2018

What’s in a name: friend or foe? Coping strategies used by stoma patients (2018)

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Type of publication:
Journal article

Author(s):
*Powell, Julie

Citation:
British Journal of Nursing; Mar 2018; vol. 27 (no. 5) S22

Abstract:
The article examines how stoma patients chose to name their stoma and discusses how this can inform medical professionals' understanding of patient experiences. It provides examples of patients who named stoma after common first names or after television characters and explores the success of such coping strategies.

Link to full-text [NHS OpenAthens account required]

Optimising patient experience within the ACHD outreach network: A questionnaire based study (2018)

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Type of publication:
Conference abstract

Author(s):
Ooues G.; Clift P.; Bowater S.; Arif S.; Hawkesford S.; Pope N.; Anthony J.; Gaffey T.; Thorne S.; Hudsmith L.; Epstein A.; Prasad N.; Adamson D.; Cummings M.; Spencer C.; Woodmansey P.; *Ingram T.; Morley-Davies A.; Roberts W.; Qureshi N.

Citation:
Heart; Feb 2018; vol. 104, Suppl 2, A12

Abstract:
Purpose The NHS England Congenital Heart Disease standards review is based on a network model to deliver high quality, safe and effective services as locally as possible. We developed a Patient Questionnaire across our Adult Congenital Heart Disease (ACHD) West Midlands network to measure patient experience, satisfaction and to improve services across the network. Methods Patient questionnaires were distributed to patients in all 8 Outreach and the Level 1 ACHD Centre (University Hospital Birmingham). Data was analysed including patients' replies on travel to outpatient clinic, satisfaction on location and timing of their appointment, review by ACHD Specialist Nurse and tests performed, information on their condition and leaflets provided and patients' demographics. Results 130 questionnaires were returned. The majority of patients (67%, n=87) travelled to their appointment with their own car, either alone (36%, n=46) or with a member of their family (44%, n=56). Most patients (93%, n=120) travelled less than one hour to hospital and less than 20 miles (86%, n=99). Patients attending Level 1 Centre appointments travelled a longer distance (mean 29.6+/-44 miles) compared to the Outreach Centres (mean 9.9+/-2.8 miles). Almost all patients found the appointment time and location convenient for them (91%, n=117% and 95%, n=121), and were given enough information regarding their condition (85%, n=98). Conclusion With the development of ACHD Network Outreach clinics to facilitate services and appointments closer to patients' homes, travel times are reduced and high patient satisfaction is maintained.

Link to full-text [NHS OpenAthens account required]

The REstart or STop Antithrombotics Randomised Trial (RESTART) after stroke due to intracerebral haemorrhage: Study protocol for a randomised controlled trial (2018)

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Type of publication:
Journal article

