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Perry N, Boulton KA, Hodge A, Ong N, Phillips N, Howard K, Raghunandan R, Silove N, Guastella AJ. A psychometric investigation of health-related quality of life measures for paediatric neurodevelopment assessment: Reliability and concurrent validity of the PEDS-QL, CHU-9D, and the EQ-5D-Y. Autism Res 2024; 17:972-988. [PMID: 38597587 DOI: 10.1002/aur.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
There is a need for tools that can provide a brief assessment of functioning for children with neurodevelopmental conditions, including health-related quality of life (HR-QoL). This study evaluated the psychometric properties of three commonly used and well known HR-QoL measures in a cohort of children presenting to clinical developmental assessment services. The most common diagnoses received in these assessment services were autism spectrum disorders. Findings showed good internal consistency for the PedsQL and the CHU-9D, but not the EQ-5D-Y. This research also found that the CHU-9D, EQ-5D-Y, and PedsQL correlated with relevant functioning domains assessed by the VABS-III. Overall, the measures showed that children with neurodevelopmental conditions experienced poor HR-QoL. The majority of children (>86%) met cut-off criteria for significant health concerns on the PedsQL. On the EQ-5D-Y and CHU-9D, they showed reduced HR-QoL particularly on domains relating to school and homework, being able to join in activities, looking after self, and doing usual activities. This study supports the use of the CHU-9D and PedsQL in this population to assess and potentially track HR-QoL in a broad neurodevelopment paediatric population.
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Affiliation(s)
- N Perry
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - K A Boulton
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - A Hodge
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Ong
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Phillips
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - K Howard
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - R Raghunandan
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - N Silove
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Child Development Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - A J Guastella
- Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Kümin M, Deery J, Turney S, Price C, Vinayakam P, Smith A, Filippa A, Wilkinson-Guy L, Moore F, O'Sullivan M, Dunbar M, Gaylard J, Newman J, Harper CM, Minney D, Parkin C, Mew L, Pearce O, Third K, Shirley H, Reed M, Jefferies L, Hewitt-Gray J, Scarborough C, Lambert D, Jones CI, Bremner S, Fatz D, Perry N, Costa M, Scarborough M. Reducing Implant Infection in Orthopaedics (RIIiO): Results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on postoperative infections following orthopaedic implant surgery. J Hosp Infect 2019; 103:412-419. [PMID: 31493477 DOI: 10.1016/j.jhin.2019.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Active warming during surgery prevents perioperative hypothermia but the effectiveness and postoperative infection rates may differ between warming technologies. AIM To establish the recruitment and data management strategies needed for a full trial comparing postoperative infection rates associated with forced air warming (FAW) versus resistive fabric warming (RFW) in patients aged >65 years undergoing hemiarthroplasty following fractured neck of femur. METHODS Participants were randomized 1:1 in permuted blocks to FAW or RFW. Hypothermia was defined as a temperature of <36°C at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections. FINDINGS A total of 515 participants were randomized at six sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7% in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were four deep surgical site infections in the FAW group and three in the RFW group. All participants who developed a postoperative infection had antibiotic prophylaxis, a cemented prosthesis, and were operated under laminar airflow; none was hypothermic. There were no serious adverse events related to warming. CONCLUSION Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate.
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Affiliation(s)
- M Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Deery
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - S Turney
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - C Price
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - P Vinayakam
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Smith
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Filippa
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - F Moore
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - M O'Sullivan
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - M Dunbar
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - J Gaylard
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Newman
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C M Harper
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - D Minney
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - C Parkin
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - L Mew
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - O Pearce
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - K Third
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - H Shirley
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - M Reed
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - L Jefferies
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Hewitt-Gray
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Lambert
- Brighton and Sussex Medical School, Brighton, UK
| | - C I Jones
- Brighton and Sussex Medical School, Brighton, UK
| | - S Bremner
- Brighton and Sussex Medical School, Brighton, UK
| | - D Fatz
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - N Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Scarborough
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Horne R, Glendinning E, King K, Chalder T, Sabin C, Walker AS, Campbell LJ, Mosweu I, Anderson J, Collins S, Jopling R, McCrone P, Leake Date H, Michie S, Nelson M, Perry N, Smith JA, Sseruma W, Cooper V. Protocol of a two arm randomised, multi-centre, 12-month controlled trial: evaluating the impact of a Cognitive Behavioural Therapy (CBT)-based intervention Supporting UPtake and Adherence to antiretrovirals (SUPA) in adults with HIV. BMC Public Health 2019; 19:905. [PMID: 31286908 PMCID: PMC6615195 DOI: 10.1186/s12889-019-6893-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background Delay to start antiretroviral therapy (ART) and nonadherence compromise the health and wellbeing of people living with HIV (PLWH), raise the cost of care and increase risk of transmission to sexual partners. To date, interventions to improve adherence to ART have had limited success, perhaps because they have failed to systematically elicit and address both perceptual and practical barriers to adherence. The primary aim of this study is to determine the efficacy of the Supporting UPtake and Adherence (SUPA) intervention. Methods This study comprises 2 phases. Phase 1 is an observational cohort study, in which PLWH who are ART naïve and recommended to take ART by their clinician complete a questionnaire assessing their beliefs about ART over 12 months. Phase 2 is a randomised controlled trial (RCT) nested within the observational cohort study to investigate the effectiveness of the SUPA intervention on adherence to ART. PLWH at risk of nonadherence (based on their beliefs about ART) will be recruited and randomised 1:1 to the intervention (SUPA intervention + usual care) and control (usual care) arms. The SUPA intervention involves 4 tailored treatment support sessions delivered by a Research Nurse utilising a collaborative Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (MI) approach. Sessions are tailored to individual needs and preferences based on the individual patient’s perceptions and practical barriers to ART. An animation series and intervention manual have been developed to communicate a rationale for the personal necessity for ART and illustrate concerns and potential solutions. The primary outcome is adherence to ART measured using Medication Event Monitoring System (MEMS). Three hundred seventy-two patients will be sufficient to detect a 15% difference in adherence with 80% power and an alpha of 0.05. Costs will be compared between intervention and control groups. Costs will be combined with the primary outcome in cost-effectiveness analyses. Quality adjusted life-years (QALYs) will also be estimated over the follow-up period and used in the analyses. Discussion The findings will enable patients, healthcare providers and policy makers to make informed decisions about the value of the SUPA intervention. Trial registration The trial was retrospectively registered 21/02/2014, ISRCTN35514212. Electronic supplementary material The online version of this article (10.1186/s12889-019-6893-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK.
