Publications by authors named "Ian Thomas"
Introduction: Atrial fibrillation (AF) in end-stage kidney disease (ESKD) and kidney transplant (KTx) recipients presents challenges in stroke risk management. This study aimed to compare hospitalization rates for ischemic and hemorrhagic cerebrovascular events in ESKD and KTx patients with and without AF.
Methods: Using the National Inpatient Sample (2005-2019), retrospective analysis was conducted on hospitalizations for ESKD and KTx patients with and without AF.
Purpose: To evaluate the survival benefit of chemotherapy intensification in older patients with AML who have not achieved a measurable residual disease (MRD)-negative remission.
Methods: Five hundred twenty-three patients with AML (median age, 67 years; range, 51-79) without a flow cytometric MRD-negative remission response after a first course of daunorubicin and AraC (DA; including 165 not in remission) were randomly assigned between up to two further courses of DA or intensified chemotherapy-either fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin (FLAG-Ida) or DA with cladribine (DAC).
Results: Overall survival (OS) was not improved in the intensification arms (DAC DA: hazard ratio [HR], 0.
The diagnosis of death by neurological criteria (DNC) requires the exclusion of any clinical effect attributable to xenobiotics. We undertook a retrospective analysis of enquiries to the National Poisons Information Service (NPIS) relating to DNC over a 10-year period. Enquiries were categorised as toxicological, where exposure to a non-therapeutically administered xenobiotic was implicated in the clinical presentation and non-toxicological where exposure to the xenobiotic was not the primary cause of the clinical state.
View Article and Find Full Text PDFArticle Synopsis
- Treatment outcomes for acute promyelocytic leukemia (APL) have significantly improved through targeted therapies like ATRA and arsenic trioxide, as confirmed by a study analyzing 1,438 newly diagnosed patients from 1999 to 2022.
- Among those treated, patients receiving the ATRA-ATO regimen demonstrated a higher 7-year overall survival rate (91%) compared to those on AIDA-like chemotherapy (81%), along with better event-free survival and lower relapse rates.
- The study highlights the ongoing issue of early death, particularly in older patients and those with high Sanz risk scores, suggesting a need for further examination and targeted interventions in these vulnerable groups.
Article Synopsis
- The European Union includes 30 outermost and overseas countries and territories (OCTs), where renal transplantation is growing, but many patients still seek treatment in continental Europe, necessitating collaborative care.
- Each OCT has its own infectious disease patterns, which are crucial for ensuring effective post-transplant care for kidney transplant recipients (KTRs).
- The paper suggests a practical approach to enhance pre-transplant evaluations and provides region-specific epidemiological data, advocating for more collaborative research among the OCTs to improve care for infected KTRs.
Article Synopsis
- - The study focuses on older patients (over 60 years) with acute myeloid leukemia (AML) and aims to create a prognostic model to identify those who would benefit from intensive chemotherapy and stem cell transplantation.
- - Researchers analyzed data from 1,910 patients, using a random survival forest to evaluate clinical and genetic factors associated with overall survival, resulting in the identification of four distinct survival groups based on nine variables.
- - The newly developed AML60+ classification shows improved prognostic accuracy and indicates that intermediate- and very poor-risk patients may benefit from allogeneic hematopoietic cell transplantation, potentially guiding treatment decisions for older adults with AML.
Article Synopsis
- Accurate data extraction is crucial for valid evidence synthesis, and recent interest in large language models (LLMs) like Claude 2 and GPT-4 has raised questions about their effectiveness for this purpose.
- In a comparison of these two LLMs on extracting data from PDFs of systematic review articles, Claude 2 achieved high accuracy (96.3%), while GPT-4 had a lower accuracy (68.8%) mainly due to the challenges of using a third-party PDF parsing plugin.
- Although both models performed well in identifying missing data and generating correct information, the study emphasizes the need for human verification of LLM extractions and highlights limitations such as the study’s narrow focus and potential biases in the training data.
Article Synopsis
- There are limited treatment options for people with HIV-1 who have already tried many medicines and have drug-resistant HIV-1.
- Since 2018, three new medications have been approved to help these patients: ibalizumab, fostemsavir, and lenacapavir.
- Experts created guidelines to help doctors use these new medicines better and suggested more areas to study for future research.
Treatment options are currently limited for persons with HIV-1 (PWH) who are heavily treatment-experienced and/or have multidrug-resistant HIV-1. Three agents have been approved by the U.S.
