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Faux JW, Cock K, Bromley R, Feldman M. Colorectal two-week wait service and quantitative FIT: it's not just about colon cancer. Ann R Coll Surg Engl 2021; 104:257-260. [PMID: 34939845 DOI: 10.1308/rcsann.2021.0184] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess faecal immunochemical test (FIT) negativity in terms of its effect on cancer risk in the local symptomatic two-week wait (2WW) population. FIT was introduced to the colorectal 2WW pathway at the start of the pandemic. This study analyses the FIT-negative (<10µg Hb/g) cohort and calculates the relative risk and odds ratio associated with a negative FIT test. METHODS FIT tests were sent to symptomatic 2WW patients without rectal bleeding, iron-deficient anaemia or palpable mass. Where FIT was <10µg Hb/g investigations were moved to a radiology protocol. RESULTS The test return rate was 91% with a FIT-negative (<10µg Hb/g) rate of 82%. The FIT-negative group in the symptomatic referral pathway in Cornwall have a low (1.4%) risk of colon cancer but a significant risk (6.6%) when all cancer types are considered. The impact of a negative quantitative FIT changes the odds ratio of a patient having a luminal cancer by 0.26. The odds ratio for 'all cancer' risk was affected by 0.83. CONCLUSION A negative FIT test within the local NG12 symptomatic patient group signifies a low risk of colon cancer and identifies patients who can be initially investigated with cross-sectional imaging. However, when all cancer types are considered, cancer prevalence in this group remains above 6%. In relative risk terms a negative FIT represents a small change in overall risk and this patient group still qualify for investigation through 2WW pathways.
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Affiliation(s)
- J W Faux
- Royal Cornwall Hospitals NHS Trust, UK
| | - K Cock
- Royal Cornwall Hospitals NHS Trust, UK
| | - R Bromley
- Royal Cornwall Hospitals NHS Trust, UK
| | - M Feldman
- Royal Cornwall Hospitals NHS Trust, UK
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McCluskey G, Kinney MO, Russell A, Smithson WH, Parsons L, Morrison PJ, Bromley R, MacKillop L, Heath C, Liggan B, Murphy S, Delanty N, Irwin B, Campbell E, Morrow J, Hunt SJ, Craig JJ. Zonisamide safety in pregnancy: Data from the UK and Ireland epilepsy and pregnancy register. Seizure 2021; 91:311-315. [PMID: 34273670 DOI: 10.1016/j.seizure.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Animal data suggest teratogenic effects with zonisamide use and risk of pregnancy losses. Human data following zonisamide exposure are presently limited, but suggest low risk of malformation with elevated risk of low birth weight. OBJECTIVE To calculate the major congenital malformation (MCM) rate of zonisamide in human pregnancy and assess for a signal of any specific malformation pattern and associations with birth weight. METHODS AND MATERIALS Data were obtained from the UK and Ireland Epilepsy and Pregnancy register (UKIEPR) which is an observational, registration, and follow up study from December 1996 to July 2020. Eligibility criteria were use of zonisamide and to have been referred to the UKIEPR before the outcome of the pregnancy was known. Primary outcome was evidence of MCM. RESULTS From December 1996 through July 2020 there were 112 cases of first trimester exposure to zonisamide, including 26 monotherapy cases. There were 3 MCM for monotherapy cases (MCM rate 13.0% (95% confidence interval 4.5-32.1)), and 5 MCM for polytherapy cases (MCM rate 6.9% (95% confidence interval 3.0-15.2)). While the median birth weight was on 71st and 44th centile for monotherapy and polytherapy cases respectively, there was a high rate of infants born small for gestational age (21% for both). CONCLUSION These data raise concerns about a signal for potential teratogenicity with zonisamide in human pregnancy. Given the low numbers reported, further data will be required to adequately counsel women who use zonisamide in pregnancy.
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Affiliation(s)
- G McCluskey
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - M O Kinney
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - A Russell
- Scottish Epilepsy Centre, Glasgow, United Kingdom
| | - W H Smithson
- Department of General Practice, University College Cork, Cork, Ireland
| | - L Parsons
- Neurology Department, Luton & Dunstable Hospitals NHS Trust, Luton, United Kingdom
| | - P J Morrison
- Department of Medical Genetics, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - R Bromley
- Royal Manchester Children's Hospital, Central Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - L MacKillop
- Women's Centre. Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C Heath
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - B Liggan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - S Murphy
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - N Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Neurology, Beaumont Hospital, and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Irwin
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - E Campbell
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - J Morrow
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - S J Hunt
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - J J Craig
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom.
