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Hermsen M, Bossi P, Capper D, Fleming J, Haybaeck J, Martinez-Balibrea E, Nuyts S, Skalova A, Thomson D, Trama A, Turri-Zanoni M, Verillaud B, Woods R, von Buchwald C, Lechner M. The European Network for Sinonasal Cancer Research (EUSICA) - A pan-European initiative targeting a group of orphan tumours. Eur J Cancer 2024; 202:113939. [PMID: 38447380 DOI: 10.1016/j.ejca.2024.113939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Mario Hermsen
- Dept Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20072, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - David Capper
- Department of Neuropathology, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Johannes Haybaeck
- Diagnostic & Research Center for Molecular BioMedicine, Institute of Pathology, Medical University of Graz, Graz, Styria, Austria; Department of Pathology, Saint Vincent Hospital Zams, Zams, Tyrol, Austria; Department of Pathology, University Medical Centre Maribor, Maribor, Styria, Slovenia
| | - Eva Martinez-Balibrea
- ProCURE program, Catalan Institute of Oncology and CARE program, Germans Trias i Pujol Research Institute (IGTP) Ctra. De Can Ruti, cami de les escoles s/n, Badalona 08916, Spain
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals, Leuven 3000, Belgium
| | - Alena Skalova
- Department of Pathology, Charles University, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - David Thomson
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - Annalisa Trama
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, University of Insubria, Como, Italy
| | | | - Robbie Woods
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital / Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christian von Buchwald
- Department of ORL, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matt Lechner
- Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK.
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Tomasicchio M, Jaumdally S, Wilson L, Kotze A, Semple L, Meier S, Pooran A, Esmail A, Pillay K, Roberts R, Kriel R, Meldau R, Oelofse S, Mandviwala C, Burns J, Londt R, Davids M, van der Merwe C, Roomaney A, Kühn L, Perumal T, Scott AJ, Hale MJ, Baillie V, Mahtab S, Williamson C, Joseph R, Sigal A, Joubert I, Piercy J, Thomson D, Fredericks DL, Miller MGA, Nunes MC, Madhi SA, Dheda K. SARS-CoV-2 Viral Replication Persists in the Human Lung for Several Weeks after Symptom Onset. Am J Respir Crit Care Med 2024; 209:840-851. [PMID: 38226855 PMCID: PMC10995573 DOI: 10.1164/rccm.202308-1438oc] [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: 08/17/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
Rationale: In the upper respiratory tract, replicating (culturable) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is recoverable for ∼4-8 days after symptom onset, but there is a paucity of data about the frequency and duration of replicating virus in the lower respiratory tract (i.e., the human lung).Objectives: We undertook lung tissue sampling (needle biopsy) shortly after death in 42 mechanically ventilated decedents during the Beta and Delta waves. An independent group of 18 ambulatory patients served as a control group.Methods: Lung biopsy cores from decedents underwent viral culture, histopathological analysis, electron microscopy, transcriptomic profiling, and immunohistochemistry.Measurements and Main Results: Thirty-eight percent (16 of 42) of mechanically ventilated decedents had culturable virus in the lung for a median of 15 days (persisting for up to 4 wk) after symptom onset. Lung viral culture positivity was not associated with comorbidities or steroid use. Delta but not Beta variant lung culture positivity was associated with accelerated death and secondary bacterial infection (P < 0.05). Nasopharyngeal culture was negative in 23.1% (6 of 26) of decedents despite lung culture positivity. This hitherto undescribed biophenotype of lung-specific persisting viral replication was associated with an enhanced transcriptomic pulmonary proinflammatory response but with concurrent viral culture positivity.Conclusions: Concurrent rather than sequential active viral replication continues to drive a heightened proinflammatory response in the human lung beyond the second week of illness and was associated with variant-specific increased mortality and morbidity. These findings have potential implications for the design of interventional strategies and clinical management of patients with severe coronavirus disease (COVID-19).
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Affiliation(s)
- Michele Tomasicchio
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Shameem Jaumdally
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Lindsay Wilson
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Andrea Kotze
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Lynn Semple
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Stuart Meier
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Anil Pooran
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Aliasgar Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Komala Pillay
- Division of Anatomical Pathology, Department of Pathology, and
| | - Riyaadh Roberts
- Division of Anatomical Pathology, Department of Pathology, and
| | - Raymond Kriel
- Division of Anatomical Pathology, Department of Pathology, and
| | - Richard Meldau
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Suzette Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Carley Mandviwala
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Jessica Burns
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Rolanda Londt
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Malika Davids
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Charnay van der Merwe
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Aqeedah Roomaney
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Louié Kühn
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Tahlia Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | - Alex J. Scott
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
| | | | - Vicky Baillie
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Alex Sigal
- Africa Health Research Institute, Durban, South Africa; and
| | - Ivan Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenna Piercy
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David Thomson
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David L. Fredericks
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Malcolm G. A. Miller
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Marta C. Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre of Excellence in Respiratory Pathogens, Hospices Civils de Lyon and Centre International de Recherche en Infectiologie, Équipe Santé Publique, Épidémiologie et Écologie Évolutive des Maladies Infectieuses, Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard – Lyon 1, Lyon, France
| | - Shabir A. Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, and
- Department of Science and Technology/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC Centre for the Study of Antimicrobial Resistance
- Institute of Infectious Disease and Molecular Medicine
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
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3
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Mithen J, Archibald D, Begnell P, Thomson D, Vally H. Insights into a collective impact partnership to promote consumption of healthy drinks in North East Melbourne: A qualitative case study. Health Promot J Austr 2024. [PMID: 38423005 DOI: 10.1002/hpja.852] [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: 07/19/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
ISSUE ADDRESSED To explore insights and perspectives of a collective impact (CI) partnership taking on a new project that aimed to reduce sugary drink consumption and promote water as the drink of choice across North East Melbourne. METHODS A qualitative case study was undertaken. Semi-structured interviews were conducted with key stakeholders in the partnership. Data were analysed using thematic analysis. RESULTS Fourteen organisations participated in the North East Healthy Drinks Alliance. The data demonstrated that investing in developing a common agenda supported the establishment of a CI approach. The backbone organisation was found to have played a crucial role in coordinating the activities of the Alliance. This coordination was found to be particularly important in terms of ensuring that organisations were able to work on mutually reinforcing activities at their own pace. Program planning and reporting was managed through open continuous communication by the backbone organisation. The data collected pertains to the activities of the Alliance in its first 2 years, prior to the development of a shared measurement strategy, thus no data was collected on this aspect of the collective impact framework. Although some participants were found to have limited knowledge of CI, this did not seem to hinder their participation in the Alliance. CONCLUSION Selecting a relevant and accessible focus area and investing in developing a common agenda supported the establishment of a CI approach. SO WHAT?: The CI framework offers a valuable tool for undertaking cross-sectoral, local partnerships for health.