| | - E Glendinning
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - K King
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - C Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - A S Walker
- MRC Clinical Trials Unit at UCL, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK
| | - L J Campbell
- HIV Research Centre, King's College London, London, SE5 9RJ, UK
| | - I Mosweu
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - J Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital, E9 6RS, London, UK
| | - S Collins
- HIV i-Base, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - R Jopling
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
| | - P McCrone
- Institute of Psychiatry at King's College London, Denmark Hill, London, SE5 8AF, UK
| | - H Leake Date
- Departments of of Pharmacy and HIV Medicine, Brighton & Sussex University Hospitals NHS Trust, Brighton, BN2 5B, UK
| | - S Michie
- Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - M Nelson
- Kobler Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - N Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, UK
| | - J A Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - W Sseruma
- UK-CAB, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - V Cooper
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, BMA House, Tavistock Square, London, WC1H 9JP, UK
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Sewell J, Daskalopoulou M, Nakagawa F, Lampe FC, Edwards S, Perry N, Wilkins E, O'Connell R, Jones M, Collins S, Speakman A, Phillips AN, Rodger AJ. Accuracy of self-report of HIV viral load among people with HIV on antiretroviral treatment. HIV Med 2017; 18:463-473. [PMID: 28004523 PMCID: PMC5516233 DOI: 10.1111/hiv.12477] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess, among people living with HIV, knowledge of their latest HIV viral load (VL) and CD4 count. METHODS Agreement between self-report and clinic record was assessed among 2771 HIV-diagnosed individuals on antiretroviral treatment (ART) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes Study (2011-2012). A confidential self-completed questionnaire collected information on demographic, socioeconomic, HIV-related and health-related factors. Participants were asked to self-report their latest VL [undetectable (≤ 50 copies/mL), detectable (> 50 copies/mL) or "don't know"] and CD4 count (< 200, 200-350, 351-500 or > 500 cells/μL, or "don't know"). Latest clinic-recorded VL and CD4 count were documented. RESULTS Of 2678 participants on ART, 434 (16.2%) did not accurately report whether their VL was undetectable. Of 2334 participants with clinic-recorded VL ≤ 50 copies/mL, 2061 (88.3%) correctly reported undetectable VL; 49 (2.1%) reported detectable VL; 224 (9.6%) did not know their VL. Of 344 participants with clinic-recorded VL > 50 copies/mL, 183 (53.2%) correctly reported detectable VL; 76 (22.1%) reported undetectable VL; 85 (24.7%) did not know their VL. Of 2137 participants who reported undetectable VL, clinic-recorded VL was ≤ 50 copies/mL for 2061 (96.4%) and <1000 copies/mL for 2122 (99.3%). In analyses adjusted for gender/sexual orientation, ethnicity, age and time since starting ART, factors strongly associated with inaccurate self-report of VL (including "don't know") included socioeconomic disadvantage [prevalence ratio (95% CI) for "not" vs. "always" having enough money for basic needs: 2.4 (1.9, 3.1)], poor English fluency [3.5 (2.4, 5.1) vs. UK born], nondisclosure of HIV status [1.7 (1.3, 2.1)], ART nonadherence [2.1 (1.7, 2.7) for three or more missed doses vs. none in the past 2 weeks] and depressive symptoms (PHQ-9 score ≥ 10) [1.9 (1.6, 2.2)]. Overall, 612 (22.9%) of 2667 participants on ART did not accurately self-report whether or not their CD4 count was ≤ 350 cells/μL. CONCLUSIONS There is a high level of accuracy of a self-report of undetectable VL in people on ART in the UK. Overall, accurate knowledge of personal VL level varied according to demographic, socioeconomic, HIV-related and health-related factors. Active identification of people who may benefit from increased levels of support and engagement in care is important.
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Affiliation(s)
- J Sewell
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - M Daskalopoulou
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - F Nakagawa
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - FC Lampe
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - S Edwards
- Mortimer Market CentreCentral and North West London NHS Foundation TrustLondonUK
| | - N Perry
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - E Wilkins
- Pennine Acute Hospitals NHS TrustManchesterUK
| | | | - M Jones
- East Sussex Healthcare NHS TrustEastbourneUK
| | | | - A Speakman
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - AN Phillips
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
| | - AJ Rodger
- Research Department of Infection & Population HealthUniversity College LondonLondonUK
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6
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Cooper V, Clatworthy J, Youssef E, Llewellyn C, Miners A, Lagarde M, Sachikonye M, Perry N, Nixon E, Pollard A, Sabin C, Foreman C, Fisher M. Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review. BMC Health Serv Res 2016; 16:677. [PMID: 27899106 PMCID: PMC5129660 DOI: 10.1186/s12913-016-1914-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/07/2016] [Accepted: 11/09/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Increasing numbers of people with HIV are living into older age and experiencing comorbidities. The development of new models of care to meet the needs of this population is now a priority. It is important that the views and preferences of patients inform the development of services in order to maintain high levels of patient satisfaction and engagement. The aim of this systematic review was to determine which aspects of healthcare are particularly valued by people living with HIV. METHODS We searched electronic databases and reference lists of relevant articles. The search strategy was developed to identify articles reporting on HIV positive patients' perceptions, evaluations or experiences of healthcare services and factors associated with satisfaction with care. Peer-reviewed papers and conference abstracts were included if the study reported on aspects of health care that were valued by people living with HIV, data were collected during the era of combination therapy (from 1996 onwards), and the paper was published in English. A thematic approach to data synthesis was used. RESULTS Twenty-three studies met the inclusion criteria. Studies used both qualitative and quantitative methods. Six studies specifically reported on relative importance to patients of different aspects of care. The valued aspects of care identified were grouped into seven themes. These highlighted the importance to patients of: a good health care professional-patient relationship, HIV specialist knowledge, continuity of care, ease of access to services, access to high quality information and support, effective co-ordination between HIV specialists and other healthcare professionals, and involvement in decisions about treatment and care. We were unable to determine the relative importance to patients of different aspects of care because of methodological differences between the studies. CONCLUSIONS This review identified several attributes of healthcare that are valued by people living with HIV, many of which would be relevant to any future reconfiguration of services to meet the needs of an ageing population. Further research is required to determine the relative importance to patients of different aspects of care.
