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Abstract
Adolescent screen usage is ubiquitous and influences development and behavior. Longitudinal screen usage data coupled with psychometrically valid constructs of problematic behaviors can provide insights into these relationships. We describe methods by which the screen usage questionnaire was developed in the Adolescent Brain Cognitive Development (ABCD) Study, demonstrate longitudinal changes in screen usage via child report and describe data harmonization baseline-year 2. We further include psychometric analyses of adapted social media and video game addiction scales completed by youth. Nearly 12,000 children ages 9-10 years at baseline and their parents were included in the analyses. The social media addiction questionnaire (SMAQ) showed similar factor structure and item loadings across sex and race/ethnicities, but that item intercepts varied across both sex and race/ethnicity. The videogame addiction questionnaire (VGAQ) demonstrated the same configural, metric and scalar invariance across racial and ethnic groups, however differed across sex. Video gaming and online social activity increased over ages 9/10-11/12 (p's < 0.001). Compared with boys, girls engaged in greater social media use (p < .001) and demonstrated higher ratings on the SMAQ (p < .001). Compared with girls, boys played more video games (p < .001) and demonstrated higher ratings on the VGAQ (p < .001). Time spent playing video games increased more steeply for boys than girls from age 9/10-11/12 years (p < .001). Black youth demonstrated significantly higher SMAQ and VGAQ scores compared to all other racial/ethnic groups. These data show the importance of considering different screen modalities beyond total screen use and point towards clear demographic differences in use patterns. With these comprehensive data, ABCD is poised to address critical questions about screen usage changes across adolescence.
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Optimal timing of pacemaker implantation after cardiac surgery: should we wait 12 days? A 5-year observational study from a UK tertiary centre. Europace 2022. [DOI: 10.1093/europace/euac053.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Post-operative bradycardia is common but intrinsic rhythm often recovers. There is little consensus on the optimum time to wait between cardiac surgery and the implantation of a permanent pacemaker (PPM). Earlier device implantation may facilitate shorter length of stay. However, it may expose some patients who have no long-term pacing requirement to the risks associated with device therapy. This study aimed to understand how the number of days between cardiac surgery and PPM implantation is associated with pacing dependence and recovery of intrinsic conduction by 30 days.
Methods
We examined healthcare records of consecutive patients who underwent cardiac surgery at our centre between 01/01/2015 to 01/01/2021. The primary outcome measures were pacing dependence (PD) at 30 days and recovery of intrinsic conduction at 30 days. Recovery was defined as showing evidence of intrinsic rhythm at the 30 day check after being pacing dependent at the time of implant. Patient demographics, baseline ECG characteristics and surgical procedure were recorded. Time to pacemaker implantation and pacing indication were identified.
Pacing checks at 30 days post implant were reviewed and PD defined as no intrinsic rhythm seen over a 30 second period with base rate set at 40bpm. Univariate analysis and binary logistic regression were used to determine factors significantly associated with the primary outcome measures. Subsequent receiver-operator characteristic (ROC) analysis was used to determine the optimal timing of pacemaker implantation as defined by the Youden Index. This aims to maximise sensitivity and specificity of days to implant in predicting PD and conduction recovery at 30 days.
Results
Following 5849 operations, 103 (1.8%) patients underwent PPM implantation for a new bradycardic indication. The baseline characteristics of those paced are summarised in table 1. Numerous factors were associated with pacing dependence at 30 days on univariate analysis (table 2). However, multivariate analysis showed that only PD at implant and days to implant (DTI) were significant predictors of PD at 30 days. The only significant association with conduction recovery was DTI.
ROC analysis showed that the optimal DTI is 12 days for a variety of analyses: 1.) Predicting PD at 30 days for all patients (AUC 0.620, SE 0.056, p=0.031, 95% CI 0.511-0.730) 2.) Predicting PD in patients whose PPM indication was AV nodal dysfunction (AUC 0.706, p=0.001, Youden Index (YI) 1.34). 3.) Predicting recovery of intrinsic rhythm in patients who were pacing dependent at implant (AUC 0.80, p= 0.000, YI 1.515).
Conclusions
The number of days between surgery and pacemaker implantation is the only factor significantly associated with both pacing dependence and recovery of intrinsic conduction at 30 days. The optimum time to wait is 12 days to allow time for intrinsic conduction to recover.