Author(s):
Al-Shahi Salman R.; Dennis M.S.; Innes K.; Drever J.; Dinsmore L.; Williams C.; Whiteley W.N.; Sandercock P.A.G.;  Sudlow C.L.M.; Murray G.D.; White P.M.; Newby D.E.; Sprigg N.; Werring D.J.; Dennis M.; Sudlow C.; Whiteley W.; Lerpiniere C.; McCormick K.; Perry J.; Parakramawansha R.; Hunter N.; Doubal F.; Paulton R.; O'Brien R.; Burgess S.; Mead G.; Taylor P.; MacLeod M.-J.; Maclennan B.; Clarke R.; Taylor V.; Klaasen K.; Crouch N.; Jagpal B.; Furnace J.; Irvine J.; Gow H.; Joyson A.; Nelson S.; Ross S.; Davies R.; Jose D.; Robinson N.; Codd L.; Dodd A.; Moroney H.; Weir P.; Little V.; Gott V.; Sangster G.; Owings P.; Cherian S.; Downham S.; Epstein D.; Webber A.; Qureshi S.; Nicholas P.; Krishnamurthy V.; Shukla A.; Jones I.; Ahmed A.; Cunningham M.; Zahoor T.; Johnson S.; Denniss C.; Albazzaz M.; Ramadan H.; Maguire S.; Patterson C.; Bellfield R.; Hairsine B.; Quinn O.; Hooley M.; Nair A.; Alam M.I.; Greig J.; Rana P.; Robinson M.; Sajid M.; Ball M.; Gascoyne R.; Ghaly G.; Raghunathan S.; Clarke J.; Wilkes G.; Law Z.; Appleton J.; Matias O.; Jackson B.; Keshvara R.; Whittamore K.; Jordan C.; Sheikh S.; Roffe J.; Gilzeane N.; Krishnan K.; Buck A.; Havard D.; Hedstrom A.; Shelton F.; Godfrey M.; Webster T.; Haider S.; Seagrave S.; Leason S.; Nallasivan A.; Chatterjee K.; Perkins C.; Mohd Nor A.; Persad N.; Eglinton C.; Brown C.; Weinling M.; Shah A.; Baker J.; Hyams B.; Kini M.; Fong R.; Chadha D.; Walstow D.; Proeschel H.; Sharpe S.; Horton S.; Jones S.; Byrne A.; McGhee C.; Smart A.; Copeland C.; Dutta D.; Bakawala R.; O'Connell S.; Hughes C.; Brown P.; Davis F.; Collins K.; Ward D.; Turfrey J.; Rudd T.; Marks K.; Kullane S.; Jonathan B.; Bhalla A.; Yip B.; Bell M.; MacInnes B.; Macliver L.; Esson D.; Yadava R.; Stafford S.; Reddan J.; Sangombe M.; Azhar K.; Jenkins C.; Price F.; Mercer L.; Vasileiadis E.; Mason C.; Aweid B.; Holden M.; Parry A.; Landers G.; Broughton D.; Chapman K.; Sigsworth A.; Tryambake D.; Young A.; Dixon L.; Bergin A.; Barber M.; Brodie F.; Anjum T.; Connor L.; Tucker S.; Thomas S.; Davies C.; Slade P.; Treadwell S.; Wani M.; Beaty T.; Krishnan M.; Dacey L.; Spencer J.; Quinn L.; Chenna S.; Storton S.; Jones T.; Jones H.T.; Hussain M.; Homan J.; Foster E.; Brotherton L.; Durman H.; Hunt N.; Foot J.; Whitcher A.; Pawley C.; Khan M.; Whiting R.; Harvey M.; Brown S.; Foote L.; Richard B.; Triscott C.; Edwards M.; Lawson H.; Wallace R.; Nott C.; Moseley S.; Buckle S.; Sarah P.; Whiteman J.; Fotherby K.; Butler D.; Willberry A.; Ahmad N.; Jennings-Preece K.; Baig F.; Morgan D.; Stevens A.; Metcalf K.; McDonald S.; Ravenhill G.; Anversha A.; Shinh N.; Perfitt R.; Greenwood R.; Saada J.; Waterfield K.; Sutton P.; Jagger J.; Wiltshire A.; Luder R.; Johnson V.V.; Bridger H.; Bhargava M.; Gallagher J.; Adesina T.; van Someren C.; Carpenter M.; Walker M.; Stanners A.; Ball J.; Jackson L.; Datta P.; Bateman G.; Fathima R.; Davey R.; Needle A.; Siddegowda P.; Ponnambath S.; Suttling A.; Harrington-Davies Y.; Butler R.; James M.C.; Valentine M.S.; Dobson T.; Howard P.; Tandy J.; Hyatt L.; Jarrett D.; Saulat A.; Sims D.; Willmot M.; Green C.; Jones R.; Cunningham J.; Maiden S.; Sutton C.; Hurley J.; Littleton E.; Shekhar R.; Crown R.; Ahmed I.; Fuller S.T.; Gilham E.; Andole S.; Gadapa N.; Dunne M.K.; Krommyda M.; Burssens E.; King S.; Goorah N.; Bell A.; Patel F.; Tomlinson B.; Duberley S.; Singh A.; Kelly C.; Walford J.; Harrington F.; Schofield C.; Lucas L.; Ellis S.; Bond K.; Mate A.; Adie K.; James A.; Maund B.; Courtauld G.; Mudd P.; Hemsley A.; Thorpe K.; Gupwell K.; Goff A.; Sword J.; Roughan C.; Strain D.; Cageao J.; Bowring A.; Keenan S.; James M.; Kingwell H.; Miller K.; Harkness K.; Doyle C.; Majis A.; Stocks K.; Maatouk A.; Barron L.; Dakin K.; Lindert R.; Kamara C.; Bayliss P.; Redgrave J.; Kibutu F.; Blank C.; Ali A.; Balitska O.; Birchall K.; Richards E.; Howe J.; Smyth N.; Giallombardo E.; Sykes L.; Wilson J.; Langhorne P.; McAlpine C.; Humphreys L.; Iqbal M.S.; Graham R.; Kerr G.; Wright F.; Kumar P.; Thomas P.; Culmsee C.; Huggett I.; Dunn M.L.; Barker J.; Manoj A.; Fitzsimmons P.; Lopez M.P.; Sharma N.; Cox P.; Fletcher G.; Wilkinson M.; Emsley H.; Raj S.; Doyle D.; Gregory B.; Punekar S.; Sultan S.; McLoughlin A.; Pasco K.; Balazikova M.O.; Nasim A.; Peixoto C.; Kane I.; Pitt- Ford A.; Hervey S.; Thompson P.; Latter M.L.; Barbon E.; Breeds J.; Rajkumar C.; Gainsborough N.; Gaylard J.; Choulerton J.; Shaw L.; Madigan B.; Howcroft D.; Lucas S.; Stone A.; Avis J.; Gbadamoshi L.; Button D.; Stephanie M.; Dow L.; Davis M.; Thompson T.; Hogg V.; Hays C.; Fawcett M.; Atkinson N.; Guy H.; Woodward S.; Parry-Jones A.; Marshall S.; Jarapa R.; Lee S.; Harrison L.; Johnes M.; Oloughlin V.; Wood E.; Perez J.; Naing Z.; Morell J.; Marsden T.; Ingham A.; Burger I.; Shaw K.M.; Hall A.; Punter M.; Weir N.; Evans S.; Walters A.; Gartrell M.I.; Smith M.F.; Cox M.C.; Smith C.N.S.; Egerton S.; Creeden R.; Marigold