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Affiliation(s)
- J Mithen
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - D Archibald
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
- Olga Tennison Autism Research Centre (OTARC), La Trobe University, Bundoora, Victoria, Australia
| | - P Begnell
- Independent Researcher, Melbourne, Australia
| | - D Thomson
- North East Healthy Communities, Heidelberg West, Victoria, Australia
| | - H Vally
- Institute of Health Transformation, Deakin University, Waurn Ponds, Victoria, Australia
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Cho SM, Premraj L, Battaglini D, Fanning JP, Suen J, Bassi GL, Fraser J, Robba C, Griffee M, Solomon T, Semple MG, Baillie K, Sigfrid L, Scott JT, Citarella BW, Merson L, Arora RC, Whitman G, Thomson D, White N. Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after coronavirus disease 2019 hospitalization: an international multi-centre prospective observational study. Brain Commun 2024; 6:fcae036. [PMID: 38444907 PMCID: PMC10914448 DOI: 10.1093/braincomms/fcae036] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39-1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60-0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
- Neuroscience Critical Care Division, Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - Lavienraj Premraj
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Griffith University School of Medicine, Gold Coast 4215, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
| | - Denise Battaglini
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
- Department of Medicine, University of Barcelona, Barcelona 08036, Spain
| | - Jonathon Paul Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Gianluigi Li Bassi
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - John Fraser
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- St Andrew’s War Memorial Hospital, UnitingCare, Spring Hill 4000, Australia
| | - Chiara Robba
- Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa 16132, Italy
| | - Matthew Griffee
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Tom Solomon
- Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, L3 5TR, UK
- Department of Neuroscience, University of Liverpool, Liverpool, L3 5TR, UK
- Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Malcolm G Semple
- Child Health and Outbreak Medicine, University of Liverpool, Liverpool, L3 5TR, UK
| | - Kenneth Baillie
- Experimental Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7LG, UK
| | - Janet T Scott
- Infectious Disease, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, OX1 2JD, UK
| | - Laura Merson
- Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona 08036, Spain
| | - Rakesh C Arora
- Department of Surgery, University Hospitals/Case Western Reserve University, Cleveland, OH 44106, USA
| | - Glenn Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21278, USA
| | - David Thomson
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town 7700, South Africa
- Division of Critical Care, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Nicole White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
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Battaglini D, White NM, Premraj L, Wanjiru Citarella B, Merson L, Robba C, Thomson D, Cho SM. Long-term neurological symptoms after acute COVID-19 illness requiring hospitalization in adult patients: insights from the ISARIC-COVID-19 follow-up study. J Neurol 2024; 271:79-86. [PMID: 38055020 PMCID: PMC10769963 DOI: 10.1007/s00415-023-12133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Affiliation(s)
| | - Nicole M White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Lavienraj Premraj
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
- Griffith University School of Medicine, Gold Coast, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Laura Merson
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | - David Thomson
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Department of Anesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- Division of Critical Care, Groote Schuur Hospital, Cape Town, South Africa
| | - Sung-Min Cho
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Neuroscience Critical Care Division, Departments of Neurology, Surgery, and Anaesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gaffney J, Ramzan A, Dinizulu T, Maley C, Onamusi O, Motamedi-Ghahfarokhi G, Price G, Metcalf R, Garcez K, Hughes C, Lee L, Thomson D, Price J, Jain Y, McPartlin A. Association of follow-up imaging frequency with temporal incidence and patterns of distant failure following (chemo) radiotherapy for HPV related oropharyngeal cancer. Oral Oncol 2024; 148:106645. [PMID: 37992488 DOI: 10.1016/j.oraloncology.2023.106645] [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: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Emerging data supports radical intent therapy for oligometastatic (OM) relapsed human papilloma virus (HPV+) related oropharyngeal cancer (OPC). We assess the association of follow-up imaging frequency amongst HPV + OPC, with temporal and spatial patterns of distant relapse, to inform rationalisation of routine post-treatment imaging. MATERIALS AND METHODS A retrospective single centre cohort study was carried out of consecutive HPV + OPC patients treated with radical intent (chemo)radiotherapy ((CT)RT) between 2011 and 2019. OM state was defined as ≤ 5 metastasis, none larger than 3 cm (OMs) or, if interval from last negative surveillance imaging > 6-months, then ≤ 10 metastasis, none larger than 5 cm, (OMp). Patients not meeting OMs / OMp criteria were deemed to have incurable diffuse metastatic disease (DMdiffuse). RESULTS 793 HPV-OPC patients were identified with median follow-up 3.15years (range 0.2-8.9). 52 (6.6 %) patients had radiologically identified DM at first failure and were considered for analysis. The median time to recurrence was 15.1 months (range: 2.6-63 months). 87 % of distant metastasis (DM) occurred in the first two years after treatment. Twenty-seven (52 %) patients had OM (OMs or OMp) at time of failure, with 31 % having OMs. The median time from completion of treatment to diagnosis of DMdiffuse vs OM was 22.2 months (range: 2.6-63.1 months) vs 11.6 months (range: 3.5-32.5 months). The probability of being diagnosed with OM vs DMdiffuse increased with reducing interval from last negative surveillance scan to imaging identifying DM (≤6 months 88.9 %, 7-12 months 71.4 %, 13-24 months 35 %, > 24 months 22.2 %). CONCLUSION We demonstrate that a reduced interval between last negative imaging and subsequent radiological diagnosis of DM is associated with increased likelihood of identification of OM disease. Consideration of increased frequency of surveillance imaging during the first two years of follow up is supported, particularly for patients at high risk of distant failure.
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Affiliation(s)
- John Gaffney
- The Christie NHS Foundation Trust, Manchester, UK.
| | | | | | | | | | | | - Gareth Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | | | - Kate Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lip Lee
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - James Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - Yatin Jain
- The Christie NHS Foundation Trust, Manchester, UK
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Calligaro G, Thomson D. Bridging hope: South Africa's ECMO reporting journey begins. Afr J Thorac Crit Care Med 2023; 29:e1727. [PMID: 38239773 PMCID: PMC10795018 DOI: 10.7196/ajtccm.2023.v29i4.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Affiliation(s)
- G Calligaro
- Division of Pulmonology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - D Thomson
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023; 8:29. [PMID: 37954925 PMCID: PMC10638482 DOI: 10.12688/wellcomeopenres.18710.3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Affiliation(s)
- The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA)
- Institute of Health Informatics, University College London, London, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
- Department of Critical Care Medicine, Apollo Hospitals Educational and Research Foundation, Chennai, India
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- Centre for Preoperative Medicine, University College London, London, UK
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
- General Surgery, Wazir Akbar Khan Hospital, Kabul, Afghanistan
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
- Department of Targeted Intervention, University College London, London, UK
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
- Teaching Hospital Jaffna, Jaffna, Sri Lanka
- AII India Institute of Medical Sciences, New Delhi, India
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | - Aasiyah Rashan
- Institute of Health Informatics, University College London, London, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Aniruddha Ghose
- Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arthur Kwizera
- Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
| | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Cassia Righy
- National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C. Louise Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Cornelius Sendagire
- Uganda Heart Institute, University of Makerere, Makerere, Uganda
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - David Thomson
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Dilanthi Gamage Done
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Diptesh Aryal
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- D'Or Institute for Research and Education, Sao Paulo, Brazil
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Duncan Wagstaff
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Preoperative Medicine, University College London, London, UK
| | - Farah Nadia
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Giovanni Putoto
- Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Hem Panaru
- Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Ishara Udayanga
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - John Amuasi
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jorge Salluh
- D'Or Institute for Research and Education, Sao Paulo, Brazil
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Madiha Hashmi
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Marcus Schultz
- Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mohammed Basri Mat-Nor
- Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Moses Siaw-frimpong
- Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Ronnie P Kaddu
- Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
| | | | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Steve Harris
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Swagata Tripathy
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- AII India Institute of Medical Sciences, New Delhi, India
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timo Tolppa
- Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
| | - Vrindha Pari
- Chennai Critical Care Consultants Private Limited, Chennai, India
| | | | - Yen Lam Minh
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
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Thomson D, Brand M, Bocchino L, Hardcastle T, Noel K. 218.3: A 6 year report on using a massive open online course to teach deceased organ donation. Transplantation 2023; 107:49. [PMID: 37845921 DOI: 10.1097/01.tp.0000993264.37568.21] [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: 10/18/2023]
Affiliation(s)
- David Thomson
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Martin Brand
- Department of Surgery, University of Pretoria, Pretoria, South Africa
| | - Loredana Bocchino
- Department of Medicine, University of the Witwatersand, Johannesburg, South Africa
| | - Timothy Hardcastle
- Department of Surgery, University of Kwa-Zulu Natal, Durban, South Africa
| | - Kiera Noel
- Department of Surgery, University of the Free State, Bloemfontein, South Africa
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10
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Allan S, Beedie S, McLeod HJ, Farhall J, Gleeson J, Bradstreet S, Morton E, Bell I, Wilson-Kay A, Whitehill H, Matrunola C, Thomson D, Clark A, Gumley A. Using EMPOWER in daily life: a qualitative investigation of implementation experiences. BMC Psychiatry 2023; 23:597. [PMID: 37592231 PMCID: PMC10433590 DOI: 10.1186/s12888-023-05096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Digital self-management tools blended with clinical triage and peer support have the potential to improve access to early warning signs (EWS) based relapse prevention in schizophrenia care. However, the implementation of digital interventions in psychosis can be poor. Traditionally, research focused on understanding how people implement interventions has focused on the perspectives of mental health staff. Digital interventions are becoming more commonly used by patients within the context of daily life, which means there is a need to understand implementation from the perspectives of patients and carers. METHODS Semi-structured one-on-one interviews with 16 patients who had access to the EMPOWER digital self-management intervention during their participation in a feasibility trial, six mental health staff members who supported the patients and were enrolled in the trial, and one carer participant. Interviews focused on understanding implementation, including barriers and facilitators. Data were coded using thematic analysis. RESULTS The intervention was well implemented, and EMPOWER was typically perceived positively by patients, mental health staff and the carer we spoke to. However, some patients reported negative views and reported ideas for intervention improvement. Patients reported valuing that the app afforded them access to things like information or increased social contact from peer support workers that went above and beyond that offered in routine care. Patients seemed motivated to continue implementing EMPOWER in daily life when they perceived it was creating positive change to their wellbeing, but seemed less motivated if this did not occur. Mental health staff and carer views suggest they developed increased confidence patients could self-manage and valued using the fact that people they support were using the EMPOWER intervention to open up conversations about self-management and wellbeing. CONCLUSIONS The findings from this study suggest peer worker supported digital self-management like EMPOWER has the potential to be implemented. Further evaluations of these interventions are warranted, and conducting qualitative research on the feasibility gives insight into implementation barriers and facilitators, improving the likelihood of interventions being usable. In particular, the views of patients who demonstrated low usage levels would be valuable.
