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Fostervold A, Raffelsberger N, Hetland MAK, Bakksjø R, Bernhoff E, Samuelsen Ø, Sundsfjord A, Afset JE, Berntsen CF, Bævre-Jensen R, Ebbesen MH, Gammelsrud KW, Guleng AD, Handal N, Jakovljev A, Johal SK, Marvik Å, Natvik A, Sandnes RA, Tofteland S, Bjørnholt JV, Löhr IH. Risk of death in Klebsiella pneumoniae bloodstream infections is associated with specific phylogenetic lineages. J Infect 2024; 88:106155. [PMID: 38574775 DOI: 10.1016/j.jinf.2024.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Klebsiella pneumoniae species complex (KpSC) bloodstream infections (BSIs) are associated with considerable morbidity and mortality, particularly in elderly and multimorbid patients. Multidrug-resistant (MDR) strains have been associated with poorer outcome. However, the clinical impact of KpSC phylogenetic lineages on BSI outcome is unclear. METHODS In an 18-month nationwide Norwegian prospective study of KpSC BSI episodes in adults, we used whole-genome sequencing to describe the molecular epidemiology of KpSC, and multivariable Cox regression analysis including clinical data to determine adjusted hazard ratios (aHR) for death associated with specific genomic lineages. FINDINGS We included 1078 BSI episodes and 1082 bacterial isolates from 1055 patients. The overall 30-day case-fatality rate (CFR) was 12.5%. Median patient age was 73.4, 61.7% of patients were male. Median Charlson comorbidity score was 3. Klebsiella pneumoniae sensu stricto (Kp) (79.3%, n = 858/1082) and K. variicola (15.7%, n = 170/1082) were the dominating phylogroups. Global MDR-associated Kp clonal groups (CGs) were prevalent (25.0%, n = 270/1082) but 78.9% (n = 213/270) were not MDR, and 53.7% (n = 145/270) were community acquired. The major findings were increased risk for death within 30 days in monomicrobial BSIs caused by K. variicola (CFR 16.9%, n = 21; aHR 1.86, CI 1.10-3.17, p = 0.02), and global MDR-associated Kp CGs (CFR 17.0%, n = 36; aHR 1.52, CI 0.98-2.38, p = 0.06) compared to Kp CGs not associated with MDR (CFR 10.1%, n = 46). CONCLUSION Bacterial traits, beyond antimicrobial resistance, have a major impact on the clinical outcome of KpSC BSIs. The global spread of MDR-associated Kp CGs is driven by other mechanisms than antibiotic selection alone. Further insights into virulence determinants, and their association with phylogenetic lineages are needed to better understand the epidemiology of KpSC infection and clinical outcome.
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Affiliation(s)
- Aasmund Fostervold
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway.
| | - Niclas Raffelsberger
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway; Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit A K Hetland
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway; Department of Biological Sciences, Faculty of Mathematics and Natural Sciences, University of Bergen, Bergen, Norway
| | - Ragna Bakksjø
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Eva Bernhoff
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Ørjan Samuelsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway; Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Arnfinn Sundsfjord
- Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Jan E Afset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Microbiology, St. Olav's Hospital, Trondheim University hospital, Trondheim, Norway
| | - Christopher F Berntsen
- Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Roar Bævre-Jensen
- Department of Medical Microbiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Marit H Ebbesen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Karianne W Gammelsrud
- Department of Microbiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anja D Guleng
- Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Nina Handal
- Department of Microbiology and Infection control, Akershus University Hospital, Lørenskog, Norway
| | - Aleksandra Jakovljev
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Microbiology, St. Olav's Hospital, Trondheim University hospital, Trondheim, Norway
| | - Simreen K Johal
- Department of Medical Microbiology, Nordland Hospital Trust, Bodø, Norway
| | - Åshild Marvik
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ane Natvik
- Department of Medical Microbiology, Vestre Viken Hospital Trust, Bærum, Norway
| | - Rolf-Arne Sandnes
- Department of Medical Microbiology, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ståle Tofteland
- Department of Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Jørgen V Bjørnholt
- Department of Microbiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Iren H Löhr
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
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Jansen SJ, Broer SDL, Hemels MAC, Visser DH, Antonius TAJ, Heijting IE, Bergman KA, Termote JUM, Hütten MC, van der Sluijs JPF, d'Haens EJ, Kornelisse RF, Lopriore E, Bekker V. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect 2024; 144:20-27. [PMID: 38103692 DOI: 10.1016/j.jhin.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. AIM To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). METHODS Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. RESULTS A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CONCLUSIONS CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
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Affiliation(s)
- S J Jansen
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
| | - S D L Broer
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - M A C Hemels
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - D H Visser
- Emma Children's Hospital, Department of Paediatrics, Division of Neonatology, Amsterdam University Medical Centre (AUMC), Location AMC, Amsterdam, The Netherlands
| | - T A J Antonius
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - I E Heijting
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - K A Bergman
- Beatrix Children's Hospital, Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - J U M Termote
- Wilhelmina Children's Hospital, Department of Neonatology, Division of Mother and Child, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - M C Hütten
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - J P F van der Sluijs
- Department Paediatrics, Division of Neonatology, Máxima Medical Centre (MMC), Veldhoven, The Netherlands
| | - E J d'Haens
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - R F Kornelisse
- Erasmus MC - Sophia Children's Hospital, Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E Lopriore
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - V Bekker
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
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3
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Tran-Gia J, Denis-Bacelar AM, Ferreira KM, Robinson AP, Bobin C, Bonney LM, Calvert N, Collins SM, Fenwick AJ, Finocchiaro D, Fioroni F, Giannopoulou K, Grassi E, Heetun W, Jewitt SJ, Kotzasarlidou M, Ljungberg M, Lourenço V, McGowan DR, Mewburn-Crook J, Sabot B, Scuffham J, Sjögreen Gleisner K, Solc J, Thiam C, Tipping J, Wevrett J, Lassmann M. On the use of solid 133Ba sources as surrogate for liquid 131I in SPECT/CT calibration: a European multi-centre evaluation. EJNMMI Phys 2023; 10:73. [PMID: 37993667 PMCID: PMC10665282 DOI: 10.1186/s40658-023-00582-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/25/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Commissioning, calibration, and quality control procedures for nuclear medicine imaging systems are typically performed using hollow containers filled with radionuclide solutions. This leads to multiple sources of uncertainty, many of which can be overcome by using traceable, sealed, long-lived surrogate sources containing a radionuclide of comparable energies and emission probabilities. This study presents the results of a quantitative SPECT/CT imaging comparison exercise performed within the MRTDosimetry consortium to assess the feasibility of using 133Ba as a surrogate for 131I imaging. MATERIALS AND METHODS Two sets of four traceable 133Ba sources were produced at two National Metrology Institutes and encapsulated in 3D-printed cylinders (volume range 1.68-107.4 mL). Corresponding hollow cylinders to be filled with liquid 131I and a mounting baseplate for repeatable positioning within a Jaszczak phantom were also produced. A quantitative SPECT/CT imaging comparison exercise was conducted between seven members of the consortium (eight SPECT/CT systems from two major vendors) based on a standardised protocol. Each site had to perform three measurements with the two sets of 133Ba sources and liquid 131I. RESULTS As anticipated, the 131I pseudo-image calibration factors (cps/MBq) were higher than those for 133Ba for all reconstructions and systems. A site-specific cross-calibration reduced the performance differences between both radionuclides with respect to a cross-calibration based on the ratio of emission probabilities from a median of 12-1.5%. The site-specific cross-calibration method also showed agreement between 133Ba and 131I for all cylinder volumes, which highlights the potential use of 133Ba sources to calculate recovery coefficients for partial volume correction. CONCLUSION This comparison exercise demonstrated that traceable solid 133Ba sources can be used as surrogate for liquid 131I imaging. The use of solid surrogate sources could solve the radiation protection problem inherent in the preparation of phantoms with 131I liquid activity solutions as well as reduce the measurement uncertainties in the activity. This is particularly relevant for stability measurements, which have to be carried out at regular intervals.
