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Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
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Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
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2
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Walters S, Trompeter A. Broken tibial nail extraction: a useful technique. Ann R Coll Surg Engl 2024. [PMID: 38445599 DOI: 10.1308/rcsann.2023.0025] [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: 03/07/2024] Open
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3
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Li CWY, Walters S, Müller JF, Orlando J, Brasseur GP. Contamination of tea leaves by anthraquinone: The atmosphere as a possible source. Ambio 2023; 52:1373-1388. [PMID: 37115429 PMCID: PMC10272057 DOI: 10.1007/s13280-023-01858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 06/16/2023]
Abstract
The detection of anthraquinone in tea leaves has raised concerns due to a potential health risk associated with this species. This led the European Union to impose a maximum residue limit (MRL) of 0.02 mg/kg for anthraquinone in dried tea leaves. As atmospheric contamination has been identified as one of the possible sources of anthraquinone residue, this study investigates the contamination resulting from the deposition of atmospheric anthraquinone using a global chemical transport model that accounts for the emission, atmospheric transport, chemical transformation, and deposition of anthraquinone on the surface. The largest contribution to the global atmospheric budget of anthraquinone is from residential combustion followed by the secondary formation from oxidation of anthracene. Simulations suggest that atmospheric anthraquinone deposition could be a substantial source of the anthraquinone found on tea leaves in several tea-producing regions, especially near highly industrialized and populated areas of southern and eastern Asia. The high level of anthraquinone deposition in these areas may result in residues in tea products exceeding the EU MRL. Additional contamination could also result from local tea production operations.
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Affiliation(s)
- Cathy W. Y. Li
- Environmental Modelling Group, Max Planck Institute for Meteorology, Bundesstrasse 53, 20146 Hamburg, Germany
| | - Stacy Walters
- Atmospheric Chemistry Observations & Modeling Lab, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307 USA
| | - Jean-François Müller
- Department “Sources and Sinks of Atmospheric Constituents”, Royal Belgian Institute for Space Aeronomy, Ringlaan 3 Avenue Circulaire, 1180 Brussels, Belgium
| | - John Orlando
- Atmospheric Chemistry Observations & Modeling Lab, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307 USA
| | - Guy P. Brasseur
- Environmental Modelling Group, Max Planck Institute for Meteorology, Bundesstrasse 53, 20146 Hamburg, Germany
- Atmospheric Chemistry Observations & Modeling Lab, National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307 USA
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4
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Tran M, Yoon S, Teoh M, Andersen S, Lam PY, Purdue BW, Raghubar A, Hanson SJ, Devitt K, Jones K, Walters S, Monkman J, Kulasinghe A, Tuong ZK, Soyer HP, Frazer IH, Nguyen Q. A robust experimental and computational analysis framework at multiple resolutions, modalities and coverages. Front Immunol 2022; 13:911873. [PMID: 35967449 PMCID: PMC9373800 DOI: 10.3389/fimmu.2022.911873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
The ability to study cancer-immune cell communication across the whole tumor section without tissue dissociation is needed, especially for cancer immunotherapy development, which requires understanding of molecular mechanisms and discovery of more druggable targets. In this work, we assembled and evaluated an integrated experimental framework and analytical process to enable genome-wide scale discovery of ligand-receptors potentially used for cellular crosstalks, followed by targeted validation. We assessed the complementarity of four different technologies: single-cell RNA sequencing and Spatial transcriptomic (measuring over >20,000 genes), RNA In Situ Hybridization (RNAscope, measuring 4-12 genes) and Opal Polaris multiplex protein staining (4-9 proteins). To utilize the multimodal data, we implemented existing methods and also developed STRISH (Spatial TRanscriptomic In Situ Hybridization), a computational method that can automatically scan across the whole tissue section for local expression of gene (e.g. RNAscope data) and/or protein markers (e.g. Polaris data) to recapitulate an interaction landscape across the whole tissue. We evaluated the approach to discover and validate cell-cell interaction in situ through in-depth analysis of two types of cancer, basal cell carcinoma and squamous cell carcinoma, which account for over 70% of cancer cases. We showed that inference of cell-cell interactions using scRNA-seq data can misdetect or detect false positive interactions. Spatial transcriptomics still suffers from misdetecting lowly expressed ligand-receptor interactions, but reduces false discovery. RNAscope and Polaris are sensitive methods for defining the location of potential ligand receptor interactions, and the STRISH program can determine the probability that local gene co-expression reflects true cell-cell interaction. We expect that the approach described here will be widely applied to discover and validate ligand receptor interaction in different types of solid cancer tumors.
