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  1. Article ; Online: Theories behind Bacillus Calmette-Guérin failure in high-risk non-muscle-invasive bladder cancer and update on current management.

    Maroof, Hanna / Paramore, Louise / Ali, Ahmed

    Cancer pathogenesis and therapy

    2023  Volume 2, Issue 2, Page(s) 74–80

    Abstract: Bladder cancer encapsulates a wide spectrum of disease severities, with non-muscle invasive bladder cancer (NMIBC) representing an entirely different entity from muscle-invasive disease. Bacillus Calmette-Guérin (BCG) is one of the most successful ... ...

    Abstract Bladder cancer encapsulates a wide spectrum of disease severities, with non-muscle invasive bladder cancer (NMIBC) representing an entirely different entity from muscle-invasive disease. Bacillus Calmette-Guérin (BCG) is one of the most successful intravesical treatment methods for patients diagnosed. However, a considerable proportion of patients fail to respond to BCG treatment. Given the propensity for recurrence in patients with high-risk bladder cancer, these patients present with surgical dilemmas. There is currently no gold standard for salvage treatment post-BCG failure or unified definition as to what that means. In this review, we discuss the mechanisms of action and pathophysiology of BCG, potential theories behind BCG failure, and the scope of novel treatments for this surgical conundrum.
    Language English
    Publishing date 2023-11-29
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 2949-7132
    ISSN (online) 2949-7132
    DOI 10.1016/j.cpt.2023.11.004
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  2. Article: Cost-Effectiveness Analysis of the Oncotype DX Breast Recurrence Score

    Berdunov, Vladislav / Millen, Steve / Paramore, Andrew / Griffin, Jane / Reynia, Sarah / Fryer, Nina / Brown, Rebecca / Longworth, Louise

    ClinicoEconomics and outcomes research : CEOR

    2022  Volume 14, Page(s) 619–633

    Abstract: Background: The 21-gene assay (the Oncotype DX Breast Recurrence Score: Methods: The proportion of patients assigned to chemotherapy conditional on their RS result was obtained from retrospective data from the Clalit registry. The probability of ... ...

    Abstract Background: The 21-gene assay (the Oncotype DX Breast Recurrence Score
    Methods: The proportion of patients assigned to chemotherapy conditional on their RS result was obtained from retrospective data from the Clalit registry. The probability of distant recurrence with endocrine and chemo-endocrine therapy conditional on RS result was obtained from TAILORx and NSABP B-20 trials. The cost-effectiveness of the 21-gene assay compared to using clinical risk tools alone was estimated in terms of cost per quality-adjusted life-year (QALY) over a lifetime horizon.
    Results: The 21-gene assay was more effective (0.17 more quality-adjusted life years) at a lower cost (-£519) over a lifetime compared to clinical risk alone. The model results were sensitive to assumptions around the magnitude of benefit of chemotherapy in the high RS result subgroup. Other assumptions underpinning the model, such as the proportion of patients assigned to chemotherapy in the low and mid-range RS result subgroups and long-term distant recurrence probabilities, had a smaller impact on the results.
    Conclusion: The analysis showed that the cost-effectiveness of the 21-gene assay is sensitive to assumptions for chemotherapy sparing for patients with RS 0-25 whose outcomes with endocrine therapy are no worse compared to chemotherapy-assigned patients, and a chemotherapy benefit in the RS 26-100 group. Future studies need to incorporate a wider set of tumour profiling tests other than the 21-gene assay to allow a direct comparison of their cost-effectiveness.
    Language English
    Publishing date 2022-09-19
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2520698-9
    ISSN 1178-6981
    ISSN 1178-6981
    DOI 10.2147/CEOR.S360049
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  3. Article ; Online: Cost-effectiveness analysis of the Oncotype DX Breast Recurrence Score test in node-positive early breast cancer.