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The acute haemodynamic response with endocardial biventricular pacing: comparing RV paced and LBBB patients. Europace 2022. [DOI: 10.1093/europace/euac053.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Background
A third of patients that receive cardiac resynchronisation (CRT) are non-responders. Predictors of positive response include broader QRS duration, non-ischaemic aetiology and sinus rhythm, but it is still unclear whether lead placement site determines a positive responder.
Purpose
We assessed the acute haemodynamic response of endocardial biventricular pacing in patients with intrinsic left bundle brunch block (LBBB) versus LBBB due to pre-existing right ventricular pacing (RVP).
Methods
Patients who fulfilled standard criteria for CRT implantation but had failed conventional (coronary sinus) left ventricular (LV) lead placement (primary or revision) or were deemed clinical ‘non-responders after > 6 months of conventional CRT were enrolled. The acute haemodynamic response during endocardial biventricular pacing was assessed with a roving LV lead at 9 different locations (basal and mid: septal, anterior, posterior and lateral walls and apex). Acute changes in beat-to-beat systolic blood pressure (SBP) in the left ventricle were recorded and analysed.
Results
We recruited 23 patients across 10 UK centres: 14 intrinsic LBBB and 9 dependent on RVP. Patient characteristics were comparable: age (mean 67 + 10.6 years vs. 62 + 15.4 years), ischaemic (63% vs 50%), QRS (160 + 18ms vs. 190 + 36ms, p =0.07). Of the RVP group 5/9 had septal RV leads (the remainder apically positioned).
There was no difference in the SBP improvement between the groups: change in SBP ranged from -5.25 – 19.91mmHg (median 3mmHg) in RVP patients vs -5.92 – 23.03mmHg (median 3mmHg) for intrinsic LBBB. However, the improvement in SBP was more consistent across the different segments in the patients with RVP (group A), as compared to intrinsic LBBB (group B), where the lateral wall and then non-septal walls provided the greatest haemodynamic improvement.
Figure 1: depicts SBP improvement (in mmHg) during endocardial biventricular pacing in different positions within the LV for patients with RVP (A) vs underlying intrinsic LBBB (B): 9 segment model of the LV: Ant (anterior wall), Lat (lateral wall), Post (posterior wall), Sept (septum). Outer ring represents the four basal LV locations, middle ring the mid LV locations and centre ring the apex. Scale depicts mmHg improvement in SBP.
Conclusion
When implanting an LV lead for patients who are RV pacing dependent any position within the LV provides an acute haemodynamic improvement, compared with those with intrinsic LBBB, where a targeted lateral wall approach is more important. This finding corroborates the key differences in LV activation patterns for induced versus intrinsic LBBB.
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OC-0105 PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Evaluation of oncological outcomes and data quality in studies assessing nerve sparing versus non-nerve sparing radical prostatectomy in non-metastatic prostate cancer: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative. Br J Oral Maxillofac Surg 2021; 59:831-836. [PMID: 34272114 DOI: 10.1016/j.bjoms.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though not all units offered the full range of service audited. Users suggest the skin and ODA audits were sufficiently clear, but improvement is required in the oncology and reconstruction questionnaire particularly. The pilot was successful in aiding the project team identify areas of weaknesses and strength in the design of the REDCap registry and implementation of the next phase of the initiative. The information and experience gained has to date enabled a successful application for section 251 approval from the HRA and progress for the next phase of national data collection.
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BAOMS QOMS (Quality and Outcomes in Oral and Maxillofacial Surgery), a specialty-wide quality improvement initiative: progress since conception. Br J Oral Maxillofac Surg 2021; 59:619-622. [PMID: 33985849 DOI: 10.1016/j.bjoms.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022]
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Men's experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study. Cancer Causes Control 2021; 32:261-269. [PMID: 33394204 PMCID: PMC7870600 DOI: 10.1007/s10552-020-01380-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT. Supplementary Information The online version of this article (10.1007/s10552-020-01380-3) contains supplementary material, which is available to authorized users.