J.R.; Blades A.; Crawford P.; Battersby- Wood E.; Pressly V.; Allen C.; Howard G.; Muir K.; Kalladka D.; Smith W.; Day N.; Moreton F.; Cheripelli B.K.; Huang X.; Welch A.; El Tawil S.; Ramachandran S.; Crosbie C.; Elliot J.; Cluckie G.; Clarke B.; Dayal N.; Orefo C.; Adedoyin T.; Ghatala R.; Clarke N.; Jones V.; Blight A.; Lovelock C.; Chopra N.; Moynihan B.; Kennedy K.; Williams R.; Kerin M.L.; Jeyaraj M.N.; Choy L.; Watson F.; Trippier S.; O'Reill J.; Haque M.; Symonds S.; Maanoosi M.; Herman J.; Vassallo J.; Krishnamoorthy S.; Cochrane H.; Walter D.; O'Connell J.; Fox C.; Krishnamurthy R.; Osborne E.; Smith A.; Mokoena B.; Gulliver D.; Brew H.; Myint M.; Majmudar N.; Bunea G.; Sattar N.; *Srinivasan M.; *Mukherjee I.; *Motherwell N.; *Donaldson D.; *Campbell R.; *Hurford F.; Thavanesan K.; David O.; Tiwari D.; Hann G.; Longland B.; Bell J.; Rogers M.E.; Bagnall M.C.; Iqbal M.A.; Keltos M.; Jupp B.; Roberts J.; Cox C.; Ovington C.; Bhaskaran B.; Garfield-Smith J.; Buxton J.; Horan K.; Ayres G.; Bearne H.; Tomlin D.; Szabo S.; Kelly D.; Salih I.; Bhakri H.; Fitzell P.; Wilson D.; Wroath B.; Dynan K.; Power M.; Thompson S.; Ghosh S.; Henry M.; Gilmour D.; Barrie E.; Kenton A.; Nyabadza M.S.; Martin M.I.; Hunt B.; Hassan H.; Dallol B.; Muddegowda G.; Hiden M.J.; Maguire H.; Grocott J.; Finney K.; Barry A.; Roffe C.; Lyjko S.; Sanyal R.; Remegoso A.; Ferdinand P.; Butler A.; Abano N.; Causley M.C.; Denic H.; Carpio R.; Stevens S.; Moores A.; Varquez R.; Pai Y.; Bruce D.; Dima S.; Baliga V.; Naeem M.; Rogers G.; Brown E.; Hayman R.; Garside M.; Dhakal M.; Smith G.M.; Clayton S.; Orugun E.; Poultney U.; Glover R.; Crowther H.; Thornthwaite S.; Webb T.; Beranova E.; Walker S.; Cosier T.; Rudenko H.; Cowie L.; Verrion A.; Thomson A.; Gamble E.; Charles B.; Grue R.; Blane S.; Hague A.; Rashed K.; Vickers C.; Wood D.; Board J.; Buckley C.; Allison J.; Board S.; William-Yesson B.; Balian L.; Keeling E.; Kar A.; Halse O.; Nguyen V.; Harvey K.; Gardener L.; Mashate S.; Tilley V.; Wilding P.; Geraghty O.; Hazel B.; Harrison T.; Cuenoud L.; Auld G.; Erumere E.; Redjep O.; Grimwood G.; Howaniec L.; Hove D.; Salek-Haddadi A.; Saastamoinen K.; Argandona L.; Wiggam I.; Wallace A.; Cuddy S.; Tauro S.; Hunter A.; Kerr E.; Fulton A.; Putterill J.; Kakar P.; Jha R.; Gallifent R.; Pusalkar A.; Chan K.; Dangri P.; Crabtree K.; Beadle H.; Cook A.; Black T.; Cronin J.; Fennelly R.; Tribbeck M.; Clarke C.; Miriam S.; Anthony A.; Mead D.; Esisi B.; Bokhari M.; Cassidy T.; McClelland B.; Cooper M.; Wynter I.; Rajapakse A.; Nasar M.; Anwar I.; Ramshaw A.; Annamalai A.; Crawford S.; Nozedar T.; Skinner H.; Kumar B.; McArdle D.; Holmes C.; Dodd E.; Clarke S.; Caine S.; Baker P.; Murphy P.; Osborn M.; Guthrie L.B.; Steele A.; Devitt N.; Mangion D.; Fletcher J.; Hardwick A.; Constantin C.; Markova S.; Lawrence T.; Subramonian S.; Temple M.N.; Owusu-Agyei P.; Butterworth-Cowin N.; Werring D.; Hogan C.; brezitski M.; Elliott E.; Francia N.; Ashton A.; Hostettler I.; Oji N.; Banaras A.; Patel K.; Crook L.; Watchurst C.; Erande R.; Sekaran L.; Mohammed N.; Chauhan M.; Sethuraman S.; Simon R.; Bharaj K.; Tate M.; Justin F.; Phiri D.; Hewitt J.; Gray J.; Mardania R.; Procter M.S.; Elfandi K.; Khan U.; Ragab S.; Knops K.; Jinks E.; Dickson C.; Gleave L.; Leggett J.; Dube J.; Garcia T.; McIlmoyle J.; Anwar S.; Dhar S.; Jones K.; Jeffs C.; Dickinson C.; Howard J.; England T.; Donnelly R.; Maddula M.; Hassan A.; Veraque E.; Kambafwile M.; Makawa L.; Randall M.; Papavasileiou V.; Waugh D.; Ispoglou S.; Hayes A.; Ankolekar S.; Evans R.; Ni H.; Graham C.; Jose J.; Milligan J.; Rahman B.; Findlay P.; Macaden A.; Shread I.; Keegan B.; Blair C.; Kelly J.; Doherty M.; Dewar R.; White J.; Thomas K.; Cohen D.; David A.; Owoyele E.; Njoku K.; Poku P.; Sukdeo V.; Chandrakumar A.; Chamberlain A.; Abbdulsaheb M.; Guo F.; Oshodi M.A.; Licenik R.; Devine J.; Davies S.; Nisar N.; Niranchanan R.; Roganova T.; Mpelembue M.; Burgess L.; Bathula R.; Ngwako M.; Eveson D.; Mistri A.; Stephens C.; Musarrat K.; Lam M.Y.; Sattar S.; Khan S.; Moqsith M.; Manning L.; Patel C.; Schulz U.; Kennedy J.; Ford G.; Harston G.; Teal R.; Mathieson P.; Lenti G.; Reckless I.; Cullen C.; Stevenson S.; Harrison M.; Ewing J.; Shackcloth D.; Durairaj R.; Zoe M.; Ingram T.; Thant H.; Peters J.; Sutton V.; Ivatts S.; Amey I.; Clayton-Evans L.; Baird Y.; Sally M.; Newton S.; Guyler P.; Ng K.X.; Prabakaran R.O.; Ngo D.; Rashmi S.; Coward L.; Menon N.; Kelavkar S.; Kunhunny S.; Sinha D.; Siddiqui A.; Loganathan T.; Tysoe S.; Shah S.; Kalathil L.; Gautam N.; Meir J.; Bailey D.; Salehin M.; Miller R.; Kelly A.; Rayessa R.; Rodgers A.; Wilson L.; Naylor C.; Wilson S.; Clarkson E.; McCarron M.; McVerry F.; McKee S.J.; Cvoro V.; Ullah K.; Chapman N.; Couser M.; Mcauley S.; Pound S.; Nicolson A.; Imam J.; Wood L.; O'Brien E.; Hannon N.; Finlay S.; Hayhoe H.; Handley D.; Kelly S.; Mcgee J.; Mitchell J.; Amis E.; Sesay J.; Crisp S.; Francis J.