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Affiliation(s)
- Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | | | | | | | - Christophe Bobin
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Lara M Bonney
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Calvert
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester, UK
| | - Sean M Collins
- National Physical Laboratory, Hampton Road, Teddington, UK
- School of Mathematics and Physics, University of Surrey, Guildford, UK
| | | | - Domenico Finocchiaro
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Federica Fioroni
- Medical Physics Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | | | - Elisa Grassi
- Medical Physics Unit, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Warda Heetun
- National Physical Laboratory, Hampton Road, Teddington, UK
| | - Stephanie J Jewitt
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria Kotzasarlidou
- Nuclear Medicine Department, "THEAGENIO" Anticancer Hospital, Thessaloniki, Greece
| | | | - Valérie Lourenço
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Daniel R McGowan
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Benoit Sabot
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - James Scuffham
- Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Jaroslav Solc
- Czech Metrology Institute, Okruzni 31, 638 00, Brno, Czech Republic
| | - Cheick Thiam
- Université Paris-Saclay, CEA, List, Laboratoire National Henri Becquerel (LNE-LNHB), 91120, Palaiseau, France
| | - Jill Tipping
- Department of Medical Physics and Clinical Engineering, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jill Wevrett
- Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Walker Z, Bartley G, Hague C, Kelly D, Navarro C, Rogers J, South C, Temple S, Whitehurst P, Chuter R. Evaluating the Effectiveness of Deep Learning Contouring across Multiple Radiotherapy Centres. Phys Imaging Radiat Oncol 2022; 24:121-128. [PMID: 36405563 PMCID: PMC9668733 DOI: 10.1016/j.phro.2022.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Received: 01/25/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background and purpose Deep learning contouring (DLC) has the potential to decrease contouring time and variability of organ contours. This work evaluates the effectiveness of DLC for prostate and head and neck across four radiotherapy centres using a commercial system. Materials and methods Computed tomography scans of 123 prostate and 310 head and neck patients were evaluated. Besides one head and neck model, generic DLC models were used. Contouring time using centres' existing clinical methods and contour editing time after DLC were compared. Timing was evaluated using paired and non-paired studies. Commercial software or in-house scripts assessed dice similarity coefficient (DSC) and distance to agreement (DTA). One centre assessed head and neck inter-observer variability. Results The mean contouring time saved for prostate structures using DLC compared to the existing clinical method was 5.9 ± 3.5 min. The best agreement was shown for the femoral heads (median DSC 0.92 ± 0.03, median DTA 1.5 ± 0.3 mm) and the worst for the rectum (median DSC 0.68 ± 0.04, median DTA 4.6 ± 0.6 mm). The mean contouring time saved for head and neck structures using DLC was 16.2 ± 8.6 min. For one centre there was no DLC time-saving compared to an atlas-based method. DLC contours reduced inter-observer variability compared to manual contours for the brainstem, left parotid gland and left submandibular gland. Conclusions Generic prostate and head and neck DLC models can provide time-savings which can be assessed with paired or non-paired studies to integrate with clinical workload. Reducing inter-observer variability potential has been shown.
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Affiliation(s)
- Zoe Walker
- Medical Physics, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Gary Bartley
- Medical Physics, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Christina Hague
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Daniel Kelly
- Physics Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK
| | - Clara Navarro
- Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Jane Rogers
- Medical Physics, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Christopher South
- Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Simon Temple
- Physics Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Robert Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Knowlson C, Dean A, Doherty L, Fairhurst C, Brealey S, Torgerson DJ. Recruitment patterns in multicentre randomised trials fit more closely to Price's Law than the Pareto Principle: A review of trials funded and published by the United Kingdom Health Technology Assessment Programme. Contemp Clin Trials 2021; 113:106665. [PMID: 34968767 DOI: 10.1016/j.cct.2021.106665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This review investigates whether the distribution of recruitment to multicentre randomised controlled trials (RCTs) fits the "Pareto Principle", i.e. 80% of participants are recruited by 20% of sites, or Price's Law, i.e. 50% of participants are recruited by the square root of the total number of sites. METHODS A review of HTA reports published between 2017 and 2019. RESULTS 40 RCTs conducted face-to-face recruitment, five recruited via mail-outs and one used both methods. For face-to-face recruitment (n = 41 studies), 80% of participants were recruited by the top recruiting 42.6% of sites; for mail-out methods (n = 6 studies) this was 52.0%. From the square root of sites, 51.3% and 31.8% of participants were recruited for the two recruitment approaches, respectively. Specifically, 3 (7.3%, 95% CI 2.5% to 19.4%) and 20 (48.8%, 95% CI 34.3% to 63.5%) RCTs followed Pareto Principle and Price's Law, respectively. One mail-out recruitment study followed one of these principles, Price's Law. Chief Investigator (CI) sites (n = 24) in face-to-face recruitment studies recruited 18.1% of participants. CONCLUSION Face-to-face recruitment to HTA-funded RCTs fits more closely to Price's Law than the Pareto Principle, with the CI's site recruiting nearly a fifth of participants. Since we focussed on HTA-funded RCTs with ≥9 recruiting sites and for which the recruitment method and number recruited by site were known, our findings are limited in their generalizability. However, this trend could be used as a guide to aid in estimating how many sites RCTs need. More accurate estimation may prevent the need for recruitment extensions.