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The National Psoriasis Foundation psoriasis treatment targets in real‐world patients: prevalence and association with patient‐reported outcomes in the Corrona Psoriasis Registry. J Eur Acad Dermatol Venereol 2020; 34:2051-2058. [DOI: 10.1111/jdv.16274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/27/2020] [Indexed: 01/12/2023]
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The role of primary care in management of rare diseases in Ireland. Ir J Med Sci 2020; 189:771-776. [PMID: 31933130 PMCID: PMC7363724 DOI: 10.1007/s11845-019-02168-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
Background ‘Slaintecare’ aims to address complex patient care needs in an integrated fashion with an emphasis on patient-centred, patient-empowered community care.Currently there is a lack of knowledge of the impact of rare disease management in primary care and of the information tools required by general practitioners to deliver integrated care for rare disease patients. Aims To complete a pilot survey to estimate the general practice clinical workload attributable to selected rare diseases and assess the use of relevant information sources. Methods A retrospective cross-sectional survey was carried out of general practice consultations (2013–2017) for patients with 22 commonly recognised rare diseases. Results Around 31 general practitioners from 10 Irish practices completed information on 171 patients with rare diseases over 3707 consultations. General practice-specific coding systems were inadequate for rare disease patient identification. Over 139 (81.3%) patients were adult, and 32 (18.7%) were children. Management of care was hospital and not primary care based in 63%. Those eligible for state-reimbursed care had a significantly higher median number of consultations (23 consultations, IQR = 13–37, or 5.8 consultations/year) than those who paid privately (10 consultations, IQR = 4–19, or 2.5 consultations/year) (p < 0.005).General practitioners had access to public information resources on rare diseases but few had knowledge of (35.5%), or had ever used (12.9%) Orphanet, the international rare disease information portal. Conclusions Both specific rare disease-specific coding and use of the relevant rare disease information sources are lacking in general practice in Ireland.
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The association of ethnicity and Hispanic acculturation status with advance directive completion among older patients in an integrated health system. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Prospective cohort study of surgical trainee experience of access to gastrointestinal endoscopy training in the UK and Ireland. Int J Surg 2019; 67:113-116. [PMID: 30708061 DOI: 10.1016/j.ijsu.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Surgical trainees are reporting barriers to training in gastrointestinal (GI) endoscopy. This snapshot survey aimed to gather data on variation in access to quality GI endoscopy training for Colorectal and Upper Gastrointestinal (GI) surgical trainees across the UK and Ireland. MATERIALS AND METHODS An online 20-point survey was designed and distributed nationally to surgical trainee members of the Association of Surgeons in Training (ASiT), Dukes and The Roux Group (formerly Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland Trainees). The survey was designed in collaboration with The Roux Group for Upper GI trainees and the Dukes' Club for Colorectal trainees. RESULTS 218 responses were received, most with a Colorectal or Upper GI sub-specialty interest (colorectal 56.0%; upper GI surgery 25.7%). Only 28.6% of trainees attended a dedicated training endoscopy list at least once a week with 28.1% not attending any at all. Less than half of trainees reported having endoscopy formally timetabled on rotas (36.9%). Most trainees (88.0%) encountered difficulties in gaining endoscopy training including lack of available lists (77.2%), conflicting operative commitments (59.4%), preferential allocation of lists to gastroenterology trainees (57.9%) and resistance from endoscopy departmental leads (38.6%). Regarding JAG accreditation, 77.1% respondents felt it should be mandatory prior to CCT with 80.3% believing this would lead to better access to dedicated endoscopy training equivalent to gastroenterology trainees. 93.1% trainees felt that attaining JAG accreditation by surgical trainees was important to patient care. DISCUSSION This study demonstrates significant barriers in accessing GI endoscopy training for general surgical trainees which urgently needs to be improved. In order to meet JAG training requirements for surgical trainees, a multifaceted collaborative approach from surgical and gastroenterology training bodies, local JAG trainers and the General Surgery SAC and JCST is required. This is to ensure that endoscopy is promoted and a robust model of training is successfully designed and delivered to general surgery trainees.
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Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci 2018; 32:121-129. [PMID: 29636283 PMCID: PMC6447367 DOI: 10.1016/j.dcn.2018.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 01/06/2023] Open
Abstract
Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.
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Session 2: Extramural vascular invasion and extranodal deposits: should they be treated the same? Colorectal Dis 2018; 20 Suppl 1:43-48. [PMID: 29878681 DOI: 10.1111/codi.14078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Professor Nagtegaal has already highlighted that lymph nodes are probably not responsible for the development of liver metastases. If they are not, then is there another mechanism? Professor Haboubi addresses the question of extranodal deposits - their frequency and their importance in the development of metastatic disease. The experts review the evidence and discuss whether this information will alter treatment decisions and staging systems in the future.