Citation:
Trials; Mar 2018; vol. 19 (no. 1)

Abstract:
Background: For adults surviving stroke due to spontaneous (non-traumatic) intracerebral haemorrhage (ICH) who had taken an antithrombotic (i.e. anticoagulant or antiplatelet) drug for the prevention of vaso-occlusive disease before the ICH, it is unclear whether starting antiplatelet drugs results in an increase in the risk of recurrent ICH or a beneficial net reduction of all serious vascular events compared to avoiding antiplatelet drugs. Methods/design: The REstart or STop Antithrombotics Randomised Trial (RESTART) is an investigatorled, randomised, open, assessor-blind, parallel-group, randomised trial comparing starting versus avoiding antiplatelet drugs for adults surviving antithrombotic-associated ICH at 122 hospital sites in the United Kingdom. RESTART uses a central, web-based randomisation system using a minimisation algorithm, with 1:1 treatment allocation to which central research staff are masked. Central follow-up includes annual postal or telephone questionnaires to participants and their general (family) practitioners, with local provision of information about adverse events and outcome events. The primary outcome is recurrent symptomatic ICH. The secondary outcomes are: symptomatic haemorrhagic events; symptomatic vaso-occlusive events; symptomatic stroke of uncertain type; other fatal events; modified Rankin Scale score; adherence to antiplatelet drug(s). The magnetic resonance imaging (MRI) sub-study involves the conduct of brain MRI according to a standardised imaging protocol before randomisation to investigate heterogeneity of treatment effect according to the presence of brain microbleeds. Recruitment began on 22 May 2013. The target sample size is at least 720 participants in the main trial (at least 550 in the MRI sub-study). Discussion: Final results of RESTART will be analysed and disseminated in 2019.