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Affiliation(s)
- M. Tran
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Yoon
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - M. Teoh
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - S. Andersen
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience (IMB) Sequencing Facility, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - PY. Lam
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - B. W. Purdue
- Genome Innovation Hub, The University of Queensland, Brisbane, QLD, Australia
| | - A. Raghubar
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - SJ. Hanson
- School of Medical Science, Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - K. Devitt
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - K. Jones
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - S. Walters
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - J. Monkman
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - A. Kulasinghe
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - ZK. Tuong
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Medical Research Council (MRC)-Laboratory of Molecular Biology, Brisbane, United Kingdom
- Cellular Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - HP. Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Center, The University of Queensland, Brisbane, QLD, Australia
| | - I. H. Frazer
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Q. Nguyen
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Q. Nguyen,
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Schwantes RH, Lacey FG, Tilmes S, Emmons LK, Lauritzen PH, Walters S, Callaghan P, Zarzycki CM, Barth MC, Jo DS, Bacmeister JT, Neale RB, Vitt F, Kluzek E, Roozitalab B, Hall SR, Ullmann K, Warneke C, Peischl J, Pollack IB, Flocke F, Wolfe GM, Hanisco TF, Keutsch FN, Kaiser J, Bui TPV, Jimenez JL, Campuzano‐Jost P, Apel EC, Hornbrook RS, Hills AJ, Yuan B, Wisthaler A. Evaluating the Impact of Chemical Complexity and Horizontal Resolution on Tropospheric Ozone Over the Conterminous US With a Global Variable Resolution Chemistry Model. J Adv Model Earth Syst 2022; 14:e2021MS002889. [PMID: 35864945 PMCID: PMC9286600 DOI: 10.1029/2021ms002889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/24/2022] [Accepted: 04/24/2022] [Indexed: 05/19/2023]
Abstract
A new configuration of the Community Earth System Model (CESM)/Community Atmosphere Model with full chemistry (CAM-chem) supporting the capability of horizontal mesh refinement through the use of the spectral element (SE) dynamical core is developed and called CESM/CAM-chem-SE. Horizontal mesh refinement in CESM/CAM-chem-SE is unique and novel in that pollutants such as ozone are accurately represented at human exposure relevant scales while also directly including global feedbacks. CESM/CAM-chem-SE with mesh refinement down to ∼14 km over the conterminous US (CONUS) is the beginning of the Multi-Scale Infrastructure for Chemistry and Aerosols (MUSICAv0). Here, MUSICAv0 is evaluated and used to better understand how horizontal resolution and chemical complexity impact ozone and ozone precursors over CONUS as compared to measurements from five aircraft campaigns, which occurred in 2013. This field campaign analysis demonstrates the importance of using finer horizontal resolution to accurately simulate ozone precursors such as nitrogen oxides and carbon monoxide. In general, the impact of using more complex chemistry on ozone and other oxidation products is more pronounced when using finer horizontal resolution where a larger number of chemical regimes are resolved. Large model biases for ozone near the surface remain in the Southeast US as compared to the aircraft observations even with updated chemistry and finer horizontal resolution. This suggests a need for adding the capability of replacing sections of global emission inventories with regional inventories, increasing the vertical resolution in the planetary boundary layer, and reducing model biases in meteorological variables such as temperature and clouds.
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6
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Quinn M, Walters S, McEnhill P, Oyston M, Schiff R. 685 HOSPITAL @HOME: TREATING SEVERE COVID-19 IN THE COMMUNITY. Age Ageing 2022. [PMCID: PMC9383592 DOI: 10.1093/ageing/afac034.685] [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: 11/25/2022] Open
Abstract
Introduction Patient numbers during the second wave of COVID-19 threatened to overwhelm hospital capacity. Hospital @home services bring the ward to the patient; providing acute care in the home, delivered by a specialised multi-disciplinary team. Our Hospital @home was ideally placed to adapt to support the care of COVID patients in the community who would otherwise have required hospitalisation yet were unlikely to benefit from level 2/3 care. Here we report on the process and 30 day outcomes. Methods An evidence-based guideline for the treatment of severe COVID by Hospital @home was developed. A severe bundle pack including dexamethasone, oxygen, IV fluids and thromboprophylaxis was used at first patient contact. Patients were referred from the community or from hospital and streamed into severe or non-severe pathways. Outcome data was retrospectively extracted from the notes of all COVID positive patients admitted to hospital @home between 16/12/2020 and 14/02/2021. Results 125 COVID patients were treated by hospital @home. Patients were triaged by infection severity: severe (n = 42, 34%) and non-severe (n = 83, 66%). Average length of stay with hospital @home was 6.8 days (IQR 4–8); equivalent to 855 occupied bed days—i.e. one 28 bed ward for 30.5 days. 33 patients were treated with the severe COVID bundle with an average Clinical Frailty Score 6.9 (IQR 6–8). 30 day outcomes for patients treated with the severe bundle were: 13 (39%) alive in the community (average CFS 6.2), 1 (3%) in hospital and 19 (57%) deceased (average CFS 7.4). Conclusion Rapid redesign of an existing hospital @home service during the COVID pandemic offered appropriate patients the choice to have Level 1 hospital care in their home. Hospital @home has an essential role in offering alternative pathways of care to patients and optimising local healthcare capacity.
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Affiliation(s)
- M Quinn
- Guy's and St Thomas' NHS Foundation Trust
| | - S Walters
- Guy's and St Thomas' NHS Foundation Trust
| | - P McEnhill
- Guy's and St Thomas' NHS Foundation Trust
| | - M Oyston
- Guy's and St Thomas' NHS Foundation Trust
| | - R Schiff
- Guy's and St Thomas' NHS Foundation Trust
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7
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Hussain SA, Walters S, Ahluwalia A, Trompeter A. Diagnosis and management of arterial injuries associated with limb fracture or dislocation. Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0454] [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: 11/11/2022]
Abstract
An arterial injury is a time-critical emergency and, when associated with a fracture or dislocation, its management requires joint specialist input from orthopaedic and vascular or plastic surgeons. Initial management involves haemorrhage control and stabilisation of the patient, reduction and splinting of the limb and careful reassessment. With ongoing vascular compromise, urgent surgery is indicated to restore arterial flow and stabilise the skeleton, and this should be performed at a centre with appropriate expertise. This article provides an evidence-based review of the British Orthopaedic Association Standards for Trauma for the diagnosis and management of arterial injuries associated with extremity fractures and dislocations.