    Berdunov, Vladislav / Millen, Steve / Paramore, Andrew / Hall, Peter / Perren, Timothy / Brown, Rebecca / Griffin, Jane / Reynia, Sarah / Fryer, Nina / Longworth, Louise

    Journal of medical economics

    2022  Volume 25, Issue 1, Page(s) 591–604

    Abstract: Aims: Given the high rate of adverse events and high cost of adjuvant chemotherapy, it is optimal to avoid its use when endocrine therapy is equally effective at preventing distant recurrence of early breast cancer. The Oncotype DX test is a predictive ... ...

    Abstract Aims: Given the high rate of adverse events and high cost of adjuvant chemotherapy, it is optimal to avoid its use when endocrine therapy is equally effective at preventing distant recurrence of early breast cancer. The Oncotype DX test is a predictive and prognostic multigene assay used to guide adjuvant chemotherapy decisions in early breast cancer based on a Recurrence Score (RS) result. A model-based cost-effectiveness analysis compared the Oncotype DX test to clinical risk tools alone for HR+/HER2- node-positive (1-3 axillary lymph nodes) early breast cancer patients based on results from the RxPONDER trial.
    Materials and methods: A decision-tree and Markov model was developed in Microsoft Excel. Distributions of patients and distant recurrence probabilities with endocrine and chemo-endocrine therapy were derived from the RxPONDER trial, TransATAC and SWOG-8814. Chemotherapy assignment data were obtained from the Clalit registry. The cost of adjuvant chemotherapy was based on the distribution of treatments used in the UK combined with published drug unit costs in the UK. The cost of distant recurrence and health state utility values were obtained from literature.
    Results: The Oncotype DX test was found to be more effective (with an estimated 0.02 additional QALYs) at a lower estimated cost (-£989) compared to clinical risk tools alone. The results did not substantially change with more conservative clinical and cost scenarios. The RxPONDER trial was restricted to RS 0-25, and data synthesis with other studies was required to inform the analysis, which increased uncertainty.
    Conclusions: The Oncotype DX test is highly likely to be cost-effective in node-positive early breast cancer. The results were driven by reduction in the use of chemotherapy with consequence avoidance of the costs and harmful effects of chemotherapy. Targeted treatment of a minority (11%) of women with RS 26-100 who benefit from chemotherapy reduced cost and improved survival.
    MeSH term(s) Breast Neoplasms/drug therapy ; Breast Neoplasms/genetics ; Chemotherapy, Adjuvant ; Cost-Benefit Analysis ; Female ; Gene Expression Profiling/methods ; Humans ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/genetics ; Prognosis ; Quality-Adjusted Life Years
    Language English
    Publishing date 2022-05-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2270945-9
    ISSN 1941-837X ; 1369-6998
    ISSN (online) 1941-837X
    ISSN 1369-6998
    DOI 10.1080/13696998.2022.2066399
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    Zs.A 6450: Show issues Location:
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  4. Article ; Online: Rezum water vapour therapy: promising early outcomes from the first UK series.

    Johnston, Maximilian J / Noureldin, Mohamed / Abdelmotagly, Yehia / Paramore, Louise / Gehring, Tina / Nedas, Timothy G / Rajkumar, Govindaraj / Emara, Amr / Hindley, Richard G

    BJU international

    2020  Volume 126, Issue 5, Page(s) 557–558

    MeSH term(s) Aged ; Humans ; Male ; Prospective Studies ; Prostatic Hyperplasia/surgery ; Steam ; Transurethral Resection of Prostate/methods ; Treatment Outcome
    Chemical Substances Steam
    Keywords covid19
    Language English
    Publishing date 2020-08-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 1462191-5
    ISSN 1464-410X ; 1464-4096 ; 1358-8672
    ISSN (online) 1464-410X
    ISSN 1464-4096 ; 1358-8672
    DOI 10.1111/bju.15203
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  5. Article: Rezum water vapour therapy: promising early outcomes from the first UK series

    Johnston, Maximilian J / Noureldin, Mohamed / Abdelmotagly, Yehia / Paramore, Louise / Gehring, Tina / Nedas, Timothy G / Rajkumar, Govindaraj / Emara, Amr / Hindley, Richard G

    BJU int

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #704108
    Database COVID19

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  6. Article ; Online: Delivering urgent urological surgery during the COVID-19 pandemic in the UK: outcomes from our initial 52 patients.

