Publications by authors named "Gillian Smith"

209 Publications

Continuous improvement of a bioengineering CURE: Preparing students for a changing world.

Biochem Mol Biol Educ 2022 Aug 5. Epub 2022 Aug 5.

Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, Indiana, USA.

Based on recent education reform guidelines to prepare professionals who are able to handle new technological, economic, social, and environmental challenges, pedagogical modifications are deemed necessary by the educators. Specifically, in biology, the rapid changes in the content and biological products demand changes in the curriculum. We aim to address this current need by providing an example of a course that was redesigned to meet the current trends of biological engineering education. In this course-based undergraduate research experience (CURE), learning objectives and possible outcomes were developed and assessment mapping was performed to align the course objectives with the Accreditation Board for Engineering and Technology (ABET) recommendations. A description of how one can assess authentic inquiry courses while adhering to the recommendations are discussed. For example, in this particular course, students completed weekly reflection assignments, maintained lab notebooks that were graded every week, presented their research to their peers at the end of the semester, and submitted a final paper to be graded. "Holistic" engineering is crucial for the all-around development of a 21st century engineer. Altering the traditional lecturing with more hands-on learning is crucial for the development of professional and communication skills of students. Such alterations could lead to the production of well-rounded life-long learners to serve the upcoming world.
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http://dx.doi.org/10.1002/bmb.21656DOI Listing
August 2022

Fibroblast growth factor signalling influences homologous recombination-mediated DNA damage repair to promote drug resistance in ovarian cancer.

Br J Cancer 2022 Jul 1. Epub 2022 Jul 1.

Division of Cellular Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.

Background: Ovarian cancer patients frequently develop chemotherapy resistance, limiting treatment options. We have previously shown that individuality in fibroblast growth factor 1 (FGF1) expression influences survival and chemotherapy response.

Methods: We used MTT assays to assess chemosensitivity to cisplatin and carboplatin following shRNA-mediated knockdown or heterologous over-expression of FGF1 (quantified by qRT-PCR and immunoblot analysis), and in combination with the FGFR inhibitors AZD4547 and SU5402, the ATM inhibitor KU55933 and DNA-PK inhibitor NU7026. Immunofluorescence microscopy was used to quantify the FGF1-dependent timecourse of replication protein A (RPA) and γH2AX foci formation.

Results: Pharmacological inhibition of FGF signalling reversed drug resistance in immortalised cell lines and in primary cell lines from drug-resistant ovarian cancer patients, while FGF1 over-expression induced resistance. Ataxia telangiectasia mutated (ATM) phosphorylation, but not DNA adduct formation was FGF1 dependent, following cisplatin or carboplatin challenge. Combining platinum drugs with the ATM inhibitor KU55933, but not with the DNA-PK inhibitor NU7026 re-sensitised resistant cells. FGF1 expression influenced the timecourse of damage-induced RPA and γH2AX nuclear foci formation.

Conclusion: Drug resistance arises from FGF1-mediated differential activation of high-fidelity homologous recombination DNA damage repair. FGFR and ATM inhibitors reverse platinum drug resistance, highlighting novel combination chemotherapy approaches for future clinical trial evaluation.
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http://dx.doi.org/10.1038/s41416-022-01899-zDOI Listing
July 2022

Estimating the Impact of Air Pollution on Healthcare-Seeking Behaviour by Applying a Difference-in-Differences Method to Syndromic Surveillance Data.

Int J Environ Res Public Health 2022 06 9;19(12). Epub 2022 Jun 9.

Real-Time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham B2 4BH, UK.

Syndromic surveillance data were used to estimate the direct impact of air pollution on healthcare-seeking behaviour, between 1 April 2012 and 31 December 2017. A difference-in-differences approach was used to control for spatial and temporal variations that were not due to air pollution and a meta-analysis was conducted to combine estimates from different pollution periods. Significant increases were found in general practitioner (GP) out-of-hours consultations, including a 98% increase (2-386, 95% confidence interval) in acute bronchitis and a 16% (3-30) increase in National Health Service (NHS) 111 calls for eye problems. However, the numbers involved are small; for instance, roughly one extra acute bronchitis consultation in a local authority on a day when air quality is poor. These results provide additional information for healthcare planners on the impacts of localised poor air quality. However, further work is required to identify the separate impact of different pollutants.
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http://dx.doi.org/10.3390/ijerph19127097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9222304PMC
June 2022

Cohort profile: Scotland's record-linkage e-cohorts of people with intellectual disabilities, and autistic people (SCIDA).

BMJ Open 2022 05 13;12(5):e057230. Epub 2022 May 13.

Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

Purpose: To investigate health, mortality and healthcare inequalities experienced by people with intellectual disabilities, and autistic people, and their determinants; an important step towards identifying and implementing solutions to reduce inequalities. This paper describes the cohorts, record-linkages and variables that will be used.

Participants: Scotland's Census, 2011 was used to identify Scotland's citizens with intellectual disabilities, and autistic citizens, and representative general population samples with neither. Using Scotland's community health index, the Census data (demography, household, employment, long-term conditions) were linked with routinely collected health, death and healthcare data: Scotland's register of deaths, Scottish morbidity data 06 (SMR06: cancer incidence, mortality, treatments), Prescribing Information System (identifying asthma/chronic obstructive pulmonary disease; angina/congestive heart failure/hypertension; peptic ulcer/reflux; constipation; diabetes; thyroid disorder; depression; bipolar disorders; anxiety/sleep; psychosis; attention deficit hyperactivity disorder; epilepsy; glaucoma), SMR01 (general/acute hospital admissions and causes, ambulatory care sensitive admissions), SMR04 (mental health admissions and causes), Scottish Care Information-Diabetes Collaboration (diabetic care quality, diabetic outcomes), national bowel screening programme and cervical screening.

