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Mishra EK, Stanton A. Patient-Reported Outcomes in Pleural Effusions: A Systematic Review. Cureus 2024; 16:e52430. [PMID: 38371010 PMCID: PMC10870697 DOI: 10.7759/cureus.52430] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Pleural effusions cause breathlessness, decreased activity levels, and impaired quality of life. Clinical trials of drainage of pleural effusion use patient-reported outcome measures (PROMs) to assess these variables. This systematic review aimed to identify which PROMs have been used in clinical trials in pleural effusions, what variables were assessed, whether they were responsive to pleural interventions, and whether they have been validated in patients with pleural effusions, including a defined minimal clinically important difference (MCID). A systematic review was performed to identify relevant clinical trials from Medline, EMBASE, Emcare, and CINAHL and data were extracted. From 329 abstracts, 29 clinical trials of pleural effusion drainage that used PROMs as an outcome measure were identified. A total of 16 different PROMs were used. The most used PROMs were unidimensional measurements of breathlessness, particularly the visual analogue scale for dyspnoea (VASD), all of which nearly showed improvements in breathlessness following pleural fluid drainage. Other variables commonly assessed included activity levels and health-related quality of life. Multidimensional PROMs showed inconsistent responsiveness to pleural fluid drainage. Only the VASD was validated in this patient group with a defined MCID. A range of PROMs are used in clinical trials of pleural fluid drainage. No single PROM measures all the outcomes of interest. Unidimensional measurements of breathlessness are responsive to pleural fluid drainage. Only the VASD is validated with an MCID. There is a need for properly validated, response PROMs which measure the key outcomes of interest in this patient group.
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Affiliation(s)
- Eleanor K Mishra
- Respiratory Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, GBR
| | - Andrew Stanton
- Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, GBR
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Probst H, Reed H, Stanton A, Simpson RM, Walters SJ, Simpson H, Brown G, Hielscher S, Bryan-Jones K, Johnson J, Horsman J, Din OS. A Randomised Clinical Feasibility Trial of a Breast Immobilisation Device: The SuPPORT 4 All Bra. Clin Oncol (R Coll Radiol) 2023; 35:801-810. [PMID: 37777357 DOI: 10.1016/j.clon.2023.09.008] [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: 02/17/2023] [Revised: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 10/02/2023]
Abstract
AIMS Despite the breast being a mobile organ, there is currently no standard suitable immobilisation device to optimise radiotherapy for women with larger breasts treated after a wide local excision. The SuPPORT 4 All (S4A) bra was co-designed with patients and radiotherapy professionals. The purpose of this study was to test the feasibility of using the S4A bra in the existing breast cancer radiotherapy pathway. MATERIALS AND METHODS A randomised feasibility trial was conducted in a single institution; the primary feasibility endpoint was the recruitment of 50 participants. Efficacy endpoints were also tested, including assessment of skin reactions, dose to organs at risk and patient comfort. Fifty women were randomised to receive either standard radiotherapy with no immobilisation (control) or radiotherapy with the S4A bra (intervention). A separate planning study was undertaken on the cases randomised to receive the S4A bra. Participants in the intervention arm (S4A bra) underwent two planning computed tomography scans, one with the bra on and one without the bra; allowing direct comparison of organs at risk data for S4A bra versus no bra. RESULTS All women who started radiotherapy wearing the S4A bra completed treatment with the bra; patient comfort did not change across the 3 weeks of treatment. Positional accuracy using the bra was comparable with existing published accuracy for methods without immobilisation. The mean ipsilateral lung doses showed some improvement when positioning with the S4A bra was compared with the no bra set-up (3.72 Gy versus 4.85 Gy for right-sided cases, 3.23 Gy versus 3.62 Gy for left-sided cases). CONCLUSIONS The S4A bra is feasible to use in the radiotherapy pathway with good patient adherence. The S4A bra has potential to reduce dose to organs at risk (specifically ipsilateral lung dose) while maintaining good breast tissue coverage, and improved patient dignity, warranting further investigation on a larger scale.
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Affiliation(s)
- H Probst
- Sheffield Hallam University, Sheffield, UK.
| | - H Reed
- Sheffield Hallam University, Sheffield, UK
| | - A Stanton
- Sheffield Hallam University, Sheffield, UK
| | | | | | - H Simpson
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - G Brown
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - S Hielscher
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - K Bryan-Jones
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - J Johnson
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - O S Din
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Ferguson J, Tsim S, Kelly C, Alexander L, Shad S, Neilly M, Tate M, Zahra B, Saleh M, Cowell G, Banks E, Grundy S, Corcoran J, Downer N, Stanton A, Evison M, Rahman NM, Maskell N, Blyth KG. Staging by Thoracoscopy in potentially radically treatable Lung Cancer associated with Minimal Pleural Effusion (STRATIFY): protocol of a prospective, multicentre, observational study. BMJ Open Respir Res 2023; 10:e001771. [PMID: 37996118 PMCID: PMC10668291 DOI: 10.1136/bmjresp-2023-001771] [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: 04/16/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Recurrence rate following radical therapy for lung cancer remains high, potentially reflecting occult metastatic disease, and better staging tools are required. Minimal pleural effusion (mini-PE) is associated with particularly high recurrence risk and is defined as an ipsilateral pleural collection (<1/3 hemithorax on chest radiograph), which is either too small to safely aspirate fluid for cytology using a needle, or from which fluid cytology is negative. Thoracoscopy (local anaesthetic thoracoscopy (LAT) or video-assisted thoracoscopic surgery (VATS)) is the gold-standard diagnostic test for pleural malignancy in patients with larger symptomatic effusions. Staging by Thoracoscopy in potentially radically treatable Lung Cancer associated with Minimal Pleural Effusion (STRATIFY) will prospectively evaluate thoracoscopic staging in lung cancer associated-mini-PE for the first time. METHODS AND ANALYSIS STRATIFY is a prospective multicentre observational study. Recruitment opened in January 2020. The primary objective is to determine the prevalence of detectable occult pleural metastases (OPM). Secondary objectives include assessment of technical feasibility and safety, and the impact of thoracoscopy results on treatment plans, overall survival and recurrence free survival. Inclusion criteria are (1) suspected/confirmed stages I-III lung cancer, (2) mini-PE, (3) Performance Status 0-2 (4), radical treatment feasible if OPM excluded, (5) ≥16 years old and (6) informed consent. Exclusion criteria are any metastatic disease or contraindication to the chosen thoracoscopy method (LAT/VATS). All patients have LAT or VATS within 7 (±5) days of registration, with results returned to lung cancer teams for treatment planning. Following an interim analysis, the sample size was reduced from 96 to 50, based on a lower-than-expected OPM rate. An MRI substudy was removed in November 2022 due to pandemic-related site setup/recruitment delays. These also necessitated a no-cost recruitment extension until October 2023. ETHICS AND DISSEMINATION Protocol approved by the West of Scotland Research Ethics Committee (Ref: 19/WS/0093). Results will be published in peer-reviewed journals and presented at international meetings. TRIAL REGISTRATION NUMBER ISRCTN13584097.
