Presentation by Rochelle Lowe of Great Ormond Street Hospital for Children NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
12.COMPREHENSIVE OFANTIMICROBIAL AGENTS AND CHEMOTHERAPY ( CLASSIFICATION AND...Saminathan Kayarohanam
Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.
Definition
Anticancer, or antineoplastic, drugs are used to treat malignancies, or cancerous growths. Drug therapy may be used alone, or in combination with other treatments such as surgery or radiation therapy.
Purpose
Anticancer drugs are used to control the growth of cancerous cells. Cancer is commonly defined as the uncontrolled growth of cells, with loss of differentiation and commonly, with metastasis, spread of the cancer to other tissues and organs. Cancers are malignant growths. In contrast, benign growths remain encapsulated and grow within a well-defined area. Although benign tumors may be fatal if untreated, due to pressure on essential organs, as in the case of a benign brain tumor, surgery or radiation are the preferred methods of treating growths which have a well defined location. Drug therapy is used when the tumor has spread, or may spread, to all areas of the body.
Journal Club
Adaptive Covid-19 Treatment Trial 1 - A critical appraisal
Review of the ACTT - 1 trial from a critical and statistical analysis perspective
When Old Beliefs Won’t Budge: Evaluating Entrenched Attitudes and Resistance ...Anne Jacobson, MPH, CCMEP
When Old Beliefs Won’t Budge: Evaluating Entrenched Attitudes and Resistance to Change Among Health Care Professionals. Presented at the 2013 ACEHP Annual Meeting.
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
What is therapeutic drug monitoring (TDM)? Therapeutic drug monitoring (TDM) is testing that measures the amount of certain medicines in your blood. It is done to make sure the amount of medicine you are taking is both safe and effective. Not all medications require therapeutic monitoring. Most drugs have a wide therapeutic index and can be prescribed based upon pre-established dosing schedules. The effectiveness of these treatments has been evaluated, but monitoring the concentration of the drug in the blood is not required for dosing.Aminoglycoside antibiotics (gentamicin) Antiepileptics (such as carbamazepine, phenytoin and valproic acid).Why do I need TDM? You may need testing when you first start taking a medicine. This helps your provider figure out the most effective dose for you. Once that dose is determined, you may be tested regularly to make sure the medicine is still effective without being harmful.
An introduction to the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames by Director Professor Rosalind Raine
Improving children and their families experience of the cancer care pathwayUCLPartners
Presentation by Zoe Berger, Joint Chair of the London Cancer Patient Experience Sub Group, at the Teenager and Young Adults Study Day, held on 25 July 2013.
Audit of TYA cancer patient's views on supportive services offered by UCLHUCLPartners
Presentation by patient representatives Aaron Eglin and Benjamin Wilson at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
TYA and Adult Late Effects Service at UCLHUCLPartners
Presentation by Victoria Grandage of University College London Hospitals NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
Transition: paediatric to TYA to adult follow up services - a nursing perspe...UCLPartners
Presentation by Susan Mehta of University College London Hospitals NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
Presentation by Sara Portnoy of University College London Hospitals NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
TYA Cancer Care in the North Thames NetworkUCLPartners
Presentation by North Thames Teenager and Young Adults Cancer Network Coordinating Group Co-Chair Rachael Hough at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
Presentation by Mike Groszmann of University College London Hospitals NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
Update on local and national survivorship initiativesUCLPartners
Presentation by Gill Levitt of Great Ormond Street Hospital for Children NHS Foundation Trust at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
North Thames Children's Cancer Network Coordinating GroupUCLPartners
Presentation by Darren Hargrave, Co-Chair of the North Thames Children's Cancer Network Coordinating Group at the London Cancer Children, Teenager and Young Adults Study Day, held on 25 July 2013.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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2. Preliminary results February 2010
• Patients eligible for study 2522
• Deaths in induction 25
• Non-relapse deaths 82
• Relapses 124
• Patients randomised
408 high risk, 521 low risk
3. Preliminary results continued
High risk
2 years 92.9%, 3 years 90.5%, 4 years 87.4%, 5
years 86.1%
Low risk
2 years 99%, 3 years 98.7%, 4 & 5 years 98.4%
Other
2 years 93.8%, 3 years 92.7%, 4 years 92.2%, 5
years 91.5%
4. UKALL 2011
• Phase III randomised trial for patients
with Acute Lymphoblastic Leukaemia
(ALL) and Lymphoblastic Lymphoma
(LBL) aged 1-25 years
• Recruitment target: 2640 patients
• Opened 26th April 2012
5. UKALL 2011 OBJECTIVES
• To reduce toxicity through introduction of a short 14-
day course of high dose dexamethasone in lieu of the
conventional lower dose given for 28 days in induction
• To provide more effective CNS prophylaxis and
reduce burden of therapy through introduction of high
dose methotrexate and by omission of vincristine and
dexamethasone pulses and continuing intrathecal
therapy in maintenance
• To decrease toxicity and reduce burden of therapy by
administering a single delayed intensification to all
patients and limiting augmented therapy to those who
are not MRD Low Risk.