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Affiliation(s)
- V. Cooper
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
| | - J. Clatworthy
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
| | - E. Youssef
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
| | - C. Llewellyn
- Division of Public Health & Primary Care, Brighton & Sussex Medical School, Room 317 Mayfield House, Falmer, Brighton, BN1 9PH UK
| | - A. Miners
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - M. Lagarde
- Health Services Research Unit, Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1E 9SY UK
| | - M. Sachikonye
- UK Community Advisory Board Country United Kingdom (England), c/o HIV i-Base, 4th Floor, 57 Great Suffolk Street, London, SE1 0BB UK
| | - N. Perry
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
| | - E. Nixon
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
| | - A. Pollard
- Division of Public Health & Primary Care, Brighton & Sussex Medical School, Room 317 Mayfield House, Falmer, Brighton, BN1 9PH UK
| | - C. Sabin
- UCL Medical School, Infection and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - C. Foreman
- NHS England, Southside - Mezzanine Floor, 105 Victoria Street, London, SW1E 6QT UK
| | - M. Fisher
- Elton John Centre, Sussex House, Brighton and Sussex University Hospitals NHS Trust, 1 Abbey Road, Brighton, BN2 1ES UK
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7
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Miners AH, Llewellyn CD, Cooper VL, Youssef E, Pollard AJ, Lagarde M, Sabin C, Nixon E, Sachikonye M, Perry N, Fisher M. A discrete choice experiment to assess people living with HIV's (PLWHIV's) preferences for GP or HIV clinic appointments. Sex Transm Infect 2016; 93:105-111. [PMID: 27535762 PMCID: PMC5339551 DOI: 10.1136/sextrans-2016-052643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To understand which aspects of general practitioner (GP) and HIV clinic appointments people living with HIV (PLWHIV) most value when seeking advice for new health problems. METHODS A discrete choice experiment using a convenience sample of people diagnosed with HIV. Participants were recruited from 14 general HIV clinics in the South East of England between December 2014 and April 2015. ORs were calculated using conditional logit (CLOGIT) and latent class models (LCMs). RESULTS A total of 1106 questionnaires were returned. Most participants were male (85%), white (74%) and were men who have sex with men (69%). The CLOGIT analysis showed people particularly valued shorter appointment waiting times (ORs between 1.52 and 3.62, p<0.001 in all instances). The LCM analysis showed there were two distinct classes, with 59% and 41% of respondents likely to be in each. The first class generally preferred GP to HIV clinic appointments and particularly valued 'being seen quickly'. For example, they had strong preferences for shorter appointment waiting times and longer GP opening hours. People in the second class also valued shorter waiting times, but they had a strong general preference for HIV clinic rather than GP appointments. CONCLUSIONS PLWHIV value many aspects of care for new health problems, particularly short appointment waiting times. However, they appear split in their general willingness to engage with GPs.
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Affiliation(s)
- A H Miners
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - C D Llewellyn
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - V L Cooper
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - E Youssef
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - A J Pollard
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - M Lagarde
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - C Sabin
- HIV Epidemiology & Biostatistics Group, University College London, London, UK
| | - E Nixon
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Sachikonye
- UK Community Advisory Board Country (UKCAB), London, UK
| | - N Perry
- Brighton and Sussex Clinical Trials Unit, Brighton and Sussex Medical Schools, Brighton, UK
| | - M Fisher
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Affiliation(s)
- N Mody
- King's College Hospital NHS Foundation Trust; London UK
| | - N Perry
- Brighton & Sussex University Hospitals NHS Trust; Brighton UK
- Brighton & Sussex Medical School; Brighton UK
| | - D Richardson
- Brighton & Sussex University Hospitals NHS Trust; Brighton UK
- Brighton & Sussex Medical School; Brighton UK
| | - L Barbour
- Brighton & Sussex University Hospitals NHS Trust; Brighton UK
| | - M Fisher
- Brighton & Sussex University Hospitals NHS Trust; Brighton UK
- Brighton & Sussex Medical School; Brighton UK
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9
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Luu M, Patel J, Kittleson M, Czer L, Aintablian T, Norland K, Perry N, Chang D, Hamilton M, Geft D, Kobashigawa J. Lower Dose Tacrolimus Monotherapy in Heart Transplant Patients: Is It Safe. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.794] [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: 11/30/2022] Open
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10
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Patel J, Kittleson M, Czer L, Aintablian T, Sharoff R, Rodriguez G, Kearney B, Perry N, Hage A, Esmailian F, Kobashigawa J. Severity of Hypertension After Heart Transplant: Does It Impact Outcome? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.840] [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: 11/16/2022] Open
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11
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Ong KJ, Thornton AC, Fisher M, Hutt R, Nicholson S, Palfreeman A, Perry N, Stedman-Bryce G, Wilkinson P, Delpech V, Nardone A. Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England. HIV Med 2015; 17:247-54. [PMID: 26394818 DOI: 10.1111/hiv.12293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. METHODS Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. RESULTS In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. CONCLUSIONS Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.
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Affiliation(s)
- K J Ong
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A C Thornton
- Department of Infection and Population Health, University College London, London, UK
| | - M Fisher
- Brighton and Sussex University Hospital, Brighton, UK
| | - R Hutt
- NHS South East London, Public Health Lewisham, London, UK
| | - S Nicholson
- Brighton and Hove City Council, Brighton, UK
| | | | - N Perry
- Brighton and Sussex University Hospital, Brighton, UK
| | | | - P Wilkinson
- Brighton and Hove City Council, Brighton, UK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A Nardone
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
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12
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Kiryu Y, Landsberg JH, Peters EC, Tichenor E, Burleson C, Perry N. Pathological effects of cyanobacteria on sea fans in southeast Florida. J Invertebr Pathol 2015; 129:13-27. [PMID: 25958261 DOI: 10.1016/j.jip.2015.04.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 11/24/2022]
Abstract
In early August 2008, observations by divers indicated that sea fans, particularly Gorgonia ventalina, Gorgonia flabellum, and Iciligorgia schrammi, were being covered by benthic filamentous cyanobacteria. From August 2008 through January 2009 and again in April 2009, tissue samples from a targeted G. ventalina colony affected by cyanobacteria and from a nearby, apparently healthy (without cyanobacteria) control colony, were collected monthly for histopathological examination. The primary cellular response of the sea fan to overgrowth by cyanobacteria was an increase in the number of acidophilic amoebocytes (with their granular contents dispersed) that were scattered throughout the coenenchyme tissue. Necrosis of scleroblasts and zooxanthellae and infiltration of degranulated amoebocytes were observed in the sea fan surface tissues at sites overgrown with cyanobacteria. Fungal hyphae in the axial skeleton were qualitatively more prominent in cyanobacteria-affected sea fans than in controls.
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Affiliation(s)
- Y Kiryu
- Fish and Wildlife Research Institute (FWRI), Florida Fish and Wildlife Conservation Commission (FWC), 100 Eighth Avenue SE, St. Petersburg, FL 33701, USA.
| | - J H Landsberg
- Fish and Wildlife Research Institute (FWRI), Florida Fish and Wildlife Conservation Commission (FWC), 100 Eighth Avenue SE, St. Petersburg, FL 33701, USA.
| | - E C Peters
- Department of Environmental Science and Policy, George Mason University, Fairfax, VA 22030, USA.
| | - E Tichenor
- Palm Beach County Reef Rescue, Boynton Beach, FL 33425, USA.
| | - C Burleson
- Fish and Wildlife Research Institute (FWRI), Florida Fish and Wildlife Conservation Commission (FWC), 100 Eighth Avenue SE, St. Petersburg, FL 33701, USA.
| | - N Perry
- Fish and Wildlife Research Institute (FWRI), Florida Fish and Wildlife Conservation Commission (FWC), 100 Eighth Avenue SE, St. Petersburg, FL 33701, USA.