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Affiliation(s)
- Catherine Knowlson
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK.
| | - Alexandra Dean
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Laura Doherty
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
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Oliveira C, Amstutz F, Vuong D, Bogowicz M, Hüllner M, Foerster R, Basler L, Schröder C, Eboulet EI, Pless M, Thierstein S, Peters S, Hillinger S, Tanadini-Lang S, Guckenberger M. Preselection of robust radiomic features does not improve outcome modelling in non-small cell lung cancer based on clinical routine FDG-PET imaging. EJNMMI Res 2021; 11:79. [PMID: 34417899 PMCID: PMC8380219 DOI: 10.1186/s13550-021-00809-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/08/2021] [Indexed: 12/25/2022] Open
Abstract
Background Radiomics is a promising tool for identifying imaging-based biomarkers. Radiomics-based models are often trained on single-institution datasets; however, multi-centre imaging datasets are preferred for external generalizability owing to the influence of inter-institutional scanning differences and acquisition settings. The study aim was to determine the value of preselection of robust radiomic features in routine clinical positron emission tomography (PET) images to predict clinical outcomes in locally advanced non-small cell lung cancer (NSCLC). Methods A total of 1404 primary tumour radiomic features were extracted from pre-treatment [18F]fluorodeoxyglucose (FDG)-PET scans of stage IIIA/N2 or IIIB NSCLC patients using a training cohort (n = 79; prospective Swiss multi-centre randomized phase III trial SAKK 16/00; 16 centres) and an internal validation cohort (n = 31; single centre). Robustness studies investigating delineation variation, attenuation correction and motion were performed (intraclass correlation coefficient threshold > 0.9). Two 12-/24-month event-free survival (EFS) and overall survival (OS) logistic regression models were trained using standardized imaging: (1) with robust features alone and (2) with all available features. Models were then validated using fivefold cross-validation, and validation on a separate single-centre dataset. Model performance was assessed using area under the receiver operating characteristic curve (AUC). Results Robustness studies identified 179 stable features (13%), with 25% stable features for 3D versus 4D acquisition, 31% for attenuation correction and 78% for delineation. Univariable analysis found no significant robust features predicting 12-/24-month EFS and 12-month OS (p value > 0.076). Prognostic models without robust preselection performed well for 12-month EFS in training (AUC = 0.73) and validation (AUC = 0.74). Patient stratification into two risk groups based on 12-month EFS was significant for training (p value = 0.02) and validation cohorts (p value = 0.03). Conclusions A PET-based radiomics model using a standardized, multi-centre dataset to predict EFS in locally advanced NSCLC was successfully established and validated with good performance. Prediction models with robust feature preselection were unsuccessful, indicating the need for a standardized imaging protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00809-3.
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Affiliation(s)
- Carol Oliveira
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Division of Radiation Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada.
| | - Florian Amstutz
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Diem Vuong
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Foerster
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lucas Basler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eric I Eboulet
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Sandra Thierstein
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Hatch R, Young D, Barber VS, Griffiths J, Harrison DA, Watkinson PJ. Anxiety, depression and post-traumatic stress disorder management after critical illness: a UK multi-centre prospective cohort study. Crit Care 2020; 24:633. [PMID: 33138832 PMCID: PMC7607621 DOI: 10.1186/s13054-020-03354-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/18/2020] [Accepted: 10/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Survivors of critical illness have significant psychopathological comorbidity. The treatments offered by primary health care professionals to affected patients are unstudied. AIM To report the psychological interventions after GPs received notification of patients who showed severe symptoms of anxiety, depression or Post-Traumatic Stress Disorder. METHODS Design: Multi-centre prospective cohort sub-study of the ICON study. SETTING NHS primary care in the United Kingdom. PARTICIPANTS Adult patients, November 2006-October 2010 who had received at least 24 h of intensive care, where the general practitioner recorded notification that the patient had reported severe symptoms or caseness using the Hospital Anxiety and Depression Scale (HADS) or the Post-Traumatic Stress Disorder Check List-Civilian (PCL-C). INTERVENTIONS We notified general practitioners (GPs) by post if a patient reported severe symptoms or caseness and sent a postal questionnaire to determine interventions after notification. MAIN OUTCOME MEASURE Primary or secondary healthcare interventions instigated by general practitioners following notification of a patient's caseness. RESULTS Of the 11,726 patients, sent questionnaire packs containing HADS and PCL-C, 4361 (37%) responded. A notification of severe symptoms was sent to their GP in 25% (1112) of cases. Of notified GPs, 65% (725) responded to our postal questionnaire. Of these 37% (266) had no record of receipt of the original notification. Of the 459 patients where GPs had record of notification (the study group for this analysis), 21% (98) had pre-existing psychopathology. Of those without a pre-existing diagnosis 45% (162) received further psychological assessment or treatment. GP screening or follow-up alone occurred in 18% (64) whilst 27% (98) were referred to mental health services or received drug therapy following notification. CONCLUSIONS Postal questionnaire identifies a burden of psychopathology in survivors of critical illness that have otherwise gone undiagnosed following discharge from an intensive care unit (ICU). After being alerted to the presence of psychological symptoms, GPs instigate treatment in 27% and augmented surveillance in 18% of cases. TRIAL REGISTRATION ISRCTN69112866 (assigned 02/05/2006).
