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Marie Kirwan talks about her research on refining diagnostic techniques for airway samples. Aspergillosis Patients Support Meeting
 

Marie Kirwan talks about her research on refining diagnostic techniques for airway samples. Aspergillosis Patients Support Meeting

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This Aspergillosis Patients Support Meeting took place at the National Aspergillosis Centre, Manchester, UK

This Aspergillosis Patients Support Meeting took place at the National Aspergillosis Centre, Manchester, UK

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    Marie Kirwan talks about her research on refining diagnostic techniques for airway samples. Aspergillosis Patients Support Meeting Marie Kirwan talks about her research on refining diagnostic techniques for airway samples. Aspergillosis Patients Support Meeting Presentation Transcript

    • Support Meeting for Aspergillosis Patients LED BY GRAHAM ATHERTON SUPPORTED BY MARIE KIRWAN GEORGINA POWELL, & DEBBIE KENNEDY NAC CENTRE MANAGER CHRIS HARRIS DIAGNOSING ASPERGILLUS: THE FUTURE AND THE WAY FORWARD BY MARIE B KIRWAN NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTERFungal Research Trust
    • National Aspergillosis Centre Research Programme Translational Research From Bedside to Bench Research for Patient Benefit Research Team  Professor David Denning  Professor Malcolm Richardson  Specialist Nurses Marie, Georgina and Debbie  Graham Atherton – Patient Support and Education Lead  Chris Harris – NAC manager  Phil Langridge - Physiotherpist  Doctors – Clinic based, Laboratory Based  Patients !!!
    • National Aspergillosis Centre Research Programme WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI Ethical Principles for Medical Research Involving Human Subjects Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the:  29th WMA General Assembly, Tokyo, Japan, October 1975  35th WMA General Assembly, Venice, Italy, October 1983  41st WMA General Assembly, Hong Kong, September 1989  48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996  52nd WMA General Assembly, Edinburgh, Scotland, October 2000  53rd WMA General Assembly, Washington 2002 (Note of Clarification on paragraph 29 added)  55th WMA General Assembly, Tokyo 2004 (Note of Clarification on Paragraph 30 added)  59th WMA General Assembly, Seoul, October 2008
    • Ethical Principles International Conference on Harmonisation - Good Clinical Practice (GCP) Compliance with this standard provides public assurance that the rights, safety and well-being of trial subjects are rights protected. Consistent with the principles that have their origin in the Declaration of Helsinki, and that the clinical trial data are credible. GCP Certificate
    • Good Clinical Practice
    • Principles of ICH GCP 13 Principles of ICH GCP –  2.1 Clinical trials should be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, and that are Helsinki consistent with GCP and the applicable regulatory requirement(s).  2.3 The rights, safety, and well-being of the trial subjects are the most important considerations and should prevail over interests of science and society.  2.8 Each individual involved in conducting a trial should be qualified by education, training, and experience to perform his or her respective task(s).  2.9 Freely given informed consent should be obtained from every subject prior to clinical trial participation.
    • Clinical Research Process Idea Protocol Patient Information Sheet Patient Consent Form Sample Collection
    • Suspected Aspergillus Bronchitis Morning Sputum Bronchoscopy Second Sputum Young et al (1970) described eight patients with Aspergillus bronchitis - All eight patients displayed respiratory symptomatology including breathlessness, wheeze, cough and often mild haemoptysis yet interestingly, seven patients had only scanty sputum production.
    • Bronchoscopy Study The primary objective of this study was to compare the Aspergillus species diagnostic yield from bronchoalveolar lavage (BAL), bronchial aspirate and post bronchoscopy sputum samples by quantitative detection using Real Time - Polymerase Chain Reaction (RT-PCR) and standard fungal culture. Is there a more accurate way and can WE do it better?
    • Objective No prospective comparisons of laboratory methods for culture of respiratory specimens for fungi have been published. We conducted a 3 way comparison of standard culture, higher volume culture and RT-PCR Aspergillus spp. on sputa and bronchoscopy specimens Five patients thought to have bronchial or pulmonary aspergillosis.
