referred. Majority did not perform pre/post void bladder scans prior to referring. 58% of all referrals were made without an MRI. 22% of those referred within ‘working hours’ were referred without MRI scan. There were significant variations in time taken to perform MRI at the referring hospital; median delay 11.1 hours (3-21hrs).
Conclusions
SBNS/BASS standards are currently not being met, which may adversely impact patient outcomes. Cost implications of patients being transferred to tertiary spinal centres who are found to have no abnormality, must be balanced against the cost of missed CES. This audit highlights the need for improvement in the quality of referrals through education and training at the referring centres.
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Affiliation(s)
- M J Choudri
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M Tahir
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S Haleem
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S Hughes
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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19
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Lithgow K, Venkataraman H, Hughes S, Shah H, Kemp-Blake J, Vickrage S, Smith S, Humphries S, Elshafie M, Taniere P, Diaz-Cano S, Dasari BVM, Almond M, Ford S, Ayuk J, Shetty S, Shah T, Geh I. Well-differentiated gastroenteropancreatic G3 NET: findings from a large single centre cohort. Sci Rep 2021; 11:17947. [PMID: 34504148 PMCID: PMC8429701 DOI: 10.1038/s41598-021-97247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
Neuroendocrine neoplasms are known to have heterogeneous biological behavior. G3 neuroendocrine tumours (NET G3) are characterized by well-differentiated morphology and Ki67 > 20%. The prognosis of this disease is understood to be intermediate between NET G2 and neuroendocrine carcinoma (NEC). Clinical management of NET G3 is challenging due to limited data to inform treatment strategies. We describe clinical characteristics, treatment, and outcomes in a large single centre cohort of patients with gastroenteropancreatic NET G3. Data was reviewed from 26 cases managed at Queen Elizabeth Hospital, Birmingham, UK, from 2012 to 2019. Most commonly the site of the primary tumour was unknown and majority of cases with identifiable primaries originated in the GI tract. Majority of cases demonstrated somatostatin receptor avidity. Median Ki67 was 30%, and most cases had stage IV disease at diagnosis. Treatment options included surgery, somatostatin analogs (SSA), and chemotherapy with either platinum-based or temozolomide-based regimens. Estimated progression free survival was 4 months following initiation of SSA and 3 months following initiation of chemotherapy. Disease control was observed following treatment in 5/11 patients treated with chemotherapy. Estimated median survival was 19 months; estimated 1 year survival was 60% and estimated 2 year survival was 13%. NET G3 is a heterogeneous group of tumours and patients which commonly have advanced disease at presentation. Prognosis is typically poor, though select cases may respond to treatment with SSA and/or chemotherapy. Further study is needed to compare efficacy of different treatment strategies for this disease.
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Affiliation(s)
- K Lithgow
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
| | - H Venkataraman
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Hughes
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Kemp-Blake
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Vickrage
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Smith
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Humphries
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Elshafie
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Taniere
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Diaz-Cano
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B V M Dasari
- Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Almond
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ford
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Ayuk
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Shetty
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Geh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mcgaffin S, Taggart M, Smyth D, O"doherty D, Brown J, Teague S, Slevin C, Montgomery L, Coll M, Lindsay C, Crumley B, Gibson L, Elliott H, Hughes S, Connolly S. Transitioning a cardiovascular health and rehabilitation programme to a virtual platform during covid 19. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Our Hearts Our Minds
Purpose
Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme.
Background
The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme
Methods
Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided)
Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL
Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate
Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs
Bimonthly virtual coaching consultation for monitoring/goal resetting
Bimonthly group video education sessions
Results
From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below.
The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face.
Conclusion
Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service.
Table 1 below exhibits the clinical and patient-reported outcomes.
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Affiliation(s)
- S Mcgaffin
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - M Taggart
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D Smyth
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D O"doherty
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - J Brown
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Teague
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - C Slevin
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - L Montgomery
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - M Coll
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - C Lindsay
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - B Crumley
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - L Gibson
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - H Elliott
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Connolly
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
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21
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Jinadu T, Dowd R, Bradley L, Painter E, Hughes S, Ahmad S, Khan N, Khanra D, Arya A, Selvakumar V, Spencer C, Petkar S. Observations during the COVID-19 pandemic in chronic heart failure patients with complex devices in a tertiary care cardiac centre using the HeartLogic software. Europace 2021. [PMCID: PMC8194883 DOI: 10.1093/europace/euab116.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Decompensation of heart failure leading (HF) to hospitalisation is the single most important drain on healthcare resources when managing patients with left ventricular systolic dysfunction. Cardiac resynchronisation therapy with/without defibrillators (CRT-P/D) decreases hospitalisation due to HF and improves survival while implantable cardiac defibrillators (ICD"s) have a favourable effect on the former. Proprietary software algorithms embedded in these complex devices give an early warning to clinicians when decompensation of HF is imminent allowing preventative action to be undertaken. HeartLogic (HL) is one such new algorithm in Boston Scientific CRT-D/ICD devices using multiple sensors to track 5 physiological parameters, combining them into one composite Index, with an Alert being triggered if the Index is >16. The COVID-19 pandemic, due to multiple reasons, resulted in a significant decrease in availability of routine HF services in the United Kingdom, especially during the initial lockdown period from 23rd March to 1st July 2020. Aim To assess the impact of the COVID-19 pandemic, using HL, in patients with HF and complex devices. Materials and Methods Retrospective analysis of patients in a tertiary care cardiac centre in whom the HL software had been activated in March/April 2019 (n = 49) and comparison of those with (Group A n = 21) and without (Group B n = 28) an Alert (HLA) during the COVID-19 pandemic. Results (Table): Whole cohort n = 49. Age: 72 ± 12 years, Median: 75, Range: 36-95. 36/49 (73.5%) males. Type of device implanted: Resonate X4 CRT-D: 28/49 (57.1%); Momentum CRT-D: 8/49 (16.3%); Resonate ICD: 13/49 (26.5%). Ischaemic aetiology of HF: 35/49 (71.4%), Total duration of HL monitoring: 632 ± 7 days (median: 632; range: 626-672). There was no difference in the age, gender, and type of device implanted between Group A and Group B. Over nearly ∼1 year of monitoring in each of the groups, Group A had more unstable HF with 10/21 (47.6%) having their first HLA during the pandemic. Multiple HLA"s, longer period in HLA and those with ischaemic aetiology of HF were higher in Group A. 17/40 (42.5%) HLA"s in Group A were within the first lockdown period (March - July). 24/28 (85.7%) patients in Group B had no HLA"s either before or during the pandemic. There was no difference in the HLA score between Groups A and B. Conclusion In this limited group of patients with a medium term follow-up, using the HeartLogic software, patients with ischaemic aetiology of HF and those with more HLA"s prior to the pandemic did worse than those who no HLA"s. First HLA"s, multiple alerts and longer duration of alerts in this group of patients suggests a lack of access to adequate HF services during the pandemic. It has implications with regard to how HF services are configured in future whenever resources are constrained.