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Affiliation(s)
- Robert Hatch
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Duncan Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Vicki S. Barber
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - John Griffiths
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU UK
| | - David A. Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - Peter J. Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU UK
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Abualfadl E, Ismail F, Shereef RRE, Hassan E, Tharwat S, Mohamed EF, Abda EA, Radwan AR, Fawzy RM, Moshrif AH, Noor RA, Senara S, Elazim MIA, Abaza NM, Raafat HA, El-Gazzar II, El-Hammady DH, Hammam N, Gheita TA, El-Mallah R; ECR COVID19-Study Group. Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural-urban gap and north-south gradient. Rheumatol Int 2021; 41:345-53. [PMID: 33130920 DOI: 10.1007/s00296-020-04736-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2020] [Indexed: 02/02/2023]
Abstract
During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care.
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Chan CL, Smuk M, Sohanpal R, Pinnock H, Taylor SJC. Tailored, psychological intervention for anxiety and/or depression in people with chronic obstructive pulmonary disease (COPD), TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD): statistical analysis plan for a randomised controlled trial. Trials 2020; 21:858. [PMID: 33059755 PMCID: PMC7559776 DOI: 10.1186/s13063-020-04786-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background The aim of the TANDEM trial is to evaluate whether a tailored, psychological cognitive behavioural approach intervention, which links into, and optimises the effects of routine pulmonary rehabilitation (PR), leads to a reduction in mild/moderate anxiety and/or depression in people with moderate, severe or very severe chronic obstructive pulmonary disease. Methods and design TANDEM is a multi-centre, two-arm, parallel group, pragmatic, individually randomised controlled, superiority trial including an internal pilot. Participants are randomised to receive either the intervention (a tailored psychological intervention plus usual care including referral to PR) or the control (usual care including referral to PR). The designed randomisation ratio is 1.25:1 in favour of the intervention. The multiple-primary outcomes are participant depression and anxiety at 6 months, measured using the Hospital Anxiety and Depression Scale (HADS) depression and anxiety subscales. Results This article describes the statistical analysis plan (SAP) for the TANDEM trial. In particular, we describe the general analysis principles, how we will handle missing data, the primary and secondary outcomes and how these will be analysed, sensitivity analyses for the multiple-primary outcomes, and any other analyses and data summaries. The SAP was developed and published prior to completion of follow-up of the last participant. Trial registration ISRCTN registry ISRCTN59537391. Registered on 20 March 2017.
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Affiliation(s)
- Claire L Chan
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
| | - Melanie Smuk
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ratna Sohanpal
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Stephanie J C Taylor
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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10
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Rua C, Clarke WT, Driver ID, Mougin O, Morgan AT, Clare S, Francis S, Muir KW, Wise RG, Carpenter TA, Williams GB, Rowe JB, Bowtell R, Rodgers CT. Multi-centre, multi-vendor reproducibility of 7T QSM and R 2* in the human brain: Results from the UK7T study. Neuroimage 2020; 223:117358. [PMID: 32916289 DOI: 10.1016/j.neuroimage.2020.117358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction We present the reliability of ultra-high field T2* MRI at 7T, as part of the UK7T Network's “Travelling Heads” study. T2*-weighted MRI images can be processed to produce quantitative susceptibility maps (QSM) and R2* maps. These reflect iron and myelin concentrations, which are altered in many pathophysiological processes. The relaxation parameters of human brain tissue are such that R2* mapping and QSM show particularly strong gains in contrast-to-noise ratio at ultra-high field (7T) vs clinical field strengths (1.5–3T). We aimed to determine the inter-subject and inter-site reproducibility of QSM and R2* mapping at 7T, in readiness for future multi-site clinical studies. Methods Ten healthy volunteers were scanned with harmonised single- and multi-echo T2*-weighted gradient echo pulse sequences. Participants were scanned five times at each “home” site and once at each of four other sites. The five sites had 1× Philips, 2× Siemens Magnetom, and 2× Siemens Terra scanners. QSM and R2* maps were computed with the Multi-Scale Dipole Inversion (MSDI) algorithm (https://github.com/fil-physics/Publication-Code). Results were assessed in relevant subcortical and cortical regions of interest (ROIs) defined manually or by the MNI152 standard space. Results and Discussion Mean susceptibility (χ) and R2* values agreed broadly with literature values in all ROIs. The inter-site within-subject standard deviation was 0.001–0.005 ppm (χ) and 0.0005–0.001 ms−1 (R2*). For χ this is 2.1–4.8 fold better than 3T reports, and 1.1–3.4 fold better for R2*. The median ICC from within- and cross-site R2* data was 0.98 and 0.91, respectively. Multi-echo QSM had greater variability vs single-echo QSM especially in areas with large B0 inhomogeneity such as the inferior frontal cortex. Across sites, R2* values were more consistent than QSM in subcortical structures due to differences in B0-shimming. On a between-subject level, our measured χ and R2* cross-site variance is comparable to within-site variance in the literature, suggesting that it is reasonable to pool data across sites using our harmonised protocol. Conclusion The harmonized UK7T protocol and pipeline delivers on average a 3-fold improvement in the coefficient of reproducibility for QSM and R2* at 7T compared to previous reports of multi-site reproducibility at 3T. These protocols are ready for use in multi-site clinical studies at 7T.
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11
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Kenyon-Smith TJ, Kroon HM, Miura JT, Teras J, Beasley GM, Mullen D, Farrow NE, Mosca PJ, Lowe MC, Farley CR, Potdar A, Daou H, Sun J, Farma JM, Henderson MA, Speakman D, Serpell J, Delman KA, Smithers BM, Barbour A, Coventry BJ, Tyler DS, Zager JS, Thompson JF. Factors predicting toxicity and response following isolated limb infusion for melanoma: An international multi-centre study. Eur J Surg Oncol 2020; 46:2140-2146. [PMID: 32739218 DOI: 10.1016/j.ejso.2020.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Isolated limb infusion (ILI) is a minimally-invasive procedure for delivering high-dose regional chemotherapy to treat melanoma in-transit metastases confined to a limb. The aim of this international multi-centre study was to identify predictive factors for toxicity and response. METHODS Data of 687 patients who underwent a first ILI for melanoma in-transit metastases confined to the limb between 1992 and 2018 were collected at five Australian and four US tertiary referral centres. RESULTS After ILI, predictive factors for increased limb toxicity (Wieberdink grade III/IV limb toxicity, n = 192, 27.9%) were: female gender, younger age, procedures performed before 2005, lower limb procedures, higher melphalan dose, longer drug circulation and ischemia times, and increased tissue hypoxia. No patient experienced grade V toxicity (necessitating amputation). A complete response (n = 199, 28.9%) was associated with a lower stage of disease, lower burden of disease (BOD) and thinner Breslow thickness of the primary melanoma. Additionally, an overall response (combined complete and partial response, n = 441, 64.1%) was associated with female gender, Australian centres, procedures performed before 2005, lower limb procedures and lower actinomycin-D doses. On multivariate analysis, higher melphalan dose remained a predictive factor for toxicity, while lower stage of disease and lower BOD remained predictive factors for overall response. CONCLUSION ILI is safe and effective to treat melanoma in-transit metastases. Predictive factors for toxicity and response identified in this study will allow improved patient selection and optimization of intra-operative parameters to increase response rates, while keeping toxicity low.