Findings To Date: Of the whole population, 0.5% had intellectual disabilities, and 0.6% were autistic. Linkage was successful for >92%. The resultant e-cohorts include: (1) 22 538 people with intellectual disabilities (12 837 men and 9701 women), 4509 of whom are children <16 years, (2) 27 741 autistic people (21 390 men and 6351 women), 15 387 of whom are children <16 years and (3) representative general population samples with neither condition. Very good general health was reported for only 3389 (15.0%) people with intellectual disabilities, 10 510 (38.0%) autistic people, compared with 52.4% general population. Mental health conditions were reported for 4755 (21.1%) people with intellectual disabilities, 3998 (14.4%) autistic people, compared with 4.2% general population.

Future Plans: Analyses will determine the extent of premature mortality, causes of death, and avoidable deaths, profile of health conditions and cancers, healthcare quality and screening and determinants of mortality and healthcare.
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http://dx.doi.org/10.1136/bmjopen-2021-057230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9109103PMC
May 2022

Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study.

JMIR Public Health Surveill 2022 Aug 3;8(8):e32347. Epub 2022 Aug 3.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores.

Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England.

Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis.

Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems-a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service-while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems.

Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored.
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http://dx.doi.org/10.2196/32347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359118PMC
August 2022

The Utility of Ambulance Dispatch Call Syndromic Surveillance for Detecting and Assessing the Health Impact of Extreme Weather Events in England.

Int J Environ Res Public Health 2022 03 24;19(7). Epub 2022 Mar 24.

Real-Time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham B2 4BH, UK.

Extreme weather events present significant global threats to health. The National Ambulance Syndromic Surveillance System collects data on 18 syndromes through chief presenting complaint (CPC) codes. We aimed to determine the utility of ambulance data to monitor extreme temperature events for action. Daily total calls were observed between 01/01/2018-30/04/2019. Median daily 'Heat/Cold' CPC calls during "known extreme temperature" (identified ), "extreme temperature"; (within 5th or 95th temperature percentiles for central England) and meteorological alert periods were compared to all other days using Wilcoxon signed-rank test. During the study period, 12,585,084 calls were recorded. In 2018, median daily "Heat/Cold" calls were higher during periods of known extreme temperature: heatwave (16/day, 736 total) and extreme cold weather events (28/day, 339 total) compared to all other days in 2018 (6/day, 1672 total). Median daily "Heat/Cold" calls during extreme temperature periods (16/day) were significantly higher than non-extreme temperature periods (5/day, < 0.001). Ambulance data can be used to identify adverse impacts during periods of extreme temperature. Ambulance data are a low resource, rapid and flexible option providing real-time data on a range of indicators. We recommend ambulance data are used for the surveillance of presentations to healthcare related to extreme temperature events.
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http://dx.doi.org/10.3390/ijerph19073876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8997786PMC
March 2022

Adverse Events of Interest Following Influenza Vaccination in the First Season of Adjuvanted Trivalent Immunization: Retrospective Cohort Study.

JMIR Public Health Surveill 2022 03 28;8(3):e25803. Epub 2022 Mar 28.

University of Oxford, Oxford, United Kingdom.

Background: Vaccination is the most effective form of prevention of seasonal influenza; the United Kingdom has a national influenza vaccination program to cover targeted population groups. Influenza vaccines are known to be associated with some common minor adverse events of interest (AEIs), but it is not known if the adjuvanted trivalent influenza vaccine (aTIV), first offered in the 2018/2019 season, would be associated with more AEIs than other types of vaccines.

Objective: We aim to compare the incidence of AEIs associated with different types of seasonal influenza vaccines offered in the 2018/2019 season.

Methods: We carried out a retrospective cohort study using computerized medical record data from the Royal College of General Practitioners Research and Surveillance Centre sentinel network database. We extracted data on vaccine exposure and consultations for European Medicines Agency-specified AEIs for the 2018/2019 influenza season. We used a self-controlled case series design; computed relative incidence (RI) of AEIs following vaccination; and compared the incidence of AEIs associated with aTIV, the quadrivalent influenza vaccine, and the live attenuated influenza vaccine. We also compared the incidence of AEIs for vaccinations that took place in a practice with those that took place elsewhere.

Results: A total of 1,024,160 individuals received a seasonal influenza vaccine, of which 165,723 individuals reported a total of 283,355 compatible symptoms in the 2018/2019 season. Most AEIs occurred within 7 days following vaccination, with a seasonal effect observed. Using aTIV as the reference group, the quadrivalent influenza vaccine was associated with a higher incidence of AEIs (RI 1.46, 95% CI 1.41-1.52), whereas the live attenuated influenza vaccine was associated with a lower incidence of AEIs (RI 0.79, 95% CI 0.73-0.83). No effect of vaccination setting on the incidence of AEIs was observed.

Conclusions: Routine sentinel network data offer an opportunity to make comparisons between safety profiles of different vaccines. Evidence that supports the safety of newer types of vaccines may be reassuring for patients and could help improve uptake in the future.
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http://dx.doi.org/10.2196/25803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9002594PMC
March 2022

Impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February-July 2020.

BMJ Open 2022 03 21;12(3):e050469. Epub 2022 Mar 21.

UK Health Security Agency, London, UK.

Objective: To establish the impact of the first 6 months of the COVID-19 outbreak response on gastrointestinal (GI) infection trends in England.