Abstract Figure. ![]()
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Affiliation(s)
- T Jinadu
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - R Dowd
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - L Bradley
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - E Painter
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Ahmad
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - N Khan
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - D Khanra
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - A Arya
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - V Selvakumar
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - C Spencer
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Petkar
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
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22
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Garner D, Leung WY, Llewellyn J, Goode R, Lunt L, Hughes S, Kahn M, Wright DJ, Rao A. CIED guided HF management : a prospective cohort study. Europace 2021. [DOI: 10.1093/europace/euab116.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group
Background
Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2)
Aim
To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams.
Methods
We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback.
Results
365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had >3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy.
Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive.
Conclusions
An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.
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Affiliation(s)
- D Garner
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - WY Leung
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Goode
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Lunt
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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23
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Marlin D, Martin H, Hughes S, Williams J. Stirrup forces during approach, take-off and landing in horses jumping 70 cm. Comparative Exercise Physiology 2021. [DOI: 10.3920/cep200056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stirrups aid the rider to stabilise their lower leg allowing it to be used effectively for communication and in maintaining their position in the saddle. Relatively few studies have investigated stirrup forces and to the best our knowledge no studies have reported stirrup forces in jumping. The aim of the present study was to measure stirrup forces in five showjumping horses ridden by the same professional rider. All horses were in regular training and competition jumping at least 30 cm higher than the fence used for the study. The fence chosen was a 70 cm upright with a pole at the top and a groundline. Right and left stirrup forces were measured using wireless load cells placed between the stirrup leathers and the stirrup. The signals were transmitted and digitised at 100 Hz and synchronised with video from a webcam using an inertial measurement unit. After warming-up, including over jumps, each horse attempted the jump three times from each rein in canter (3 horses left then right rein; 2 horses right then left rein). Mean peak total (sum of left and right) stirrup force for the approach (n=5 strides per horse per jump), take-off and landing phase of the jump was 1,034±110, 1,042±284 and 1,447±256 N (range 905 to 1,815 N), respectively (mean ± standard deviation). There was no significant difference between right or left mean peak stirrup force during approach or take-off, but mean peak force was consistently higher on the right stirrup during the early phase of landing on either the right or left rein (right: 827±320 N; left: 615±336 N; P<0.05). In conclusion, the mean total peak stirrup forces measured in the present study in the same rider jumping five different horses over a 70 cm single upright fence are similar to previous reports of peak stirrup forces in gallop and consistent with observations of asymmetric loading of the saddle and horses’ backs by riders.
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Affiliation(s)
- D.J. Marlin
- AnimalWeb Ltd, Cambridge, CB4 0WZ, United Kingdom
| | - H.P. Martin
- Higher Durston, Taunton, TA3 5AG, United Kingdom
| | - S. Hughes
- Wilby, Wellingborough, Northants, NN8 2UQ, United Kingdom
| | - J.M. Williams
- Department of Animal Science, Hartpury University, Hartpury, Gloucestershire, Gl19 3BE, United Kingdom
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Sumner RC, Crone DM, Hughes S, James DVB. Arts on prescription: observed changes in anxiety, depression, and well-being across referral cycles. Public Health 2021; 192:49-55. [PMID: 33631514 DOI: 10.1016/j.puhe.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/07/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Arts on prescription (AoP) interventions are part of mainstream social prescribing provision in primary health care. Whilst the body of evidence for AoP interventions has been developing, this has primarily focused on well-being. STUDY DESIGN The present work is an observational longitudinal study on a community-based AoP social prescribing intervention in the South West UK. METHOD The present study assessed changes in anxiety, depression, and well-being in a cohort of patients participating in up to two eight-week cycles of AoP. The sample consisted of 245 individuals referred into the programme from 2017 to 2019, with a sub-sample of participants (N = 110) with identifiable multimorbidity. Outcomes were measured pre- and post-intervention at both initial and re-referral. RESULTS Anxiety, depression, and well-being were all significantly improved after initial referral, re-referral, and overall from initial to post re-referral for this intervention in the whole sample and multimorbid sub-sample. Multivariate analyses revealed that no participant variables appeared to account for the variance in outcome change scores. CONCLUSION The research provides further support for AoP interventions, finding associations with reduced anxiety and depression and increased well-being. Additionally, these outcomes are evidenced in those with multimorbidity, as well as across initial- and re-referral cycles.
