Janine Bestall

University of Leeds · Leeds Institute of Health Sciences (LIHS)

Background: Temporary drug treatment cessation might alleviate toxicity without substantially compromising efficacy in patients with cancer. We aimed to determine if a tyrosine kinase inhibitor drug-free interval strategy was non-inferior to a conventional continuation strategy for first-line treatment of advanced clear cell renal cell carcinoma....

Lung cancer is the third most common type of cancer in the UK, with nearly 50 000 new cases diagnosed a year. Treatments for lung cancer have improved in recent years with the advent of new surgical and radiotherapy techniques and the increased use of immunotherapies. These advances have resulted in increasing numbers of patients surviving beyond t...

Background Immunotherapy is revolutionising the treatment of patients diagnosed with melanoma and other cancers. The first immune checkpoint inhibitor, ipilimumab (targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)), showed a survival advantage over standard chemotherapy. Subsequently the anti-programmed cell death protein 1 (PD-1) anti...

Objectives Stereotactic Ablative Radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I non-small cell lung cancer (NSCLC). Previous non-randomised evidence supports SABR as an alternative to surgery, but high quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establi...

Background Protein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expe...

Aims and method This paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to id...

Guidance for involving members of the public in interview panels, committees, and other panel membership

Background Stage I non-small cell lung cancer (NSCLC) is potentially curable, and surgery is considered to be the standard of care for patients with good performance status and minimal co-morbidity. However, a significant proportion of patients with stage I NSCLC have a poorer performance status and significant medical co-morbidity that make them a...

Background: Stage I non-small cell lung cancer (NSCLC) is potentially curable, and surgery is considered to be the standard of care for patients with good performance status and minimal co-morbidity. However, a significant proportion of patients with stage I NSCLC have a poorer performance status and significant medical co-morbidity that make them...

The authors describe the use of cognitive interviewing methodology in the development of a new supportive and palliative care screening measure to identify the specialist supportive and palliative care needs of patients with an advanced illness. A draft screening measure was developed by literature reviewing and consultation with patients, carers a...

Inhaled fluticasone propionate (FP) is a relatively new inhaled corticosteroid for the treatment of asthma. To assess efficacy and safety outcomes in studies that compared FP to placebo for treatment of chronic asthma. We searched the Cochrane Airways Group Specialised Register (January 2008), reference lists of articles, contacted trialists and se...

Background: Inhaled fluticasone propionate (FP) is a high-potency inhaled corticosteroid used in the treatment of asthma. Objectives: 1. To assess the efficacy and safety outcomes of inhaled fluticasone at different nominal daily doses in the treatment of chronic asthma.2. To test for the presence of a dose-response effect. Search strategy: We...

Background: Inhaled corticosteroids are available in the form of a suspension for nebulisation, although the role of this mode of therapy in the treatment of chronic asthma is still unclear. Objectives: To assess the efficacy and safety of inhaled corticosteroids delivered via nebuliser versus holding chamber for the treatment of chronic asthma....

Background: Inhaled fluticasone propionate (FP) is a relatively new inhaled corticosteroid for the treatment of asthma. Objectives: 1. To assess efficacy and safety outcomes in studies that compared FP to placebo for treatment of chronic asthma.2. To explore the presence of a dose-response effect. Search strategy: We searched the Cochrane Airw...

Fluticasone (FP) is an inhaled corticosteroid commonly used to treat inflammation of the airways (passages to the lungs) and improve breathing in people with asthma. This review examined the effectiveness of FP when given at different doses for treating asthma in children and adults. High doses (800 to 1000 microgram per day) led to small improveme...

This review compares the effectiveness of three inhaled steroids. Fluticasone (FP) was compared with either beclomethasone (BDP) or budesonide (BUD) for treating people with chronic asthma. When FP was given to children or adults at approximately half the daily dose of either BDP or BUD, it appeared to be at least as effective as the other two drug...

Patients with chronic heart failure (CHF) are often admitted to hospital as an emergency. The authors looked at 16 clinical trials that tested different ways of organising the care of CHF patients after they leave hospital. Only one of these trials was determined to be of high quality. There was some weak evidence that the intense monitoring of pat...