Design: Retrospective ecological study using routinely collected national and regional surveillance data from seven UK Health Security Agency coordinated laboratory, outbreak and syndromic surveillance systems using key dates of UK governmental policy change to assign phases for comparison between 2020 and historic data.

Results: Decreases in GI illness activity were observed across all surveillance indicators as COVID-19 cases began to peak. Compared with the 5-year average (2015-2019), during the first 6 months of the COVID-19 response, there was a 52% decrease in GI outbreaks reported (1544 vs 3208 (95% CI 2938 to 3478)) and a 34% decrease in laboratory confirmed cases (27 859 vs 42 495 (95% CI 40 068 to 44 922)). GI indicators began to rise during the first lockdown and lockdown easing, although all remained substantially lower than historic figures. Reductions in laboratory confirmed cases were observed across all age groups and both sexes, with geographical heterogeneity observed in diagnosis trends. Health seeking behaviour changed substantially, with attendances decreasing prior to lockdown across all indicators.

Conclusions: There has been a marked change in trends of GI infections in the context of the COVID-19 pandemic. The drivers of this change are likely to be multifactorial; while changes in health seeking behaviour, pressure on diagnostic services and surveillance system ascertainment have undoubtably played a role, there has likely been a true decrease in the incidence for some pathogens resulting from the control measures and restrictions implemented. This suggests that if some of these changes in behaviour such as improved hand hygiene were maintained, then we could potentially see sustained reductions in the burden of GI illness.
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http://dx.doi.org/10.1136/bmjopen-2021-050469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968111PMC
March 2022

Fragility fractures of the pelvis in the older population.

Age Ageing 2022 03;51(3)

Department of Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, UK.

Pelvic fractures are an increasingly common injury seen in the older population and represent a significant burden of morbidity and mortality in this age group, as well as a large financial burden on the health service. It is well established that early fixation of femoral neck and acetabular fractures improves outcomes and increases the chances of patients returning close to their premorbid functional baseline. However, fixation of fragility fractures of the pelvis is less well established in current practice. There has been recent development of novel stabilisation techniques for unstable pelvic fractures, designed to tackle the difficulties associated with fixation in poor bone quality, along with medical trials of parathyroid hormone analogue treatment. However, it is still current practice to manage nearly all fragility fractures of the pelvis conservatively. In this article, we consider whether the development of surgical stabilisation techniques for pelvic fragility fractures may have the potential to improve the well-described morbidity and mortality associated with them.
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http://dx.doi.org/10.1093/ageing/afac063DOI Listing
March 2022

Bladder filling in patients undergoing prostate radiotherapy on a MR-linac: The dosimetric impact.

Tech Innov Patient Support Radiat Oncol 2022 Mar 16;21:41-45. Epub 2022 Feb 16.

Royal Marsden NHS Foundation Trust, United Kingdom.

The implementation of adaptive radiotherapy for prostate cancer compensates for inter-fraction motion, at the penalty of increased time in room. The subsequent increase in bladder filling may impact dosimetry, which we have investigated on ten patients treated on the MR-linac. Patients drank water before treatment, to achieve a bladder volume of 200-300 cm. Bladder and bowel were re-outlined offline on 140 images and plans recalculated. All mandatory bladder dose constraints and 99.1% of bowel constraints were achieved at time of treatment, despite varying bladder volumes and varying adherence to original bladder filling guidance.
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http://dx.doi.org/10.1016/j.tipsro.2022.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857515PMC
March 2022

Pirin, an Nrf2-Regulated Protein, Is Overexpressed in Human Colorectal Tumors.

Antioxidants (Basel) 2022 Jan 28;11(2). Epub 2022 Jan 28.

Jacqui Wood Cancer Centre, Division of Cellular Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, UK.

The evolutionary conserved non-heme Fe-containing protein pirin has been implicated as an important factor in cell proliferation, migration, invasion, and tumour progression of melanoma, breast, lung, cervical, prostate, and oral cancers. Here we found that pirin is overexpressed in human colorectal cancer in comparison with matched normal tissue. The overexpression of pirin correlates with activation of transcription factor nuclear factor erythroid 2 p45-related factor 2 (Nrf2) and increased expression of the classical Nrf2 target NAD(P)H:quinone oxidoreductase 1 (NQO1), but interestingly and unexpectedly, not with expression of the aldo-keto reductase (AKR) family members AKR1B10 and AKR1C1, which are considered to be the most overexpressed genes in response to Nrf2 activation in humans. Using pharmacologic and genetic approaches to either downregulate or upregulate Nrf2, we show that pirin is regulated by Nrf2 in human and mouse cells and in the mouse colon in vivo. The small molecule pirin inhibitor TPhA decreased the viability of human colorectal cancer (DLD1) cells, but this decrease was independent of the levels of pirin. Our study demonstrates the Nrf2-dependent regulation of pirin and encourages the pursuit for specific pirin inhibitors.
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http://dx.doi.org/10.3390/antiox11020262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8868368PMC
January 2022

Evaluating multi-purpose syndromic surveillance systems - a complex problem.

Online J Public Health Inform 2021 24;13(3):E15. Epub 2021 Dec 24.

Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham B2 4BH, United Kingdom.

Surveillance systems need to be evaluated to understand what the system can or cannot detect. The measures commonly used to quantify detection capabilities are sensitivity, positive predictive value and timeliness. However, the practical application of these measures to multi-purpose syndromic surveillance services is complex. Specifically, it is very difficult to link definitive lists of what the service is intended to detect and what was detected. First, we discuss issues arising from a multi-purpose system, which is designed to detect a wide range of health threats, and where individual indicators, e.g. 'fever', are also multi-purpose. Secondly, we discuss different methods of defining what can be detected, including historical events and simulations. Finally, we consider the additional complexity of evaluating a service which incorporates human decision-making alongside an automated detection algorithm. Understanding the complexities involved in evaluating multi-purpose systems helps design appropriate methods to describe their detection capabilities.
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http://dx.doi.org/10.5210/ojphi.v13i3.10818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765799PMC
December 2021

Mortality in patients with carbapenem-resistant with and without susceptibility to traditional antipseudomonal β-lactams.