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Affiliation(s)
- R C Sumner
- HERA Lab, School of Natural and Social Sciences, University of Gloucesterhire, Cheltenham, UK.
| | - D M Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - S Hughes
- HERA Lab, School of Natural and Social Sciences, University of Gloucesterhire, Cheltenham, UK
| | - D V B James
- School of Sport and Exercise Science, University of Gloucestershire, Gloucester, UK
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25
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Quarterman C, Shaw M, Hughes S, Wallace V, Agarwal S. Anaemia in cardiac surgery - a retrospective review of a centre's experience with a pre-operative intravenous iron clinic. Anaesthesia 2020; 76:629-638. [PMID: 33150612 DOI: 10.1111/anae.15271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Pre-operative anaemia is associated with higher rates of transfusion and worse outcomes, including prolonged hospital stay, morbidity and mortality. Iron deficiency is associated with significantly lower haemoglobin levels throughout the peri-operative period and more frequent blood transfusion. Correction of iron stores before surgery forms part of the first pillar of patient blood management. We established a pre-operative anaemia clinic to aid identification and treatment of patients with iron deficiency anaemia scheduled for elective cardiac surgery. We present a retrospective observational review of our experience from January 2017 to December 2019. One-hundred and ninety patients received treatment with intravenous iron, a median of 21 days before cardiac surgery. Of these, 179 had a formal laboratory haemoglobin level measured before surgery, demonstrating a median rise in haemoglobin of 8.0 g.l-1 . Patients treated with i.v. iron demonstrated a significantly higher incidence of transfusion (60%) compared with the non-anaemic cohort (22%) during the same time period, p < 0.001. Significantly higher rates of new requirement for renal replacement therapy (6.7% vs. 0.6%, p < 0.001) and of stroke (3.7% vs. 1.2%, p = 0.010) were also seen in this group compared with those without anaemia, although there was no significant difference in in-hospital mortality (1.6% vs. 0.8%, p = 0.230). In patients where the presenting haemoglobin was less than 130 g.l-1 , but there was no intervention or treatment, there was no difference in rates of transfusion or of complications compared with the anaemic group treated with iron. In patients with proven iron deficiency anaemia, supplementation with intravenous iron showed only a modest effect on haemoglobin and this group still had a significantly higher transfusion requirement than the non-anaemic cohort. Supplementation with intravenous iron did not improve outcomes compared with patients with anaemia who did not receive intravenous iron and did not reduce peri-operative risk to non-anaemic levels. Questions remain regarding identification of patients who will receive most benefit, the use of concomitant treatment with other agents, and the optimum time frames for treatment in order to produce benefit in the real-world setting.
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Affiliation(s)
- C Quarterman
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, UK
| | - M Shaw
- Liverpool Heart and Chest Hospital, UK
| | - S Hughes
- Liverpool Heart and Chest Hospital, UK
| | - V Wallace
- Liverpool Heart and Chest Hospital, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University NHS Foundation Trust, UK
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26
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Weir A, Hughes S, Rashidi M, Hildebrand JM, Vince JE. Necroptotic movers and shakers: cell types, inflammatory drivers and diseases. Curr Opin Immunol 2020; 68:83-97. [PMID: 33160107 DOI: 10.1016/j.coi.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
The necroptotic cell death pathway has received significant attention for its ability to trigger inflammatory responses and its potential involvement in related conditions. Recent insights into the essential membrane damaging necroptotic pseudokinase effector, Mixed lineage kinase domain like (MLKL), have revealed a number of diverse MLKL functions that contribute to the inflammatory nature of necroptosis. Here we review distinct MLKL signalling roles and document the immunogenic molecules released by necroptosis. We discuss specific in vivo MLKL-driven responses, the activation of inflammasome complexes and innate lymphoid cells, which have been documented to drive disease. Finally, we list necroptotic competent cell types and their involvement in MLKL-driven cell death-associated and inflammatory-associated conditions.
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Affiliation(s)
- Ashley Weir
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Sebastian Hughes
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Maryam Rashidi
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Joanne M Hildebrand
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - James E Vince
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; The Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.