    • Specimens All samples were divided into three even fractions. One was used for DNA extraction and RT-PCR One processed in accordance with BSOP57 for culture – Clinical Sciences Laboratory One processed identically, except that the whole (1/3rd) specimen was cultured – Mycology Laboratory. Laboratory
    • Sputum Specimen Collections Morning Sputum
    • Bronchoscopy Specimens
    • Results Of the 25 specimens analysed from 5 patients, 1 (4%) was culture positive (1 cfu) with the BSOP57 method, 9 (36%) by higher volume culture (p = 0.01) and 23 (92%) by RT-PCR (p = 1.2x10-10 and p= 0.00007 respectively). Pre- and post-bronchoscopy samples (n=9) were always positive by RT-PCR compared with 4 of 9 (44%) by higher volume culture (p=0.02). RT-PCR signals on sputum samples were higher than BAL samples. All 5 (100%) BAL samples were RT PCR positive compared with higher volume culture (20%) (p=0.04). From multiple specimens, only 1 colony of A. fumigatus was grown on high volume culture from 1 plate in 2 patients.
    • Results
    • Results
    • Conclusions Higher volume culture has a higher yield for Aspergillus culture than current UK standard methodology. RT-PCR is much more sensitive than culture, and has a wider dynamic range for quantitation. The current UK standard method requires revision and RT- PCR should be implemented for patients suspected of having aspergillosis.
    • Bronchoscopy Study
    • What are we looking for?Klich MA. Identification of common Aspergillus species (2002). CBS.
    • Aspergillus fumigatus
    • Thank You“The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust
    • Programme 1pm Introduction 1:05 Marie Kirwan Talks about… 2:00 Tea & Coffee 2:15 Future & feedback 3:00 Close
    • Local Support Groups Local Support Groups – first one starting in Liverpool Local support Local awareness (need to advertise locally) Encourages proactivity Information dissemination (leaflets etc.) I could be available on PC to answer questions?? I have 6 possible groups starting up – London, Southampton, Cornwall, West Midlands, USA & Liverpool Want these all over UK & the world if possible!
    • Local Patients Support Group Brenda Winslade & Lynn Took place 29th Feb in a Wetherspoons pub, Liverpool Advertised through radio (BBC) & local media Local GP surgeries? Local respiratory nurse attended who has helped with publicising through hospital email to consultants
    • Local Patients Support GroupAchievements 5 patients attended, one or two had never met anyone with aspergillosis before Increased awareness in local community & media Increased awareness in local medical community Involvement of local staff A GREAT SUCCESS!!!
    • AwarenessUnderestimated and highly valuableIncreased awareness leads to : Better diagnosis & treatment as medics start to include aspergillosis as a possible diagnosis (requires prevalence info) Better funding from private & government sources for diagnosis treatment AND research (politicians take notice when lots of their voters start talking about a health issue) Many health advantages (e.g. avoidance of damp buildings) Better coverage in media which leads to better awareness – the virtuous circle
    • Student competitionsAim: Building awareness amongst younger people & parents Art & music Original compositions £1200 prize (school & individual share) Theme is ‘funky fungi’ Starting this month with mailshot to all schools in NW England, will spread from there.  www. projectlifecompetition.org
    • Facebook A massive marketing tool, therefore a massive help in spreading awareness Nearly half the population of the UK has an account! More in the US Older age groups are rapidly adding themselves (including me)
    • Facebook – how does it help? Current technique – website = one person does a search and finds us – linear increase in users
    • Facebook dynamics One user = multiple friends One person reached = many people reached Massively used so can reach many people Users Time
    • Facebook Starting to design for Facebook for patient meeting support, Q & A Easy to do (but time consuming) Clearer set-out so you can find all of the parts in one place Yahoo group NOT changing
    • AOB Mobile phone numbers so I can text you about the meeting New leaflet - Photosensitivity Funguide Cook book – keep sending in recipes !
    • Thank You“The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust