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Richard Sainsbury

Publications and source records attributed to Richard Sainsbury.

At least 19 recordsLinked to original sources
PubMed2006

Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost.

PURPOSE: Patients undergoing breast-conserving surgery were offered boost radiotherapy with targeted intraoperative radiotherapy (TARGIT) using the Intrabeam system to test the feasibility, safety, and efficacy of the new approach. METHODS AND MATERIALS: We treated 302 cancers in 301 unselected patients. This was not a low-risk group. One-third of patients (98/301) were younger than 51 years of age. More than half of the tumors (172, 57%) were between 1 cm and 2 cm, and one-fifth (62, 21%) were >2 cm; 29% (86) had a Grade 3 tumor and, in 29% (87), axillary lymph nodes contained metastasis. After primary surgery, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy (EBRT), but excluding the usual boost. RESULTS: The treatment was well tolerated. The follow-up ranged from 3 to 80 months (164 and 90 patients completed 2 and 3 years follow-up, respectively). Four patients (1.3%) had local recurrence. The Kaplan-Meier estimate of local recurrence is 2.6% (SE = 1.7) at 5 years. This compares favorably with the 4.3% recurrence rate in boosted patients from the EORTC boost study, in which only 8.1% patients were node-positive, as opposed to 29% in our series. CONCLUSION: Targeted intraoperative radiotherapy combined with EBRT results in a low local recurrence rate. This could be attributed to both accurate targeting and timeliness of the treatment. These data support the need for a randomized trial to test whether the TARGIT boost is superior to conventional external boost, especially in high-risk women.

Adult↗
PubMed2006

Breast cancer: multidisciplinary care and clinical outcomes.

A multidisciplinary approach to the management of breast cancer is the standard of care in developed health systems. We performed a systematic review to assess the extent and quality of evidence on whether multidisciplinary care (MDC), or related aspects of care contribute to clinical outcomes in breast cancer, and in particular whether these influence survival. Only two primary studies have looked at MDC and neither of these studies considered long-term outcomes. The studies of MDC (case series) provide weak evidence that MDC may alter treatment patterns. Several population-based cohort studies showed that related aspects of team work, specialist (surgeon) and hospital workload and specialisation, are associated with improved survival. This group of studies used better quality design with more clearly defined outcome measures, and most of the studies have allowed for possible confounding variables. Evidence of a survival benefit was most consistent for specialist (surgeon) effect. However, the reasons behind the improved survival reported in these studies are unclear, and it is unlikely that this is entirely attributable to treatment patterns. We conclude that although intrinsically multidisciplinary care should be associated with better survival, there remains a paucity of evidence to support this. Studies of the long-term clinical effects of MDC in breast cancer should be a priority for future evaluation.

Breast Neoplasms↗
PubMed2006

Using the COPE assessment tool with informal carers of people with dementia in New Zealand.

AIMS: To evaluate the validity of the COPE index (CI) carer assessment tool within a study exploring perceptions of carer support, health, and wellbeing. To assess the utility and acceptability of the CI with health practitioners and informal carers of people with dementia, following the European COPE protocol. METHODS: Research interviews (one pre- and two post-CI assessment) recorded demographic characteristics of carer (n = 45) and care recipient, formal (service) and informal support use and satisfaction, self-reported health, the General Health Questionnaire (GHQ-30), Burden Interview, Caregiver Competence, and Personal Gain. COPE Index assessment was undertaken by referring health practitioners (n = 12). RESULTS: Construct validity of the CI compared positively with findings reported in the literature. Psychological morbidity in carers (33%) was often undiagnosed; 19% of carers presented a more positive perception of their health to the health practitioner than to the researcher; diagnosis of care recipients was not always clear to carers (25%). COPE Index assessment improved both communication and understanding of carers' needs and was evaluated positively by most carers and health practitioners. CONCLUSIONS: The COPE Index is an easily administered and generally acceptable tool that may be useful for initiating more comprehensive assessment of dementia carers' needs.