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13
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Jamero G, Kittleson M, Patel J, Liou F, Yu Z, Dilibergo D, Perry N, Chang D, Czer L, Hage A, Esmailian F, Kobashigawa J. Are First Year Mycophenolate Trough Levels Associated With the Subsequent Outcomes After Heart Transplant? Transplantation 2014. [DOI: 10.1097/00007890-201407151-01433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Whitlock GG, Warwick Z, Perry N, Ottewill M, Richardson D, Fisher M, Gilson R. Why do men who have sex with men and who are at high risk of HIV infection, decline HIV testing? Int J STD AIDS 2013; 24:503. [DOI: 10.1177/0956462412473886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G G Whitlock
- Centre for Sexual Health & HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, off Capper Street, London WC1E 6JB
| | - Z Warwick
- Plymouth Hospitals Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH
| | - N Perry
- Brighton & Sussex Hospital Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - M Ottewill
- Brighton & Sussex Hospital Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - D Richardson
- Brighton & Sussex Hospital Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - M Fisher
- Brighton & Sussex Hospital Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - R Gilson
- Centre for Sexual Health & HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, off Capper Street, London WC1E 6JB
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Perry N, Cheasty T, Dallman T, Launders N, Willshaw G. Application of multilocus variable number tandem repeat analysis to monitor Verocytotoxin-producing Escherichia coli O157 phage type 8 in England and Wales: emergence of a profile associated with a national outbreak. J Appl Microbiol 2013; 115:1052-8. [PMID: 23848315 DOI: 10.1111/jam.12303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/17/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
AIMS Evaluation of multilocus variable number tandem repeat analysis (MLVA) to subtype all isolates of Vero cytotoxin-producing Escherichia coli O157 phage type 8 in England and Wales. METHODS AND RESULTS Over a 13 month period from December 2010, 483 isolates of VTEC O157 PT8 were tested by MLVA; 39% were received in the first 4 months of 2011, when infections are generally low. One profile, or single locus variants of it, was present in 249 (52%) isolates but was not common previously. These cases represented a national increase in PT8, associated epidemiologically with soil-contaminated vegetables. Most of the 177 other MLVA profiles were unique to a single isolate. Profiles shared by >1 isolate included cases from two small community, food-borne outbreaks and 11 households. Several shared profiles were found among 23 isolates without known links. Apart from one group, isolates linked to travel abroad had very diverse profiles. CONCLUSIONS Multilocus variable number tandem repeat analysis discriminated apparent sporadic isolates of the same PT and assisted in detection of cases in an emerging national outbreak. SIGNIFICANCE AND IMPACT OF THE STUDY Multilocus variable number tandem repeat analysis is an epidemiologically valid complement to surveillance and applicable as a rapid, practical test for large numbers of isolates.
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Affiliation(s)
- N Perry
- Gastrointestinal Bacteria Reference Laboratory, Microbiology Services Colindale, Public Health England, London, UK
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Downie J, Cruikshank M, McGettrick A, Perry N, Kidson C, Davies P, Hughes D, Davidson J. AB0758 Extra corporal membrane oxygenation in an adolescent with anca associated vasculitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Bayley J, Perry N, Shaw S, Campbell L, Richardson D. P78 The acceptability of digital self-examination in men who have sex with men (MSM) at risk of anal intraepithelial neoplasia (AIN). Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Younger D, Wu W, Hardy C, Perry N, Gonen O. Lyme Neuroborreliosis and Proton MR Spectroscopy: Preliminary Results from an Urban Referral Center Employing Strict CDC Criteria for Case Selection (P03.246). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.246] [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: 11/15/2022] Open
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19
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Rigotti DJ, Kirov II, Djavadi B, Perry N, Babb JS, Gonen O. Longitudinal whole-brain N-acetylaspartate concentration in healthy adults. AJNR Am J Neuroradiol 2011; 32:1011-5. [PMID: 21511862 DOI: 10.3174/ajnr.a2452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although NAA is often used as a marker of neural integrity and health in different neurologic disorders, the temporal behavior of WBNAA is not well characterized. Our goal therefore was to establish its normal variations in a cohort of healthy adults over typical clinical trial periods. MATERIALS AND METHODS Baseline amount of brain NAA, Q(NAA), was obtained with nonlocalizing proton MR spectroscopy from 9 subjects (7 women, 2 men; 31.2 ± 5.6 years old). Q(NAA) was converted into absolute millimole amount by using phantom-replacement. The WBNAA concentration was derived by dividing Q(NAA) with the brain parenchyma volume, V(B), segmented from MR imaging. Temporal variations were determined with 4 annual scans of each participant. RESULTS The distribution of WBNAA levels was not different among time points with respect to the mean, 12.1 ± 1.5 mmol/L (P > .6), nor was its intrasubject change (coefficient of variation = 8.6%) significant between any 2 scans (P > .5). There was a small (0.2 mL) but significant (P = .05) annual V(B) decline. CONCLUSIONS WBNAA is stable over a 3-year period in healthy adults. It qualifies therefore as a biomarker for global neuronal loss and dysfunction in diffuse neurologic disorders that may be well worth considering as a secondary outcome measure candidate for clinical trials.