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Ortega Franco A, Tay R, Raja H, Ackermann C, Carter M, Lindsay C, Hughes S, Cove-Smith L, Taylor P, Summers Y, Blackhall F, Califano R. 108P Pembrolizumab in pre-treated advanced non-small cell lung cancer (NSCLC) patients (pts): Impact of blood-based biomarkers on survival outcomes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.229] [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] Open
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28
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Niazi T, Williams S, Davis I, Stockler M, Martin A, Bracken K, Roncolato F, McJannett M, Horvath L, Sengupta S, Hughes S, McDermott R, Catto J, Kelly P, Vapiwala N, Parulekar W, Morgan S, Rendon R, Sweeney C. 694TiP DASL-HiCaP: Darolutamide augments standard therapy for localised very high-risk cancer of the prostate (ANZUP1801). A randomised phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 2020; 26:1395-1399. [PMID: 32603803 PMCID: PMC7320692 DOI: 10.1016/j.cmi.2020.06.025] [Citation(s) in RCA: 399] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Objectives To investigate the incidence of bacterial and fungal coinfection of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study across two London hospitals during the first UK wave of coronavirus disease 2019 (COVID-19). Methods A retrospective case series of hospitalized patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (20 February–20 April 2020; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza-positive patients admitted during the 2019–2020 flu season. Patient demographics, microbiology and clinical outcomes were analysed. Results A total of 836 patients with confirmed SARS-CoV-2 were included; 27 (3.2%) of 836 had early confirmed bacterial isolates identified (0–5 days after admission), rising to 51 (6.1%) of 836 throughout admission. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens and respiratory viral PCR panels were obtained from 643 (77%), 110 (13%), 249 (30%), 246 (29%) and 250 (30%) COVID-19 patients, respectively. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteraemia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteraemia was identified in six patients (three Candida, two Enterococcus spp. and one Pseudomonas aeruginosa). All other community-acquired bacteraemias (n = 16) were attributed to nonrespiratory infection. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Comparable rates of positive coinfection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141; 1.4%), respiratory cultures (10/38; 26.3%) and pneumococcal-positive antigens (1/19; 5.3%) were low. Conclusions We found a low frequency of bacterial coinfection in early COVID-19 hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.
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Affiliation(s)
- S Hughes
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK.
| | - O Troise
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK
| | - H Donaldson
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - N Mughal
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - L S P Moore
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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Finnegan T, Murray CF, Hughes S, Maski K. 1165 Online CME-Certified Case Challenges Improve Competence for the Diagnosis and Management of Pediatric Narcolepsy Among Pediatricians. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Narcolepsy is a chronic neurologic sleep disorder that typically starts in childhood. Symptoms of narcolepsy in pediatric patients can differ from adult onset narcolepsy and few treatment options are approved for pediatric narcolepsy. Given the challenges of recognizing the condition in children and selecting an appropriate therapeutic intervention, we investigated whether a case-based educational activity was able to improve the competence of pediatricians to accurately diagnose and manage narcolepsy.
Methods
An online, text-based educational intervention comprised of 2 patient case scenarios was developed. Using a “test and teach” approach, clinicians were presented with multiple-choice questions to evaluate their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to teach. Educational effect was evaluated with a repeated-pairs pre- to post-assessment study design in which each individual learner acts as his/her own control. A chi-square test was utilized to identify whether proportions of correct answers at pre and post were significantly different. Cramer’s V was used to calculate the effect size of the intervention. Data were collected between April 20, 2019 and September 17, 2019.
Results
The education resulted in an extensive educational effect for pediatricians (n=125; V =.424). Significant improvements were observed in several topics (P <.05 for all comparisons) including: the use of hypocretin cerebrospinal fluid testing as a diagnostic tool for patients with symptoms suggestive of type 1 narcolepsy; appropriate guidance to transition patients with type 1 narcolepsy from one therapeutic regimen to another; and therapeutic selection for a patient with type 2 narcolepsy. Overall, participation in the education resulted in 34% of pediatricians reporting increased confidence in diagnosing and managing sleep disorders in children.
Conclusion
This study demonstrated the success of a targeted, online, interactive, case-based educational intervention on improving awareness among pediatricians regarding the diagnosis and management of narcolepsy. The results indicated that pediatricians would benefit from continued education on the care of patients with narcolepsy.
Support
Support for this program came from an unrestricted educational grant from Jazz Pharmaceuticals, Inc.
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Affiliation(s)
| | | | - S Hughes
- Medscape Education, New York, NY
| | - K Maski
- Boston Children’s Hospital, Boston, MA
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Rajput J, Moore LSP, Mughal N, Hughes S. Evaluating the risk of hyperkalaemia and acute kidney injury with cotrimoxazole: a retrospective observational study. Clin Microbiol Infect 2020; 26:1651-1657. [PMID: 32220637 DOI: 10.1016/j.cmi.2020.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 02/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Increasing antimicrobial resistance has renewed interest in older, less used antimicrobials. Cotrimoxazole shows promise; however, hyperkalaemia and acute kidney injury (AKI) are potential complications. Identifying risk factors for and quantification of these events is required for safe use. This study aimed to evaluate predictors of cotrimoxazole-associated AKI and hyperkalaemia in a clinical setting. METHODS Patients prescribed cotrimoxazole were identified using electronic healthcare records over 3 years (1 April 2016 to 31 March 2019). Individual risk factors were recognized. Serum creatinine and potassium trends were analysed over the subsequent 21 days. AKI and patients with hyperkalaemia were classified using Kidney Disease Improving Global Outcomes (KDIGO) and laboratory criteria. Univariate and multiple logistic regression analyses were performed. RESULTS Among 214 patients prescribed cotrimoxazole, 42 (19.6%, 95% confidence interval (CI) 14.6-25.7) met AKI criteria and 33 (15.4%, 95% CI 11.0-21.1) developed hyperkalaemia. Low baseline estimated glomerular filtration rate (<60 mL/min/1.73 m2, odds ratio (OR) 7.78, 95% CI 3.57-16.13, p < 0.0001) and cardiac disorders (OR 2.40, 95% CI 1.17-4.82, p 0.011) predicted AKI, while low baseline estimated glomerular filtration rate (<60 mL/min/1.73 m2, OR 6.80, 95% CI 3.09-15.06, p < 0.0001) and higher baseline serum potassium (p 0.001) predicted hyperkalaemia. Low-dose cotrimoxazole (<1920 mg/d) was associated with lower AKI and hyperkalaemia risk (p 0.007 and 0.019 respectively). Early (within the first 2-4 days of therapy) serum creatinine changes predicted AKI (OR 3.65, 95% CI 1.73-7.41, p 0.001), and early serum potassium changes predicted hyperkalaemia (>0.6 mmol/L, OR 2.47, 95% CI 1.14-5.27, p 0.0236). CONCLUSIONS Cotrimoxazole-associated AKI and hyperkalaemia is frequent and dose dependent. Renal function, serum potassium and preexisting cardiac disorders should be evaluated before prescribing cotrimoxazole. Serum creatinine and potassium monitoring within first 2 to 4 days of treatment to identify susceptible patients is recommended, and the lowest effective dose ought to be prescribed.
