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2. Total Triage Model in General Practice: A Systematic Review of the Opportunities and Challenges

Author

Ciarón Cooney, Rolfe, Samuel, Owen, Emily, Yurtoglu, Nesrin, and Park, Sophie

Subjects
Medical Specialties, Medicine and Health Sciences, Public Health, Primary Care
Abstract

Increasingly, remote consultations are used within General Practice. This is a consequence of numerous factors including pandemic adaptations to appointment systems and the societal movement from personal to digital interaction. These have resulted in the development of the Total Triage Model of Appointment management. In addition to the pandemic, in recent years, there has been increasing pressure within general practice. With a decrease in general practitioners (GPs), population growth, increasing prevalence of chronic conditions, and appointment demand. Despite Government initiatives to recruit 6,000 more GPs in February 2020, the BMA has noted a real loss in full time equivalent hours of 1,808 GPs since September 2015. In the same period, the patient caseload has increased with practice’s having an average of 2,131 more patients. It has been noted that there has been a shift in GP workload with more need and demand for GPs to be completing administrative work, which often there is not scheduled time in their sessions for. Increased clinical and administrative workload has been identified as a key reason for leaving and / or intention to leave among GPs. Total Triage became critically important during the COVID-19 pandemic and in general practice, remote consultations increased from 14.7% in February 2020 to 48.1% in April 2020. Although this has now dropped to 28.5% as of September 2022. This major change within the traditional structure of general practice has been linked to workload shifts between staff, from GPs to practice nurses. Rapid changes such as this have stimulated differing opinions among key stakeholders. The NHS has stated that clinicians should offer Face to Face Appointments without prior Triage. However, research has found that patients value having the flexibility of remote consultations. The aim of this systematic review is to examine and configure the available literature about the implementation of Total Triage, the reported opportunities and challenges for patients and staff and further implications for patients and practices.

Published
2023
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3. Becoming A Member of A Ward Nursing Community of Practice: Negotiating Participation Space

Author

Chen, Xiaorong Mary, Newman, Mark, and Park, Sophie

Subjects
Nursing not elsewhere classified, Nursing workforce
Abstract

This research aimed to find out how newly graduated nurses, also known as novices, participate in clinical practice in their first year. Current literature adopts a fixed model of a competent identity, judging an individual nurse either competent or not without the consideration of the working context. We aimed to find out what really happens during their transition. The workplace is a shared space which all nurses have to navigate daily. This space consists a fabric of mental and physical factors such as people, their interactions and the perceived power positions among them. Just like how drivers do at any traffic intersection, nurses have to find their passage through this shared space with other healthcare workers. The passage each nurse negotiated is his/her Participation Space. There are various factors they need to take into consideration.We identified Prized Tasks, Relational Position and Contextual Dimensions.

Published
2022
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8. Dyserythropoiesis Evaluated By Red Score and Hepcidin/Ferritin Levels Predicts Response to Epoetin Zeta in Lower Risk MDS

Author

Kosmider, Olivier, Maloisel, Frederic, Drenou, Bernard, Chapuis, Nicolas, Alary, Anne Sophie, Rousseau, Alice, Bouilloux, Cecile, Ducamp, Sarah, Verdier, Frederique, Lefebvre, Thibaud, Zoubida Karim, Marie-Christine Jacob, Debliquis, Agathe, Charpentier, Agnes, Fenaux, Pierre, Gyan, Emmanuel, Anglaret, Bruno, Leyronnas, Cecile, Corm, Selim, Borhane Slama, Stephane Cheze, Laribi, Kamel, Ame, Shanti, Rose, Christian, Lachenal, Florence, Toma, Andrea, Pica, Gian Matteo, Garban, Frederic, Pegourie, Brigitte, Jean-Yves Cahn, Wagner-Ballon, Orianne, Herault, Olivier, Meunier, Mathieu, Bardet, Valerie, Fontenay, Michaela, and Park, Sophie

Published
2018
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9. Reactive oxygen species levels control NF-κB activation by low dose deferasirox in erythroid progenitors of low risk myelodysplastic syndromes

