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Affiliation(s)
- C. Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE UK
| | - J.‑J. Reilly
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | | | - J. Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, DE22 3NE UK
| | - D. Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, E Floor West Block, QMC Campus, Nottingham, NG7 2UH UK
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Hope C, Lund J, Griffiths G, Humes D. O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.051] [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
Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties.
Method
A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed.
Result
8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05).
Conclusion
There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations.
Take-home Message
There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.
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Affiliation(s)
- C Hope
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - J Lund
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | | | - D Humes
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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Clements JM, Burke JR, Hope C, Nally DM, Doleman B, Giwa L, Griffiths G, Lund JN. The quantitative impact of COVID-19 on surgical training in the United Kingdom. BJS Open 2021; 5:6309263. [PMID: 34169311 PMCID: PMC8226285 DOI: 10.1093/bjsopen/zrab051] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background COVID-19 has had a global impact on all aspects of healthcare including surgical training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the UK. Methods Anonymized operative logbook numbers were collated from electronic logbook and ARCP outcome data from the Intercollegiate Surgical Curriculum Programme database for trainees in the 10 surgical specialty training specialties. Operative logbook numbers and awarded ARCP outcomes were compared between predefined dates. Effect sizes are reported as incident rate ratios (IRR) with 95 per cent confidence intervals. Results Some 5599 surgical trainees in 2019, and 5310 in surgical specialty training in 2020 were included. The IRR was reduced across all specialties as a result of the COVID-19 pandemic (0.62; 95 per cent c.i. 0.60 to 0.64). Elective surgery (0.53; 95 per cent c.i. 0.50 to 0.56) was affected more than emergency surgery (0.85; 95 per cent c.i. 0.84 to 0.87). Regional variation indicating reduced operative activity was demonstrated across all specialties. More than 1 in 8 trainees in the final year of training have had their training extended and more than a quarter of trainees entering their final year of training are behind their expected training trajectory. Conclusion The COVID-19 pandemic has had a major effect on surgical training in the UK. Urgent, coordinated action is required to minimize the impacts from the reduction in training in 2020.
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Affiliation(s)
- J M Clements
- The Association of Surgeons in Training, London, UK
| | - J R Burke
- The Association of Surgeons in Training, London, UK
| | - C Hope
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, Derby, UK
| | - D M Nally
- The Association of Surgeons in Training, London, UK
| | - B Doleman
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, Derby, UK
| | - L Giwa
- The Association of Surgeons in Training, London, UK
| | - G Griffiths
- Joint Committee on Surgical Training, London, UK
| | - J N Lund
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, Derby, UK.,Joint Committee on Surgical Training, London, UK
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Davies A, McKay P, Osborne W, Stanton L, Tansley‐Hancock O, Lawrence M, Mercer K, Allen A, Pottinger B, Zhelyazkova A, Miall F, Rafferty J, Sale B, Cucco F, Nunn L, Coleman A, Griffiths G, Du MQ, Burton C, Barrons S, Johnson P. 9P GAIN PREDICTS OUTCOMES IN PATIENTS WITH RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B‐CELL LYMPHOMA (DLBCL) TREATED WITH R‐GEMOX +/‐ ATEZOLIZUMAB. ARGO: A RANDOMISED PHASE II STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.11_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A Davies
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - P McKay
- Beatson West of Scotland Cancer Centre Department of Haematology Glasgow UK
| | - W Osborne
- Freeman Hospital The Newcastle upon Tyne Hospitals NHS Foundation Trust Department of Haematology Newcastle UK
| | - L Stanton
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - O Tansley‐Hancock
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - M Lawrence
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - K Mercer
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - A Allen
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - B Pottinger
- Royal Cornwall Hospitals NHS Trust Department of Haematology Truro UK
| | - A Zhelyazkova
- The Pennine Acute Hospitals NHS Trust Department of Haematology Manchester UK
| | - F Miall
- University Hospitals of Leicester NHS Trust Department of Haematology Leicester UK
| | - J Rafferty
- Patient Representative, c/o CRUK Southampton Clinical Trials Unit Southampton UK
| | - B Sale
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - F Cucco
- University of Cambridge Department of Pathology Cambridge UK
| | - L Nunn
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - A Coleman
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - G Griffiths
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
| | - M. Q Du
- University of Cambridge Department of Pathology Cambridge UK
| | - C Burton
- Leeds Cancer Centre Haematological Malignancies Diagnostic Service Leeds UK
| | - S Barrons
- Leeds Cancer Centre Haematological Malignancies Diagnostic Service Leeds UK
| | - P Johnson
- University of Southampton Southampton Cancer Research UK (CRUK) Centre CRUK/NIHR Experimental Cancer Medicines Centre CRUK Southampton Clinical Trials Unit Southampton UK
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Toole K, Bull T, Keegan E, Goralewski J, Griffiths G, Hill D, Lee S, Smith KL, Young E, Reinhard M. Training in nuclear forensic science: the Australian experience supporting the development of regional capabilities. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1569139] [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: 10/27/2022]
Affiliation(s)
| | - T. Bull
- ANSTO, Sydney, NSW, Australia
| | | | | | | | - D. Hill
- ANSTO, Sydney, NSW, Australia
| | - S. Lee
- ANSTO, Sydney, NSW, Australia
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Cummin T, Caddy J, Mercer K, Maishman T, Schuh A, Lopez Pascua L, Collins G, McMillan A, Ardeshna K, Galanopoulous A, Burton C, Barrans S, Griffiths G, Johnson P, Davies A. ACCEPT: A PHASE IB/II COMBINATION OF ACALABRUTINIB WITH RITUXIMAB, CYCLOPHOSPHAMIDE, DOXORUBICIN, VINCRISTINE AND PREDNISOLONE (R-CHOP) FOR PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL). Hematol Oncol 2019. [DOI: 10.1002/hon.39_2629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- T.E. Cummin
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - J. Caddy