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Affiliation(s)
- D J Rigotti
- Department of Radiology, New York University School of Medicine, New York, 10016, USA
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Pinker K, Perry N, Milner S, Mokbel K, Duffy S. Abstracts of the Royal College of Radiologists Breast Group Annual Scientific Meeting. November 1-2, 2010. Brighton, United Kingdom. Breast Cancer Res 2010; 12 Suppl 3:O1-6, P1-64. [PMID: 21064244 PMCID: PMC2978812 DOI: 10.1186/bcr2648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Mayerhoefer M, Perry N, Milner S, Mokbel K, Duffy S, Pinker K. Texture analysis applied to full-field digital mammography: ability to discriminate between invasive ductal and invasive lobular breast cancer - preliminary results. Breast Cancer Res 2010. [PMCID: PMC2978829 DOI: 10.1186/bcr2665] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Pinker K, Perry N, Milner S, Mokbel K, Duffy S. Accuracy of breast cancer detection with full-field digital mammography and integral computer-aided detection correlated with breast density as assessed by a new automated volumetric breast density measurement system. Breast Cancer Res 2010. [PMCID: PMC2978821 DOI: 10.1186/bcr2657] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Baida F, Belkhir A, Arar O, Barakat E, Dahdah J, Chemrouk C, Van Labeke D, Diebold C, Perry N, Bernal MP. Enhanced optical transmission by light coaxing: Mechanism of the TEM-mode excitation. Micron 2010; 41:742-5. [DOI: 10.1016/j.micron.2010.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/18/2010] [Accepted: 06/18/2010] [Indexed: 11/26/2022]
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Pinker K, Perry N, Milner S, Mokbel K, Duffy S. Sensitivity of integral computer-aided detection with full-field digital mammography for detection of breast cancer according to different histopathological tumor types and appearances. Breast Cancer Res 2010. [PMCID: PMC2978830 DOI: 10.1186/bcr2666] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Reefy S, Osman H, Chao C, Perry N, Mokbel K. Surgical excision for B3 breast lesions diagnosed by vacuum-assisted core biopsy. Anticancer Res 2010; 30:2287-2290. [PMID: 20651381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The aim of this retrospective study was to assess whether open surgical excision is required following a B3 diagnosis on 11-gauge vacuum-assisted core biopsy (VACB) of radiologically indeterminate breast lesions. PATIENTS AND METHODS Twenty-four women with a histological diagnosis of the B3 category on VACB of radiologically indeterminate breast lesions were identified over a 3-year period. The VACB procedure was performed under stereotactic (n=21), ultrasound (n=2) or magnetic resonance imaging (MRI) (n=1) guidance using the Suros system. Nineteen patients underwent open surgical excision. The remaining 5 patients who had 'complete' removal of the radiological abnormality using VACB under ultrasound (n=2, papilloma) or stereotactic (n=4, atypical ductal hyperplasia) guidance were followed up clinically and radiologically. RESULTS The median patient age was 49 years. The disease status in three patients was upgraded to ductal carcinoma in situ at open surgical excision. The VACB showed atypical lobular hyperplasia in these 3 patients, associated with microcalcification (n=2) or mass lesion (n=1). No single case of upgrading to invasive breast cancer was identified in our series. The remaining patients (16 out of 19) had a benign biopsy. The upgrade to malignancy was significantly associated with the presence of atypical lobular hyperplasia, a BI-RADS category of 4 and incomplete removal of the radiological abnormality by VACB. After a mean follow-up of 18 months, no malignancy was detected in the 5 patients who did not undergo open surgical biopsy. CONCLUSION Open surgical excision is strongly recommended for atypical lobular hyperplasia identified in VACB specimens. VACB can be a safe alternative to surgery in the treatment of B3 lesions in selected cases, providing thorough multidisciplinary discussion has taken place.
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Affiliation(s)
- S Reefy
- London Breast Institute, The Princess Grace Hospital, 45 Nottingham Place, London W1U 5NY, UK
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Richardson D, Maple K, Perry N, Ambler E, Jurd C, Fisher M. A pilot qualitative analysis of the psychosocial factors which drive young people to decline chlamydia testing in the UK: implications for health promotion and screening. Int J STD AIDS 2010; 21:187-90. [DOI: 10.1258/ijsa.2009.009053] [Citation(s) in RCA: 23] [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: 11/18/2022]
Abstract
The main objectives of this study are to investigate the psychosocial issues for young people who decline chlamydia testing as part of the national chlamydia screening programme in the UK and to consider the implications for future opportunistic screening. Transcripts of qualitative semi-structured interviews were analysed using interpretative phenomenological analysis to identify themes. The study involved 14 young people aged 16–24 years who declined chlamydia tests in non-health-care settings as part of the chlamydia screening programme. The study was conducted in educational settings where chlamydia screening is available. Four interlinked themes were identified: stigmatization of young people with chlamydia and who take a test, the feeling of embarrassment, their perception of risk and their beliefs of what the test involves. These beliefs and feelings were pervasive and negatively affected their personal decisions of having a test. In conclusion, understanding psychosocial cultural phenomena in the context of screening programmes for sexually transmitted infections (STIs) in young people are important for their success. Chlamydia and STIs remain stigmatized; testing is poorly understood and embarrassing for young people, which impacts the poor uptake for opportunistic screening. Strategies are needed to normalize and de-stigmatize chlamydia and the chlamydia test.
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Affiliation(s)
- D Richardson
- Department of Sexual Health and HIV Medicine, Royal Sussex County Hospital
| | - K Maple
- Brighton and Sussex Medical School, Brighton, UK
| | - N Perry
- Department of Sexual Health and HIV Medicine, Royal Sussex County Hospital
| | - E Ambler
- Department of Sexual Health and HIV Medicine, Royal Sussex County Hospital
| | - C Jurd
- Department of Sexual Health and HIV Medicine, Royal Sussex County Hospital
| | - M Fisher
- Department of Sexual Health and HIV Medicine, Royal Sussex County Hospital
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Al-Reefy S, Osman H, Chao C, Perry N, Mokbel K. 407 Is surgical excision required for B3 breast lesions diagnosed at vacuum-assisted core biopsy? EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70433-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: 10/19/2022] Open
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28
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Mayerhoefer M, Perry N, Milner S, Pinker K. 597 Texture analysis applied to full field digital mammography: ability to discriminate between invasive ductal and invasive lobular breast cancer – preliminary results. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70618-2] [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: 11/29/2022] Open
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29
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Sayer C, Fisher M, Nixon E, Nambiar K, Richardson D, Perry N, Llewellyn C. Will I? Won't I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures? Sex Transm Infect 2008; 85:206-11. [DOI: 10.1136/sti.2008.033662] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Herzmann C, Cuthbertson Z, Fosdick L, Fisher M, Nelson M, Perry N, Law M, Wand H, Janossy G, Johnson MA, Youle M. Long-term clinical and surrogate marker effects of subcutaneous intermittent interleukin-2 without antiretroviral therapy in HIV-infected patients. J Antimicrob Chemother 2008; 62:583-6. [PMID: 18587135 DOI: 10.1093/jac/dkn238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Subcutaneous administration of interleukin-2 (IL-2) has been shown to increase CD4 counts in HIV-infected patients. It remains unclear whether this effect is associated with a clinical benefit. PATIENTS AND METHODS We conducted a long-term follow-up in the cohort of the UK-Vanguard study in which three groups of 12 antiretroviral-naive subjects with CD4 cell counts >350 cells/mm(3) received no treatment or IL-2 at either 4.5 or 7.5 MIU twice daily in 5 day cycles, respectively. RESULTS Mean follow-up was 376 weeks. IL-2 therapy was associated with a higher area under the curve of CD4 cell count change from baseline at week 48 but not thereafter. HIV-RNA levels were unaffected. Highly active antiretroviral therapy (HAART) was initiated after a mean of 172, 175 and 152 weeks in the control group, low-dose and high-dose IL-2 treatment group, respectively, a statistically non-significant difference. There was a tendency to start HAART soon after discontinuation of IL-2 therapy which may have been triggered by the steep decay of CD4 counts. There were two serious adverse events in the control group, seven in the low-dose IL-2 group and eight in the high-dose IL-2 group. No pattern of disease was detected, making an association with IL-2 therapy unlikely. CONCLUSIONS We could detect neither a benefit of IL-2 therapy after week 48 nor delayed initiation of HAART. This is currently the longest follow-up data comparing IL-2 therapy with no therapy in antiretroviral-naive HIV-infected patients and does not show a persistent benefit of the intervention.