Author

Meunier, Mathieu, Ancelet, Sarah, Lefebvre, Christine, Arnaud, Josyane, Garrel, Catherine, Pezet, Mylène, Wang, Yan, Faure, Patrice, Szymanski, Gautier, Duployez, Nicolas, Preudhomme, Claude, Biard, Denis, Polack, Benoît, Cahn, Jean-Yves, Moulis, Jean Marc, Park, Sophie, Université du Québec à Montréal = University of Québec in Montréal (UQAM), Institut de biologie structurale (IBS - UMR 5075 ), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Unité de Biochimie Hormonale et Nutritionnelle, Département de Biologie - Toxicologie - Pharmacologie, Centre d'Explorations Fonctionnelles Intégré (CEFI), Institut National de la Santé et de la Recherche Médicale (INSERM), Leibniz Universität Hannover=Leibniz University Hannover, Institut de Biologie et de Pathologie (DBTP), CHU Grenoble, Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Service d'Hématologie Cellulaire [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut de Radiobiologie Cellulaire et Moléculaire (IRCM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Thérapeutique Recombinante Expérimentale (TIMC-IMAG-TheREx), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Département de cancérologie et d'hématologie, CHU Grenoble-Hôpital Michallon, Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut de Recherche Interdisciplinaire de Grenoble (IRIG), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Grenoble, Leibniz Universität Hannover [Hannover] (LUH), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille

Subjects
[SDV]Life Sciences [q-bio], ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2017

10. Myelodysplastic syndromes with single neutropenia or thrombocytopenia are rarely refractory cytopenias with unilineage dysplasia by World Health Organization 2008 criteria and have favourable prognosis

Author

Beyne-Rauzy, Odile, Sebert, Marie, Sapena, Rosa, Zerazhi, Hacène, Legros, Laurence, Guerci-Bresler, Agnès, Ame, Shanti Natarjan, Germing, Ulrich, Santini, Valeria, Salvi, Flavia, Gioia, Daniela, Lunghi, Monia, Dreyfus, François, Fenaux, Pierre, Sindromi, Fdn Italiana, Registry, Dusseldorf Mds, Gyan, Emmanuel, Andrieu, Valerie, Sanna, Alessandro, Caille, Agnès, Schemenau, Jennifer, Sudaka, Isabelle, Siguret, Virginie, Malet, Michele, Park, Sophie, Bordessoule, Dominique, Mairesse, Jacques, Gelsi-Boyer, Véronique, Cheze, Stephane, Service Médecine Interne et immunologie clinique [CHU Toulouse], Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Médecine Interne Onco-hématologie, Centre Hospitalier Général, Service d'Hématologie Clinique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Department of Haematology, Oncology and Clinical Immunology, Centre for Haematology and Oncology, Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf], Service d'hématologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hémopathies Myéloïdes : Cellules Souches, Modèles Pré-Cliniques et Recherche Translationnelle (UMR 1131), Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d’Hématologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CIC - Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Thrombose : Épidémiologie, Physiopathologie et Thérapeutiques Innovantes (UMR_S 765), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges], CHU Limoges, Contrôle de la Réponse Immune B et des Lymphoproliférations (CRIBL), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Économie et Statistique (CREST), Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz] (ENSAI)-École polytechnique (X)-École Nationale de la Statistique et de l'Administration Économique (ENSAE Paris)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Médecine Interne et Immunopathologie, CHU Toulouse [Toulouse], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Heinrich-Heine-Universität Düsseldorf [Düsseldorf], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Hémopathies Myéloïdes : Cellules Souches, Modèles Pré-Cliniques et Recherche Translationnelle, Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], IUH- Institut Universitaire d'hématologie, Université Paris Diderot - Paris 7 ( UPD7 ), CHRU Tours, CHRU Tours-Institut National de la Santé et de la Recherche Médicale ( INSERM ), CIC 1415, Institut National de la Santé et de la Recherche Médicale-Université Francois Rabelais [Tours], Thrombose : Épidémiologie, Physiopathologie et Thérapeutiques Innovantes ( UMR_S 765 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Cochin [AP-HP], Contrôle de la Réponse Immune B et des Lymphoproliférations ( CRIBL ), Université de Limoges ( UNILIM ) -Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST FR CNRS 3503 ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Recherche en Économie et Statistique ( CREST ), Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz] ( ENSAI ) -École polytechnique ( X ) -École Nationale de la Statistique et de l'Administration Économique ( ENSAE ParisTech ), Centre de Recherche en Cancérologie de Marseille ( CRCM ), Aix Marseille Université ( AMU ) -Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Francois Rabelais [Tours], Centre National de la Recherche Scientifique (CNRS)-Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz] (ENSAI)-École polytechnique (X)-École Nationale de la Statistique et de l'Administration Économique (ENSAE ParisTech )-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Pediatrics, medicine.medical_specialty, classifications, diagnostic haematology, MDS, neutropenia, thrombocytopenia, Hematology, business.industry, Myelodysplastic syndromes, Neutropenia, medicine.disease, World health, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 03 medical and health sciences, 0302 clinical medicine, Refractory, Dysplasia, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, 030220 oncology & carcinogenesis, Immunology, medicine, Young adult, business, ComputingMilieux_MISCELLANEOUS, 030215 immunology
Abstract