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Affiliation(s)
- Jenny Ferguson
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Selina Tsim
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Caroline Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Laura Alexander
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Shumaila Shad
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Mark Neilly
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Matthew Tate
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Baryab Zahra
- Glasgow Clinical Research Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - Merna Saleh
- Glasgow Clinical Research Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - Gordon Cowell
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Elspeth Banks
- Cancer Research UK Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Seamus Grundy
- Department of Respiratory Medicine, Salford Royal Hospital, Salford, UK
| | - John Corcoran
- Interventional Pulmonology Service, Department of Respiratory Medicine, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Nicola Downer
- Department of Respiratory Medicine, King's Mill Hospital, Sutton-in-Ashfield, UK
| | - Andrew Stanton
- Department of Respiratory Medicine, Freeman Hospital, Newcastle, UK
| | - Matthew Evison
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Nick Maskell
- Bristol Medical School, University of Bristol Academic Respiratory Unit, Bristol, UK
| | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
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Tabebordbar S, Lagerborg K, Ye S, Stanton A, King E, Tellez L, Krunnfusz A, Tavakoli S, Widrick J, Messemer K, Troiano E, Moghadaszadeh B, Peacker B, Leacock K, Horwitz N, Beggs A, Wagers A, Sabeti P. I.11 Directed evolution of a family of AAV capsid variants enabling potent muscle-directed gene delivery across species. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.225] [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: 11/05/2022]
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Stanton A, Varughese R, Hirji A, Weinkauf J, Nagendran J, Lien D, Li D, Halloran K. Pretransplant Medications and Primary Graft Dysfunction Risk in Lung Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Probst H, Rosbottom K, Crank H, Stanton A, Reed H. The patient experience of radiotherapy for breast cancer: A qualitative investigation as part of the SuPPORT 4 All study. Radiography (Lond) 2020; 27:352-359. [PMID: 33036914 PMCID: PMC8063584 DOI: 10.1016/j.radi.2020.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/28/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022]
Abstract
Introduction Breast cancer is a global health problem with 2.09 million cases of breast cancer diagnosed worldwide in 2018. With an increase in breast cancer survival attention has now focussed on the impact treatment side effects can have on the quality of life for women during survivorship. The aim of the SuPPORT 4 All project is to develop a support bra for use during radiotherapy, that can reduce normal tissue toxicity (for women with larger breasts) and provide accuracy, dignity and modesty for all women. The first stage of the project involved a co-design process to understand the current patient experience where no support bra or modesty device is used. Method A participatory co-design methodology was adopted. Workshops were held with patient representatives (n = 9) to seek understanding of experience during radiotherapy; a total of three workshops over 4 h. The workshops were audio recorded and framework analysis was adopted to identify key patient experiences. Results Twelve categories and twenty-six sub categories were identified specific to patient experience. Patient concerns focussed on information provision, Healthcare Practitioner (HCP) knowledge of breast lymphoedema, lack of choice, experiences of being naked, and feelings of disempowerment. Conclusions A number of areas were identified that had negative effects on overall patient experience. Implications for practice Practitioners should consider patient dignity when configuring services to support patient needs regarding undressing, outside or inside the linear accelerator room. Additionally, practitioners should have an understanding of the impact permanent tattoos may have on some patients’ wellbeing and the impact that breast lymphoedema has on patient quality of life. Practitioners should also consider methods to encourage patient empowerment during radiotherapy; supporting patient self-monitoring of side-effects may be one way to facilitate this.
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Affiliation(s)
- H. Probst
- Corresponding author. Collegiate Crescent Campus, Sheffield Hallam University, Room F428, 11-15 Broomhall Road, S10 2BP, UK. Twitter icon
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Hallifax RJ, McKeown E, Sivakumar P, Fairbairn I, Peter C, Leitch A, Knight M, Stanton A, Ijaz A, Marciniak S, Cameron J, Bhatta A, Blyth KG, Reddy R, Harris MC, Maddekar N, Walker S, West A, Laskawiec-Szkonter M, Corcoran JP, Gerry S, Roberts C, Harvey JE, Maskell N, Miller RF, Rahman NM. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet 2020; 396:39-49. [PMID: 32622394 PMCID: PMC7607300 DOI: 10.1016/s0140-6736(20)31043-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax occurs in otherwise healthy young patients. Optimal management is not defined and often results in prolonged hospitalisation. Data on efficacy of ambulatory options are poor. We aimed to describe the duration of hospitalisation and safety of ambulatory management compared with standard care. METHODS In this open-label, randomised controlled trial, adults (aged 16-55 years) with symptomatic primary spontaneous pneumothorax were recruited from 24 UK hospitals during a period of 3 years. Patients were randomly assigned (1:1) to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion, or both). The primary outcome was total length of hospital stay including re-admission up to 30 days after randomisation. Patients with available data were included in the primary analysis and all assigned patients were included in the safety analysis. The trial was prospectively registered with the International Standard Randomised Clinical Trials Number, ISRCTN79151659. FINDINGS Of 776 patients screened between July, 2015, and March, 2019, 236 (30%) were randomly assigned to ambulatory care (n=117) and standard care (n=119). At day 30, the median hospitalisation was significantly shorter in the 114 patients with available data who received ambulatory treatment (0 days [IQR 0-3]) than in the 113 with available data who received standard care (4 days [IQR 0-8]; p<0·0001; median difference 2 days [95% CI 1-3]). 110 (47%) of 236 patients had adverse events, including 64 (55%) of 117 patients in the ambulatory care arm and 46 (39%) of 119 in the standard care arm. All 14 serious adverse events occurred in patients who received ambulatory care, eight (57%) of which were related to the intervention, including an enlarging pneumothorax, asymptomatic pulmonary oedema, and the device malfunctioning, leaking, or dislodging. INTERPRETATION Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Rob J Hallifax
- Oxford Centre for Respiratory Medicine, University of Oxford, Oxford, UK.