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Affiliation(s)
| | | | | | | | - John Gleeson
- Australian Catholic University, Melbourne, Australia
| | | | - Emma Morton
- University of British Columbia, Vancouver, Canada
| | - Imogen Bell
- Orygen Centre of Youth Mental Health, Melbourne, Australia
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11
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Misky AT, Thomson D, Jain A. Bizarre parosteal osteochondromatous proliferation (Nora's lesion) of the hand: management of a rare clinical entity. BMJ Case Rep 2023; 16:e253361. [PMID: 37247954 PMCID: PMC10230903 DOI: 10.1136/bcr-2022-253361] [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] [Indexed: 05/31/2023] Open
Abstract
Bizarre parosteal osteochondromatous proliferation, or Nora's lesion, is a rare benign tumour of the bone, most commonly described in the hands and feet. We present the case of a female patient in her 20s attending the hand clinic with a sudden onset, atraumatic swelling on the proximal phalanx of her right ring finger. The patient retains good hand function and remains asymptomatic 3 months after surgical excision. Our case highlights the importance of being aware of this diagnosis and differentiating it from other malignant, as well as benign tumours of the hand.
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Affiliation(s)
- Adam Tamas Misky
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, London, UK
| | - David Thomson
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, London, UK
| | - Abhilash Jain
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, London, UK
- Botnar Research Centre Institute of Musculoskeletal Sciences, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, Oxfordshire, UK
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12
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Rotimi O, Sollei T, Dheansa B, Thomson D, White N, Grimes CE. Rapidly evolving gangrenous vasculitis in a critically ill patient with ulcerative colitis: a case report. J Wound Care 2023; 32:280-283. [PMID: 37094923 DOI: 10.12968/jowc.2023.32.5.280] [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] [Indexed: 04/26/2023]
Abstract
Ulcerative colitis is a disease characterised by non-granulomatous submucosal inflammation ranging from isolated proctitis to colitis. Extra-intestinal manifestations of the condition occur in multiple organ systems, with dermatological complications occurring commonly. This case report aims to highlight an uncommon dermatological complication of ulcerative colitis with particular focus on patient care and management.
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Cho SM, White N, Premraj L, Battaglini D, Fanning J, Suen J, Bassi GL, Fraser J, Robba C, Griffee M, Singh B, Citarella ;W, Merson L, Solomon T, Thomson D. Neurological manifestations of COVID-19 in adults and children. Brain 2023; 146:1648-1661. [PMID: 36087305 PMCID: PMC9494397 DOI: 10.1093/brain/awac332] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.
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Affiliation(s)
- Sung-Min Cho
- Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Nicole White
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lavienraj Premraj
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Denise Battaglini
- San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Jonathon Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine University of Queensland, Brisbane, Queensland, Australia
| | - Jacky Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine University of Queensland, Brisbane, Queensland, Australia
| | - Gianluigi Li Bassi
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine University of Queensland, Brisbane, Queensland, Australia
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - John Fraser
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine University of Queensland, Brisbane, Queensland, Australia
- St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, Queensland, Australia
| | - Chiara Robba
- San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
| | - Matthew Griffee
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Christian Medical College, Vellore, India
| | - ;?>Barbara Wanjiru Citarella
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Laura Merson
- International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Tom Solomon
- Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neuroscience, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Thomson
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Marquina C, Morton J, Zomer E, Talic S, Lybrand S, Thomson D, Liew D, Ademi Z. Lost Therapeutic Benefit of Delayed Low-Density Lipoprotein Cholesterol Control in Statin-Treated Patients and Cost-Effectiveness Analysis of Lipid-Lowering Intensification. Value Health 2023; 26:498-507. [PMID: 36442832 DOI: 10.1016/j.jval.2022.11.013] [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] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/23/2022] [Accepted: 11/07/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health economic impact of delayed lipid-lowering intensification from an Australian healthcare and societal perspective. METHODS A lifetime Markov cohort model (n = 1000) estimating the impact on coronary heart disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients with uncontrolled LDL-C, at moderate to high risk of CHD with no delay or after a 5-year delay, compared with standard of care (no intensification), starting at age 40 years. Intensification was tested with high-intensity statins or statins + ezetimibe. LDL-C levels were extracted from a primary care cohort. CHD risk was estimated using the pooled cohort equation. The effect of cumulative exposure to LDL-C on CHD risk was derived from Mendelian randomization data. Outcomes included CHD events, quality-adjusted life-years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICERs). All outcomes were discounted annually by 5%. RESULTS Over the lifetime horizon, compared with standard of care, achieving LDL-C control with no delay with high-intensity statins prevented 29 CHD events and yielded 30 extra QALYs (ICERs AU$13 205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20 270/QALY) with a 5-year delay. For statins + ezetimibe, no delay prevented 53 CHD events and gave 45 extra QALYs (ICER AU$37 271/QALY) versus 40 CHD events and 29 QALYs (ICER of AU$44 218/QALY) after a 5-year delay. CONCLUSIONS Delaying attainment of LDL-C goals translates into lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in statin-treated patients.
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Affiliation(s)
- Clara Marquina
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Danny Liew
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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15
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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Rashan A, Beane A, Ghose A, Dondorp AM, Kwizera A, Vijayaraghavan BKT, Biccard B, Righy C, Thwaites CL, Pell C, Sendagire C, Thomson D, Done DG, Aryal D, Wagstaff D, Nadia F, Putoto G, Panaru H, Udayanga I, Amuasi J, Salluh J, Gokhale K, Nirantharakumar K, Pisani L, Hashmi M, Schultz M, Ghalib MS, Mukaka M, Mat-Nor MB, Siaw-frimpong M, Surenthirakumaran R, Haniffa R, Kaddu RP, Pereira SP, Murthy S, Harris S, Moonesinghe SR, Vengadasalam S, Tripathy S, Gooden TE, Tolppa T, Pari V, Waweru-Siika W, Minh YL. Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18710.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
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17
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Tauro A, Thomson D, Carrera I. Spinal subarachnoid diverticulum associated with vertebral articular process dysplasia in a Chow Chow dog. J Small Anim Pract 2023; 64:54. [PMID: 36229893 DOI: 10.1111/jsap.13562] [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] [Received: 03/24/2022] [Revised: 08/16/2022] [Accepted: 09/12/2022] [Indexed: 01/21/2023]
Affiliation(s)
- A Tauro
- Chestergates Veterinary Specialists, Cheshire, CH1 6LT, UK
| | - D Thomson
- Chestergates Veterinary Specialists, Cheshire, CH1 6LT, UK
| | - I Carrera
- Vet Oracle Teleneurology, CVS Limited, Norfolk, UK
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18
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Rieu R, Crellin A, Thomson D, Nutting C. Developing a National Infrastructure for Proton Beam Therapy Trials. Clin Oncol (R Coll Radiol) 2022; 35:279-282. [PMID: 36564290 DOI: 10.1016/j.clon.2022.11.017] [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] [Received: 08/18/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Affiliation(s)
- R Rieu
- The Institute of Cancer Research, London, UK; Head and Neck Unit, The Royal Marsden, London, UK.
| | - A Crellin
- Leeds Cancer Centre, St James's Institute of Oncology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - D Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - C Nutting
- Head and Neck Unit, The Royal Marsden, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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19
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Weerakoon AT, Condon N, Cox TR, Sexton C, Cooper C, Meyers IA, Thomson D, Ford PJ, Roy S, Symons AL. Dynamic dentin: A quantitative microscopic assessment of age and spatial changes to matrix architecture, peritubular dentin, and collagens types I and III. J Struct Biol 2022; 214:107899. [PMID: 36208858 DOI: 10.1016/j.jsb.2022.107899] [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: 07/01/2022] [Revised: 08/16/2022] [Accepted: 09/19/2022] [Indexed: 12/07/2022]
Abstract
To investigate age and site-related changes to human dentin collagen, sound human teeth collected from donors aged 13-29 (young) and 50-74 (aged) years (n = 9/group) were cut to shallow and deep sites. Dentin collagen orientation and fibril bundling was investigated using the Picrosirius Red (PSR) stain observed under cross-polarized light microscopy (Pol), and collagen distribution was investigated using Confocal Laser Scanning Microscopy (CLSM). Collagen types III to I distribution in peritubular dentin (PTD) was revealed using Herovici stain and brightfield microscopy. Image analysis software and linear mixed modelling quantified outcomes. In situ dentin collagen was observed using Xenon Plasma Focussed Ion Beam Scanning Electron Microscopy (Xe PFIB-SEM). The PSR-Pol analysis revealed less coherently aligned and more bundled collagen fibrils in aged dentin (P = 0.005). Deep inner dentin collagen in both groups were less coherently aligned with reduced bundling. Regardless of age, CLSM showed collagen distribution remained stable; and more collagen type III was detectable in PTD located in inner dentin (Young: P = 0.006; Aged: P = 0.008). Observations following Xe PFIB-SEM cross-sectioning showed apatite-like deposits surrounding large intratubular collagen fibers, and evidence of smaller intertubular dentin collagen fibrils in situ. In conclusion, aging changes collagen network architecture, but not distribution or content.