7. INCLUSION CRITERIA (R1)
• Patients from age 1 (first birthday) to 24 years 364
days (at time of diagnosis) with a first diagnosis of
acute lymphoblastic leukaemia (ALL) or
lymphoblastic lymphoma (LBL) diagnosed using
standard criteria
• Written informed consent
• Negative pregnancy test within 2 weeks prior to
starting treatment for female patients of
childbearing potential
8. EXCLUSION CRITERIA (R1)
• Infants less than a year old at diagnosis
• Patients diagnosed with B-ALL (Burkitt-like, t(8;14),
L3 morphology, SMIg positive)
• Patients diagnosed with Philadelphia-positive ALL
• Patients in whom written informed consent has not
been obtained from parents and/or patients prior to
randomisation
9. EXCLUSION CRITERIA (R1) CONTD.
• Patients who have received previous
treatment for ALL or LBL
– EXCEPTION: patients who have received
dexamethasone treatment for no more than 7
days (due to clinical urgency) immediately
prior to randomisation
• Patients who are sexually active and
unwilling to use adequate contraception
during therapy and for one month after last
trial treatment
10. INDUCTION
Standard induction treatment:
• 3 drug induction (Regimen A)
• 4 drug induction (Regimen B)
• Allocated by clinician based on risk group
determined by factors such as disease type,
(T-ALL, LBL), age, cytogenetics, Down’s
sydndrome etc.
• Induction lasts 5 weeks for all patients
R1 will test different dexamethasone dosing
11. B-CELL PRECURSOR ALL
(BCP ALL)
• NCI Standard Risk
– Patients aged ≥ 1 year and <10 years at
diagnosis and with a highest WCC count
before starting treatment of <50x109/L
RECEIVE REGIMEN A INDUCTION
• NCI High Risk
– Patients aged ≥10 years at diagnosis
and/or with a diagnostic WCC ≥50x109/L
RECEIVE REGIMEN B INDUCTION
12. T-CELL ALL AND ADVANCED
LBL
• All patients with T-cell ALL receive
REGIMEN B INDUCTION
• All patients with LBL receive
REGIMEN B INDUCTION
13. DOWN’S SYNDROME PATIENTS
• All DS patients receive REGIMEN A
induction
• If Day 15 bone marrow shows a slow early
response (≥25% blasts at day 15) and in
absence of serious morbidity, DS patients
switch to Regimen C induction on day 15.
• Not eligible for R2
• Guidelines for further treatment
14. Minimal residual disease (MRD)
• 10% - 15% of good risk children will relapse
• Strongest predictor of outcome is response to therapy
• New ALL 1012 malignant cells
Remission <5% blasts = 1010 undetectable cells
• MRD 100 fold increase in sensitivity
• Predict those that could be cured with less therapy
• Identify those at high risk of relapse that may benefit from more therapy
15. R1 RANDOMISATION
• All patients randomised to receive
either:
– Standard dexamethasone
• 6mg/m2/day for 28 days
– Short dexamethasone
• 10mg/m2/day for total of 14 days
• Split dosing for patients aged ≥ 10 years
16. DAY 8/15 BONE MARROW
• BM test on day 8 for all ALL patients
• BM test of day 15 for Regimen A
patients whose bone marrow show
>25% blasts on day 8.