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Affiliation(s)
- Timothy J Kenyon-Smith
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Hidde M Kroon
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - John T Miura
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA; Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jüri Teras
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia; Department of Surgical Oncology, North Estonian Medical Centre Foundation, Tallinn, Estonia; Tallinn University of Technology, Tallinn, Estonia
| | | | - Dean Mullen
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | - Paul J Mosca
- Department of Surgery, Duke University, Durham, NC, USA
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clara R Farley
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael A Henderson
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - David Speakman
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan Serpell
- Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Barbour
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Brendon J Coventry
- Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Douglas S Tyler
- Department of Surgery, University Texas Medical Branch, Galveston, TX, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA; University of South Florida Morsani College of Medicine, Tampa FL, USA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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12
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Reddy D, Shah TT, Dudderidge T, McCracken S, Arya M, Dobbs C, Emberton M, Fiorentino F, Day E, Prevost AT, Staffurth J, Sydes M, Winkler M, Ahmed HU. Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (IP4-CHRONOS): A prospective, multi-centre therapeutic phase II parallel Randomised Control Trial. Contemp Clin Trials 2020; 93:105999. [PMID: 32302790 DOI: 10.1016/j.cct.2020.105999] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Focal therapy (FT) targets individual areas of cancer within the prostate, providing oncological control with minimal side-effects. Early evidence demonstrates encouraging short-medium-term outcomes. With no randomized controlled trials (RCT) comparing FT to radical therapies, Comparative Healthcare Research Outcomes of Novel Surgery in prostate cancer (CHRONOS) will compare the cancer control of these two strategies. PATIENTS AND METHODS CHRONOS is a parallel phase II RCT for patients with clinically significant non-metastatic prostate cancer, dependent upon clinician/patient decision, patients will enrol into either CHRONOS-A or CHRONOS-B. CHRONOS-A will randomize patients to either radical treatment or FT. CHRONOS-B is a multi-arm, multistage RCT comparing focal therapy alone to FT with neoadjuvant agents that might improve the current focal therapy outcomes. An internal pilot will determine the feasibility of, and compliance to, randomization. The proposed definitive study plans to recruit and randomize 1190 patients into CHRONOS-A and 1260 patients into CHRONOS-B. RESULTS Primary outcome in CHRONOS-A is progression-free survival (transition to salvage local or systemic therapy, development of metastases or prostate-cancer-related mortality) and in CHRONOS-B is failure-free survival (includes the above definition and recurrence of clinically significant prostate cancer after initial FT). Secondary outcomes include adverse events, health economics and functional outcomes measured using validated questionnaires. CHRONOS is powered to assess non-inferiority of FT compared to radical therapy in CHRONOS-A, and superiority of neoadjuvant agents with FT in CHRONOS-B. CONCLUSION CHRONOS will assess the oncological outcomes after FT compared to radical therapy and whether neoadjuvant treatments improve cancer control following one FT session.
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Affiliation(s)
- Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Interventional Sciences, University College London, University College Hospital, London, UK
| | | | - Mark Emberton
- Department of Surgery and Interventional Sciences, University College London, University College Hospital, London, UK
| | | | - Emily Day
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | | | - Matthew Sydes
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Fiandra C, Rossi L, Alparone A, Zara S, Vecchi C, Sardo A, Bartoncini S, Loi G, Pisani C, Gino E, Ruo Redda MG, Marco Deotto G, Tini P, Comi S, Zerini D, Ametrano G, Borzillo V, Strigari L, Strolin S, Savini A, Romeo A, Reccanello S, Rumeileh IA, Ciscognetti N, Guerrisi F, Balestra G, Ricardi U, Heijmen B. Automatic genetic planning for volumetric modulated arc therapy: A large multi-centre validation for prostate cancer. Radiother Oncol 2020; 148:126-132. [PMID: 32361572 DOI: 10.1016/j.radonc.2020.04.020] [Citation(s) in RCA: 3] [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: 02/08/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The first clinical genetic autoplanning algorithm (Genetic Planning Solution, GPS) was validated in ten radiotherapy centres for prostate cancer VMAT by comparison with manual planning (Manual). METHODS Although there were large differences among centres in planning protocol, GPS was tuned with the data of a single centre and then applied everywhere without any centre-specific fine-tuning. For each centre, ten Manual plans were compared with autoGPS plans, considering dosimetric plan parameters and the Clinical Blind Score (CBS) resulting from blind clinician plan comparisons. AutoGPS plans were used as is, i.e. there was no patient-specific fine-tuning. RESULTS For nine centres, all ten plans were clinically acceptable. In the remaining centre, only one plan was acceptable. For the 91% acceptable plans, differences between Manual and AutoGPS in target coverage were negligible. OAR doses were significantly lower in AutoGPS plans (p < 0.05); rectum D15% and Dmean were reduced by 8.1% and 17.9%, bladder D25% and Dmean by 5.9% and 10.3%. According to clinicians, 69% of the acceptable AutoGPS plans were superior to the corresponding Manual plan. In case of preferred Manual plans (31%), perceived advantages compared to autoGPS were minor. QA measurements demonstrated that autoGPS plans were deliverable. A quick configuration adjustment in the centre with unacceptable plans rendered 100% of plans acceptable. CONCLUSION A novel, clinically applied genetic autoplanning algorithm was validated in 10 centres for in total 100 prostate cancer patients. High quality plans could be generated at different centres without centre-specific algorithm tuning.