JAC Antimicrob Resist 2021 Dec 17;3(4):dlab187. Epub 2021 Dec 17.

Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Background: Carbapenem-resistant (CRPA) isolates can frequently retain susceptibility to traditional antipseudomonal β-lactams including cefepime, ceftazidime and piperacillin/tazobactam.

Objectives: This observational study aimed to determine the proportion of CRPA isolates that were susceptible to all tested other traditional antipseudomonal β-lactams (S-CRPA) and assess whether patients with S-CRPA had improved 30 day mortality compared with patients with NS-CRPA (non-susceptible to cefepime, ceftazidime or piperacillin/tazobactam).

Methods: Patients with CRPA isolated from normally sterile sites, urine, lower respiratory tracts and wounds were identified using active population- and laboratory-based surveillance through the Georgia Emerging Infections Program from August 2016 to July 2018 in Atlanta, GA, USA. Only unique patients who were hospitalized at the time of, or within 1 week of, culture were included. We excluded patients with cystic fibrosis. Multivariable logistic regression estimated the association between S-CRPA and 30 day mortality.

Results: Among 635 adults hospitalized with CRPA, 219 (34%) had S-CRPA. Patients with S-CRPA were more likely to be white (50% versus 38%, = 0.01) and live in a private residence prior to culture (44% versus 28%, < 0.01), and less likely to have required ICU care within the prior week (23% versus 36%, < 0.01) compared with patients with NS-CRPA. Compared with those with NS-CRPA, patients with S-CRPA had an increased 30 day mortality (18% versus 15%, adjusted OR 1.9; 95% CI 1.2-3.1).

Conclusions: S-CRPA was associated with higher 30 day mortality than NS-CRPA in hospitalized patients. The reason for this observed increase in mortality deserves further investigation.
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http://dx.doi.org/10.1093/jacamr/dlab187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8678435PMC
December 2021

Prevalence of colistin heteroresistance in carbapenem-resistant Pseudomonas aeruginosa and association with clinical outcomes in patients: an observational study.

J Antimicrob Chemother 2022 02;77(3):793-798

Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Objectives: To describe the prevalence of colistin heteroresistance in carbapenem-resistant Pseudomonas aeruginosa (CRPA) and evaluate the association with clinical outcomes.

Methods: Colistin heteroresistance was evaluated in CRPA isolates collected from patients without cystic fibrosis in Atlanta, Georgia, USA using two definitions: HR1, growth at 4 and 8 mg/L of colistin at a frequency ≥1 × 10-6 the main population; and HR2, growth at a colistin concentration ≥8× the MIC of the main population at a frequency ≥1 × 10-7. A modified population analysis profile (mPAP) technique was compared with reference PAP for detecting heteroresistance. For adults hospitalized at the time of or within 1 week of CRPA culture, multivariable logistic regression estimated the association between heteroresistance and 90 day mortality.

Results: Of 143 colistin-susceptible CRPA isolates, 8 (6%) met the HR1 definition and 37 (26%) met the HR2 definition. Compared with the reference PAP, mPAP had a sensitivity and specificity of 50% and 100% for HR1 and 32% and 99% for HR2. Of 82 hospitalized patients, 45 (56%) were male and the median age was 63 years (IQR 49-73). Heteroresistance was not associated with 90 day mortality using HR1 (0% in heteroresistant versus 22% in non-heteroresistant group; P = 0.6) or HR2 (12% in heteroresistant versus 24% in non-heteroresistant group; P = 0.4; adjusted OR 0.8; 95% CI 0.2-3.4).

Conclusions: Colistin heteroresistance was identified in up to 26% of patients with CRPA in our sample, although the prevalence varied depending on the definition. We did not observe an apparent association between colistin heteroresistance and 90 day mortality.
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http://dx.doi.org/10.1093/jac/dkab461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097253PMC
February 2022

Describing the indirect impact of COVID-19 on healthcare utilisation using syndromic surveillance systems.

BMC Public Health 2021 11 5;21(1):2019. Epub 2021 Nov 5.

Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, B3 2PW, UK.

Background: Since the end of January 2020, the coronavirus (COVID-19) pandemic has been responsible for a global health crisis. In England a number of non-pharmaceutical interventions have been introduced throughout the pandemic, including guidelines on healthcare attendance (for example, promoting remote consultations), increased handwashing and social distancing. These interventions are likely to have impacted the incidence of non-COVID-19 conditions as well as healthcare seeking behaviour. Syndromic Surveillance Systems offer the ability to monitor trends in healthcare usage over time.

Methods: This study describes the indirect impact of COVID-19 on healthcare utilisation using a range of syndromic indicators including eye conditions, mumps, fractures, herpes zoster and cardiac conditions. Data from the syndromic surveillance systems monitored by Public Health England were used to describe the number of contacts with NHS 111, general practitioner (GP) In Hours (GPIH) and Out-of-Hours (GPOOH), Ambulance and Emergency Department (ED) services over comparable periods before and during the pandemic.

