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2. Study protocol for a randomised controlled trial to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: 2 (TOPIC 2)

Author

Ben Shelley, Andreas Goebel, Stephen Grant, Louise Jackson, Hugh Jarrett, Marcus Jepson, Amy Kerr, Nandor Marczin, Rajnikant Mehta, Teresa Melody, Lee Middleton, Babu Naidu, Lajos Szentgyorgyi, Sarah Tearne, Ben Watkins, Matthew Wilson, Andrew Worrall, Joyce Yeung, and Fang Gao Smith

Subjects
Thoracotomy, Thoracic surgery, Paravertebral block, Thoracic epidural blockade, Anaesthesia, Chronic pain, Medicine (General), R5-920
Abstract

Abstract Background Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. Methods TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as ‘worst chest pain over the last week’ equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. Discussion Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. Trial registration NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856 . First patient recruited 8 January 2019.

Published
2023
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4. Development and pilot test of criteria defining best practices for organizational sexual assault prevention

Author

Joie Acosta, Matthew Chinman, Andra Tharp, Jack Baker, Paul Flaspohler, Beverly Fortson, Amy Kerr, Andrea Lamont, Amanda Meyer, Sierra Smucker, Katelyn Wargel, and Abraham Wandersman

Subjects
Medicine
Abstract

Sexual violence affects millions of Americans, and approximately one out of every three women and one out of every four men have experienced sexual violence during their lifetime. While prevention efforts have focused on implementing specific programmatic approaches, there has been relatively little focus on developing comprehensive and effective approaches to reduce sexual assault prevention across an organization. This study describes the development of the Prevention Evaluation Framework, an assessment targeting organizational best practices for comprehensive sexual assault prevention across multiple domains including human resources, collaborative relationships and infrastructure, use of evidence-informed approaches, quality implementation and continuous evaluation of programs/policies. Using the structured RAND/University of California, Los Angeles appropriateness method to develop the assessment, we conducted a literature review and solicited expert feedback about what a comprehensive organizational approach to sexual assault prevention should entail. We then pilot tested the assessment with 3 United States military service academies; and continued to improve and adapt the assessment to a range of organizations with input from 6 Department of Defense headquarters organizations, and 9 universities across the country. Given the nascent state of the evidence about what makes an effective organizational approach to sexual assault prevention, the assessment reflects one way of promoting quality in this evolving field. The consistency between the experts’ ratings and the literature, and the relevance of the items across organizations suggest that the assessment provides important guidance to inform the development of comprehensive organizational approaches to sexual assault prevention and to the evaluation of ongoing efforts.

Published
2022
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5. Protocol for a feasibility study of smoking cessation in the surgical pathway before major lung surgery: Project MURRAY

Author

Robert West, Jamie Brown, Syed Qadri, Amy Kerr, Amanda Farley, Michael Shackcloth, Sarah Feeney, Lindsey Murphy, Salma Kadiri, Karen Dobbs, Alina-Maria Budacan, Olga Perski, Magenta Black, Sridhar Rathinam, Rebecca Boyles, Helen Shackleford, Zara Jalal, Christine Jordan, and Ben Skirth

Subjects
Medicine
Abstract

Introduction Smoking prior to major thoracic surgery is the biggest risk factor for development of postoperative pulmonary complications, with one in five patients continuing to smoke before surgery. Current guidance is that all patients should stop smoking before elective surgery yet very few are offered specialist smoking cessation support. Patients would prefer support within the thoracic surgical pathway. No study has addressed the effectiveness of such an intervention in this setting on cessation. The overall aim is to determine in patients who undergo major elective thoracic surgery whether an intervention integrated (INT) into the surgical pathway improves smoking cessation rates compared with usual care (UC) of standard community/hospital based NHS smoking support. This pilot study will evaluate feasibility of a substantive trial.Methods and analysis Project MURRAY is a trial comparing the effectiveness of INT and UC on smoking cessation. INT is pharmacotherapy and a hybrid of behavioural support delivered by the trained healthcare practitioners (HCPs) in the thoracic surgical pathway and a complimentary web-based application. This pilot study will evaluate the feasibility of a substantive trial and study processes in five adult thoracic centres including the University Hospitals Birmingham NHS Foundation Trust. The primary objective is to establish the proportion of those eligible who agree to participate. Secondary objectives include evaluation of study processes. Analyses of feasibility and patient-reported outcomes will take the form of simple descriptive statistics and where appropriate, point estimates of effects sizes and associated 95% CIs.Ethics and dissemination The study has obtained ethical approval from NHS Research Ethics Committee (REC number 19/WM/0097). Dissemination plan includes informing patients and HCPs; engaging multidisciplinary professionals to support a proposal of a definitive trial and submission for a full application dependent on the success of the study.Trial registration number NCT04190966.

Published
2020
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6. Representative Sequencing: Unbiased Sampling of Solid Tumor Tissue

Author

Kevin Litchfield, Stacey Stanislaw, Lavinia Spain, Lisa L. Gallegos, Andrew Rowan, Desiree Schnidrig, Heidi Rosenbaum, Alexandre Harle, Lewis Au, Samantha M. Hill, Zayd Tippu, Jennifer Thomas, Lisa Thompson, Hang Xu, Stuart Horswell, Aoune Barhoumi, Carol Jones, Katherine F. Leith, Daniel L. Burgess, Thomas B.K. Watkins, Emilia Lim, Nicolai J. Birkbak, Philippe Lamy, Iver Nordentoft, Lars Dyrskjøt, Lisa Pickering, Stephen Hazell, Mariam Jamal-Hanjani, James Larkin, Charles Swanton, Nelson R. Alexander, Samra Turajlic, Chris Abbosh, Kai-Keen Shiu, John Bridgewater, Daniel Hochhauser, Martin Forster, Siow-Ming Lee, Tanya Ahmad, Dionysis Papadatos-Pastos, Sam Janes, Peter Van Loo, Katey Enfield, Nicholas McGranahan, Ariana Huebner, Sergio Quezada, Stephan Beck, Peter Parker, Henning Walczak, Tariq Enver, Rob Hynds, Mary Falzon, Ian Proctor, Ron Sinclair, Chi-wah Lok, Zoe Rhodes, David Moore, Teresa Marafioti, Elaine Borg, Miriam Mitchison, Reena Khiroya, Giorgia Trevisan, Peter Ellery, Mark Linch, Sebastian Brandner, Crispin Hiley, Selvaraju Veeriah, Maryam Razaq, Heather Shaw, Gert Attard, Mita Afroza Akther, Cristina Naceur-Lombardelli, Lizi Manzano, Maise Al-Bakir, Simranpreet Summan, Nnenna Kanu, Sophie Ward, Uzma Asghar, Faye Gishen, Adrian Tookman, Paddy Stone, Caroline Stirling, Andrew Furness, Kim Edmonds, Nikki Hunter, Sarah Sarker, Sarah Vaughan, Mary Mangwende, Karla Pearce, Scott Shepherd, Haixi Yan, Ben Shum, Eleanor Carlyle, Steve Hazell, Annika Fendler, Fiona Byrne, Nadia Yousaf, Sanjay Popat, Olivia Curtis, Gordon Stamp, Antonia Toncheva, Emma Nye, Aida Murra, Justine Korteweg, Nahid Sheikh, Debra Josephs, Ashish Chandra, James Spicer, Ula Mahadeva, Anna Green, Ruby Stewart, Lara-Rose Iredale, Tina Mackay, Ben Deakin, Debra Enting, Sarah Rudman, Sharmistha Ghosh, Lena Karapagniotou, Elias Pintus, Andrew Tutt, Sarah Howlett, Vasiliki Michalarea, James Brenton, Carlos Caldas, Rebecca Fitzgerald, Merche Jimenez-Linan, Elena Provenzano, Alison Cluroe, Grant Stewart, Colin Watts, Richard Gilbertson, Ultan McDermott, Simon Tavare, Emma Beddowes, Patricia Roxburgh, Andrew Biankin, Anthony Chalmers, Sioban Fraser, Karin Oien, Andrew Kidd, Kevin Blyth, Matt Krebs, Fiona Blackhall, Yvonne Summers, Caroline Dive, Richard Marais, Fabio Gomes, Mat Carter, Jo Dransfield, John Le Quesne, Dean Fennell, Jacqui Shaw, Babu Naidu, Shobhit Baijal, Bruce Tanchel, Gerald Langman, Andrew Robinson, Martin Collard, Peter Cockcroft, Charlotte Ferris, Hollie Bancroft, Amy Kerr, Gary Middleton, Joanne Webb, Salma Kadiri, Peter Colloby, Bernard Olisemeke, Rodelaine Wilson, Ian Tomlinson, Sanjay Jogai, Christian Ottensmeier, David Harrison, Massimo Loda, Adrienne Flanagan, Mairead McKenzie, Allan Hackshaw, Jonathan Ledermann, Abby Sharp, Laura Farrelly, and Hayley Bridger

Subjects
tumor sampling, tumor sequencing, representative sampling, molecular profiling, tumor hetereogeneity, biomarkers, Biology (General), QH301-705.5
Abstract

Summary: Although thousands of solid tumors have been sequenced to date, a fundamental under-sampling bias is inherent in current methodologies. This is caused by a tissue sample input of fixed dimensions (e.g., 6 mm biopsy), which becomes grossly under-powered as tumor volume scales. Here, we demonstrate representative sequencing (Rep-Seq) as a new method to achieve unbiased tumor tissue sampling. Rep-Seq uses fixed residual tumor material, which is homogenized and subjected to next-generation sequencing. Analysis of intratumor tumor mutation burden (TMB) variability shows a high level of misclassification using current single-biopsy methods, with 20% of lung and 52% of bladder tumors having at least one biopsy with high TMB but low clonal TMB overall. Misclassification rates by contrast are reduced to 2% (lung) and 4% (bladder) when a more representative sampling methodology is used. Rep-Seq offers an improved sampling protocol for tumor profiling, with significant potential for improved clinical utility and more accurate deconvolution of clonal structure.

Published
2020
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7. Patients want more information after surgery: a prospective audit of satisfaction with perioperative information in lung cancer surgery

Author

Nicola Oswald, John Hardman, Amy Kerr, Ehab Bishay, Richard Steyn, Pala Rajesh, Maninder Kalkat, and Babu Naidu

Subjects
Education, Patient, Lung neoplasm, Assessment, Patient outcome, Patient satisfaction, Surgery, RD1-811, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background Receiving information about their disease and treatment is very important to patients with cancer. There is an association between feeling appropriately informed and better quality of life. This audit aimed to estimate patient satisfaction with perioperative information in those undergoing surgery for lung cancer and any change in satisfaction over time. Methods A questionnaire (EORTC-Info-25) was administered prospectively to patients preoperatively and up to six months postoperatively. The preoperative questionnaire was completed by 292 patients and 88 free text comments were completed. Intrapersonal responses were compared over time. Results Patients were highly satisfied with information prior to surgery. The overall helpfulness of information did not change over time but satisfaction with the amount of information decreased. Patients who received more information about ‘the disease’ and ‘things you can do to help yourself get well’ were less likely to report a drop in satisfaction (Odds Ratio 0.858, 95% Confidence interval 0.765 to 0.961, p = 0.008 and OR 0.102, 95% CI 0.018 to 0.590, p = 0.011 respectively). Free text responses revealed patients most frequently wanted more information on the disease, aftercare and self-care. Suffering complications from surgery was not associated with a change in satisfaction with information postoperatively. Conclusions Patients want to know more about their diagnosis, but also how to recover and cope with issues once they have gone home after surgery. Postoperative satisfaction with information may improve if patients are given more information on these topics.

Published
2018
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8. Altered Cytokine Response of Human Brain Endothelial Cells after Stimulation with Malaria Patient Plasma

Author

Michaela Raacke, Amy Kerr, Michael Dörpinghaus, Jana Brehmer, Yifan Wu, Stephan Lorenzen, Christine Fink, Thomas Jacobs, Thomas Roeder, Julie Sellau, Anna Bachmann, Nahla Galal Metwally, and Iris Bruchhaus

Subjects
Plasmodium falciparum, malaria, endothelial cells, cytokines, Cytology, QH573-671
Abstract

Infections with the deadliest malaria parasite, Plasmodium falciparum, are accompanied by a strong immunological response of the human host. To date, more than 30 cytokines have been detected in elevated levels in plasma of malaria patients compared to healthy controls. Endothelial cells (ECs) are a potential source of these cytokines, but so far it is not known if their cytokine secretion depends on the direct contact of the P. falciparum-infected erythrocytes (IEs) with ECs in terms of cytoadhesion. Culturing ECs with plasma from malaria patients (27 returning travellers) resulted in significantly increased secretion of IL-11, CXCL5, CXCL8, CXCL10, vascular endothelial growth factor (VEGF) and angiopoietin-like protein 4 (ANGPTL4) if compared to matching controls (22 healthy individuals). The accompanying transcriptome study of the ECs identified 43 genes that were significantly increased in expression (≥1.7 fold) after co-incubation with malaria patient plasma, including cxcl5 and angptl4. Further bioinformatic analyses revealed that biological processes such as cell migration, cell proliferation and tube development were particularly affected in these ECs. It can thus be postulated that not only the cytoadhesion of IEs, but also molecules in the plasma of malaria patients exerts an influence on ECs, and that not only the immunological response but also other processes, such as angiogenesis, are altered.

Published
2021
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9. Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery

Author

Sebastian T. Lugg, Theofano Tikka, Paula J. Agostini, Amy Kerr, Kerry Adams, Maninder S. Kalkat, Richard S. Steyn, Pala B. Rajesh, Ehab Bishay, David R. Thickett, and Babu Naidu

Subjects
Thoracic surgery, Pneumonia, Atelectasis, Smoking, Surgery, RD1-811, Anesthesiology, RD78.3-87.3
Abstract

Abstract Background Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival. Methods A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010–2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival. Results Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers

Published
2017
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13. Feasibility study of a randomised controlled trial of preoperative and postoperative nutritional supplementation in major lung surgery

Author

Amy Kerr, Sebastian T Lugg, Salma Kadiri, Amelia Swift, Nikolaos Efstathiou, Krishna Kholia, Venessa Rogers, Hazem Fallouh, Richard Steyn, Ehab Bishay, Maninder Kalkat, and Babu Naidu

Subjects
Adult, Dietary Supplements, Malnutrition, Quality of Life, Feasibility Studies, Humans, General Medicine, Lung
Abstract

ObjectivesMalnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications or quality of life.DesignA randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention involved preoperative carbohydrate-loading drinks (4×200 mL evening before surgery and 2×200 mL the morning of surgery) and early postoperative nutritional protein supplement drinks two times per day for 14 days compared with the control group receiving an equivalent volume of water.SettingSingle adult thoracic centre in the UK.ParticipantsAll adult patients admitted for major lung surgery. Patients were included if were able to take nutritional drinks prior to surgery and give written informed consent. Patients were excluded if they were likely unable to complete the study questionnaires, they had a body mass index 2, were receiving parenteral nutrition or known pregnancy.ResultsAll patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The two groups were well balanced and tools used to measure outcomes were robust. Compliance with nutritional drinks was 97% preoperatively and 89% postoperatively; 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires captured their experience of recovery from surgery well.ConclusionA large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible and required to test clinical efficacy in improving outcomes after surgery.Trial registration numberISRCTN16535341.

Published
2022

14. Predicting Post-operative Pain in Lung Cancer Patients using Pre-operative Peak Alpha Frequency

Author

David A. Seminowicz, Fang Gao-Smith, Samantha K Millard, Babu Naidu, Amy Kerr, Ali Mazaheri, and Andrew J. Furman

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Alpha (ethology), Electroencephalography, medicine.disease, Pre operative, Cardiothoracic surgery, Anesthesia, Neuropathic pain, medicine, Thoracotomy, Lung cancer, business, Post operative pain
Abstract

Aims and ObjectivesExperimental models of neuropathic pain suggest that individual peak alpha frequency (PAF), measured using electroencephalography (EEG), can predict future pain sensitivity in experimental settings. Here, we tested whether PAF could predict future pain severity in a clinical setting in patients undergoing thoracotomy.MethodsRecorded using wearable around the ear electrodes (cEEGrids), the feasibility and efficacy of pre-operative PAF as a neuro-marker for post-operative pain was assessed in 16 patients undergoing thoracic surgery for lung cancer (age = 67.53 ± 4.38 [SD]). Patients also provided numerical ratings (0-10) of current, average, and worst pain pre-operatively as well as within three days post-operativelyResults and SignificancePre-operative PAF of less than 9 Hz was highly sensitive (1.0) and specific (0.86) in identifying patients who would go on to experience severe (>7/10) worst pain. Moreover, PAF was negatively correlated with patients’ current, average, and worst post-operative pain. PAF was significantly higher for those reporting lower pain severity compared to those reporting higher pain severity in the immediate post-operative period. This suggests that PAF is a promising neuro-marker to pre-operatively assess individual susceptibility to severe pain in the immediate post-operative period, possibly enabling more informed assessment of an individual’s suitability for surgery.