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EXTREQOL Identifies Ongoing Challenges in Maximising Quality of Survival in Men with Metastatic Castrate-resistant Prostate Cancer. Clin Oncol (R Coll Radiol) 2018; 30:331-333. [PMID: 29459101 DOI: 10.1016/j.clon.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
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P215 Continuous positive airway pressure (cpap) versus auto-cpap (apap) for the initial treatment of obstructive sleep apnoea syndrome: clinical efficacy and cost. Sleep Breath 2017. [DOI: 10.1136/thoraxjnl-2017-210983.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Joint testing of the 3 Tesla ST40 spherical tokamak toroidal field coil test assembly. FUSION ENGINEERING AND DESIGN 2017. [DOI: 10.1016/j.fusengdes.2017.04.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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99Temporary pacing optimisation post cardiac surgery. Are we missing a trick? Europace 2017. [DOI: 10.1093/europace/eux283.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P613Nurse-led pre-admission clinics for percutaneous coronary intervention (PCI) patients are beneficial and are positively evaluated by patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Patient-centred dietetic care from the perspectives of older malnourished patients. J Hum Nutr Diet 2017; 30:574-587. [PMID: 28543671 DOI: 10.1111/jhn.12478] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Governing organisations for health services currently recommend a patient-centred (PC) approach to practice for all health professions, including dietetics. For the vulnerable older malnourished patient, this approach needs to be prioritised to improve outcomes. The paucity of patient experience data likely limits evidence-based, patient-centred care (PCC) from being implemented effectively. The present study aimed to identify quality indicators of dietetic services from the perspectives of older malnourished patients to inform evidence-based PC dietetic care. METHODS Surveys were completed by a sample of 28 females and 28 males (mean age 81 years) who had been seen by a dietitian for malnutrition assessment. In-depth, face-to-face, semi-structured interviews were undertaken with a sub-sample of four females and six males (mean age 81 years). Interviews were transcribed verbatim. Thematic analysis of transcripts and open-ended survey responses was conducted to determine patient-identified quality indicators. RESULTS Three structure indicators (continuity of care through regular contact and post-discharge dietetic follow-up; interdisciplinary coordination and collaboration; and high-quality hospital food services), five process indicators (addressing a patient's primary medical concern; involving the patient's family; providing clear and simple dietetic information; providing expert dietary knowledge; utilising interpersonal communication skills) and three outcome indicators (improvement in health status; improvement or maintenance of independence; weight gain) were identified. The experiences of older malnourished patients with dietetic services, as described in the present study, reinforce the importance of ensuring high-quality and tailored dietetic care as a key element of PC dietetic services. CONCLUSIONS The quality indicators of dietetic services identified in the present study may facilitate dietitians to provide evidence-based PCC for older malnourished patients.
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OC-0126: A gene expression assay to predict the risk of distant metastases in localized prostate cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30569-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Patient mobility for radical prostatectomy in the English NHS: its impact on service configuration and technology integration. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30677-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Clinical management and research priorities for high-risk prostate cancer in the UK: Meeting report of a multidisciplinary panel in conjunction with the NCRI Prostate Cancer Clinical Studies Localised Subgroup. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816651362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of high-risk prostate cancer has become increasingly sophisticated, with refinements in radical therapy and the inclusion of adjuvant local and systemic therapies. Despite this, high-risk prostate cancer continues to have significant treatment failure rates, with progression to metastasis, castrate resistance and ultimately disease-specific death. In an effort to discuss the challenges in this field, the UK National Clinical Research Institute’s Prostate Cancer Clinical Studies localised subgroup convened a multidisciplinary national meeting in the autumn of 2014. The remit of the meeting was to debate and reach a consensus on the key clinical and research challenges in high-risk prostate cancer and to identify themes that the UK would be best placed to pursue to help improve outcomes. This report presents the outcome of those discussions and the key recommendations for future research in this highly heterogeneous disease entity.