Adaptation, Psychological↗
PubMed2006

High-sensitivity blood-based detection of breast cancer by multi photon detection diagnostic proteomics.

We have developed several new methods for blood-based cancer detection by diagnostic proteomics. Ultrasensitive methods of immunoassay using multiphoton-detection (IA/MPD) increase sensitivity by 200- to 1,000-fold (1 femtogram/mL). This has allowed the measurement of cancer biomarkers with very low concentrations in blood that could not be measured for full patient cohorts with conventional immunoassays. Sensitivity and specificity in cancer detection have been found to be potentiated by use of immunoassay panels which include tissue-specific cancer biomarkers as well as cytokines and angiogenic factors. The ultrasensitive immunoassays revealed that patient to patient variations in the concentrations of individual biomarkers in blood can extend over many orders of magnitude (up to six) and that the distributions of biomarker concentrations over patient cohorts are non-Gaussian. New methods of data analysis which correlate abundances of multiple, different biomarkers have been developed to deal with such data sets. Sensitivity and specificity of about 95% have been achieved for blood-based detection of breast cancer in pilot studies on 250 patients and 95 controls. Pilot studies indicate that this methodology may also allow differentiation of malignant breast cancer from benign lesions and can provide similar sensitivity and specificity for other epithelial cancers such as prostate cancer, ovarian cancer and melanoma. The methods developed for selection, application, and evaluation of very high sensitivity biomarker panels are expected to have general relevance for diagnostic proteomics.

Adult↗
PubMed2006

Looking for Thom's biomarkers with proteomics.

In recent years, large numbers of putative disease biomarkers have been identified. Combinations of protein biomarkers have been proposed to overcome the lack of single, magic-bullet identifiers of disease conditions. The number of biomarkers in a panel must be kept small to avoid the combinatorial explosion that requires very large, uneconomical sample cohorts for validation. Recent results on high sensitivity blood-based diagnostic proteomics (Godovac-Zimmermann, J et al., J. Proteome Res. 2006) suggest that the keys to identifying useful panels include judicious application of physiological knowledge to choose appropriate combinations of local, tissue/disease markers and global, systemic markers and to use very high sensitivity protein detection. Biomarkers that show non-Gaussian landscapes reminiscent of Rene Thom's multiple, stable-state landscapes seem to have the greatest predictive value for breast cancer (Godovac-Zimmermann, J. et al., J. Proteome Res. 2006).

Biomarkers↗
PubMed2005

Older patients in the nephrology clinic--should they be referred?

AIM: To review the outcomes of elderly patients referred to a nephrology clinic and to develop referral guidelines. METHODS: A retrospective audit of patients aged 65 years or older referred over a 24-month period to a nephrology clinic. Outcomes assessed were whether a renal diagnosis was made and if there was any change in management. RESULTS: Sixty-one patients were referred with an average age of 74 years (range 65-88 years). The commonest reason for referral was renal impairment (69%); mean estimated creatinine clearance 32 ml/min. Diagnoses included hypertensive renal disease (30%), chronic renal failure - cause unknown (18%) and diabetic nephropathy (8%). In the majority of cases, the diagnosis was clinical. Renal biopsy was performed on four patients and declined by a further two. Management usually consisted of advice regarding clinical monitoring and drug treatment (80%). The clinic visit resulted in a change of management in 50% of cases. CONCLUSIONS: Most elderly patients with renal disease have chronic pathology for which intensive investigation is not warranted. The majority of nephrology clinic referrals resulted in advice on clinical management being given to the general practitioner. Patients with severe or acute renal impairment are more likely to be investigated and offered treatment. Referral guidelines for general practitioners may aid appropriate referral.