Published
2021

15. Feasibility study of a randomised controlled trial of pre and postoperative nutritional supplementation in major lung surgery

Author

Amelia Swift, Amy Kerr, Salma Kadiri, Krishna Kholia, Venessa Rogers, Ehab Bishay, Maninder S Kalkat, Sebastian T Lugg, Hazem Fallouh, Babu Naidu, Richard Steyn, and Nikolaos Efstathiou

Subjects
medicine.medical_specialty, Nutritional Supplementation, business.industry, Perioperative, law.invention, Clinical trial, Randomized controlled trial, Quality of life, Informed consent, law, Weight loss, Cohort, Physical therapy, Medicine, medicine.symptom, business
Abstract

ObjectivesMalnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications, and quality of life.DesignA randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention consisted of preoperative carbohydrate-loading drinks (4x 200mls evening before surgery and 2x 200mls the morning of surgery), and early postoperative nutritional protein supplement drinks twice a day for 2 weeks following surgery compared to the control group receiving an equivalent volume of water. Qualitative interviews were conducted with participants to help determine the acceptance of the study.SettingSingle adult thoracic centre in the UK.ParticipantsAll patients admitted for major lung surgery. Participants were included if were able to take nutritional drinks prior to surgery and were able to give written informed consent. Patients were excluded if they were likely unable to comply with completion of the study questionnaires, they had a body mass index (BMI) < 18.5 kg/m2, were receiving parenteral nutrition or known pregnancy.ResultsAll patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The 2 groups were well balanced, and tools used to measure outcomes were robust. 97% of patients were compliant with pre-surgery nutritional drinks and 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.ConclusionA large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible. It is possible to randomise eligible patients and follow up with high fidelity. A pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.Trial registration numberISRCTN16535341Strengths and limitation of this studyThis randomised, feasibility study had pre-planned feasibility to assess whether a larger randomised trial would be feasible.The study included a large regional thoracic surgical centre and cohort of patients undergoing major lung surgery predominantly for cancer, which would be representative of full trial national recruitment.The study was not designed and powered to be large enough to provide conclusive evidence to support the use of nutritional intervention in major lung surgery, but provided evidence that a larger, substantive randomised controlled trial is feasible.

Published
2021

16. Perioperative immune function and pain control may underlie early hospital readmission and 90 day mortality following lung cancer resection: A prospective cohort study of 932 patients

Author

James Halle-Smith, Ehab Bishay, Amy Kerr, Maninder S Kalkat, Richard Steyn, N. Oswald, J. Webb, Babu Naidu, and Paula Agostini

Subjects
Male, medicine.medical_specialty, Lung Neoplasms, 030204 cardiovascular system & hematology, Logistic regression, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Internal medicine, medicine, Humans, Pain Management, Surgical Wound Infection, Lymphocyte Count, Prospective Studies, Prospective cohort study, Lung cancer, Aged, Pain, Postoperative, business.industry, Mortality rate, General Medicine, Odds ratio, Perioperative, Middle Aged, medicine.disease, United Kingdom, Pneumonia, 030228 respiratory system, Oncology, Cardiothoracic surgery, Female, Surgery, business
Abstract

Background Mortality following lung cancer resection has been shown to double between 30 and 90 days and readmission following surgery is associated with an increased risk of mortality. The aim of this study was to describe the causes of readmission and mortality and enable the identification of potentially modifiable factors associated with these events. Methods Prospective cohort study at a United Kingdom tertiary referral centre conducted over 55 months. Binary logistic regression was used to identify factors associated with death within 90 days of surgery. Results The 30 day and 90 day mortality rates were 1.4% and 3.3% respectively. The most common causes of death were pneumonia, lung cancer and Acute Respiratory Distress Syndrome/Multi Organ Failure. Potentially modifiable risk factors for death identified were: Postoperative pulmonary complications (Odds ratio 6.1), preoperative lymphocyte count (OR 0.25), readmission within 30 days (OR 4.2) and type of postoperative analgesia (OR for intrathecal morphine 4.8). The most common causes of readmission were pneumonia, shortness of breath and pain. Conclusions Postoperative mortality is not simply due to fixed factors; the impacts of age, gender and surgical procedure on postoperative survival are reduced when the postoperative course of recovery is examined. Perioperative immune function, as portrayed by the occurrence of infection and lower lymphocyte count in the immediate perioperative period, and pain control method are strongly associated with 90 day mortality; further studies in these fields are indicated as are studies of psychological factors in recovery. Clinical registration number ISRCTN00061628.

Published
2019

17. Determinants of anti-PD-1 response and resistance in clear cell renal cell carcinoma

Author

Sanjay Popat, Lewis Au, Jan Attig, Catherine Horsfield, Hayley Bridger, Kitty Chan, Haixi Yan, David Moore, Lara-Rose Iredale, Salma Kadiri, Sebastian Brandner, Rebecca C. Fitzgerald, Bruce Tanchel, Maise Al-Bakir, Katey S. S. Enfield, Merche Jimenez-Linan, Andrew P. Robinson, Kim Edmonds, Stuart Horswell, Elena Provenzano, Andrew V. Biankin, Benny Chain, Scott Shepherd, Antonia Toncheva, Carlos Caldas, Gerald Langman, Fabio Gomes, I Puccio, Amy Kerr, Sharmistha Ghosh, Caroline Dive, James Larkin, Siow Ming Lee, Nicholas McGranahan, Peter Ellery, Charlotte Spencer, Dionysis Papadatos-Pastos, Charles Swanton, Maryam Razaq, Richard J. Gilbertson, Rachael Thompson, William Drake, Lyra Del Rosario, Debra Enting, Lisa Pickering, Crispin T. Hiley, David A Moore, Christian H. Ottensmeier, Ehsan Ghorani, Simon Chowdhury, Simon Tavaré, Sophie Ward, Gordon Stamp, Peter J. Parker, Sam M. Janes, Giorgia Trevisan, Mary Falzon, Ultan McDermott, Christopher Abbosh, Fiona Byrne, Kroopa Joshi, Kim Dhillon, George Kassiotis, James L. Reading, Heather Shaw, Tariq Enver, Dean A. Fennell, Jonathan Ledermann, Annika Fendler, Emma Beddowes, Peter Cockcroft, Mary Mangwende, Desiree Schnidrig, Ian Tomlinson, Mark Linch, Ben Challacombe, Vasiliki Michalarea, Yvonne Summers, Fiona H Blackhall, Robert Mason, Emma Nye, Robert E. Hynds, Debra H. Josephs, Mariana Werner Sunderland, Adrian Tookman, Emilia L. Lim, Paddy Stone, Cristina Naceur-Lombardelli, Bernard Olisemeke, Teresa Marafioti, Mat Carter, Grant D. Stewart, Sanjay Jogai, Richard Marais, Imran Uddin, Kevin Litchfield, Daniel Hochhauser, Alexander Polson, William Yang, Hang Xu, Peter Hill, Jonathon Olsburgh, Gordon Beattie, Justine Korteweg, Nnenna Kanu, Martin Forster, Andrew Tutt, Ben Shum, Elias Pintus, Alison Cluroe, Matt Krebs, Patricia Roxburgh, Caroline Stirling, Selvaraju Veeriah, Olivia Curtis, Marc Robert de Massy, Emine Hatipoglu, Tom Lund, Kai-Keen Shiu, Tina Mackay, Pablo D. Becker, Faye Gishen, Massimo Loda, Aida Murra, Karin A. Oien, Joanne Webb, Jose Lopez, Sarah Sarker, Adrienne M. Flanagan, Ula Mahadeva, Ian Proctor, Ruby Stewart, John Le Quesne, Elaine Borg, Archana Fernando, Babu Naidu, Andrew Rowan, Abby Sharp, Mairead McKenzie, Ayse Akarca, Anthony J. Chalmers, James Spicer, Gary Middleton, Hollie Bancroft, Jo Dransfield, Nicos Fotiadis, Charlotte Ferris, Ron Sinclair, Mary Varia, Peter Van Loo, Lavinia Spain, Lena Karapagniotou, Nikki Hunter, Roberto Salgado, Sarah Vaughan, Chi-wah Lok, Karen Harrison-Phipps, Hema Verma, Jacqui Shaw, Rodelaine Wilson, Zoe Rhodes, Anna Green, Reena Khiroya, Miriam Mitchison, Ashish Chandra, Colin Watts, Peter Colloby, Uzma Asghar, Laura Farrelly, Tim O'Brien, Stephan Beck, Steve Hazell, Tanya Ahmad, Martin Collard, John Bridgewater, James D. Brenton, Sarah Rudman, Eleanor Carlyle, Andrew C. Kidd, Lizi Manzano, Sergio A. Quezada, Sioban Fraser, Allan Hackshaw, Nadia Yousaf, Samra Turajlic, Henning Walczak, David Nicol, Mariam Jamal-Hanjani, Sarah Howlett, Andrew Furness, Simranpreet Summan, Kevin G. Blyth, S. Baijal, Gert Attard, Marcos Duran Vasquez, Mita Afroza Akther, Karla Lingard, Ben Deakin, Ariana Huebner, and David G. Harrison

Subjects
Cancer Research, Receptors, Antigen, T-Cell, Biology, CD8-Positive T-Lymphocytes, Clinical Trials, Phase II as Topic, Antigen, Immunity, Exome Sequencing, medicine, Tumor Microenvironment, Humans, Prospective Studies, Spotlight, Mode of action, Receptor, Carcinoma, Renal Cell, Immune Checkpoint Inhibitors, Sequence Analysis, RNA, Gene Expression Profiling, T-cell receptor, Endogenous Retroviruses, Genomics, medicine.disease, Kidney Neoplasms, Clear cell renal cell carcinoma, Nivolumab, Oncology, Drug Resistance, Neoplasm, Cancer research, Tumor Escape, Single-Cell Analysis, CD8
Abstract

ADAPTeR is a prospective, phase II study of nivolumab (anti-PD-1) in 15 treatment-naive patients (115 multiregion tumor samples) with metastatic clear cell renal cell carcinoma (ccRCC) aiming to understand the mechanism underpinning therapeutic response. Genomic analyses show no correlation between tumor molecular features and response, whereas ccRCC-specific human endogenous retrovirus expression indirectly correlates with clinical response. T cell receptor (TCR) analysis reveals a significantly higher number of expanded TCR clones pre-treatment in responders suggesting pre-existing immunity. Maintenance of highly similar clusters of TCRs post-treatment predict response, suggesting ongoing antigen engagement and survival of families of T cells likely recognizing the same antigens. In responders, nivolumab-bound CD8+ T cells are expanded and express GZMK/B. Our data suggest nivolumab drives both maintenance and replacement of previously expanded T cell clones, but only maintenance correlates with response. We hypothesize that maintenance and boosting of a pre-existing response is a key element of anti-PD-1 mode of action.

Published
2021
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18. National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland

Author

Babu Naidu, Rana Mehdi, Amy Kerr, Salma Kadiri, Timothy J.P. Batchelor, and Alina-Maria Budacan

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, media_common.quotation_subject, lcsh:Surgery, Staffing, Audit, lcsh:RD78.3-87.3, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, ERAS, Thoracotomy, Practice Patterns, Physicians', Pneumonectomy, Enhanced recovery, Retrospective Studies, media_common, Teamwork, Clinical Audit, business.industry, lcsh:RD1-811, General Medicine, medicine.disease, United Kingdom, Thoracic surgery, Malnutrition, lcsh:Anesthesiology, Cardiothoracic surgery, Health Care Surveys, Family medicine, Lobectomy, Smoking cessation, Female, Surgery, Enhanced Recovery After Surgery, Cardiology and Cardiovascular Medicine, business, Ireland, Research Article
Abstract

Background Evidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level. Methods We designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete. Results Eighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services. Conclusion Centres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into “real life” ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.

Published
2020

19. Representative Sequencing: Unbiased Sampling of Solid Tumor Tissue

Author

Richard Marais, Andrew Furness, Thomas B.K. Watkins, Maise Al-Bakir, Dionysis Papadatos-Pastos, Maryam Razaq, Mairead McKenzie, Lisa Pickering, Peter Ellery, Jonathan Ledermann, Andrew V. Biankin, Richard J. Gilbertson, Peter Cockcroft, Mary Mangwende, Sophie Ward, Mary Falzon, Cristina Naceur-Lombardelli, Carlos Caldas, Karla Pearce, Jacqui Shaw, Salma Kadiri, Lars Dyrskjøt, Mark Linch, Daniel Burgess, Nelson Alexander, Christian H. Ottensmeier, Kevin G. Blyth, Lisa L. Gallegos, Rodelaine Wilson, Hayley Bridger, Fiona H Blackhall, Peter J. Parker, Charles Swanton, Allan Hackshaw, Gert Attard, Gordon Stamp, Dean A. Fennell, Debra H. Josephs, Andrew P. Robinson, Kim Edmonds, Tina Mackay, Mita Afroza Akther, Miriam Mitchison, Sam M. Janes, Giorgia Trevisan, Adrienne M. Flanagan, Alison Cluroe, Henning Walczak, Stuart Horswell, Lena Karapagniotou, Simon Tavaré, Sarah Sarker, Teresa Marafioti, Matt Krebs, Anna Green, Philippe Lamy, Reena Khiroya, Samantha M. Hill, Andrew Tutt, Ashish Chandra, Selvaraju Veeriah, Faye Gishen, Lisa Thompson, Sarah Vaughan, Stacey Stanislaw, Kevin Litchfield, Colin Watts, Caroline Dive, Zayd Tippu, Ron Sinclair, Merche Jimenez-Linan, Lavinia Spain, Lizi Manzano, Zoe Rhodes, Caroline Stirling, Elena Provenzano, Andrew Rowan, Katey S. S. Enfield, Vasiliki Michalarea, Nahid Sheikh, Antonia Toncheva, Charlotte Ferris, James Spicer, Kai-Keen Shiu, Aida Murra, Gerald Langman, Scott Thomas Colville Shepherd, Nicholas McGranahan, Fabio Gomes, Daniel Hochhauser, Hang Xu, Sergio A. Quezada, James Larkin, Siow Ming Lee, Chi-wah Lok, Massimo Loda, Gary Middleton, Hollie Bancroft, Jo Dransfield, David Moore, Jennifer Thomas, Rebecca C. Fitzgerald, Peter Colloby, Annika Fendler, Emma Beddowes, Ultan McDermott, Christopher Abbosh, Uzma Asghar, Martin Forster, John Le Quesne, Katherine F. Leith, Paddy Stone, Bernard Olisemeke, Bruce Tanchel, Laura Farrelly, Grant D. Stewart, Justine Korteweg, Sanjay Jogai, Nnenna Kanu, Desiree Schnidrig, Heidi Rosenbaum, Elaine Borg, Mat Carter, Anthony J. Chalmers, Andrew C. Kidd, Alexandre Harlé, Ula Mahadeva, Crispin T. Hiley, Fiona Byrne, Heather Shaw, Mariam Jamal-Hanjani, Karin A. Oien, Ian Proctor, Joanne Webb, Sioban Fraser, Sarah Howlett, Ruby Stewart, Peter Van Loo, Nadia Yousaf, Tanya Ahmad, Martin Collard, Sanjay Popat, James D. Brenton, Sarah Rudman, Lewis Au, David G. Harrison, Elias Pintus, Patricia Roxburgh, Olivia Curtis, Ben Deakin, Ariana Huebner, Debra Enting, Simranpreet Summan, S. Baijal, Iver Nordentoft, Carol Jones, Haixi Yan, Sebastian Brandner, Tariq Enver, Lara-Rose Iredale, Yvonne Summers, Babu Naidu, Abby Sharp, Stephen Hazell, Aoune Barhoumi, Emma Nye, Robert E. Hynds, Sharmistha Ghosh, Emilia L. Lim, Ben Shum, Nikki Hunter, John Bridgewater, Eleanor Carlyle, Stephan Beck, Nicolai Juul Birkbak, Steve Hazell, Samra Turajlic, Amy Kerr, Ian Tomlinson, Adrian Tookman, Litchfield, Kevin [0000-0002-3725-0914], Birkbak, Nicolai J [0000-0003-1613-9587], Nordentoft, Iver [0000-0003-4856-4086], Dyrskjøt, Lars [0000-0001-7061-9851], Apollo - University of Cambridge Repository, Division of genetics and epidemiology, The institute of cancer research [London], The Wellcome Trust Centre for Human Genetics [Oxford], University of Oxford [Oxford], Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), The Royal Marsden, University of Arizona, University of Western Ontario, Physic and Astronomy Department, University of Western Ontario (UWO), Center for Biological Sequence Analysis [Lyngby], Technical University of Denmark [Lyngby] (DTU), Laboratoire d'Astrophysique de Marseille (LAM), Aix Marseille Université (AMU)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS), Aarhus University Hospital, Cancer Research UK Lung Cancer Centre of Excellence [Londres, Royaume-Uni], University College of London [London] (UCL), Comprehensive Cancer Center, UCL Cancer Institute [University College London], The Wellcome Trust Sanger Institute [Cambridge], Research Department of Pathology, Innovation North - Faculty of Information and Technology, Leeds Metropolitan University, Department of histopathology, University College Hospital, Mammalian Genetics Laboratory, Centre for Research on Adaptive Nanostructures and Nanodevices, Trinity College Dublin, Cancer Research UK London Research Institute, Guy's and St Thomas' Hospital [London], Breakthrough Breast Cancer Centre, London Institute of Cancer, Cancer Research UK Cambridge Research Institute and Department of Oncology, University of Cambridge, University of Cambridge [UK] (CAM), Cancer Division [Sydney, Australia] (The Kinghorn Cancer Centre), Garvan Institute of Medical Research [Sydney, Australia], Clinical and Experimental Pharmacology Group, Paterson Institute for Cancer Research, University of Manchester, University of Leicester, Experimental Cancer Medicine Centre, University of Southampton-Faculty of Medicine, Moses, Wittemyer, Harrison and Woodruff, P.C., University of Oxford, Danmarks Tekniske Universitet = Technical University of Denmark (DTU), and Garvan Institute of medical research

Subjects
0301 basic medicine, tumor sequencing, medicine.medical_specialty, Sampling protocol, tumor mutational burden, tumor sampling, Lung Neoplasms, molecular profiling, Biopsy, homogenization, Tissue sample, [SDV.CAN]Life Sciences [q-bio]/Cancer, Biology, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, medicine, Biomarkers, Tumor, Humans, Solid tumor, lcsh:QH301-705.5, Representative sampling, medicine.diagnostic_test, Manchester Cancer Research Centre, ResearchInstitutes_Networks_Beacons/mcrc, Clonal structure, biomarkers, High-Throughput Nucleotide Sequencing, Tumor tissue, tumor hetereogeneity, Tumor Burden, 030104 developmental biology, lcsh:Biology (General), representative sampling, Urinary Bladder Neoplasms, Mutation, Radiology, 030217 neurology & neurosurgery
Abstract

International audience; Although thousands of solid tumors have been sequenced to date, a fundamental under-sampling bias isinherent in current methodologies. This is caused by a tissue sample input of fixed dimensions (e.g., 6 mmbiopsy), which becomes grossly under-powered as tumor volume scales. Here, we demonstrate representative sequencing (Rep-Seq) as a new method to achieve unbiased tumor tissue sampling. Rep-Seq uses fixed residual tumor material, which is homogenized and subjected to next-generation sequencing. Analysis of intratumor tumor mutation burden (TMB) variability shows a high level of misclassification using current single-biopsy methods, with 20% of lung and 52% of bladder tumors having at least one biopsy with high TMB butlow clonal TMB overall. Misclassification rates by contrast are reduced to 2% (lung) and 4% (bladder) when a more representative sampling methodology is used. Rep-Seq offers an improved sampling protocol for tumor profiling, with significant potential for improved clinical utility and more accurate deconvolution of clonal structure.