International audience; no abstract

Published
2016

11. Exploring provision of Innovative Community Education Placements (ICEPs) for junior doctors in training: a qualitative study

Author

Griffin, Ann, Jones, Melvyn M, Khan, Nada, Park, Sophie, Rosenthal, Joe, and Chrysikou, Vasiliki

Subjects
Attitude of Health Personnel, Research, Teaching, Mentors, education, Medical Education and Training, Interviews as Topic, MEDICAL EDUCATION & TRAINING, PRIMARY CARE, England, Medical Staff, Hospital, Humans, Community Health Services, SOCIAL MEDICINE, Qualitative Research, Education, Medical, Undergraduate
Abstract

OBJECTIVE: Medical education in community settings is an essential ingredient of doctors' training and a key factor in recruiting general practitioners (GP). Health Education England's report 'Broadening the Foundation' recommends foundation doctors complete 4-month community placements. While Foundation GP schemes exist; other community settings, are not yet used for postgraduate training. The objective of this study was to explore how community-based training of junior doctors might be expanded into possible 'innovative community education placements' (ICEPs), examining opportunities and barriers to these developments. DESIGN: A qualitative study where semistructured interviews were undertaken and themes were generated deductively from the research questions, and iteratively from transcripts. SETTING: UK community healthcare. PARTICIPANTS: Stakeholders from UK Community healthcare providers and undergraduate GP and community educators. RESULTS: Nine participants were interviewed; those experienced in delivering community-based undergraduate education, and others working in community settings that had not previously trained doctors. Themes identified were practicalities such as 'finance and governance', 'communication and interaction', 'delivery of training' and 'perceptions of community'. ICEPs were willing to train Foundation doctors. However, concerns were raised that large numbers and inadequate resources could undermine the quality of educational opportunities, and even cause reputational damage. Organisation was seen as a challenge, which might be best met by placing some responsibility with trainees to manage their placements. ICEP providers agreed that defined service contribution by trainees was required to make placements sustainable, and enhance learning. ICEPs stated the need for positive articulation of the learning value of placements to learners and stakeholders. CONCLUSIONS: This study highlighted the opportunities for foundation doctors to gain specialist and generalist knowledge in ICEPs from diverse clinical teams and patients. We recommend in conclusion ways of dealing with some of the perceived barriers to training.

Published
2016

12. Caring for quality of care: symbolic violence and the bureaucracies of audit

Author

Emmerich, Nathan, Swinglehurst, Deborah, Maybin, Jo, Park, Sophie, Quilligan, Sally, and Apollo - University of Cambridge Repository

Subjects
Symbolism, Issues, ethics and legal aspects, Health Policy, Humans, Empathy, Violence, Morals, Delivery of Health Care, United Kingdom, Health(social science), Quality of Health Care
Abstract

BACKGROUND: This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice. DISCUSSION: This paper presents a social and ethical analysis of Quality of Care in the light of the moral notion of care and Bourdieu's conception of symbolic violence. We argue that Quality of Care bureaucracies show significant potential for symbolic violence or the domination of practice and health care professionals. This generates problematic, and unintended, consequences that can displace the goals of practice. SUMMARY: Quality of Care bureaucracies may have unintended consequences for the practice of health care. Consistent with feminist conceptions of care, Quality of Care 'audits' should be reconfigured so as to offer a more nuanced and responsive form of evaluation.