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Affiliation(s)
- Christian Fiandra
- University of Turin, Department of Oncology, Turin, Italy; School of Bioengineering and Medical-Surgical Sciences, Politecnico di Torino, Turin, Italy.
| | - Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | | | | - Anna Sardo
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Sara Bartoncini
- Radiation Oncology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Gianfranco Loi
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Carla Pisani
- Department of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy
| | - Eva Gino
- Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | - Maria Grazia Ruo Redda
- University of Turin and Radiation Oncology Department, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Paolo Tini
- Unit of Radiation Oncology, Oncology Department, University Hospital of Siena, Italy
| | - Stefania Comi
- Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Zerini
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Ametrano
- Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Naples, Italy
| | - Valentina Borzillo
- Radiation Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Naples, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, IFO, Rome, Italy
| | - Silvia Strolin
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, IFO, Rome, Italy
| | - Alessandro Savini
- Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonino Romeo
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sonia Reccanello
- U.O.C. Fisica Medica, Dipartimento Radiologia Clinica, interventistica e delle Neuroscienze, Serenissima, Italy
| | - Imad Abu Rumeileh
- U.O.C. Radioterapia, Dipartimento Radiologia Clinica, interventistica e delle Neuroscienze, Serenissima, Italy
| | | | - Flavia Guerrisi
- Department of Radiation Oncology, Asl2 Savonese, Savona, Italy
| | - Gabriella Balestra
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Roach D, Wortel G, Ochoa C, Jensen HR, Damen E, Vial P, Janssen T, Hansen CR. Adapting automated treatment planning configurations across international centres for prostate radiotherapy. Phys Imaging Radiat Oncol 2019; 10:7-13. [PMID: 33458261 DOI: 10.1016/j.phro.2019.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 11/08/2022]
Abstract
Background and purpose Automated configurations are increasingly utilised for radiotherapy treatment planning. This study investigates whether automated treatment planning configurations are adaptable across clinics with different treatment planning protocols for prostate radiotherapy. Material and methods The study comprised three participating centres, each with pre-existing locally developed prostate AutoPlanning configurations using the Pinnacle3® treatment planning system. Using a three-patient training dataset circulated from each centre, centres modified local prostate configurations to generate protocol compliant treatment plans for the other two centres. Each centre applied modified configurations on validation datasets distributed from each centre (10 patients from 3 centres). Plan quality was assessed through DVH analysis and protocol compliance. Results All treatment plans were clinically acceptable, based off relevant treatment protocol. Automated planning configurations from Centre’s A and B recorded 2 and 18 constraint and high priority deviations respectively. Centre C configurations recorded no high priority deviations. Centre A configurations produced treatment plans with superior dose conformity across all patient PTVs (mean = 1.14) compared with Centre’s B and C (mean = 1.24 and 1.22). Dose homogeneity was consistent between all centre’s configurations (mean = 0.083, 0.077, and 0.083 respectively). Conclusions This study demonstrates that automated treatment planning configurations can be shared and implemented across multiple centres with simple adaptations to local protocols.
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15
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Wiseman SJ, Meijboom R, Valdés Hernández MDC, Pernet C, Sakka E, Job D, Waldman AD, Wardlaw JM. Longitudinal multi-centre brain imaging studies: guidelines and practical tips for accurate and reproducible imaging endpoints and data sharing. Trials 2019; 20:21. [PMID: 30616680 PMCID: PMC6323670 DOI: 10.1186/s13063-018-3113-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Research involving brain imaging is important for understanding common brain diseases. Study endpoints can include features and measures derived from imaging modalities, providing a benchmark against which other phenotypical data can be assessed. In trials, imaging data provide objective evidence of beneficial and adverse outcomes. Multi-centre studies increase generalisability and statistical power. However, there is a lack of practical guidelines for the set-up and conduct of large neuroimaging studies. Methods We address this deficit by describing aspects of study design and other essential practical considerations that will help researchers avoid common pitfalls and data loss. Results The recommendations are grouped into seven categories: (1) planning, (2) defining the imaging endpoints, developing an imaging manual and managing the workflow, (3) performing a dummy run and testing the analysis methods, (4) acquiring the scans, (5) anonymising and transferring the data, (6) monitoring quality, and (7) using structured data and sharing data. Conclusions Implementing these steps will lead to valuable and usable data and help to avoid imaging data wastage.
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Affiliation(s)
- Stewart J Wiseman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK. .,CCBS, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Rozanna Meijboom
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Cyril Pernet
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Eleni Sakka
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Dominic Job
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
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James EA, Abreu JRF, McGinty JW, Odegard JM, Fillié YE, Hocter CN, Culina S, Ladell K, Price DA, Alkanani A, Rihanek M, Fitzgerald-Miller L, Skowera A, Speake C, Gottlieb P, Davidson HW, Wong FS, Roep B, Mallone R. Combinatorial detection of autoreactive CD8 + T cells with HLA-A2 multimers: a multi-centre study by the Immunology of Diabetes Society T Cell Workshop. Diabetologia 2018; 61:658-670. [PMID: 29196783 DOI: 10.1007/s00125-017-4508-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Validated biomarkers are needed to monitor the effects of immune intervention in individuals with type 1 diabetes. Despite their importance, few options exist for monitoring antigen-specific T cells. Previous reports described a combinatorial approach that enables the simultaneous detection and quantification of multiple islet-specific CD8+ T cell populations. Here, we set out to evaluate the performance of a combinatorial HLA-A2 multimer assay in a multi-centre setting. METHODS The combinatorial HLA-A2 multimer assay was applied in five participating centres using centralised reagents and blinded replicate samples. In preliminary experiments, samples from healthy donors were analysed using recall antigen multimers. In subsequent experiments, samples from healthy donors and individuals with type 1 diabetes were analysed using beta cell antigen and recall antigen multimers. RESULTS The combinatorial assay was successfully implemented in each participating centre, with CVs between replicate samples that indicated good reproducibility for viral epitopes (mean %CV = 33.8). For beta cell epitopes, the assay was very effective in a single-centre setting (mean %CV = 18.4), but showed sixfold greater variability across multi-centre replicates (mean %CV = 119). In general, beta cell antigen-specific CD8+ T cells were detected more commonly in individuals with type 1 diabetes than in healthy donors. Furthermore, CD8+ T cells recognising HLA-A2-restricted insulin and glutamate decarboxylase epitopes were found to occur at higher frequencies in individuals with type 1 diabetes than in healthy donors. CONCLUSIONS/INTERPRETATION Our results suggest that, although combinatorial multimer assays are challenging, they can be implemented in multiple laboratories, providing relevant T cell frequency measurements. Assay reproducibility was notably higher in the single-centre setting, suggesting that biomarker analysis of clinical trial samples would be most successful when assays are performed in a single laboratory. Technical improvements, including further standardisation of cytometry platforms, will likely be necessary to reduce assay variability in the multi-centre setting.