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Affiliation(s)
- C Herzmann
- Department of Infectious Diseases, Vivantes Auguste Viktoria Klinikum, Rubensstr. 125, 12159 Berlin, Germany.
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Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document. Ann Oncol 2007; 19:614-22. [PMID: 18024988 DOI: 10.1093/annonc/mdm481] [Citation(s) in RCA: 470] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breast cancer is a major cause of suffering and death and is of significant concern to many women. Early detection of breast cancer by systematic mammography screening can find lesions for which treatment is more effective and generally more favourable for quality of life. The potential harm caused by mammography includes the creation of unnecessary anxiety and morbidity, inappropriate economic cost and the use of ionising radiation. It is for this reason that the strongest possible emphasis on quality control and quality assurance is required. Development of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis has been an initiative within the Europe Against Cancer Programme. The fourth edition of the multidisciplinary guidelines was published in 2006 and comprises approximately 400 pages divided into 12 chapters prepared by >200 authors and contributors. The multidisciplinary editorial board has prepared a summary document to provide an overview of the fundamental points and principles that should support any quality screening or diagnostic service. This document includes a summary table of key performance indicators and is presented here in order to make these principles and standards known to a wider scientific community.
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Affiliation(s)
- N Perry
- London Region Breast Screening Programme, Quality Assurance Reference Centre, St Bartholomew's Hospital, London, UK
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Cataliotti L, De Wolf C, Holland R, Marotti L, Perry N, Redmond K, Rosselli Del Turco M, Rijken H, Kearney N, Ellis IO, Di Leo A, Orecchia R, Noel A, Andersson M, Audretsch W, Bjurstam N, Blamey RW, Blichert-Toft M, Bosmans H, Burch A, Bussolati G, Christiaens MR, Colleoni M, Cserni G, Cufer T, Cush S, Damilakis J, Drijkoningen M, Ellis P, Foubert J, Gambaccini M, Gentile E, Guedea F, Hendriks J, Jakesz R, Jassem J, Jereczek-Fossa BA, Laird O, Lartigau E, Mattheiem W, O'higgins N, Pennery E, Rainsbury D, Rutgers E, Smola M, Van Limbergen E, von Smitten K, Wells C, Wilson R. Guidelines on the standards for the training of specialised health professionals dealing with breast cancer. Eur J Cancer 2007; 43:660-75. [PMID: 17276672 DOI: 10.1016/j.ejca.2006.12.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 11/29/2006] [Accepted: 12/04/2006] [Indexed: 01/30/2023]
Abstract
According to EUSOMA position paper 'The requirements of a specialist breast unit', each breast unit should have a core team made up of health professionals who have undergone specialist training in breast cancer. In this paper, on behalf of EUSOMA, authors have identified the standards of training in breast cancer, to harmonise and foster breast care training in Europe. The aim of this paper is to contribute to the increase in the level of care in a breast unit, as the input of qualified health professionals increases the quality of breast cancer patient care.
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Helme S, Perry N, Mokbel K. Screening mammography in women aged 40-49: is it time to change? Int Semin Surg Oncol 2006; 3:4. [PMID: 16460572 PMCID: PMC1431548 DOI: 10.1186/1477-7800-3-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 02/06/2006] [Indexed: 11/10/2022]
Abstract
There is little doubt that significant benefits can accrue from carrying out screening mammography of women aged 40–49 in the setting of a highly quality assured service delivery. This will best be achieved using digital mammography to maximise detection rates and trained and high volume reading expert radiologists to apply economic cushions of optimising specificity as well as sensitivity in addition to utilising modern and accurate assessment and tissue sampling techniques that have evolved.
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Affiliation(s)
- S Helme
- St. George's Hospital, London, UK
| | - N Perry
- The Princess Grace Hospital, London, UK
- St. Bartholomew's Hospital, London, UK
| | - K Mokbel
- St. George's Hospital, London, UK
- The Princess Grace Hospital, London, UK
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Salhab M, Al Sarakbi W, Perry N, Mokbel K. Pneumothorax after a clinical breast fine-needle aspiration of a lump in a patient with Poland's syndrome. Int Semin Surg Oncol 2005; 2:14. [PMID: 16111483 PMCID: PMC1192816 DOI: 10.1186/1477-7800-2-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 08/19/2005] [Indexed: 11/10/2022]
Abstract
We report the first case in the medical literature of a pneumothorax complicating fine needle aspiration cytology (FNAC) of a breast lump in a woman with a mild form of Poland's syndrome. The pneumothorax was treated conservatively. This is the first case of breast FNA-related pneumothorax seen in our clinical practice. We believe that the absence of pectoral muscles has increased the risk of this complication. We have also diagnosed an incidental screen-detected breast cancer affecting the ipsilateral breast in the same patient. We conclude that caution should be exercised when performing FNAC of breast lesions in patients with Poland's syndrome. The procedure should be preferably performed under image guidance in such patients in order to minimise the risk of this complication.
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Affiliation(s)
- M Salhab
- The Princess Grace Hospital, London, UK
| | | | - N Perry
- The Princess Grace Hospital, London, UK
| | - K Mokbel
- The Princess Grace Hospital, London, UK
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Zidorn C, Ellmerer E, Konwalinka G, Ongania K, Schwaha R, Greil R, Joehrer K, Perry N, Stuppner H. 1,10-Epoxyhypocretenolides from the Azorean Endemic Leontodon rigens (Asteraceae). LETT ORG CHEM 2005. [DOI: 10.2174/1570178054406002] [Citation(s) in RCA: 8] [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: 11/22/2022]
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Lambert NL, Fisher M, Imrie J, Watson R, Mercer CH, Parry JV, Phillips A, Iversen A, Perry N, Dean GL. Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding. Sex Transm Infect 2005; 81:213-216. [PMID: 15923287 PMCID: PMC1744994 DOI: 10.1136/sti.2004.013144] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and acceptability of implementing community based syphilis screening using different sample collection techniques, and its effectiveness in screening at-risk populations and identifying new syphilis cases. METHODS Two phases of syphilis screening were conducted in venues frequented by men who have sex with men (MSM). Phase 1 used venepuncture and phase 2 a validated saliva test. Evaluation used quantitative data from testers, venues and the local genitourinary medicine (GUM) clinic, and qualitative data from venue and programme staff. RESULTS 1090 MSM were tested over 7 weeks. 62% of testers had not attended a GUM clinic in the past year. 64% of testers reported > or = 2 sexual contacts in the past 90 days and 11% reported > or = 10. Similar diagnosis rates were recorded for phase 1 (1.4%) and phase 2 (1.8%). There was greater uptake of testing with the saliva test in saunas during phase 2. CONCLUSIONS Syphilis screening in gay venues is feasible and acceptable to at-risk MSM, and reaches a group not routinely accessing GUM services. The low case detection for syphilis suggest this approach, while unlikely to contain outbreaks, may be more useful if combined with screening for other sexually transmitted infections and effective health promotion strategies.