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - K. Mercer
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - T. Maishman
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - A. Schuh
- Oxford Molecular Diagnostics Centre; University of Oxford; Oxford United Kingdom
| | - L. Lopez Pascua
- Oxford Molecular Diagnostics Centre; University of Oxford; Oxford United Kingdom
| | - G. Collins
- Lymphoma Service; Oxford Univeristy Hospitals; Oxford United Kingdom
| | - A. McMillan
- Department of Haematology; Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | - K. Ardeshna
- Department of Haematology; Univeristy College Hospitals London; London United Kingdom
| | - A. Galanopoulous
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - C. Burton
- Haematological Malignancies Diagnostic Service; Leeds Cancer Centre; Leeds United Kingdom
| | - S. Barrans
- Haematological Malignancies Diagnostic Service; Leeds Cancer Centre; Leeds United Kingdom
| | - G. Griffiths
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - P. Johnson
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
| | - A.J. Davies
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK/ Southampton CRUK Clinical Trials Unit; University of Southampton; Southampton United Kingdom
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Davies A, Tansley Hancock O, Cummin T, Caddy J, Stanton L, Burton C, Barrans S, Coleman A, Osborne W, McKay P, Griffiths G, Johnson P. ARGO: A RANDOMISED PHASE II STUDY OF ATEZOLIZUMAB WITH RITUXIMAB, GEMCITABINE AND OXALIPLATIN IN PATIENTS WITH RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA WHO ARE NOT CANDIDATES FOR HIGH-DOSE THERAPY. Hematol Oncol 2019. [DOI: 10.1002/hon.1_2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A.J. Davies
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - O. Tansley Hancock
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - T. Cummin
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - J. Caddy
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - L. Stanton
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - C. Burton
- Haematological Malignancies Diagnostic Service; St James's University Hospital; Leeds United Kingdom
| | - S. Barrans
- Haematological Malignancies Diagnostic Service; St James's University Hospital; Leeds United Kingdom
| | - A. Coleman
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - W. Osborne
- Freeman Hospital; Newcastle United Kingdom
| | - P. McKay
- Beatson West of Scotland Cancer Centre; Glasgow United Kingdom
| | - G. Griffiths
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
| | - P. Johnson
- Southampton Cancer Research UK (CRUK) Centre/CRUK Southampton Clinical Trials Unit/CRUK Experimental Cancer Medicines Centre UK; University of Southampton; Southampton United Kingdom
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Harries RL, Glasbey J, Gokani VJ, Griffiths G, Allum W. Effect of publishing surgeon-specific outcomes on surgical training. Br J Surg 2019; 106:1019-1025. [DOI: 10.1002/bjs.11150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/16/2018] [Accepted: 02/04/2019] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Over the past 10 years, the National Health Service in England has started to publish surgeon-specific outcomes publicly. The aim of this study was to investigate how this has affected training case exposure for surgeons in training.
Methods
Anonymized data were collected from the Intercollegiate Surgical Curriculum Programme database for operations in each specialty with published surgeon outcomes, involving surgical trainees on an approved training programme between 1 January 2011 and 31 December 2016. Trainee and supervisor involvement in operations before and after the start of publication of surgeon-specific outcomes were compared using mixed-effects models.
Results
A total of 163 076 recorded operative procedures were included. A statistically significant improvement in exposure to training procedures was observed for anterior resection of rectum, carotid endarterectomy, gastrectomy, meningioma excision, prostatectomy and thyroidectomy following the introduction of publication of surgeon outcomes. In coronary artery bypass grafting (CABG) and total hip replacement (THR), however, there was a reduction in involvement in training procedures. This was apparent for both trainee and supervisor involvement in CABG, and for trainee involvement in THR.
Conclusion
Exposure to training procedures has improved rather than declined in the UK in the majority of surgical specialties, since the publication of surgeon-specific outcomes.
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Affiliation(s)
- R L Harries
- Association of Surgeons in Training, 35–43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - J Glasbey
- Association of Surgeons in Training, 35–43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - V J Gokani
- Association of Surgeons in Training, 35–43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - G Griffiths
- Joint Committee on Surgical Training, 35–43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - W Allum
- Joint Committee on Surgical Training, 35–43 Lincoln's Inn Fields, London WC2A 3PE, UK
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Scrimgeour D, Patel R, Patel N, Cleland J, Lee AJ, McKinley AJ, Smith F, Griffiths G, Brennan PA. The effects of human factor related issues on assessors during the recruitment process for general and vascular surgery in the UK. Ann R Coll Surg Engl 2019; 101:231-234. [PMID: 30773892 DOI: 10.1308/rcsann.2019.0008] [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: 11/22/2022] Open
Abstract
INTRODUCTION Healthcare professionals increasingly recognise how human factors (HF) can contribute to medical error. An understanding of HF is also important during other high stakes activities such as summative assessments or examinations. National organisations hosting such events need to be aware of potential fatigue, boredom and stress that can occur in interviewers during these often repetitive activities. METHODS A previously validated questionnaire based around the well known HF analysis and classification system (HFACS) was used to evaluate four factors (care and support, asking questions about the role as an interviewer, working within the rules and boundaries, and stress and pressure) at the 2018 UK general and vascular surgery trainee national selection process. RESULTS A total of 92 questionnaires were completed and analysed (48% response rate). After recoding for negative phrased questions, no significant differences were found between years of experience in the selection process and mean scores obtained for all four factor items. Interviewers had a positive experience during national selection with mean factor scores ranging from 3.84 to 3.98 (out of a maximum satisfaction score of 5). CONCLUSIONS Organisations need to plan carefully and recognise the human element to ensure that their interviewers are cared for during any high stakes assessment such as national selection. Our work suggests that a positive assessor experience will further help contribute to a reliable and fair recruitment process.