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Affiliation(s)
- Eddie A James
- Benaroya Research Institute, 1201 9th Ave, Seattle, WA, 98101, USA.
| | - Joana R F Abreu
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - John W McGinty
- Benaroya Research Institute, 1201 9th Ave, Seattle, WA, 98101, USA
| | - Jared M Odegard
- Benaroya Research Institute, 1201 9th Ave, Seattle, WA, 98101, USA
| | - Yvonne E Fillié
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - Claire N Hocter
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | | | - Kristin Ladell
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Aimon Alkanani
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marynette Rihanek
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Fitzgerald-Miller
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cate Speake
- Benaroya Research Institute, 1201 9th Ave, Seattle, WA, 98101, USA
| | - Peter Gottlieb
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Howard W Davidson
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - F Susan Wong
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Bart Roep
- Department of Diabetes Immunology, City of Hope, Duarte, CA, USA
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17
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Marwood L, Taylor R, Goldsmith K, Romeo R, Holland R, Pickles A, Hutchinson J, Dietch D, Cipriani A, Nair R, Attenburrow MJ, Young AH, Geddes J, McAllister-Williams RH, Cleare AJ. Study protocol for a randomised pragmatic trial comparing the clinical and cost effectiveness of lithium and quetiapine augmentation in treatment resistant depression (the LQD study). BMC Psychiatry 2017; 17:231. [PMID: 28651526 PMCID: PMC5485607 DOI: 10.1186/s12888-017-1393-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately 30-50% of patients with major depressive disorder can be classed as treatment resistant, widely defined as a failure to respond to two or more adequate trials of antidepressants in the current episode. Treatment resistant depression is associated with a poorer prognosis and higher mortality rates. One treatment option is to augment an existing antidepressant with a second agent. Lithium and the atypical antipsychotic quetiapine are two such add-on therapies and are currently recommended as first line options for treatment resistant depression. However, whilst neither treatment has been established as superior to the other in short-term studies, they have yet to be compared head-to-head in longer term studies, or with a superiority design in this patient group. METHODS The Lithium versus Quetiapine in Depression (LQD) study is a parallel group, multi-centre, pragmatic, open-label, patient randomised clinical trial designed to address this gap in knowledge. The study will compare the clinical and cost effectiveness of the decision to prescribe lithium or quetiapine add-on therapy to antidepressant medication for patients with treatment resistant depression. Patients will be randomised 1:1 and followed up over 12 months, with the hypothesis being that quetiapine will be superior to lithium. The primary outcomes will be: (1) time to all-cause treatment discontinuation over one year, and (2) self-rated depression symptoms rated weekly for one year via the Quick Inventory of Depressive Symptomatology. Other outcomes will include between group differences in response and remission rates, quality of life, social functioning, cost-effectiveness and the frequency of serious adverse events and side effects. DISCUSSION The trial aims to help shape the treatment pathway for patients with treatment resistant depression, by determining whether the decision to prescribe quetiapine is superior to lithium. Strengths of the study include its pragmatic superiority design, broad inclusion criteria (external validity) and longer follow up than previous studies. TRIAL REGISTRATION ISRCTN registry: ISRCTN16387615 , registered 28 February 2016. ClinicalTrials.gov: NCT03004521 , registered 17 November 2016.
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Affiliation(s)
- L. Marwood
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - R. Taylor
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - K. Goldsmith
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Romeo
- 0000 0001 2322 6764grid.13097.3cHealth Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Holland
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - A. Pickles
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - J. Hutchinson
- grid.451089.1Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - A. Cipriani
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. Nair
- grid.439606.eTees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - M.-J. Attenburrow
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - A. H. Young
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Geddes
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. H. McAllister-Williams
- grid.451089.1Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - A. J. Cleare
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
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18
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Ertas G, Doran SJ, Leach MO. A computerized volumetric segmentation method applicable to multi-centre MRI data to support computer-aided breast tissue analysis, density assessment and lesion localization. Med Biol Eng Comput 2017; 55:57-68. [PMID: 27106750 PMCID: PMC5222930 DOI: 10.1007/s11517-016-1484-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/30/2015] [Accepted: 03/04/2016] [Indexed: 11/05/2022]
Abstract
Density assessment and lesion localization in breast MRI require accurate segmentation of breast tissues. A fast, computerized algorithm for volumetric breast segmentation, suitable for multi-centre data, has been developed, employing 3D bias-corrected fuzzy c-means clustering and morphological operations. The full breast extent is determined on T1-weighted images without prior information concerning breast anatomy. Left and right breasts are identified separately using automatic detection of the midsternum. Statistical analysis of breast volumes from eighty-two women scanned in a UK multi-centre study of MRI screening shows that the segmentation algorithm performs well when compared with manually corrected segmentation, with high relative overlap (RO), high true-positive volume fraction (TPVF) and low false-positive volume fraction (FPVF), and has an overall performance of RO 0.94 ± 0.05, TPVF 0.97 ± 0.03 and FPVF 0.04 ± 0.06, respectively (training: 0.93 ± 0.05, 0.97 ± 0.03 and 0.04 ± 0.06; test: 0.94 ± 0.05, 0.98 ± 0.02 and 0.05 ± 0.07).