| | - Edward McKeown
- Royal Berkshire National Health Service (NHS) Foundation Trust, Reading, UK
| | | | | | - Christy Peter
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Andrew Leitch
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Andrew Stanton
- Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Asim Ijaz
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | | | | | - Amrithraj Bhatta
- Blackpool Fylde and Wyre Hospitals NHS Foundation Trust, Blackpool, UK
| | - Kevin G Blyth
- Queen Elizabeth University Hospital, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Raja Reddy
- Kettering General Hospital, Kettering, UK
| | | | | | - Steven Walker
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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Stanton A, Buckley J, Villani A. Adherence to a Mediterranean Diet Is Not Associated with Risk of Sarcopenic Symptomology: A Cross-Sectional Analysis of Overweight and Obese Older Adults in Australia. J Frailty Aging 2019; 8:146-149. [PMID: 31237316 DOI: 10.14283/jfa.2018.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Adherence to a Mediterranean Diet (MedDiet) is inversely associated with sarcopenia. The aim of this study was to examine the association between adherence to a MedDiet and sarcopenic symptomology in obese older adults. For confirmation of sarcopenia, low appendicular skeletal muscle (ASM: males, ≤7.25kg/m2; females, ≤5.5kg/m2) accompanied low handgrip strength (males, ≤30kg; females, ≤20kg) or low physical performance (Short Physical Performance Battery [SPPB]: ≤8; or gait speed: ≤0.8m/sec). Adherence to a MedDiet was determined using the Mediterranean Diet Adherence Screener (MEDAS). Sixty-five older adults were included. Adherence to a MedDiet was not associated with a decreased risk of sarcopenic symptomology (SPPB: OR = 0.20; 95% CI: 0.01-3.1; P = 0.234; Muscle strength: OR = 1.81; 95% CI: 0.32-10.15; P = 0.499; Gait speed: OR = 0.58; 95% CI: 0.13-2.50; P = 0.468). Future research should investigate whether a Mediterranean-style intervention can prevent or improve sarcopenic symptomology, including in non-Mediterranean populations.
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Affiliation(s)
- A Stanton
- Dr Anthony Villani, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore Qld 4558 Australia; phone: +61 7 5456 3546;
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Elder CJ, Langley J, Stanton A, De Silva S, Akbarian-Tefaghi L, Wales JKH, Wright NP. A simulation study assessing the accuracy and reliability of orchidometer estimation of testicular volume. Clin Endocrinol (Oxf) 2019; 90:623-629. [PMID: 30585647 DOI: 10.1111/cen.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT Measuring testicular volume (TV) by orchidometer is the standard method of male pubertal staging. A paucity of evidence exists as to its inter- and intra-observer reliability and the impact of clinicians' gender, training and experience on accuracy. OBJECTIVE Prosthetic testicular models were engineered to investigate accuracy and reliability of TV estimation. DESIGN Simulation study. SETTING Conducted over three-day 2015 British Society for Paediatric Endocrinology and Diabetes (BSPED) meeting. PARTICIPANTS Two hundred fifteen meeting delegates (161F, 54M): 50% consultants, 30% trainees, 9% clinical nurse specialists, 11% other professionals. INTERVENTION Three child-sized mannequins displayed latex scrotum containing prosthetic testicles of 3, 4, 5, 10 and 20 mL. Demographic data, paediatric endocrinology experience, TV examination training, examination technique and TV estimations were collected. Delegates were asked to repeat their measurements later during the meeting. Scrotum order was changed daily. MAIN OUTCOME MEASURES Accuracy by variance from the simulated TV. Inter- and intra-observer variability. RESULTS One thousand two hundred eighty four individual estimations were obtained. Eighty-five participants repeated measurements. Delegates measured TV accurately on 33.4% (±2.6) of occasions: overestimations 37% (±2.3), underestimations 28% (±1.8) (Fleiss' Kappa score 0.04). The accuracy of assessing a 4 mL testis was 36%-39%. Observers underestimated the volume when paired with a 3 mL testis and overestimated when paired with a 5 mL testis demonstrating a tendency impose biological symmetry. Intra-observer reliability was lacking; individuals giving different estimations for the same size testicle on 61% (±4.2) of occasions, 20% (±3.5) of estimations were more than 1 size outside the previous measurement. On only 39% (±4.2) of occasions did individuals agree with their previous estimation (irrespective of whether or not it was initially accurate). Training did not impact on results but experience did improve accuracy. CONCLUSIONS Overall TV estimation accuracy was poor. Considerable variation exists between and within subjects. Seniority slightly improved measurement estimation.
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Affiliation(s)
- Charlotte J Elder
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Joe Langley
- Lab4Living: Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Andrew Stanton
- Lab4Living: Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Shamani De Silva
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Jerry K H Wales
- Univeristy of Queensland Clinical Unit, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Neil P Wright
- Department of Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Stanton A, Fogarty J, Meston C. 010 Improvements in Perceived Genital Sensations and Sexual Arousal Following App-based Intervention: Preliminary Results Form a Randomized-controlled Trial. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Handy A, Stanton A, Meston C. 016 Women's Experiences of Sexual Arousal: The Importance of Context. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.03.027] [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: 11/27/2022]
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Probst H, Reed H, Rosbottom K, Stanton A, Crank H, Bryan-Jones K, Collins K. OC-0192: The development of a device to immobilise the breast during radiotherapy: The SuPPORT 4 All project. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30502-4] [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: 10/14/2022]
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Stanton A, Williamson T, Clague DeHart J, Jorge A, Eshraghi L, Cooper Ortner H, Love S. Abstract P6-12-05: Metastatic breast cancer collateral damage project (MBCCD): Development and preliminary results of the survey of health, impact, needs, and experiences (SHINE). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-05] [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: 11/16/2022]
Abstract
Abstract
Rationale: People living with metastatic breast cancer face unique challenges, which have not been well characterized. The aim of the MBCCD was to characterize the MBC patient experience in order to identify and address potential areas of need in this underserved population.
Method: We crowdsourced input and gathered free-text data from 353 people living with MBC to document the breadth of challenges affecting quality of life. From the responses, we developed a new measure (SHINE) with 79 patient-driven items regarding the experience of MBC, including verbatim statements from crowdsourcing data. Validated quality of life scales, clinical information, and demographic data were also collected. Participants were recruited from Dr. Susan Love Research Foundation's Army of Women® and other advocacy organizations; 515 completed the questionnaire. Confirmatory and exploratory factor analyses were conducted to assess model fit for SHINE and to identify subscales. Next, differences in MBC-specific concerns and experiences as a function of age, marital status, financial status, education, children, metastatic site location(s), and current medical treatment were examined with ANOVAs and t-tests.