View Article and Find Full Text PDFArticle Synopsis
- NPM1-mutated acute myeloid leukemia (AML) has a generally good prognosis, but many patients still relapse, and traditional risk factors only include FLT3-ITD mutations and adverse karyotypes due to inconsistent findings from other factors.* -
- A study involving 1,357 patients revealed that specific mutations (FLT3-ITD, DNMT3A, WT1, and certain NPM1 mutations) correlate with poorer overall survival and are linked to measurable residual disease (MRD) status.* -
- Intensified chemotherapy using the FLAG-Ida regimen showed better outcomes across all patient subgroups, with particularly notable improvements for those in high-risk molecular categories.*
Data extraction is a crucial, yet labor-intensive and error-prone part of evidence synthesis. To date, efforts to harness machine learning for enhancing efficiency of the data extraction process have fallen short of achieving sufficient accuracy and usability. With the release of large language models (LLMs), new possibilities have emerged to increase efficiency and accuracy of data extraction for evidence synthesis.
View Article and Find Full Text PDFIndividuals with end-stage kidney disease (ESKD) face higher cerebrovascular risk. Yet, the impact of peripheral vascular disease (PVD) and kidney transplantation (KTx) on hospitalization rates for cerebral infarction and hemorrhage remains underexplored. Analyzing 2,713,194 ESKD hospitalizations (2005-2019) using the National Inpatient Sample, we investigated hospitalization rates for ischemic and hemorrhagic cerebrovascular diseases concerning ESKD, PVD, KTx, or their combinations.
View Article and Find Full Text PDFSelection of patients with NPM1-mutated acute myeloid leukemia (AML) for allogeneic transplant in first complete remission (CR1-allo) remains controversial because of a lack of robust data. Consequently, some centers consider baseline FLT3-internal tandem duplication (ITD) an indication for transplant, and others rely on measurable residual disease (MRD) status. Using prospective data from the United Kingdom National Cancer Research Institute AML17 and AML19 studies, we examined the impact of CR1-allo according to peripheral blood NPM1 MRD status measured by quantitative reverse transcription polymerase chain reaction after 2 courses of induction chemotherapy.
View Article and Find Full Text PDFImproving outcomes for older patients with acute myeloid leukaemia remains an unmet need. As part of the LI-1 trial, we evaluated lenalidomide (LEN) in combination with low-dose cytosine arabinoside (LDAC) in patients aged >60 years unfit for intensive therapy and compared this to LDAC alone. Two hundred and two patients, randomised 1:1, were evaluable.
View Article and Find Full Text PDFIntroduction: Medical patients, admitted acutely to hospital, are at risk of venous thromboembolism (VTE). Clinical guidelines advise thromboprophylaxis prophylaxis for those at high risk of VTE. VTE is a common sequela of cancer, but guidelines take little consideration of cancer as an independent risk factor and their utility in palliative care patients is unclear.
View Article and Find Full Text PDFArticle Synopsis
- Gemtuzumab ozogamicin (GO) improves outcomes for older patients with acute myeloid leukemia (AML) when added to chemotherapy, but the effectiveness of a fractionated schedule compared to a single dose is uncertain.
- In a study of 852 older adults with AML, those receiving GO on days 1 and 4 showed a higher rate of complete remission with measurable residual disease (MRD) below 0.1% compared to those receiving a single dose, though overall complete remission rates were similar.
- The five-year overall survival rates were slightly better for patients receiving the fractionated schedule, especially among those who underwent allogeneic transplantation, indicating that multiple doses might enhance benefits in certain genetic profiles.
Background: People experiencing homelessness have elevated morbidity, increasing their risk of COVID-19 related complications and mortality. Achieving high vaccination coverage in a timely manner among homeless populations was therefore important during the mass vaccination programme in Wales to limit adverse outcomes. However, no systematic monitoring of vaccinations among people experiencing homelessness in Wales has been undertaken.
View Article and Find Full Text PDFObjectives: The objectives of this scoping review are to (1) describe the available literature regarding the utility of the debate-style journal club for health professional learners on literature evaluation skills and (2) report the themes found within debate-style journal club research and assessments in the context of professional education.
Findings: A total of 27 articles written in the English language were included in this scoping review. Published evaluations of debate-style journal clubs have been predominantly based in the pharmacy profession (48%, n = 13), but are reported in other health professions, such as medicine (22%, n = 6), dentistry (15%, n = 4), nursing (7%, n = 2), occupational therapy (4%, n = 1), and physical therapy (4%, n = 1), as well.
Background: Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority.
View Article and Find Full Text PDFThis is the protocol for a Campbell review. The objectives are as follows: To carry out a mixed methods review to summarise current evidence relating to the components of case-management interventions for people experiencing homelessness.
View Article and Find Full Text PDFBackground: It is unclear if the presence of compartmental brain herniation on neuroimaging should be a prerequisite to the clinical confirmation of death using neurological criteria. The World Brain Death Project has posed this as a research question.
Methods: The final computed tomography of the head scans before death of 164 consecutive patients confirmed dead using neurological criteria and 41 patients with devastating brain injury who died following withdrawal of life sustaining treatment were assessed by a neuroradiologist to compare the incidence of herniation and other features of cerebral swelling.
Background: Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.
Aims And Objectives: This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities.
Methods: Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021.