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Affiliation(s)
| | - R Patel
- Portsmouth Hospitals NHS Trust , UK
| | - N Patel
- Portsmouth Hospitals NHS Trust , UK
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Scrimgeour DSG, Brennan PA, Griffiths G, Lee AJ, Smith FCT, Cleland J. Does the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination predict 'on-the-job' performance during UK higher specialty surgical training? Ann R Coll Surg Engl 2018; 100:1-7. [PMID: 30286650 PMCID: PMC6204508 DOI: 10.1308/rcsann.2018.0153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Intercollegiate Membership of the Royal College of Surgeons (MRCS) is a mandatory examination to enter higher surgical specialty training in the UK. It is designed to help to ensure that successful candidates are competent to practice as higher surgical trainees. The annual review of competence progression (ARCP) assesses trainees' competence to progress to the next level of training and can be interpreted as a measure of 'on-the-job' performance. We investigated the relationship between MRCS performance and ARCP outcomes. MATERIALS AND METHODS All UK medical graduates who passed MRCS (Parts A and B) from 2007 to 2016 were included. MRCS scores, attempts and sociodemographics for each candidate were crosslinked with ARCP outcomes (satisfactory, unsatisfactory and insufficient evidence). Multinomial logistic regression was used to identify potential independent predictors of ARCP outcomes. RESULTS A total of 2570 trainees underwent 11,064 ARCPs; 1589 (61.8%) had only satisfactory outcomes recorded throughout training; 510 (19.9%) had at least one unsatisfactory outcome; and 471 (18.3%) supplied insufficient evidence. After adjusting for age, gender, first language and Part A performance, ethnicity (non-white vs white, OR 1.36, 95% CI 1.08 to 1.71), Part B passing score (OR 0.98, 95% CI 0.98 to 1.00) and number of attempts at Part B (two or more attempts vs one attempt, OR 1.50, 95% CI 1.16 to 1.94) were found to be independent predictors of an unsatisfactory ARCP outcome. CONCLUSIONS This is the first study to identify predictors of ARCP outcomes during higher surgical specialty training in the UK and provides further evidence of the predictive validity of the MRCS examination.
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Affiliation(s)
- DSG Scrimgeour
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - PA Brennan
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, Scotland, UK
| | - AJ Lee
- Medical Statistics Team, University of Aberdeen, Aberdeen, Scotland, UK
| | - FCT Smith
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - J Cleland
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, Scotland, UK
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Griffiths G, Keegan E, Young E, Wotherspoon A, Palmer T, Lu K, Davis J, Alexander J, Jolly L, Nevers N, Delaunay F, Collins JM, Dimayuga I, Bergeron A, Samuleev P, Dai Z, Holliday K, Robel M, Knight K. Physical characterization of uranium oxide pellets and powder applied in the Nuclear Forensics International Technical Working Group Collaborative Materials Exercise 4. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-017-5678-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hanna G, Griffiths G, Kirkpatrick E, Cozens K, Kalevras M, Maishman T, Danson S, Lester J, Ottensmeier C, Steele N, Szlosarek P, Lord J, Nye M, Fennell D. CONFIRM: a phase III randomised trial to evaluate the efficacy of nivolumab versus placebo in relapsed mesothelioma. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30216-2] [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: 10/18/2022]
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O'Brennan EA, Severn A, Griffiths G, Affleck A. Excision of nonmelanoma skin cancer overlying arteriovenous fistulae. Clin Exp Dermatol 2017; 43:471-472. [PMID: 29266334 DOI: 10.1111/ced.13339] [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] [Accepted: 06/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E A O'Brennan
- Department of Dermatology, Ninewells Hospital, Dundee, UK
| | - A Severn
- Department of Nephrology, Ninewells Hospital, Dundee, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - A Affleck
- Department of Dermatology, Ninewells Hospital, Dundee, UK
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Fennell D, Kirkpatrick E, Cozens K, Danson S, Hanna G, Lester J, Lord J, Nye M, Ottensmeier C, Szlosarek P, Steele N, Kalevras M, Maishman T, Griffiths G. PUB035 CONFIRM: A Phase III Randomized Trial to Evaluate the Efficacy of Nivolumab versus Placebo in Relapsed Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1898] [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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Scrimgeour D, Cleland J, Lee A, Griffiths G, Brennan P. Does the Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination Predict Performance in the General and Vascular Higher Surgical Training Selection Process? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.031] [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: 10/18/2022]
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Pugh S, Bridgewater J, Finch-Jones M, Rees M, O'Reilly D, Peterson M, Davidson B, Hutchins R, Heaton N, Jiao L, Mudan S, Allen A, Mellor J, Griffiths G, Cunningham D, Maughan T, Garden J, Primrose J. Surgical quality and the impact of liver resection on outcome in the new EPOC study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bridgewater J, Pugh S, Whitehead A, Stanton L, Eminton Z, Mellor J, Allen A, Finch-Jones M, Falk S, Iveson T, Rees M, Valle J, Hornbuckle J, Hickish T, Cunningham D, Maughan T, Garden J, Griffiths G, Primrose J. Perioperative chemotherapy with or without cetuximab in patients (pts) with resectable colorectal liver metastasis (CRLM): Mature analysis of overall survival (OS) in the New EPOC randomised controlled trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Scrimgeour DSG, Cleland J, Lee AJ, Griffiths G, McKinley AJ, Marx C, Brennan PA. Impact of performance in a mandatory postgraduate surgical examination on selection into specialty training. BJS Open 2017; 1:67-74. [PMID: 29951608 PMCID: PMC5989976 DOI: 10.1002/bjs5.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/24/2017] [Indexed: 11/11/2022] Open
Abstract
Background The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is undertaken by large numbers of trainees in the UK and internationally as a mandatory step within surgical training. Unlike some high-stakes medical examinations, the MRCS is yet to be validated. A quantitative study was undertaken to assess its predictive validity by investigating the relationship between MRCS (Parts A and B) and national selection interview scores for general and vascular surgery in the UK. Methods Pearson correlation coefficients were used to examine the linear relationship between each assessment, and linear regression analyses were employed to identify potential independent predictors of the national selection score. All UK medical graduates who attempted the interview in 2011-2015 were included. Results Some 84·4 per cent of the candidates (1231 of 1458) were matched with MRCS data. There was a significant positive correlation between the first attempt score at Part B of the MRCS examination and the national selection score (r = 0·38, P < 0·001). In multivariable analysis, 17 per cent of variance in the national selection first attempt score was explained by the Part B MRCS score and number of attempts (change in R 2 value of 0·10 and 0·07 respectively; P < 0·001). Candidates who required more than two attempts at Part B were predicted to score 8·1 per cent less than equally matched candidates who passed at their first attempt. Conclusion This study supports validity of the MRCS examination, and indicates its predictive value regarding entry into specialist training.