Published
2020

20. Patients want more information after surgery: a prospective audit of satisfaction with perioperative information in lung cancer surgery

Author

John Hardman, Ehab Bishay, Maninder S Kalkat, Babu Naidu, Pala B. Rajesh, Richard Steyn, Amy Kerr, and Nicola Oswald

Subjects
Male, Lung Neoplasms, Pulmonary Surgical Procedures, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Prospective Studies, Prospective cohort study, Aged, 80 and over, Medical Audit, Lung cancer surgery, Patient, Patient Preference, Patient satisfaction, General Medicine, Middle Aged, Patient outcome, Cardiac surgery, Thoracic surgery, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Female, Cardiology and Cardiovascular Medicine, Research Article, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, lcsh:Surgery, Assessment, Perioperative Care, Education, lcsh:RD78.3-87.3, 03 medical and health sciences, Patient Education as Topic, medicine, Humans, Aged, business.industry, Perioperative, Odds ratio, lcsh:RD1-811, Lung neoplasm, Surgery, 030228 respiratory system, lcsh:Anesthesiology, Health Care Surveys, Quality of Life, business
Abstract

Background Receiving information about their disease and treatment is very important to patients with cancer. There is an association between feeling appropriately informed and better quality of life. This audit aimed to estimate patient satisfaction with perioperative information in those undergoing surgery for lung cancer and any change in satisfaction over time. Methods A questionnaire (EORTC-Info-25) was administered prospectively to patients preoperatively and up to six months postoperatively. The preoperative questionnaire was completed by 292 patients and 88 free text comments were completed. Intrapersonal responses were compared over time. Results Patients were highly satisfied with information prior to surgery. The overall helpfulness of information did not change over time but satisfaction with the amount of information decreased. Patients who received more information about ‘the disease’ and ‘things you can do to help yourself get well’ were less likely to report a drop in satisfaction (Odds Ratio 0.858, 95% Confidence interval 0.765 to 0.961, p = 0.008 and OR 0.102, 95% CI 0.018 to 0.590, p = 0.011 respectively). Free text responses revealed patients most frequently wanted more information on the disease, aftercare and self-care. Suffering complications from surgery was not associated with a change in satisfaction with information postoperatively. Conclusions Patients want to know more about their diagnosis, but also how to recover and cope with issues once they have gone home after surgery. Postoperative satisfaction with information may improve if patients are given more information on these topics.

Published
2018

23. Multicentre review of readmission rates within 30 days of discharge following lung cancer surgery

Author

Alison Smith, Sarah Taylor, Charlotte Merriman, Amy Kerr, Maureen King, Jane Canavan, Jenny Mitchell, Sandra Dixon, and Verity Hunter

Subjects
Lung cancer surgery, medicine.medical_specialty, Lung Neoplasms, Time Factors, business.industry, 030204 cardiovascular system & hematology, medicine.disease, Patient Readmission, Patient Discharge, United Kingdom, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, 030228 respiratory system, Cardiothoracic surgery, Internal medicine, medicine, Humans, Lung cancer, business, General Nursing
Abstract

Postoperative complications following curative lung cancer surgery are well recognised, but there is limited data on 30-day readmission rates. The UK Thoracic Surgery Group conducted a multicentre review over a 3-month period to assess readmission rates. Overall readmission among the 268 patients who had undergone primary lung cancer surgery was 30 (11%); 14/30 of readmissions occurred within 7 days of discharge, with 13/30 patients readmitted to a hospital that had not performed the surgery. The causes of readmission were mainly pulmonary related (16/30). Readmission was associated with being discharged with a pleural drain 11/30 (P

Published
2019

24. Fit 4 surgery, a bespoke app with biofeedback delivers rehabilitation at home before and after elective lung resection

Author

Sarah Flanagan, Babu Naidu, Stuart Lightfoot, Amy Kerr, Salma Kadiri, Nicola Oswald, Alina-Maria Budacan, and Christopher Golby

Subjects
Male, Technology, medicine.medical_treatment, 030204 cardiovascular system & hematology, Cohort Studies, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Quality of life, Postoperative Period, Pneumonectomy, Rehabilitation, Lung Cancer, General Medicine, Middle Aged, Mobile Applications, Exercise Therapy, Cardiac surgery, Thoracic surgery, Elective Surgical Procedures, Cardiothoracic surgery, Preoperative Period, Female, Cardiology and Cardiovascular Medicine, Research Article, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, lcsh:Surgery, Walk Test, Intervention, Biofeedback, Time-to-Treatment, lcsh:RD78.3-87.3, 03 medical and health sciences, medicine, Humans, Pulmonary rehabilitation, Exercise, Aged, business.industry, Biofeedback, Psychology, lcsh:RD1-811, Surgery, Clinical trial, 030228 respiratory system, lcsh:Anesthesiology, Feasibility Studies, Patient Compliance, business
Abstract

Background Pulmonary rehabilitation programme for lung surgery patients can reduce the risk of post-operative complications but compliance to programmes can be limited by access to health care. We developed a home-based rehabilitation app and tested its feasibility in patients undergoing lung resection surgery. Methods A cohort study was conducted over 18 months at a regional thoracic unit. The Fit 4 Surgery app included ten exercises. Patients were instructed to exercise for at least three minutes for each exercise. Data was transmitted back to the researchers remotely. Data was also collected from a contemporaneous group of surgery patients who attended local outpatient-based Chronic Obstructive Pulmonary Disease rehabilitation classes. Quality of Life and outcomes data in the app group were collected. Patients were also interviewed about their experience of the app. Results App patients had a shorter wait before surgery compared to patients attending rehabilitation classes (24 vs 45 days) but managed four times as many sessions (2 vs 9), improving incremental shuttle walk test distance by 99 ± 83 (p

Published
2019

25. Randomised controlled trial to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain (TOPIC) : a pilot study to assess feasibility of a large multicentre trial

Author

Lajos Szentgyorgyi, Amy Kerr, Joyce Yeung, Sarah Flanagan, Rajesh Shah, Babu Naidu, Lee J Middleton, Matthew Wilson, Sajith Kumar, Antony Worrall, Andreas Goebel, Jane P Daniels, Kostas Tryposkiadis, Teresa Melody, and Fang Gao

Subjects
Adult, Male, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, Pilot Projects, Chest pain, Thoracic Vertebrae, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, RZ, medicine, Humans, 030212 general & internal medicine, Thoracotomy, Contraindication, Aged, Pain Measurement, Pain, Postoperative, business.industry, Incidence (epidemiology), Correction, Nerve Block, General Medicine, Middle Aged, Blockade, Clinical trial, Analgesia, Epidural, Treatment Outcome, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Anesthesia, Feasibility Studies, Female, medicine.symptom, Chronic Pain, business, RD
Abstract

ObjectivesThoracotomy is considered one of the most painful surgical procedures. The incidence of chronic post-thoracotomy pain (CPTP) is up to 50%. Paravertebral blockade (PVB) may be superior to thoracic epidural blockade (TEB) in preventing CPTP. The specific objective of this pilot study was to assess the feasibility of conducting a larger trial to determine whether PVB at thoracotomy is more effective in reducing CPTP compared with TEB.DesignA randomised, parallel, external pilot study was conducted to assess whether a large randomised trial of TEB and PVB with CPTP as the primary outcome is feasible.SettingTwo adult thoracic centres in the UK.ParticipantsAll adult patients admitted for elective open thoracotomy. Participants were excluded if they were American Society of Anesthesiologists physical status IV or V; or if there is contraindication to local anaesthetics; infection near the proposed puncture site; coagulation/thoracic spine disorders; required chest wall resection or emergency thoracic surgery or had a previous thoracotomy.ResultsAll patients presenting for thoracotomy were screened over a 12-month period with 194 found to be eligible. Of these, 69 (36%) were randomised (95% CI 29% to 42%). Discounting five participants who died, 54 of 64 participants (84%) returned questionnaire booklets at 6 months. The number of participants indicating at least a moderate level of chest pain at 6 months was lower with PVB but with high levels of uncertainty (RR: 0.7; 95% CI 0.3 to 1.7 for worst pain; RR: 0.3; 95% CI 0.0 to 2.8 for average pain). There were no safety concerns.ConclusionsA large, multicentre randomised controlled trial of PVB versus TEB is feasible as it is possible to randomise and follow up participants with high fidelity. Pain scores were lower on average with PVB compared with TEB but a much larger trial is required to confirm this reliably.Trial registration numberISRCTN45041624

Published
2019

26. The Reading House: A Children’s Book for Emergent Literacy Screening During Well-Child Visits

Author

Amy Kerr, Laura M. Justice, Thomas G. DeWitt, John S. Hutton, Richard F. Ittenbach, and Guixia Huang

Subjects
Rasch model, business.industry, media_common.quotation_subject, MEDLINE, Logistic regression, Literacy, 03 medical and health sciences, 0302 clinical medicine, Promotion (rank), Private practice, 030225 pediatrics, Intervention (counseling), Reading (process), Pediatrics, Perinatology and Child Health, Medicine, business, Clinical psychology, media_common
Abstract

BACKGROUND: The American Academy of Pediatrics recommends literacy promotion and developmental assessment during well-child visits. Emergent literacy skills are well defined, and the use of early screening has the potential to identify children at risk for reading difficulties and guide intervention before kindergarten. METHODS: The Reading House (TRH) is a children’s book designed to screen emergent literacy skills. These are assessed by sharing the book with the child and using a 9-item, scripted scoring form. Get Ready to Read! (GRTR) is a validated measure shown to predict reading outcomes. TRH and GRTR were administered in random order to 278 children (mean: 43.1 ± 5.6 months; 125 boys, 153 girls) during well-child visits at 7 primary care sites. Parent, child, and provider impressions of TRH were also assessed. Analyses included Rasch methods, Spearman-ρ correlations, and logistic regression, including covariates age, sex, and clinic type. RESULTS: Psychometric properties were strong, including item difficulty and reliability. Internal consistency was good for new measures (rCo-α = 0.68). The mean TRH score was 4.2 (±2.9; range: 0–14), and mean GRTR was 11.1 (±4.4; range: 1–25). TRH scores were positively correlated with GRTR scores (rs = 0.66; high), female sex, private practice, and child age (P < .001). The relationship remained significant controlling for these covariates (P < .05). The mean TRH administration time was 5:25 minutes (±0:55; range: 3:34–8:32). Parent, child, and provider impressions of TRH were favorable. CONCLUSIONS: TRH is a feasible, valid, and enjoyable means by which emergent literacy skills in 3- and 4-year-old children can be directly assessed during primary care.

