Aims To determine the efficacy and patient perception of various transfer procedures from paediatric to adult diabetes services.
Methods Comparison between four districts in the Oxford Region ...employing different transfer methods, by retrospective study of case records and interviews of patients recently transferred from paediatric diabetes clinics. The main outcome measures were age at transfer, clinic attendance rates, HbA1c measurements and questionnaire responses.
Results Two hundred and twenty‐nine subjects (57% males) > 18 years old in 1998 and diagnosed with Type 1 diabetes < 16 years of age between 1985 and 1995, identified from the regional diabetes register. The notes audit was completed for 222 (97%) and 164 (72%) were interviewed by a single research nurse. Mean age at transfer was 17.9 years (range 13.3–22.4 years). Few young people were lost to follow‐up at the point of transfer. There was a high rate of clinic attendance (at least 6 monthly) 2 years pretransfer (94%), but this declined to 57% 2 years post‐transfer (P < 0.0005). There was large interdistrict variation in clinic attendance 2 years post‐transfer (29% to 71%); higher rates were seen in districts where young people had the opportunity to meet the adult diabetes consultant prior to transfer. The importance of this opportunity was confirmed by questionnaire responses on interview.
Conclusions Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.
Diabet. Med 19, 649–654 (2002)
e12512
Background: Sentinel lymph node biopsy (SLNB) has traditionally been used to stage the axilla in early breast cancer (EBC) to guide adjuvant treatment recommendations. Following advances in ...genomic testing and tumor biology understanding, its role may be less critical especially in selected groups of women. The aim was to evaluate clinical utility of SLNB in adjuvant treatment recommendations for women ≥ 70 years with EBC in a tertiary unit in the United Kingdom. Methods: Retrospective cohort study of women ≥ 70 years with cT1-2N0 EBC undergoing primary surgery and SLNB between 01/2018-12/2022. Simple descriptive statistics and non-parametric tests were performed, including cost analysis of the SLNB procedure. Results: A total of 528 patients were included. The median age was 75 (IQR 72-79) years. Most cancers were invasive ductal (84.7%), grade 2 (66.9%), hormone receptor (HR) positive/HER2 negative (84.4%) with a median tumor size of 17 (IQR 4-50) mm. SLNB was positive in 64 (12.1%) patients. Of these 64 patients, 13 (20.3%) had completion ALND and 39 (60.9%) had adjuvant locoregional nodal radiotherapy (RT) including levels 1 & 2 of the axilla; adjuvant RT to levels 3 & 4 after ALND was given to 5/13. As per ACOSOG Z0011 criteria, 2/13 could have been spared ALND and 31/39 axillary RT. The multidisciplinary team (MDT) recommended adjuvant chemotherapy (AC) in 72 (13.6%) patients and 45 received it. Of those with a positive SLNB (n = 64), AC was recommended in 15, and received by 11. Recommendation for AC was significantly associated with age (p = 0.006), tumor grade (p < 0.0001), size (p = 0.001), receptor status (p < 0.0001) and positive SLNB status (p = 0.02) but not with comorbidities (p = 0.06). A subgroup analysis of 294 patients with cT1N0, HR+/HER2- EBC, representing a more favorable prognosis group, was performed. Here, 31/294 (10.5%) patients had positive SLNB, of whom 5 underwent ALND and 16 regional nodal RT, where 2/5 could have been spared ALND and 13/16 axillary RT as per ACOSOG Z0011 criteria. AC was recommended in 11/294 (3.7%) women and 9 received it. AC was not recommended in 20/31 (64.5%) cases, despite a positive SLNB. MDT recommendation for AC was associated with SLNB status (p = 0.02), grade 3 (p = 0.002) and multifocal disease (p = 0.02), while AC receipt was only associated with grade 3 (p = 0.017) and multifocal disease (p = 0.009) but not SLNB status (p = 0.058). Given an average cost of $6504.95 / £5359.38 per SLNB procedure in this unit, avoiding routine SLNB in the subgroup population may have potentially saved $1,912,493.95 / £1,575,657.72 in this 5 year period. Conclusions: Only a small proportion of women ≥ 70 years with EBC had positive SLNB that may influence adjuvant treatment recommendations, especially with favorable prognosis tumors. In such cases, where clinical morbidity and financial burden of SLNB may outweigh the benefits, a nuanced discussion for opting in SLNB rather than routine performance should be considered.