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Keall P, Nguyen D, O'Brien R, Hewson E, Ball H, Poulsen P, Booth J, Greer P, Hunter P, Wilton L, Bromley R, Kipritidis J, Eade T, Kneebone A, Hruby G, Moodie T, Hayden A, Turner S, Arumugam S, Sidhom M, Hardcastle N, Siva S, Tai K, Gebski V, Martin J. PO-0842 Real-Time tracking improves treatment: The TROG Stereo Prostate Ablative Radiotherapy with KIM trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31262-9] [Citation(s) in RCA: 2] [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: 11/24/2022]
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Hewson E, Nguyen D, O'Brien R, Poulsen P, Booth J, Bromley R, Kipritidis J, Moodie T, Greer P, Eade T, Kneebone A, Martin J, Hayden A, Hruby G, Hunter P, Wilton L, Turner S, Gebski V, Keall P. Kilovoltage Intrafraction Monitoring (KIM) Real-Time Tracking Improves Patient Dose Distributions: Interim Primary Hypothesis Results from the First 20 Patients on the TROG 15.01 Stereotactic Prostate Ablative Radiation Therapy SPARK Trial. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Byrne K, Ambrose L, Bromley R, Cruikshank S, Guo L, Morgia M, Lamoury G. PO4 Toxicity outcomes from conformal prone breast radiotherapy and a dosimetric comparison with hybrid IMRT prone radiotherapy. Breast 2018. [DOI: 10.1016/j.breast.2018.02.015] [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: 10/17/2022] Open
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Keall P, Booth J, Nguyen D, O'Brien R, Poulsen P, Caillet V, Bromley R, Alfieri F, Bell L, Eade T, Kneebone A, Martin J. The First Clinical Implementation of Real-time Adaptive Radiation Therapy Using a Standard Linear Accelerator. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Charlton RA, McGrogan A, Snowball J, Yates LM, Wood A, Clayton-Smith J, Smithson WH, Richardson JL, McHugh N, Thomas SHL, Baker GA, Bromley R. Sensitivity of the UK Clinical Practice Research Datalink to Detect Neurodevelopmental Effects of Medicine Exposure in Utero: Comparative Analysis of an Antiepileptic Drug-Exposed Cohort. Drug Saf 2017; 40:387-397. [PMID: 28188601 PMCID: PMC5384950 DOI: 10.1007/s40264-017-0506-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction Electronic healthcare data have several advantages over prospective observational studies, but the sensitivity of data on neurodevelopmental outcomes and its comparability with data generated through other methodologies is unknown. Objectives The objectives of this study were to determine whether data from the UK Clinical Practice Research Datalink (CPRD) produces similar risk estimates to a prospective cohort study in relation to the risk of neurodevelopmental disorders (NDDs) following prenatal antiepileptic drug (AED) exposure. Methods A cohort of mother–child pairs of women with epilepsy (WWE) was identified in the CPRD and matched to a cohort without epilepsy. The study period ran from 1 January 2000 to 31 March 2007 and children were required to be in the CPRD at age 6 years. AED exposure during pregnancy was determined from prescription data and children with an NDD diagnosis by 6 years were identified from Read clinical codes. The prevalence and risk of NDDs was calculated for mother–child pairs in WWE stratified by AED regimen and for those without epilepsy. Comparisons were made with the results of the prospective Liverpool and Manchester Neurodevelopment Group study which completed assessment on 201 WWE and 214 without epilepsy at age 6 years. Results In the CPRD, 1018 mother–child pairs to WWE and 6048 to women without epilepsy were identified. The CPRD identified a lower prevalence of NDDs than the prospective study. In both studies, NDDs were more frequently reported in children of WWE than women without epilepsy, although the CPRD risk estimate was lower (2.16 vs. 0.96%, p < 0.001 and 7.46 vs. 1.87%, p = 0.0128). NDD prevalence differed across AED regimens but the CPRD data did not replicate the significantly higher risk of NDDs following in utero monotherapy valproate exposure (adjusted odds ratio [ORadj] 2.02, 95% confidence interval [CI] 0.52–7.86) observed in the prospective study (ORadj 6.05, 95% CI 1.65–24.53). Conclusion It was possible to identify NDDs in the CPRD; however, the CPRD appears to under-record these outcomes. Larger studies are required to investigate further. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0506-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R A Charlton
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - A McGrogan
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - J Snowball
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - L M Yates
- The UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle Upon Tyne, UK
| | - A Wood
- School of Life and Health Sciences, Aston Brain Centre, Aston University, West Midlands, UK
| | - J Clayton-Smith
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - W H Smithson
- Department of General Practice, University College Cork, Cork, Ireland
| | - J L Richardson
- The UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - S H L Thomas
- The UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, UK
| | - G A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - R Bromley
- Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Bromley R. The treatment of epilepsy in pregnancy: The neurodevelopmental risks associated with exposure to antiepileptic drugs. Reprod Toxicol 2016; 64:203-10. [PMID: 27312074 DOI: 10.1016/j.reprotox.2016.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/12/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
A number of antiepileptic drugs (AEDs) have been confirmed as teratogens due to their association with an increased malformation rate. The majority of research to date does not find an association between prenatal exposure to monotherapy carbamazepine, lamotrigine or phenytoin and neurodevelopmental outcome in comparison to control children and noted higher abilities in comparison to children exposed to valproate; but further work is needed before conclusions can be drawn. Data for levetiracetam was limited to one study, as was the evidence for topiramate. Sodium valproate exposure appeared to carry a dose dependent risk to the developing brain, with evidence of reduced levels of IQ, poorer verbal abilities and increased rate of autistic spectrum disorder both in comparison to control children and children exposed to other AEDs. The severity of the neurodevelopmental deficits associated with prenatal exposure to valproate highlight the critical need to consider neurodevelopmental outcomes as a central aspect of teratological research.