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Affiliation(s)
- SA Hussain
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - S Walters
- Department of Trauma and Orthopaedic Surgery, Croydon University Hospital, London, UK
| | - A Ahluwalia
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - A Trompeter
- Orthopaedic Trauma/Limb Reconstruction Unit, St George's University Hospital, London, UK
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8
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Raza M, Walters S, Richardson C, Bretherton C, Longhurst K, Trompeter A. Weight-bearing in Trauma Surgery (WiTS) Study: A national survey of UK Trauma & Orthopaedic multidisciplinary health professionals. Injury 2022; 53:427-433. [PMID: 34937671 DOI: 10.1016/j.injury.2021.12.019] [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: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Weight-bearing (WB) status following a fracture or surgical fixation is an important determinant of the mechanical environment for healing. In order for healthcare professionals to communicate and understand the extent of bearing weight through a limb, clear terminology must be used. There is widespread variation in the usage and definitions of WB terminology in the literature and clinical practice. This study sought to define the understanding and extent of variation across the United Kingdom. METHODS A nationwide online survey of UK-based Trauma & Orthopaedic (T&O) multidisciplinary healthcare professionals was conducted. Participants answered seven questions assessing their usage and understanding of various WB terminology. RESULTS A total of 707 responses were received: 48% by doctors, 32% by physiotherapists, 13% by occupational therapists and 7% from other healthcare professionals. In terms of understanding of WB terminology with respect to percentage body weight (BW), 89% of respondents interpret 'full WB' as 100% BW, 97% interpret 'non WB' as 0% BW, 80% interpret 'partial WB' as 50% BW, and 89% interpret 'touch/toe-touch WB' as 10% or 20% BW. There were statistically significant differences between the responses of doctors and therapists for these four terms, with doctors tending to give higher %BW values. 'Protected WB' and 'WB as tolerated' had less consensus and more variability in responses. The majority (68%) of respondents do not usually quantify terminology such as 'partial WB' with a value, and 94% agreed that standardisation of WB terminology would improve communication amongst professionals. CONCLUSION This study provides evidence of the substantial variation in the understanding of WB terminology amongst healthcare professionals, which likely results in ambiguous rehabilitation advice. Existing literature has shown that patients struggle to comply with terms such as 'partial weight-bearing'. We recommend consensus within the T&O multidisciplinary community to standardise and define common weight-bearing terminology.
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Affiliation(s)
- M Raza
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.
| | - S Walters
- Department of Trauma & Orthopaedics, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - C Richardson
- Department of Trauma & Orthopaedics, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - C Bretherton
- Department of Trauma & Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Longhurst
- Department of Physiotherapy, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Trompeter
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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9
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Quality of life outcomes following breast surgery in older women with operable breast cancer: Analysis of the Bridging the Age Gap study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30598-0] [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: 10/23/2022]
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10
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Wyld L, Reed M, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Ring A, Martin C, Shrestha A, Nettleship A, Brown M, Richards P, Todd A, Harder H, Brain K. Cluster randomised trial to evaluate the clinical benefits of decision support interventions for older women with operable breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30545-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Variation in the rates of surgical treatment of older women with operable breast cancer between UK breast units: Analysis of the Bridging the Age Gap Study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30597-9] [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: 11/25/2022]
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12
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Higgins E, Walters S, Powell E, Staffurth J. The Impact of the Acute Phase of COVID-19 on Radiotherapy Demand in South East Wales. Clin Oncol (R Coll Radiol) 2020; 32:e217. [PMID: 32487503 PMCID: PMC7250785 DOI: 10.1016/j.clon.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - E Powell
- Velindre Cancer Centre, Cardiff, UK
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Aber A, Phillips P, Hughes J, Keetharuth AD, Rooney G, Radley S, Walters S, Nawaz S, Jones G, Michaels J. Electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS): development and validity. Br J Surg 2020; 107:1004-1012. [DOI: 10.1002/bjs.11531] [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] [Received: 10/03/2019] [Revised: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022]
Abstract
Abstract
Background
This paper describes the development and validation of an electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) that captures the symptomatology, quality of life and clinically relevant data of patients presenting to vascular services.
Methods
A two-stage survey was conducted in patients attending a tertiary vascular department. Patients completed the ePAQ-VAS remotely online, or on site using an electronic tablet. In the first stage of the survey, the responses were used to perform confirmatory factor analysis to assess the construct validity and remove redundant items. The internal reliability of disease-specific scales was investigated. In the second stage of the survey, the acceptability, known-group validity, test–retest reliability, and responsiveness of ePAQ-VAS was assessed.
Results
In total, 721 patients completed ePAQ-VAS. Their mean(s.d.) age was 63·5(15·7) years and 468 (64·9 per cent) were men. Some 553 patients (76·7 per cent) completed the questionnaire in clinic and the remainder completed the questionnaire online. The results of the confirmatory factor analysis confirmed the conceptual model for ePAQ-VAS structure and eliminated six items. Internal reliability was acceptable for all the scales (Cronbach's α greater than 0·7). The test–retest reliability measured by the intraclass correlation coefficient ranged from 0·65 to 0·99. The results showed that the instrument was responsive over time with the standardized response mean ranging from 0·69 to 1·60.
Conclusion
ePAQ-VAS is a holistic data-collection process that is relevant to vascular service users and has potential to contribute to patient-focused care and the collection of aggregate data for service evaluation. A demonstration version of the final version of ePAQ can be viewed at http://demo-questionnaire.epaq.co.uk/home/project?id=VASC_1.7&page=1.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Rooney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Jones
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Neyestani SE, Walters S, Pfister G, Kooperman GJ, Saleh R. Direct Radiative Effect and Public Health Implications of Aerosol Emissions Associated with Shifting to Gasoline Direct Injection (GDI) Technologies in Light-Duty Vehicles in the United States. Environ Sci Technol 2020; 54:687-696. [PMID: 31876411 DOI: 10.1021/acs.est.9b04115] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Due to their enhanced fuel economy, the market share of gasoline direct injection (GDI) vehicles has increased significantly over the past decade. However, GDI engines emit higher levels of black carbon (BC) aerosols compared to traditional port fuel injection (PFI) engines. Here, we performed coupled chemical transport and radiative transfer simulations to estimate the aerosol-induced public health and direct radiative effects of shifting the U.S. fleet from PFI to GDI technology. By comparing simulations with current emission profiles and emission profiles modified to reflect a shift from PFI to GDI, we calculated the change in aerosol (mostly BC) concentrations associated with the fleet change. Standard concentration-response calculations indicated that the total annual deaths in the U.S. attributed to particulate gasoline-vehicle emissions would increase from 855 to 1599 due to shifting from PFI to GDI. Furthermore, the increase in BC associated with the shift would lead to an annual average positive radiative effect over the U.S. of approximately +0.075 W/m2, with values as large as +0.45 W/m2 over urban regions. On the other hand, the reduction in CO2 emissions associated with the enhanced fuel economy of GDI vehicles would yield a globally uniform negative radiative effect, estimated to be -0.013 W/m2 over a 20 year time horizon. Therefore, the climate burden of the increase in BC emissions dominates over the U.S., especially over source regions.