Clinical Update series. Domestic violence and emotional abuse of women, and in particular, coercive control. The recognition of coercive control in women presenting with unwanted pregnancies or ...sexually transmitted diseases is discussed, where partners have hindered safe contraceptive or sex practice. Communication with the patient, and taking sexual histories, are discussed as methods of encouraging women to disclose abuse. (BNI unique abstract) 22 references
Some women do not engage with contraception, which can lead to increased financial costs for health services, and to an emotional cost for the women themselves. Encouraging adherence is discussed in ...the context of the NICE guidelines (2009). Reasons for nonadherence, both intentional and unintentional, are considered. Long-acting reversible contraception, which does not require daily concordance, can be useful in tackling unintentional non-adherence. Reasons for intentional non-adherence are considered, including pre-existing fears and concerns. Prescribers need to be skilled communicators, and understand and take into account a woman's personal belief system around contraception.
Renal cell carcinoma (RCC) accounts for approximately 3% of all cancers and is refractory to cytotoxic chemotherapy - immunotherapy has until recently been the standard of care for advanced disease. ...Randomised trials reported in the last 5 years have demonstrated that a number of agents including the monoclonal antibody, bevacizumab, and the kinase inhibitors - sorafenib sunitinib, temsirolimus and everolimus - are active in advanced RCC. Bevacizumab is directed against the vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, whilst sorafenib and sunitinib inhibit a number of targets including the VEGF and platelet-derived growth factor (PDGFR) receptor tyrosine kinases. Temsirolimus and everolimus inhibit the intracellular mammalian target of rapamycin (mTOR) kinase. Sunitinib and temsirolimus have demonstrated efficacy in comparison with immunotherapy in the first-line setting in patients with favourable and poor prognosis advanced disease respectively. In the second-line setting, everolimus has shown benefit over placebo in patients who progress following treatment with a VEGF receptor tyrosine kinase inhibitor and sorafenib has demonstrated efficacy in comparison with placebo in patients with immunotherapy-refractory disease. We review here recent clinical trial data and discuss future developments in the systemic treatment of RCC including combination and sequential therapy, adjuvant therapy, the role of biomarkers and the prospects for the development of rational mechanism-directed therapy in this disease.
Under the conditions of the Rotation Experiment with Fertilizers, the following results were obtained with corn:
The phosphorous plat, complete fertilizer plat and the manure plats produced a much ...higher yield of corn than the check plat. Also, these plats produced a higher percentage of marketable grain than the other plats.
There was not much difference in the shelling percentage from the various plats but it was somewhat lower on the nitrogen and the floats plats.
The nitrogen-phosphorous plat produced the greatest number pounds of shelled corn per pound of stover. The complete fertilizer plat also produced a high percentage of grain to stover.
The percentage of matured ears was greatly increased on the nitrogen-phosphorous plat and the three manure plats.
The corn plants on the manure plat developed sooner than those on the other plats while those of the check plat developed later. Also, the plants were larger in circumference and in height on the manured plat.
The means of the corn characters were greater on the fertilized plats than on the check plat, and the means increased as the productivity increased.
On the whole, the constants of variation were greater on the fertilized plats than on the check plat. The differences were sufficiently great to indicate that they were significant. On the whole, the coefficients of correlation of the corn characters were greater on the fertilized plats than on the check plat but the odds do not show that they are significant. Opposite results were obtained with wheat which is shown in Table 9. Also, in the case of wheat, the odds on the whole are not significant .
In summing up all of the data in this experiment, it may be said that manure and acid phosphate were the chief limiting factors affecting yield. High yield of corn is usually accompanied by a high percentage of marketable grain, high shelling percentage, high ratio of grain to stover, high percentage of matured ears, and early maturity of plants.
Master of Science
Renal cell carcinoma (RCC) accounts for approximately 3% of all cancers and is refractory to cytotoxic chemotherapy - immunotherapy has until recently been the standard of care for advanced disease. ...Randomised trials reported in the last 5 years have demonstrated that a number of agents including the monoclonal antibody, bevacizumab, and the kinase inhibitors - sorafenib sunitinib, temsirolimus and everolimus - are active in advanced RCC. Bevacizumab is directed against the vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, whilst sorafenib and sunitinib inhibit a number of targets including the VEGF and platelet-derived growth factor (PDGFR) receptor tyrosine kinases. Temsirolimus and everolimus inhibit the intracellular mammalian target of rapamycin (mTOR) kinase. Sunitinib and temsirolimus have demonstrated efficacy in comparison with immunotherapy in the first-line setting in patients with favourable and poor prognosis advanced disease respectively. In the second-line setting, everolimus has shown benefit over placebo in patients who progress following treatment with a VEGF receptor tyrosine kinase inhibitor and sorafenib has demonstrated efficacy in comparison with placebo in patients with immunotherapy-refractory disease. We review here recent clinical trial data and discuss future developments in the systemic treatment of RCC including combination and sequential therapy, adjuvant therapy, the role of biomarkers and the prospects for the development of rational mechanism-directed therapy in this disease.
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