Author: Jason Curtis

A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial (2024)

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Type of publication:
Randomised controlled trial

Author(s):
Smith, Tim A D; West, Catharine M L; Joseph, Nuradh; Lane, Brian; Irlam-Jones, Joely; More, Elisabet; Mistry, Hitesh; Reeves, Kimberley J; Song, Yee Pei; Reardon, Mark; Hoskin, Peter J; Hussain, Syed A; *Denley, Helen; Hall, Emma; Porta, Nuria; Huddart, Robert A; James, Nick D; Choudhury, Ananya.

Citation:
EBioMedicine. 101:105032, 2024 Feb 21.

Abstract:
BACKGROUND: BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS: RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT: invasive loco-regional control (ILRC); secondary overall survival. FINDINGS: Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION: Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial.

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Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data (2024)

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Type of publication:
Journal article

Author(s):
Joyner, J; Ayyaz, F M; Cheetham, M; Briggs, T W R; Gray, W K.

Citation:
Hernia. 2024 Feb 12.

Abstract:
PURPOSE: Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS: A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. CONCLUSIONS: There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.

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Rhabdomyolysis Following Prolonged Entrapment on a Fence: A Case Report (2024)

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Type of publication:
Journal article

Author(s):
*Nwaneri, Chukwuemeka; *Aboshehata, Ahmed M; *Marsh, Adrian R.

Citation:
Cureus. 16(1):e51954, 2024 Jan.

Abstract:
It is well documented that prolonged immobilization and heavy alcohol consumption can independently cause rhabdomyolysis; however, entrapment on a fence following alcohol consumption resulting in rhabdomyolysis without prolonged coma or seizures has not been reported. We report a case of a 25-year-old man who, following alcohol consumption, whilst attempting to climb a fence, became entrapped and desperately had to clinch on the fence with both forearms for over three hours, resulting in rhabdomyolysis. This case report highlights the importance of recognizing the potential complications associated with prolonged immobilization and the subsequent management of rhabdomyolysis.

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A UK prospective multicentre decision impact, decision conflict and economic evaluation of the 21-gene assay in women with node+ve, hormone receptor+ve, HER2-ve breast cancer (2024)

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Type of publication:
Journal article

Author(s):
Holt, Simon; Verrill, Mark; *Pettit, Laura; Rigg, Anna; Hickish, Tamas; Archer, Caroline; Dent, Jo; Dillon, Marianne; Nathan, Mark; Barthelmes, Ludger; Rehman, Shazza; Sharaiha, Yousef; Innis, Paige; Sai-Giridhar, Priya; Khawaja, Saira.

Citation:
British Journal of Cancer. 2024 Feb 02.

Abstract:
BACKGROUND: For a tumour profiling test to be of value, it needs to demonstrate that it is changing clinical decisions, improving clinical confidence, and of economic benefit. This trial evaluated the use of the Oncotype DX Breast Recurrence Score R assay against these criteria in 680 women with hormone receptor-positive (HR+), HER2-negative early breast cancer with 1-3 lymph nodes positive (LN+) in the UK National Health Service (NHS). METHODS: Prior to receipt of the Recurrence Score (RS) result, both the physician and the patient were asked to state their preference for or against chemotherapy and their level of confidence on a scale of 1-5. Following receipt of the RS result, the physician and patient were asked to make a final decision regarding chemotherapy and record their post-test level of confidence. RESULTS: Receipt of the RS result led to a 51.5% (95% CI, 47.2-55.8%) reduction in chemotherapy, significantly increased the relative and absolute confidence for both physicians and patients and led to an estimated saving to the NHS of 787 per patient. CONCLUSION: The use of the Oncotype DX assay fulfils the criteria of changing clinical decisions, improving confidence and saving money.

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An overview of exertional leg pain in the athlete (2024)

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Type of publication:
Journal article

Author(s):
*Crooks S.A.; *Paavana T.; *Heaver C.

Citation:
Orthopaedics and Trauma. 38(1) (pp 56-64), 2024. Date of Publication: February 2024.

Abstract:
Exertional leg pain is a common problem in the athletic population, presenting with a constellation of similar symptoms. Delayed or incorrect diagnosis and treatment may result in significant morbidity and avoidable cessation of activity. Multiple causes such as chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), nerve or vascular entrapment syndromes may be responsible. A thorough history and focused clinical examination is mandated, and may yield clues as to the definitive diagnosis. Investigative adjuncts include imaging, compartment pressure measurement and electrodiagnostic studies. Whilst specific management depends on the underlying cause, the mainstay of initial management is activity modification, with surgery reserved for those who fail to respond to conservative measures.

A QIP on the completion of the AMHT Form in the Emergency Department in SaTH (2024)

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Type of publication:
Service improvement case study

Author(s):
*Kallum Claire

Citation:
SaTH Improvement Hub, April 2024

Abstract:
I aim to improve completion of the adult mental health triage form in SaTH ED by 20% by 31/05/2023 through the use of a poster, which will highlight the necessity of completion as well as serving as a reminder for staff to complete paperwork in the correct manner.

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