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Affiliation(s)
| | - Stacy Walters
- National Center for Atmospheric Research (NCAR) , Boulder , Colorado 80307 , United States
| | - Gabriele Pfister
- National Center for Atmospheric Research (NCAR) , Boulder , Colorado 80307 , United States
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15
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Gonzalez Catalan M, Lindbergh C, Staffaroni A, Walters S, Casaletto K, Walker N, Kramer J. C-24 Longitudinal Trajectories of Working Memory Performance in Typically Aging Older Adults. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.186] [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: 11/12/2022] Open
Abstract
Abstract
Objective
Cross-sectional studies have shown age-related differences in working memory (WM), but the trajectory is unclear due to the scarcity of longitudinal studies. Additional research is needed to better characterize the course of age-related changes in WM in older adults. The present study sought to address this gap in the literature by conducting serial assessments of WM in a longitudinally followed cohort of typically aging adults. We hypothesized a significant age × time interaction, such that WM would show pronounced declines with advancing age.
Methods
640 functionally intact participants in an aging cohort (clinical dementia rating = 0; age range 52-99, mean age = 75) completed a computerized WM measure, Running Letter Memory (RLM), every ~15 months for up to 8.5 years (mean follow-up = 1.9 years). Longitudinal changes in RLM scores were analyzed using linear mixed effects models, allowing for random slopes and intercepts. All models were adjusted for sex and education.
Results
RLM performance did not significantly decline over time (b = -.14, p = .43). As hypothesized, there was a significant age × time interaction predicting RLM scores (b = -.08, p = .006). Specifically, RLM performance remained relatively stable (or slightly improved) until around age 75, beyond which increasingly precipitous declines were observed with advancing age.
Conclusion
The present results suggest that WM performance does not evidence declines until the mid-70s in typically aging adults, at which point increasingly steep decline trajectories are observed with advancing age. These findings highlight that cognitive aging does not occur at a constant rate in late life.
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Walters S, Prasad A, Guevel B, Sarraf KM, Achan P, Dawson-Bowling S, Millington S, Hanna SA. Systematic review of the outcome of cemented versus uncemented total hip arthroplasty following pelvic irradiation. Musculoskelet Surg 2019; 103:221-230. [PMID: 30937859 DOI: 10.1007/s12306-019-00597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study is to evaluate the outcomes of total hip arthroplasty (THA) in patients with radiation-related changes to the bone, and specifically whether there is a difference in outcomes between cemented and uncemented acetabular components. METHODS A database search was performed to identify available studies reporting adults undergoing THA who have previously had pelvic irradiation. Data were extracted and analysed with respect to the use of cemented versus uncemented acetabular components. Statistical analysis was performed using the Chi-square test for independence. RESULTS The all-cause revision rate was 24% in the cemented THA group (27/111), compared with 15% of uncemented THAs (22/143) (p = 0.073). Revision for acetabular aseptic loosening occurred in 16% of cases (18/111) in the cemented group and 10% (15/143) in the uncemented group (p = 0.178). Acetabular aseptic loosening was reported in 24% of cemented THAs (27/111) and 14% of uncemented THAs (20/143), which was statistically significant (p = 0.035). Not all of these went on to have revision THA. The Incidence of prosthetic joint infection was similar in both groups. CONCLUSION Overall outcomes appear to be better for uncemented THAs in post-radiotherapy patients, with a significantly lower rate of aseptic loosening and an appreciable (but not statistically significant) reduction in revision rate. The best outcomes seem to be associated with the use of acetabular reinforcement across both cemented and uncemented groups, but further work is needed to evaluate this.
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Affiliation(s)
- S Walters
- Health Education England, London, UK
| | - A Prasad
- Imperial College London, London, UK
| | - B Guevel
- Health Education England, London, UK
| | - K M Sarraf
- Imperial Healthcare NHS Trust, London, UK
| | - P Achan
- Barts Health NHS Trust, London, UK
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Walters S, Cuthbert R, Karaj J, Zincraft C, Kalyaniwalla T, Tibrewal S. 33BEST PRACTICE TARIFF FOR FRAGILITY HIP FRACTURES - A COMPLETED AUDIT CYCLE IN A DISTRICT GENERAL HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Walters
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - R Cuthbert
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - J Karaj
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - C Zincraft
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - T Kalyaniwalla
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - S Tibrewal
- University Hospital Lewisham, Lewisham and Greenwich NHS Trust
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Aber A, Tong TS, Chilcott J, Thokala P, Maheswaran R, Thomas SM, Nawaz S, Walters S, Michaels J. Sex differences in national rates of repair of emergency abdominal aortic aneurysm. Br J Surg 2018; 106:82-89. [PMID: 30395361 DOI: 10.1002/bjs.11006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. METHODS Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. RESULTS In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in-hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co-morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in-hospital mortality rate after emergency repair of an intact AAA was also higher among women. CONCLUSION Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co-morbidities, the differences persist after case-mix adjustment.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - T S Tong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Maheswaran
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S M Thomas
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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19