Results: The peak pandemic period in 2020 (weeks 13-20), compared to the same period in 2019, displayed on average a 12% increase in NHS 111 calls, an 11% decrease in GPOOH consultations, and a 49% decrease in ED attendances. In the GP In Hours system, conjunctivitis consultations decreased by 64% and mumps consultations by 31%. There was a 49% reduction in attendance at EDs for fractures, and there was no longer any weekend increase in ED fracture attendances, with similar attendance patterns observed across each day of the week. There was a decrease in the number of ED attendances with diagnoses of myocardial ischaemia.

Conclusion: The COVID-19 pandemic drastically impacted healthcare utilisation for non-COVID-19 conditions, due to a combination of a probable decrease in incidence of certain conditions and changes in healthcare seeking behaviour. Syndromic surveillance has a valuable role in describing and understanding these trends.
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http://dx.doi.org/10.1186/s12889-021-12117-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571013PMC
November 2021

Predicting Survival in Repaired Tetralogy of Fallot: A Lesion-Specific and Personalized Approach.

JACC Cardiovasc Imaging 2022 02 13;15(2):257-268. Epub 2021 Oct 13.

Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom. Electronic address:

Objectives: This study sought to identify patients with repaired tetralogy of Fallot (rTOF) at high risk of death and malignant ventricular arrhythmia (VA).

Background: To date there is no robust risk stratification scheme to predict outcomes in adults with rTOF.

Methods: Consecutive patients were prospectively recruited for late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) to define right and left ventricular (RV, LV) fibrosis in addition to proven risk markers.

Results: The primary endpoint was all-cause mortality. Of the 550 patients (median age 32 years, 56% male), 27 died (mean follow-up 6.4 ± 5.8; total 3,512 years). Mortality was independently predicted by RVLGE extent, presence of LVLGE, RV ejection fraction ≤47%, LV ejection fraction ≤55%, B-type natriuretic peptide ≥127 ng/L, peak exercise oxygen uptake (V0) ≤17 mL/kg/min, prior sustained atrial arrhythmia, and age ≥50 years. The weighted scores for each of the preceding independent predictors differentiated a high-risk subgroup of patients with a 4.4%, annual risk of mortality (area under the curve [AUC]: 0.87; P < 0.001). The secondary endpoint (VA), a composite of life-threatening sustained ventricular tachycardia/resuscitated ventricular fibrillation/sudden cardiac death occurred in 29. Weighted scores that included several predictors of mortality and RV outflow tract akinetic length ≥55 mm and RV systolic pressure ≥47 mm Hg identified high-risk patients with a 3.7% annual risk of VA (AUC: 0.79; P < 0.001) RVLGE was heavily weighted in both risk scores caused by its strong relative prognostic value.

Conclusions: We present a score integrating multiple appropriately weighted risk factors to identify the subgroup of patients with rTOF who are at high annual risk of death who may benefit from targeted therapy.
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http://dx.doi.org/10.1016/j.jcmg.2021.07.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8821017PMC
February 2022

Diabetes status modifies the long-term effect of lipoprotein-associated phospholipase A2 on major coronary events.

Diabetologia 2022 01 25;65(1):101-112. Epub 2021 Sep 25.

Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.

Aims/hypothesis: Lipoprotein-associated phospholipase A2 (Lp-PLA2) activity has an independent prognostic association with major coronary events (MCE). However, no study has investigated whether type 2 diabetes status modifies the effect of Lp-PLA2 activity or inhibition on the risk of MCE. We investigate the interaction between diabetes status and Lp-PLA2 activity with risk of MCE. Subsequently, we test the resulting hypothesis that diabetes status will play a role in modifying the efficacy of an Lp-PLA2 inhibitor.

Methods: A retrospective cohort study design was utilised in two study populations. Discovery analyses were performed in the Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) cohort based in Scotland, UK. Participants were categorised by type 2 diabetes control status: poorly controlled (HbA ≥ 48 mmol/mol or ≥6.5%) and well-controlled (HbA < 48 mmol/mol or <6.5%) diabetes (n = 7420). In a secondary analysis of the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy (STABILITY) trial of Lp-PLA2 inhibitor (darapladib) efficacy, 15,828 participants were stratified post hoc by type 2 diabetes diagnosis status (diabetes or no diabetes) at time of recruitment. Lp-PLA2 activity was then divided into population-specific quartiles. MCE were determined from linked medical records in GoDARTS and trial records in STABILITY. First, the interaction between diabetes control status and Lp-PLA2 activity on the outcome of MCE was explored in GoDARTS. The effect was replicated in the placebo arm of STABILITY. The effect of Lp-PLA2 on MCE was then examined in models stratified by diabetes status. This helped determine participants at higher risk. Finally, the effect of Lp-PLA2 inhibition was assessed in STABILITY in the higher risk group. Cox proportional hazards models adjusted for confounders were used to assess associations.

Results: In GoDARTS, a significant interaction between increased Lp-PLA2 activity (continuous and quartile divided) and diabetes control status was observed in the prediction of MCE (p < 0.0001). These effects were replicated in the placebo arm of STABILITY (p < 0.0001). In GoDARTS, stratified analyses showed that, among individuals with poorly controlled diabetes, the hazards of MCE for those with high (Q4) Lp-PLA2 activity was 1.19 compared with individuals with lower (Q1-3) Lp-PLA2 activity (95% CI 1.11, 1.38; p < 0.0001) and 1.35 (95% CI 1.16, 1.57; p < 0.0001) when compared with those with the lowest activity (Q1). Those in the higher risk group were identified as individuals with the highest Lp-PLA2 activity (Q4) and poorly controlled diabetes or diabetes. Based on these observations in untreated populations, we hypothesised that the Lp-PLA2 inhibitor would have more benefit in this higher risk group. In this risk group, Lp-PLA2 inhibitor use was associated with a 33% reduction in MCE compared with placebo (HR 0.67 [95% CI 0.50, 0.90]; p = 0.008). In contrast, Lp-PLA2 inhibitor showed no efficacy in individuals with low activity, regardless of diabetes status, or among those with no baseline diabetes and high Lp-PLA2 activity.