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Affiliation(s)
- D S G Scrimgeour
- Centre For Healthcare Education Research and Innovation University of Aberdeen Aberdeen UK.,Department of Colorectal Surgery Aberdeen Royal Infirmary Aberdeen UK.,Intercollegiate Committee for Basic Surgical Examinations London UK
| | - J Cleland
- Centre For Healthcare Education Research and Innovation University of Aberdeen Aberdeen UK
| | - A J Lee
- Department of Medical Statistics University of Aberdeen Aberdeen UK
| | - G Griffiths
- Department of Vascular Surgery Ninewells Hospital Dundee UK
| | - A J McKinley
- Department of Colorectal Surgery Aberdeen Royal Infirmary Aberdeen UK
| | - C Marx
- Royal College of Surgeons of England London UK
| | - P A Brennan
- Intercollegiate Committee for Basic Surgical Examinations London UK
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Cummin T, Araf S, Du M, Barrans S, Bentley M, Clipson A, Wang M, Ahmed S, Rahim T, Shah C, Hamid D, Dhondt J, Maishman T, Vaughan-Spickers N, Pocock C, Forbes A, O'Callaghan A, Westhead D, Griffiths G, Fitzgibbon J, Tooze R, Care M, Burton C, Davies A, Johnson P. PROGNOSTIC SIGNIFICANCE AND CORRELATION TO GENE EXPRESSION PROFILE OF EZH2
MUTATIONS IN DIFFUSE LARGE B-CELL LYMPHOMA (DLBL) IN 2 LARGE PROSPECTIVE STUDIES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_13] [Citation(s) in RCA: 2] [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] [Indexed: 11/05/2022]
Affiliation(s)
- T.E. Cummin
- Cancer Sciences; University of Southampton; Southampton UK
| | - S. Araf
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - M. Du
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - M.A. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Ahmed
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - T. Rahim
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - C. Shah
- Bioinformatics group,IMCB; University of Leeds; Leeds UK
| | - D. Hamid
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Dhondt
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T. Maishman
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - N. Vaughan-Spickers
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - C. Pocock
- Haematology Department; East Kent Hospitals University NHS Foundation Trust; Canterbury UK
| | - A. Forbes
- Haematology Department; Royal Cornwall Hospital; Truro UK
| | - A. O'Callaghan
- Haematology Department; Queen Alexandra Hospital, PO6 3LY; Portsmouth UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - R.M. Tooze
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - C.H. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - A.J. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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21
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Davies A, Barrans S, Maishman T, Cummin T, Bentley M, Mamot C, Novak U, Caddy J, Hamid D, Kazmi-Stokes S, Mcmillan A, Fields P, Pocock C, Kruger A, Collins G, Sha C, Clipson A, Wang M, Tooze R, Care M, Griffiths G, Du M, Westhead D, Burton C, Jack A, Johnson P. DIFFERENTIAL EFFICACY OF BORTEZOMIB IN SUBTYPES OF DIFFUSE LARGE B-CELL LYMPHOMA (DLBL): a PROSPECTIVE RANDOMISED STUDY STRATIFIED BY TRANSCRIPTOME PROFILING: REMODL-B. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A.J. Davies
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - T. Maishman
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T.E. Cummin
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - M. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - C. Mamot
- Swiss Group for Clinical Cancer Research (SAKK); Kantonsspital Aarau; Bern Switzerland
| | - U. Novak
- Swiss Group for Clinical Cancer Research (SAKK); Inselspital / Bern University Hospital; Bern Switzerland
| | - J. Caddy
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - D. Hamid
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - S.H. Kazmi-Stokes
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
| | - A. Mcmillan
- Haematology; Nottingham City Hospital; Nottingham UK
| | - P.A. Fields
- Haematology; Guy's and St Thomas' and King's College Hospitals; London UK
| | - C. Pocock
- Haematology; East Kent Hospitals University NHS Trust; Canterbury UK
| | - A. Kruger
- Haematology; Royal Cornwall Hospital; Truro UK
| | - G. Collins
- Clinical Haematology; Churchill Hospital; Oxford UK
| | - C. Sha
- Bioinformatics group, IMCB; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - R.M. Tooze
- Faculty of Medicine and Health; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - M. Du
- Division of Molecular Histopathology; University of Cambridge; Cambridge UK
| | - D.R. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - C. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - A. Jack
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology, Leeds; Leeds UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton (PMAL Consortium); Southampton UK