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Affiliation(s)
- J Rajput
- Imperial College London, South Kensington Campus, London, England, UK
| | - L S P Moore
- Imperial College London, South Kensington Campus, London, England, UK; Chelsea and Westminster NHS Foundation Trust, London, England, UK; North West London Pathology, Imperial College Healthcare NHS Trust, London, England, UK
| | - N Mughal
- Imperial College London, South Kensington Campus, London, England, UK; Chelsea and Westminster NHS Foundation Trust, London, England, UK; North West London Pathology, Imperial College Healthcare NHS Trust, London, England, UK
| | - S Hughes
- Chelsea and Westminster NHS Foundation Trust, London, England, UK.
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Moss C, Haire A, Cahill F, Enting D, Hughes S, Smith D, Sawyer E, Davies A, Zylstra J, Haire K, Rigg A, Van Hemelrijck M. Guy's cancer cohort - real world evidence for cancer pathways. BMC Cancer 2020; 20:187. [PMID: 32178645 PMCID: PMC7077127 DOI: 10.1186/s12885-020-6667-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background The burden of disease due to cancer remains substantial. Since the value of real-world evidence has also been recognised by regulatory agencies, we established a Research Ethics Committee (REC) approved research database for cancer patients (Reference: 18/NW/0297). Construction and content Guy’s Cancer Cohort introduces the concept of opt-out consent processes for research in a subset of oncology patients diagnosed and treated at a large NHS Trust in the UK. From April 2016 until March 2017, 1388 eligible patients visited Guy’s and St Thomas’ NHS Foundation Trust (GSTT) for breast cancer management. For urological cancers this number was 1757 and for lung cancer 677. The Cohort consists of a large repository of routinely collected clinical data recorded both retrospectively and prospectively. The database contains detailed clinical information collected at various timepoints across the treatment pathway inclusive of diagnostic data, and data on disease progression, recurrence and survival. Conclusions Guy’s Cancer Cohort provides a valuable infrastructure to answer a wide variety of research questions of a clinical, mechanistic, and supportive care nature. Clinical research using this database will result in improved patient safety and experience. Guy’s Cancer Cohort promotes collaborative research and will accept applications for the release of anonymised datasets for research purposes.
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Affiliation(s)
- C Moss
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.
| | - A Haire
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - F Cahill
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - D Enting
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Hughes
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Smith
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Sawyer
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Davies
- Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Zylstra
- Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Haire
- South East London (SEL) Accountable Cancer Network, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rigg
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
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Abstract
BACKGROUND Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries. METHODS PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers. RESULTS Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles. CONCLUSIONS This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.
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Affiliation(s)
- D Fearon
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
- Cairdeas International Palliative Care Trust, Nouakchott, Mauritania.
| | - S Hughes
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - S G Brearley
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Beech A, Faivre-Finn C, Bayman N, Blackhall F, Califano R, Chan C, Cobben D, Coote J, Cove-Smith L, Harris M, Hughes S, Martimarti F, Pemberton L, Salem A, Summers Y, Taylor P, Wang X, Woolf D, Sheikh H. Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) ± chemotherapy (CTRT): audit of the first UK departmental guideline. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30113-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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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Finnegan T, Murray C, Hughes S, Roth T. Online medical education improves knowledge of physiologic mechanisms of sleep among neurologists and primary care clinicians. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Patro S, Niyongabo A, Guo S, Wu X, Boritz E, Deeks S, Maldarelli F, Hughes S, Coffin J, Kearney M. HIV proviruses with identical sequences arise from cell expansion and infection by a common ancestor virus. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30140-0] [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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Bale M, Katusiime M, Wells D, Wu X, Coffin J, Cotton M, Hughes S, Mellors J, Van Zyl G, Kearney M. Long-term persistence of HIV-infected cell clones in early treated children. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30146-1] [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: 10/23/2022] Open
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Simpson C, Roscoe D, Hughes S, Hulse D, Guthrie H. Surgical outcomes for chronic exertional compartment syndrome following improved diagnostic criteria. BMJ Mil Health 2019; 166:e17-e20. [PMID: 30992340 DOI: 10.1136/jramc-2019-001171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic exertional compartment syndrome (CECS) presents with pain during exercise, most commonly within the anterior compartment of the lower limb. A diagnosis is classically made from a typical history and the measurement of intramuscular compartmental pressure (IMCP) testing. Improved, more specific diagnostic criteria for IMCP testing allow clinicians to now be more certain of a diagnosis of CECS. Outcomes following surgical treatment in patients diagnosed using these more robust criteria are unknown. METHODS All patients undergoing fasciectomy for anterior compartment CECS at a single rehabilitation unit were identified between 2014 and 2017. Wilcoxen signed-rank test was used to compare military fitness grading and paired t-test was used to compare Foot and Ankle Ability Measure, FAAM Sport Specific and Exercise-Induced LimbPain-G outcome measures, presurgery and postsurgery. RESULTS There was a significant difference in fitness grading between presurgical and postsurgical intervention (Z = -2.68, p < 0.01) with 46 % of patients improving their occupational medical grading. All secondary measures of outcome, looking at clinical symptoms, also improved. CONCLUSION Almost half of the patients undergoing fasciectomy, following diagnosis using more specific criteria, will have an improvement in occupational medical grading. These outcomes represent the lower end of those reported in civilian populations. This is likely a result of a combination of factors, most notably the different diagnostic criteria followed and the more stringent criteria applied to military occupational grading, compared with civilian practice. Further work is now required to evaluate the impact of differing rehabilitation regimes on postoperative patients identified through this more specific diagnostic testing.