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Abstract
BACKGROUND Robust data on patient-reported outcome measures comparing treatments for clinically localized prostate cancer are lacking. We investigated the effects of active monitoring, radical prostatectomy, and radical radiotherapy with hormones on patient-reported outcomes. METHODS We compared patient-reported outcomes among 1643 men in the Prostate Testing for Cancer and Treatment (ProtecT) trial who completed questionnaires before diagnosis, at 6 and 12 months after randomization, and annually thereafter. Patients completed validated measures that assessed urinary, bowel, and sexual function and specific effects on quality of life, anxiety and depression, and general health. Cancer-related quality of life was assessed at 5 years. Complete 6-year data were analyzed according to the intention-to-treat principle. RESULTS The rate of questionnaire completion during follow-up was higher than 85% for most measures. Of the three treatments, prostatectomy had the greatest negative effect on sexual function and urinary continence, and although there was some recovery, these outcomes remained worse in the prostatectomy group than in the other groups throughout the trial. The negative effect of radiotherapy on sexual function was greatest at 6 months, but sexual function then recovered somewhat and was stable thereafter; radiotherapy had little effect on urinary continence. Sexual and urinary function declined gradually in the active-monitoring group. Bowel function was worse in the radiotherapy group at 6 months than in the other groups but then recovered somewhat, except for the increasing frequency of bloody stools; bowel function was unchanged in the other groups. Urinary voiding and nocturia were worse in the radiotherapy group at 6 months but then mostly recovered and were similar to the other groups after 12 months. Effects on quality of life mirrored the reported changes in function. No significant differences were observed among the groups in measures of anxiety, depression, or general health-related or cancer-related quality of life. CONCLUSIONS In this analysis of patient-reported outcomes after treatment for localized prostate cancer, patterns of severity, recovery, and decline in urinary, bowel, and sexual function and associated quality of life differed among the three groups. (Funded by the U.K. National Institute for Health Research Health Technology Assessment Program; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 .).
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Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention. Heart 2016; 102:1980-1987. [PMID: 27504003 PMCID: PMC5256395 DOI: 10.1136/heartjnl-2015-308660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 11/05/2022] Open
Abstract
Objective We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term. Methods In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI. Results From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics. Conclusions Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar.
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OP0186 Immune Complex Bound U1 and Y1 RNA Correlates with Interferon-Stimulated Gene Expression and Disease Activity: An Observational Study of Sysytemic Lupus Erythematosus Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Associations of Eating Two Breakfasts With Childhood Overweight Status, Sociodemographics, and Parental Factors Among Preschool Students. HEALTH EDUCATION & BEHAVIOR 2016; 43:665-673. [PMID: 27162242 DOI: 10.1177/1090198116629421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND School breakfast may contribute to increased risk for obesity because children may be consuming two breakfasts: at home and at school. The purpose of this study is to determine the prevalence of preschoolers consuming two breakfasts and to assess relationships with overweight/obesity and other factors. METHOD Head Start parents (n = 273, 84.6% Hispanic) in the southwest completed cross-sectional surveys on child breakfast patterns and parental perceptions of school breakfast and personal breakfast consumption habits. Surveys were linked with sociodemographics and body mass index in Head Start databases in 2013. General estimating equation binomial models (schools as a random effect) were used to assess the relationship between two breakfasts (at home and school) and key variables, adjusting for gender, race, ethnicity, and household income. RESULTS The prevalence of consuming two breakfasts was 34%. Children's overweight/obesity status was inversely related to two-breakfast consumption, but it was significant only for the Hispanic subgroup; the odds of being overweight/obese was 60% lower among those who ate two breakfasts (p < .05). The likelihood of consuming a second breakfast increased over twofold among children who woke up before 7 a.m. (p = .004). Among Hispanic families, a significant association was observed between children's two-breakfast consumption and parental perceptions about whether they perceived the breakfast at Head Start was culturally appropriate (p = .040). CONCLUSIONS Not only was eating two breakfast not associated with obesity, the association was in the opposite of the expected direction and significant for Hispanic participants. Factors such as earlier wake-up time were related to reports of two breakfast intake. While more research is needed, these findings provide information for policy makers and practitioners; caution should be exercised when suggesting that breakfast programs may be related to the consumption of two breakfasts and the risk for childhood obesity, particularly among the preschool students in this study.