Aged↗
PubMed2005

Shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

AIMS: To evaluate the effect of shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures. METHODS: All patients over the age of 65 years are under the shared care of an orthopaedic surgeon and geriatrician (the Ortho-Medicine Service) when they are admitted to the Orthopaedic Service, Christchurch Hospital, New Zealand. This retrospective case records audit includes all patients over the age of 65 years with hip fracture admitted to this service over a 6-month period from December 2002 to June 2003. RESULTS: There were 150 patients. The median age was 83 years (range 66-99 years). Median total length of stay was 23 days. Median time delay until theatre was 43.5 hours. Inpatient mortality was 0.7%. Of 97 patients admitted from home, 86(88.6%) returned home, 6 (6.2%) went to rest home care, and 5 (5.2 %) went to hospital level care. Of 43 patients admitted from rest home care, 40 (93%) returned to rest home care, and 3 (7.0 %) were discharged to hospital level care. Three patients admitted from rest home dementia care and six patients admitted from hospital level care were discharged back to their pre-morbid place of domicile. At discharge, 86.8% of patients were on Vitamin D supplementation and over 80% were on calcium. Only 10.6% were discharged on bisphosphonates. CONCLUSIONS: Shared care between geriatricians and orthopaedic surgeons for older people with hip fractures is associated with a low in-patient mortality, with the majority returning to their pre-morbid place of domicile. Length of stay has increased. Most patients are discharged on treatment for osteoporosis.

Aged↗
PubMed2004

Intraoperative radiotherapy for breast cancer.

Postoperative radiotherapy, which forms part of breast-conserving therapy, may not need to encompass the whole breast. Apart from the consumption of huge resources and patients' time, postoperative radiotherapy deters many women from receiving the benefits of breast-conserving surgery, forcing them to choose a mastectomy instead. If radiotherapy could be given in the operating theatre immediately after surgery, many of these disadvantages could be overcome. One striking fact about local recurrence after breast-conserving surgery is that most occurs in the area of breast immediately next to the primary tumour; this is despite the finding that two-thirds of mastectomy samples have microscopic tumours distributed throughout the breast, even when radiotherapy is omitted. Thus, only the area adjacent to the tumour may need treatment with radiotherapy. On the basis of this premise, clinical scientists have used new technology to administer radiotherapy to the area at greatest risk of local recurrence, with the aim of completing the whole local treatment in one sitting. In this review, we have elaborated on the rationale and different methods of delivery of intraoperative radiotherapy. If this approach is validated by the results of current randomised trials, it could save time, money, and breasts.

Breast Neoplasms↗
PubMed2003

The use of inhaled and related respiratory medications in Christchurch rest homes.

AIM: To describe the use of inhaled and related respiratory medications ('asthma medications') and associated management amongst Christchurch rest-home residents. METHODS: Fifty per cent of Christchurch rest homes were randomly selected. All residents on asthma medications, the rest-home managers, care-giving staff, and the residents' general practitioners were interviewed using specific questionnaires. RESULTS: All of the rest homes, residents using asthma medications and senior staff members participated. Seventy five per cent of caregivers and 73% of general practitioners took part. Asthma medications were used by 13% of 1416 rest-home residents. Eighty four per cent of these used a preventer medication, mostly inhaled steroids. Some daily doses exceeded current treatment guidelines. One third of residents using inhalers had an inadequate technique. Some staff and residents chose the wrong inhaler to manage 'shortness of breath'. Regular bronchodilator dosing, rather than 'as required', was common. Those using a spacer device usually had a good technique. Residents appreciated non-pharmacological strategies for breathlessness. Staff identified a need for clear written management plans. CONCLUSIONS: There were significant deficiencies in the staff and residents' knowledge of obstructive airways management and medications. Regular review of inhaler technique, greater use of spacers, and regular staff education may improve residents' respiratory management. Inhaled corticosteroids may be used in too high a dose. Inconsistent management of acutely deteriorating asthma/chronic obstructive pulmonary disease may be addressed by greater use of written management plans in residents' notes.