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Hurt CN, Falk S, Crosby T, McDonald A, Ray R, Joseph G, Staffurth J, Abrams RA, Griffiths G, Maughan T, Mukherjee S. Long-term results and recurrence patterns from SCALOP: a phase II randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer 2017; 116:1264-1270. [PMID: 28376080 PMCID: PMC5482737 DOI: 10.1038/bjc.2017.95] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/07/2017] [Accepted: 03/17/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND SCALOP, a randomised, phase II trial, tested the activity and safety of gemcitabine (GEM)-based and capecitabine (CAP)-based chemoradiation (CRT) for locally advanced pancreatic cancer (LAPC). Here we present the long-term outcomes. METHODS Eligibility: histologically proven LAPC ⩽7 cm. Following 12 weeks of induction GEMCAP chemotherapy (three cycles: GEM 1000 mg m-2 days 1, 8, 15; CAP 830 mg m-2 days 1-21 q28 days) patients with stable/responding disease, tumour ⩽6 cm, and WHO Performance Status 0-1 were randomised to receive one cycle GEMCAP followed by CAP (830 mg m-2 b.d. on weekdays only) or GEM (300 mg m-2 weekly) with radiation (50.4 Gy per 28 fractions). RESULTS One-hundred fourteen patients (28 UK centres) were registered between 24 December 2009 and 25 October 2011, and 74 were randomised (CAP-RT=36; GEM-RT=38). At the time of this analysis, 105 of the 114 patients had died and the surviving 9 patients had been followed up for a median of 10.9 months (IQR: 2.9-18.7). Updated median OS was 17.6 months (95% CI: 14.6-22.7) in the CAP-CRT arm and 14.6 months (95% CI: 11.1-16.0) in the GEM-CRT arm (intention-to-treat adjusted hazard ratio (HR): 0.68 (95% CI: 0.38-1.21, P=0.185)); median progression-free survival (PFS) was 12.0 months (95% CI: 10.0-15.2) in the CAP-CRT arm and 10.4 months (95% CI: 8.8-12.7) in the GEM-CRT arm (intention-to-treat adjusted HR: 0.60 (95% CI: 0.32-1.14, P=0.120)). In baseline multivariable model, age ⩾65 years, better performance status, CA19.9<613 IU l-1, and shorter tumour diameter predicted improved OS. CAP-CRT, age ⩾65 years, better performance status, CA19.9 <46 IU ml-1 predicted improved OS and PFS in the pre-radiotherapy model. Nine-month PFS was highly predictive of OS. CONCLUSIONS CAP-CRT remains the superior regimen. SCALOP showed that patients with CA19.9 <46 IU ml-1 after induction chemotherapy are more likely to benefit from CRT.
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Affiliation(s)
- C N Hurt
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, Bristol BS2 8ED, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - A McDonald
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - R Ray
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - G Joseph
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - J Staffurth
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - R A Abrams
- Department of Radiation Oncology, Rush University Medical Center, 500 S. Paulina, 013 Atrium Building, Chicago, IL 60612, USA
| | - G Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - T Maughan
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford OX3 7DQ, UK
| | - S Mukherjee
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford OX3 7DQ, UK
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23
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Elsey EJ, Griffiths G, Humes DJ, West J. Meta-analysis of operative experiences of general surgery trainees during training. Br J Surg 2017; 104:22-33. [PMID: 28000937 DOI: 10.1002/bjs.10396] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. METHODS Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. RESULTS The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I2 = 99·6 per cent). CONCLUSION There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.
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Affiliation(s)
- E J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - D J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - J West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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24
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Crosby T, Hurt CN, Falk S, Gollins S, Staffurth J, Ray R, Bridgewater JA, Geh JI, Cunningham D, Blazeby J, Roy R, Maughan T, Griffiths G, Mukherjee S. Long-term results and recurrence patterns from SCOPE-1: a phase II/III randomised trial of definitive chemoradiotherapy +/- cetuximab in oesophageal cancer. Br J Cancer 2017; 116:709-716. [PMID: 28196063 PMCID: PMC5355926 DOI: 10.1038/bjc.2017.21] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The SCOPE-1 study tested the role of adding cetuximab to conventional definitive chemoradiotherapy (dCRT), and demonstrated greater toxicity and worse survival outcomes. We present the long-term outcomes and patterns of recurrence. METHODS SCOPE-1 was a phase II/III trial in which patients were randomised to cisplatin 60 mg m-2 (day 1) and capecitabine 625 mg m-2 bd (days 1-21) for four cycles +/- cetuximab 400 mg m-2 day 1 then by 250 mg m-2 weekly. Radiotherapy consisted of 50 Gy/25# given concurrently with cycles 3 and 4. Recruitment was between February 2008 and February 2012, when the IDMC recommended closure on the basis of futility. RESULTS About 258 patients (dCRT=129; dCRT+cetuximab (dCRT+C)=129) were recruited from 36 centres. About 72.9% (n=188) had squamous cell histology. The median follow-up (IQR) was 46.2 (35.9-48.3) months for surviving patients. The median overall survival (OS; months; 95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (hazard ratio (HR)=1.25, 95% CIs: 0.93-1.69, P=0.137). Median progression-free survival (PFS; months; 95% CI) was 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months, respectively (HR=1.28, 95% CIs: 0.94-1.75; P=0.114). On multivariable analysis only earlier stage, full-dose RT, and higher cisplatin dose intensity were associated with improved OS. CONCLUSIONS The mature analysis demonstrates that the dCRT regimen used in the study provided useful survival outcomes despite its use in patients who were largely unfit for surgery or who had inoperable disease. Given the competing risk of systemic and local failure, future studies should continue to focus on enhancing local control as well as optimising systemic therapy.