Conclusions/interpretation: These results support the hypothesis that diabetes status modifies the association between Lp-PLA2 activity and MCE. These results suggest that cardiovascular morbidity and mortality associated with Lp-PLA2 activity is especially important in patients with type 2 diabetes, particularly those with worse glycaemic control. Further investigation of the effects of Lp-PLA2 inhibition in diabetes appears warranted.

Data Availability: STABILITY trial data are available from clinicaltrials.gov repository through the GlaxoSmithKline clinical study register https://clinicaltrials.gov/ct2/show/NCT00799903 . GoDARTS datasets generated during and/or analysed during the current study are available following request to the GoDARTS Access Managements Group https://godarts.org/scientific-community/ .
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http://dx.doi.org/10.1007/s00125-021-05574-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8660745PMC
January 2022

Uptake and impact of vaccinating primary school children against influenza: Experiences in the fourth season of the live attenuated influenza vaccination programme, England, 2016/2017.

Influenza Other Respir Viruses 2022 01 17;16(1):113-124. Epub 2021 Aug 17.

Immunisation and Countermeasures, National Infection Service, Public Health England (PHE), London, UK.

Background: In the 2016/2017 influenza season, England was in its fourth season of the roll-out of a live-attenuated influenza vaccine (LAIV) targeted at healthy children aged two to less than 17 years. For the first time, all healthy children aged 2 to 8 years were offered LAIV at national level in 2016/2017. Since the commencement of the programme in 2013/2014, a series of geographically discrete pilot areas have been in place where quadrivalent LAIV was also offered to all school age children. In 2016/2017, these were children aged 8 to 11 years, other than those targeted by the national programme.

Methods: We evaluated the overall and indirect impact of vaccinating primary school age children, on the population of England, by measuring vaccine uptake levels and comparing cumulative disease incidence through various influenza surveillance schemes, in targeted and non-targeted age groups in pilot and non-pilot areas in 2016/2017.

Results: Our findings indicate that cumulative primary care influenza-like consultations, primary and secondary care swab positivity, influenza confirmed hospitalisations and emergency department attendances in pilot areas were overall lower than those observed in non-pilot areas; however, significant differences were not always observed in both targeted and non-targeted age groups. Excess mortality was higher in pilot areas compared with non-pilot areas.

Conclusions: These results are similar to earlier seasons of the programme indicating the importance and continuing support of vaccinating all primary school children with LAIV to reduce influenza related illness across the population, although further work is needed to understand the differences in excess mortality.
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http://dx.doi.org/10.1111/irv.12898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692804PMC
January 2022

Barriers and enablers to health service access amongst people with diabetes: An exploration of the perceptions of health care staff in regional Australia.

Health Soc Care Community 2022 01 29;30(1):e234-e244. Epub 2021 Jul 29.

School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia.

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social-ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.
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http://dx.doi.org/10.1111/hsc.13433DOI Listing
January 2022

Development and results of a patient-reported treatment experience questionnaire on a 1.5 T MR-Linac.

Clin Transl Radiat Oncol 2021 Sep 29;30:31-37. Epub 2021 Jun 29.

Royal Marsden NHS Foundation Trust, United Kingdom.

Introduction: With the implementation of new radiotherapy technology, it is imperative that patient experience is investigated alongside efficacy and outcomes. This paper presents the development of a specifically designed validated questionnaire and a first report of international multi-institutional preliminary patient experience of MRI-guided adaptive radiotherapy (MRgART) on the 1.5 T MR-Linac (MRL).

Methods: A patient experience questionnaire was developed and validated before being distributed to the Elekta MRL Consortium, to gather first patient-reported experience from participating centres worldwide. The final version of the questionnaire contains 18 questions covering a range of themes and was scored on a Likert scale of 0-3. Responses were post-processed so that a score of 0 represents a negative response and 3 represents the most favourable response. These results were analysed for patient-reported experience of treatment on the MRL. Results were also analysed for internal consistency of the questionnaire using Chronbach's Alpha and the questionnaire contents were validated for relevance using content validity indexes (CVI).

Results: 170 responses were received from five centres, representing patients with a wide range of tumour treatment sites from four different countries. MRgART was well tolerated with an 84% favourable response across all questions and respondents. When analysed by theme, all reported the highest percentage of results in the favourable categories (2 and 3). Internal consistency in the questionnaire was high (Cronbach's α = 0.8) and the item-level CVI for each question was 0.78 or above and the Scale-level CVI was 0.93, representing relevant content.

Conclusion: The developed questionnaire has been validated as relevant and appropriate for use in reporting experience of patients undergoing treatment on the MRL. The overall patient-reported experience and satisfaction from multiple centres within the Elekta MRL Consortium was consistently high. These results can reinforce user confidence in continuing to expand and develop MRL use in adaptive radiotherapy.
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http://dx.doi.org/10.1016/j.ctro.2021.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283148PMC
September 2021

Respiratory-associated deaths in people with intellectual disabilities: a systematic review and meta-analysis.

BMJ Open 2021 07 14;11(7):e043658. Epub 2021 Jul 14.

Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

Objective: To review and synthesise evidence on rates of respiratory-associated deaths and associated risk factors in the intellectual disability population.

Design: Systematic review and meta-analysis.