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Affiliation(s)
- Arosha T Weerakoon
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia.
| | - Nicholas Condon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Thomas R Cox
- Garvan Institute of Medical Research & School of Clinical Medicine, UNSW, Sydney, Australia
| | - Christopher Sexton
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Crystal Cooper
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Western Australia, Australia
| | - Ian A Meyers
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - David Thomson
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline J Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandrine Roy
- Translational Research Institute, Brisbane, Queensland, Australia; Olympus Life Science, Australia
| | - Anne L Symons
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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20
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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21
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [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] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abhilash Jain
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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22
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Weerakoon AT, Cooper C, Sokolowski KA, Meyers IA, Thomson D, Ford PJ, Sexton C, Symons AL. Effect of dentine site on resin and cement adaptation tested using X-ray and electron microscopy to evaluate bond durability and adhesive interfaces. Eur J Oral Sci 2022; 130:e12890. [PMID: 35959863 DOI: 10.1111/eos.12890] [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: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
Glass ionomer (GI) cements and self-etch (SE) or universal adhesives after etching (ER) adapt variably with dentine. Dentine characteristics vary with depth (deep/shallow), location (central/peripheral), and microscopic site (intertubular/peritubular). To directly compare adhesion to dentine, non-destructive imaging and testing are required. Here, GI, ER, and SE adapted at different dentine depths, locations, and sites were investigated using micro-CT, xenon plasma focused ion beam scanning electron microscopy (Xe PFIB-SEM), and energy dispersive X-ray spectroscopy (EDS). Extracted molars were prepared to deep or shallow slices and treated with the three adhesives. Micro-CT was used to compare changes to air volume gaps, following thermocycling, and statistically analysed using a quantile regression model and Fisher's exact test. The three adhesives performed similarly across dentine depths and locations, yet no change or overall increases and decreases in gaps at all dentine depths and locations were measured. The Xe PFIB-SEM-milled dentine-adhesive interfaces facilitated high-resolution characterization, and element profiling revealed variations across the tooth-material interfaces. Dentine depth and location had no impact on adhesive durability, although microscopic differences were observed. Here we demonstrate how micro-CT and Xe PFIB-SEM can be used to compare variable dental materials without complex multi-stage specimen preparation to minimize artefacts.
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Affiliation(s)
| | - Crystal Cooper
- Institute for Future Environments, Central Analytical Research Facility, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Ian Arthur Meyers
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - David Thomson
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline Jane Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Sexton
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne Louise Symons
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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23
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Reyes LF, Murthy S, Garcia-Gallo E, Merson L, Ibáñez-Prada ED, Rello J, Fuentes YV, Martin-Loeches I, Bozza F, Duque S, Taccone FS, Fowler RA, Kartsonaki C, Gonçalves BP, Citarella BW, Aryal D, Burhan E, Cummings MJ, Delmas C, Diaz R, Figueiredo-Mello C, Hashmi M, Panda PK, Jiménez MP, Rincon DFB, Thomson D, Nichol A, Marshall JC, Olliaro PL. Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study. Crit Care 2022; 26:276. [PMID: 36100904 PMCID: PMC9469080 DOI: 10.1186/s13054-022-04155-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). CONCLUSIONS In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
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Affiliation(s)
- Luis Felipe Reyes
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia.
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Laura Merson
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Elsa D Ibáñez-Prada
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuli V Fuentes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | - Fernando Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Sara Duque
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, Depok, Indonesia
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Rodrigo Diaz
- Intensive Care Unit, Clinica Las Condes, Santiago, Chile
| | | | - Madiha Hashmi
- Critical Care Asia and Ziauddin University, Karachi, Pakistan
| | | | | | | | - David Thomson
- Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alistair Nichol
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - John C Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Piero L Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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24
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Citron I, Thomson D, Pescarini E, Creasy H, Sorooshian P, Berner JE, Neville C, Kannan RY, Nduka C. Descriptive Study of Facial Motor Cocontractions During Voluntary Facial Movement in a Healthy Population: A New Hypothesis Contributing to Synkinesis. Facial Plast Surg Aesthet Med 2022; 25:244-249. [PMID: 36083281 DOI: 10.1089/fpsam.2022.0072] [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: 11/12/2022] Open
Abstract
Background: Motor overflow refers to involuntary movements that accompany voluntary movements in healthy individuals. This may have a role in synkinesis. Objective: To describe the frequency and magnitude of facial motor overflow in a healthy population. Methodology: Healthy participants performed unilateral facial movements: brow elevation, wink, snarl, and closed smile. Two reviewers analyzed the magnitude of each movement and cocontraction. Patterns of movements are described. Univariate analysis was used to assess the relationship between efficacy of unilateral facial control and the frequency and magnitude of cocontractions. Results: Eighty-nine participants completed the videos. Consensual mirror movements occurred in 96% of participants during unilateral eye closure and 86% during brow elevation. The most common associated movement was ipsilateral eye constriction occurring during snarl (90.1%). Improved unilateral facial control was associated with a decrease in frequency and magnitude of associated movements during brow elevation, wink, and snarl. Conclusion: This study showed stereotyped patterns of motor overflow in facial muscles that resemble those in synkinesis and become more evident as unilateral control of the face decreases.
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Affiliation(s)
- Isabelle Citron
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - David Thomson
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Elena Pescarini
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - Henrietta Creasy
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Parviz Sorooshian
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Catriona Neville
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Ruben Y Kannan
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
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25
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du Toit T, Chibuye K, Thomson D, Manning K. The use of brachiobasilic arteriovenous fistulae for haemodialysis: a single-centre descriptive study. Cardiovasc J Afr 2022; 33:248-253. [PMID: 35788625 PMCID: PMC9887435 DOI: 10.5830/cvja-2022-006] [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: 03/06/2021] [Accepted: 02/01/2022] [Indexed: 10/08/2023] Open
Abstract
AIM The main aim of the study was to report on our local experience with the use of brachiobasilic arteriovenous fistulae (BBAVF) and to encourage wider local acceptance of the procedure in accordance with international guidelines. The primary aim was to report on access patency. The secondary aims were to report on functional outcomes and complications. METHODS This was a retrospective, descriptive study of 41 consecutive haemodialysis patients who underwent BBAVF creation. RESULTS The primary patency rates at 30 days, and one and three years were 95.1, 48.8 and 19.5%, respectively. Assisted primary patency rates at 30 days, and one and three years were 100, 67.7 and 24.3%, respectively. Secondary patency rates at 30 days, and one and three years were 100, 70.3 and 27%, respectively. CONCLUSION BBAVF creation can successfully be performed in a resource-constrained environment by surgeons with limited prior experience with the technique. However, careful monitoring, well-established referral pathways for dysfunctional fistulae and access to surgical and endovascular revision seem to be key factors in ensuring long-term patency.
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Affiliation(s)
- Tinus du Toit
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Kenward Chibuye
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - David Thomson
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Kathryn Manning
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Lechner M, Takahashi Y, Turri-Zanoni M, Ferrari M, Liu J, Counsell N, Mattavelli D, Rampinelli V, Vermi W, Lombardi D, Saade R, Park KW, Schartinger VH, Franchi A, Facco C, Sessa F, Battocchio S, Fenton TR, Vaz FM, O'Flynn P, Howard D, Stimpson P, Wang S, Hannan SA, Unadkat S, Hughes J, Dwivedi R, Forde CT, Randhawa P, Gane S, Joseph J, Andrews PJ, Dave M, Fleming JC, Thomson D, Zhu T, Teschendorff A, Royle G, Steele C, Jimenez JE, Laco J, Wang EW, Snyderman C, Lacy PD, Woods R, O'Neill JP, Saraswathula A, Kaur RP, Zhao T, Ramanathan M, Gallia GL, London NR, Le QT, West RB, Patel ZM, Nayak JV, Hwang PH, Hermsen M, Llorente J, Facchetti F, Nicolai P, Bossi P, Castelnuovo P, Jay A, Carnell D, Forster MD, Bell DM, Lund VJ, Hanna EY. International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System. J Neurol Surg B Skull Base 2022. [DOI: 10.1055/s-0042-1750178] [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: 10/17/2022] Open
Abstract
Abstract
Objectives Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past.
Methods We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed.
Results One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic (p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57–0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25–1.00, p = 0.036).