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Affiliation(s)
- T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - C N Hurt
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Conwy and Denbighshire NHS Trust, Rhyl LL18 5UJ, UK
| | - J Staffurth
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - R Ray
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - J A Bridgewater
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - J I Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2GW, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London SM2 5PT, UK
| | - J Blazeby
- Centre for Surgical Research, University of Bristol, Bristol BS8 2PS, UK
| | - R Roy
- Diana Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby DN33 2BA, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - G Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton SO16 6YD, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
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Hurt C, Bridgewater J, Falk S, Cummins S, Wasan H, Crosby T, Radhakrishna G, Jephcott C, Roy R, McDonald A, Ray R, Joseph G, Staffurth J, Abrams R, Griffiths G, Maughan T, Mukherjee S. O-003 Long-term outcome from the SCALOP trial: a multi-centre randomized phase II trial of gemcitabine or capecitabine-based chemoradiation (CRT) for locally advanced pancreatic cancer (LAPC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Kiernan M, Chalmers A, Griffiths G. Waiting for test results before isolating patients with Clostridium difficiledisease may be associated with increased transmission. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474795 DOI: 10.1186/2047-2994-4-s1-p26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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27
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Dreyer B, Dreyer S, Griffiths G. Post-operative fluid prescribing: Is teaching adequate in the undergraduate curriculum? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hillen M, Seymour J, Yeo J, Griffiths G, Howd A. A prospective study to establish whether the malnutrition universal screening tool (MUST) score can independently predict outcomes of patients undergoing reconstructive surgery or amputation for critical limb ischaemia (CLI). Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.627] [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: 11/15/2022]
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29
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Rees J, Hurt CN, Gollins S, Mukherjee S, Maughan T, Falk SJ, Staffurth J, Ray R, Bashir N, Geh JI, Cunningham D, Roy R, Bridgewater J, Griffiths G, Nixon LS, Blazeby JM, Crosby T. Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer. Br J Cancer 2015; 113:603-10. [PMID: 26203761 PMCID: PMC4647690 DOI: 10.1038/bjc.2015.258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 03/03/2015] [Revised: 05/07/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here. METHODS Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented. RESULTS Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups. CONCLUSIONS CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.
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Affiliation(s)
- J Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C N Hurt
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, North Wales, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - S J Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Staffurth
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Ray
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - N Bashir
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Roy
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - G Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - L S Nixon
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
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31
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Neal R, Hurt C, Roberts K, Rogers T, Hamilton W, Edwards RT, Tod A, Parker D, Jones ET, Nelson A, Prout H, Hood K, Griffiths G. 220 A feasibility randomised controlled trial looking at the effect on lung cancer diagnosis of giving a chest X-ray to smokers aged over 60 with new chest symptoms – the ELCID trial. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70220-x] [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: 10/25/2022]
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Nixon L, Mukherjee S, Wills L, Millin T, Bridges S, Abrams R, Joseph G, Griffiths G, Hurt C, Staffurth J. The SCALOP Trial Plan Assessment Form (PAF) as a Tool for Radiation Therapy Trials Quality Assurance (RTTQA). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.804] [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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Griffiths G, Herwig A, Schneider WX. Stimulus localization interferes with stimulus recognition: Evidence from an attentional blink paradigm. J Vis 2013; 13:13.7.7. [DOI: 10.1167/13.7.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Application for a Certificate of Completion of Training (CCT) in general surgery includes assessment of a validated logbook. The content of a satisfactory logbook has long been an area of contention. The logbook allows trainees to record their operative experience and to show the level of supervision. It is tempting to set a specific number of procedures to be completed by the end of training. However, such a number must be evidence based rather than chosen subjectively.
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Affiliation(s)
- W Allum
- Past Chairman, General Surgery Specialist Advisory Committee
| | - S Hornby
- President, Association of Surgeons in Training
| | - G Khera
- Past President, Association of Surgeons in Training
| | - E Fitzgerald
- Past President, Association of Surgeons in Training
| | - G Griffiths
- Past Chairman, Association of Surgeons in Training
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Stimpson A, Griffiths G, Murray J. An unusual case of hip pain in a keen runner. Br J Hosp Med (Lond) 2013; 74:110-1. [PMID: 23411982 DOI: 10.12968/hmed.2013.74.2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Stimpson
- Department of Trauma and Orthopaedics, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taff CF72 8XR.
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Barrett-Lee PJ, Casbard A, Abraham J, Grieve R, Wheatley D, Simmons P, Coleman R, Hood K, Griffiths G, Murray N. Abstract PD07-09: Zoledronate versus ibandronate comparative evaluation (ZICE) trial - first results of a UK NCRI 1,405 patient phase III trial comparing oral ibandronate versus intravenous zoledronate in the treatment of breast cancer patients with bone metastases. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd07-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction Bone metastases in patients with breast cancer have serious effects on health including pain, poor mobility, skeletal fractures, spinal cord compression and the need for radiotherapy/surgery. The introduction of intravenous (IV) bisphosphonates, such as zoledronic acid (Z) has significantly delayed the onset of skeletal-related events (SRE). However, prolonged IV bisphosphonates place burdens upon patient and hospital, and can also cause renal and acute phase toxicities. Ibandronic acid (I), a third generation amino-bisphosphonate in its oral form has previously been compared with placebo and was shown to be well tolerated and effective. Indirect comparisons with IV Z indicated similar efficacy in reducing bone events, but adverse events were overall comparable with placebo. One might therefore assume that oral ibandronate would be more acceptable to patients, and the ZICE Trial is the only large scale direct randomised comparison between IV Z and oral I to report.
Methods Between January 2006 and October 2010, 1405 newly diagnosed metastatic breast cancer patients with proven bone metastases were randomised 1:1 to IV Z (4mg 15 min infusion every 3–4 weeks) or oral I (50mg per day) for up to 96 weeks. All patients were prescribed daily calcium & vitamin D supplementation, and patients with current active dental problems including infection were excluded. Patients also received chemotherapy, and or endocrine therapy as determined by their physician. The primary objective was to demonstrate non-inferiority of oral I in comparison with IV Z in terms of the SRE rate, defined as the number of SREs reported per year (using multiple event analysis). Secondary endpoints included time to 1st SRE, proportion of patients with SRE, Pain Scores, side effect profiles including ONJ and renal toxicities, quality of life and Health resources and overall survival. The trial was run under the auspices of the NCRI, sponsored by Velindre NHS Trust, coordinated by the Wales Cancer Trials Unit, funded by an educational grant from Roche and peer reviewed/endorsed by Cancer Research UK (CRUKE/04/022).