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Affiliation(s)
- Christopher Simpson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
| | - D Roscoe
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
| | - S Hughes
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
| | - D Hulse
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
| | - H Guthrie
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
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Udintsev V, Danani S, Taylor G, Giacomin T, Guirao J, Pak S, Hughes S, Worth L, Vayakis G, Walsh M, Schneider M, Pandya H, Kumar R, Kumar V, Jha S, Thomas S, Padasalagi SB, Kumar S, Phillips PE, Rowan WL, Austin M, Khodak A, Feder R, Neilson H, Basile A, Hubbard AE, Saxena A, Nazare C, Maquet P, Gimbert N. Progress in ITER ECE Diagnostic Design and Integration. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201920303003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The ITER Electron Cyclotron Emission (ECE) diagnostic is progressing towards its Preliminary Design Review (PDR). In parallel, the diagnostic integration in the Equatorial Port is ongoing. Port Integration has to address the structural integrity to withstand various loads, maintenance and the safety aspects of ECE diagnostic. The ITER ECE system includes radial and oblique lines-of-sight. Recently, a successful peer-review of the in-port plug Hot Calibration Source has taken place and its performance and integration feasibility has been demonstrated. Four 45-meter long low-loss transmission lines are designed to transmit mm-wave power in the frequency range of 70- 1000 GHz in both X- and O-mode polarization from the port plug to the ECE instrumentation room in the diagnostic building. Prototype transmission lines are being tested [1]. A prototype polarizing Martin-Puplett type Fourier Transform Spectrometer (FTS) operating in the frequency range 70-1000 GHz, has a fast scanning mechanism and a cryo-cooled dual-channel THz detector system. Its performance has been tested as per ITER requirements. Assessment of the instrumentation and control requirements, functional and non-functional requirements, operation procedures, plant automation are ongoing for the PDR. The current status of the diagnostic, together with integration activities, is presented.
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Young T, Vaughan G, Enting D, Hughes S, Khan S, Thurairaja R. Clinical Outcomes of Patients with Squamous Cell Carcinoma of the Bladder Compared with Urothelial Carcinoma with Extensive or Focal Squamous Differentiation after Radical Treatment. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.024] [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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Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker IS. The FACE-Q Skin Cancer Module addresses post-resection aesthetic and quality of life outcomes: reply from authors. Br J Dermatol 2018; 180:954. [PMID: 30561004 DOI: 10.1111/bjd.17526] [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)
- T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | | | - S Hughes
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, U.K
| | - H A Hutchings
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker I. Patient-reported outcome measures for facial skin cancer: a systematic review and evaluation of the quality of their measurement properties. Br J Dermatol 2018; 180:1018-1029. [PMID: 30362522 DOI: 10.1111/bjd.17342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Skin cancer is the commonest malignancy worldwide, often occurring on the face. Both the condition and treatment can lead to scarring and facial disfigurement, affecting a patient's health-related quality of life (HRQoL), which can be measured using patient-reported outcome measures (PROMs). OBJECTIVES This systematic review identifies PROMs for facial skin cancer and appraises their methodological quality and psychometric properties using up-to-date methods. METHODS MEDLINE, Embase, PsycINFO, Cochrane and CINAHL were searched systematically in accordance with PRISMA guidelines, identifying all PROMs designed for or validated in facial skin cancer. Methodological quality and evidence of psychometric properties were assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist and criteria proposed by Terwee and colleagues. A best-evidence synthesis and assessment of instrument focus on post-resection reconstruction was also performed. RESULTS We included 24 studies on 11 PROMs. Methodological quality and psychometric evidence was variable, with the Patient Outcome of Surgery - Head/Neck (POS-H/N), Skin Cancer Index (SCI), Skin Cancer Quality of Life Impact Tool (SCQOLIT) and Essers and colleagues demonstrating the greatest level of validation. None scored well in their relevance to post-skin cancer reconstruction of the face. CONCLUSIONS This systematic review critically appraises PROMs for facial skin cancer using internationally accepted criteria. The identified PROMs demonstrate a variation in the quality of validation performed, with a need to improve this across all PROMs in the field. Only through improving the quality of available PROMs and their focus on the post-treatment aesthetic and functional outcome will we be able to truly appreciate the concerns of our patients and improve the management of facial skin cancer.