Inhaled fluticasone propionate (FP) is a relatively new inhaled corticosteroid for the treatment of asthma. 1. To assess efficacy and safety outcomes in studies that compared FP to placebo for treatment of chronic asthma.2. To explore the presence of a dose-response effect. We searched the Cochrane Airways Group Trial Register (January 2004), refer...

Background: Inhaled beclomethasone dipropionate (BDP) has been, together with inhaled budesonide, the mainstay of anti-inflammatory therapy for asthma for many years. A range of new prophylactic therapies for asthma is becoming available and BDP has been reformulated using a hydrofluoroalkane-134a (HFA) propellant which is free from chlorofluoroca...

To determine the problems and issues of accessing specialist palliative care by patients, informal carers and health and social care professionals involved in their care in primary and secondary care settings. Eleven electronic databases (medical, health-related and social science) were searched from the beginning of 1997 to October 2003. Palliativ...

The aim of this study was to explore the reasons why patients and families are referred to specialist palliative care. Semi-structured interviews were undertaken with patients and professionals from primary care and specialist palliative care services in the north of England. A content analysis of the transcripts was undertaken, key issues were ide...

Beclomethasone dipropionate (BDP) and budesonide (BUD) are commonly prescribed inhaled corticosteroids for the treatment of asthma, Fluticasone propionate (FP) is newer agent with greater potency in in-vitro assays. To compare the efficacy and safety of Fluticasone to Beclomethasone or Budesonide in the treatment of chronic asthma. We searched the...

Pulmonary rehabilitation (PR) programmes produce initial improvements in exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). However, there is limited data on the longer term effects of PR. This study has examined whether the initial benefits gained in exercise tolerance and health status may be maint...

Beclomethasone dipropionate (BDP) and budesonide (BUD) are used widely in the treatment of chronic asthma. The two drugs have different in vitro pharmacokinetic characteristics. It is unclear whether this translates into clinically significant differences in efficacy or safety when treating children and adults with chronic asthma. To assess clinica...

Inhaled fluticasone propionate (FP) is a high potency inhaled corticosteroid used in the treatment of asthma. 1. To assess the efficacy and safety outcomes in studies that compared inhaled fluticasone at different nominal daily doses in the treatment of chronic asthma. 2. To test for the presence of a dose response effect. We searched the Cochrane...

Beclomethasone dipropionate (BDP) and budesonide (BUD) are commonly prescribed inhaled corticosteroids for the treatment of asthma, Fluticasone propionate (FP) is newer agent with greater potency in in-vitro assays. To compare the efficacy and safety of Fluticasone to Beclomethasone or Budesonide in the treatment of chronic asthma. We searched the...

Inhaled fluticasone propionate (FP) is a relatively new inhaled corticosteroid for the treatment of asthma. 1. To assess efficacy and safety outcomes in studies that compared FP to placebo for treatment of chronic asthma. 2. To explore the presence of a dose-response effect. We searched the Cochrane Airways Group Trial Register (1999), reference li...

Inhaled budesonide (BUD) is available in a range of doses for treating chronic asthma. To quantitatively assess the efficacy and safety of budesonide at different doses in order to establish whether a clinically significant dose response profile exists. A search was carried out for Controlled and Randomised Clinical Trials (RCTs) using the Cochrane...

Inhaled budesonide is a widely used inhaled corticosteroid for asthma. The objectives of this review was to compare the efficacy of budesonide with placebo in the treatment of chronic asthma. The Cochrane Airways Group Trial Register and reference lists of articles was searched. We contacted trialists for additional studies and searched abstracts o...

Beclomethasone dipropionate (BDP) is available in a wide range of daily doses for the treatment of long-term asthma. To assess the evidence for a dose response relationship for BDP in the treatment of long-term asthma. We searched the Cochrane Airways Group trial register, Cochrane Controlled Trials Register (The Cochrane Library issue 1 1999) and...

Inhaled corticosteroids are available in the form of a suspension for nebulisation, although the role of this mode of therapy in the treatment of chronic asthma is still unclear. To assess the efficacy and safety of inhaled corticosteroids delivered via nebuliser versus holding chamber for the treatment of chronic asthma. We searched the Cochrane A...