Link to full-text [no password required]

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Early and late pregnancy outcomes in women treated with cold-coagulation versus LLETZ cervical treatment for cervical intraepithelial neoplasia; a retrospective cohort study (2018)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; *Underwood, Martyn ; *Parry-Smith, William; *Panikkar, Jane

Citation:
Archives of Gynecology and Obstetrics; Apr 2018; Vol.297(4):1015-1025

Abstract:
PURPOSE To compare the pregnancy outcomes between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia. METHODS This was a retrospective cohort study of women who had a single cervical treatment between 2010 and 2011. We identified those women who had a singleton pregnancy subsequent to their cervical treatment until September 2017. Women with previous cervical treatment, previous miscarriage or preterm delivery were excluded. RESULTSWe identified 86 women with a pregnancy after LLETZ treatment and 75 women after cold coagulation. Those who had LLETZ when compared to cold coagulation miscarried more often in the first trimester (33.7 vs 17.3%; p = 0.01) than in the second trimester. In women with LLETZ this effect of increased early miscarriage was shown to be prolonged and to persist up to 17 months after excision. Women with LLETZ when compared to cold coagulation had higher spontaneous preterm birth rates (8.9 vs 6.7%) even though the difference was non significant, with the earliest spontaneous preterm birth occurring at 32 weeks and 34 weeks, respectively. CONCLUSION We found that women who received LLETZ treatment when compared to cold coagulation had higher spontaneous preterm birth rates in their subsequent pregnancy and miscarried more frequently in the first trimester, and demonstrated an increased early miscarriage risk that persisted for more than a year after excisional treatment.