Published
2019

27. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

Author

Jennifer Morrish, Emily J Robson, Georgina Ashfield, Karuna Kotur, Jashmin Maria, Charlotte Downes, Shweta Patro, Mark Scrutton, George Gladstone, Andy Burton, Paula Mulligan, Wei Lin Allen, Michael McCusker, Dee Leonard, James Edwards, Sarah Dolling, Katherine Pass, Hywel Garrard, Francis Young, Paul Edgar, Elaine Matthews, Douglas Findlay, Helen Whittle, Aillison MacLean, Chris Levett, Claire-Marie Agius, Kim Porter, Nurse Charlotte White, Bridget Campbell, Gemma Scotland, Patrick Haywood, Liz Shenton, Tom Hatton, Laura McAffrey, Jane Hunt, Jaime Carungcong, Sara Owen, Fiona Christie, Lesley Milne, Liza Tharakan, Ruth Smith, Henry Nash, Timothy Gould, Jodie Fitzgerald, Wael Zghaibe, Mark Gaskell, Dushyanthi Jayasekera, Elana Owen, Kinga Dwornik, Amr Ali, Donna Cotterill, Martyn Cain, Peter Wicks, Daniel West, Catriona Walker, Rebecca Lee, Amanda Isaac, Naresh Rajasekar, Sally Collins, Laura Hammon, Tim Hendra, Yemi Adelaja, Mike Pollard, Ellen L. Brown, Matt Clayton, Rachel Bown, Sally Moore, Keyury Desai, Tony Kinsey, Charlotte Dunn, Li Lian Loh, Emelia Passaro, Timothy Faccini, Stephen Linter, Sumant Shanbhag, David Lee, David Restall, Angela Cook, Simon Ripoll, Rachael Bird, Vicky Murray, Alex Wollaston, Daniel Yarwood, Sonia Bhangu, Sahar Biuk, Jenny Ferry, Alexander Michael Stewart, Ceri Lynch, Lucy Sheppard, Denise Webster, Jamie Allen, Merle Cohen, James Hanison, Shilpa Rawat, Prabhakaran Premraj, Gamunu Ratnayake, Clare Bird, Lorna Filby, Clare Allcock, Babak Sedghi, Celly Weegenaar, Dawn Collier, Sreekanth Rayalu Uppugonduri, Amanda Whileman, Su Ying Ong, Jack Carmichael, Victoria O'Loughlin, Barbara Linklater-Jones, Maria Lackmann, Vitul Manhas, Albert Brennan, Alasdair Waite, Andrew Smallwood, Salvatore Bruni, Catriona Barr, Thomas Murphy, Gemma Hudson, Khalid Hasan, Alison J. Campbell, Radu Chiravasuta, Charlotte Maden, Roddy Chapman, Jon Clark, Nauman Iftikhar, Sarah Hagyard, Denis O'Leary, Steven Forde, Joanne Webb, Ryan W Haines, Andrea Galloway, Richard Siviter, Heidi Lightfoot, Hew D.T. Torrance, Christopher Smith, Hollie Robinson-Perrie, Josh Wall, Carina Cruz, Andrew Song, Stephen T. Webb, Nurse Sara-Beth Sutherland, Carol-Ann Woolley, Susan Martin, S.L.M. Walker, George Koshy, Renee Ford, Mona Mubarak, Robert Stuart, Keshava Reddy Burijinti Chenna, Rizana Ghafoor, Katie Hanlon, Fiona Faulds, Hiba Khaled, Richard Jones, Karin Duckett, Cathryn Matthews, Charles Chan, Sanjeewa Ranaweera, Nurse Rebecca Hinch, Richard Shawyer, Jo Cudlip, Marion Ashe, Steve Harris, Ravi K. Alagar, Jonathan Hetherington, Sara Churchill, Yolanda Baird, Maria Tritean, Gabriela Wong, Dermot Moloney, Lee Tbaily, Jonathan Finnity, Norbert Bokor, Peter Indoe, Lucy Stelfox, Simon Marcus, Bryony Burrill, Ellie Roderick, Carina Lilley, Alex Yusaf, Lucy Corbett, Esther Neilly, Christine Ryan, Amon Wijunamai, Katie Atterbury, Abigail Clarke, Josh Patch, Otto Mohr, Ronan Mukherjee, Asokan Krishnaier, Chen Yun-Han, Prasan Panagoda, Polly Rice, Katherine Jones, James Hudson, Sophie Uren, Peter Sutton, Evangelia Poimenidi, Tracy Marsden, Veronica Barnes, Alice Drysdale, Tara Lawrence, Lisa Sharpe, John G. Francis, N. M. Wharton, Claire Kurasz, Marina Iaverdino, Caradog Thomas, Emma Gold, Raj McNab, Tom E.F. Abbott, Claire Dowse, Jane Hamilton, Tony Sutherland, Robert P. Jones, Peter Alston, Daniel Haslam, Philippa Marshall, Bernadette Tilley, Cathleen Chabo, Adam Carpenter, Steve Cole, Nicholas Hooper, Kate Arrow, Alka Shah, Rosie Furness, Susie Chapman, Sachini Dhamaratne, Constandinos Papageorgiou, Michael Girgis, Sandra Pearson, Andrew W. Wood, Jaya Nariani, Sonia White, Christopher Godden, Mary Bellamy, Indra Chadbourn, Laura Parker, Peter Knowlden, Cat Griffiths, Jeanette Smith, David Brooks, Jonathan Smith-Williams, Elizabeth Barnes, Sunil Jamadarkhana, Andrew Feneley, Maria Croft, Tom Disney, Paramesh Kumara, Anna Warrington, Seetal Aggarwal, Zackriah Badsha, Suman Biswas, Suzanne Shuttleworth, Ben Jones, Jose Lourtie, Mark Stubbington, Asya Mussad, Patrick Johnson, Sister Amanda Cowton, James Spargo, Kelly Hard, Annette Fraine, William Weston, Farrukh Ameer, Andrew Prenter, Lisa Bacon, Sunil kumar Chaurasia, Claire Nicholas, Amy Kitching, Sneha Prasad, Catriona Ferguson, Martin P. Huntley, Claire Cameron, Hugh Cutler, Anne Harrison, Kunal Joshi, Anna Cormack, Rebecca Jones, Martin Paul, Jean Bage, Stephen Cole, Usman Razaque, Robert Lewis, David O'Callaghan, Samantha Strong, Victoria Frost, Peter Ip, Victoria Male, Mat Molyneux, Christopher Worth, Michael Brett, Megan Smith, Shayan Arshed, Timothy McMillan, Lorri James, Frances Lay, Jennifer Bennett-Britton, Patrick Colhoun, Alison Shaw, Michael Stewart, Maie Templeton, Karin Gupwell, Mujeeb Khan, Elena Stanton, Chandini Chuni, Janette Brown, Mariam Latif, Rebecca L. Wilson, Felix Fombon, Jo Novaga, Cindy Persad, Matthew Thomas, Maryna Garmash, Metod Oblak, Sarah Maher, Rahul Muddanyake, Morgan Foster, Kris Parker, Tim Sutton, Ndi Ekwere, Samuel Armanious, Mohammad Bhatti, Steve Phillips, Maria Rivero-Bosch, Nick Spittle, David Harding, Henry Hammerbeck, Rose Buckley, Jonathan Hatton, Ahmed Gilani, Ali Watts, Neeraj Bhardwaj, Lesley McShane, Simon Ridler, Martin Murphy, Vandana Goel, S Ramani Moonesinghe, Sophie Scutt, Sanniah Hussain, Hannah Donaldson, Tom Bennett, Helen Boys, David Steven Davies, Bev Hammond, Bryan Yates, Victoria Hawley, Chris Gibb, Ulrika Winstone, Keith Couper, Benedict Williams, Louise Duncan, Georgina Wilson, Anil Hormis, Emily Dana, Jens Full, Amina Chohan, Amanda Ebejer, Sian McKillop, Tomas Bakonyi, Georgina Bird, George Davies, Christina Penny, Helen Thornley, Karen Jewers, Kingsin Ang, Mishell Cunningham, Conny Blunt, Ronald Carrera, Kay Finney, Alvin Soosay, Nagaraj Rao, Jason Mann, Carol Edwards, Richard Lowe, Paul Stevens, Hilary Ashton, Rachel Codling, Rhys Davies, Muthuraj Kanakaraj, Zoe Apple, Kirsty Meats, Tammy Smith, Charmaine Beirnes, John Gardner, Peter Featherstone, Claire Williams, Rohit Mittal, Emma Shinn, Alex Moore, Michael Whitear, Hannah Rose, Paul Kelly, Megan Thomas, Matthew Gibbins, Jack Reid, Caroline Clarke, Victoria Irvine, Bhavesh Pratap, Ella Buchanan, Nurse Francesca Wright, Vatsharlan Santhirapala, Richard Gould, Dionne Dervin, Behzad Sohail, Lauren Duraman, Thecla Scully, Adnaan Qureshi, Muditha Peiris, Thomas Ratcliffe-Law, Samuel J. Clark, Ben Vowles, Sam Keable, Hoda Abou Ghoneim, Becky Morris, Aidan Hulbert, Rachael Craven, Ashish Kundu, Emma M. Casely, Maya Kommer, Tom Poulton, Greg Nussbaum, Ahmad Huda, Caroline Davis, Suzanne Gleeson, Paul Clements, Matt Willis, Isobel Amey, David J. Perry, Rachel Harford, Bianca Hulance, Kirsty Baron, Charlotte Grove, Sergio Dominguez, Susanna Richie-Mclean, John Stones, Ioana Simionescu, Khaled Razouk, Cristina Niciu, Ben Hyams, Mark Doran, Carolyn Colvin, Jonathan Rivers, Raluca Ene, Rebecca Jackson, Jonathan Edgar, Ben Robinson, Lisa Wilkinson-Guy, Aji Mathew, Christopher Patrick, Gauhar Sharih, Ismail Tariq, Andrea Kay, Joshua O'Donnell, Dafydd Watterson, Lail Zaheer, Fiona Reed, Tom Johnson, Christopher Oscier, Mirain Phillips, Edmund Gerrans, Joanna Hackney, Sally M. Dunlop, Elizabeth Willetts, Jiang Yuchen, Lizzie Ashton, Theresa Cooper, Paul W. Davies, Carly Brown, James Small, Julie Lowe, Amarjeet Patil, Filipe Helder, Joshua Cuddihy, Faisal Sheikh, Hayley Tarft, Enid Leung, Adrian Percuin, Paolo Mazzone, Rochelle Rhodes, Jane Pilsbury, Kerry Cullis, Peter Brook, Helen McNamara, Carin Swanevelder, Claire Frith, Adrian Clarke, Stuart Watson, Glenn Vetuz, Zoe Riddell, Drew Welch, Geoff Warnock, Lalani Induruwage, Paul Mallett, Elizabeth Cervi, Santinder Dalay, Supriya Antrolikar, Sinead O'Kane, Toby Hoskins, Stephen Duberley, Sophie Parcell, Jayne Sutherland, Lynn Fairless, Dave Parkinson, Matron Beryl Davis, Abigail Patrick, Jithu Jayan, Nicola Harvey, Catherine Pitman, Donata Banni, Samuel Passey, Omar Alex Pemberton, Becky Sands, Hon Sum Liu, Alexandra Mudd, Sheldon Zhang, Ange Lise John-Baptiste, Thomas Clayton, Charlotte Marriot, Tom Reevell, Nicola Mackenzie, Temitope Aiyedun, Andy Cruickshanks, Jacqueline Gunn, Alison Moss, Martyn Clark, Swetha Rambhatla, Claire Matata, Ben Cracknell, Pauline Mercer, Matthew Morgans, Catrin Williams, Shareef Madhi, Jane Montgomery, George Kohler, Yasir Hameed, Muneeba Ahmed, Glenn Saunders, Anand Kulkarni, Craig Pinner, Lauren Pearce, Vishnu Bhardwa, Judi Ramsey, Meghna Sharma, Rob Hull, Srinivasan Perumal, Julia Critchley, Stephen Hill, Bethany Fitzmaurice, Robert Crichton, Cormac O'Connor, M. Dickinson, Alison Pearce-Smith, Julie Toms, Kathleen Horan, Ammy Dodd, Rachel Crone, Graeme Finnie, Suman Shrestha, Saul Sundayi, Shamini Sivakumaran, Robert Collin, Janine Musselwhite, Yuvaraj Kummur, Mariana Bernardo, Amrinda Sayan, Gabrielle De Selincourt, Laura Bridge, Melissa Rosbergen, Philip Barclay, Garry Davenport, Daniel Murrell, Andrew Drummond, Eireann Allen, Emma Fadden, Subha Arunachalam, David Robinson, Stephanie Dukes, Catherine Jardine, Sunny Bhat, Hemantha Shiva, Amy Kerr, Henry Elms, Anam Asif, Sandra Evans, Girish Rangaswamy, Laura Thomson, Asad Javed, Jenny Shuttleworth Davies, Maren Kleine-Brueggeney, Sian Edwards, Jean-Paul Zahra, Jo simpson, Priya Verma, Bhamini Tharmalingam, Matthew Edmunds, Stephen Adshead, Hannah Luckhurst, Lara Allen, Colin Merrill, Fiona Lyle, Falguni Choksey, Mohyman El Habishi, Holly Notman, Lisa Murthen, Christiana Georgiou, Georgina Singleton, Tim Cook, Melba Knighton, Shirley Pyke, Amit Gadre, Maria Rehnstrom, Helen Hothersall, Anja Kuttler, Anita Boltres, Sarah Williams, Sarah Welch, Yamuna Madhu, Pramod Nalwaya, Alistair Coleman, Jeanie Worthington, Jasmine Samuel, Rajashekar Gowni, Karen Burt, Shamim Haque, Reynard Knoetze, Hakeem Yusuff, Tom Taylor, Val Parkinson, Sheik Pahary, Jonathan Fortune, Natalie Long, David Gilhooly, Karthick Duraisamy, Duncan Baines, Shondipon Laha, Marie Appleby, Jyothi Hosahalli, Christine Catley, Jasmine Jose, Damien Mantle, Dinkar Gowda, Permendra Singh, Ramesh Khoju, Carol Bradbury, Sarah Hazeldine, Karan Kanal, Sonal Lodhi, James Craig, Rachel Wong, Teresa Ferreira, Charis Banks, Ben Chandler, Asia Sarwar, Sivaprakash Vaitheeswaran, Sam Bews, Katie Hunter, Sohan Bisonoothan, Lauren Hunt, Melony Hayes, Nilesh Chauhan, Janet Pickett, Sharon Dealing, Jamie Plumb, Thomas Hollins, Claire Hill, Claire Hindmoor, Nicolas Hooker, Hannah Davis, Laura Mee, Elizabeth Thomas, James Self, Jenny May-Ling Cheung, Jane Varin, Manish Kakkar, Anuj Wali, Omar Siddique, Sophie Earl, Elizabeth Longdon, Alison Meadows, Shafi Ahmed, David MacPherson, Shaima Elnour, Suzi Hale, Ramez Ibrahim, Fei Long, Orlanda Allen, Alice Groves, Mohammed Wahid, Angela Stevens, Carl Ilyas, Richard Robley, Nichola Bleasby, Peter Havalda, Ursula McHugh, Judith Brade, Georgia Monantera, Stuart Younie, Brian Johnston, Jamie Brookes, Linda Park, Graeme Wilson, Mark Greasley, Lohita Nanda, Vineetha Jayakumar, Ian M. Lyons, Ayman Abdu, Paul Athanasopoulos, Justin Woods, Kariem El-Boghdadly, Diane Simpson, Georgina Williamson, Jonathan McCarter, Anil Golhar, Alicia Waite, Claire Halligan, Sarah Anne Leir, Joanne Turner, Matthew O'Meara, Claire Atkinson, Adam Yarnold, Mark Fernie, Rhiann Marie O'Shaughnessy, Jamie Elwood, Laura Harvey, Ali Atrah, Helen Terrett, Sam Scholes, Rebecca E. Saunders, Vin Vyapury, Amir Rafi, Peter Bradley, Srikant Ganesh, Zehrin Nassa, Ulf Buhmann, Laura Carrick, Natalie Rogers, Said Seifalan, Ian Ryder, Jennifer Partridge, Tim Lovell, Martin Priestley, Caroline Wrey Brown, Joanna Moore, Vidhya Nagaratnam, Saba Iqbal, Francesca Mazzola, Samantha Weller, Laura Gould, Helen Johnston, Jenny Spimpolo, Carmen Scott, Stephen J. Brett, Paul Cripps, Amit Kurani, Alexander Knight, Nirav Shah, Pushkar Patankar, Fraser Waterson, Sarah Martindale, Johannes Mellinghoff, Joanne Wootton, Sarah McCormick, Sameer Somanath, Bilal Yasin, Christopher Skeoch, Toby Jacobs, Katrina Eaton, Lynne Connell, Harry Soar, Yvonne Bramma, Tom Gately, Renjith Joseph, Anish Gupta, Lucie Hobson, Charindri Wariyapola, Maryam Zaky, Nimu Varsani, Gerhardus Van Rensberg, Jackie Evans, Rosahn Saleh, William Sutcliffe, Louise Potter, Harvey Dymond, Catherine (Katie) Patton, Andrew Selman, Stephen Traynor, Kate Tizzard, Rumyana Nyathi, Caroline Reavley, Saima Hashmi, Kerry Hughes, Isabelle Sykes, Kate Slade, Anne Troy, David Castillo, Jennifer Quinton, Anne Adams, Joanne Gresty, Stella Wright, Victoria Christenssen, Iain Mooney, Fiqry Fadhlillah, Seema Pai, Gabor Debreceni, Aleinmar Winthein, Denise Griffin, Hannah Beadle, Elisa Kam, Marie Williams, Helen Howes, Tariq Tabiner, Saxon Prentice, James Bedford, Emma Craig, Peter Standen, Stephen Petley, Janaki Pearson, Cheryl Marriott, Harry Barclay, Alexandra Matson, Michael P.W. Grocott, Alison Thorne, Joanne Humphreys, Vishal Patil, Nick Greenwood, Richard Wassall, S.K. Harris, Valpuri Luoma, Dancho Ignatov, Rebecca Fry, Anamika Sehgal, Antonio Paredes-Guerra, Manjula Yadagiri, Yuvraj Doriaswami, Benjamin O'Donovan, Adam Mounce, Stephanie Wright, Linda Webber, Tracy Hazelton, Ethan Bateson, Theresa Garrett, Chris Honstvet, John Scriven, Rahul Dimber, Phillip Lo, Jenny Stead, Catherine Plowright, Rachel Morris, Pallavbhai Desai, Nicola Johnson, Neil Muchatuta, Vijayakumar Gopal, Sherma Turner, Karina Fitzgibbon, John B. Davis, Sarah Patch, Erica Jolly, Rob Gregory, Christopher Lochrin, Geoffrey Ryder, Sam Michlig, Liana Zucco, Susan Nimmo, Jessica Whiston, Sarah Goellner, Rohan Babla, Deborah Skelton, Lucy Mcmanoman, Darcy Pearson, Diane Forrest, Sanjeev Garg, Joanne Bradley-Potts, Joel Perfitt, Danny J.N. Wong, Mike Weisz, Caroline Lowrie, Timothy Alce, Alice Michell, Charlotte Soulsby, Dominic Hayes, Arnab Mandal, Stephanie Ridgway, Angela Willberry, Alka Grover, Simran Minhas, Kerwei Tan, Sharon Jones, Sam Marcangelo, Ben Millette, Hilary Thatcher, Greg Foster, Krishna Balachandar, Megan McAtear, Richard Shellard, Chris Littler, Thunga Setty, Kavita Sasi-Kumar, Theodore Floyd, Duncan Adshead, Stephen Hickey, South Yorkshire Hospitals Audit, Amy Barker, Ewen Cameron, Dawn Trodd, Wendy Nichols, Beth Farr, Mike Salmon, Naomi Fleming, Umairali Ikram, Ben Straughan, Peter J O'Brien, Laura Purandare, Janine Thomas, Elizabeth Wood, Kate Bosworth, Stewart Mckie, Samantha Evans, Tamilselvan Rajamanickam, Srinivasan Dhileepan, Paul Hindmarch, Colin Bergin, Sange Mansoor, Lisa Armstrong, Nagendra Natarajan, Irmeet Banga, Fiona Osborne, Lynne Williams, Pieter Bothma, Jade Woolley, Joanne Finn, Bernd Oliver Rose, Shaman Jhanji, Bennur Katyayani, Gillian Robertson, Laura Bird, Pauline Fitzell, Sally Anne Smith, Serena Yen, Stuart Clelland, Thomas Urwin, Luff Delme, Rocio Ochoa Ferraro, Nurse Cheryl Padilla Harris, Asad Naqvi, Andy Cumpstey, Natalie C. Wood, Samar Al-Rawi, Pulak Padhi, Claire Botfield, Bhavesh Raithatha, Michael Briskoe, Jolyon Cohen, Ben Gibbison, John John, Stephen Washington, Jayne Foot, Karen Chadwick, Naomi