Conclusions We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, United Kingdom
- UCL Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of ENT, Barts Health NHS Trust, London, United Kingdom
| | - Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom
| | - Davide Mattavelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - William Vermi
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Rami Saade
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Department of Otolaryngology—Head and Neck Surgery, Lebanese American University, Beirut, Lebanon
| | - Ki Wan Park
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Volker H. Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Carla Facco
- Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Unit of Pathology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Simonetta Battocchio
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Tim R. Fenton
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, United Kingdom
| | - Francis M. Vaz
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Paul O'Flynn
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - David Howard
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Paul Stimpson
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Simon Wang
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S. Alam Hannan
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Samit Unadkat
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Jonathan Hughes
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Raghav Dwivedi
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Cillian T. Forde
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Premjit Randhawa
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Simon Gane
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Jonathan Joseph
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Peter J. Andrews
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Manas Dave
- Division of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Jason C. Fleming
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - David Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Liverpool Head & Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Tianyu Zhu
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Andrew Teschendorff
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Gary Royle
- UCL Cancer Institute, University College London, London, United Kingdom
| | | | - Joaquin E. Jimenez
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Czech Republic
| | - Eric W. Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, United States
- Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Peter D. Lacy
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Robbie Woods
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - James P. O'Neill
- Department of Otolaryngology—Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
- The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anirudh Saraswathula
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
| | - Raman Preet Kaur
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
| | - Tianna Zhao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Murugappan Ramanathan
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gary L. Gallia
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Nyall R. London
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Sinonasal and Skull Base Tumor Program—Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Robert B. West
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Zara M. Patel
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jayakar V. Nayak
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Peter H. Hwang
- Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, United States
| | - Mario Hermsen
- Department of Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jose Llorente
- Department of Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology—Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, London, United Kingdom
| | - Dawn Carnell
- Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Martin D. Forster
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Diana M. Bell
- Disease Team Alignment: Head and Neck, City of Hope Medical Center, Duarte, California, United States
| | - Valerie J. Lund
- Royal National ENT Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, United Kingdom
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Beddok A, Guzene L, Coutte A, Thomson D, Yom SS, Calugaru V, Blais E, Gilliot O, Racadot S, Pointreau Y, Corry J, Jensen K, Porceddu S, Khalladi N, Bastit V, Lasne-Cardon A, Marcy PY, Carsuzaa F, Nioche C, Bourhis J, Salleron J, Thariat J. International assessment of interobserver reproducibility of flap delineation in head and neck carcinoma. Acta Oncol 2022; 61:672-679. [PMID: 35139735 DOI: 10.1080/0284186x.2022.2036367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/11/2021] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
Background: Several reports have suggested that radiotherapy after reconstructive surgery for head and neck cancer (HNC), could have deleterious effects on the flaps with respect to functional outcomes. To predict and prevent toxicities, flap delineation should be accurate and reproducible. The objective of the present study was to evaluate the interobserver variability of frequent types of flaps used in HNC, based on the recent GORTEC atlas.Materials and methods: Each member of an international working group (WG) consisting of 14 experts delineated the flaps on a CT set from six patients. Each patient had one of the five most commonly used flaps in HNC: a regional pedicled pectoralis major myocutaneous flap, a local pedicled rotational soft tissue facial artery musculo-mucosal (FAMM) (2 patients), a fasciocutaneous radial forearm free flap, a soft tissue anterolateral thigh (ALT) free flap, or a fibular free flap. The WG's contours were compared to a reference contour, validated by a surgeon and a radiologist specializing in HNC. Contours were considered as reproducible if the median Dice Similarity Coefficient (DSC) was > 0.7.Results: The median volumes of the six flaps delineated by the WG were close to the reference contour value, with approximately 50 cc for the pectoral, fibula, and ALT flaps, 20 cc for the radial forearm, and up to 10 cc for the FAMM. The volumetric ratio was thus close to the optimal value of 100% for all flaps. The median DSC obtained by the WG compared to the reference for the pectoralis flap, the FAMM, the radial forearm flap, ALT flap, and the fibular flap were 0.82, 0.40, 0.76, 0.81, and 0.76, respectively.Conclusions: This study showed that the delineation of four main flaps used for HNC was reproducible. The delineation of the FAMM, however, requires close cooperation between radiologist, surgeon and radiation oncologist because of the poor visibility of this flap on CT and its small size.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Leslie Guzene
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - Alexandre Coutte
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Valentin Calugaru
- Department of Radiation Oncology, Institut Curie, Paris - Orsay, France
| | - Eivind Blais
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Olivier Gilliot
- Department of Radiation Oncology, Polyclinique Marzet, Pau, France
| | - Séverine Racadot
- Department of Radiation Oncology, Centre Léon Bérard Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - June Corry
- Department of Radiation Oncology, GenesisCare. St Vincent's Hospital, Fitzroy, Australia
| | - Kenneth Jensen
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Danemark
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital Southside Clinical Unit, Australia
| | - Nazim Khalladi
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, Centre François Baclesse, Caen, France
| | | | | | - Florent Carsuzaa
- Department of Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Christophe Nioche
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Université Paris Saclay/Inserm/Institut Curie, Orsay, France
| | - Jean Bourhis
- Department of Radiation Oncology, University Hospital of Vaudois, Lausanne, Swiss
| | - Julia Salleron
- Department of Statistics, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
- Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534 - Normandie Université, Caen, France
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Marquina C, Talic S, Zomer E, Vargas-Torres S, Petrova M, Wolfe R, Abushanab D, Lybrand S, Thomson D, Stratton G, Ofori-Asenso R, Liew D, Ademi Z. Attainment of low-density lipoprotein cholesterol goals in patients treated with combination therapy: A retrospective cohort study in primary care. J Clin Lipidol 2022; 16:498-507. [DOI: 10.1016/j.jacl.2022.05.002] [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] [Received: 10/07/2021] [Revised: 03/01/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
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Tikekar A, De Vicente F, McCormack A, Thomson D, Farrell M, Carmichael S, Chase D. Retrospective comparison of outcomes following tibial plateau leveling osteotomy and lateral fabello-tibial suture stabilisation of cranial cruciate ligament disease in small dogs with high tibial plateau angles. N Z Vet J 2022; 70:218-227. [DOI: 10.1080/00480169.2022.2052992] [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: 10/18/2022]
Affiliation(s)
- A Tikekar
- Veterinary Specialists Auckland, Mount Albert, Auckland, New Zealand
| | - F De Vicente
- Pride Veterinary Specialists, Derby, Derbyshire, UK
| | | | - D Thomson
- Chester Gates Veterinary Referrals, Chester, Cheshire, UK
| | | | - S Carmichael
- School of Veterinary Medicine, University of Surrey, Guildford, Surrey, UK
| | - D Chase
- Veterinary Specialists Auckland, Mount Albert, Auckland, New Zealand
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Weerakoon AT, Cooper C, Meyers IA, Condon N, Sexton C, Thomson D, Ford PJ, Symons AL. Does dentine mineral change with anatomical location, microscopic site and patient age? J Struct Biol X 2022; 6:100060. [PMID: 35146411 PMCID: PMC8818708 DOI: 10.1016/j.yjsbx.2022.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
The SEM BSE micrographs show dentine tubules penetrating intertubular dentine. SEM BSE micrographs illustrates mineral to fill mature not young dentine tubules and branches. Mineral density varies with the ratio of tubular to intertubular dentine. Dentine composition remains stable for age, anatomical location and microscopic site. Xe PFIB-SEM cross-sections show structural integration between peritubular and intertubular dentine.
Objective To determine the effect of patient age (young or mature), anatomical location (shallow/deep and central/peripheral) and microscopic site (intertubular/peritubular) on dentine mineral density, distribution and composition. Methods Extracted posterior teeth from young (aged 19–20 years, N = 4) and mature (aged 54–77 years, N = 4) subjects were prepared to shallow and deep slices. The dentine surface elemental composition was investigated in a SEM using Backscattered Electron (BSE) micrographs, Energy Dispersive X-ray Spectroscopy, and Integrated Mineral Analysis. Qualitative comparisons and quantitative measures using machine learning were used to analyse the BSE images. Quantitative outcomes were compared using quantile or linear regression models with bootstrapping to account for the multiple measures per sample. Subsequently, a Xenon Plasma Focussed Ion Beam Scanning Electron Microscopy (Xe PFIB-SEM) was used to mill large area (100 µm) cross-sections to investigate morphology through the dentine tubules using high resolution secondary electron micrographs. Results With age, dentine mineral composition remains stable, but density changes with anatomical location and microscopic site. Microscopically, accessory tubules spread into intertubular dentine (ITD) from the main tubule lumens. Within the lumens, mineral deposits form calcospherites in the young that eventually coalesce in mature tubules and branches. The mineral occlusion in mature dentine increases overall ITD density to reflect peritubular dentine (PTD) infiltrate. The ITD observed in micrographs remained consistent for age and observation plane to suggest tubule deposition affects overall dentine density. Mineral density depends on the relative distribution of PTD to ITD that varies with anatomical location. Significance Adhesive materials may interact differently within a tooth as well as in different age groups.