Published
2015

13. Bortezomib combined with low-dose cytarabine in Intermediate-2 and high risk myelodysplastic syndromes. A phase I/II Study by the GFM

Author

Natarajan-Amé, Shanti, Park, Sophie, Ades, Lionel, Vey, Norbert, Guerci-Bresler, Agnès, Cahn, Jean-Yves, Etienne, Gabriel, Bordessoule, Dominique, Ravoet, Christophe, Legros, Laurence, Cheze, Stephane, Stamatoullas, Aspasia, Berger, Elisabeth, Schmidt, Aline, Charbonnier, Aude, Chaury, Marie-Pierre, Braun, Thorsten, Fenaux, Pierre, Dreyfus, Francois, Renseigné, Non, Service d'hématologie clinique [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hematology (IPC-Marseille), Service d'Hématologie Clinique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hematology, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Service de médecine interne et maladies infectieuses [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Saint-André, Service d'Hématologie clinique et thérapie cellulaire [CHU Limoges], CHU Limoges, Centre Hospitalier de Jolimont-Lobbes, Institut de Biologie Valrose (IBV), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Groupe d'étude des proliférations lymphoïdes (GPL), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Service d'hématologie, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP]

Subjects
Male, MESH: Anemia, Refractory, with Excess of Blasts, medicine.medical_treatment, Low dose cytarabine, Gastroenterology, Bortezomib, 0302 clinical medicine, MESH: Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, MESH: Cytarabine, [SDV.BDD]Life Sciences [q-bio]/Development Biology, MESH: Treatment Outcome, MESH: Aged, Aged, 80 and over, 0303 health sciences, MESH: Middle Aged, Cytarabine, Hematology, MESH: Follow-Up Studies, Middle Aged, Boronic Acids, 3. Good health, MESH: Antineoplastic Combined Chemotherapy Protocols, Leukemia, Myeloid, Acute, Treatment Outcome, 030220 oncology & carcinogenesis, MESH: Pyrazines, MESH: Survival Analysis, Pyrazines, Toxicity, MESH: Boronic Acids, Drug Therapy, Combination, Female, MESH: Leukemia, Myeloid, Acute, MESH: Myelodysplastic Syndromes, medicine.drug, medicine.medical_specialty, MESH: Drug Administration Schedule, Drug Administration Schedule, 03 medical and health sciences, Internal medicine, medicine, Humans, In patient, 030304 developmental biology, Aged, Chemotherapy, MESH: Humans, Anemia, Refractory, with Excess of Blasts, business.industry, Myelodysplastic syndromes, medicine.disease, Survival Analysis, MESH: Male, MESH: Drug Therapy, Combination, Phase i ii, Myelodysplastic Syndromes, Immunology, Proteasome inhibitor, business, MESH: Female, Follow-Up Studies
Abstract

International audience; Marrow cells from patients with higher-risk myelodysplastic syndrome (MDS) exhibit constitutive nuclear factor (NF)-κB activation. The proteasome inhibitor, bortezomib, has limited efficacy as a single agent in acute myeloid leukaemia. Its activity on leukaemic cell lines is potentiated by chemotherapy. We treated 43 higher-risk MDS patients with bortezomib (1*5 mg/m(2) , days 1, 4, 8 and 11) and low dose cytarabine arabinoside (LDAC; 10 mg/m(2) , then 20 mg/m(2) from days 1-14), every 28 d for four cycles. Median follow-up was 29*7 months. Responses were seen in 12 of the 43 patients (28%), including complete response (CR, n = 1), marrow-CR (n = 3), partial response (PR, n = 5) and haematological improvement (HI, n = 3). Responses were seen in 12 (36%) of the 33 previously untreated patients (11% CR, 13% PR, 2*5% HI), compared to none in the 12 previously treated patients (P < 0*01). Responders had better overall survival (median 18*2 vs. 10 months). One CR and 3 marrow-CRs were seen in patients with complex karyotypes. Main toxicity was haematological, responsible for infection in six patients and bleeding in 3. Three patients with Grade 1-2 pre-treatment haematotoxicity developed Grade 3-4 toxicity. Neuropathy was seen in 12% of patients. The addition of bortezomib to LDAC in higher-risk MDS may improve results obtained with LDAC alone, especially in patients with unfavourable karyotypes.