Administration, Inhalation↗
PubMed2003

Ovarian ablation as a treatment for breast cancer.

Ovarian ablation is an effective treatment for premenopausal women with hormone receptor positive breast cancer. It can be achieved permanently by surgery or radiotherapy and reversibly by LhRH agonists. This paper discusses the evidence that it is an effective adjuvant therapy and defines the place of oophorectomy in the management of such patients. The achievement of an amenhorreic state is important and chemotherapy may well exert some of its effects by causing ovarian suppression. The use of LhRH agonists in managing such patients is discussed.

Adult↗
PubMed2003

A needs-based study and examination skills course improves students' performance.

BACKGROUND: Adult learning theory suggests that learning is most effective when related to need, when driven by the learner and when it is flexible. We describe the effect of an educational intervention that was driven by student need, and largely designed by students. METHODS: We undertook a needs assessment of fifth year medical students' study needs. Based on this, we helped them design a course to meet these needs. This was predominantly related to study skills and a practice objective structured clinical examination (OSCE). We evaluated the course by asking for student opinion and by measuring the effect on student performance in a high stakes medical school examination (written examination and OSCE). FINDINGS: Despite the course being run voluntarily and in after-hours sessions, 80-90% of the medical student class attended each session. Student performance on the end of year examinations was significantly enhanced in the year of the intervention, compared with previous years and with students from other schools sitting identical examinations in the same year. INTERPRETATION: Learning activities that are directly based on student needs, that focus on study and examination techniques, and that are largely student-driven, result in effective and valuable outcomes.

Community Participation↗
PubMed2002

Tolerance of early diet textures as indicators of recovery from dysphagia after stroke.

We undertook this 12-month retrospective cohort study, of 186 teaching hospital inpatients, to determine how tolerance of differing diet textures after a stroke predicts recovery from dysphagia. Outcome measures were insertion of a percutaneous endoscopic gastrostomy (PEG) tube and/or ability to tolerate a normal diet 28 days after the stroke. Likelihood ratios for needing a PEG were highest for intolerance of pureed food. People who tolerated grade 1 fluids (300-600 cP) or thinner, or who tolerated a modified soft diet or better, 7 days after the stroke did not need a PEG. Half (13/26) the people who could not tolerate grade 3 thickened fluids (10,000-12,000 cP) and 52% (13/25) of people who could not tolerate a puree diet 14 days after the stroke needed a PEG. No one who was intolerant of grade 2 thickened fluids (4000-7000 cP) 7 or 14 days after the stroke could tolerate a normal diet and fluids by day 28. If people were tolerating grade 3 thickened fluids at day 7, the proportion tolerating a normal diet at day 28 was 36%. We present similar data for tolerance of differing fluids and diets at each of the measured time points. We suggest a PEG should be considered in people unable to tolerate grade 3 thickened fluids or a puree diet 14 days after their stroke. However, even in these groups, half will recover sufficiently to manage oral feeding.

Adult↗
PubMed2002

The earlier, the better: the effect of early community contact on the attitudes of medical students to older people.

BACKGROUND: Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. SUBJECTS: Second and fourth-year medical students. METHODS: We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. RESULTS: Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. CONCLUSION: Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.

Aged↗
PubMedDate not supplied

Ultra-sensitive immunoassays using multi-photon-detection in diagnostic proteomics of blood.

Multiphoton-detection methods that detect as little as 1000 atoms of (125)I-streptavidin increase the sensitivity of immunoassays by 200- to 1000-fold (1 femtogram/mL). Improved background suppression allows 20- to 100-fold improvements in sensitivity for conventional immunoassays (10-50 femtogram/mL). Quantitation of low abundance biomarkers in blood (PSA, TNFalpha, VEGF, IL-1beta, IL-6, and IL-8), for the first time for complete patient cohorts, indicates that very high analytical sensitivity and new statistical methods are crucial for serum-based diagnostic proteomics.

Adult↗