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Key Words
- Age
- Apatite
- BSE
- BSE, Backscatter Electron
- Ca, Calcium
- Cl, Chloride
- DEJ, Dentine-enamel junction
- DT, Dentine Tubule
- Dentine
- EPMA, Electron Probe Microanalyser
- Ga, Gallium
- H, Hydrogen
- Human
- ITD, Intertubular Dentine
- Intertubular dentine
- LA-ICP-MS, Laser Ablation Induction Coupled Plasma Mass Spectroscopy
- Mg, Magnesium
- Mineral
- Na, Sodium
- O, Oxygen
- Odontoblasts
- P, Phosporus
- PTD, Peritubular Dentine
- Peritubular dentine
- SEM, Scanning Electron Microscope
- SEM-EDS
- SEM-EDS, Scanning Electron Microscope Energy Dispersive X-ray Spectroscopy
- TEM, Transmission Electron Microscope
- TIMA, Integrated Mineral Analysis
- XE PFIB-SEM, Xenon Plasma Focussed Ion Beam Scanning Electron Microscope
- Xe PFIB-SEM
- β-TCMP, Magnesium-whitlockite
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Affiliation(s)
- Arosha T Weerakoon
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Crystal Cooper
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian A Meyers
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Condon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Sexton
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - David Thomson
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline J Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne L Symons
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
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Thomson D, Khoury A, Jones M. Hand Trauma Aetiology and Anaesthesia during the first UK lockdown: "&#".ord($0).";""&#".ord($0).";"Lessons for Pandemic Planning"&#".ord($0).";""&#".ord($0).";". Hand Microsurg 2022. [DOI: 10.5455/handmicrosurg.139354] [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] Open
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Bookholane H, du Toit T, Muller E, Thomson D. Organ transplantation during the COVID-19 pandemic - impact on deceased organ donor referrals and consent rates in the Western Cape, South Africa. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/2022/v60n1a3694] [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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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak 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D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Andary T, Cavaleri R, Chang W, Imam S, Moukhaiber N, Summers S, Thomson D. Investigating the effects of Theta Burst Stimulation (TBS) on experimentally-induced hamstring pain. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.073] [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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Cavaleri R, Imam S, Moukhaiber N, Rio E, Summers S, Thomson D. Investigating neural representations in response to posterior thigh pain – a potential risk factor for hamstring injury recurrence? J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khoury A, Thomson D, Jones M. 1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.506] [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: 11/14/2022]
Abstract
Abstract
Introduction
Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic.
Method
Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology.
Results
2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia.
Conclusions
Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.
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Affiliation(s)
- A Khoury
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - D Thomson
- Queen Victoria Hospital, East Grinstead, United Kingdom
| | - M Jones
- Queen Victoria Hospital, East Grinstead, United Kingdom
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Wildi K, Li Bassi G, Barnett A, Panigada M, Colombo SM, Bandera A, Muscatello A, McNicholas B, Laffey JG, Battaglini D, Robba C, Torres A, Motos A, Luna CM, Rainieri F, Hodgson C, Burrell AJC, Buscher H, Dalton H, Cho SM, Choi HA, Thomson D, Suen J, Fraser JF. Design and Rationale of a Prospective International Follow-Up Study on Intensive Care Survivors of COVID-19: The Long-Term Impact in Intensive Care Survivors of Coronavirus Disease-19-AFTERCOR. Front Med (Lausanne) 2021; 8:738086. [PMID: 34568393 PMCID: PMC8455846 DOI: 10.3389/fmed.2021.738086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 01/16/2023] Open
Abstract
Background: In a disease that has only existed for 18 months, it is difficult to be fully informed of the long-term sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Evidence is growing that most organ systems can be affected by the virus, causing severe disabilities in survivors. The extent of the aftermath will declare itself over the next 5-10 years, but it is likely to be substantial with profound socio-economic impact on society. Methods: This is an international multi-center, prospective long-term follow-up study of patients who developed severe coronavirus disease-2019 (COVID-19) and were admitted to Intensive Care Units (ICUs). The study will be conducted at international tertiary hospitals. Patients will be monitored from time of ICU discharge up to 24 months. Information will be collected on demographics, co-existing illnesses before ICU admission, severity of illness during ICU admission and post-ICU quality of life as well as organ dysfunction and recovery. Statistical analysis will consist of patient trajectories over time for the key variables of quality of life and organ function. Using latent class analysis, we will determine if there are distinct patterns of patients in terms of recovery. Multivariable regression analyses will be used to examine associations between baseline characteristics and severity variables upon admission and discharge in the ICU, and how these impact outcomes at all follow-up time points up to 2 years. Ethics and Dissemination: The core study team and local principal investigators will ensure that the study adheres to all relevant national and local regulations, and that the necessary approvals are in place before a site may enroll patients. Clinical Trial Registration:anzctr.org.au: ACTRN12620000799954.
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Affiliation(s)
- Karin Wildi
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Gianluigi Li Bassi
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology QUT, Brisbane, QLD, Australia
| | - Mauro Panigada
- Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Sebastiano M Colombo
- Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Bairbre McNicholas
- Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERESUCICOVID, Barcelona, Spain
| | - Ana Motos
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERESUCICOVID, Barcelona, Spain
| | | | | | - Carol Hodgson
- The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | | | - Hergen Buscher
- St. Vincent's Hospital Sydney, University of New South Wales, Darlinghurst, NSW, Australia
| | - Heidi Dalton
- Inova Fairfax Hospital, Falls Church, VA, United States
| | - Sung-Min Cho
- Departments of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, John Hopkins Hospital, Baltimore, MD, United States
| | | | - David Thomson
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jacky Suen
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Dunn HP, Browning SD, Thomson D, Yates WB, McCluskey P, Keay L, White AJ, Fraser CL. Impact on patient management of non-mydriatic fundus photography compared to direct ophthalmoscopy in a regional Australian emergency department. Emerg Med Australas 2021; 34:186-193. [PMID: 34448357 DOI: 10.1111/1742-6723.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the management impact of non-mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. METHODS This before/after crossover study prospectively enrolled patients presenting with headache, neurological deficit, visual disturbance and/or hypertensive urgency. Patients received DO examination, then separate NMFP examination. Emergency clinicians (ECs) were surveyed on their patient management plans following both DO examination and NMFP imaging. Telemedicine review of NMFP images was performed by an ophthalmologist within 48 h, and any additional management changes were documented. RESULTS The use of NMFP influenced changes in management in 52 (39%) of 133 enrolled patients (95% confidence interval 31-48%). Of these, 65% were escalations of management due to acute fundus pathology, while 35% were de-escalating changes following normal fundus findings. ECs diagnostic accuracy for acute fundus pathology improved from 0% to 29% sensitivity, and 59% to 84% specificity using DO and NMFP respectively, and telemedicine registrar review increased this to 50% sensitivity and 86% specificity. The period prevalence of acute fundus pathology was 10.5% (95% confidence interval 6-17%). CONCLUSION The addition of NMFP images can significantly impact the management of ED patients requiring fundus examination, facilitating expedited and optimised patient care. NMFP improves ECs diagnostic acumen for fundus pathology over DO examination and telehealth specialist review is important for diagnostic accuracy. There is a clinically important prevalence of fundus pathology in this regional ED setting.
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Affiliation(s)
- Hamish P Dunn
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Samuel D Browning
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - David Thomson
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - William B Yates
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew J White
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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Biccard BM, Thomson D, Miller M, Taylor EH, Gopalan PD. Critically ill COVID-19 patients in Africa: it is time for quality registry data - Authors' reply. Lancet 2021; 398:486-487. [PMID: 34364516 PMCID: PMC8341819 DOI: 10.1016/s0140-6736(21)01545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town 7925, South Africa.
| | - David Thomson
- Division of Critical Care, University of Cape Town, Cape Town 7925, South Africa
| | - Malcolm Miller
- Division of Critical Care, University of Cape Town, Cape Town 7925, South Africa
| | - Elliott H Taylor
- Groote Schuur Hospital, Faculty of Health Sciences, and Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town 7925, South Africa; Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - P Dean Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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Price J, Fornacon-Wood I, Thomson D, Lee L, Sykes A, Garcez K, Price G, McPartlin A. PO-1001 The effect of switching to carboplatin chemo-RT for cycle 2 in cisplatin-ineligible HNSCC patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Crockett C, Gomes F, Faivre-Finn C, Howell S, Kasipandian V, Smith E, Thomson D, Yorke J, Price J. The Routine Clinical Implementation of Electronic Patient-reported Outcome Measures (ePROMs) at The Christie NHS Foundation Trust. Clin Oncol (R Coll Radiol) 2021; 33:761-764. [PMID: 34229926 DOI: 10.1016/j.clon.2021.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- C Crockett
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Gomes
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - S Howell
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - V Kasipandian
- Department of Critical Care and Anaesthesia, The Christie NHS Foundation Trust, Manchester, UK
| | - E Smith
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - J Yorke
- Christie Patient-Centred Research, Division of Nursing, Midwifery & Social Work, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - J Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
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Gaito S, France A, Foden P, Abravan A, Burnet N, Garcez K, Kota VR, Lee LW, Price J, Sykes A, Thomson D, Smith E, Osorio EV, McPartlin A. A Predictive Model for Reactive Tube Feeding in Head and Neck Cancer Patients Undergoing Definitive (Chemo) Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:e433-e441. [PMID: 34090753 DOI: 10.1016/j.clon.2021.05.002] [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: 08/19/2020] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
AIMS Careful management of a patient's nutritional status during and after treatment for head and neck squamous cell cancers (HNSCC) is crucial for optimal outcomes. The aim of this study was to develop a model for stratifying a patient's risk of requiring reactive enteral feeding through a nasogastric tube during radiotherapy for HNSCC, based on clinical and treatment-related factors. MATERIALS AND METHODS A cohort of consecutive patients treated with definitive (chemo)radiotherapy for HNSCC between January 2016 and January 2018 was identified in the institutional electronic database for retrospective analysis. Patients requiring enteral feeding pretreatment were excluded. Clinical and treatment data were obtained from prospectively recorded electronic clinical notes and planning software. RESULTS Baseline patient characteristics and tumour-related parameters were captured for 225 patients. Based on the results of the univariate analysis and using a stepwise backwards selection process, clinical and dosimetric variables were selected to optimise a clinically predictive multivariate model, fitted using logistic regression. The parameters found to affect the probability, P, of requiring a nasogastric feeding tube for >4 weeks in our clinical multivariate model were: tumour site, tumour stage (early T0/1/2 stage versus advanced T3/T4 stage), chemotherapy drug (none versus any drug) and mean dose to the contralateral parotid gland. A scoring model using the regression coefficients of the selected variables in the clinical multivariate model achieved an area under the curve (AUC) of 0.745 (95% confidence interval 0.678-0.812), indicating good discriminative performance. Internal validation of the model involved splitting the dataset 80:20 into training and test datasets 10 times and assessing differences in AUC of the model fitted to these. CONCLUSIONS We developed an easy-to-use prediction model based on both clinical and dosimetric parameters, which, once externally validated, can lead to more personalised treatment planning and inform clinical decision-making on the appropriateness of prophylactic versus reactive enteral feeding.