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Affiliation(s)
- T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | | | - S Hughes
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, U.K
| | - H A Hutchings
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K
| | - I Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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Bricheux A, Lenggenhager L, Hughes S, Karmime A, Lescuyer P, Huttner A. Therapeutic drug monitoring of imipenem and the incidence of toxicity and failure in hospitalized patients: a retrospective cohort study. Clin Microbiol Infect 2018; 25:383.e1-383.e4. [PMID: 30528370 DOI: 10.1016/j.cmi.2018.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Therapeutic drug monitoring (TDM) of beta-lactam antibiotics is increasingly employed to ensure adequate antibiotic exposure and slow emergence of resistance. Imipenem's therapeutic range has not been defined; we report plasma concentrations and clinical outcomes of patients receiving imipenem for bacterial infections. METHODS All hospitalized adult patients undergoing imipenem TDM during therapy for suspected or confirmed bacterial infections between 1 January 2013 and 28 February 2017 were included in this single-centre retrospective cohort. The primary outcome was incidence of clinical toxicity; secondary outcomes included incidence of clinical failure and median imipenem concentrations in those with and without toxicity and/or failure. Total imipenem concentrations were measured via high-performance liquid chromatography with ultraviolet detection. RESULTS A total of 403 imipenem levels were drawn from 300 patients. Fifteen (5%) patients experienced an adverse event considered at least possibly related to imipenem. Eighty-eight (29%) patients had clinical failure; augmented renal clearance appeared to emerge as a protective factor against failure (OR 0.42; 95% CI 0.20-0.89). Median first-measure trough concentration was 3.2 mg/L (IQR 1.7-6.5). Patients with suspected toxicity did not have higher concentrations. Patients whose dose was not increased after a trough level <2 mg/L was returned trended towards increased clinical failure (3/28 (11%) vs. 12/63 (19%)), though the difference was not statistically significant. CONCLUSIONS Toxicity was rare and clinical failure frequent in this cohort of patients whose imipenem concentrations were generally low and occasionally undetectable. Larger trials are needed to define optimal imipenem exposure.
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Affiliation(s)
- A Bricheux
- Geneva University Faculty of Medicine, Geneva, Switzerland
| | - L Lenggenhager
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S Hughes
- Toxicology and Therapeutic Drug Monitoring Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - A Karmime
- Toxicology and Therapeutic Drug Monitoring Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - P Lescuyer
- Toxicology and Therapeutic Drug Monitoring Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - A Huttner
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Steinman LE, Haynes P, Denison PE, Hughes S, Weisner SE. SUPPORTING APPLICANTS FOR THE ACL/AOA EVIDENCE-BASED REVIEW PROCESS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3155] [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: 11/14/2022] Open
Affiliation(s)
- L E Steinman
- Health Promotion Research Center, University of Washington, Seattle, Washington, United States
| | - P Haynes
- Elder Care Services, Partnership for Healthy Aging, MaineHealth, Portland, ME, USA; Evidence-Based Leadership Council, Los Angeles, CA, USA
| | - P E Denison
- Project Enhance, Sound Generations, Seattle, WA, USA; Evidence-Based Leadership Council, Los Angeles, CA, USA
| | - S Hughes
- Center for Research on Health and Aging, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA; Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA; Evidence-Based Leadership Council, Los Angeles, CA, USA
| | - S E Weisner
- Specialist in Healthy Aging & Community Programming, Raleigh, NC, USA; Evidence-Based Leadership Council, Los Angeles, CA, USA
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Hughes S. CENTER FOR RESEARCH ON HEALTH AND AGING AT THE UNIVERSITY OF ILLINOIS AT CHICAGO. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1286] [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: 11/14/2022] Open
Affiliation(s)
- S Hughes
- University of Illinois, Chicago, Chicago, Illinois, United States
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Blagden S, Bertelli G, Frangou E, Butcher C, Love S, Mackean M, Glasspool R, Cook A, Nicum S, Lord R, Ferguson M, Roux R, Martinez M, Black S, James A, Palmer H, Hughes S, Marriott C, Howells L. OVPSYCH2: A randomised study of psychological support versus standard of care following chemotherapy for ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.149] [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: 11/14/2022] Open
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Anderson A, Verrill K, Hughes S, Harenwall S, Howells L. Enhancing Quality of Life Through an Innovative, Multidisciplinary Model of Supportive Cancer Care and Rehabilitation. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.57600] [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: 11/20/2022] Open
Abstract
Background: Advancements in diagnosis and cancer treatment mean survival rates have improved but as a consequence many people are living with the adverse physical effects of complex treatments, financial hardship, work and relationship stress, and fear of recurrence. Person-centered, holistic care is required to help people maximize all aspects of their quality of life when living with and beyond their cancer, but debate continues around which models are economically sustainable and effective in achieving the desired outcomes. Maggie's ( www.maggiescentres.org ) is an innovative, multidisciplinary model of holistic supportive cancer care, widely regarded as an exemplar of best practice in cancer rehabilitation and supported self-management. In 2017 Maggie's received 249,247 visits across the network of centres in the UK, Hong Kong and Tokyo. The Maggie's program is designed to incorporate evidence based psychoeducation techniques delivered by multidisciplinary oncology professionals; offer personalised and understandable treatment and lifestyle information; and maximize the opportunity for social-support. Outcome evaluation is embedded within the model of care. Aim: To illustrate the holistic Maggie's model using outcome data from “Managing Stress” and “Living with and after Prostate Cancer (LWAPC)” courses to provide examples of the impact Maggie´s makes in enhancing quality of life. Methods: A subset of participants in “Managing Stress” and “Living with and after Prostate Cancer” courses across the network of UK Maggie´s Centres completed pre and post course standardized questionnaires. Results: Participants in “Managing Stress” found significant improvements in overall psychological well-being and quality of life (QoL) (t(40)=3.28, P = .002) and significant improvements in their ability to tolerate uncertainty (t(47) = 3.23, P = .002). Participants in the LWAPC found significant improvements in overall prostate cancer specific QoL ( t(37)=3.603, P = .001), general well-being ( t(37)=2.61, P = .013), and emotional well-being ( t(37)=2.62, P = .013). Also, significant reductions were found in overall negative appraisal of life (t(52)=2.96, P = .005), overall health worries (t(52) 2.28, P = 0.27), worries about the future (t(52) = 2.85, P = .006) and uncertainty (t(52) = 3.89, P < .001). Conclusion: Globally, the supportive care needs of people affected by cancer are changing but the Maggie's model of care offers valuable lessons that can be generalized across varied support settings to meet these emerging needs.
