Joseph Descallar

Upregulated Polo-Like Kinase 1 Expression Correlates with Inferior Survival Outcomes in Rectal Cancer.

Background Human polo-like kinase 1 (PLK1) expression has been associated with inferior outcomes in colorectal cancer. Our aims were to analyse PLK1 in rectal cancer, and its association with clinicopathological variables, overall survival as well as tumour regression to neoadjuvant treatment. Methods PLK1 expression was quantified with immunohistochemistry in the centre and periphery (invasive front) of rectal cancers, as well as in the involved regional lymph nodes from 286 patients. Scores were based on staining intensity and percentage of positive cells, multiplied to give weighted scores from 1–12, dichotomised into low (0–5) or high (6–12). Results PLK1 scores in the tumour periphery were significantly different to adjacent normal mucosa. Survival analysis revealed that low PLK1 score in the tumour periphery had a hazard ratio of death of 0.59 in multivariate analysis. Other predictors of survival included age, tumour depth, metastatic status, vascular and perineural invasion and adjuvant chemotherapy. There was no statistically significant correlation between PLK1 score and histological tumour regression in the neoadjuvant cohort. Conclusion Low PLK1 score was an independent predictor of superior overall survival, adjusting for multiple clinicopathological variables including treatment.

Left Atrial Volume and Adverse Cardiovascular Outcomes in Unselected Patients with and without CKD

BACKGROUND AND OBJECTIVES Patients with CKD have increased cardiovascular morbidity and mortality. This study investigated the prognostic value of common clinical echocardiographic parameters. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS There were 289 unselected consecutive patients who had a transthoracic echocardiogram between January and June 2003. Patients with stage 3 or 4 CKD (n=49) were compared with those with eGFR≥60 ml/min per 1.73 m(2), n=240). Left ventricular volume, ejection fraction and mass, left atrial volume, and function parameters were measured. The primary endpoint, determined a priori, was a composite of cardiac death, myocardial infarction, and congestive cardiac failure. RESULTS Patients were followed for a median 5.6 years. The incidence of the primary endpoint was higher in patients with CKD (29% versus 12%, P=0.001), who were older and had a higher prevalence of hypertension and ischemic heart disease. Indexed left ventricular mass (LVMI) and left atrial volume (LAVI) were higher in patients with CKD. Furthermore, patients with LAVI>32 ml/m(2) had significantly lower event-free survival than patients with normal (<28 ml/m(2)) or mildly dilated LAVI (28-32 ml/m(2)) (P<0.001). Multivariate analysis showed that age (odds ratio [OR], 1.19; 95% confidence interval [95% CI], 1.08 to 1.31; P=0.001) and LVMI (OR, 3.66; 95% CI, 2.47 to 5.41; P<0.001) were independently associated with LAVI>32 ml/m(2). Multivariate Cox regression analysis demonstrated that CKD (hazard ratio [HR], 1.13; 95% CI, 1.01 to 1.26; P=0.04), hypertension (HR, 2.18; 95% CI, 1.05 to 4.54; P=0.04), and a larger LAVI (HR, 1.35; 95% CI, 1.02 to 1.77; P=0.04) were independent predictors of the primary endpoint. CONCLUSIONS Patients with CKD were at higher risk for cardiovascular events. LAVI was significantly larger in the CKD group and was a predictor of adverse cardiac events.

Health professionals’ opinions on supporting a cancer biobank: identification of barriers to combat biobanking pitfalls

Although rarely acknowledged, a successful biobank is highly dependent on the support of the health professionals who assist the biobank in all aspects of its activities. In many cases, the lack of health professional support can be a limiting factor in the biobanking process of collecting and processing high-quality biospecimens. The aim of this study was to determine the attitudes of health professionals towards cancer biobanking. Using a 5-point Likert scale questionnaire, important aspects of biobanking, including accrual, quality, knowledge, responsiveness, impact, access, trust, governance and accreditation, were investigated. In total, 95 of 124 health and medical practitioners who were approached participated in this study (77% response rate). Health professionals in general supported the aims of biobanking with 56% of participants showing willingness to create a biobank and recruit donors (accrual), 85% understanding the importance in the storage and distribution of biospecimens (quality), 88% having an appreciation for the role of a biobank in furthering cancer research (knowledge), 70% showing awareness of the use of biospecimens in future research initiatives (responsiveness) and 73% demonstrating support for a biobank with proper control, authority and credibility measures in place (governance and accreditation). Overall, provided that proper information about the activities of the biobank and researcher access was transparent, health professionals were very willing to support cancer biobanking. These findings may assist in developing strategies for the establishment and maintenance of biobanks and aid the implementation of more effective policies and procedures to embed biobanking into routine hospital practices.

Mail Versus Telephone Administration of the Oxford Knee and Hip Scores

Telephone and postal methods of administration of the Oxford Knee Score (OKS) and the Oxford Hip Score (OHS) were compared on 85 and 61 patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA), respectively. The test for equivalence was significant for both the knee (P<0.001) and hip participants (P<0.001) indicating that the modes of administration yielded similar results. The ICCs of the OKS and OHS were 0.79 (95% Confidence Interval (CI) 0.70, 0.86) and 0.87 (0.79, 0.92) respectively. The 95% limits of agreement were wide for both scores (OKS LOA, -8.6, 8.2; OHS LOA, -7.7, 5.3). The two modes of administration of the OKS and OHS produce equivalent survey responses at a group level but the same method of administration should be constant for individual monitoring in a clinical setting.

Emergence of Klebsiella pneumoniae liver abscesses in South-western Sydney.