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Affiliation(s)
- S Gaito
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK.
| | - A France
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK
| | - P Foden
- The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK
| | - A Abravan
- The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK; The Christie NHS Foundation Trust, Department of Radiotherapy Related Research, Manchester, UK
| | - N Burnet
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - K Garcez
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - V R Kota
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - L W Lee
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - J Price
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - A Sykes
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK
| | - D Thomson
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - E Smith
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The Christie NHS Foundation Trust, Proton Clinical Outcomes Unit, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
| | - E V Osorio
- The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK; The Christie NHS Foundation Trust, Department of Radiotherapy Related Research, Manchester, UK
| | - A McPartlin
- The Christie NHS Foundation Trust, Clinical Oncology, Proton Beam Therapy Centre, Manchester, UK; The University of Manchester, Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, UK
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Barea A, Martinucci M, Wertheim D, Morley IFI, Thomson D, Soldin MG. Five year basal cell carcinoma recurrence rates treated with curettage and cautery, a single centre retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74:1931-1971. [PMID: 34134938 DOI: 10.1016/j.bjps.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alberto Barea
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames KT2 7QB, United Kingdom
| | - Matthew Martinucci
- Queen Elizabeth the Queen Mother Hospital, St Peter's Rd, Margate CT9 4AN, United Kingdom
| | - David Wertheim
- Kingston University, Penrhyn Road, Kingston upon Thames, Surrey KT1 2EE, United Kingdom
| | | | - David Thomson
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames KT2 7QB, United Kingdom
| | - Mark George Soldin
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames KT2 7QB, United Kingdom
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Carsuzaa F, Lapeyre M, Gregoire V, Maingon P, Beddok A, Marcy PY, Salleron J, Coutte A, Racadot S, Pointreau Y, Graff P, Beadle B, Benezery K, Biau J, Calugaru V, Castelli J, Chua M, Di Rito A, Dore M, Ghadjar P, Huguet F, Jardel P, Johansen J, Kimple R, Krengli M, Laskar S, Mcdowell L, Nichols A, Tribius S, Valduvieco I, Hu C, Liem X, Moya-Plana A, D'onofrio I, Parvathaneni U, Takiar V, Orlandi E, Psyrri A, Shenouda G, Sher D, Steuer C, Shan Sun X, Tao Y, Thomson D, Tsai MH, Vulquin N, Gorphe P, Mehanna H, Yom SS, Bourhis J, Thariat J. Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus. Radiother Oncol 2021; 160:140-147. [PMID: 33984351 DOI: 10.1016/j.radonc.2021.04.026] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. MATERIAL AND METHODS Radiation, medical, and surgical oncologists were assembled from GORTEC and internationally with the Head and Neck Cancer International Group (HNCIG). The consensus-building approach covered 59 topics across four domains: (1) identification of postoperative tissue changes on imaging for flap delineation, (2) understanding of tumor relapse risks and target volume definitions, (3) functional radiation-induced deterioration, (4) feasibility of flap avoidance. RESULTS Across the 4 domains, international consensus (median score ≥ 7/9) was achieved only for functional deterioration (73.3%); other consensus rates were 55.6% for poRT avoidance of flap structures, 41.2% for flap definition and 11.1% for tumor spread patterns. Radiation-induced flap fibrosis or atrophy and their functional impact was well recognized while flap necrosis was not, suggesting dose-volume adaptation for the former. Flap avoidance was recommended to minimize bone flap osteoradionecrosis but not soft-tissue toxicity. The need for identification (CT planning, fiducials, accurate operative report) and targeting of the junction area at risk between native tissues and flap was well recognized. Experts variably considered flaps as prone to tumor dissemination or not. Discrepancies in rating of 11 items among international reviewing participants are shown. CONCLUSION International GORTEC and HNCIG-endorsed recommendations were generated for the management of flaps in head and neck radiotherapy. Considerable knowledge gaps hinder further consensus, in particular with respect to tumor spread patterns.
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Affiliation(s)
| | - Michel Lapeyre
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Philippe Maingon
- Department of Radiation Oncology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pierre-Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Julia Salleron
- Department of Biostatistics, Institut de cancérologie de Lorraine, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Amiens Picardie University Medical Center, Amiens, France
| | - Severine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Pierre Graff
- Department or Radiation Oncology, Institut C. Regaud, Toulouse, France
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University Medical Center, Stanford University Medical Center, USA
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julian Biau
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Joel Castelli
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | - Melvin Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Alessia Di Rito
- Department of Radiation Oncology, OC Radioterapia Ospedale "Mons. A.R. Dimiccoli" di Barletta, Rome, Italy
| | - Melanie Dore
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, St Herblain, France
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité, Berlin, Germany
| | - Florence Huguet
- Department of Radiation Oncology, Hospital de Tenon, Paris, France
| | - Pauline Jardel
- Department of Radiation Oncology, CHU de la Milétrie, Poitiers, France
| | - Jorgen Johansen
- Department of Radiation Oncology, Odense University Hospital, Denmark
| | - Randall Kimple
- Department of Medical Oncology, University of Wisconsin-Madison, WI, USA
| | - Marco Krengli
- Department of Translational Medicine University of Piemonte Orientale, Novara, Italy
| | | | - Lachlan Mcdowell
- Department of Radiation Oncology, Peter McCallum Cancer Center, Melbourne, Australia
| | - Anthony Nichols
- Department of Head and Neck surgery, London Health Sciences Center, Ontario, Canada
| | - Silke Tribius
- Department of Radiation Oncology, Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Chaosu Hu
- Department of Radiation Oncology, Fundan University, Shanghai, China
| | - Xavier Liem
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Ida D'onofrio
- Department of Radiation Oncology, Hospital Naples, Italy
| | | | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinaty, USA
| | - Ester Orlandi
- Department of Radiation Oncology, CNAO, Milan, Italy
| | - Amanda Psyrri
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - David Sher
- Department of Radiation Oncology, UT Southwestern, Dallas, USA
| | - Conor Steuer
- Department of Head and Neck Surgery, Winship Cancer Institute, Atlanta, USA
| | - Xu Shan Sun
- Department of Radiation Oncology, University hospital CHBM, Montbéliard, France
| | - Yungan Tao
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tïnan, Taiwan
| | - Noemie Vulquin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Hisham Mehanna
- Department of Radiation Oncology, Institute for Global Innovation, Birmingham, UK
| | - Sue S Yom
- Department of Radiation Oncology, NRG Oncology Cancer Research Group, USA
| | - Jean Bourhis
- Department of Radiation Oncology, UNIL-CHUV, Lausanne, Switzerland
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François-Baclesse, Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534. Normandie University, Caen, and GORTEC, France.
