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1.  Improving access to diagnostics: an evaluation of a satellite laboratory service in the emergency department 
Emergency Medicine Journal : EMJ  2004;21(4):452-456.
Objectives: To measure the impact of a satellite laboratory upon laboratory result turnaround times and clinical decision making times.
Design: A prospective cohort study, the intervention group had blood tests sent Monday to Friday 12 noon to 8 pm and the control group had blood tests sent outside these hours. The data were collected over a six week period before the laboratory was opened, and a subsequent six week period.
Setting: An urban teaching hospital emergency department.
Participants: 1065 patients requiring blood tests.
Main outcome measure: Time from the blood sample being sent to the laboratory to the results being available on the clinician's computer.
Results: The time to haematology (blood count) results in the intervention group decreased by 47.2 minutes (95% CI 38.3 to 56.1, p<0.001) after the laboratory was opened. The corresponding control group times were unchanged (0.6 minutes; –13.8 to 15.0, p = 0.94). Similar sized differences were also seen for haemostasis (D-dimer) testing 66.1 (41.8 to 90.4) minutes compared with –14.2 (–47.1 to 18.7) and chemistry 41.3 (30.3 to 52.2) compared with –4.2 (–17.4 to 8.9) testing. Decisions to discharge patients were significantly faster (28.2 minutes, 13.5 to 42.8, p<0.0001) in the intervention group after the laboratory was opened (controls; –2.6 minutes –27.0 to 21.7). No change was seen with decisions to admit patients. There was a trend for earlier laboratory results modifying intravenous drug or fluids orders, or both (p = 0.06)
Conclusion: A comprehensive satellite laboratory service is an important adjunct to improve the timeliness of care in the emergency department.
PMCID: PMC1726394  PMID: 15208229
2.  Chemotherapy in advanced ovarian cancer: four systematic meta-analyses of individual patient data from 37 randomized trials. Advanced Ovarian Cancer Trialists' Group. 
British Journal of Cancer  1998;78(11):1479-1487.
The purpose of this systematic study was to provide an up to date and reliable quantitative summary of the relative benefits of various types of chemotherapy (non-platinum vs platinum, single-agent vs combination and carboplatin vs cisplatin) in the treatment of advanced ovarian cancer. Also, to investigate whether well-defined patient subgroups benefit more or less from cisplatin- or carboplatin-based therapy. Meta-analyses were based on updated individual patient data from all available randomized controlled trials (published and unpublished), including 37 trials, 5667 patients and 4664 deaths. The results suggest that platinum-based chemotherapy is better than non-platinum therapy, show a trend in favour of platinum combinations over single-agent platinum, and suggest that cisplatin and carboplatin are equally effective. There is no good evidence that cisplatin is more or less effective than carboplatin in any particular subgroup of patients.
PMCID: PMC2063202  PMID: 9836481
4.  Fucosylated forms of alpha-1-antitrypsin that predict unresponsiveness to chemotherapy in ovarian cancer. 
British Journal of Cancer  1988;58(5):589-593.
We have discovered modified fucosylation of alpha 1-antitrypsin (F-AT) in the sera of ovarian cancer patients. This was detected by SDS/electrophoresis and silver-staining after extracting the sera with the fucose-binding lectin, Lotus tetragonolobus, and was identified as alpha 1-antitrypsin by Western blotting. Initially, high F-AT levels appeared to be related to the recurrence of cancer, but later measurements showed that elevated levels were also present in patients who did not respond to therapy. Using an arbitrary grading system, the level of F-AT was assessed in pairs of sera from 29 ovarian cancer patients undergoing therapy; one specimen collected just after the start of therapy and the other on a later occasion. In 75% of the 15 non-responders, F-AT was higher when measured on a second occasion; whereas in 86% of the 14 responders the second measurement was either unchanged or lower, being frequently undetectable. F-AT levels were also low or undetectable in sera from healthy women. Eight responders were monitored for F-AT throughout cyclophosphamide chemotherapy. Despite a high tumour burden at the start of therapy, all patients had relatively low levels of F-AT and this was maintained throughout remission; the levels only becoming elevated with the recurrence of tumour growth. Increased F-AT expression did not appear to be particularly associated with the presence of liver metastases and frequently predated any clinical signs of a recurrence. The interesting characteristics of these molecules could make them useful in the management of ovarian cancer.