Results: Factor analyses indicated good model fit (CFI=.96, RMSEA=.05, SRMR=.04) for a 36-item scale of MBC-specific concerns and experiences with nine subscales: 1) Employment/achievement, 2) Finances, 3) Insurance, 4) Mortality/uncertainty, 5) Activity disruption, 6) Concern for others, 7) Social isolation/withdrawal, 8) Self-concept disruption, 9) Benefit finding. A within-subjects ANOVA revealed that participants were most bothered by mortality/uncertainty concerns, followed by activity disruption, financial, employment/achievement, and insurance concerns, respectively (F(4,508)=111.38, p<0.01). Additionally, participants endorsed strongest agreement with benefit finding, followed by concern for others, self-concept disruption, and social isolation/withdrawal (F(4,508)=101.53, p<.01). Participants younger than 50 years and those with lower financial status reported higher concerns on all subscales (ps<0.01), except for benefit finding (ps>0.18). Participants with a child under 18 living at home, those on combination therapies, and those with metastases to multiple sites or bone only reported higher concerns on several subscales (ps<0.05). Being married was significantly associated with higher concern for others and lower concern about finances (ps<0.02). Education was not significantly related to any subscale.
Conclusions: Several important concerns and experiences related to MBC are not captured adequately in existing measures. This study developed a new measure (SHINE), which reliably assessed these disease-specific concerns and experiences in 515 adults living with MBC. Concerns regarding mortality and uncertainty were most prominent. Specific demographic and medical characteristics modified responses on eight subscales, but not on the benefit finding subscale. Findings can aid the development of supportive care efforts that address areas of need (e.g., concerns about mortality and uncertainty) in this understudied medical population.
Citation Format: Stanton A, Williamson T, Clague DeHart J, Jorge A, Eshraghi L, Cooper Ortner H, Love S. Metastatic breast cancer collateral damage project (MBCCD): Development and preliminary results of the survey of health, impact, needs, and experiences (SHINE) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-05.
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Affiliation(s)
- A Stanton
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - T Williamson
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - J Clague DeHart
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - A Jorge
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - L Eshraghi
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - H Cooper Ortner
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - S Love
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
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Williamson T, Stanton A, Clague DeHart J, Jorge A, Eshraghi L, Cooper Ortner H, Love S. Abstract P6-12-07: Metastatic breast cancer collateral damage project: Associations of disease-specific concerns and experiences with psychological health, illness management, and health behaviors. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Rationale: Research has identified risk and protective factors that predict health and well-being in adults with breast cancer, but this work has been focused largely on women with early-stage disease. Metastatic breast cancer (MBC) patients report worse psychological health and poorer quality of life compared to those with early-stage breast cancer. We investigated whether a newly developed measure of MBC-specific concerns and experiences, the Survey of Health, Impact, Needs, and Experiences (SHINE), is associated with psychological health, illness management, and health behaviors in a sample of MBC patients.
Method: SHINE includes 36 items capturing the experience of MBC, including verbatim statements from previously collected crowdsourcing data. Participants (N=515) were recruited from Dr. Susan Love Research Foundation's Army of Women® and other advocacy organizations. Participants also completed measures of psychological health (i.e., depression, anxiety), illness management (i.e., self-efficacy for managing medications/treatments and symptoms), and health behaviors (i.e., sleep, degree of moderate physical activity). The nine SHINE subscales, along with age, marital status, financial status, children, metastatic site location(s), and current medical treatment(s), were entered as simultaneous predictors in a multivariate regression. Psychological health, illness management, and health behaviors were entered as dependent variables in separate models.
Results: With demographic and medical variables controlled, MBC-specific concerns were associated significantly with depressive symptoms (ΔR2=.38), anxiety (ΔR2=.37), efficacy for medication/treatment management (ΔR2=.08), efficacy for symptom management (ΔR2=.32), sleep disruption (ΔR2 =.10), and physical activity (ΔR2=.17), with all ps<.01. Specifically, higher depressive symptoms and anxiety were associated greater mortality/uncertainty concerns (ps<.01), greater social isolation/withdrawal (ps<.01), and higher self-concept disruption (ps<.02). Anxiety was uniquely associated with greater financial concerns (p<.02), whereas depression was uniquely associated with fewer positive experiences (p<.05). Higher self-efficacy for managing symptoms was related to more positive experiences, higher mortality concerns, and more self-concept and activity disruption (ps<.01), whereas higher efficacy for managing medications/treatments was associated with lower social isolation/withdrawal (p<.03). More sleep disruption was associated with higher concern for others (p<.05), and less physical activity was associated with more activity disruption (p<.01).
Conclusions: After controlling for demographic and medical characteristics, MBC-specific concerns were related significantly to psychological health, self-efficacy for illness management, and health behaviors. Mortality/uncertainty concerns, social isolation/withdrawal, and self-concept disruption were especially important correlates of depressive symptoms, anxiety, and MBC-related self-efficacy. Higher concern for others was related to more sleep disruption. Approaches that address these MBC-specific concerns and promote positive experiences may be beneficial for patients.
Citation Format: Williamson T, Stanton A, Clague DeHart J, Jorge A, Eshraghi L, Cooper Ortner H, Love S. Metastatic breast cancer collateral damage project: Associations of disease-specific concerns and experiences with psychological health, illness management, and health behaviors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-07.
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Affiliation(s)
- T Williamson
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - A Stanton
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - J Clague DeHart
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - A Jorge
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - L Eshraghi
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - H Cooper Ortner
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
| | - S Love
- University of California, Los Angeles, Los Angeles, CA; City of Hope, Duarte, CA; Dr. Susan Love Research Foundation, Encino, CA
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Affiliation(s)
- Annabel Suarez
- Great Western Hospital NHS Foundation Trust, Great Western Hospital, Swindon, UK
| | - Benjamin Faber
- Great Western Hospital NHS Foundation Trust, Great Western Hospital, Swindon, UK
| | - Andrew Stanton
- Great Western Hospital NHS Foundation Trust, Great Western Hospital, Swindon, UK
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del Rey G, Stanton A, Meston C. 050 The Relationship Between Sexual Shame and Sexual Self-Schemas in College Women. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.051] [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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Dimri AP, Thayyen RJ, Kibler K, Stanton A, Jain SK, Tullos D, Singh VP. A review of atmospheric and land surface processes with emphasis on flood generation in the Southern Himalayan rivers. Sci Total Environ 2016; 556:98-115. [PMID: 26974566 DOI: 10.1016/j.scitotenv.2016.02.206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
Floods in the southern rim of the Indian Himalayas are a major cause of loss of life, property, crops, infrastructure, etc. They have long term socio-economic impacts on the habitat living along/across the Himalayas. In the recent decade extreme precipitation events have led to numerous flash floods in and around the Himalayan region. Sporadic case-based studies have tried to explain the mechanisms causing the floods. However, in some of the cases, the causative mechanisms have been elusive. Various types of flood events have been debated at different spatial and temporal scales. The present study provides an overview of mechanisms that lead to floods in and around the southern rim of the Indian Himalayas. Atmospheric processes, landuse interaction, and glacier-related outbreaks are considered in the overview.