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Abstract P3-14-07: Intra-cellular dsRNA receptor RIG-I: A ubiquitous novel target for treatment of chemotherapy drug resistant breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-14-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Toll-like receptor 3 (TLR3), the cell surface receptor for double stranded RNA (dsRNA), expressed in ∼40% of advanced primary breast cancers (T2/T3/N+) has been shown to be an effective therapeutic target for synthetic dsRNA poly A:U in combination with radiation and adjuvant chemotherapy, producing a significant decrease in risk of metastatic relapse (HR 1.85-2.0; 1.03-3.89; Cancer Res;71:1607).
AIM: The present pre-clinical study aimed to explore the therapeutic potential of a ubiquitously expressed intracellular dsRNA receptor, retinoic-acid-inducible gene-I (RIG-I) - a cytoplasmic pathogen recognition receptor directed at pathogen-associated molecular pattern (PAMP) motifs to differentiate viral from cellular dsRNAs. We have shown Ampligen, poly I:C12U (a synthetic dsRNA polymer designed to rapidly degrade in vivo to prevent the toxicity of long dsRNA polymers such as poly I:C) is capable of entering cells in its fragmented dsRNA oligomeric form (<1–2 kb) optimal for activation of intra-cellular RIG-I (J Exp Med 2008;205:1601–1610).
METHODOLOGY & RESULTS: Preliminary experiments with Ampligen on several human breast cancer cell lines (MCF-7 & MDA-MB 453) and normal human mammary epithelial & fibroblast cell lines (HMEC & HFC) unexpectedly showed it to consistently cause a significant loss of cell viability (CellTiter-Glo Luminescent Cell Viability Assay) in p53-deficient drug resistant (5-FU/doxorubicin) MDA-MB 453 cell line in contrast to cell growth arrest (Guava cell Cycle Assay) in p53 wild type MCF-7 cancer and the two non-neoplastic cells lines. This selective effect was confirmed using syngeneic clones of MCF-7 breast cancer cells stably transfected with a dominant negative p53 construct or vector alone: p53-function blocked (DD1) vs p53-function active (EV1) MCF-7 cell lines, respectively (J Nucl Med 2006; 47:1525–1530), and shown to be associated with RIG-I specific mRNA induction (RT-PCR) and Type I interferon pathway activation both inhibited by BX795 (selective inhibitor of IRF3 activation and IFN-b production). Decitabine (DNA demethylating drug capable of intra-cellular generation of dsRNA through transcriptional activation of Alu retrotransposons - PNAS 2012; December 10: E89–E98 ) was next tested as an alternative source of intra-cellular dsRNA, and found to produce results similar to Ampligen on DD1 and EV1. Work is in progress to examine dose response and time-course relationships of the effects Ampligen or decitabine added singly or in combination with chemotherapeutic drug (e.g. doxorubicin) on DD1 and triple negative breast cancer cell lines such as MDA-MB 453 to explore potential therapeutically most effective protocols.
PROVISIONAL CONCLUSIONS: Intra-cellular dsRNA receptor RIG-I constitutively expressed in all cells offers a more ubiquitous target compared to TLR3 for the treatment of breast cancer. Ampligen and decitabine with their selective growth inhibitory effect on drug resistant p53-deficient breast cancer cell lines, merit testing as novel drugs for treatment of p53-deficient drug resistant breast cancer e.g. triple negative breast cancer frequently (∼70%) associated with drug resistance and altered p53 status.
Citation Format: Jasani B, Navabi N, Barrett-Lee P, Thompson A, Chester J, Mason M. Intra-cellular dsRNA receptor RIG-I: A ubiquitous novel target for treatment of chemotherapy drug resistant breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-14-07.