Results At the time of this analysis the last randomised patient had completed 96 weeks of therapy, median follow up was 18.4 months and total number of SREs was 865 (468 in I and 397 in Z). For the primary objective, the SRE rate was 0.543 and 0.444 in I and Z groups respectively (Hazard ratio, 1.22; 95% CI, 1.04 to 1.45; P = .017). Ibandronate failed to meet the criteria for non-inferiority to Zoledronate, but was similar in delaying time to first SRE (hazard ratio, 1.11; 95% CI, 0.94 to 1.31; P = .233). Overall survival (disease progression), was very similar between groups but renal AEs occurred more frequently with Z than I; Compliance with oral therapy was 82%. ONJ rate was very low in both arms (0.71%, I; 1.29%, Z; P = 0.28).
Conclusion Oral I is inferior to Z in terms of the SRE rate in metastatic breast cancer patients with bone metastases, but is similar to Z in delaying time to first SRE. Both drugs had acceptable safety profiles, with adverse events consistent with those reported previously.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD07-09.
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Affiliation(s)
- PJ Barrett-Lee
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - A Casbard
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - J Abraham
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - R Grieve
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - D Wheatley
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - P Simmons
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - R Coleman
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - K Hood
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - G Griffiths
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
| | - N Murray
- Velindre NHS Trust, Cardiff, Wales, United Kingdom; Cardiff University School of Medicine, Cardiff, Wales, United Kingdom; University Hospital, Coventry, England, United Kingdom; Royal Cornwall Hospital, Truro, England, United Kingdom; University Hospital, Southampton, England, United Kingdom; Weston Park Hospital, Sheffield, England, United Kingdom; Royal Adelaide Hospital, Adelaid, South Australia, Australia
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Griffiths G, Schneider WX. Memory-guided saccading and letter encoding in visual working memory share attentional resources: Evidence from SOA-based interference effects. J Vis 2012. [DOI: 10.1167/12.9.1332] [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: 11/24/2022] Open
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Byrne A, Adamson D, Sivell S, Griffiths G, Crosby T, Staffurth J, Cohen D, Blazeby J, Fitzgibbon J, Nelson A. Palliative radiotherapy in addition to self-expanding metal stent for improving outcomes of dysphagia and survival in advanced oesophageal cancer: ROCS (Radiotherapy after Oesophageal Cancer Stenting) Study. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000264.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ardeshirpour Y, Chernomordik V, Capala J, Hassan M, Zielinsky R, Griffiths G, Achilefu S, Smith P, Gandjbakhche A. Using in-vivo fluorescence imaging in personalized cancer diagnostics and therapy, an image and treat paradigm. Technol Cancer Res Treat 2012; 10:549-60. [PMID: 22066595 DOI: 10.1177/153303461101000605] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The major goal in developing drugs targeting specific tumor receptors, such as Monoclonal AntiBodies (MAB), is to make a drug compound that targets selectively the cancer-causing biomarkers, inhibits their functionality, and/or delivers the toxin specifically to the malignant cells. Recent advances in MABs show that their efficacy depends strongly on characterization of tumor biomarkers. Therefore, one of the main tasks in cancer diagnostics and treatment is to develop non-invasive in-vivo imaging techniques for detection of cancer biomarkers and monitoring their down regulation during the treatment. Such methods can potentially result in a new imaging and treatment paradigm for cancer therapy. In this article we have reviewed fluorescence imaging approaches, including those developed in our group, to detect and monitor Human Epidermal Growth Factor 2 (HER2) receptors before and during therapy. Transition of these techniques from the bench to bedside is the ultimate goal of our project. Similar approaches can be used potentially for characterization of other cancer related cell biomarkers.
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Affiliation(s)
- Y Ardeshirpour
- NIH/National Institute of Child Health and Human Development, 9 Memorial Dr., Bethesda, MD 20892, USA
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Lester J, Nixon L, Mayles P, Mayles H, Tsang Y, Ionescu A, Courtier N, Nahum A, Fenwick J, Eswar C, Malik Z, Mohammed N, Griffiths G. 156 The I-START trial: ISoToxic Accelerated RadioTherapy in locally advanced non-small cell lung cancer. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70157-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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41
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Gwynne S, Spezi E, Staffurth J, Palaniappan N, Wills L, Hurt C, Nixon L, Evans M, Griffiths G, Crosby T. Inter-observer Variation in Outlining of Pre-trial Test Case in the SCOPE1 Trial: A United Kingdom Definitive Chemoradiotherapy Trial for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Fortes AD, Griffiths G, Needs RJ, Pickard CJ, Hansen T. High-pressure polymorphism of ammonia hydrates. Acta Crystallogr A 2011. [DOI: 10.1107/s010876731109934x] [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: 11/10/2022] Open
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43
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Thomas AL, Wilson RH, Steward WP, Adams RA, Bridges SE, Casbard AC, Maughan T, Griffiths G. A randomized phase II study of irinotecan, 5-fluorouracil, and folinic acid (FOLFIRI) with or without the addition of an endothelin receptor antagonist in patients with metastatic colorectal cancer after failure of oxaliplatin-containing chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps161] [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: 11/20/2022] Open
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44
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Barrett-Lee PJ, Murray N, Abraham J, Casbard A, Clements H, Maughan TS, Griffiths G. Interim safety data on the ZICE trial: A randomized phase III, open-label, multicener, parallel group clinical trial to evaluate and compare the efficacy, safety profile, and tolerability of oral ibandronate versus intravenous zoledronate in the treatment of patients with breast cancer with bone metastases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1085] [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: 11/20/2022] Open