    Paramore, Louise / Yang, Bob / Abdelmotagly, Yehia / Noureldin, Mohamed / McLean, Duncan / Rajkumar, Govindaraj / Adamson, Andrew / Emara, Amr / White, Christopher / Hindley, Richard / Nedas, Timothy

    BJU international

    2020  Volume 126, Issue 2, Page(s) 248–251

    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Emergencies ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Treatment Outcome ; United Kingdom/epidemiology ; Urologic Diseases/complications ; Urologic Diseases/surgery ; Urologic Surgical Procedures/methods ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-07-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 1462191-5
    ISSN 1464-410X ; 1464-4096 ; 1358-8672
    ISSN (online) 1464-410X
    ISSN 1464-4096 ; 1358-8672
    DOI 10.1111/bju.15110
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  7. Article ; Online: Investigating the Rationale for Extending CT KUB to Include the Chest for Suspected Renal Colic Patients During the COVID-19 Pandemic

    Abdelmotagly, Yehia / Noureldin, Mohamed / Paramore, Louise / Govindaraj, Rajkumar / Ubhayakar, Gaurang / Nedas, Tim / Hindley, Richard / Emara, Amr

    Journal of Endoluminal Endourology

    2020  Volume 3, Issue 3, Page(s) e1–e6

    Abstract: Background and ObjectiveFollowing on from the Royal College of Surgeons (RCS) recommendation of 5th of April 2020 to perform computed tomography (CT) scan of the chest in patients presenting with an abdominal pain emergencies and undergoing an abdominal ... ...

    Abstract Background and ObjectiveFollowing on from the Royal College of Surgeons (RCS) recommendation of 5th of April 2020 to perform computed tomography (CT) scan of the chest in patients presenting with an abdominal pain emergencies and undergoing an abdominal CT; comparison was made between a cohort of patients with a RCS-COVID recommended scan and a similar group of patients in the pre-COVID era. To evaluate the value of extending CT-KUB scan to include the chest area, in patients presenting to the emergency department with acute renal colic during the COVID-19 pandemic. Material and MethodsRetrospective data included; initial presentation, COVID-19-related symptoms, dose length product (DLP), scan extension, Ground glass appearance (GGO), Wuhan corona virus swab polymerase chain reaction (PCR) test. ResultsA total of 100 patients underwent CT KUB in April 2020 (Group 1) with a similar number of patients from the pre-COVID-19 pandemic randomly selected from August to October 2019 (Group 2). Patients age ranged from 15 to 91 years with a median of 48 years in Group 1, whilst in Group 2 the range was 19 to 85 years with a median of 50 years. All patients in both groups initially presented with renal colic. No COVID-19-related respiratory manifestations were recorded. Nine patients from Group 1 had GGO identified in their chest CT with all of them returning with negative COVID-19 swabs. Interestingly there was almost the same number of stones diagnosed 49% (49/ 100) in Group 1 patients compared with 50% (23/5150/100) from Group 2. ConclusionsDespite the RCS COVID CT scan recommendations, our study has demonstrated no significant additional value of extending the CT-KUB to include the chest area in renal colic patients with no respiratory manifestations. Further studies are recommended in order to validate these results.
    Keywords covid19
    Publisher Dougmar Publishing Group, Inc.
    Publishing country ca
    Document type Article ; Online
    ISSN 2561-9187
    DOI 10.22374/jeleu.v3i3.94
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article: Delivering urgent urological surgery during the COVID-19 pandemic in the UK: outcomes from our initial 52 patients

    Paramore, Louise / Yang, Bob / Abdelmotagly, Yehia / Noureldin, Mohamed / McLean, Duncan / Rajkumar, Govindaraj / Adamson, Andrew / Emara, Amr / White, Christopher / Hindley, Richard / Nedas, Timothy

    BJU Int

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #266318
    Database COVID19

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  9. Article ; Online: Health state utilities associated with treatment for transfusion-dependent β-thalassemia.