PMCID: PMC2246816  PMID: 3265332
6.  Urine cyclic nucleotide concentrations in cancer and other conditions; cyclic GMP: a potential marker for cancer treatment. 
Journal of Clinical Pathology  1982;35(8):800-806.
Cyclic guanosine 3',5' monophosphate (cyclic GMP) and cyclic adenosine 3',5' monophosphate (cyclic AMP) have been determined in random urine specimens from 95 healthy individuals, 60 patients with non-cancerous conditions, 52 patients with benign tumours, and 74 patients with malignant tumours. Concentrations of cyclic GMP have also been determined in a number of other groups, including some undergoing cancer treatment. Ninety-three per cent of cancer patients had raised urinary cyclic GMP concentrations compared to the reference range for healthy subjects. For the non-cancerous and benign groups, 33% and 42% respectively had raised concentrations. The urine cyclic AMP concentrations were similar in all groups. Urine cyclic GMP appeared to rise early in the onset of malignant growth. Successful cancer treatment was accompanied by a dramatic fall in the urine cyclic GMP concentrations, whereas if the treatment was unsuccessful the level did not change. It is concluded that urine cyclic GMP may have important applications in the monitoring of cancer treatment.
PMCID: PMC497792  PMID: 6286732
7.  Relation between raised concentrations of fucose, sialic acid, and acute phase proteins in serum from patients with cancer: choosing suitable serum glycoprotein markers. 
Journal of Clinical Pathology  1985;38(5):588-592.
Serum concentrations of fucose, sialic acid, and eight acute phase proteins were measured in single specimens from patients with cancer in order to determine whether the raised concentrations of protein bound sugars commonly found in cancer correlate with increased concentrations of the acute phase proteins. Strong positive correlations were found only with alpha 1-acid glycoprotein, alpha 1-antitrypsin, and haptoglobins. Changes in protein bound sugars and acute phase proteins were also examined in relation to patients' disease states. Serum fucose was raised more often in patients with advanced disease than in those in whom the spread of the tumour was more restricted; increased sialic acid concentrations, however, were found with a similar frequency in both these groups. Combined use of fucose and sialic acid values gave a high degree of marker positivity which could be only slightly improved on by including measurement of acute phase proteins. The combined use of serum fucose and sialic acid concentrations may have value in monitoring patients with cancer: the sialic acid provides an index of the acute phase response and the fucose a measure of the tumour spread.
PMCID: PMC499217  PMID: 2582003
8.  Platelet size: no correlation with migraine or monoamine oxidase activity. 
A Coulter Model "S Plus" counter has been used to study platelets from 39 migrainous patients between attacks, six during attacks, eight with active cluster headache and 26 controls. None of the patient groups showed any abnormality in platelet size profile. There was no correlation between platelet monoamine oxidase activity and mean platelet volume in any of the groups.
PMCID: PMC491566  PMID: 7131016
11.  Doxorubicin cardiotoxicity: possible role of digoxin in its prevention. 
British Medical Journal  1977;2(6100):1447-1449.
Twenty-nine patients with gynaecological cancers who received over 400 mg of doxorubicin were monitored electrocardiographically to determine whether cardiac glycosides countered the adverse effects of high total doses of doxorubicin. Minor electrocardiographical changes were noted in five out of six patients who were not receiving a cardiac glycoside and four out of six who were receiving ouabain, and none of the 16 who were receiving digoxin. One other patient on digoxin stopped taking it and developed cardiomyopathy. One patient on ouabain also developed cardiomyopathy. So far nine patients on digoxin have received between 550 and 1000 mg/m2 of doxorubicin without ill effect. Cardiac glycosides are thought to prevent doxorubicin cardiomyopathy by competitively inhibiting doxorubicin at its receptor sites, but ouabain has a much shorter half life than doxorubicin and its metabolites and so is less effective than digoxin.
PMCID: PMC1632597  PMID: 589261

Results 1-13 (13)