Leeds Research: A miniature robot that could check colons for early signs of disease

University of Leeds | July 2019| A miniature robot that could check colons for early signs of disease

An  academic at the University of Leeds is a senior author of a piece of research that demonstrates it is technically possible to guide a tiny robotic capsule inside the colon to take micro-ultrasound images. The capsule, known as Sonopill, has taken an international consortium of scientists and engineers a decade to develop. 

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It is hoped that the technology will one day mean patients will not need to undergo an endoscopic examination- as the Sonopill is capable of intelligent magnetic manipulation. Based on the principle that magnets can attract and repel one another, a series of magnets on a robotic arm that passes over the patient interacts with a magnet inside the capsule, gently manoeuvring it through the colon (Source: University of Leeds).

The full news story is available from the University of Leeds

Full reference:

Norton, J.C. et al. | 2019| Intelligent magnetic manipulation for gastrointestinal ultrasound | Science Robotics | Vol. 4|31| eaav7725
DOI: 10.1126/scirobotics.aav7725

Abstract

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Rotherham NHS staff can request a copy of this article here 

 

 

Psychosocial interventions for informal caregivers of people living with cancer

Treanor,  C.J. | 2019| Psychosocial interventions for informal caregivers of people living with cancer| Cochrane Database of Systematic Reviews |6. Art. No| CD009912| DOI: 10.1002/14651858.CD009912.pub2.

Reviewers have assessed the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well‐being of informal caregivers of people living with cancer compared with usual care. Their findings have now been published by Cochrane. 

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Psychosocial support for informal caregivers of people living with cancer

Background

Increasingly, people who are not health professionals provide care for a partner, family member or friend affected by cancer, which can have negative effects on their health and well‐being. Psychosocial interventions that comprise psychological or social support and involve direct interaction between a healthcare professional and caregivers (or caregiver‐patient pairs) may help to address the negative health effects for caregivers.

Review question

What is the effectiveness of psychosocial interventions compared to usual care for informal caregivers of people living with cancer on a range of outcomes related to health and well‐being?

Results

We found19 trials that compared psychosocial interventions with usual care, in studies that included almost four thousand participants. Studies included caregivers of people affected by different cancers across all stages of the disease. There were differences in intervention make‐up. Intervention examples include providing information and/or teaching caregivers (or caregiver‐patient pairs) coping, communication or problem‐solving skills to manage symptoms or improve relationships. Interventions were delivered by nurses, psychologists or other professionals on an outpatient basis or at home via telephone.

There may be a minimal benefit for caregiver quality‐of‐life immediately after the intervention, but this may not last. Psychosocial interventions may have little to no effect on quality of life for patients six to 12 months post‐intervention, but we are uncertain whether or not interventions improve quality of life for patients immediately post‐intervention.

Psychosocial interventions may have little to no effect on caregiver depression, anxiety, distress and physical health and patient anxiety and distress at any time after the intervention, or on patient depression immediately and patient physical health six to 12 months post‐intervention. Psychosocial interventions probably have little to no effect on patient physical health immediately post‐intervention or patient depression three to six months post‐intervention.

Three studies reported adverse effects including increased distress and sexual function‐related distress and lower relationship satisfaction levels for carers, increased distress levels for patients, and intervention content that was seen as inappropriate for some participants. No studies looked at cost‐effectiveness or intervention satisfaction for caregivers or patients. Because the quality of evidence was low generally, findings must be treated with caution.

Conclusion

Psychosocial interventions do not impact to a clinically meaningful degree outcomes for caregivers irrespective of patient cancer stage or type. Perhaps, other outcomes (e.g. relationship quality) or other psychosocial interventions (e.g. meditation) may be more helpful for caregivers. Interventions should be subjected to better conducted trials. Intervention development should involve caregivers and pay particular attention to individual personal needs (Source: Cochrane).

Read the full review and abstract at Cochrane Library

The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics

Sinclair JMcCann MSheldon E, et al | 2019| The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics| 
New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.
The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 
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Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

Female patients more likely to survive but experience worse side effects from cancer treatment

OnMedica  | May 2019 |Female patients more likely to survive but experience worse side effects from cancer treatment

Oncologists from The Royal Marsden NHS Foundation Trust have led analysis into patient data for more than 3000 people with cancer of the oesophagus and stomach; their findings indicate that female patients being treated with chemotherapy prior to having surgery were significantly more likely to experience side effects such as nausea (10% compared to 5%), vomiting (10% versus 4%) and diarrhoea (9% versus 4%), than male patients. 