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Casaletto KB, Elahi FM, Fitch R, Walters S, Fox E, Staffaroni AM, Bettcher BM, Zetterberg H, Karydas A, Rojas JC, Boxer AL, Kramer JH. A comparison of biofluid cytokine markers across platform technologies: Correspondence or divergence? Cytokine 2018; 111:481-489. [PMID: 29908923 PMCID: PMC6289877 DOI: 10.1016/j.cyto.2018.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/12/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Quantification of biofluid cytokines is a rapidly growing area of translational research. However, comparability across the expanding number of available assay platforms for detection of the same proteins remains to be determined. We aimed to directly compare a panel of commonly measured cytokines in plasma of typically aging adults across two high sensitivity quantification platforms, Meso Scale Discovery high performance electrochemiluminiscence (HPE) and single-molecule immunosorbent assays (Simoa) by Quanterix. METHODS 57 community-dwelling older adults completed a blood draw, neuropsychological assessment, and brain MRI as part of a healthy brain aging study. Plasma samples from the same draw dates were analyzed for IL-10, IP-10, IL-6, TNFα, and IL-1β on HPE and Simoa, separately. Reliable detectability (coefficient of variance (CV) < 20% and outliers 3 interquartiles above the median removed), intra-assay precision, absolute concentrations, reproducibility across platforms, and concurrent associations with external variables of interest (e.g., demographics, peripheral markers of vascular health, and brain health) were examined. RESULTS The proportion of cytokines reliably measured on HPE (87.7-93.0%) and Simoa (75.4-93.0%) did not differ (ps > 0.32), with the exception of IL-1β which was only reliably measured using Simoa (68.4%). On average, CVs were acceptable at <8% across both platforms. Absolute measured concentrations were higher using Simoa for IL-10, IL-6, and TNFα (ps < 0.05). HPE and Simoa shared only small-to-moderate proportions of variance with one another on the same cytokine proteins (range: r = 0.26 for IL-10 to r = 0.64 for IL-6), though platform agreement did not dependent on cytokine concentrations. Cytokine ratios within each platform demonstrated similar relative patterns of up- and down-regulation across HPE and Simoa, though still significantly differed (ps < 0.001). Supporting concurrent validity, all 95% confidence intervals of the correlations between cytokines and external variables overlapped between the two platforms. Moreover, most associations were in expected directions and consistently so across platforms (e.g., IL-6 and TNFα), though with several notable exceptions for IP-10 and IL-10. CONCLUSIONS HPE and Simoa showed comparable detectability and intra-assay precision measuring a panel of commonly examined cytokine proteins, with the exception of IL-1β which was not reliably detected on HPE. However, Simoa demonstrated overall higher concentrations and the two platforms did not show agreement when directly compared against one another. Relative cytokine ratios and associations demonstrated similar patterns across platforms. Absolute cytokine concentrations may not be directly comparable across platforms, may be analyte dependent, and interpretation may be best limited to discussion of relative associations.
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Affiliation(s)
- K B Casaletto
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States.
| | - F M Elahi
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - R Fitch
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - S Walters
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - E Fox
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - A M Staffaroni
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - B M Bettcher
- University of Colorado, Denver Anschutz Medical Center, 13001 E 17th Fl, Aurora, CO 80045, United States
| | - H Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, SE-43180 Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, SE-43180 Mölndal, Sweden; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom; UK Dementia Research Institute at UCL, London WC1N 3BG, United Kingdom
| | - A Karydas
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - J C Rojas
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - A L Boxer
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
| | - J H Kramer
- Memory and Aging Center, University of California, San Francisco, Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94158, United States
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Majano SB, Di Girolamo C, Maringe C, Walters S, Morris M, Guren M, Glimelius B, Iversen L, Schnell E, Lundqvist K, Christensen J, Coleman M, Rachet B. Treatment and Survival From Colorectal Cancer in Denmark, England, Norway, and Sweden: A Population-Based Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.52300] [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: 11/20/2022] Open
Abstract
Background: Colorectal cancer (CRC) patients in Denmark and England have historically had worse outcomes than patients diagnosed in other high-income countries with similar healthcare coverage. This survival deficit may be partly explained by differences in stage distribution due to delays in cancer diagnosis, however, differences in stage-specific survival suggest that differences in treatment also explain the survival gap. Aim: We aim to provide a comparison of stage-specific survival of CRC patients diagnosed in Denmark, England, Norway and Sweden, and compare the probability of receiving potentially curative surgery (PCS) by patient and tumor characteristics to understand whether differences in stage and treatment help explain the international differences in survival. Methods: Population-based information on patients aged 18-99 years diagnosed with primary malignant colon or rectal cancer in Denmark, England, Norway, and Sweden during 2010-2012 was extracted from national CRC registries. We compared the prevalence of PCS by stage and age category, and estimated the probability of receiving it using multivariate logistic regression. Age-standardized net survival was estimated using a multivariable modeling approach. Results: There were 13,230 patients diagnosed with CRC in Denmark, 99,869 in England, 11,754 in Norway, and 17,584 in Sweden between 2010 and 2012. The proportion of patients with missing stage information was higher in England than in the other countries. Stage distribution was otherwise similar. Survival of patients with stage I-II tumors was generally comparable between the countries, but lower in England and - to a lesser degree - in Denmark for stage III-IV disease. Patients with unknown stage had lower survival than staged patients in all countries. We found marked disadvantages in the probability of receiving PCS in older patients with stage II-IV disease in England, and stage IV colon cancer patients in Denmark. The proportion of surgically-treated rectal cancer patients (and their survival) was comparable between Denmark, Norway and Sweden for each combination of age group and stage, except for patients diagnosed with stage I disease. The proportion of patients receiving surgery and survival from rectal cancer was generally lower in England. Conclusion: Denmark seems to be catching up with Norway and Sweden, especially in rectal cancer survival. Despite recent improvements, CRC survival in England remains lower than in Sweden and Norway. Survival generally paralleled countries' relative performance in the provision of potentially curative surgery. Differences in patient selection for surgery, especially in older patients and/or with advanced disease, may partly explain the survival deficit. Increases in the proportion treated, in combination with efforts in postoperative care and with other treatment modalities, may translate into better longer-term outcomes, especially for frail patients.