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Affiliation(s)
- N L Lambert
- HIV/GUM Research Department, Residence Block, Brighton General Hospital, Elm Grove, Brighton, UK
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Evans AJ, Wilson R, Britton P, Given-Wilson R, Cornford E, Burrell H, James J, Hamilton L, Kutt E, Vinnicombe S, Perry N, Michell M. Staging imaging in women with primary operable breast cancer. Clin Radiol 2005; 60:520; author reply 520-1. [PMID: 15767113 DOI: 10.1016/j.crad.2004.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Perry N. Quality assurance in breast screening in Europe. Breast 2004; 9:61-5. [PMID: 14731700 DOI: 10.1054/brst.2000.0137] [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: 11/18/2022] Open
Abstract
An extensive pathology External Quality Assurance has been set up in Europe based on the experience of the UK programme. There are approximately 300 participating pathologists in France alone. With the end of the Third Action Plan (1996-2000) it is likely that the Europe Against Cancer programme will cease. However, screening will remain one of the four major public health activities funded by the European Commission and the screening network which has resided under the auspices of DGV (Industrial Relations and Social Affairs) is likely to be transferred to DGXXIV (Consumer Protection and Public Health). This would seem to be ideal the site for the activities necessary for high quality screening. It is anticipated that the drive for continued quality assurance, expansion of organised screening and the spread of skills from high quality screening programmes into symptomatic sector activity will continue for the foreseeable future.
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Affiliation(s)
- N Perry
- Quality Assurance Reference Center, North Thames Breast Programme, St Bartholomew' Hospital, London, UK
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Domingue G, Willshaw GA, Smith HR, Perry N, Radford D, Cheasty T. DNA-based subtyping of verocytotoxin-producing Escherichia coli (VTEC) O128ab:H2 strains from human and raw meat sources. Lett Appl Microbiol 2003; 37:433-7. [PMID: 14633094 DOI: 10.1046/j.1472-765x.2003.01424.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS To investigate subtyping methods for verocytotoxin-producing Escherichia coli (VTEC) O128ab:H2. METHODS AND RESULTS Eleven human and food strains isolated over a 15-year period were examined. All were intimin (eae)-negative, but all possessed enterohaemolysin and VT1-encoding sequences which in nine strains were vtx1c variant. Ten strains had VT2 genes which were all vtx2d. Plasmid profiles and randomly amplified polymorphic DNA-PCR were not discriminatory. Long-PCR restriction fragment length polymorphism of amplicons bound by the p gene and the VT2A subunit had screening potential. Pulsed field gel electrophoresis (PFGE) using XbaI gave fine discrimination although VT2 sequences were located on a 220 kbp fragment conserved in nine strains and on a 200 kbp fragment in the 10th. CONCLUSIONS As a result of apparent clonality, PFGE proved essential for differentiation. Long-PCR has promise for screening but requires further evaluation of inter-strain variable sequences. SIGNIFICANCE AND IMPACT OF THE STUDY A combined phenotypic and genotypic screen, and PFGE for selected strains was effective.
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Affiliation(s)
- G Domingue
- Laboratory of Enteric Pathogens, Specialist and Reference Microbiology Division, Health Protection Agency, London, UK.
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McCormack VA, dos Santos Silva I, De Stavola BL, Perry N, Vinnicombe S, Swerdlow AJ, Hardy R, Kuh D. Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort. Br J Cancer 2003; 89:852-9. [PMID: 12942117 PMCID: PMC2394467 DOI: 10.1038/sj.bjc.6601207] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Dense mammographic parenchymal patterns are associated with an increased risk of breast cancer. Certain features of body size have been found to be associated with breast cancer risk, but less is known about their relation to breast density. We investigated the association of birth size, childhood growth and life-course changes in body size with Wolfe grade in 1298 perimenopausal women from a British cohort of women born in 1946. The cohort benefits from repeated measures of body size in childhood and adulthood. We obtained mammograms for 90% of women who at age 53 years reported having previously had a mammogram. We found no associations with birth weight or maximum attained height. Body mass index (BMI) at age 53 years and breast size were independently and inversely associated with Wolfe grade (P-value for trend <0.001 for both). Women who reached puberty later were at a greater odds of a higher Wolfe grade than women who had an earlier puberty (odds ratio associated with a 1 year delay in menarche 1.14, 95% CI: 1.01-1.27, adjusted for BMI and breast size at mammography). A higher BMI at any age during childhood or adult life was associated with a reduction in the odds of a higher Wolfe grade, after controlling for breast size and BMI at mammography, for example, standardised odds ratio for height at age 7 was 0.72 (95% CI: 0.64, 0.81). These findings reveal the importance of taking life-course changes in body size, and not just contemporaneous measures, into account when using mammographic density as an intermediate marker for risk of breast cancer.
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Affiliation(s)
- V A McCormack
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [Citation(s) in RCA: 4] [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: 11/15/2022]
Abstract
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
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Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
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Kessar P, Perry N, Vinnicombe S, Hussain H, Carpenter R, Wells C. How Significant is Detection of Ductal Carcinoma In Situ in a Breast Screening Programme? Clin Radiol 2002. [DOI: 10.1053/crad.2001.0962] [Citation(s) in RCA: 5] [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: 11/11/2022]
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Kessar P, Perry N, Vinnicombe SJ, Hussain HK, Carpenter R, Wells CA. How significant is detection of ductal carcinoma in situ in a breast screening programme? Clin Radiol 2002; 57:807-14. [PMID: 12384106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
PURPOSE To compare the histological grades of screen detected and non-screen detected ductal carcinoma in situ (DCIS) and to identify any differences that might support the contention that DCIS found by breast screening represents an over-diagnosis. The aim was also to establish whether any particular mammographic features of DCIS can be used to predict tumour grade reliably. MATERIALS AND METHODS Biopsy proven cases of DCIS (n=153) were reviewed with respect to grade and subdivided into high, intermediate and low grades using the Van Nuys classification. A more aggressive subset of DCIS (microinvasive and interval cancers) were similarly analysed. Mammograms were reviewed with regard to abnormal features and distribution, and the appearances correlated with grade. RESULTS Fifty-four percent (53/98) of screen detected and 62% (34/52) of non-screen detected DCIS were high grade. The rest were equally intermediate and low grade, with no statistical difference between the two groups. Eighty-four percent of the aggressive subset of tumours were high grade. Micro-calcification was present in 90% and in 10% there were soft tissue changes alone. Seventy-six percent of linear branching calcification was associated with high grade DCIS. Only 13% of high grade DCIS demonstrated punctate micro-calcification; however, 38% of cases of punctate micro-calfication were associated with high grade tumours and there was a great deal of overlap between the groups. CONCLUSION Most cases of DCIS in both screen and non-screen detected groups were high grade. Only one in five was low grade. Analysis of the aggressive subgroup underlines the significance of high grade DCIS. Mammographic patterns are not always reliable in the prediction of tumour grade. The detection of DCIS in screening programmes is important and should not be regarded as over-diagnosis.