Klebsiella pneumoniae liver abscess (KPLA) with metastatic infection has been recognised as an emerging infectious disease since being described originally from Taiwan (where it accounts for up to 78.5 % of all liver abscesses), subsequently from other Asian countries and, more recently, from non-Asian countries [1, 2]. The risk of metastatic infection with KPLA has been linked to APACHE II scores C20 and septic shock [1]. In non-Asian countries, KPLA syndrome cases have arisen predominantly in patients of Asian ethnicity [3, 4]. South-western Sydney is ethnically diverse, with 28 % of the total population and 12 % of regional hospital admissions being of Asian ethnicity (Australian Bureau of Statistics census data 2011; Clinical Information Department Statistics). We retrospectively reviewed patient files for this KPLA syndrome to determine their age, gender, ethnicity, travel history as recorded in formal infectious disease consultation, contact history, presenting features, APACHE II scores, diabetic status, baseline investigations, management and outcomes by the time of discharge. Data were analysed using SAS version 5.1 for Windows (Cary, NC, USA) and study approval was granted by the South Western Sydney Local Health District (SWSLHD) ethics committee (QA2010/015). From 01/01/2001 to 31/12/2010, 180 patients were identified with liver abscess using ICD-10 (International Classification of Diseases) admission codes from SWSLHD hospitals. After excluding cases without radiologically proven liver abscess, 21 cases of KPLA (12 % of all liver abscesses) were identified by cross-referencing microbiology computer records of Klebsiella pneumoniae (KP) isolates in blood cultures or liver aspirates over the same period. This represents the largest study to date of KPLA in Australia. In two Sydney-based, 10-year reviews of liver abscess in general, one study had only 11 KPLA patients, whereas the other study documented 13 KP microbiological isolates without specifying the number of patients with KPLA [5, 6]. Of our 21 cases, 5 patients (24 %) developed metastatic infection (see Table 1), which is comparable to rates of 20–28 % in other KPLA case series from non-Asian countries [2, 4, 7]. There was a single death in the non-metastatic KPLA group, giving a 5 % mortality rate, which is at the lower end of the reported range varying from 4 to 10 % [2, 7]. Of this case series, 71 % (15 patients) were of Asian ethnicity, which is higher than the baseline of 28 %, supporting an association with KPLA, as has been found with other studies from non-Asian countries [3, 4, 7]. This association could be due to genetic susceptibility or KP being more frequent in the local microbiota. Using a significance threshold of P B 0.05, diabetes mellitus, high APACHE II score and septic shock were not significantly associated with metastatic disease, possibly because of the small patient numbers. However, large abscess size, intra-abscess gas formation and history of Asian travel were significantly associated with metastatic infection. Speculatively, the former two factors correlate with high organism burden and, Part of this study was presented in a poster format at the 22nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), London, UK, March/April 2012.

An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey?

BackgroundTo determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms.MethodsPeople awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items.ResultsSeventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results.ConclusionsEquivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.

Hypofractionated versus conventionally fractionated radiotherapy for ductal carcinoma in situ (DCIS) of the breast

Hypofractionated radiotherapy (RT) in the setting of early invasive breast cancer has been shown to have similar local control rates and cosmetic outcomes as conventionally fractionated RT. This study compares ipsilateral recurrence rates between hypofractionated and conventional RT, with and without a boost. The effect of hypofractionated RT and chest wall separation (CWS) on cosmetic outcome was also assessed.

Screen time of infants in Sydney, Australia: a birth cohort study

Objectives To determine the amount of daily screen time in children 18 months of age and ascertain correlations that may be contributing to excessive screen use. Design A birth cohort was followed with telephone interviews at 6, 12 and 18 months of age. Information about screen time was collected at 18 months. Setting Parents were recruited from postnatal wards of 2 major public hospitals and at home visits conducted for new mothers within 4 weeks of birth in South Western Sydney (SWS). Participants Parents of 500 children with infants 18 months of age residing in SWS. Primary and secondary outcomes Screen time in infants 18 months of age and associated correlations. Results A large percentage of children 18 months of age (40%) had screen times >2 hours daily. There were significant associations between more than 2 hours of screen time daily and mothers without a partner (OR 4.32 (95% CI 1.67 to 11.15)); having <3 siblings (no siblings: OR 2.44 (95% CI 1.20 to 4.94); 1–2 siblings: OR 2.08 (95% CI 1.06 to 4.08)); an employed father (OR 1.96 (95% CI 1.09 to 3.52)); no outdoor equipment at home (OR 1.89 (95% CI 1.08 to 3.34)) and fewer than 5 outings per week (OR 2.08 (95% CI 1.37 to 3.17)). Conclusions There is emerging evidence that excess screen time in children causes adverse cognitive, developmental and health outcomes. This study has shown that a large proportion of very young children residing in SWS have screen exposures for >2 hours per day. Factors contributing to excess screen time have also been identified in this study; however, a greater understanding of risk factors needs to be ascertained in order to facilitate greater public health efforts to reduce screen exposure.

A decade of community‐based outcomes of patients treated with curative radiotherapy with or without chemotherapy for non‐small cell lung cancer

Clinical trials have reported good outcomes for non‐small cell lung cancer (NSCLC) patients treated with curative radiotherapy. These populations are highly selected and may not be representative of lung cancer population. We aim to evaluate the outcomes of NSCLC patients treated with radiotherapy ± chemotherapy in Australian community setting and to assess the effect of comorbidity on outcomes.

Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment?

Clinical guidelines provide evidence‐based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline‐recommended treatment and determine reasons for not receiving guideline‐recommended treatment.