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Affiliation(s)
- S. Benitez Majano
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C. Di Girolamo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C. Maringe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S. Walters
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M. Morris
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M.G. Guren
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - B. Glimelius
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - L. Iversen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E. Schnell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K. Lundqvist
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J. Christensen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M.P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - B. Rachet
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Benitez Majano S, Vansteelandt S, Di Girolamo C, Morris M, Walters S, Rachet B. Completeness of staging investigation for colorectal cancer: Exploring the role of increasing age and comorbidity using mediation analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy297.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Walters S, Cuthbert R, Karaj J, Zincraft C, Kalyaniwalla T, Tibrewal S. Best practice tariff for fragility hip fractures – A completed audit cycle in a district general hospital. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.372] [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: 11/25/2022]
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23
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Shrestha A, Martin C, Burton M, Collins K, Holmes G, Ward S, Audisio R, Chater T, Pemberton K, Robinson T, Cheung K, Ring A, Walters S, Reed M, Gath J, Green T, Revell D, Wyld L. Comparison of quality of life of older women treated with surgery or primary endocrine therapy for early breast cancer: propensity score matched analysis of a large prospective multicentre cohort study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30261-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Di Girolamo C, Walters S, Gildea C, Benitez Majano S, Coleman MP, Rachet B, Morris M. Which patients are not included in the English Cancer Waiting Times monitoring dataset, 2009-2013? Implications for use of the data in research. Br J Cancer 2018; 118:733-737. [PMID: 29348489 PMCID: PMC5846064 DOI: 10.1038/bjc.2017.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer waiting time targets are routinely monitored in England, but the Cancer Waiting Times monitoring dataset (CWT) does not include all eligible patients, introducing scope for bias. METHODS Data from adults diagnosed in England (2009-2013) with colorectal, lung, or ovarian cancer were linked from CWT to cancer registry, mortality, and Hospital Episode Statistics data. We present demographic characteristics and net survival for patients who were and were not included in CWT. RESULTS A CWT record was found for 82% of colorectal, 76% of lung, and 77% of ovarian cancer patients. Patients not recorded in CWT were more likely to be in the youngest or oldest age groups, have more comorbidities, have been diagnosed through emergency presentation, have late or missing stage, and have much poorer survival. CONCLUSIONS Researchers and policy-makers should be aware of the limitations in the completeness and representativeness of CWT, and draw conclusions with appropriate caution.
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Affiliation(s)
- C Di Girolamo
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, 40126 Bologna, Italy
| | - S Walters
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C Gildea
- National Cancer Registration and Analysis Service, Public Health England, Vulcan House Steel, 6 Millsands, Sheffield S3 8NU, UK
| | - S Benitez Majano
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M P Coleman
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - B Rachet
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Morris
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Merriott D, Chaudhuri A, Jin M, Chabon J, Newman A, Stehr H, Say C, Carter J, Walters S, Becker H, Das M, Padda S, Loo B, Wakelee H, Neal J, Alizadeh A, Diehn M. Circulating Tumor DNA Quantitation for Early Response Assessment of Immune Checkpoint Inhibitors for Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Benitez Majano S, Di Girolamo C, Morris M, Rachet B, Coleman M, Walters S. International comparison of stage-specific treatment of and survival from colorectal cancer: England, Norway and Sweden, 2010-2012. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Phillips P, Poku E, Essat M, Woods HB, Goka EA, Kaltenthaler EC, Shackley P, Walters S, Michaels JA. Systematic review of carotid artery procedures and the volume-outcome relationship in Europe. Br J Surg 2017. [PMID: 28632941 DOI: 10.1002/bjs.10593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospitals that conduct more procedures on the carotid arteries may achieve better outcomes. In the context of ongoing reconfiguration of UK vascular services, this systematic review was conducted to evaluate the relationship between the volume of carotid procedures and outcomes, including mortality and stroke. METHODS Searches of electronic databases identified studies that reported the effect of hospital or clinician volume on outcomes. Reference and citation searches were also performed. Inclusion was restricted to European populations on the basis that the model of healthcare delivery is similar across Europe, but differs from that in the USA and elsewhere. Analyses of hospital and clinician volume, and carotid endarterectomy (CEA) and carotid artery stenting (CAS) were conducted separately. RESULTS Eleven eligible studies were identified (233 411 participants), five from the UK, two from Sweden, one each from Germany, Finland and Italy, and a combined German, Austrian and Swiss population. All studies were observational. Two large studies (179 736 patients) suggested an inverse relationship between hospital volume and mortality (number needed to treat (NNT) as low as 165), and combined mortality and stroke (NNT as low as 93), following CEA. The evidence was less clear for CAS; multiple analyses in three studies did not identify convincing evidence of an association. Limited data are available on the relationship between clinician volume and outcome in CAS; in CEA, an inverse relationship was identified by two of three small studies. CONCLUSION The evidence from the largest and highest-quality studies included in this review support the centralization of CEA.
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Affiliation(s)
- P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H B Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E A Goka
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E C Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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28
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Cull G, Hall D, Fabis-Pedrini MJ, Carroll WM, Forster L, Robins F, Ghassemifar R, Crosbie C, Walters S, James I, Augustson B, Kermode AK. Lymphocyte reconstitution following autologous stem cell transplantation for progressive MS. Mult Scler J Exp Transl Clin 2017; 3:2055217317700167. [PMID: 28607754 PMCID: PMC5415040 DOI: 10.1177/2055217317700167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/10/2016] [Accepted: 02/26/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) for progressive multiple sclerosis (MS) may reset the immune repertoire. OBJECTIVE The objective of this paper is to analyse lymphocyte recovery in patients with progressive MS treated with ASCT. METHODS Patients with progressive MS not responding to conventional treatment underwent ASCT following conditioning with high-dose cyclophosphamide and antithymocyte globulin. Lymphocyte subset analysis was performed before ASCT and for two years following ASCT. Neurological function was assessed by the EDSS before ASCT and for three years post-ASCT. RESULTS CD4+ T-cells fell significantly post-transplant and did not return to baseline levels. Recent thymic emigrants and naïve T-cells fell sharply post-transplant but returned to baseline by nine months and twelve months, respectively. T-regulatory cells declined post-transplant and did not return to baseline levels. Th1 and Th2 cells did not change significantly while Th17 cells fell post-transplant but recovered to baseline by six months. Neurological function remained stable in the majority of patients. Progression-free survival was 69% at three years. CONCLUSION This study demonstrates major changes in the composition of lymphocyte subsets following ASCT for progressive MS. In particular, ablation and subsequent recovery of thymic output is consistent with the concept that ASCT can reset the immune repertoire in MS patients.