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Talic S, Marquina Hernandez C, Ofori-Asenso R, Liew D, Owen A, Petrova M, Lybrand S, Thomson D, Ilomaki J, Ademi Z, Zomer E. Trends in the Utilization of Lipid-Lowering Medications in Australia: An Analysis of National Pharmacy Claims Data. Curr Probl Cardiol 2021; 47:100880. [PMID: 34108083 DOI: 10.1016/j.cpcardiol.2021.100880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Lipid-lowering medications comprise standard of care in the prevention of cardiovascular disease. This study examined the trends in the utilization of statin and non-statin medications in the Australian general population between 2013 and 2019. Pharmacoepidemiological analyses were performed using pharmacy dispensing data from Australian Pharmaceutical Benefits Scheme. One-year prevalence and incidence of statin and non-statin prescribing patterns were reported, and relative variations in prescribing examined via Poisson regression modelling. The one-year prevalence of statins' prescriptions decreased between 2013-2019 by 5.5% (from 25.0%-19.5%). Females were less likely than males to be prescribed statins (rate ratio [RR]=0.90, 95% confidence interval [CI] 0.89-0.91). The one-year prevalence of ezetimibe alone, and in combination with statins, increased consistently from 2013-2019 from 1.5%-3.6% (P<0.01) and 0.1%-1.1% (P<0.01), respectively. The prevalence was higher among those aged 61-80 years (RR=1.20, 95%CI 1.10-1.21) and those aged older than 80 years (RR=1.34, 95%CI 1.22-1.47), when compared to people aged <60 years. The incidence of ezetimibe prescriptions was highest in people aged 61-80 years (RR=1.36, 95%CI 1.31-1.41) compared to those aged <60 years. The one-year prevalence of proprotein convertase subtilisin/kexin type 9 inhibitor prescriptions was highest among those aged 46-60 years (RR=1.24, 95%CI 0.97-4.97) compared to people aged <46 and >60 years. Females were less likely than males to be prescribed a proprotein convertase subtilisin/kexin type 9 inhibitor (RR=0.87, 95%CI 0.75-0.98). Statins remain the most prevalent lipid-lowering medication prescribed in Australia. The prescribing of non-statin medications remains low, but is increasing.
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Affiliation(s)
- Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marjana Petrova
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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46
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Marquina C, Talic S, Vargas-Torres S, Petrova M, Abushanab D, Owen A, Lybrand S, Thomson D, Liew D, Zomer E, Ademi Z. Future burden of cardiovascular disease in Australia: impact on health and economic outcomes between 2020 and 2029. Eur J Prev Cardiol 2021; 29:1212-1219. [PMID: 33686414 DOI: 10.1093/eurjpc/zwab001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/21/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
AIMS To estimate the health and economic burden of new and established cardiovascular disease from 2020 to 2029 in Australia. METHODS AND RESULTS A two-stage multistate dynamic model was developed to predict the burden of the incident and prevalent cardiovascular disease, for Australians 40-90 years old from 2020 to 2029. The model captured morbidity, mortality, years of life lived, quality-adjusted life years, healthcare costs, and productivity losses. Cardiovascular risk for the primary prevention population was derived using Australian demographic data and the Pooled Cohort Equation. Risk for the secondary prevention population was derived from the REACH registry. Input data for costs and utilities were extracted from published sources. All outcomes were annually discounted by 5%. A number of sensitivity analyses were undertaken to test the robustness of the study. Between 2020 and 2029, the model estimates 377 754 fatal and 991 375 non-fatal cardiovascular events. By 2029, 1 061 756 Australians will have prevalent cardiovascular disease (CVD). The population accrued 8 815 271 [95% uncertainty interval (UI) 8 805 083-8 841 432] years of life lived with CVD and 5 876 975 (5 551 484-6 226 045) QALYs. The total healthcare costs of CVD were projected to exceed Australian dollars (AUD) 61.89 (61.79-88.66) billion, and productivity losses will account for AUD 78.75 (49.40-295.25) billion, driving the total cost to surpass AUD 140.65 (123.13-370.23) billion. CONCLUSION Cardiovascular disease in Australia has substantial impacts in terms of morbidity, mortality, and lost revenue to the healthcare system and the society. Our modelling provides important information for decision making in relation to the future burden of cardiovascular disease.
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Affiliation(s)
- Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Sandra Vargas-Torres
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Marjana Petrova
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Dina Abushanab
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia.,Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Sean Lybrand
- External Access Engagement, Value Access and Policy, Amgen Europe GmbH, Zurich, Switzerland
| | - David Thomson
- Policy and Advocay, Amgen Australia Pty Ltd, Sydney, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
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47
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Thomson D, Joubert I, De Vasconcellos K, Paruk F, Mokogong S, Mathivha R, McCulloch M, Morrow B, Baker D, Rossouw B, Mdladla N, Richards GA, Welkovics N, Levy B, Coetzee I, Spruyt M, Ahmed N, Gopalan D. South African guidelines on the determination of death. South Afr J Crit Care 2021; 37:10.7196/SAJCC.2021v37i1b.466. [PMCID: PMC10193841 DOI: 10.7196/sajcc.2021v37i1b.466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 05/20/2023] Open
Abstract
Summary
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis
and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination
of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South
African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination
of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will
provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken
with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence.
The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round
modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment
(https://criticalcare.org.za/resource/death-determination-checklists/). Key points Brain death and circulatory death are the accepted terms for defining death in the hospital context. Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks’ corrected
gestation. Brain-death testing while on extra-corporeal membrane oxygenation is outlined. Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family
are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
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Affiliation(s)
- D Thomson
- Division of Critical Care, Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital,
Cape Town, South Africa
| | - K De Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical
Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
| | - S Mokogong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M McCulloch
- Paediatric Intensive Care Unit and Transplant Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of
Cape Town, South Africa
| | - B Morrow
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - D Baker
- Department of Adult Critical Care, Livingstone Hospital and Faculty of Health Sciences, Walter Sisulu University, Port Elizabeth, South Africa
| | - B Rossouw
- Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital, Sefako Makgatho University, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Welkovics
- Netcare Unitas Hospital, Centurion, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - I Coetzee
- Department of Nursing Science, University of Pretoria, South Africa
| | - M Spruyt
- Busamed Bram Fischer International Airport Hospital, Bloemfontein, South Africa
| | - N Ahmed
- Consolidated Critical Care Unit, Tygerberg Hospital, Department of Surgical Sciences, Department of Anaesthesiology and Critical Care, Faculty
of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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48
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Waltho A, Thomson D, Pattison R, Woolley J, Hawthorn T. Developing and evaluating a pathway for screening and treatment of depression in patients with head and neck cancer. J Psychosom Res 2021; 141:110346. [PMID: 33387700 DOI: 10.1016/j.jpsychores.2020.110346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Alison Waltho
- Derbyshire Community Health Services Foundation Trust, Cavendish Hospital, Manchester Road, Buxton SK17 6TE, United Kingdom
| | - David Thomson
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | - Richard Pattison
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | - Joanne Woolley
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom
| | - Tania Hawthorn
- Pennine Care NHS Foundation Trust, Tameside General Hospital Fountain Street, Ashton Under Lyne OL6 9RW, Manchester, United Kingdom.
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49
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Thomson D, Joubert I, De Vasconcellos K, Paruk F, Mokogong S, Mathiva R, McCulloch M, Morrow B, Baker D, Rossouw B, Mdladla N, Richards GA, Welkovics N, Levy B, Coetzee I, Spruyt M, Ahmed N, Gopalan D. South African guidelines on the determination of death. S Afr Med J 2021; 111:367-380. [PMID: 37114488 DOI: 10.7196/samj.2021.v111i4b.15200] [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: 04/29/2023] Open
Abstract
Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks' corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.
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Affiliation(s)
- D Thomson
- Division of Critical Care, Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - K De Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
| | - S Mokogong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - R Mathiva
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M McCulloch
- Paediatric Intensive Care Unit and Transplant Unit, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - B Morrow
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - D Baker
- Department of Adult Critical Care, Livingstone Hospital and Faculty of Health Sciences, Walter Sisulu University, Port Elizabeth, South Africa
| | - B Rossouw
- Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital, Sefako Makgatho University, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Welkovics
- Netcare Unitas Hospital, Centurion, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - I Coetzee
- Department of Nursing Science, University of Pretoria, South Africa
| | - M Spruyt
- Busamed Bram Fischer International Airport Hospital, Bloemfontein, South Africa
| | - N Ahmed
- Consolidated Critical Care Unit, Tygerberg Hospital, Department of Surgical Sciences, Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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50
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Thomson D, Sommer DE, Falcó O, Quino G, Cui H, Erice B, Petrinic N. Numerical prediction of the ballistic performance of hygrothermally aged CFRP laminates using a multi-scale modelling approach. EPJ Web Conf 2021. [DOI: 10.1051/epjconf/202125003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A multi-scale modelling strategy is proposed to investigate the potential effects of hygrothermal ageing on the ballistic performance of CFRP laminates. At the micro-scale, damage evolution due to cyclic hygrothermal loads is simulated on a representative microstructure using an adapted fatigue damage law. Then, the results of the micro-mechanical analysis are used to measure the predicted transverse crack density and calibrate a meso-scale material model with the effects of micro-scale damage. Finally, a meso-scale impact model is generated with seeded transverse cracks at the predicted crack density and the calibrated material properties from the homogenisation step, which allows for the performance of the laminate to be compared at different stages of hygrothermal ageing damage.
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