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Affiliation(s)
- P Kessar
- Department of Radiology, St Bartholomew's Hospital, London, UK
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Bartella L, Perry N, Young KC, Lawinski CP, Evans D. Assessment of full field digital mammography (FFDM) detected microcalcification is not hindered by low spatial resolution. Breast Cancer Res 2002. [PMCID: PMC3300451 DOI: 10.1186/bcr477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Athow AC, Gattuso JM, Perry N, Wells C, Dutt N, Bahsir GM, Mair G, Carpenter R. Is radiotherapy needed after breast conservation for small invasive breast cancers? Eur J Surg Oncol 2002; 28:379-82. [PMID: 12099645 DOI: 10.1053/ejso.2002.1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The purpose of this study was to determine the rate of local recurrence in patients with small invasive breast cancers (<1 cm) who had been treated with breast-conserving surgery either with (group 1) or without (group 2) adjuvant radiotherapy. METHODS This is a retrospective study of 110 patients with an invasive breast cancer less than 1 cm in size, treated in our centre by breast-conserving surgery. Parameters examined included age at and mode of presentation, histopathological features, adjuvant therapy, length of follow-up and outcome in terms of local recurrence rate and death. RESULTS In group 1 there were 59 women of median age 57 (38-80) years. The median tumour size was 9 (1-10) mm and median follow-up was 74 (15-110) months. There were no local recurrences. In group 2 the median age at presentation was 59 (48-81) years. The median tumour size was 7 (2-10) mm and median follow-up was 47 (14-93) months. There were three non-breast-cancer related deaths and three local recurrences (6%). CONCLUSIONS A local recurrence rate of 6% at almost 4 years median follow-up suggests that it may be possible to avoid adjuvant radiotherapy in a subgroup of largely screen-detected, node-negative patients with invasive tumours less than 1 cm, in whom adequate local excision is performed. Further follow-up is required to substantiate this.
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MESH Headings
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Case-Control Studies
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Incidence
- Mammography
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Factors
- Treatment Outcome
- Unnecessary Procedures
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Affiliation(s)
- A C Athow
- St Bartholomew's Hospital, West Smithfield, London, UK
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Abstract
OBJECTIVES To find out whether a false positive breast screening result has a negative effect on subsequent screening attendance. Also considered was the proportion of women who had ever failed to reattend for screening, having previously attended routinely. DESIGN The study was a retrospective cohort design. SETTING Data from the call and recall records of the Central and East London Breast Screening Service (CELBSS) were used. PARTICIPANTS Women who had been invited to attend for breast screening by the CELBSS during 1997. MAIN OUTCOME MEASURES Subsequent attendance or non-attendance for the next routine breast screen, after a false positive screening result. RESULTS A substantial number of women failed to reattend for a breast screen during their screening history, having attended for their previous routine breast screen. No differences in the rates of reattendance were found between those who had previously received a false positive result and those who had not. CONCLUSION From the results obtained in the present study it would seem that the experience of a false positive breast screen does not deter women from reattending in the future. However, many women living in inner city areas who attend for an initial breast screen are failing to attend for subsequent routine mammograms. This may have a deleterious effect for these women in terms of the benefits of attendance for regular screening.
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Affiliation(s)
- I O'Sullivan
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, UK.
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48
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Abstract
The twentieth century saw the introduction of mammography as a diagnostic tool and its refinement as a screening method. It appears guaranteed that women who are well informed will seek mammography screening with high expectations of technical quality and accurate interpretation. More refined knowledge of breast anatomy and pathology will assist radiologists to interpret with high specificity. We will learn how to recognized more accurately normal structures and doubtful findings. We will gain experience in interpretation through faithful review of interval cancers and subtle screen-detected cancers, and will use educational tools that have the potential to improve the efficiency of education by directing attention to specific deficiencies. Mammographic screening has been advanced through the efforts of dedicated teams of physicians, scientists, and other professionals throughout the world. The international communication of ideas and discoveries will continue to challenge the boundaries of what can be accomplished in early detection as well as noninvasive therapy, and this body of knowledge will continue to be enriched by these diverse contributions.
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Affiliation(s)
- L J Burhenne
- Department of Radiology, University of British Columbia, #505-750 W Broadway, Vancouver, BC V5Z 1H4, Canada
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Mokbel K, Choy C, Leris C, Akbar M, Vinnicombe S, Kessar P, Perry N, Wells C, Carpenter R. Predictors of positive margins after local excision of ductal carcinoma in situ. Am J Surg 2001; 181:91-5. [PMID: 11425066 DOI: 10.1016/s0002-9610(00)00572-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to examine the association between clinicopathologic parameters and positive margins in women with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery (BCS). METHODS We retrospectively reviewed the clinical, radiologic, and pathologic data of 100 women who had undergone BCS for DCIS in our center. RESULTS Sixty-seven percent of patients presented via breast screening and 55% of all cases were diagnosed preoperatively on fine needle aspiration cytology ([FNAC] ie, C5). Overall, 45% of patients had clear margins after initial local excision. Positive margins showed a nonsignificant trend of association with distribution of microcalcifications (MCC), nonconsultant operating surgeon, inconclusive preoperative FNAC, presence of necrosis, and low specimen weight. There was a highly significant association between low grade DCIS (P = 0.003) and incomplete excision. There was no significant association with age, associated invasive focus, morphology of MCC, or with mode of presentation. CONCLUSION Positive margins after local excision of DCIS are significantly associated with low nuclear grade, and preoperative determination of nuclear grade by core biopsy may have surgical implications.
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Affiliation(s)
- K Mokbel
- Breast Cancer Centre, St. George's Hospital, London, United Kingdom.
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50
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Binder PM, Perry N. Comment II on "Simple measure for complexity". Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 62:2998-2999. [PMID: 11088794 DOI: 10.1103/physreve.62.2998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/1999] [Indexed: 05/23/2023]
Abstract
The measure of complexity recently proposed by Shiner, Davidson, and Landsberg [Phys. Rev. E 59, 1459 (1999)] does not adequately describe the transition from regular to indexed languages observed at the period-doubling accumulation points of quadratic maps. This Comment points to a generic inadequacy of that measure.
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Affiliation(s)
- PM Binder
- Departamento de Fisica, Universidad de Los Andes, Apartado Aereo 4976, Bogota, Colombia
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