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Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328283 DOI: 10.1186/1532-429x-17-s1-p104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Infarct burden following multivessel PCI vs. infarct-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328183 DOI: 10.1186/1532-429x-17-s1-o9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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S27 Predictive performance of STOPBANG questionnaire for diagnosis of sleep apnoea in a cardiac surgical cohort. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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S28 Effect of sleep apnoea on post-operative outcomes in cardiac surgery. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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191 Potential interactions between Interleukin-20 and Transglutaminase 4 might affect prostate cancer cell function. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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110 Infarct Burden Following Multivessel PCI Vs. Infarct-Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 110 Table 1. BRITISH HEART JOURNAL 2015. [DOI: 10.1136/heartjnl-2015-308066.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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109 Left Ventricular Outcomes Following Multivessel PCI Vs. Infarct -Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 109 Table 1. BRITISH HEART JOURNAL 2015. [DOI: 10.1136/heartjnl-2015-308066.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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PO-0734: Long term outcomes stratified by age for men treated with monotherapy I-125 permanent brachytherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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LEFT VENTRICULAR OUTCOMES FOLLOWING MULTIVESSEL PCI VERSUS INFARCT-ONLY PCI IN PATIENTS WITH ACUTE STEMI: THE GLASGOW PRAMI CMR SUB-STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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P292 Validation Of The Stop-bang Questionnaire As A Screening Tool For Sleep Apnoea In Patients Undergoing Ablation For Paroxysmal Atrial Fibrillation. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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RT-19 * PROGNOSTIC VALUE OF EARLY CHANGES IN NEUTROPHIL AND LYMPHOCYTE MEASURES DURING CHEMORADIOTHERAPY FOR GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou270.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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71 * Does triage of patients diagnosed by paramedics with ventricular tachycardia directly to arrhythmia centres improve patient care? Europace 2014. [DOI: 10.1093/europace/euu243.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patient-Reported Outcomes: Correlation of MDASI-HN and Clinical Support Required for Patients Receiving Curative Head and Neck Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Impact of D90 on PSA Outcomes in Men Treated With Low-Dose-Rate Prostate I125 Monotherapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Impact of Node Status and Radiotherapy on Failure-Free Survival in Patients with Newly Diagnosed Non-Metastatic Prostate Cancer: Data from >690 Patients in the Control Arm of the Stampede Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Second primary cancers occurring after I-125 brachytherapy as monotherapy for early prostate cancer. Clin Oncol (R Coll Radiol) 2014; 26:210-5. [PMID: 24507938 DOI: 10.1016/j.clon.2014.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
AIMS Prostate brachytherapy may be associated with a lower risk of radiation-induced second primary cancer (SPC) as a significantly smaller volume of normal tissue is irradiated when compared with external beam techniques. Limited data are available as it has been a routine treatment option for less than 20 years. This study identified cases of SPC in patients who underwent I-125 prostate brachytherapy as monotherapy in a single institution. MATERIALS AND METHODS SPC incidence was retrieved by conducting a UK cancer registry search (Northern and Yorkshire Cancer Registry and Information Service) for 1805 consecutive patients with localised prostate cancer who received monotherapy with I-125 brachytherapy from 1995 to 2006 at a single public hospital. Of 1730 UK residents, the completeness of the registry match was 91% (1574 patients). The mean age at treatment (interquartile range) of the cohort was 63 (58-68) years with 1100 patients (70%) over the age of 60 years at treatment. The median (range) follow-up was 8 (6-10) years with 487 patients (31%) having 10 years or more. RESULTS In total, 170 patients (10.8%) were diagnosed with second primaries (1 year or more after implant); 20 of these were bladder and 10 rectal cancers. The 10 year cumulative incidences were 14.6, 1 and 0.84% for any second malignancy, bladder and rectal cancer, respectively. Only the standardised incidence rate (SIR) for bladder cancer was higher at 1.54 (95% confidence interval 0.96-2.46) compared with the general population. The SIR for bladder cancer was higher in the first few years after treatment, suggesting that the increased incidence of bladder cancer is due to increased urological surveillance. CONCLUSIONS Overall, the incidence of SPC after I-125 is comparable with other published data with no significant excess more than 5 years from treatment. Mortality secondary to SPC of the bladder or rectum is unusual.