Published
2012

15. Reconsidering ‘ethics’ and ‘quality’ in healthcare research: the case for an iterative ethical paradigm

Author

Stevenson, Fiona A, Gibson, William, Pelletier, Caroline, Chrysikou, Vasiliki, and Park, Sophie

Subjects
Informed Consent, ComputingMilieux_THECOMPUTINGPROFESSION, Debate, Health Policy, Health Services, Quality, Health research, State Medicine, United Kingdom, Ethics, Research, Health(social science), Issues, ethics and legal aspects, Research Design, Research ethics committees, Outcome Assessment, Health Care, Humans, UK, Health Services Research, Ethical Review, Delivery of Health Care, Qualitative Research, Ethics Committees, Research
Abstract

Background UK-based research conducted within a healthcare setting generally requires approval from the National Research Ethics Service. Research ethics committees are required to assess a vast range of proposals, differing in both their topic and methodology. We argue the methodological benchmarks with which research ethics committees are generally familiar and which form the basis of assessments of quality do not fit with the aims and objectives of many forms of qualitative inquiry and their more iterative goals of describing social processes/mechanisms and making visible the complexities of social practices. We review current debates in the literature related to ethical review and social research, and illustrate the importance of re-visiting the notion of ethics in healthcare research. Discussion We present an analysis of two contrasting paradigms of ethics. We argue that the first of these is characteristic of the ways that NHS ethics boards currently tend to operate, and the second is an alternative paradigm, that we have labelled the ‘iterative’ paradigm, which draws explicitly on methodological issues in qualitative research to produce an alternative vision of ethics. We suggest that there is an urgent need to re-think the ways that ethical issues are conceptualised in NHS ethical procedures. In particular, we argue that embedded in the current paradigm is a restricted notion of ‘quality’, which frames how ethics are developed and worked through. Specific, pre-defined outcome measures are generally seen as the traditional marker of quality, which means that research questions that focus on processes rather than on ‘outcomes’ may be regarded as problematic. We show that the alternative ‘iterative’ paradigm offers a useful starting point for moving beyond these limited views. Summary We conclude that a ‘one size fits all’ standardisation of ethical procedures and approach to ethical review acts against the production of knowledge about healthcare and dramatically restricts what can be known about the social practices and conditions of healthcare. Our central argument is that assessment of ethical implications is important, but that the current paradigm does not facilitate an adequate understanding of the very issues it aims to invigilate.

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16. Outcome of lower-risk patients with myelodysplastic syndromes without 5q deletion after failure of erythropoiesis-stimulating agents

Author

Jennifer Kaivers, Ulrich Germing, Rosa Sapena, Giovanni Cametti, Mikkael A. Sekeres, Katharina Götze, Maria Diez Campelo, Agnès Guerci-Bresler, Fabrizio Pane, Stéphane Cheze, François Dreyfus, Teresa Bernal, Enrico Balleari, David P. Steensma, Rami S. Komrokji, Pierre Fenaux, Christian Rose, Guillermo Sanz, Valeria Santini, Catharina Müller-Thomas, Marisa Calabuig, Aspasia Stamatoullas, Norbert Vey, Dario Ferrero, Alessandro Sanna, Jean Francois Hamel, Jaime Fensterl, Dominique Bordessoule, Ioannis Kotsianidis, Sophie Park, Andrea Toma, Charikleia Kelaidi, Gail J. Roboz, Fernando Ramos, Gianluca Gaidano, Sylvain Thepot, Odile Beyne-Rauzy, Pascale Cony-Makhoul, Eric Wattel, Daniela Gioia, Park, Sophie, Hamel, Jean Françoi, Toma, Andrea, Kelaidi, Charikleia, Thépot, Sylvain, Campelo, Maria Diez, Santini, Valeria, Sekeres, Mikkael A, Balleari, Enrico, Kaivers, Jennifer, Sapena, Rosa, Götze, Katharina, Müller Thomas, Catharina, Beyne Rauzy, Odile, Stamatoullas, Aspasia, Kotsianidis, Ioanni, Komrokji, Rami, Steensma, David P, Fensterl, Jaime, Roboz, Gail J, Bernal, Teresa, Ramos, Fernando, Calabuig, Marisa, Guerci Bresler, Agnè, Bordessoule, Dominique, Cony Makhoul, Pascale, Cheze, Stéphane, Wattel, Eric, Rose, Christian, Vey, Norbert, Gioia, Daniela, Ferrero, Dario, Gaidano, Gianluca, Cametti, Giovanni, Pane, Fabrizio, Sanna, Alessandro, Germing, Ulrich, Sanz, Guillermo F, Dreyfus, Françoi, and Fenaux, Pierre