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Affiliation(s)
- A P Dimri
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - R J Thayyen
- National Institute of Hydrology, Roorkee, Uttarakhand, India
| | - K Kibler
- University of Central Florida, Orlando, FL, USA
| | - A Stanton
- Water Resources Engineering, Oregon State University, Corvallis, OR, USA
| | - S K Jain
- National Institute of Hydrology, Roorkee, Uttarakhand, India
| | - D Tullos
- Water Resources Engineering, Oregon State University, Corvallis, OR, USA
| | - V P Singh
- Department of Biological and Agricultural Engineering, and Zachry Department of Civil Engineering, Texas A & M University, College Station, TX, USA
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Stanton A, Pulverman C, Meston C. 042 Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.04.041] [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: 10/21/2022]
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Baxter S, Reed H, Clarke Z, Judge S, Heron N, Mccarthy A, Langley J, Stanton A, Wells O, Squire G, Quinn A, Strong M, Shaw PJ, Mcdermott CJ. Evaluating a novel cervical orthosis, the Sheffield Support Snood, in patients with amyotrophic lateral sclerosis/motor neuron disease with neck weakness. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:436-42. [DOI: 10.3109/21678421.2016.1148170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Sheffield,
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield,
| | - Zoë Clarke
- Barnsley Hospital NHS Foundation Trust, Barnsley,
| | - Simon Judge
- Barnsley Hospital NHS Foundation Trust, Barnsley,
| | - Nicola Heron
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
- NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield,
| | - Avril Mccarthy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
- NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield,
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield,
| | - Andrew Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield,
| | - Oliver Wells
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
- NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield,
| | - Gill Squire
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, and
| | - Ann Quinn
- South Yorkshire Motor Neurone Disease Association, Sheffield, UK
| | - Mark Strong
- School of Health and Related Research, University of Sheffield, Sheffield,
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, and
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Pancani S, Rowson J, Tindale W, Heron N, Langley J, McCarthy AD, Quinn A, Reed H, Stanton A, Shaw PJ, McDermott CJ, Mazzà C. Assessment of the Sheffield Support Snood, an innovative cervical orthosis designed for people affected by neck muscle weakness. Clin Biomech (Bristol, Avon) 2016; 32:201-6. [PMID: 26673978 DOI: 10.1016/j.clinbiomech.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed at quantifying the biomechanical features of the Sheffield Support Snood, a cervical orthosis specifically designed for patients with neck muscle weakness. The orthosis is designed to be adaptable to a patient's level of functional limitation using adjustable removable supports, which contribute support and restrict movement only in desired anatomical planes. METHODS The snood was evaluated along with two commercially available orthoses, the Vista and Headmaster, in a series of flexion, extension, axial-rotation and lateral flexion movements. Characterization was performed with twelve healthy participants with and without the orthoses. Two inertial-magneto sensors, placed on the forehead and sternum, were used to quantify the neck's range of motion. FINDINGS In its less supportive configuration, the snood was effective in limiting movements to the desired planes, preserving free movement in other planes. The Headmaster was only effective in limiting flexion. The range of motion achieved with the snood in its rigid configuration was equivalent (P>0.05, effect size<0.4) to that achieved with the Vista, both in trials performed reaching the maximum amplitude (range of motion reduction: 25%-34% vs 24%-47%) and at maximum speed (range of motion reduction: 24%-29% vs 25%-43%). INTERPRETATION The Sheffield Support Snood is effectively adaptable to different tasks and, in its most supportive configuration, offers a support comparable to the Vista, but providing a less bulky structure. The chosen method is suitable for the assessment of range of motions while wearing neck orthoses and is easily translatable in a clinical context.
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Affiliation(s)
- Silvia Pancani
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK.
| | - Jennifer Rowson
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK
| | - Wendy Tindale
- Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK; National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Nicola Heron
- National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Avril D McCarthy
- Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK; National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ann Quinn
- South Yorkshire Motor Neurone Disease Association, Sheffield, UK
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Andrew Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Christopher J McDermott
- National Institute for Health Research, Devices for Dignity Healthcare Technology Co-Operative, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; Insigneo Institute for In silico Medicine, University of Sheffield, Sheffield, UK
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Reed H, Stanton A, Wheat J, Kelley J, Davis L, Rao W, Smith A, Owen D, Francese S. The Reed-Stanton press rig for the generation of reproducible fingermarks: Towards a standardised methodology for fingermark research. Sci Justice 2016; 56:9-17. [PMID: 26746821 DOI: 10.1016/j.scijus.2015.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 06/22/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 12/01/2022]
Abstract
In the search for better or new methods/techniques to visualise fingermarks or to analyse them exploiting their chemical content, fingermarks inter-variability may hinder the assessment of the method effectiveness. Variability is due to changes in the chemical composition of the fingermarks between different donors and within the same donor, as well as to differential contact time, pressure and angle. When validating a method or comparing it with existing ones, it is not always possible to account for this type of variability. One way to compensate for these issues is to employ, in the early stages of the method development, a device generating reproducible fingermarks. Here the authors present their take on such device, as well as quantitatively describing its performance and benefits against the manual production of marks. Finally a short application is illustrated for the use of this device, at the method developmental stages, in an emerging area of fingerprinting research concerning the retrieval of chemical intelligence from fingermarks.
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Affiliation(s)
- H Reed
- Art and Design Research Centre, Sheffield Hallam University, UK
| | - A Stanton
- Art and Design Research Centre, Sheffield Hallam University, UK
| | - J Wheat
- Centre for Sports Engineering Research, Sheffield Hallam University, UK
| | - J Kelley
- Centre for Sports Engineering Research, Sheffield Hallam University, UK
| | - L Davis
- Fingerprint Bureau, Forensic Services, Scottish Police Authority, Glasgow, UK
| | - W Rao
- Department of Chemistry and Biochemistry, University of Oklahoma, OK, USA
| | - A Smith
- Department of Health Sciences, University of Milano Bicocca, Monza, Italy
| | - D Owen
- Department of Physics and Astronomy, The University of Sheffield, UK
| | - S Francese
- Centre For Mass Spectrometry Imaging, Biomolecular Research Centre, Sheffield Hallam University, UK.