Cochrane, Sophie Spencer, Alexandra Gatehouse, Susan Smolen, Aaron D'Sa, John Sturrock, Christopher P Bourdeaux, Kumud Bhandari, Neil Kellie, Elizabeth Denman, Samson Tou, Laura Kettley, Alex Eros, Stuart McLellan, Nicola Ball, Emily Kirk, Sue Smyth, Kim Gibson, Oliver Barker, Mohammad Masood, Dabeeruddeen Ahmed, Geoff Thorning, Jennifer Van Ross, Esme Elloway, Kat Rhead, Sei Nishimura, Maximiliane Kellner, Benjamin Jacobs, Sanjoy Shah, Matthew Stubbs, Faye Moore, Greg Cox, Nishita Patel, Ashok Nair, Elizabeth Hawes, A Espinosa, Kavita Wankhade, Vladimir Bashliyski, Carina Bautista, Susan Lyjko, Michelle Rowe, Nikita Whotton, Julie Temple, Inthu Kangesan, Gemma McIntosh, Samir Nazir, R. N. Kumar, Jen Warren, Alex Coombs, Marilyn Boampomaa, Kaya Jeyarajah, Heather Savill, Claudette Jones, Vinayak Vanjari, Caroline Tierney, Santhana Kannan, Jennifer Aston, Helen Melsom, Valantine Woodham, Nichola White, Niraj Barot, Paolo Perella, Mayumi Vianzon, Padmanabhan Vatsala, Claire Boynton, Alexandra Edwards, Elisa Masoni, Jayne Edwards, Julie Edwards, Thomas Garth, Amanda Skinner, Kate Blethyn, Jonathan Chambers, Katie Ramm, Rosada Jackson, Thomas Coleman, Tracey White, Emma McKenna, Kanchan Umbarje, Thomas Sheppard, Deepa Jumani, Emma Murphy, Peter Lawley, David Howe, Daisy Alston, Ania Dean, Prasun Mukerjee, Julian Hood, Mahmoud Alkholany, Sarah Goff, Gillian Rennie, Bridget Fuller, Ciara Walker, Jonathan Pipe, Alex Eeles, Wai Soon, Catherine McMillan, Martha Wrigley, Neil Brown, Peter Sandbach, Claire McCahill, Anna Wilson Charlotte Yates, Paul Sampson, Natasha Muzengi, Colum Slorach, Moyra Hynd, Arjun Ardeshna, Trish Boateng, James C. Geoghegan, Rhys Williams, Karoline Middleton, Brian Campbell, Srikanth Chukkambotla, Daniel Leslie, Sherrie Samuels, Michael Allan, Ruth Clarke, Christopher Nutt, Kirsten Reid, Hannah Smith, Surabhi Jain, Stephanie Reed, Hywel Evans, Irene Gardner, Ben Griffiths, Guy Shinner, Marek Frenkiel, Jacek Zeber, Gary Minto, Simon Parrington, Louise Harrison, Carlos Kidel, Hawa Desai, Lois Steuart, Claire Hirst, Johann Harten, Marc Slorach, Angela Christofides, Claire Macey, Helen Moore, Chantal Busby, Andrew Robertson, Leanne Milner, Catherine Chapman, Rebecca Reeves, Lawrence Wilson, Alice Aarvold, Lizzie Irvine, Narayanan Suresh, Kirsteen Brown, James Dalton, Sam Miller, Yasir Rashid, Andrew Swain, Liliana Czukowska, Natasha Permall, Carys Durie, Peter Carroll, Lauren Cooper, Prerna Mehrotra, Sarah Clayton, Martina McMonagle, Sarah Buckley, Enoch Onya, Elizabeth Perritt, Domonique Georgiou, Manjeet Save, Lauren Friedman, David W. Hewson, Katherine McAndrew, Simon Morton, James Morgan, Susan Underwood, Helen Bowyer, Avninder Chana, Lucy Sootheran, Kieron Rooney, Pooja Patel, Jessica Summers, Laura Farmer, Kiran Keshvara, Victoria Richardson, Hannah Crowther, Geejo Rappai, Adam E. Green, Sarah Willcock, Smitangshu Mukherjee, Samuel Tyrrell, Geraldine Landers, Claire McAteer, Jennifer Awolesi, Sarah Higgin, Orla O'Neill, Chrissie Chevis, Paul Winwright, Vikram Malhotra, Jonathan Ogor, Maria Muelmenstaedt, Richard Stead, Lindsay Roughley, Sara Balliston, Nevena Kalcheva, Marc Wittenberg, Adrian Taylor, Lydia Shatanda, Anjali Soodan, Angela Moon, Sarah Elgarf, Matthew Roche, Sanchita Bhatia, Clare Howcroft, Emma Butterfield, Emily Gannon, Matthew Needham, Jacqueline McCormick, Daniel Bendel, Victoria Martinson, David Hall, Richard A. Armstrong, Lara Herbert, Beverly Kilner, Kathy Dent, Victoria Thwaites, Issy Thomas, Maggie Peat, Lisa Macbeth, Alex James, Rachel Flight, Nick Black, Elizabeth Boyd, Catherine Gedling, Suzanne Body, Nadine Farrell, Samantha Clayton, Paula Hiltout, Richard Haddon, Bethany Philpott, Victoria A Burgess, John Jackson, Anita Patil, Chris Platt, Lindsey Iles, Chrissy Braybrook, Katherine Morris, Emma Karsten, Minna Meritahti, Anastasia Lynn-Smith, Dorothy Hutchinson, Rebecca Darbyshire, Joanne Riches, Astri Luoma, Andy Gibson, Dushanthi Thurairasa, Roisin Baker, Xantha Holmwood, Alda Remegoso, Trusha Mistry, Sarah Hennell, Suganthi Joachim, Stephen Harris, Sam Eggleston, Melanie Morrison, Boon Ang, Natalie Jackson, Nicola Jones, Zena Haslam, Beata Iwanicka, Laura Graham, King Dhar, Melanie Kent, Daniel Wirth, Umakanth Kempanna, Laura Troth, Robert Orme, D. Campbell, Raquel Duarte, Muzaffar Sheik, Robert Maher, Jon Bramall, Rebecca Coates, Tracey Cosier, Sarah Vest, Kajan Kamalanathan, Graeme Foggo, Amanda Mohabir, Ritoo Kapoor, Precious Basvi, Jamie McCanny, Christian Frey, Bruce Emerson, Anantharaman Venkataraman, Karen Burns, Gail Pottinger, Mohamed Elwkhiee, Farkhunda Waqas, Alison Loftus, Amanda Kirrage, Ilma Songaile, Craig Smith, Jo Mullender, Hannah McPhee, Miriam Namih, Linda Gregson, Rachel K. Walker, Iain K. Moppett, Christine Adamson, Katie Flower, Tina Stoycheva, Beena Parker, Caroline Thompson, Kootharajan Kamraj, Vignesh Ashok, Ranjit Gidda, Istvan Koczka, Sadie Perkin, Vandita Ralhan, Arun Sengottaiyans, Ruth Hodgson, Peter Valentine, David Nunn, John Hickman, Molly Waldron, Lauren Elliott, Irene Echaveznaguicni, Lisa Dunlop, Julian Sonksen, Robert Fallon, Huw Griffiths, Thoy Ruth, Olivia Clancy, Lucy Dudgeon, Alicia Rodgers, Pamela Oracki, Phoebe Syme, Maria Newton, Stuart P. D. Gill, Julie Foxton, Jane Perez, Liam Gleeson, Richard Green, Sally Beer, Rohit Juneja, Loretta Barnett, Alex Bonner, Eunice Emeakaroha, Andrew V. Bradley, Ravishankar Jakkala Saibaba, Dipali Verma, J. Joseph Kinsella, Swee Ang Tung, Anju Raina, Verity Calder, Andrea Ortu, Chris Walmsley, Suneal Sharma, Michelle Reichman, Tom Stocks, Annika Smith, Ross Cruikshank, Sharon Storton, Matyas Andorka, Abhishek Kakkar, Allison Daniels, Priya Datar, Nichola Wakeford, Sheila Black, Usman Choudhry, Stephen Hackett, Huw Wilkins, Kirtida Mukherjee, Tim Green, Rebecca Hill, Ishan Dharmarathna, Jennifer Crooks, Serah Mungai, Luisa Howlett, Niveen El-Wahab, Linda Prasad, Amy Sadler, David Sharpley, Daphne Varveris, Victoria Ashton, Rajeev Jeevananthan, Safia Begum, Helen Anderson, Katherine Nahajski, Vanessa Linnett, Laura Morland, Stephen Mowat, Nenette Abano, Kathryn James, Ian Butler, Madelaine Ocampo, D. Williams, Gabriella Frunza, Wendy Deamer, Dominic Espitalier-Noel, Sian Liddle, Jane McConniffe, Anthony E. Pickering, Lisha Aju, Catherine Morgan, Hao Ern Tan, Jemma Tate, Emma Dooks, Anna Moore, Alison Hardwick, Liam Scott, Zak Rob, Rajeev Jha, Sujesh Bansal, Lynda Connor, Seliat Sanusi, Sophie Mason, Nipun Agarwal, James Woodier, Julian Giles, Lauren Collis, Jill Brown, Natalie Constable, Nichola Cahill, Anne Cowley, Mai Wakatsuki, Kelly Mintrim, Glenn Arnold, Donna Doyle, Ryhs Millington, Richard Dobson, Monica Serrano, Saqib Naji, Walid Hammad, Jacob Osbourne-Wylde, David Rollins, Claudia Paoloni, Nathan Anderson, Rachel Ingham, Alison Whitcher, Vicky Hills, Nina Toms, Jon Witby, Amy Nash, Marcus Fletcher, Jane Gibson, Martin Warin, Katherine McDowall, William Malein, Madhurima Das, Wael Abdelrhamen, Tom Neal, Sister Jenny Ritzema, James Collins, Chandana Rao, Joyce Yeung, Nadeem Shakir, Andrea Weigert, Atideb Mitra, Hari Arunachalam, Amy Morgan, Richard J. Jackson, Julie Chadwick, Debbie Callaghan, Frank Swinton, Lorraine Lock, Rahul Wakhle, Krish Kapoor, Ryan Humphries, Sarah Beavis, John-Paul Cutts, Julie Wilson, Keith Kelly, James Gill, Angela Loughlin, Rhys Rhidian, Christopher McGovern, Tom Hickish, Rachel Campbell, James Pennington, James Tozer, Philip Coakley, Lynn Fenner, Sally Tomkins, Lester Ribeiro, Shabir Qadri, Hristina Petkova, Christina Timmons, Katy Smith, Jonathan Perry, Stephen Crotty, Tanmay Patil, Mayavan Abayalingam, Ahmed Foly, Anna Wahed, Lewys Winfield-Young, Naomi Goodwin, Mark Verlander, Clare Donovan, Milena Vannahme, David Helm, Murali Vallabhaneni, Clare Ingram, Neil Moreland, Lorraine Stephenson, Jenny Jackson, Lindsay McOwat, Sathya Visvendra, Rhiannon Jones, Sarah Bird, M. H. Nathanson, Beryl Jones, Claire Davies, Beena David, Ian Sheldrake, Jeremy Guilford, Sister Bryony Storey, Rajeev Mishra, Irina Halfacree, Kiran Rait, Sameer Ahmed, Victoria Poyntz, Pamela Birks, Tom Kennedy, Angiy Michael, Michael McEvoy, Ian Davies, James Chan, Sajjad Ahmed, Laura Sweeney, Anne Whaley, Andrew Moores, Stella Gillies, Gearoid Crosbie, Antoinette Wilson, Iain Walker, Fiona Brailsford, Virginia Solanki, Elizabeth Turnbull, Lyndon Harkett, Sarah Ramsay, Thomas Syratt, Pushpaj Gajendragadkar, Cathal Small, Joanna Poole, Annabelle Whapples, Raghavendran Krishnaiyan, Elizabeth Smee, Richard Pierson, Taslima Rabbi, Alexandra Murphy, Angela Rooney, Sarah Crawford, Peter Bamford, Stephen Worthy, Sarah Munsie, Lucy Venyo, Henry Wang, Aditya Kuravi, Dennis Barnes, Ruth Han, Benjamin Gupta, Nurse Lynn Wren, Robert Hartley, Emma Edmunds, Laura Blood, Valerie J. Page, Thomas Judd, Puvan Suppiah, Emma Jenkins, Kate Gallagher, Fionnuala Lenehen, Rashidat Adeniba, Julius Cranshaw, Julie Wollaston, Kathryn Allison, Richard Kirkdale, Samantha Griffith-Norris, Jenna Kelly, Snehasish Guha, Stefan Schraag, Joy Dearden, Elizabeth Bell, Stephen Smith, Sarah Longhurst, Elizabeth Wilby, Annaliza Sevillano, Raksha Mistry, Aalisha Mariam Karimi, Kaung Pyae, Sarang Puranik, Maggie Collingborn, Karen Cranmer, Chandrashekhar Vaidyanath, M. Chincholkar, Narendra Siddaiah, Gillian Bell, Edward Rintoul, Nicki Devooght-Johnson, Tom Lovejoy, Eleanor Roscoe, Zoe Neilson, Joanne Hill, Kamal Sharif, Sharon Meehan, Bassey Nkanang, Thomas Georgiou, Martin Goodman, Prashant Kakodkar, Rebecca Martin, Philip Roddam, Evanna McEvoy, Peter Tsim, Janakan Anandarajah, Shub Gupta, Oliver Pratt, Yang Ng, Francesca Th'ng, Linda Kent, Graham Soulsby, Danielle Kirk, Ramana Govindaraju, Rebecca McClean, Samantha Harkett, Obaid Tarin, Shalini Chinna, Susan Gallagher, Laura Gardiner, Marc Turnbull, James Briscoe, Anna McSkeane, Melanie Claridge, Gillian Fleming, Thomas Huttley, Elaine Spruce, Lianne Hufton, Susan Hendy, Adrian Barry, Jeremy Drake, Cody Allen, James Hillier, Manju Patel, C. Gray, Nasreen Iqbal, Karen Markwell, Linzi Heaton, Michelle Nicholas, Gary Lau, Laura Catchpole, Nurse Sonia Walia, Kerry Elliott, Jake Hartford-Beynon, Amee Samani, Kathryn King, José William Martínez, Skylar Paulich, Ifan Patchell, Killian McCourt, Rebekah Rodgers, Christine Wood, Richard Wan, Karan Verma, H. W. Cain, Eleonore Quinn, Lisa Richardson, Muhammad Usman Latif, Nicholas Hingley, Rajesh Gilla, Roopa McCrossan, Mayeth Recto, Russell Hedley, Lucy McClelland, Suzie Marriott, Deepak Seharawat, Gururaj Mudimadagu, Claire Jones, Michelle Yare, Sophia Henderson, Rupinder Kaur, Emily Spence, David Wright, Bhaskar Dutta, Tom Pettigrew, Vikki Atkinson, Lorna Sissons, Segun Oladele, Sue Thomas, Hani Ali, Rebecca Robson, David Buckley, Kevin Hamilton, Amanda Hall, Anaesthetic Audit, Anna Watkin, Donna Kelly, Graham White, Sarah Sanders, Henry Boyle, Joao Galente, Thomas Williams, Justin Ang, Sarah Horton, Abdelrahman Soliman, Vijay Jeganath, Kavita Upadhyaya, Plamen Stoyanov, Murray Geddes, Alan Pope, Khaled Ellisy, Thomas Walker, Emma Finlay, Penny Parsons, McDonald Mupudzi, Adam Duffen, James Goodwin, Rob Penson, Laura O'Sullivan, Vinesh Mistry, Ravindra Mallavalli, Krzysztos Guz, Deepti Bhuwanee, Eleanor Andrews, Justine Burns, Sarah Kirk, Faith Kibutu, Sam Stafford, Julia Blackburn, Joellene Mitchell, Robert Spencer, Helen Williams, Karen Riley, Gabbie Young, Tom Williams, James Wu, Emma Wheatley, Alistair Johnstone, Rachel Stoeter, Timothy Cominos, Guy Coady, Ruth Mawhinney, Sam Spinney, ruthy Arumugam, Myura Nagendram, Jason Lie, Sian Hughes, Linda Bairkdar, Peter Evans, Daniel Pygall, Graeme Brown, Susan Livingstone, Norbert Skarbit, Amit Pruthi, Zakaulla Belagodu, Ben Linton-Willoughby, Richard A Cowan, Helena Prady, Mike Raffles, Sonia Rasoli, Katherine Cullen, Jessica Lees, Peter Lax, Ashok Puttapa, Fran Millinchamp, Aneta Oborska, Benita Adams, Kathryn Newton, Mrutyunjaya Rao Rambhatla, Sunny Nayee, Madlena Ivanova Vrazhalska, Jonathan Clarke, Aariana Sohal, Siobhan King, James Bain, Jessica Wilson, Anthony Carver, Jack Davies, Lucy Connolly, Samuel Morrish, Robyn Lee, Lucia Stancombe, Satyanarayan Jakkampudi, Kath Rosedale, Philip Hopkins, Clovis Rau, Katherine Hunter, Amy Farrow, Kathleen Holding, Elizabeth Vassell, Oliver Boney, Julia Icke, Ewa Prusack, Osi Egole, Fiona Linton, Suresh Eapen, Wendy Goddard, Ayda Borjian Boroojeny, Simon J. Davies, Jackie Terry, Fiona Graham, Thomas Pratt, Hanzla Naeem, Viv Colclough, Yeng Yap, Tejuswi Patel, Susan Midgley, Mark MacGregor, Ben Marshall, Talitha Devries, Cheng Ong, Katie Molloy, Kat Walker, Katy Irwin, Abbas Majeed, Mark Pinkerton, Nicki Russell, Sibtain Anwar, Ian A Jenkins, Lucy Allen, Elaine Coulborn, Ganesh Nair, Stewart Brown, Melissa Addy, Matt Milner, Amr Hassan, Victoria Millar, Sarah Turner, Gary Baigel, Amanda Lyle, Simon Young, Kathy Malinovszky, Heather Short, Mary Newmarch, Colin McAdam, Andrew Robert Bailey, Kevin Draper, Michael Agyemang, Kieran Oglesby, Clare Mewies, Ruth Ugochukwu, Shibu Jacob, Susan O'Connell, Charlotte Topham, Xiao Zhao, Shay Willoughby, Ossian Aukland Child, Manish Torne, Ben Wetherell, Divya Veluvolu, Dominic Wu, Elizabeth Evans, Daniel Eden, Suzannah Peggler, Lucy Emmett, Romit Samanta, Ravi Parekh, Jane Hermanowski, Will Shankey-Smith, Sam Papadopoullos, Julie Camsooksai, Sara Mistry, James Wigley, Anna Todd, Bally Purewal, Natalie Baldry, Kate Wilkinson, Aalia Sange, Kirsty Baillie, Joanne Topliffe, Denise McSorland, Saheli Das, Nikki Staines, Catherine Harris, Anna-Marie Boniface, Gemma Milne, Tessa Rowlands, Leanne Quinn, Svetlana Kulikouskaya, Christopher Bull, Angus Sutherland, Mihir Desai, Hannah Goodhand, Meenal Rana, John Bugo, Maria Chazapis, Sarah Kent, Sarah Siew, Marcin Pachucki, Tim Forsyth-Jones, John McKenna, Sarah Driscoll, Laura Hunter, Penny Bedoes, Natasha Santana-Vaz, Sandra Latham, Robert Coe, Sharon Christie, Lawrence R Kidd, Katy Redington, Alastair Sawyer, Abdalla Ali, Rekha Jayapal, Manfred Staber, Emma Pearson, Stuart Reilley, Tom Bird, Kristofor Inkpin, Annette Haines, Manish Verma, Naomi Wee, Ozerah Choudhry, Daniel Tucker, Euan Campbell, Aaron Stokes, Ashley Allan, Emma Reeves, Helen Fenner, Melanie Cockroft, Tom Nicholls, Sinan Bahlool, Sharon Drake, Nalini Sethia, Lesley Jordan, Martin Northey, Paul Glyn Jones, Lara Jeanes, Emma Simpson, Julia Brown, Samantha Coetzee, James Nicholas, Adam Samways, Ritesh Ganesh, Martin Ward Platt, Mizan Khondoker, Helen Wibberley, Lauren Simmonds, Sunita Agarwal, Linda Titinchi, Fran O'Higgins, David Pritchard, Laura Beard, Yvonne Lester, Charlotte Hirst, Louise Wills, Kevin Windsor, Haren Jyothiraj, Carmela Martella, Stephanie Bell, Christopher Nwaefulu, Hemamangala Venkatesh, Camilla Stagg, Soumi Ghosh, Thomas Dawes, Jennifer Lockhart, Stavros Papadopoulos, Nanci Doyle, Gillian Whalley, Rachael Britton, James Goddin, Maggie Dawson, Carole Holder, Elaine Morsman, Rachel Lovatt, Venu Mehta, John J.B. Allen, Anna Perham, Stephanie Wallis, Dmitry Zabauski, Peter Hart, Tracy Sharp, Martin Pope, Jo Knight, Jane Wright, Nageena