Subjects
Male, Cancer Research, 0302 clinical medicine, Recurrence, Risk Factors, hemic and lymphatic diseases, Hydroxyurea, Cumulative incidence, Treatment Failure, Enzyme Inhibitors, Lenalidomide, Aged, 80 and over, Cytarabine, Anemia, Middle Aged, Thalidomide, Melodysplastic syndrome, Survival Rate, Leukemia, Myeloid, Acute, Oncology, International Prognostic Scoring System, 030220 oncology & carcinogenesis, Retreatment, Azacitidine, Cyclosporine, Disease Progression, Chromosomes, Human, Pair 5, Female, Chromosome Deletion, Erythrocyte Transfusion, medicine.drug, medicine.medical_specialty, Melodysplastic syndrome, erytropoiesis stimulating agents, 5q, erytropoiesis stimulating agents, Decitabine, Antineoplastic Agents, Tretinoin, Lower risk, 5q, Arsenic, 03 medical and health sciences, Internal medicine, medicine, Humans, Immunologic Factors, Survival rate, Aged, Antilymphocyte Serum, Retrospective Studies, business.industry, Valproic Acid, Myelodysplastic syndromes, Retrospective cohort study, medicine.disease, Myelodysplastic Syndromes, Hematinics, Physical therapy, business, 030215 immunology
Abstract

Purpose Most anemic patients with non-deleted 5q lower-risk myelodysplastic syndromes (MDS) are treated with erythropoiesis-stimulating agents (ESAs), with a response rate of approximately 50%. Second-line treatments, including hypomethylating agents (HMAs), lenalidomide (LEN), and investigational drugs, may be used after ESA failure in some countries, but their effect on disease progression and overall survival (OS) is unknown. Here, we analyzed outcome after ESA failure and the effect of second-line treatments. Patients and Methods We examined an international retrospective cohort of 1,698 patients with non-del(5q) lower-risk MDS treated with ESAs. Results Erythroid response to ESAs was 61.5%, and median response duration was 17 months. Of 1,147 patients experiencing ESA failure, 653 experienced primary failure and 494 experienced relapse after a response. Primary failure of ESAs was associated with a higher risk of acute myeloid leukemia (AML) progression, which did not translate into an OS difference. Of 450 patients (39%) who received second-line treatment, 194 received HMAs, 148 received LEN, and 108 received other treatments (MISC), whereas 697 received RBC transfusions only. Five-year AML cumulative incidence was 20.3%, 20.3%, and 11.3% for those receiving HMAs, LEN, and MISC, respectively ( P = .05). Five-year OS for patients receiving HMA, LEN, and MISC was 36.5%, 41.7%, and 51%, respectively ( P = .21). In a multivariable analysis adjusted for age, sex, revised International Prognostic Scoring System score, and progression at ESA failure, there was no significant OS difference among the three groups. Conclusion In this large, multicenter, retrospective cohort of patients with non-del(5q) lower-risk MDS treated with ESAs, none of the most commonly used second-line treatments (HMA and LEN) significantly improved OS. Early failure of ESAs was associated with a higher risk of AML progression.

Published
2017

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