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Affiliation(s)
- Amy Hawkins
- Faculty of Medicine; University of Bristol; Bristol UK
| | | | - Karen Forbes
- Faculty of Medicine; University of Bristol; Bristol UK
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Lobo M, Dolan E, Stanton A, Sabotka P. PP.LB01.14. J Hypertens 2015. [DOI: 10.1097/01.hjh.0000468136.04466.8f] [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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Hawkins A, Jones K, Stanton A. Limitations of medical student mentor programmes: a response. Clin Teach 2015; 12:221. [DOI: 10.1111/tct.12367] [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: 11/27/2022]
Affiliation(s)
| | | | - Andrew Stanton
- Respiratory Department; Great Western Hospital; Swindon UK
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25
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Peart JM, Stanton A. Factors affecting adherence in cardiovascular protective medications: An UMPIRE sub-study. BMC Proc 2015. [PMCID: PMC4306039 DOI: 10.1186/1753-6561-9-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Stanton A, Mackinlay C. P225 Revised Bts Guidelines For Securing Cancer Diagnosis At Bronchoscopy - A Higher Recommended Yield Is Realistic And Achievable. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.354] [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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Bibby A, Slade G, Morley A, Fallon J, Psallidas I, Clive A, Pepperall J, Slade M, Stanton A, Rahman N, Maskell N. S117 Survival In Patients With Malignant Pleural Effusions Who Developed Pleural Infection: A Retrospective Case Review From 6 Uk Centres. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.123] [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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28
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Jones R, Stanton A, Juniper M. P107 Knowledge Of Non Invasive Ventilation In A District General Hospital - A Cause For Concern? Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.248] [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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Affiliation(s)
- Amy Hawkins
- University of Bristol Academy; Great Western Hospital; Swindon UK
| | - Kevin Jones
- University of Bristol Academy; Great Western Hospital; Swindon UK
| | - Andrew Stanton
- University of Bristol Academy; Great Western Hospital; Swindon UK
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30
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Affiliation(s)
- Georgia Woodfield
- University of Bristol Academy at Great Western Hospital; Swindon Wiltshire UK
| | - Marie O'Sullivan
- University of Bristol Academy at Great Western Hospital; Swindon Wiltshire UK
| | - Nicholas Haddington
- University of Bristol Academy at Great Western Hospital; Swindon Wiltshire UK
| | - Andrew Stanton
- University of Bristol Academy at Great Western Hospital; Swindon Wiltshire UK
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Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SUN, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, Edwards S. Children must be protected from the tobacco industry's marketing tactics. BMJ 2013; 347:f7358. [PMID: 24324220 DOI: 10.1136/bmj.f7358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Hopkinson
- British Thoracic Society Chronic Obstructive Pulmonary Disease Specialist Advisory Group, National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
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Abstract
A previously well 66-year-old woman presented with a recurrent transudative right-sided pleural effusion. A nodular liver with coarse echotexture was demonstrated on ultrasound and subsequent MRI found hepatocellular carcinoma. In the absence of cardiopulmonary disease and significant protein uria, the recurrent pleural effusion was presumed to be hepatic hydrothorax despite the absence of ascites or other clinical features of chronic liver disease. The patient is currently awaiting liver transplantation.
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Affiliation(s)
- Kittiya Sukcharoen
- Department of General Surgery, Great Western Hospital, Swindon, Wilshire, UK
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Khamis R, Batty T, Wong I, Johns M, Thom S, Mayet J, Stanton A, Hughes AL, Haskard DO. Dissecting the protective IgG anti-malondialdehyde-LDL (MDA-LDL) antibody response in a substudy of the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p704] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sohail I, Jonker L, Stanton A, Walker M, Joseph T. Physiological POSSUM as an Indicator for Long-term Survival in Vascular Surgery. Eur J Vasc Endovasc Surg 2013; 46:223-6. [DOI: 10.1016/j.ejvs.2013.05.018] [Citation(s) in RCA: 2] [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] [Received: 02/25/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
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Kelleher E, Stanton A, Vale G, Smith D. Recurring themes arising during medical research ethics committee review. Ir Med J 2013; 106:184-185. [PMID: 23909158] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A standard application form for the ethical review of health-related research studies has recently been adopted by many Irish medical research ethics committees. In order to assess the impact of the new form, we reviewed all comments made by the Beaumont Hospital Ethics Committee during two six-month periods, immediately prior to adoption of the new form (2010), and soon afterwards (2011). Neither volume nor comment type differed significantly between the two observation periods. Participant documentation (information leaflets and consent forms) accounted for the largest proportion of comments (2010; 44%, 2011; 37%). Other common areas prompting queries were study administration (7%), design (12%) and procedures (13%), participant selection and recruitmen (8%), and lastly data protection (9%). Because of these findings, the standard operating procedures of the committee have been revised--use of provided template participant documentation is strongly encouraged, and a "Recurring Review Themes" checklist is highlighted to all applicants.
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Wells V, Stanton A, Osborne P, Hicks W, Beale A, Ridley N. P64 Review of CXRs Requested in the Community: Can We Improve Cancer Detection? Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.205] [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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White LH, Backway S, Kerry A, Stanton A, Juniper M. P23 500 consecutive referrals to a DGH sleep service: how useful is the Epworth? Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.23] [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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39
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Khamis RY, Johns M, Thom S, Mayet J, McConnell E, Stanton A, Jeyapalan S, Annon S, Wrigley S, Hughes A, Haskard DO. 9 IgG anti-malonedialdehyde-LDL antibodies are associated with low risk of cardiovascular events in a substudy of the anglo-scandinavian cardiac outcomes trial (Ascot), and are unrelated To LDL, CRP levels and statin treatment. Heart 2011. [DOI: 10.1136/heartjnl-2011-300920b.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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Desmond A, Stanton A, Maher V, Crean P, Feely J, Sullivan P. A survey of patients' attitudes to clinical research. Ir Med J 2011; 104:117-119. [PMID: 21675095] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.
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Affiliation(s)
- A Desmond
- Boehringer Ingelheim Ireland Ltd, Sandyford Business Estate, Dublin 18.