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Affiliation(s)
- G Cull
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - D Hall
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - M J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - W M Carroll
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - L Forster
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - F Robins
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - R Ghassemifar
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - C Crosbie
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - S Walters
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - I James
- Institute for Immunology and Infectious Diseases, Murdoch University, Australia
| | - B Augustson
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - A K Kermode
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
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Phillips P, Poku E, Essat M, Woods H, Goka E, Kaltenthaler E, Walters S, Shackley P, Michaels J. Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review. Eur J Vasc Endovasc Surg 2017; 53:77-88. [DOI: 10.1016/j.ejvs.2016.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/10/2016] [Indexed: 01/03/2023]
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Fosnacht AM, Patel S, Yucus C, Pham A, Rasmussen E, Frigerio R, Walters S, Maraganore D. From Brain Disease to Brain Health: Primary Prevention of Alzheimer's Disease and Related Disorders in a Health System Using an Electronic Medical Record-Based Approach. J Prev Alzheimers Dis 2017; 4:157-164. [PMID: 28856120 PMCID: PMC5573186 DOI: 10.14283/jpad.2017.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Alzheimer's disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported. OBJECTIVES We aim to primarily prevent Alzheimer's disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance. DESIGN We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention. SETTING A Community Based Health System. PARTICIPANTS In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer's disease and related disorders. MEASUREMENTS We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR. RESULTS This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients. CONCLUSION We are translating research into primary prevention of Alzheimer's disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.
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Affiliation(s)
- A M Fosnacht
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - S Patel
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - C Yucus
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - A Pham
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - E Rasmussen
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - R Frigerio
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - S Walters
- Research Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - D Maraganore
- NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, IL, USA
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Coventry T, Walters S, Kodavatiganti R, Garcia A. 133: Palliative whole brain radiotherapy in metastatic lung cancer. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30183-6] [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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Bowns IR, Newton P, Long S, Walters S, Rector A, Conway JV. Testing headings for communicating the personal health record: comparison from the recipients’ perspective. Health Informatics J 2016. [DOI: 10.1177/146045829900500402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the spring of 1998, 16 general practitioners and 16 community psychiatric nurses participated in a study to test a draft set of headings for communicating clinical summaries. Eight anonymized psychiatric discharge summaries were used to assess the impact of the presentational format on the time taken by professionals to read the summaries and to answer a series of standard questions about each of them. Respondents also completed a questionnaire on their opinions of the headings. There was considerable variation between individuals in the times taken to read the summaries and answer the questions, but no evidence that any of the formats was associated with decreased reading time or with improvement in retrieving information. Most respondents preferred information structured using the headings rather than the original semi-structured discharge summaries, and information on paper rather than on computer screen. Respondents were guardedly supportive of the particular draft headings presented. A weak preference was expressed for locally defined headings, with some recognition of advantages in widely agreed headings. There was a view that there were too many headings, and there was overlap between specific heading pairs (for example, ‘aim’ and ‘goal’). Concerns were expressed about specific headings, particularly the ‘softer’ headings, such as ‘informing’ and ‘communicating’.
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Affiliation(s)
- I. R. Bowns
- Health Policy & Management, University of Sheffield, UK,
| | - P. Newton
- Institute of General Practice and Primary Care, University of Sheffield, UK
| | - S. Long
- Institute of General Practice and Primary Care, University of Sheffield, UK
| | - S. Walters
- Sheffield Health Economics Group, School of Health and Related Research, University of Sheffield, UK
| | | | - J. V. Conway
- Old Age Psychiatry, Northern General Hospital, Sheffield, UK
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Byrne R, Garcia Alonso A, Turnbull L, Kodavatiganti R, Walters S. P-118 Histopathological diagnoses of pancreatic cancer with endoscopic ultrasound guided fine needle biopsy (EUS-FNAB). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Turkova A, Welch SB, Paton JY, Riordan A, Williams B, Patel SV, Clark JE, Bernatoniene J, Doerholt K, Child F, Walters S, Riddell A, Shingadia D, Liebeschuetz S, Kampmann B. Management of paediatric tuberculosis in leading UK centres: unveiling consensus and discrepancies. Int J Tuberc Lung Dis 2016; 18:1047-56. [PMID: 25189551 DOI: 10.5588/ijtld.14.0094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Large specialist paediatric TB clinics in the UK. OBJECTIVE To evaluate clinical practice and compare with national and international guidelines. DESIGN A survey based on an electronic questionnaire on the management of latent tuberculous infection (LTBI) and tuberculosis (TB) disease was conducted in 13 specialist paediatric TB clinics. The consensus and discrepancies were evaluated by descriptive analysis. RESULTS Practice was reportedly different when choosing age limits for preventive treatment for TB contacts with initially negative tuberculin skin tests (TSTs), interpretation of TST results and use of interferon-gamma release assays (IGRAs) in the context of LTBI. In relation to management of children with TB disease, practices varied for duration of treatment of osteoarticular TB, monitoring for ethambutol ocular toxicity and use of pyridoxine. There was limited experience with multidrug-resistant TB (MDR-TB), and over half of the clinics monitored MDR-TB contacts without giving preventive treatment. CONCLUSIONS The survey showed heterogeneity in several aspects of clinical care for children with TB. Available paediatric TB guidelines differ substantially, explaining the wide variations in management of childhood TB. Prospective paediatric studies are urgently required to inform and standardise clinical practice, especially in the context of evolving drug resistance.