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Stepped-wedge randomised trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation: Study protocol for a randomized controlled trial (2018)

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Type of publication:
Randomised controlled trial

Author(s):
Ugo Grossi, Natasha Stevens, Eleanor McAlees, *Jon Lacy-Colson, Steven Brown, Anthony Dixon, Gian Luca Di Tanna, S. Mark Scott, Christine Norton, Nadine Marlin, James Mason, Charles H. Knowles, and On behalf of the NIHR CapaCiTY working group

Citation:
Trials; Feb 2018; vol. 19 (no. 1)

Abstract:
Background: Laparoscopic ventral mesh rectopexy (LVMR) is an established treatment for external full thickness rectal prolapse. However, its clinical efficacy in patients with internal prolapse is uncertain due to the lack of high-quality evidence. Methods: An individual level, stepped-wedge randomised trial has been designed to allow observer-blinded data comparisons between patients awaiting LVMR with those who have undergone surgery. Adults with symptomatic internal rectal prolapse, unresponsive to prior conservative management, will be eligible to participate. They will be randomised to three arms with different delays before surgery (0, 12 and 24 weeks). Efficacy outcome data will be collected at equally stepped time points (12, 24, 36 and 48 weeks). The primary objective is to determine clinical efficacy of LVMR compared to controls with reduction in the Patient Assessment of Constipation Quality of Life (PAC-QOL) at 24 weeks serving as the primary outcome. Secondary objectives are to determine: (1) the clinical effectiveness of LVMR to 48 weeks to a maximum of 72 weeks; (2) pre-operative determinants of outcome; (3) relevant health economics for LVMR; (4) qualitative evaluation of patient and health professional experience of LVMR and (5) 30-day morbidity and mortality rates. Discussion: An individual-level, stepped-wedge, randomised trial serves the purpose of providing an untreated comparison for the active treatment group, while at the same time allowing the waiting-listed participants an opportunity to obtain the intervention at a later date. In keeping with the basic ethical tenets of this design, the average waiting time for LVMR (12 weeks) will be shorter than that for routine services (24 weeks).

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Prostatic abscess: A rare complication of staghorn calculi (2018)

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Type of publication:
Journal article

Author(s):
*Quraishi M.K.; *Phan Y.C.; *Asaad W.; *Lynn N.

Citation:
BMJ Case Reports; 2018; vol. 2018

Abstract:
A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. A conservative approach to its treatment may lead to high morbidity and mortality rates. Such morbidity usually manifests with renal failure, obstructed upper urinary tractand/or life-Threatening sepsis. Prostatic abscesses have never been associated with staghorn calculi in the literature. We report a case of a 70-year-old man who presented with sepsis, which was found to originate from a complex prostatic abscess. The patient had no history of urinary tract infections or risk factors. The authors believe that the incidentally identified staghorn calculi promoted the growth of Proteus mirabilis which led to the development of the prostatic abscess. The patient underwent a transurethral resection and drainage of the abscess following a failed course of antibiotic therapy. This case also highlights the paucity of guidelines available in treating prostatic abscesses.

Link to full-text [NHS OpenAthens account required]

3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial (2018)

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Type of publication:
Randomised controlled trial

Author(s):
Iveson TJ, Kerr RS, Saunders MP, Cassidy J, Hollander NH, Tabernero J, Haydon A, Glimelius B, Harkin A, Allan K, McQueen J, Scudder C, Boyd KA, Briggs A, Waterston A, Medley L, Wilson C, Ellis R, Essapen S, Dhadda AS, Harrison M, Falk S, Raouf S, Rees C, Olesen RK, Propper D, Bridgewater J, Azzabi A, Farrugia D, Webb A, Cunningham D, Hickish T, Weaver A, Gollins S, Wasan HS, Paul J. [SaTH was one of the sites this trial took place at]