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Affiliation(s)
- R Bromley
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, United Kingdom; Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, United Kingdom.
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Hansen CR, Sykes JR, Barber J, West K, Bromley R, Szymura K, Fisher S, Sim J, Bailey M, Chrystal D, Deshpande S, Franji I, Nielsen TB, Brink C, Thwaites DI. Multicentre knowledge sharing and planning/dose audit on flattening filter free beams for SBRT lung. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1742-6596/573/1/012018] [Citation(s) in RCA: 8] [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] [Indexed: 11/11/2022]
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Hansen C, Sykes J, Barber J, Bromley R, Fisher S, Bailey M, Brink C, Thwaites D. PD-0410: Multi centre planning study on flattening filter free beams for SBRT lung cancer treatment. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30515-6] [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: 11/26/2022]
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Johnston M, Clifford S, Bromley R, Back M, Oliver L, Eade T. Volumetric-modulated Arc Therapy in Head and Neck Radiotherapy: A Planning Comparison using Simultaneous Integrated Boost for Nasopharynx and Oropharynx Carcinoma. Clin Oncol (R Coll Radiol) 2011; 23:503-11. [DOI: 10.1016/j.clon.2011.02.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 11/18/2010] [Accepted: 01/06/2011] [Indexed: 11/26/2022]
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Bromley R, Oliver L, Davey R, Harvie R, Baldock C. SU-DD-A2-03: Can the Linear Quadratic (LQ) Model Predict the Biological Response of Cells to Simple Dose Heterogeneity for Single and Multiple Fraction Irradiation? Med Phys 2010. [DOI: 10.1118/1.3467990] [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: 11/07/2022] Open
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Mawer G, Briggs M, Baker GA, Bromley R, Coyle H, Eatock J, Kerr L, Kini U, Kuzmyshcheva L, Lucas SB, Wyatt L, Clayton-Smith J. Pregnancy with epilepsy: obstetric and neonatal outcome of a controlled study. Seizure 2009; 19:112-9. [PMID: 20036166 DOI: 10.1016/j.seizure.2009.11.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 11/12/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the influence of epilepsy and its treatment on pregnancy and its outcome. DESIGN Controlled, observational study. SETTING National Health Service maternity hospitals in Liverpool and Manchester regions. POPULATION 277 women with epilepsy (WWE) and 315 control women. METHODS WWE were recruited from antenatal clinics. Controls were matched for age and parity but not gestational age. Information was obtained by interview and from clinical records. MAIN OUTCOME MEASURES Obstetric complications, mode of delivery, condition of newborn. RESULTS Distribution of epilepsy syndromes was similar to previous surveys. Most WWE (67%) received monotherapy with carbamazepine, sodium valproate or lamotrigine. Half WWE had no seizures during pregnancy but 34% had tonic clonic seizures. Seizure-related injuries were infrequent. Pregnancies with obstetric complications were increased in women with treated epilepsy (WWTE 45%, controls 33%; p=0.01). Most had normal vaginal delivery (WWTE 63%, controls 61%; p=0.65). Low birth weight was not increased (WWTE 6.2%, controls 5.2%; p=0.69). There were more major congenital malformations (MCM) (WWTE 6.6%, controls 2.1%; p=0.02) and fetal/infant deaths (WWTE 2.2%, controls 0.3%; p=0.09). Amongst monotherapies MCM prevalence was highest with valproate (11.3%; p=0.005). Lamotrigine (5.4%; p=0.23) and carbamazepine (3.0%; p=0.65) were closer to controls (2.1%). There was no association between MCM and dose of folic acid pre-conception. CONCLUSION MCM were more prevalent in the babies of WWTE particularly amongst those receiving sodium valproate.
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Affiliation(s)
- G Mawer
- Department of Genetic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, Manchester M13 9WL, UK.
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Back M, Oliver L, Bromley R, Eade T. Multicentre quality assurance of intensity-modulated radiotherapy planning: Beware the benchmarker. J Med Imaging Radiat Oncol 2008; 52:197. [DOI: 10.1111/j.1440-1673.2008.01944.x] [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: 11/28/2022]
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Bromley R, Oliver L, Harvie R, Davey R. SU-FF-J-104: In Vitro Model to Study the Biological Effect of Dose Gradients On a Cell Culture System. Med Phys 2005. [DOI: 10.1118/1.1997650] [Citation(s) in RCA: 2] [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: 11/07/2022] Open
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Bromley R, Clark M. Revenue Act of 1987 imposes new disclosure and reporting obligations on exempt organizations. J Health Hosp Law 1988; 21:162-8. [PMID: 10288156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bromley R. Implementing a Salmon pilot scheme. Nurs Times 1968; 64:Suppl:87-8. [PMID: 5648635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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