Hussain, Josie Snell, Thomas Knight, Philippa Hill, Nic Martins, Robin Williams, Beverley Stidolph, Beth Peers, Brian Lafferty, Alicja A'Court, Joanna Collins, Charlie Kennedy, Andy Bates, Graham Walkden, Mia Marsden, Lauren Shillito, Poonam Bopanna, Raheel Ahmed, Ada Ezihe-Ejiofor, Kate Driver, Mevan Gooneratne, Carolyn Smith, Caroline Abernethy, Kathy Shammas, Chanice Alcock, Yin Yong Choo, Mark Vertue, Ratna Makker, Victoria C. Smith, Sachin Mehta, Clare Denford, Wint Mon, Jose Miguel Sabugueiro, Liz Varghese, Mohamed Ahmed, Rebekah Chan, Alexandra Williams, Stephanie Pauling, Maria Faulkner, Ryan Wilkins, Sara Stevenson, Kathryn Simpson, Moiz Alibhai, Patricia Williams, Pascal Defeyter, Siva Sangaralingham, Lucy Evans, Shirley Cocks, Simon Dyer, William Rea, Caroline Renton, Karl Braid, Ranjit Bains, Holly Owen, Sue Brixey, Calum Taylor, Laura Coleman, Andrew Peeling, Daniel Solomon, Christopher Perman, Roisin McCallum, Helen Church, Martin Watson, Amy Bamford, Elizabeth Bradshaw, Elizabeth Turner, Owen Vale, Suneetha Ramani Moonesinghe, Preeti Mahidik, Lynsey Cubitt, Catherine Hunter, Eleanor Warwick, Sam McAleer, Suresh Singaravelu, James Hilton, Rebecca Aspinall, Icel Souleimanova, Muna Elsheikh Idris, Wei Teo, Sarah El-Sheika, Adrienne Stewart, Sadia Habib, Emily Wade, Liesl Despy, Sharmin Shohelly, Colin Williams, Louise Shaw, Shree Voralia, Dafydd Lloyd, Barbara A. Crooks, Laura D Howe, Una Gunter, Edward Hare, Louise Nimako, Ruth Young, Helen Doherty, Sock Huang Koh, Stephen Merron, Martina Coulding, Agilan Kaliappan, Clare Bolton-Hill, Jill Wain, Maria O'Callaghan, Catherine Cartmell, Nicola Pemberton, Hannah Bennett, Lynda Garcia, Riquella Abbott, Sally Jeffrey, Thomas McLoughlin, Andrew Gratrix, Christopher Harrison, Matt Mackenzie, Jayshree Gracey, Chris Moore, Benjamin Parsons, Nehal Patel, Stephanie Brooks, Catherine Riley, Jemma Gilmore, Ilya Kantsedikas, Simon Whiteley, Emily Pallister, Angie Organ, Yohinee Rajendran, Gopinath Selvraj, Priya Thorat, Ilona Schmidt, Pauline Austin, Nitin Madhukar Sadavarte, James Haddock, Alastair Duncan, Richard Bateman, Elaine Chinery, Martin Gray, Felicity Corcoran, Shanelle Tharuka Wijesuria, Bryany Bond, Charlene Otieno, Sion Lewis, Cieron Roe, Dan Freshwater-Turner, Annette Bolger, Sarah Steynberg, Louie Saclot, Charlotte Busby, Jack Roberts, Richard Dagnan, Jasna Comara, Krishnakar Melachuri, Sian Gibson, Joanne Taylor, Manju Agarwal, Mark Sheils, Matthew Bell, Rosemary Anna Lewis, Kiran Patel, Mansoor Siddiqui, Christopher J. Groves, Mini Thankachen, Sharon Turney, Viral Dalal, Pele Banugo, Andrew Baird, Euan Kerr, Simon Tomlins, Laura Osbourne, Nicola Pattison, Stuart Joy, Susan Merotra, Lorna Ryan, Lisa-Jayne Cottam, Chye Siaw, Keelan Jerram, Nurse Diane Scarletta, Carole Paley, Jennie Smith, Will Gatfield, Stephen Alderson, Claire Swarbrick, Amelia van Manen, Stephan Clements, Sophia Strong-Sheldrake, Jake Drinkwater, John McLenachan, Lucinda Williams, Dianne Heaton, Sandor Orosz, Chloe O'Hara, Nina Barratt, Justine Elliot, Michael Gardner, Nicola Crowther, Bharati Rajdev, Linda Hall, Youssef Girgis, Michael Kinsella, Alison Potter, Matthew Martin, Rosie Reece-Anthony, Richard Pugh, Tracey Taylor, Esme Marshall, Wendy Stoker, Helen Worrell, Kay Housley, Rebecca Leslie, Helen Jewitt, Sandeep Sharma, Maire Gallagher, Jon Fenn, Jade Harrison, Hannah Watson, Natalie Morris, Lewis Schofield, Nisha Pattni, Charlotte Thomas, Eleanor Walshe, Richard Snooks, Ruth Murphy, Emily Pickford, Gnanshree Krishnamurthy, Donna McIntosh, Rachel Dolan, Emma Stoddard, Kelly Goffin, Shady Elhallous, Adrian Butler, Ildiko Nemeth, Hannah Wilson, James Sylvester, Melanie Sahni, James Wardlow, Ann Lachana, Emma Barr, Kayleigh Gilbert, Yazzim Hammoud, Peter Csabi, Maqsood Bajwa, James D Turner, Alex Hunt, Samantha Moore, Stephanie Hii, Philip Atkinson, Michelle Walter, Elizabeth Bailey, Frances Tait, Annie Newby, Jane Martin, Greg Forshaw, Bert Quartermain, Sally Humphreys, Aoife Hegarty, Caroline Bennett, Satyajeet Ghatge, Charles Prior, Kribashnie Nundlall, Priaykam Chowdhury, Jill Fitchett, Daiva Bernotaitis, Sandeep Varma, Alex Dunn, Rebecca Dooley, Mahamed Mostafa, Shelly Wood, James Humphreys, Anna Celnik, John Bailes, Mark Snazelle, Christina McCarroll, Matthew Govier, Emert White, Matthew Taylor, Alastair Rose, Brigid Hairsine, Natalie Whybro, Allen George, Robin Wilson, Filipe Vieira, Leon Cohen, Jonathan Womack, Thomas Woodward, Nimali Lochanie, Ben Howes, Joshua Nelson, Preea Gill, Gayle Clifford, Lushani Suntharanathan, Duncan Wagstaff, Steve Pryn, Lalindra Bandara, Sneh Shah, Nowfal Rahman, Iolo Roberts, Mirriam Sangombe, Shaik Subhani, Hannah Phelan, William Udall, Katy Allan, Nicola Zondo, Tim J Peters, James Roe, Catherine Addleton, Angus McKnight, James McCaul, Flora Kormendy, Anil Rao, Luke Vamplew, Andrew Rees, Jeanette Gilbert, Mandy Austin, Thomas Hunt, Sian Birch, Catherine Lloyd, Stewart D'Sylva, Jill Smith, Wendy Lum Hee, Michael Munro, Jean Denton, Julia Hindle, Alice Brown, Ursula Kirwan, Dinithi Yogya, Maria Mclaughlin, Nurse Louise Moran, Larysa Duniec, Sophie Benoliel, Gail Evans, Linda Bailey, Colin Hall, Katie Rowland, Krupali Patel, Ashwini Keshkamat, Zorba Begum, Resti Varquez, Victoria Apps, Giles Bond-Smith, Shirin Dastur, Andy Chapman, Amy Smith, Sarada Gurung, Ruth Delascasas, Nicole Issit, Pauline Sibley, Jaina Parmar, George Madden, Eveliina Nurmi, Katja van de Snepscheut-Jones, Louise Peacock, Vanja Srbljak, Kellie Allen, Andy Chamberlain, Suhail Zaidi, Andrew Boyle, Daniel Stolady, Rita Saha, Mark Clayton, Mitul Patel, Emily King, Hannah Oliver, Ewa Werpachowska, Holly Coles, John Dereix, Agnieszka Kubisz-Pudelko, Clare Watkinson, David Rogerson, Laurence Inman, Jaspreet Rayet, Jenny Finch, Emma Stewart, K. E. Wilson, Emma Tyson, Asif Gani, Reni Jacob, Neil Smith, Johnny Holland, Max Richardson, Mark Chen, Richard George, Helen Laycock, Anoushka Winton, Emily Hignell, Li Fang, Emma Welfare, Rochelle Velho, Fayaz Baba, Finbar O'Sullivan, Lisa Zeidan, N. Beauchamp, Neil Rasburn, Guy Rousseau, Victoria Roberts, Hollie Bancroft, Holly Maguire, Mechele Couch-Upite, Rahul Kumar, Chandra Bhimarasetty, Matt Lovell, Sujata Anipindi, Charlotte Small, Matthew Faulds, Alex Mattin, Alice O'Donnell, James Jack, Richard Boulding, Tarek Mostafa, Rhian Bull, Corinne Pawley, Ruth Killen, Jessica Lowe, Frances Taylor, Ethel Black, Michael F. M. James, Jenny Child, Lisa Emery, Kim Hoyland, David Hay, Janet Cotta, Josephine Stewart, Sue Spearritt, Laura MacNally, Fatma Lahloub, Katie Welham, Sanjoy Bhattacharyya, Shanteela McCooty, Heena Bidd, Hugo Buckley, Ervin Shpuza, Zaid Ahmed, Emily Craven, Amanda Cook, Caroline Dixon, Tara Pauley, Tariq Azad, Helena Barcraft-Barnes, Sindy Lee, Kate Penhaligon, Bernice Dudkowsky, Karen Ellis, Laura Montague, Ching Pang, Elsie Bickmore, Veronica Marsh, Toby Winterbottom, Marta Campbell, Rhys Hughes, Issie Gardner, Elizabeth Steel, Ramai Santhirapala, Katie Sweet, Michelle Scott, John Ekpa, Bhavia Janardhana, Catriona Frankling, Julia Ottaway, Alexander Middleditch, Elna Cifre, Annabel Pearson, Amanda Cotterill, Sarah Raut, Hannah Blanshard, Sara Eddy, Garry Henry, Elizabeth Hood, Maria Loy, Matthew Campbell, Marc Gimenez, Jessica Thrush, Jeremy Henning, Vlad Kushakavsky, Nikolaos Makris, Deborah Fradkin, Karen Fan, Fiona Hammonds, Kathryn Jackson, John Hadfield, Pyda Venkatesh, David Read, Daniel Zeinali, Ryan Hynd, James Carvell, Richard McCormick, Emily Dodds, Sana Rizvi, Amelia Daniel, Dan Sellers, Thomas E. Miller, Daniel Haigh, Nicky Moss, Patrick Dill-Russell, Priya Shekar, Teresa Melody, Randeep Dhaliwal, Nigel Hollister, Andrew Burtenshaw, Adrian Wagstaff, Ben Scoones, Eduardo Osorio, Joanna Allison, Lucy Willsher, Carol McArthur, Stephan Dalchow, Elaine Winkley, Eleanor Reeves, Ben Eden Green, Andrea Ingham, Mohammad Auldin, Freda Amoakwa-Adu, Jonathan Adams, Fiona Oglesby, Charlotte Steeds, Nurse Sara Greig, Obla Suganthi, Puja Chhaniyara, Clare De'Ath, Chandrakant Gosavi, Bart Ordys, Adele Flowerdew, Doug Tunney, Rachel Alexander, Oliver Griffith, Thomas Saunders, Matthew Maton-Howarth, Gabi Metiu, Akmal Shakoor, Elizabeth Willard, Katherine Russell, Matthew Robinson, Emma O'Kane, Meera Raja, Phillippa Falkner, Kerry Colling, Natasha Joshi, Laura Pearse, Tim J. Smith, Anitha James, Mona Mohamed, Richard Kennedy, Samson Ma, Tasmeen Ghafoor, Matthew N. Davies, Henry Lewith, Samuel Mindel, Sarah-Jane Dunn, Hemangini Barot, Sadie Diamond-Fox, Jenny Macallan, Arun Menon, Helen Farrah, Emma Plunkett, Brendon Spooner, Sorana White, Katie Samuel, David Crabtree, Katherine Cheshire, Gareth Harrop, Dionne Wortley, Tim Warrener, Joanne Mullen, Peter Taysum, John Whitaker, Kathy Wilkinson, Jean Dent, Nicola Farmer, Thelma Darian, Guru Hosdurga, Phillipa Wakefield, Christopher W Horner, Julie Steen, Elena Teh, Helen Gerrish, Betty Travasso, Mhairi Jhugursing, Michelle Gardener, Alexandra Crook, Edward W. Miles, Patricia Doble, Ashok Raj, Hanna Wong, Kay Protheroe, Chiraag Talati, Banher Sandhu, Cara Marshall, Matt Holl, Julie Sheriff, Frances Forrest, Adam Mitchell, Hindusha Keerthikumar, Mohamad Mahmoud, Simon Ben-Nathan, Janice Hartley, Danielle Ormandy, Hayleigh Morris, Steven Tran, Imogen Hayes, Trudy Smith, Kirsty Duell, Jennifer Cunningham, Richard Appleton, Lucy Pippard, Debroah Beeby, Hayley Bridger, Manuel Pinto, Susan Beames, Huiqi Wang, Cain Hunter, Flora Darch, Debbie Weller, Jonathan Hulme, Jacqueline Howes, Michael Kriger, Badrinath Manikundalam, D.J.N. Wong, Tim Arnold, Belinda Wroath, Rachel McKendry, Harry Knight, Caroline Bushell, Victoria Siddons, Louise Humphries, Joanne Vere, Vinanti Cherian, Janine Birch, Kate Blyth, Tatyana Bolonenkova, Meredith Harris, Alice Sisson, Sarah Clark, Sandeep Saxena, Samira Green, Amit Ranjan, Gillian Bennett, Chris Smales, Laura Ferguson, Ash Bharti, Francisca Mautadin, Katherine Brown, Lydia Jones, Christopher Adeney, Nikkita Carden, Sanjay Behl, Sonia Sathe, Elizabeth Neale, Helen French, Charlotte Mundy, Anna Batchelor, David Morris, Nithin Roy, Evelyn Philip, P.A.-A. Marc Hastie, Andrea Cole, Edmund Quak, Claire Totten, Karen McIntosh, Fiona Davis, Søren Kudsk-Iversen, Vanessa Unsworth, Andrew McIndoe, Jeremy Bewley, Sarbpreet Sarao, Laura Wood, Elaine Walker, Egidio Da Silva, Danielle Gilmour, Richard Yardley, Zara Eagle, Vijay Ragothaman, Sean Rayappu, Moira Tait, Alex Hamilton, Chris Gillett, Adeel Majeed, John Elton, Arlo Whitehouse, Fiona Robertson, Tim Martindale, Kin So, Kathryn Dixon, Toby Shipway, Fiona Mcneela, Simon Cousins, Brian Conway, Merate Place, Phil Duggleby, Rhian Morgan, Racquel Carpio, Carina Casey, Edward Mew, Jo Han Gan, Caroline Clark, Natasha Sharma, Kay Anne Mak, Gahan Bose, Chris Ford, Ruoling Yan, Anand Sathiapillai, Panagiotis Sgardelis, Sue Redhead, Arjun Alva, Cathy Jones, Vincent Hamlyn, Gemma Squires, Karen Smallshaw, John Whitwell, Sarah Shaw, Paul Watson, Michelle Cheeseman, Kimberley Netherton, Juneenath Karattuparambil, Niyesa Ranasinghe, Jeet Patel, Rob Lyons, Gemma Bown, Helen Bromhead, Zhana Ignatova, Kudakwashe Nyangoni, Linden Baxter, Thomas Moody, Sachin Valap, Esme Sleap, Mario Fernandes, Kinga Bodo, Jane Silk, Charlie Pope, Donna Ferraioli, Chloe Billingham, Rachel Butterworth, Andrew Kelly, Lesley Hawkins, Issac Gill, Hannah Greenlee, Sue Kirby, Jessica Giles, Anna Pierson, Roxana Sandhar, Claire Smyth, Rhona Younger, Ciara Coary, Arif Qureshi, Tahir Abbas, Corinne Rimmer, James Evans, Ida Ponce, Fenner Christoper, Buzz Shephard, Sophie Tang, Lauren Milian, Joanne Hiden, Dhania Haron, Jamie Calderwood, David Freeman, Virginia McTaggart, Carla Lewis, Chai Obeysekera, Alan H. Cohen, Melvin Leong, Jenni Law, Noor Elahi, Kim Holland, Victor Maduekwe, James Garwood, Lizzie Dawson, Virginia Iqbal, Thomas J Craig, Daniel Shuttleworth, Anand Perumal, Mahmood Saad, Seema Charters, Bethany Tookey, P Gunning, Suresh Panchakshariah, I.J. Wrench, Mayur Murali, Susan McInerney, Paul Foley, Charlotte Perkins, Marie-Louise Svensson, Karen Birnie, Samantha Hagan, Emily Hetherington, Anna-Marie Love, Annette Woods, Karen Green, Steve Hillier, Hannah Conway, Rebecca Reilly, Laura Bubb, Amy Ashford, Andrew Savva, Melody MacGregor, Stephen Lord, Ahmed Hassanin, Ramdas Howard, Laura Ashton, Arihant Jain, Simon Williams, Michael Shaw, Jill Deane, Abbie Singleton, Catriona Routley, Christopher Hall, Robin Webber, Tressy Pitt-Kerby, Stuart M. White, Shannon Gawley, Nick Heseltine, Christina Lalani, Claudia Dulea, Arindam Biswas, Rebecca Harris, Aislinn Brown, Nicholas Francis, Ben Holst, Ryan Perry, Cathie Melvin, Mark Darbyshire, Stephen Mulvany, Amy Ashton, Petrus Fourie, Emma Temlett, Jason Cupitt, Vanisha Patel, Alice Trimble, Andrew Brammar, Sarah Grayland, Eleanor Pett, Tom Standley, Carly Webb, Manamohan Rangaiah, Laura Peltola, Leanne Darwin, Yvonne Grimes, Elizabeth Brodier, Scott Berwick, Adam Janeczko, Madeleine McKee, Katherine Davidson, Jan Woodward, Saurabh Mehotra, Tara Keogh, Kofi Mensah, Joyce Guy, James King, Matt Aldridge, Nicolas Price, Alaine Done, Teresa Jones, Julia Sampson, Smita Bapat, Lauren Perkins, Tamas Szelei, Ryan Kingan, Suleman Mulla, Celia Montgomery, Alex Belcher, Salma Kadiri, Bryan Singizi, Peter Chater-Lea, Jennifer Claire Taylor, Lauren Oswald, Stephanie L. Lee, Rhys Griffiths, Samuel Pestell, John Livesy, Sarah Ciechanowicz, Alexander Stephen Harrison, Richard Partridge, Alex Daniels, Beth Penhaligan, Lyndsay Bibb, Jonathan Little, Margaret Cullen, Anya Eijk, Charlotte Earnshaw, Elena Lynes, Nicholas Jenkins, Inthekab Mohammed Ali, Madhu Balasubramaniam, Vusumuzi Shabangu, Paul-Simon Whitney, Rebecca Denyer, Kathryn Potts, Andrew Ray, Jonny Guy, Mike (Stephen) Kinsella, Pearl Baker, Olga Fernandez, Julian Berry, Callum Forbes, Southcoast Peri-operative Audit, Rebecca Rice, Lisa Horner, Sally Pitts, Kirat Panesar, Joe Stevens, Timothy Molitor, Oon Chiu, Piers Murphy, Sudeshkumar Muniyappa, David George, Jonathan Veitch, Shifa Yaruk, Lynn O'Donohoe, Theresa Murray, Laura Tasker, Johanna Wales, Diane Mellers, Robert Sparrow, Olivia Ward, Emma Shacklock, Janet Middle, Sarah MacLennan, Martin Knight, Lindsay Dawson, Teodora Orasanu, Jo Fletcher, Sarah Martin, Pnt Laloë, Gregor Imrie, Harriet Pudge, Tamsin Gregory, Andrea Wood, Colin Christie, James Penketh, Mia Andrews, Nicky Ford, Ellie Fisher, Sophie Robin, Richard Stewart, Steve Williams, Harriet Gardiner, Alison Evans, Guanmei Luo, Urmila Ratnasabapathy, Ruth Joslyn, R. Sneyd, John Westwood, Naomi Cassells, Olivia Kay, Jordi Margalef, S Butler, Hari Nageswaran, Chloe Searles, Geoffrey Wright, Thomas Potter, Drew Norwood-Green, Jonathan Ramsden, Sarah Bean, Emma Sadler, Anaesthetic Trainees, Stephanie Lewis, Kevin E. Thorpe, Sarah MacLean, Paul Ogle, Mary O'Sullivan, Diane Whitehouse, Mandy Oakley, Rachel Coathup, Harisg Venkatesh, Lisa Burgess, Daniela Smith, Kimberley Plummer, Hilary Robb, Jeanette Grocott, Rebecca Mairs, Helen Gilfillan, Moira Morrison, Sharon Garner, and Tammy Towers