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Kantor M, Eiseler S, Schiller A, Hughes S, Liu X, Lai J. Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review. Clin Res Hepatol Gastroenterol 2018; 42:e72-e76. [PMID: 29625925 DOI: 10.1016/j.clinre.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 02/04/2023]
Abstract
Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.
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Affiliation(s)
- M Kantor
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States.
| | - S Eiseler
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States
| | - A Schiller
- Department of Pathology, Kendall Regional Medical Center, Miami, FL, United States
| | - S Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - X Liu
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
| | - J Lai
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
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Harris M, Wilson JC, Hughes S, Knevel RJM, Radford DR. Perceived stress and well-being in UK and Australian dental hygiene and dental therapy students. Eur J Dent Educ 2018; 22:e602-e611. [PMID: 29696731 DOI: 10.1038/bdjteam.2017.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/04/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION This study aimed to explore United Kingdom (UK) and Australian (Aus) dental hygiene and dental therapy students' (DHDTS) perception of stress and well-being during their undergraduate education. Upon qualification, DHDTS in the UK register as dental therapists (DT), and in Australia, they register as Oral Health Therapists (OHT). MATERIALS AND METHODS A questionnaire was distributed to years 1, 2 and 3 DHDTS at the University of Portsmouth Dental Academy (UPDA) in the UK and La Trobe Rural Health School in Australia. The questionnaire consisted of 5 well-used measurement instruments which included the following: Dental Environment Stress questionnaire (DES); Depression Anxiety Stress Scales (DASS-21); Scales of Psychological Well-Being (SPWB); Valuing Questionnaire (VQ); and the Adult Hope Scale (AHS) to collect data on students' perception of levels of stress and well-being. RESULTS A response rate of 58% (UK) and 55% (Australia) was achieved. Clinical factors and academic work were perceived as stressful for DHDTS in both the UK and Australia. The Australian DHDTS-perceived stress in the educational environment was significantly higher (P < .002) than the UK DHDTS. The majority of respondents reported levels of depression, anxiety and stress to be within the normal-to-moderate range. All students reported high levels of positive well-being, with no significant differences between the 2 groups. CONCLUSIONS DHDTS in the UK and Australia identified sources of stress within their undergraduate education, but also perceived themselves as positively functioning individuals.
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Affiliation(s)
- M Harris
- University of Portsmouth Dental Academy, Portsmouth, UK
| | - J C Wilson
- Applied Psychology, University of Portsmouth, Portsmouth, UK
| | - S Hughes
- Clinical and Restorative Dental Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - R J M Knevel
- Department of Dentistry and Oral Health, La Trobe Rural Health School, Bendigo, VIC, Australia
| | - D R Radford
- Integrated Dental Education and Multi-Professional Care, King's College London Dental Institute and the University of Portsmouth Dental Academy, London, UK
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Damy T, Maurer MS, Heitner SB, Drachman BM, Whela CJ, Judge DP, Guthrie S, Tai LJ, Hughes S, Monia BP, Ackermann E, Benson MD. P685Hereditary transthyretin amyloidosis is associated with significant disease burden: analysis of the baseline characteristics of patients from the phase 3 study NEURO-TTR. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Damy
- National Referral Center for Cardiac Amyloidosis, Cardiology, Creteil, France
| | - M S Maurer
- Columbia University Medical Center, New York, United States of America
| | - S B Heitner
- Oregon Health & Science University, Portland, United States of America
| | - B M Drachman
- University of Pennsylvania, Philadelphia, United States of America
| | - C J Whela
- University College London, National Amyloidosis Center, London, United Kingdom
| | - D P Judge
- Medical University of South Carolina, Charleston, United States of America
| | - S Guthrie
- Independant Consultant, San Francisco, United States of America
| | - L J Tai
- Ionis Pharmaceuticals, Carlsbad, United States of America
| | - S Hughes
- Ionis Pharmaceuticals, Carlsbad, United States of America
| | - B P Monia
- Ionis Pharmaceuticals, Carlsbad, United States of America
| | - E Ackermann
- Ionis Pharmaceuticals, Carlsbad, United States of America
| | - M D Benson
- Ionis Pharmaceuticals, Carlsbad, United States of America
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