Citation:
Lancet Oncology 2018 Apr;19(4):562-578

Abstract:
BACKGROUND: 6 months of oxaliplatin-containing chemotherapy is usually given as adjuvant treatment for stage 3 colorectal cancer. We investigated whether 3 months of oxaliplatin-containing chemotherapy would be non-inferior to the usual 6 months of treatment.
METHODS: The SCOT study was an international, randomised, phase 3, non-inferiority trial done at 244 centres. Patients aged 18 years or older with high-risk stage II and stage III colorectal cancer underwent central randomisation with minimisation for centre, choice of regimen, sex, disease site, N stage, T stage, and the starting dose of capecitabine. Patients were assigned (1:1) to receive 3 months or 6 months of adjuvant oxaliplatin-containing chemotherapy. The chemotherapy regimens could consist of CAPOX (capecitabine and oxaliplatin) or FOLFOX (bolus and infused fluorouracil with oxaliplatin). The regimen was selected before randomisation in accordance with choices of the patient and treating physician. The primary study endpoint was disease-free survival and the non-inferiority margin was a hazard ratio of 1·13. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who started study treatment. This trial is registered with ISRCTN, number ISRCTN59757862, and follow-up is continuing.
FINDINGS: 6088 patients underwent randomisation between March 27, 2008, and Nov 29, 2013. The intended treatment was FOLFOX in 1981 patients and CAPOX in 4107 patients. 3044 patients were assigned to 3 month group and 3044 were assigned to 6 month group. Nine patients in the 3 month group and 14 patients in the 6 month group did not consent for their data to be used, leaving 3035 patients in the 3 month group and 3030 patients in the 6 month group for the intention-to-treat analyses. At the cutoff date for analysis, there had been 1482 disease-free survival events, with 740 in the 3 month group and 742 in the 6 month group. 3 year disease-free survival was 76·7% (95% CI 75·1-78·2) for the 3 month group and 77·1% (75·6-78·6) for the 6 month group, giving a hazard ratio of 1·006 (0·909-1·114, test for non-inferiority p=0·012), significantly below the non-inferiority margin. Peripheral neuropathy of grade 2 or worse was more common in the 6 month group (237 [58%] of 409 patients for the subset with safety data) than in the 3 month group (103 [25%] of 420) and was long-lasting and associated with worse quality of life. 1098 serious adverse events were reported (492 reports in the 3 month group and 606 reports in the 6 month group) and 32 treatment-related deaths occurred (16 in each group).
INTERPRETATION: In the whole study population, 3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care.
FUNDING: Medical Research Council, Swedish Cancer Society, NETSCC, and Cancer Research UK.

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Spinal Motocross Injuries in the United Kingdom (2018)

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Type of publication:
Journal article

Author(s):
*Singh, Rohit; Bhalla, Amit; Ockendon, Matthew; *Hay, Stuart

Citation:
Orthopaedic journal of sports medicine; Jan 2018; vol. 6 (no. 1); p.

Abstract:
Background Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually.PurposeTo assess the current trend of spine-related motocross injuries over the past 5 years.Study DesignDescriptive epidemiology study.MethodsData were prospectively collected over 5 years (August 2010-August 2015) at our regional trauma and spine unit, regardless of whether the rider was performing the sport competitively or recreationally. Results During the study period, spine related injuries were identified for 174 patients (age range, 6-75 years) who were directly referred to our department following recreational or competitive motocross, with most injuries being sustained within the early spring and summer months, representing the start of the motocross season. A significant number of injuries were in males (n = 203, 94%), with the majority of injuries occurring within the 21- to 30-year-old age group. A total of 116 (54%) injuries required operative treatment. The most common spinal injury was thoracolumbar burst fracture (n = 95), followed by chance fractures (n = 26).ConclusionThis data series emphasizes the prevalence and devastation of motocross-related spinal injuries in the United Kingdom and may serve in administering sanctions and guidelines to governing bodies of motocross. The spinal injuries that occur during motocross have significant capital connotations for regional spinal centers. The recent surge in motocross popularity is correlated with the number of injuries, which have increased over the past 5 years by almost 500%.

Link to full-text [no password required]