Data Sources: Embase, CINAHL, ISI Web of Science (all databases including Medline) and PsychINFO were searched for studies published between 1st January 1985 and 27th April 2020 and examined study and outcome quality. Reference lists and Google Scholar were also hand searched.

Results: We identified 2295 studies, 17 were included in the narrative synthesis and 10 studies (11 cohorts) in the meta-analysis. Data from 90 302 people with intellectual disabilities and 13 808 deaths from all causes in people with intellectual disabilities were extracted. Significantly higher rates of respiratory-associated deaths were found among people with intellectual disabilities (standardised mortality ratio(SMR): 10.86 (95% CI: 5.32 to 22.18, p<0.001) compared with those in the general population, lesser rates for adults with ID (SMR: 6.53 (95% CI: 4.29 to 9.96, p<0.001); and relatively high rates from pneumonia 26.65 (95% CI: 5.63 to 126.24, p<0.001). The overall statistical heterogeneity was I=99.0%.

Conclusion: Premature deaths due to respiratory disorders are potentially avoidable with improved public health initiatives and equitable access to quality healthcare. Further research should focus on developing prognostic guidance and validated tools for clinical practice to mitigate risks of respiratory-associated deaths.

Prospero Registration Number: CRD42020180479.
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http://dx.doi.org/10.1136/bmjopen-2020-043658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280912PMC
July 2021

Recognising the value of student involvement in the MDT huddle: A junior doctor's perspective.

Med Teach 2022 04 15;44(4):454-455. Epub 2021 Jun 15.

Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.

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http://dx.doi.org/10.1080/0142159X.2021.1937590DOI Listing
April 2022

Study into COVID-19 Crisis Using Primary Care Mental Health Consultations and Prescriptions Data.

Stud Health Technol Inform 2021 May;281:759-763

Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

The effect of the 2020 pandemic, and of the national measures introduced to control it, is not yet fully understood. The aim of this study was to investigate how different types of primary care data can help quantify the effect of the coronavirus disease (COVID-19) crisis on mental health. A retrospective cohort study investigated changes in weekly counts of mental health consultations and prescriptions. The data were extracted from one the UK's largest primary care databases between January 1st 2015 and October 31st 2020 (end of follow-up). The 2020 trends were compared to the 2015-19 average with 95% confidence intervals using longitudinal plots and analysis of covariance (ANCOVA). A total number of 504 practices (7,057,447 patients) contributed data. During the period of national restrictions, on average, there were 31% (3957 ± 269, p < 0.001) fewer events and 6% (4878 ± 1108, p < 0.001) more prescriptions per week as compared to the 2015-19 average. The number of events was recovering, increasing by 75 (± 29, p = 0.012) per week. Prescriptions returned to the 2015-19 levels by the end of the study (p = 0.854). The significant reduction in the number of consultations represents part of the crisis. Future service planning and quality improvements are needed to reduce the negative effect on health and healthcare.
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http://dx.doi.org/10.3233/SHTI210277DOI Listing
May 2021

How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.

Appl Health Econ Health Policy 2021 11 19;19(6):797-810. Epub 2021 May 19.

Research Department of Primary Care and Population Health, University College London, London, UK.

Background: Studies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study.

Methods: We outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed.

Results: Cost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million).

Conclusions: These principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC.

Trial Registration: Not applicable.
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http://dx.doi.org/10.1007/s40258-021-00660-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547208PMC
November 2021

Supporting and sustaining care at home: Experiences of adult daughters who support a parent with dementia to remain in their own home.

Health Soc Care Community 2022 01 6;30(1):81-90. Epub 2021 Apr 6.

Staffordshire Centre for Psychological Research, Department of Psychology, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK.

Supporting a parent with dementia living in their own home is a challenging care issue which has potential for negative physical, emotional and psychosocial impacts. This research explores the experiences of adult daughters who sustain this arrangement as well as managing the competing demands of their lives. Using a qualitative approach, semistructured interviews were conducted between March and October 2017. Eight adult females in the United Kingdom who were supporting a parent with dementia to remain living in their home were interviewed. Photo-elicitation was used as an aid to data collection and complemented the use of Thematic Analysis (TA) to analyse verbatim transcripts. Four themes were identified: (a) Impact on identity: impact of the participants' experience on their sense of identity; (b) Continuity and change: relationship redefinition and duality of roles; (c) Stepping up to the challenge: adjustment to and coping with competing demands and ethical dilemmas; and (d) Finding help: 'It is just a minefield': experiences of help-seeking and service provision. This study highlights the experiences and challenges for adult daughters who support a parent with dementia. Ethical dilemmas regarding autonomy and safeguarding concerns figure large along with the competing demands of multiple roles. Service providers should aim to be more proactive in offering timely practical and psychosocial support and guidance to avoid compassion fatigue and acknowledge the valuable unpaid service provided by these 'women in the middle'.
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http://dx.doi.org/10.1111/hsc.13373DOI Listing
January 2022

The impact of social and physical distancing measures on COVID-19 activity in England: findings from a multi-tiered surveillance system.

Euro Surveill 2021 03;26(11)

Public Health England COVID-19 Surveillance Cell, London, United Kingdom.