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Affiliation(s)
- Gokhan Ertas
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
- Department of Biomedical Engineering, Yeditepe University, Istanbul, Turkey
| | - Simon J. Doran
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP UK
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Milutinović D, Repić G, Aranđelović B. Clinical nurses' knowledge level on pulse oximetry: A descriptive multi-centre study. Intensive Crit Care Nurs 2016; 37:19-26. [PMID: 27575619 DOI: 10.1016/j.iccn.2016.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 01/13/2016] [Accepted: 05/30/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the level of knowledge on pulse oximetry among nurses. Understanding this is important because insufficient knowledge can lead to misinterpretation of pulse oximetry readings and consequently compromise patient safety. RESEARCH METHODOLOGY The study was cross-sectional and included a sample of 198 nurses. A modified questionnaire by Kiekkas et al. was used as the research tool. SETTING Intensive care units, anaesthesiology and emergency departments in two tertiary health care institutions in Serbia. MAIN OUTCOME MEASURES Principles of pulse oximeter function and conditions that can affect accuracy and reliability of pulse oximetry readings. RESULTS The lower percentage of correct responses about principles of pulse oximetry function was found in items related with the alarm reliability and understanding technical limitations. The factors that might affect pulse oximetry readings which were not identified by the nurses at a satisfactory level were the body position and specific kinds of ambient light. The mean scores of knowledge level were significantly different regarding departments (p=0.015). CONCLUSION Since this study revealed a lower level of knowledge in some aspects of pulse oximetry, it can be concluded that the generally firm belief that "experience is everything" can be challenged. This fact is important for the quality of health care and the patient's safety.
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Sanderson G, Ariyaratne TV, Wyss J, Looi V. A global patient outcomes registry: Cochlear paediatric implanted recipient observational study (Cochlear(™) P-IROS). BMC Ear Nose Throat Disord 2014; 14:10. [PMID: 25317075 PMCID: PMC4196206 DOI: 10.1186/1472-6815-14-10] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/01/2014] [Indexed: 11/29/2022]
Abstract
Background Currently, there is a paucity of data concerning the long-term outcomes, educational placement and quality of life of children implanted with hearing devices from large and representative samples of the population. To address this concern, a large, prospective, multicentre, multinational patient-outcomes registry for paediatric recipients of implantable hearing devices was developed. The benefits of this registry, its approach and methodology are described. Methods/Design The Cochlear™ Paediatric Implanted Recipient Observational Study (Cochlear P-IROS) is a prospective international patient-outcomes registry for children who are implanted in routine clinical practice with one or more hearing devices. The study aims to collect data on patient comorbidities, device use, auditory performance, quality of life and health-related utilities, across different types of implantable hearing devices from a range of manufacturers. Patients will be evaluated with a set of standardised and non-standardised questionnaires prior to initial device activation (baseline) and at six-monthly follow-up intervals up to 24 months and annually thereafter. The Cochlear P-IROS utilises a secure web interface to administer electronic case report forms to clinicians and families of implanted children. The web interface is currently available in five languages: English, Japanese, Korean, Mandarin and Russian. The interface also provides printable versions of the case report forms translated into 22 local languages for collection of data prior to entry online; additional languages may be added, as required. Participation in the Cochlear P-IROS registry is investigator-driven and voluntary. To date, the Cochlear P-IROS has recruited implant clinics across Australia, China, India, Indonesia, Turkey and Vietnam. The registry also aims to recruit multiple clinics in Cuba, Israel, Japan, Malaysia, Singapore, South Africa, South Korea and Russia. Discussion The use of a registry such as the Cochlear P-IROS will generate valuable data to support research interests of academics and clinicians around the globe. The data generated will be relevant for a wide range of stakeholders including regulators, payers, providers, policy makers, patients and their families, each with a different perspective for the acceptance and adoption of implantable hearing devices for the treatment of hearing loss.
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Affiliation(s)
- Georgina Sanderson
- Cochlear Limited, Asia Pacific Region, Macquarie University, 1 University Avenue, Sydney, NSW 2109, Australia
| | - Thathya V Ariyaratne
- Cochlear Limited, Asia Pacific Region, Macquarie University, 1 University Avenue, Sydney, NSW 2109, Australia
| | - Josephine Wyss
- Cochlear AG Europe, Middle East and Africa Headquarters, Peter Merian-Weg 4, 4052 Basel, Switzerland
| | - Valerie Looi
- Sydney Cochlear Implant Centre, Macquarie University, Ground Floor, The Australian Hearing Hub, 16 University Avenue, Sydney, NSW 2109, Australia
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Dickinson L, Ahmed HU, Kirkham AP, Allen C, Freeman A, Barber J, Hindley RG, Leslie T, Ogden C, Persad R, Winkler MH, Emberton M; INDEX Study Group. A multi-centre prospective development study evaluating focal therapy using high intensity focused ultrasound for localised prostate cancer: The INDEX study. Contemp Clin Trials 2013; 36:68-80. [PMID: 23774040 DOI: 10.1016/j.cct.2013.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/05/2013] [Accepted: 06/08/2013] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Focal therapy offers the possibility of cancer control, without the side effect profile of radical therapies. Early single centre prospective development studies using high intensity focused ultrasound (HIFU) have demonstrated encouraging genitourinary functional preservation and short-term cancer control. Large multi-centre trials are required to evaluate medium-term cancer control and reproduce functional recovery. We describe the study design of an investigator-led UK multi-centre, single arm trial using HIFU to deliver focal therapy for men with localised prostate cancer. METHODS One-hundred and forty men with histologically proven localised low or intermediate risk prostate cancer (PSA < 15, Gleason ≤ 7, ≤ T2cN0M0) will undergo precise characterisation of the prostate using a combination of multi-parametric (mp)MRI and transperineal template prostate mapping (TPM) biopsies. Unilateral dominant tumours, the so-called index lesion, will be eligible for treatment provided the contra-lateral side is free of 'clinically significant' disease (as defined by Gleason ≥ 7 or maximum cancer core length ≥4 mm). Patients will receive focal therapy using HIFU (Sonablate 500®). Treatment effect will be assessed by targeted biopsies of the treated area and TPM biopsies at 36-months. RESULTS Primary outcome is the absence of clinically significant disease based on 36-month post-treatment TPM biopsies. Secondary outcomes address a) genitourinary function using validated patient questionnaires (IPSS, IPSS-QoL, IIEF-15, EPIC-Urinary, EPIC-Bowel, FACT-P, EQ-5D), b) the predictive validity of imaging, and c) risk factors for treatment failure. CONCLUSIONS INDEX will be the first multi-centre, medium term follow-up trial to evaluate the outcomes of a tissue preserving strategy for men with localised prostate cancer using the TPM-ablate-TPM strategy.
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