    Matza, Louis S / Paramore, L Clark / Stewart, Katie D / Karn, Hayley / Jobanputra, Minesh / Dietz, Andrew C

    The European journal of health economics : HEPAC : health economics in prevention and care

    2019  Volume 21, Issue 3, Page(s) 397–407

    Abstract: Objectives: Transfusion-dependent β-thalassemia (TDT) is a genetic disease that affects production of red blood cells. Conventional treatment involves regular red blood cell transfusions and iron chelation, which has a substantial impact on quality of ... ...

    Abstract Objectives: Transfusion-dependent β-thalassemia (TDT) is a genetic disease that affects production of red blood cells. Conventional treatment involves regular red blood cell transfusions and iron chelation, which has a substantial impact on quality of life. While potentially curative, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with risk of complications, including graft-versus-host disease (GvHD). Gene addition therapy, a novel treatment approach, involves autologous transplantation of the patient's own genetically modified hematopoietic stem cells. The purpose of this study was to estimate utilities associated with treatment approaches for TDT.
    Methods: General population respondents in England valued eight health state vignettes (developed with clinician, patient, and parent input) in time trade-off interviews.
    Results: A total of 207 participants completed interviews (49.8% female; mean age = 43.2 years). Mean (SD) utilities for the pre-transplant health states were 0.73 (0.25) with oral chelation and 0.63 (0.32) with subcutaneous chelation. Mean utilities for the transplant year were 0.62 (0.35) for gene addition therapy, 0.47 (0.39) for allo-HSCT, and 0.39 (0.39) for allo-HSCT with acute GvHD. Post-transplant utilities were 0.93 (0.15) for transfusion independent, 0.75 (0.25) for 60% transfusion reduction, and 0.51 (0.38) for chronic GvHD. Acute and chronic GvHD were associated with significant disutility (acute = - 0.09, p < 0.0001; chronic = - 0.42, p < 0.0001).
    Conclusions: Utilities followed expected patterns, with logical differences between treatment options for TDT and substantially greater utility for transfusion independence than for ongoing treatment involving transfusion and chelation. These utilities may be useful in cost-utility models estimating the value of treatments for TDT.
    MeSH term(s) Adult ; Aged ; Blood Transfusion ; Chelation Therapy/economics ; England ; Female ; Genetic Therapy/economics ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Patient Preference/economics ; Patient Preference/psychology ; Pilot Projects ; Quality of Life ; beta-Thalassemia/economics ; beta-Thalassemia/psychology ; beta-Thalassemia/therapy
    Language English
    Publishing date 2019-12-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2045253-6
    ISSN 1618-7601 ; 1618-7598
    ISSN (online) 1618-7601
    ISSN 1618-7598
    DOI 10.1007/s10198-019-01136-0
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    Zs.A 5475: Show issues Location:
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  10. Article ; Online: Delivering urgent urological surgery during the COVID-19 pandemic in the UK

    Paramore, Louise / Yang, Bob / Abdelmotagly, Yehia / Noureldin, Mohamed / McLean, Duncan / Rajkumar, Govindaraj / Adamson, Andrew / Emara, Amr / White, Christopher / Hindley, Richard / Nedas, Timothy

    BJU International

    outcomes from our initial 52 patients

    2020  Volume 126, Issue 2, Page(s) 248–251

    Keywords Urology ; covid19
    Language English
    Publisher Wiley
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1462191-5
    ISSN 1464-410X ; 1464-4096 ; 1358-8672
    ISSN (online) 1464-410X
    ISSN 1464-4096 ; 1358-8672
    DOI 10.1111/bju.15110
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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