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Beulens JWJ, Patel A, Vingerling JR, Cruickshank JK, Hughes AD, Stanton A, Lu J, McG Thom SA, Grobbee DE, Stolk RP. Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial. Diabetologia 2009; 52:2027-36. [PMID: 19633827 DOI: 10.1007/s00125-009-1457-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The aim of the present study was to investigate the effect of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in type 2 diabetic patients. METHODS The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) Retinal Measurements study, a substudy of ADVANCE, is a randomised (using a central, computer-based procedure) controlled 2 x 2 factorial trial comprising a double-blind comparison of blood pressure lowering with perindopril-indapamide vs placebo, and an open comparison of standard vs intensive glucose control targeting a HbA(1c) of < or = 6.5% in 1,602 diabetic patients from ADVANCE centres with access to retinal cameras conducted from 2001 to 2008. At baseline and the final visit, seven-field stereoscopic retinal photographs were taken and graded by blinded readers (gradeable baseline and final photographs from 1,241 patients). Progression of > or =2 steps in the Early Treatment of Diabetic Retinopathy Study classification (using the eye with worst grading) was the primary outcome. RESULTS Retinopathy progressed in 59 (4.8%) patients and developed in 128 (10.3%) patients over 4.1 years. Fewer patients on blood pressure-lowering treatment (n = 623) experienced incidence or progression of retinopathy compared with patients on placebo (n = 618), but the difference was not significant (OR 0.78; 95% CI 0.57-1.06; p = 0.12). Blood pressure-lowering treatment reduced the occurrence of macular oedema (OR 0.50; 95% CI 0.29-0.88; p = 0.016) and arteriovenous nicking compared with placebo (OR 0.60; 95% CI 0.38-0.94; p = 0.025). Compared with standard glucose control (n = 611), intensive glucose control (n = 630) did not reduce (p = 0.27) the incidence and progression of retinopathy (OR 0.84; 95% CI 0.61-1.15). Lower, borderline significant risks of microaneurysms, hard exudates and macular oedema were observed with intensive glucose control, adjusted for baseline retinal haemorrhages. These effects of the two treatments were independent and additive. Adverse events in the ADVANCE study are reported elsewhere. CONCLUSIONS/INTERPRETATION Blood pressure lowering or intensive glucose control did not significantly reduce the incidence and progression of retinopathy, although consistent trends towards a benefit were observed, with significant reductions in some lesions observed with both interventions. TRIAL REGISTRATION ClinicalTrials.gov ID no. NCT00145925. FUNDING Grants from Servier and the National Health and Medical Research Council of Australia.
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Affiliation(s)
- J W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA, the Netherlands.
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Bucknall C, Stanton A, Miller G, Rajoriya N, Babu S, Mackenzie J. The impact of normalization of esophageal acid profile by incremental protein pump inhibitors dosing in difficult asthma patients with proven gastro-esophageal acid reflux. J Asthma 2009; 46:506-11. [PMID: 19544173 DOI: 10.1080/02770900902866784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND GER is common in patients with asthma and some, although not all, studies have shown benefit from identification and treatment of GER. METHODS patients with persistent symptoms after optimisation of asthma therapy underwent pH monitoring and adjustment of GER therapy based on the results of repeated pH monitoring. Gastrointestinal symptom scores and asthma therapy requirements were recorded. RESULTS Over a 2 year period, 51 patients with a definite diagnosis of asthma underwent pH monitoring with GER being identified in 32 (63%). Normal oesophageal acid exposure was achieved in 11 patients, 7 requiring a daily PPI dose greater than 20 mg; 8 patients had persisting abnormal oesophageal acid exposure (OAE) despite daily PPI doses up to 80 mg. 13 patients declined further pH studies. 8 (73%) patients with normalisation of OAE had meaningful reductions in long term asthma therapy with 2 patients stopping and 2 patients reducing long term oral corticosteroids and 4 others halving the dose of inhaled corticosteroids. No patient who had persisting GER had asthma therapy reduced, neither did any of the group of patients in whom GER was not identified. CONCLUSION Tailoring GER therapy with repeated pH studies had a major impact in a subgroup of patients, greater than any other intervention employed in our clinic over the same period. This uncontrolled data adds to the evidence that effective management of GER reduces asthma symptomatology and allows therapy to be reduced in a subgroup of patients with difficult to control asthma.
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Affiliation(s)
- Christine Bucknall
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Stobhill Hospital, Glasgow G21 3UW, UK.
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O'Halloran AM, Patterson CC, Horan P, Maree A, Curtin R, Stanton A, McKeown PP, Shields DC. Genetic polymorphisms in platelet-related proteins and coronary artery disease: investigation of candidate genes, including N-acetylgalactosaminyltransferase 4 (GALNT4) and sulphotransferase 1A1/2 (SULT1A1/2). J Thromb Thrombolysis 2009; 27:175-84. [PMID: 18259693 DOI: 10.1007/s11239-008-0196-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 01/08/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both platelet function and heart disease show strong genetic components, many of which remain to be elucidated. MATERIALS AND METHODS The roles of candidate polymorphisms in ten platelet-associated genes were compared between 1,237 Acute Coronary Syndrome (ACS) cases (with myocardial infarction and unstable angina) and 386 controls, from an Irish Caucasian population. Additionally, 361 stable angina patients were investigated. Two genes of interest were followed up in a separate Irish study of 1,484 individuals (577 with IHD and 907 unaffected). RESULTS The GALNT4 (N-acetyl galactosaminyl transferase 4) 506I allele was significantly underrepresented in ACS (OR = 0.66, CI = 0.52-0.84; P = 0.001; P = 0.01 after correction for multiple testing), while the SULT1A1 (Sulphotransferase 1A1) 213H allele was associated with risk of ACS (OR = 1.37, CI = 1.08-1.74; P = 0.01; P = 0.1 after correction for multiple testing). Subsequent genotyping of further SNPs in GALNT4 in the family-based (IHD) group revealed that the 506I allele showed the same trend towards protecting against ACS but the haplotypic test over the four commonest haplotypes was not significant (P = 0.55). In contrast, the SULT1A1/SULT1A2 gene complex showed suggestive haplotypic association in the family-based study (P = 0.07), with the greatest increase in risk conferred by the SULT1A2 235T allele (P = 0.025). CONCLUSION We have identified two risk genes for cardiovascular disease, one of whose (GALNT4) effects may be on either platelet or endothelial function through modifications of PSGL1 or other important glycosylated proteins. The role of sulphotransferases (SULT1A1/2) in cardiovascular disease requires further exploration. Further validation of cardiovascular risks conferred by both genes in other populations (including gene copy number variation) is warranted.
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Affiliation(s)
- A M O'Halloran
- School of Biochemistry and Immunology, Trinity College Dublin, Dublin 2, Ireland.