Subjects
Adult, medicine.medical_specialty, Adolescent, State Medicine, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, Risk Factors, Neoplasms, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Young adult, Prospective cohort study, health care economics and organizations, Aged, Aged, 80 and over, Health Facility Size, Postoperative Care, Models, Statistical, business.industry, Incidence (epidemiology), Incidence, Health services research, Operating room management, Odds ratio, Middle Aged, Confidence interval, United Kingdom, Surgery, Obstetrics, Anesthesiology and Pain Medicine, Hospital Bed Capacity, General Surgery, Female, business, Emergency Service, Hospital, human activities, Cohort study
Abstract

Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; PConclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

Published
2018

28. Surgical lung cancer patients’ views about smoking and support to quit after diagnosis: a qualitative study

Author

George Dowswell, Babu Naidu, Paul Aveyard, Amanda Farley, and Amy Kerr

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Coping (psychology), Lung Neoplasms, medicine.medical_treatment, Alternative medicine, Health informatics, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Humans, Medicine, Survivors, 030212 general & internal medicine, Lung cancer, Qualitative Research, Aged, Aged, 80 and over, Oncology (nursing), business.industry, Public health, Qualitative interviews, Smoking, Patient Preference, Middle Aged, medicine.disease, Oncology, 030220 oncology & carcinogenesis, Family medicine, Smoking cessation, Female, Smoking Cessation, business, Qualitative research
Abstract

Evidence suggests that quitting smoking improves symptoms as well as disease-related mortality for cancer patients. However, smoking cessation support is typically not well integrated into routine cancer care even in the case of lung cancer.. We explored surgical lung cancer patients’ views about smoking and about their preferences for support to help them to quit. We conducted semi-structured, qualitative interviews with 22 surgical lung cancer patients with a smoking history, after treatment with surgery. Data were analysed using the framework approach. Although diagnosis promoted a successful quit attempt in some, others continued smoking or relapsed after a quit attempt. Most participants wished they were a non-smoker but, in conflict with this, also felt that smoking was enjoyable, helped with psychological coping or had some health benefits. Some also demonstrated a fatalist attitude towards the potential detrimental health effects. However, all participants felt that it was important for health professionals to address smoking and some wanted cessation support although it was often not provided. Participants wanted support to start as early as possible and to continue for the first weeks after discharge. Surgical lung cancer patients often stop smoking during hospitalisation, and many want to remain quit but relapse shortly after discharge. Although it is often not provided, many patients want to be offered support to help them quit. Surveys suggest that clinicians believe that addressing smoking will be difficult and/or unwanted. However, these findings suggest that surgical lung cancer patients would tolerate, and most would prefer, integration of smoking cessation support into routine cancer care.

Published
2015

29. Allele-Specific HLA Loss and Immune Escape in Lung Cancer Evolution

Author

Nicholas McGranahan, Rachel Rosenthal, Crispin T. Hiley, Andrew J. Rowan, Thomas B.K. Watkins, Gareth A. Wilson, Nicolai J. Birkbak, Selvaraju Veeriah, Peter Van Loo, Javier Herrero, Charles Swanton, Mariam Jamal-Hanjani, Seema Shafi, Justyna Czyzewska-Khan, Diana Johnson, Joanne Laycock, Leticia Bosshard-Carter, Pat Gorman, Robert E. Hynds, Gareth Wilson, Stuart Horswell, Richard Mitter, Mickael Escudero, Aengus Stewart, Andrew Rowan, Hang Xu, Samra Turajlic, Crispin Hiley, Christopher Abbosh, Jacki Goldman, Richard Kevin Stone, Tamara Denner, Nik Matthews, Greg Elgar, Sophia Ward, Marta Costa, Sharmin Begum, Ben Phillimore, Tim Chambers, Emma Nye, Sofia Graca, Maise Al Bakir, Kroopa Joshi, Andrew Furness, Assma Ben Aissa, Yien Ning Sophia Wong, Andy Georgiou, Sergio Quezada, John A. Hartley, Helen L. Lowe, David Lawrence, Martin Hayward, Nikolaos Panagiotopoulos, Shyam Kolvekar, Mary Falzon, Elaine Borg, Teresa Marafioti, Celia Simeon, Gemma Hector, Amy Smith, Marie Aranda, Marco Novelli, Dahmane Oukrif, Sam M. Janes, Ricky Thakrar, Martin Forster, Tanya Ahmad, Siow Ming Lee, Dionysis Papadatos-Pastos, Dawn Carnell, Ruheena Mendes, Jeremy George, Neal Navani, Asia Ahmed, Magali Taylor, Junaid Choudhary, Yvonne Summers, Raffaele Califano, Paul Taylor, Rajesh Shah, Piotr Krysiak, Kendadai Rammohan, Eustace Fontaine, Richard Booton, Matthew Evison, Phil Crosbie, Stuart Moss, Faiza Idries, Leena Joseph, Paul Bishop, Anshuman Chaturved, Anne Marie Quinn, Helen Doran, Angela Leek, Phil Harrison, Katrina Moore, Rachael Waddington, Juliette Novasio, Fiona Blackhall, Jane Rogan, Elaine Smith, Caroline Dive, Jonathan Tugwood, Ged Brady, Dominic G. Rothwell, Francesca Chemi, Jackie Pierce, Sakshi Gulati, Babu Naidu, Gerald Langman, Simon Trotter, Mary Bellamy, Hollie Bancroft, Amy Kerr, Salma Kadiri, Joanne Webb, Gary Middleton, Madava Djearaman, Dean Fennell, Jacqui A. Shaw, John Le Quesne, David Moore, Apostolos Nakas, Sridhar Rathinam, William Monteiro, Hilary Marshall, Louise Nelson, Jonathan Bennett, Joan Riley, Lindsay Primrose, Luke Martinson, Girija Anand, Sajid Khan, Anita Amadi, Marianne Nicolson, Keith Kerr, Shirley Palmer, Hardy Remmen, Joy Miller, Keith Buchan, Mahendran Chetty, Lesley Gomersall, Jason Lester, Alison Edwards, Fiona Morgan, Haydn Adams, Helen Davies, Malgorzata Kornaszewska, Richard Attanoos, Sara Lock, Azmina Verjee, Mairead MacKenzie, Maggie Wilcox, Harriet Bell, Allan Hackshaw, Yenting Ngai, Sean Smith, Nicole Gower, Christian Ottensmeier, Serena Chee, Benjamin Johnson, Aiman Alzetani, Emily Shaw, Eric Lim, Paulo De Sousa, Monica Tavares Barbosa, Alex Bowman, Simon Jordan, Alexandra Rice, Hilgardt Raubenheimer, Chiara Proli, Maria Elena Cufari, John Carlo Ronquillo, Angela Kwayie, Harshil Bhayani, Morag Hamilton, Yusura Bakar, Natalie Mensah, Lyn Ambrose, Anand Devaraj, Silviu Buderi, Jonathan Finch, Leire Azcarate, Hema Chavan, Sophie Green, Hillaria Mashinga, Andrew G. Nicholson, Kelvin Lau, Michael Sheaff, Peter Schmid, John Conibear, Veni Ezhil, Babikir Ismail, Melanie Irvin-sellers, Vineet Prakash, Peter Russell, Teresa Light, Tracey Horey, Sarah Danson, Jonathan Bury, John Edwards, Jennifer Hill, Sue Matthews, Yota Kitsanta, Kim Suvarna, Patricia Fisher, Allah Dino Keerio, Michael Shackcloth, John Gosney, Pieter Postmus, Sarah Feeney, Julius Asante-Siaw, Hugo J.W.L. Aerts, Stefan Dentro, Christophe Dessimoz, TRACERx Consortium, Swanton, C., Jamal-Hanjani, M., Veeriah, S., Shafi, S., Czyzewska-Khan, J., Johnson, D., Laycock, J., Bosshard-Carter, L., Rosenthal, R., Gorman, P., Hynds, R.E., Wilson, G., Birkbak, N.J., Watkins, TBK, McGranahan, N., Horswell, S., Mitter, R., Escudero, M., Stewart, A., Van Loo, P., Rowan, A., Xu, H., Turajlic, S., Hiley, C., Abbosh, C., Goldman, J., Stone, R.K., Denner, T., Matthews, N., Elgar, G., Ward, S., Costa, M., Begum, S., Phillimore, B., Chambers, T., Nye, E., Graca, S., Al Bakir, M., Joshi, K., Furness, A., Ben Aissa, A., Wong, YNS, Georgiou, A., Quezada, S., Hartley, J.A., Lowe, H.L., Herrero, J., Lawrence, D., Hayward, M., Panagiotopoulos, N., Kolvekar, S., Falzon, M., Borg, E., Marafioti, T., Simeon, C., Hector, G., Smith, A., Aranda, M., Novelli, M., Oukrif, D., Janes, S.M., Thakrar, R., Forster, M., Ahmad, T., Lee, S.M., Papadatos-Pastos, D., Carnell, D., Mendes, R., George, J., Navani, N., Ahmed, A., Taylor, M., Choudhary, J., Summers, Y., Califano, R., Taylor, P., Shah, R., Krysiak, P., Rammohan, K., Fontaine, E., Booton, R., Evison, M., Crosbie, P., Moss, S., Idries, F., Joseph, L., Bishop, P., Chaturved, A., Quinn, A.M., Doran, H., Leek, A., Harrison, P., Moore, K., Waddington, R., Novasio, J., Blackhall, F., Rogan, J., Smith, E., Dive, C., Tugwood, J., Brady, G., Rothwell, D.G., Chemi, F., Pierce, J., Gulati, S., Naidu, B., Langman, G., Trotter, S., Bellamy, M., Bancroft, H., Kerr, A., Kadiri, S., Webb, J., Middleton, G., Djearaman, M., Fennell, D., Shaw, J.A., Le Quesne, J., Moore, D., Nakas, A., Rathinam, S., Monteiro, W., Marshall, H., Nelson, L., Bennett, J., Riley, J., Primrose, L., Martinson, L., Anand, G., Khan, S., Amadi, A., Nicolson, M., Kerr, K., Palmer, S., Remmen, H., Miller, J., Buchan, K., Chetty, M., Gomersall, L., Lester, J., Edwards, A., Morgan, F., Adams, H., Davies, H., Kornaszewska, M., Attanoos, R., Lock, S., Verjee, A., MacKenzie, M., Wilcox, M., Bell, H., Hackshaw, A., Ngai, Y., Smith, S., Gower, N., Ottensmeier, C., Chee, S., Johnson, B., Alzetani, A., Shaw, E., Lim, E., De Sousa, P., Barbosa, M.T., Bowman, A., Jordan, S., Rice, A., Raubenheimer, H., Proli, C., Cufari, M.E., Ronquillo, J.C., Kwayie, A., Bhayani, H., Hamilton, M., Bakar, Y., Mensah, N., Ambrose, L., Devaraj, A., Buderi, S., Finch, J., Azcarate, L., Chavan, H., Green, S., Mashinga, H., Nicholson, A.G., Lau, K., Sheaff, M., Schmid, P., Conibear, J., Ezhil, V., Ismail, B., Irvin-Sellers, M., Prakash, V., Russell, P., Light, T., Horey, T., Danson, S., Bury, J., Edwards, J., Hill, J., Matthews, S., Kitsanta, Y., Suvarna, K., Fisher, P., Keerio, A.D., Shackcloth, M., Gosney, J., Postmus, P., Feeney, S., Asante-Siaw, J., Aerts, HJWL, Dentro, S., and Dessimoz, C.