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Affiliation(s)
- A Turkova
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S B Welch
- Department of Paediatrics, Heartlands Hospital, Birmingham, UK
| | - J Y Paton
- School of Medicine, University of Glasgow, Glasgow, UK
| | - A Riordan
- Department of Paediatrics, Alder Hey Children's Hospital, Liverpool, UK
| | - B Williams
- Department of Paediatrics, North West London Hospitals NHS Trust, London, UK
| | - S V Patel
- Department of Paediatric Infectious Diseases, University Hospital Southampton, Southampton, UK
| | - J E Clark
- Department of Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - J Bernatoniene
- Department of Paediatric Infectious Diseases, Bristol Children's Hospital, Bristol, UK
| | - K Doerholt
- Department of Paediatric Infectious Diseases, St George's Hospital, London, UK
| | - F Child
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - S Walters
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - A Riddell
- Department of Paediatrics, The Royal London Hospital, London, UK
| | - D Shingadia
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK
| | - S Liebeschuetz
- Department of Paediatrics, Newham University Hospital, London, UK
| | - B Kampmann
- Academic Department of Paediatrics, Imperial College London, UK
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Massalha S, Walters S, Bale C, Fuller C, Bishop J. Radiological Staging in Newly Diagnosed Breast Cancer. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Beckett P, Woolhouse I, Walters S, Benitez-Majano S, Muller P, West D, McPhail S, Broggio J, Peake MD. S72 Improving lung cancer survival in England evidenced through multiple data sources: Abstract S72 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network. DESIGN A retrospective review of the clinical outcomes of paediatric and adolescent (0-21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013. RESULTS 234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10-15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input. CONCLUSIONS Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network.
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Affiliation(s)
- Kirsty Le Doare
- St. Mary's Hospital, Imperial College NHS Trust, London, UK,Department of Paediatrics, Imperial College London, London, UK
| | - N E Mackie
- St. Mary's Hospital, Imperial College NHS Trust, London, UK
| | - S Kaye
- St. Mary's Hospital, Imperial College NHS Trust, London, UK
| | - A Bamford
- St. Mary's Hospital, Imperial College NHS Trust, London, UK,Great Ormond Street Hospital, London, UK
| | - S Walters
- St. Mary's Hospital, Imperial College NHS Trust, London, UK,Department of Paediatrics, Imperial College London, London, UK
| | - C Foster
- St. Mary's Hospital, Imperial College NHS Trust, London, UK
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Xiang N, James M, Walters S, Bamford A, Foster C. Improved serum cholesterol in paediatric patients switched from suppressive lopinavir-based therapy to boosted darunavir or atazanavir: an 18-month retrospective study. HIV Med 2015; 15:635-6. [PMID: 25334035 DOI: 10.1111/hiv.12180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Xiang
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Affiliation(s)
- S Walters
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, Bergh J, Boyages J, Christiansen P, Lee M, Wärnberg F, Allemani C, Engholm G, Fornander T, Gjerstorff ML, Johannesen TB, Lawrence G, McGahan CE, Middleton R, Steward J, Tracey E, Turner D, Richards MA, Coleman MP. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. Br J Cancer 2013; 108:1195-208. [PMID: 23449362 PMCID: PMC3619080 DOI: 10.1038/bjc.2013.6] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/11/2012] [Accepted: 12/16/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in stage at diagnosis using routine data from population-based cancer registries. METHODS We analysed the data on 257,362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis. RESULTS Age-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM stage III-IV disease compared with other countries. CONCLUSION International differences in breast cancer survival are partly explained by differences in stage at diagnosis, and partly by differences in stage-specific survival. Low overall survival arises if the stage distribution is adverse (e.g. Denmark) but stage-specific survival is normal; or if the stage distribution is typical but stage-specific survival is low (e.g. UK). International differences in staging diagnostics and stage-specific cancer therapies should be investigated.
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Affiliation(s)
- S Walters
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.
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Hirst M, Vatsavayai S, Dallerac G, Milnerwood A, Cummings D, Rezaie P, Evans K, Stramek A, Walters S, Murphy K. B05 CAG profiling in R6/1 89Q indicates early and progressive expansion in critical neuronal populations and expansion and changes in surrounding glial cell populations. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rojana-udomsart A, Needham M, Luo Y, Fabian V, Walters S, Zilko P, Mastaglia F. The association of sporadic inclusion body myositis and Sjögren's syndrome in carriers of HLA-DR3 and the 8.1 MHC ancestral haplotype. Clin Neurol Neurosurg 2011; 113:559-63. [DOI: 10.1016/j.clineuro.2011.03.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 03/13/2011] [Accepted: 03/22/2011] [Indexed: 01/28/2023]
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Eriksen J, Chow JY, Mellis V, Whipp B, Walters S, Abrahamson E, Abubakar I. Protective effect of BCG vaccination in a nursery outbreak in 2009: time to reconsider the vaccination threshold? Thorax 2010; 65:1067-71. [DOI: 10.1136/thx.2010.140186] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rojana-udomsart A, Fabian V, Luo Y, Walters S, Zilko P, Mastaglia F. P2.45 Sporadic inclusion body myositis and Sjögren’s syndrome. Neuromuscul Disord 2010. [DOI: 10.1016/j.nmd.2010.07.117] [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: 10/19/2022]
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Matthes K, Marsh DR, Garcia RR, Kinnison DE, Sassi F, Walters S. Role of the QBO in modulating the influence of the 11 year solar cycle on the atmosphere using constant forcings. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2009jd013020] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Walters S, Quaresma M, Rachet B, Forman D, Gordon E, Coleman MP. 039 Regional disparities in cancer survival following the NHS National Cancer Plan for England: an analysis by cancer network. Br J Soc Med 2010. [DOI: 10.1136/jech.2010.120956.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Calculations indicate that chlorofluoromethanes produced by man can greatly affect the concentrations of stratospheric ozone in future decades. This effect follows the release of chlorine from these compounds in the stratosphere. Present usage levels of chlorofluoromethanes can lead to chlorine-catalyzed ozone destruction rates that will exceed natural sinks of ozone by 1985 or 1990.
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Wyld L, Collins K, Winslow M, Reed M, Robinson T, Walters S, Madan J, Green T, Cocker H. 631 The views of older women regarding mammographic screening: a qualitative and quantitative study. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70651-0] [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: 10/19/2022] Open
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Dehnel P, Peitso M, Golnik A, Harvieux G, Kopski K, Broers J, Jewett T, Walters S, Coy H. Building a home. Twenty tips for creating a medical home. Minn Med 2010; 93:32-35. [PMID: 20191729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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