Pulmonary rehabilitation is a package of physical training and psychosocial education aimed at maximizing the functioning and independence of patients with respiratory disease. There is strong evidence to support the efficacy of pulmonary rehabilitation in improving exercise tolerance, health-related quality of life, and dyspnea. More recent studie...

Activities of daily living (ADL) may be severely restricted in patients with COPD and assessment requires evaluation of the impact of disability and handicap on daily life. This study is concerned with the development and validation of a standardized 15-item questionnaire to assess routine ADL. Sixty (33 male, 27 female) patients with severe COPD,...

Inhaled beclomethasone can help relieve the symptoms of asthma in both children and adults. During an asthma attack, the airways narrow, causing breathing problems, wheezing and coughing. Inhaled corticosteroids (ICS) are used to reduce swelling of the airways. Inhaled beclomethasone dipropionate (BDP) is commonly used. This review of trials found...

A systematic review was undertaken to test for the presence of a dose-response relationship for beclomethasone (BDP) and budesonide (BUD) in the treatment of chronic asthma. 1536 potentially relevant studies were identified from a search of the Cochrane Airways Group Register of Trials. Of these, 12 trials (median publication date 1992) met the inc...

The choice of outcome in asthma trials is subjective since there are currently no indices of the reliability and sensitivity of such measures. This study aimed to assess the relative performance of three asthma outcomes through a systematic review of randomised controlled trials of salmeterol or formoterol vs. placebo in patients with chronic asthm...

Methods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study ex...

Oxygen conserving devices may lead to substantial increases in the duration of oxygen provided. A study was undertaken to compare the performance of a pulsed dose oxygen delivery (PDOD) system with continuous flow oxygen or air during a maximal walking test. Fourteen patients with chronic obstructive pulmonary disease (COPD) and arterial oxygen des...

Pulmonary rehabilitation (PR) programmes have previously shown improvements in exercise tolerance and quality of life (QOL), however mere is little data reporting reductions in dyspnea during activities of daily living. We have shown significant reduction in scores of the London Chest Activity of Daily Living Scale (LCADL) after a 6 week, 3 times w...

This study tested the hypothesis that severity of respiratory disability may affect the outcome of pulmonary rehabilitation. In this randomized, controlled study, 126 patients with chronic obstructive pulmonary disease (COPD) were stratified for dyspnoea using the Medical Research Council (MRC) dyspnoea score into MRC3/4 (Moderate) (n=66) and MRC 5...

Exacerbations occur commonly in patients with moderate or severe chronic obstructive pulmonary disease (COPD) but factors affecting their severity and frequency or effects on quality of life are unknown. We measured daily peak expiratory flow rate (PEFR) and daily respiratory symptoms for 1 yr in 70 COPD patients (52 male, 18 female, mean age [+/-...

Ambulatory oxygen may enable patients with COPD to maximise their functional performance, however continuous flow (CF) oxygen is wasteful and uneconomical. Oxygen conserving devices can substantially increase the duration of oxygen provided, though studies are limited in evaluating the effectiveness of these devices during exercise. The purpose of...

Patients with COPD gain benefits in exercise tolerance and health status following pulmonary rehabilitation, though there is relatively limited information on the longer term benefits. This randomised controlled study assessed patients 6 months after they had attended an 8 week out-patient supervised rehabilitation programme. 56 stable COPD patient...

Physical training as part of pulmonary rehabilitation programmes in COPD patients improves exercise capacity, while education programmes alone appear to have little benefit. However, most of this data has come from uncontrolled studies of rehabilitation and few controlled studies have been reported. We have performed a randomised controlled study o...

The Medical Research Council Breathlessness Score (MRC BS) has been used to grade perceived respiratory disability and consists of five statements relating to perceived breathlessness and mobility. Since Pulmonary rehabilitation programmes are tailored to the needs of the individual we used the MRC BS to allocate patients to either rehabilitation s...

Nasal positive pressure ventilation (NIPPV) is effective in selected hypercapnic patients with stable COPD, though correction of blood gases may be more difficult to achieve in these patients, than in other causes of respiratory failure. Increasing inspiratory positive airway pressure (IPAP) during pressure cycled NIPPV could improve gas exchange....