Subjects
Male, immune-editing, 0301 basic medicine, DOWN-REGULATION, immune-escape, Lung Neoplasms, Loss of Heterozygosity, Cohort Studies, Loss of heterozygosity, HLA Antigens, Carcinoma, Non-Small-Cell Lung, Chromosome instability, MUTATIONAL PROCESSES, 11 Medical and Health Sciences, Aged, 80 and over, Antigen Presentation, cancer evolution, Manchester Cancer Research Centre, bioinformatics, Middle Aged, 3. Good health, Female, loss of heterozygosity, SENSITIVITY, Life Sciences & Biomedicine, Adult, Biochemistry & Molecular Biology, chromosomal instability, Antigen presentation, Locus (genetics), NEOANTIGENS, Human leukocyte antigen, Biology, Polymorphism, Single Nucleotide, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Immune system, copy number, medicine, Humans, Lung cancer, Aged, Science & Technology, ResearchInstitutes_Networks_Beacons/mcrc, CTLA-4 BLOCKADE, Cell Biology, 06 Biological Sciences, medicine.disease, PD-1 BLOCKADE, neoantigen, lung cancer, 030104 developmental biology, Carcinoma, Non-Small-Cell Lung/genetics, Carcinoma, Non-Small-Cell Lung/immunology, Carcinoma, Non-Small-Cell Lung/pathology, Carcinoma, Non-Small-Cell Lung/therapy, HLA Antigens/genetics, HLA Antigens/immunology, Lung Neoplasms/genetics, Lung Neoplasms/immunology, Lung Neoplasms/pathology, Lung Neoplasms/therapy, Mutation, Tumor Escape, heterogeneity, TRACERx Consortium, DISCOVERY, CELLS, Immunology, RESISTANCE, Developmental Biology
Abstract

Immune evasion is a hallmark of cancer. Losing the ability to present neoantigens through human leukocyte antigen (HLA) loss may facilitate immune evasion. However, the polymorphic nature of the locus has precluded accurate HLA copy-number analysis. Here, we present loss of heterozygosity in human leukocyte antigen (LOHHLA), a computational tool to determine HLA allele-specific copy number from sequencing data. Using LOHHLA, we find that HLA LOH occurs in 40% of non-small-cell lung cancers (NSCLCs) and is associated with a high subclonal neoantigen burden, APOBEC-mediated mutagenesis, upregulation of cytolytic activity, and PD-L1 positivity. The focal nature of HLA LOH alterations, their subclonal frequencies, enrichment in metastatic sites, and occurrence as parallel events suggests that HLA LOH is an immune escape mechanism that is subject to strong microenvironmental selection pressures later in tumor evolution. Characterizing HLA LOH with LOHHLA refines neoantigen prediction and may have implications for our understanding of resistance mechanisms and immunotherapeutic approaches targeting neoantigens. VIDEO ABSTRACT.

Published
2017

30. P-150RISK FACTORS FOR QUALITY OF LIFE FOLLOWING LUNG RESECTION SURGERY

Author

J. Webb, Pala B. Rajesh, Amy Kerr, Babu Naidu, Ehab Bishay, Maninder S Kalkat, Richard Steyn, and Nagarjun Konda

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Quality of life, business.industry, General surgery, medicine, Surgery, Lung resection, Cardiology and Cardiovascular Medicine, business
Published
2017

31. The role of lymphopenia in the development and severity of postoperative pulmonary complications after lung surgery

Author

Maninder S Kalkat, Pala B. Rajesh, Sebastian T Lugg, David R Thickett, Amy Kerr, Babu Naidu, Paula Agostini, Kerry Adams, Ehab Bishay, and Richard Steyn

Subjects
03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, 030220 oncology & carcinogenesis, medicine, Lung surgery, 030204 cardiovascular system & hematology, business, Surgery
Published
2017

32. Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery

Author

Sebastian T, Lugg, Theofano, Tikka, Paula J, Agostini, Amy, Kerr, Kerry, Adams, Maninder S, Kalkat, Richard S, Steyn, Pala B, Rajesh, Ehab, Bishay, David R, Thickett, and Babu, Naidu

Subjects
Male, Lung Neoplasms, Time Factors, Thoracic Surgery, Video-Assisted, Incidence, Smoking, Pneumonia, Atelectasis, United Kingdom, Thoracic surgery, Postoperative Complications, Risk Factors, Carcinoma, Non-Small-Cell Lung, Humans, Female, Smoking Cessation, Prospective Studies, Pneumonectomy, Aged, Follow-Up Studies, Research Article
Abstract

Background Smoking is a risk factor for postoperative pulmonary complications (PPC) following non-small cell lung cancer (NSCLC) surgery. The optimal timing for preoperative smoking cessation has not been identified. Our study aimed to observe the impact of preoperative smoking cessation on PPC incidence and other postoperative outcomes including long-term survival. Methods A prospective study included consecutive patients following resection for NSCLC in a regional thoracic centre over a 4-year period (2010–2014). Patients were stratified according to self-reported preoperative smoking status. The primary endpoint was PPC incidence, which was assessed from postoperative day one onwards using the Melbourne Group Scale. Secondary endpoints included short-term outcomes (hospital length of stay [LOS], intensive therapy unit [ITU] admission, 30-day hospital readmission rate) and long-term survival. Results Four hundred and sixty-two patients included 111 (24%) current smokers, 55 (12%) ex-smokers

Published
2016

34. Long-term impact of developing a postoperative pulmonary complication after lung surgery

Author

Sebastian T Lugg, Ehab Bishay, Amy Kerr, Theofano Tikka, Maninder S Kalkat, Richard Steyn, David R Thickett, Kerry Adams, Babu Naidu, Pala B. Rajesh, and Paula Agostini

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Atelectasis, Patient Readmission, 03 medical and health sciences, Pneumonectomy, 0302 clinical medicine, Postoperative Complications, Cause of Death, medicine, Humans, Prospective Studies, Lung cancer, Prospective cohort study, Survival rate, Aged, business.industry, Incidence, Pulmonary Complication, Pneumonia, medicine.disease, Prognosis, United Kingdom, Surgery, Survival Rate, 030228 respiratory system, Cardiothoracic surgery, 030220 oncology & carcinogenesis, Female, business, Follow-Up Studies
Abstract

Postoperative pulmonary complications (PPC) such as atelectasis and pneumonia are common following lung resection. PPCs have a significant clinical impact on postoperative morbidity and mortality. We studied the long-term effects of PPCs and sought to identify independent risk factors.A prospective observational study involved all patients following lung resection in a regional thoracic centre over 4 years. PPCs were assessed daily in hospital using the Melbourne group scale based on chest X-ray, white cell count, fever, purulent sputum, microbiology, oxygen saturations, physician diagnosis and intensive therapy unit (ITU)/high-dependency unit readmission. Follow-up included hospital length of stay (LOS), 30-day readmissions, and mortality.86 of 670 patients (13%) who had undergone a lung resection developed a PPC. Those patients had a significantly longer hospital LOS in days (13, 95% CI 10.5-14.9 vs 6.3, 95% CI 5.9 to 6.7; p0.001) and higher rates of ITU admissions (28% vs 1.9%; p0.001) and 30-day hospital readmissions (20.7% vs 11.9%; p0.05). Significant independent risk factors for development of PPCs were COPD and smoking (p0.05), not age. Excluding early postoperative deaths, developing a PPC resulted in a significantly reduced overall survival in months (40, 95% CI 34 to 44 vs 46, 95% CI 44 to 47; p=0.006). Those who developed a PPC had a higher rate of non-cancer-related deaths (11% vs 5%; p=0.020). PPC is a significant independent risk factor for late deaths in non-small cell lung cancer patients (HR 2.0, 95% CI 1.9 to 3.2; p=0.006).Developing a PPC after thoracic surgery is common and is associated with a poorer long-term outcome.

Published
2016

37. A randomised controlled trial to investigate the feasibly of a nutritional intervention of carbohydrate and post-operative nutritional drinks after elective major lung surgery

Author

Amy Kerr, N. Oswald, Maninder S Kalkat, H. Bancroft, Richard Steyn, Babu Naidu, Ehab Bishay, J. Webb, S. Kadiri, and J. Taylor

Subjects
Pulmonary and Respiratory Medicine, Cancer Research, medicine.medical_specialty, business.industry, law.invention, Oncology, Randomized controlled trial, law, Internal medicine, Intervention (counseling), Medicine, Lung surgery, Post operative, business
Published
2018

39. Smoking habits of pre-surgery patients

Author

David R Thickett, Amy Kerr, Babu Naidu, and J. Webb

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Smoking habit, medicine.medical_treatment, Population, law.invention, Pre-surgery, law, Family medicine, Health care, medicine, Physical therapy, Smoking cessation, Lung surgery, business, education, Electronic cigarette, Surgical patients
Abstract

OBJECTIVE: To assess the current smoking habits and attitudes towards smoking cessation among elective surgical patients with specific emphasis on the use of electronic cigarettes. METHODS: A questionnaire was given to 105 adult patients attending the pre-operative assessment unit at a regional Thoracic centre. RESULTS: 24 were current smokers of which 92% smoked cigarettes only, of these 19 patients had previously tried to quit, 5 had never tried. Multiple approaches had been used. 16 out of 24 were aware of the risks associated with smoking at the time of surgery and were also aware of available smoking cessation services. When asked if they had been specifically approached by a health care professional about stopping smoking only 9/24 said yes. Asked if they would consider stopping smoking immediately and using an electronic cigarette (supplied free) if this were an option - 13 said yes. Of those 19 patients who had previously quit 16 said they thought an electronic cigarette may have helped them. CONCLUSION: The majority of current smokers (80%) who undergo lung surgery have previously tried to quit and failed. Current methods of smoking cessation in this population are ineffective. Surprisingly the majority of patients (60%) report they were not approached to stop before surgery. Patients appear to be a willing to use electronic cigarette as a tobacco replacement prior to surgery.

Published
2015

40. Smoking at the time of curative-intent lung cancer surgery dramatically influences peri-operative complications

Author

Richard Steyn, Ehab Bishay, Amy Kerr, Kerry Adamas, Pala B. Rajesh, Maninder S Kalkat, Sebastian T Lugg, Theofano Tikka, David R Thickett, Babu Naidu, and Paula Agostini

Subjects
Thorax, medicine.medical_specialty, Lung cancer surgery, COPD, business.industry, medicine.medical_treatment, Perioperative, medicine.disease, Surgery, Internal medicine, Medicine, Smoking cessation, Observational study, Risk factor, business, Lung cancer
Abstract

Introduction: Smoking is a risk factor for postoperative pulmonary complications (PPCs) following curative-intent surgery for lung cancer (P.Agostini et al, Thorax 2010;65:815-8). Risk modification is via smoking cessation programmes; whether surgery should be delayed for this is a debated topic. Aims & Objectives: To study the impact of smoking on postoperative outcome including long-term survival. Methods: A prospective observational study was carried out on all patients following curative-intent lung cancer resection in a regional thoracic centre over 4 years. Preoperative smoking status was self-reported by all patients. Data included patient demographics, PPCs, hospital length of stay (LOS), intensive treatment unit (ITU) admission and mortality. Results: Of 460 patients, 24% were current smokers, 12% ex-smokers 6 weeks, and 11% never smokers. Independent risk factors associated with smoking status using multivariate analysis were FEV1% predicted, COPD and BMI (p Conclusions: Preoperatively, 1 in 4 patients continue to smoke. Current smokers have higher postoperative morbidity with no significant survival difference within our short follow-up period. Further research into effective short-term smoking abstinence programmes is needed.

Published
2015

41. Neutrophil/lymphocyte ratio as a prognostic marker for curative-intent surgery in non-small cell lung cancer

Author

Tikka Theofano, Amy Kerr, Babu Naidu, Paula Agostini, Sebastian T Lugg, David R Thickett, Richard Steyn, Maninder S Kalkat, Kerry Adamas, Pala B. Rajesh, and Ehab Bishay

Subjects
Curative intent, medicine.medical_specialty, Univariate analysis, business.industry, Lymphocyte, fungi, Cancer, medicine.disease, Surgery, medicine.anatomical_structure, Median follow-up, medicine, Non small cell, Stage (cooking), Lung cancer, business
Abstract

Introduction: Neutrophil/lymphocyte ratio (NLR) is a prognostic marker for curative-intent surgery for cancer. Few studies have investigated NLR in lung cancer (NSCLC) patients, and any association between NLR and postoperative pulmonary complications (PPC) and readmission has not been explored. Aims & Objectives: To study the prognostic role of NLR on postoperative outcome. Methods: A prospective observational study was carried out on all NSCLC patients following lung resection in the UK's largest thoracic surgical centre over 4 years. All patients had pre-operative bloods (including NLR), demographics and postoperative histological diagnosis with staging obtained. Follow up data included record of PPCs, hospital length of stay (LOS), 30-day hospital re-admission for complications and mortality. Results: Of 463 patients, the mean NLR was 3.5±2.2. Risk factors which were significantly associated with elevated NLR on univariate analysis included advancing age, BMI, stage and male sex (p 5 had a significantly increased frequency of 30-day hospital readmission for complications (25.8% vs. 12.9%; p 5 had a significantly higher mortality of all causes (41.7% vs. 16.8; p5 have a higher rate of hospital readmission with complications and a poorer survival.

Published
2015

42. P1.10-002 Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water

Author

Ehab Bishay, N. Oswald, Amy Kerr, Babu Naidu, Richard Steyn, J. Taylor, J. Webb, Pala B. Rajesh, H. Bancroft, S. Kadiri, and Maninder S Kalkat

Subjects
Pulmonary and Respiratory Medicine, Lung cancer surgery, medicine.medical_specialty, Oncology, Randomized controlled trial, business.industry, law, medicine, Intensive care medicine, business, law.invention
Published
2017

46. 106: Patient experiences and factors affecting adherence to pulmonary rehabilitation classes before and after lung surgery – the need for a tailored programme

Author

Amy Kerr, Richard Steyn, Ehab Bishay, S. Kadiri, Maninder S Kalkat, A. Robertson, Babu Naidu, and Pala B. Rajesh

Subjects
Pulmonary and Respiratory Medicine, Cancer Research, medicine.medical_specialty, Oncology, business.industry, medicine.medical_treatment, Physical therapy, Medicine, Pulmonary rehabilitation, Lung surgery, business, Intensive care medicine
Published
2017

47. Success and Challenges Among Community Technology Programs in Illnois

Author

Amy Kerr, Amy Kerr, Aparna Sharma, Tanya Kellam, Amy Kerr, Amy Kerr, Aparna Sharma, and Tanya Kellam

Abstract

In an effort to bridge the digital divide, 76 organizations throughout the state of Illinois received Illinois Community Technology Fund (ICTF) grants between the years of 2000 and 2001 to provide technology services to Illinois residents representing a broad spectrum of ages and populations. After the disbursement of the grants, CURL was invited to collaborate with ICTF to evaluate the effectiveness of the grants.

Published
2005

48. S65 Developing a multi-disciplinary thoracic surgery research team improves the recruitment into and quality of clinical trials

Author

Pala B. Rajesh, J. Taylor, E. Virgilio, Ehab Bishay, N. Oswald, M. Bellamy, Maninder S Kalkat, Amy Kerr, H. Bancroft, Richard Steyn, S. Kadiri, Babu Naidu, and J. Webb

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, education, Clinical trial, Clinical pathway, Clinical research, Nursing, Cardiothoracic surgery, Informed consent, Health care, Patient experience, medicine, Anxiety, medicine.symptom, business
Abstract

Objectives Recruitment into surgical trials historically has been fraught with difficulty. We examine whether developing a multi-disciplinary research team has aided recruitment, data collection, patient retention and so success of clinical trials. In addition we look at effects on the patient experience of the surgical pathway. Methods We evaluated the development and impact of a specialist thoracic trained research team of nurses and allied health care professionals in a regional thoracic unit from 2009–2015. We assessed the impact on the recruitment into National Institute for Health Research Clinical Research Network (NIHR CRN) thoracic surgery portfolio trials. Patient experience was captured through a survey (n = 30) and research team feedback through interviews (n = 5). During the development, clear leadership and support networks were created, new members were trained by specialist thoracic research nurses to obtain competences in both research and thoracic surgery to enable confident valid informed consent and the collection of robust quality data. Results Since the development of a specialised thoracic surgery research team in 2010 the number trials have steadily increased and along with number of team members whilst clinical activity remained constant. The number of patient consented into clinical trials increased 7 fold (Table 1). From staff interviews a recurring theme was that a clear team structure and a specialist training aided them to be better patient advocate not only in research but in the clinical pathway. Patients universally agreed that involvement of the research team helped reduce their anxiety about their surgery and so enhanced patients experience. Conclusion The impact of a dedicated research team goes well beyond research but improves clinical care. Having a clear support system and a specialist trained team has increased recruitment and retention into thoracic surgical trials and enhanced the patient’s experience of research and the surgical pathway.

Published
2016

49. 182 Patient satisfaction with quality of information in lung cancer surgery

Author

Babu Naidu, Amy Kerr, Maninder S Kalkat, Pala B. Rajesh, Richard Steyn, J. Hardman, Ehab Bishay, N. Oswald, M. Bellamy, and J. Webb

Subjects
Pulmonary and Respiratory Medicine, Oncology, Cancer Research, Lung cancer surgery, medicine.medical_specialty, Patient satisfaction, business.industry, Internal medicine, General surgery, medicine, Information quality, business
Published
2016

50. 172 A national survey of thoracic surgery units: pre-operative smoking cessation practice shows need for better provision of service

Author

N. Oswald, D. Thickett, J. Webb, N. Konda, Amy Kerr, R. Dancer, and Babu Naidu

Subjects
Pulmonary and Respiratory Medicine, Cancer Research, medicine.medical_specialty, business.industry, medicine.medical_treatment, Lumen (anatomy), Cryotherapy, Chest pain, Surgery, FEV1/FVC ratio, Oncology, Quality of life, Cardiothoracic surgery, medicine, Physical therapy, Smoking cessation, medicine.symptom, business, Survival rate
Abstract

68.8%, adenocarcinoma 14.7%, large cell 2.6%, small cell 8.8% and unclassified NSC 5.3%. The mean FEV1 increased from 1.39 to 1.51 litres (p

Published
2016

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