BackgroundA multi-tiered surveillance system based on influenza surveillance was adopted in the United Kingdom in the early stages of the coronavirus disease (COVID-19) epidemic to monitor different stages of the disease. Mandatory social and physical distancing measures (SPDM) were introduced on 23 March 2020 to attempt to limit transmission.AimTo describe the impact of SPDM on COVID-19 activity as detected through the different surveillance systems.MethodsData from national population surveys, web-based indicators, syndromic surveillance, sentinel swabbing, respiratory outbreaks, secondary care admissions and mortality indicators from the start of the epidemic to week 18 2020 were used to identify the timing of peaks in surveillance indicators relative to the introduction of SPDM. This timing was compared with median time from symptom onset to different stages of illness and levels of care or interactions with healthcare services.ResultsThe impact of SPDM was detected within 1 week through population surveys, web search indicators and sentinel swabbing reported by onset date. There were detectable impacts on syndromic surveillance indicators for difficulty breathing, influenza-like illness and COVID-19 coding at 2, 7 and 12 days respectively, hospitalisations and critical care admissions (both 12 days), laboratory positivity (14 days), deaths (17 days) and nursing home outbreaks (4 weeks).ConclusionThe impact of SPDM on COVID-19 activity was detectable within 1 week through community surveillance indicators, highlighting their importance in early detection of changes in activity. Community swabbing surveillance may be increasingly important as a specific indicator, should circulation of seasonal respiratory viruses increase.
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http://dx.doi.org/10.2807/1560-7917.ES.2021.26.11.2001062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976385PMC
March 2021

MR-Guided Adaptive Radiotherapy for Bladder Cancer.

Front Oncol 2021 25;11:637591. Epub 2021 Feb 25.

Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.

Radiotherapy has an important role in the curative and palliative treatment settings for bladder cancer. As a target for radiotherapy the bladder presents a number of technical challenges. These include poor tumor visualization and the variability in bladder size and position both between and during treatment delivery. Evidence favors the use of magnetic resonance imaging (MRI) as an important means of tumor visualization and local staging. The availability of hybrid systems incorporating both MRI scanning capabilities with the linear accelerator (MR-Linac) offers opportunity for in-room and real-time MRI scanning with ability of plan adaption at each fraction while the patient is on the treatment couch. This has a number of potential advantages for bladder cancer patients. In this article, we examine the technical challenges of bladder radiotherapy and explore how magnetic resonance (MR) guided radiotherapy (MRgRT) could be leveraged with the aim of improving bladder cancer patient outcomes. However, before routine clinical implementation robust evidence base to establish whether MRgRT translates into improved patient outcomes should be ascertained.
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http://dx.doi.org/10.3389/fonc.2021.637591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947660PMC
February 2021

Influenza and Respiratory Virus Surveillance, Vaccine Uptake, and Effectiveness at a Time of Cocirculating COVID-19: Protocol for the English Primary Care Sentinel System for 2020-2021.

JMIR Public Health Surveill 2021 02 19;7(2):e24341. Epub 2021 Feb 19.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

Background: The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when SARS-CoV-2 infections are likely to be cocirculating with the usual winter infections.

Objective: The aim of this study is to conduct surveillance of influenza and other monitored respiratory conditions and to report on vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerized medical records systems. We also aim to have general practices collect virology and serology specimens and to participate in trials and other interventional research.

Methods: The RCGP RSC network comprises over 1700 general practices in England and Wales. We will extract pseudonymized data twice weekly and are migrating to a system of daily extracts. First, we will collect pseudonymized, routine, coded clinical data for the surveillance of monitored and unexpected conditions; data on vaccine exposure and adverse events of interest; and data on approved research study outcomes. Second, we will provide dashboards to give general practices feedback about levels of care and data quality, as compared to other network practices. We will focus on collecting data on influenza-like illness, upper and lower respiratory tract infections, and suspected COVID-19. Third, approximately 300 practices will participate in the 2020-2021 virology and serology surveillance; this will include responsive surveillance and long-term follow-up of previous SARS-CoV-2 infections. Fourth, member practices will be able to recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point-of-care testing. Lastly, the legal basis for our surveillance with PHE is Regulation 3 of the Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval.

Results: The RCGP RSC network has tripled in size; there were previously 100 virology practices and 500 practices overall in the network and we now have 322 and 1724, respectively. The Oxford-RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network; currently, 1076 practices are uploaded. We are implementing a central swab distribution system for patients self-swabbing at home in addition to in-practice sampling. We have converted all our primary care coding to Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) coding. Throughout spring and summer 2020, the network has continued to collect specimens in preparation for the winter or for any second wave of COVID-19 cases. We have collected 5404 swabs and detected 623 cases of COVID-19 through extended virological sampling, and 19,341 samples have been collected for serology. This shows our preparedness for the winter season.

Conclusions: The COVID-19 pandemic has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, the RCGP and University of Oxford collaboration.
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http://dx.doi.org/10.2196/24341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899204PMC
February 2021

Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study.

Infect Control Hosp Epidemiol 2021 08 10;42(8):962-967. Epub 2020 Dec 10.

Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Objective: To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia.

Design: Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year.

Setting: The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia.

Patients: Residents of HD3 with CRE first identified in urine between 2012 and 2017.

Results: We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8-34.9), central venous catheter (OR, 4.3; 95% CI, 1.7-10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6-11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3-25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1-7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2-23.6).

Conclusions: In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.
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http://dx.doi.org/10.1017/ice.2020.1325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190175PMC
August 2021

Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: a retrospective time series analysis.

BMJ Open 2020 12 4;10(12):e036724. Epub 2020 Dec 4.

Health Services Division, Warwick Medical School, University of Warwick, Coventry, UK.

Objectives: To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data.

Design: A retrospective, time series analysis of GP consultations for AR.

Setting: A large GP surveillance network of GP practices in the London area.

Participants: The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014).

Primary Measure: Consultations for AR (numbers of consultations).

Results: During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO) appeared to be associated with increased consultations (for the category 70-85 µg/m, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980).

Conclusions: Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.
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http://dx.doi.org/10.1136/bmjopen-2019-036724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722376PMC
December 2020
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