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45
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Mukherjee S, Hurt C, Griffiths G, Crosby T, Staffurth J, Bridges S, Bridgewater JA, Mcdonald A, Falk S, Maughan TS. A Cancer Research UK multicenter randomized phase II study of induction chemotherapy followed by gemcitabine- or capecitabine-based chemoradiotherapy for locally advanced nonmetastatic pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps222] [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: 11/20/2022] Open
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46
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Koch F, Pagel J, Ehl S, Griffiths G, Hennies HC, Beutel K, Horstmann M, zur Stadt U. Functional characterisation of Munc18–2 missense mutations in patients with familial hemophagocytic lymphohistiocytosis type 5 (FHL-5). Klin Padiatr 2010. [DOI: 10.1055/s-0030-1254490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Young J, Mofidi R, Howd A, Griffiths G. An Unusual Cause of Recurrent Pulmonary Emboli. Eur J Vasc Endovasc Surg 2009. [DOI: 10.1016/j.ejvs.2009.03.030] [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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48
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Highley M, Griffiths G, Uscinska B, Huddart R, Barber J, Parmar M, Harper P. A Phase II Trial of Continuous 5-Fluorouracil in Recurrent or Metastatic Transitional Cell Carcinoma of the Urinary Tract. Clin Oncol (R Coll Radiol) 2009; 21:394-400. [DOI: 10.1016/j.clon.2009.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 12/15/2008] [Accepted: 01/28/2009] [Indexed: 11/30/2022]
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Dorman S, Jolley C, Abernethy A, Currow D, Johnson M, Farquhar M, Griffiths G, Peel T, Moosavi S, Byrne A, Wilcock A, Alloway L, Bausewein C, Higginson I, Booth S. Researching breathlessness in palliative care: consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. Palliat Med 2009; 23:213-27. [PMID: 19251835 DOI: 10.1177/0269216309102520] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathlessness is common in advanced disease and can have a devastating impact on patients and carers. Research on the management of breathlessness is challenging. There are relatively few studies, and many studies are limited by inadequate power or design. This paper represents a consensus statement of the National Cancer Research Institute Palliative Care Breathlessness Subgroup. The aims of this paper are to facilitate the design of adequately powered multi-centre interventional studies in breathlessness, to suggest a standardised, rational approach to breathlessness research and to aid future 'between study' comparisons. Discussion of the physiology of breathlessness is included.
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Affiliation(s)
- S Dorman
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole.
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50
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Capala J, Kramer-Marek G, Lee S, Hassan M, Kiesewetter DO, Puri A, Chernomordik V, Gandjbakhche A, Griffiths G, Blumenthal R. Molecular targeting of HER2 for diagnosis and therapy of breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #6004
Background: Expression of HER2 receptors in breast cancer is correlated with poor prognosis and may be different in distant metastases as compared to the primary tumor. We are developing methods to assess global expression of HER2 in vivo and to deliver therapeutic agents specifically to HER2-positve cells.
 Materials and Methods: As the targeting agent we use an Affibody molecule (http://www.affibody.com). These very stable and highly soluble proteins are relatively small (8.3 kDa) and bind to HER2 receptors with high affinity (22 pM). For imaging with PET, SPECT, or optical methods, an appropriate group containing the imaging beacon can be attached by a selective chemical reaction to a unique C-terminal cysteine residue of Affibody. For therapeutic purposes, they can be conjugated to multifunctional nanoparticles containing both imaging and therapeutic agents. We have conjugated affibody molecules with thermo-sensitive liposomes or gold nanoparticles (subsequently activated with neutrons) and characterized their biodistribution using optical imaging and SPECT, respectively. We used PET imaging with 18F-ZHER2-Affibody to monitor the down-regulation of HER2 following four doses (50 mg/kg) of 17-dimethylaminoethylamino-17-demethoxy-geldanamycin, 17-DMAG, an inhibitor of Hsp90 known to decrease HER2 expression. Animals were scanned before and after treatment. Immediately after the last scan, the mice were euthanized and tumors were frozen for ex-vivo analysis of receptor expression. For optical imaging, we used AlexaFluor dyes conjugated with affibody molecules containing an albumin binding domain that extended their circulation time. We have attached nanoparticles (liposomes and gold) to Affibody molecules using the same type of maleimide chemistry.
 Results: Our results showed that Affibody molecules do not affect the targeted cells and that their binding does not interfere with either the binding or the effectiveness of trastuzumab. 18F-ZHER2-Affibody was eliminated quickly from blood and normal tissues, providing high tumor/blood and tumor/muscle ratios by 1h post injection. The signal obtained from PET and optical imaging correlated well with the number of receptors expressed in the studied tumors as assessed by western blot, ELISA, and IHC. Following 17-DMAG treatment, the level of HER2 expression, estimated by PET imaging, in BT474 and Mcf-7/clone18 tumors decreased 70% and 30%. This change was confirmed by the biodistribution studies, ELISA and western blot.
 Discussion: This strategy, involving assessment of target presence and distribution in an individual patient followed by optimized, target-specific drug delivery, may significantly improve efficacy of breast cancer treatment while reducing side effects.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6004.
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Affiliation(s)
- J Capala
- 1 National Cancer Institute, NIH, Bethesda, MD
| | | | - S Lee
- 1 National Cancer Institute, NIH, Bethesda, MD
| | - M Hassan
- 2 National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - DO Kiesewetter
- 3 National Institute of Biomedical Imaging and Bioengineering, NIH, Bethesda, MD
| | - A Puri
- 1 National Cancer Institute, NIH, Bethesda, MD
| | - V Chernomordik
- 2 National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - A Gandjbakhche
- 2 National Institute of Child Health and Human Development, NIH, Bethesda, MD
| | - G Griffiths
- 4 Imaging Probe Development Center, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
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