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The analysis of four large randomised controlled trials, in collaboration with the UK Medical Research Council Clinical Trials Unit at University College London, will be presented in a poster session at this weekend’s American Society of Clinical Oncology Annual Meeting in Chicago, could potentially help to tailor the management of patients and also highlight those more at risk from specific side effects (Source: OnMedica).

Full story from OnMedica 

Night shift work and risk of breast cancer in women

Jones, M.E. et al. | 2019|Night shift work and risk of breast cancer in women: the Generations Study cohort | British Journal of Cancer |https://www.nature.com/articles/s41416-019-0485-7

Scientists have examined risk of breast cancer in relation to timing of night shift work and receptor status, in a large UK cohort study- The Generations Study (GS)- of more than 113,700 females aged 16 or over from the United Kingdom. Breast and other cancers occurring in the cohort were identified from recruitment and follow-up questionnaires, and spontaneous reports to the study centre. Their detailed analysis found no evidence for an overall increase in risk of breast cancer for women who had been night shift workers within the last 10 years, or by hours worked per night, nights worked per week, average
hours worked per week, cumulative years of employment, cumulative hours, or time since cessation of such work. With the research found no significantly raised risks with type of night shift occupation (Source: Jones et al, 2019)

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Background: It is plausible that night shift work could affect breast cancer risk, possibly by melatonin suppression or circadian clock disruption, but epidemiological evidence is inconclusive.
Methods: Using serial questionnaires from the Generations Study cohort, we estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for breast cancer in relation to being a night shift worker within the last 10 years, adjusted for potential confounders.
Results: Among 102,869 women recruited in 2003–2014, median follow-up 9.5 years, 2059 developed invasive breast cancer. The HR in relation to night shift work was 1.00 (95%CI: 0.86–1.15). There was a significant trend with average hours of night work per week (P = 0.035), but no significantly raised risks for hours worked per night, nights worked per week, average hours worked per week, cumulative years of employment, cumulative hours, time since cessation, type of occupation, age starting night shift work, or age starting in relation to first pregnancy.
Conclusions: The lack of overall association, and no association with all but one measure of dose, duration, and intensity in our data, does not support an increased risk of breast cancer from night shift work in women.

The full article is available to read in full from British Journal of Cancer

In the news:

The Independent | May 2019 | Night shift work does not increase breast cancer risk, study suggests 

Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases

Nguyen Q, Chun SG, Chow E, et al.| 2019|  Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone MetastasesA Randomized Phase 2 Trial| JAMA Oncology  doi:10.1001/jamaoncol.2019.0192

Research published in the JAMA Oncology concludes that delivering high-dose, single-fraction (SBRT) seems to be an effective treatment option for patients with painful bone metastases.

Question  Does single-fraction stereotactic body radiotherapy (SBRT) for bone metastases lead to better pain response rates than standard multifraction radiotherapy (MFRT)?

Findings  In this prospective randomized phase 2 noninferiority trial, 160 patients with mostly nonspine bone lesions were randomly assigned to receive single-fraction SBRT (12 Gy for less than or equal to 4-cm lesions or 16 Gy for more than 4-cm lesions) or MFRT to 30 Gy in 10 fractions. Single-fraction radiation led to more patients experiencing complete or partial pain response at 2 weeks, 3 months, and 9 months compared with standard MFRT.

Meaning  Pain response rates were higher for high-dose, single-fraction SBRT, which should be considered for patients with bone metastases and long estimated survival times.

The full text of the article is available from the Library

In the news:

OnMedica  OTP Oncology – May 2019

 

University of Edinburgh research: £6M boost to train doctors in cancer research

University of Edinburgh | May 2019 | £6M boost to train doctors in cancer research

Cancer Research UK has awarded more than £6 million to its research centres in Edinburgh and Glasgow to train early-career doctors to conduct medical research, known as clinician scientists.

Clinical Academic Training Programme will introduce new measures, including more flexible training options and improved mentorship and networking opportunities, It will better support women clinicians who want to get involved and stay in cancer research.

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In particular, the programme will offer a new type of qualification – known as an MB-PhD – which allows doctors to study for a PhD earlier in their medical training.

Traditionally, becoming a clinician scientist involves doctors taking time out of training to undertake a PhD before returning to complete their medical specialism.

Many doctors – particularly women – do not return to research after qualifying as consultants. As a result, the number of clinician scientists in Scotland is in decline, particularly in senior posts.

Now the joint Clinical Academic Training Programme will introduce new measures, including more flexible training options and improved mentorship and networking opportunities, It will better support women clinicians who want to get involved and stay in cancer research.

In particular, the programme will offer a new type of qualification – known as an MB-PhD – which allows doctors to study for a PhD earlier in their medical training (Source: University of Edinburgh).

News story £6M boost to train doctors in cancer research