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Somanchi B, Stanton A, Webb M, Loncaster J, Allan E, Muir L. Hand Function after High Dose Rate Brachytherapy for Squamous Cell Carcinoma of the Skin of the Hand. Clin Oncol (R Coll Radiol) 2008; 20:691-7. [DOI: 10.1016/j.clon.2008.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 06/23/2008] [Accepted: 06/24/2008] [Indexed: 11/26/2022]
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Hoffmeister S, Stanton A. Digital screening on a mobile unit: the Coventry experience. Breast Cancer Res 2008. [PMCID: PMC3332641 DOI: 10.1186/bcr2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Abstract
There are two distinct models to explain how genetic variants contributing to cardiovascular disease may have arisen. Firstly, variants may result from random, initially neutral, mutations whose effects are largely revealed in post-reproductive individuals in industrialized societies. Alternatively, the introduced variants may confer an adaptive advantage in certain circumstances. Resistance to pathogens is one of the strongest selection pressures on human proteins. To determine whether this evolutionary pressure has made a large contribution to heart disease we tested whether seventeen polymorphisms in fourteen innate-immunity genes, with documented evidence of modulating response to pathogens, had an impact on heart disease. Genotyping was performed in 1,598 CAD subjects (ACS or stable angina) and 332 controls. The TLR4 399Ile allele had the greatest impact on ACS risk (uncorrected p = 0.006); however there was no evidence overall that the resistance alleles cumulatively influenced the risk of ACS compared to controls or stable angina patients (p = 0.12, and p = 0.40, respectively). We did note a significant interaction between age at onset of disease and combined resistance allele carriership when the ACS and non-thrombotic, stable angina groups were compared (p = 0.04, 16 d.f.). This suggests that innate immunity factors could have a greater impact on thrombus formation among younger CAD patients.
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Affiliation(s)
- A M O'Halloran
- Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Abstract
BACKGROUND Teenage smoking prevalence is around 15% in developing countries (with wide variation from country to country), and around 26% in the UK and USA. Although most tobacco control programmes for adolescents are based around prevention of uptake, there are also a number of initiatives to help those who want to quit. Since those who do not smoke before the age of 20 are significantly less likely to start as adults, there is a strong case for programmes for young people that address both prevention and treatment. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, and the bibliographies of identified trials. We also searched the 'grey' literature (unpublished materials), and contacted authors and experts in the field where necessary. SELECTION CRITERIA Types of studies: Randomized controlled trials, cluster-randomized controlled trials and controlled trials. TYPES OF PARTICIPANTS Young people, aged less than 20, who are regular tobacco smokers. Types of interventions: The interventions ranged from simple ones such as pharmacotherapy, targeting individual young people, through complex programmes targeting people or organizations associated with young people (for example, their families or schools), or the community in which young people live. We included cessation programmes but excluded programmes primarily aimed at prevention of uptake. Types of outcome measures: The primary outcome was smoking status at six months follow up, among those who smoked at baseline. We report the definition of cessation used in each trial (e.g seven- or thirty-day point prevalence abstinence, or sustained or prolonged abstinence), and we preferred biochemically verified cessation when that measure was available. DATA COLLECTION AND ANALYSIS Both authors independently assessed the eligibility of candidate trials identified by the searches, and extracted data from them. We categorized included trials as being at low, medium or high risk of bias, based on concealment of allocation, blinding (where applicable) and the handling of attrition and losses to follow up. We conducted limited meta-analyses of some of the trials, provided that it was appropriate to group them and provided that there was minimal heterogeneity between them. We estimated pooled odds ratios using the Mantel-Haenszel method, based on the quit rates at longest follow up for trials with at least six months follow up from the start of the intervention. MAIN RESULTS We found 15 trials, covering 3605 young people, which met our inclusion criteria (seven cluster-randomized controlled trials, six randomized controlled trials and two controlled trials). Three trials used or tested the transtheoretical model (stages of change) approach, two tested pharmacological aids to quitting (nicotine replacement and bupropion), and the remaining trials used various psycho-social interventions, such as motivational enhancement or behavioural management. The trials evaluating TTM interventions achieved moderate long-term success, with a pooled odds ratio (OR) at one year of 1.70 ( 95% confidence interval (CI) 1.25 to 2.33) persisting at two-year follow up with an OR of 1.38 (95% CI 0.99 to 1.92). Neither of the pharmacological intervention trials achieved statistically significant results (data not pooled), but both were small-scale, with low power to detect an effect. The three interventions (5 trials) which used cognitive behavioural therapy interventions did not individually achieve statistically significant results, although when the three Not on Tobacco trials were pooled the OR 1.87; (95% CI 1.00 to 3.50) suggested some measure of effectiveness. Although the three trials that incorporated motivational interviewing as a component of the intervention achieved a pooled OR of 2.05 (95% CI 1.10 to 3.80), the impossibility of isolating the effect of the motivational interviewing in these trials meant that we could not draw meaningful inferences from that analysis. AUTHORS' CONCLUSIONS Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitive to stage of change. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. Psycho-social interventions have not so far demonstrated effectiveness, although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective; however, their definition of cessation (one or more smoke-free days) may not adequately account for the episodic nature of much adolescent smoking. There is a need for well-designed adequately powered randomized controlled trials for this population of smokers, with a minimum of six months follow up and rigorous definitions of cessation (sustained and biochemically verified). Attrition and losses to follow up are particularly problematic in trials for young smokers, and need to be kept to a minimum, so that management and interpretation of missing data need not compromise the findings.
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Affiliation(s)
- G M Grimshaw
- Warwick Medical School, Medical Teaching Centre, University of Warwick, Coventry, UK.
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Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M. Lowering of Central Aortic Blood Pressure—Not All Antihypertensive Agents Are Created Equal. J Am Soc Nephrol 2006; 17:1207-1217. [PMID: 37000963 DOI: 10.1681/01.asn.0000926828.10238.cf] [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: 03/28/2023] Open
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Abstract
BACKGROUND The prevalence of white-coat hypertension (WCH) is considerable in patients referred with elevated office blood pressure. Failure to recognise this phenomenon can lead to the inappropriate use of antihypertensive medications. We undertook this study to determine the profile of patients with WCH. METHODS Baseline clinic and daytime ambulatory blood pressures were available from 5716 patients referred over a 22-year period. Individuals were considered to have WCH if they had an elevated clinic blood pressure measurement greater than 140/90 mmHg and normal daytime mean ambulatory blood pressure. Mean age was 53.6 years and 53.2% were female. RESULTS The overall prevalence of white-coat hypertension was 15.4%. A higher prevalence was seen amongst older adults, females, and non-smokers. CONCLUSION Multivariate logistic regression analysis confirmed these characteristics as independent predictors of WCH.
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Affiliation(s)
- E Dolan
- ADAPT Centre, Beaumont Hospital, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin, Ireland
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