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P253 Obstructive sleep apnoea syndrome: Patients’ experience of the driver and vehicle licensing agency: Abstract P253 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Evaluating the interaction between progesterone, tumor necrosis factor-alpha and cortisol on early loss of transferred embryo in beef cows. CANADIAN JOURNAL OF ANIMAL SCIENCE 2013. [DOI: 10.4141/cjas2012-099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mason, M., Cuadra, E. J., Elsasser, T. H., Lopez, J. and Yoonsung, J. 2013. Evaluating the interaction between progesterone, tumor necrosis factor-alpha and cortisol on early loss of transferred embryo in beef cows. Can. J. Anim. Sci. 93: 217–225. Fifty-eight non-lactating cows previously synchronized for estrus were assigned to two treatments to assess the effects of progesterone supplementation and its correlation with tumor necrosis factor-α (TNF-α) and cortisol on the survival of the transferred embryos. On day 7 after exhibiting estrus (day 0), cows in both groups received embryos. In contrast with the control group, animals in the CIDR-group had a controlled internal drug release (CIDR) additionally inserted. Blood samples for progesterone, TNF-α and cortisol analysis were taken immediately before insertion and removal of CIDRs and 7 d after insertion. Progesterone did not differ between the control and the CIDR animals at any day of the study; however, it significantly increased at 7 and 14 d after insertion of the embryos in the control animals, compared with the levels observed in that same experimental group at the time of the transfer. Regardless of the treatment, all pregnant cows experienced a significant increase in progesterone from day 0 to day 7. Progesterone on day 0 was correlated to itself (r=0.46) on day 14 and to TNF-α (r=−0.37) on day 0 in pregnant animals; TNF-α on day 7 was significantly higher in pregnant cows compared with non-pregnant and correlated between day 0 and day 14. These results suggest that high levels of progesterone during the first 14 d after the transfer are indicative of the survival of transferred embryos. Additionally, these data also indicate that the decrease in TNF-α concentration on day 7 after the transfer of embryos may be associated with the low concentrations of progesterone observed in the non-pregnant animals.
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106 Cabazitaxel adverse events are manageable in senior adults with metastatic castration-resistant prostate cancer (mCRPC): Results of the European Compassionate Use Programme. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s1569-9056(13)60598-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Neoadjuvant androgen deprivation therapy for prostate volume reduction, lower urinary tract symptom relief and quality of life improvement in men with intermediate- to high-risk prostate cancer: a randomised non-inferiority trial of degarelix versus goserelin plus bicalutamide. Clin Oncol (R Coll Radiol) 2012; 25:190-6. [PMID: 23257248 DOI: 10.1016/j.clon.2012.09.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/02/2012] [Accepted: 08/14/2012] [Indexed: 12/14/2022]
Abstract
AIMS The treatment of intermediate- to high-risk prostate cancer with radical radiotherapy is usually in combination with neoadjuvant androgen deprivation therapy. The aim of the present trial was to investigate whether degarelix achieves comparable efficacy with that of goserelin plus bicalutamide as neoadjuvant therapy before radiotherapy. MATERIALS AND METHODS The study was a randomised, parallel-arm, active-controlled, open-label trial in 244 men with a UICC prostate cancer TNM category T2b-T4, N0, M0, Gleason score ≥7, or prostate-specific antigen ≥10 ng/ml and a total prostate volume >30 ml, who were scheduled to undergo radical radiotherapy and in whom neoadjuvant androgen deprivation therapy was indicated. Eligible patients received treatment with either monthly degarelix (240/80 mg) or goserelin (3.6 mg) for 12 weeks, the latter patients also receiving bicalutamide (50 mg) for 17 days initially. The primary efficacy measure was the mean percentage reduction in total prostate volume from baseline at week 12 measured by transrectal ultrasound. The severity and relief of lower urinary tract symptoms were assessed by the International Prostate Symptom Score questionnaire. Quality of life was assessed by the eighth question of the International Prostate Symptom Score. About 50% of the patients had moderate to severe lower urinary tract symptoms at baseline. RESULTS The total prostate volume decreased significantly from baseline to week 12 in both treatment groups, reaching -36.0 ± 14.5% in degarelix-treated patients and -35.3 ± 16.7% in goserelin-treated patients (adjusted difference: -0.3%; 95% confidence interval: -4.74; 4.14%). At the end of the therapy, more degarelix- than goserelin-treated patients reported International Prostate Symptom Score decreases of ≥3 points (37% versus 27%, P = 0.21). In addition, in patients with a baseline International Prostate Symptom Score of ≥13, the magnitude of the decrease was larger in degarelix- (n = 53) versus goserelin-treated patients (n = 17) (6.04 versus 3.41, P = 0.06). CONCLUSIONS The efficacy of degarelix in terms of prostate shrinkage is non-inferior to that of goserelin plus bicalutamide. The added benefits of degarelix in terms of more pronounced lower urinary tract symptom relief in symptomatic patients could be the reflection of differences in the direct effects on extra-pituitary receptors in the lower urinary tract [Clinicaltrials.gov ID: NCT00833248].
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