• Day 8/15 result used to stratify
treatment in cases of MRD failure/No
result.
17. DAY 29
• Minimal Residual Disease (MRD) Test
for ALL patients.
– MRD sample sent to MRD laboratory as
per protocol
• Tumour volume assessment for LBL
patients
• Further treatment allocated based on
result of day 29 test.
18. DAY 29 – ALL PATIENTS
• MRD Low Risk
– MRD <0.005%
– Continue Regimen A or B as previous
assigned
– No further MRD measurement
– Eligible for R2
R2 randomisation should be performed as soon
as possible after obtaining day 29 MRD Result
and after Informed Consent obtained.
19. DAY 29 – ALL PATIENTS
• MRD Risk
– MRD ≥0.005%
– Receive Regimen C consolidation
– Week 9 MRD Test (result not given to
clinician)
– Further MRD measurement upon recovery
from consolidation at week 14
Await week 14 MRD Result
20. WEEK 14 MRD
For MRD Risk Patients:
• MRD Intermediate Risk
– MRD <0.5%
– CONTINUE REGIMEN C
R2 randomisation should be performed as soon as possible after
obtaining Week 14 MRD Result and after Informed Consent
obtained.
• MRD High Risk
– MRD≥0.5%
– Taken off UKALL 2011 protocol treatment
21. DAY 29 – ALL PATIENTS
• MRD No Result
– Inadequate sample or no MRD marker
– Approx 7% patients
– Further therapy determined by early response as
assessed by morphology:
• Slow Early Response (SER): Receive regimen C
consolidation and continue Regimen C
• Rapid Early Response (RER): continue Regimen
A or B as assigned for induction.
No further MRD required. Perform R2 randomisation as
soon as possible
22. R2 RANDOMISATION
• Factorial randomisation affecting
treatment in 2 phases:
– Interim maintenance phase
– Maintenance phase
• Inclusion in the second part of the trial
requires consent to participate in both
elements of R2.
23. R2 RANDOMISATION – IM
PHASE
• Patients randomised to received
either:
– Standard Interim Maintenance
• For Reg C patients this is Capizzi Interim
Maintenance
or
– High dose methotrexate
• For Regimen A/B: Protocol M
• For Regimen C: Protocol M-A
24. AALL0232: DH vs. PH in
Patients 1-9.99 Years Old
Winick, ASCO 2011
Interaction between
steroid and MTX
questions, so outcome
examined on the
superior HD MTX arm
25. R2 RANDOMISATION – MAINTENANCE
PHASE
• Patients randomised to received either:
– Maintenance with pulses
• This is the standard maintenance treatment for
patients with ALL
• Patients receive ‘pulses’ of dexamethasone
and vincristine
– Maintenance without pulses
• Experimental arm with removal of the ‘pulses’
normally given in the maintenance phase of
treatment
27. EXCLUSION CRITERIA (R2)
• MRD High Risk ALL patients and LBL patients with
a poor response
• Patients with significant renal impairment (renal
function outside of normal limits corrected for age),
pleural effusion or ascites
• Previous history of methotrexate encephalopathy
• MRD Intermediate Risk patients with history of
pancreatitis
28. EXCLUSION CRITERIA (R2)
CONTD.
• Candidates for allogeneic SCT in CR 1
• Down’s syndrome patients
• Prior cranial irradiation
• M3 marrow at day 29
29. IMPS IN UKALL 2011
Phase of treatment Regime
n
IMP Formulation
Induction A,B,C dexamethasone Tablets or syrup (or
injection#)
Standard Interim
Maintenance
A,B dexamethasone
vincristine
mercaptopurine
oral methotrexate
intrathecal
methotrexate
Tablets or syrup
Injection
Tablets or IMP oral
suspension
Tablets or IMP oral
suspension
Injection
Protocol M A,B mercaptopurine
intravenous
methotrexate
intrathecal
methotrexate
Tablets or IMP oral
suspension
Injection
Injection
Capizzi Maintenance C vincristine
intravenous
methotrexate
pegaspargase /
crisantaspase*
intrathecal
methotrexate
Injection
Injection
Injection
Injection
Protocol M-A C mercaptopurine
intravenous
methotrexate
intrathecal
methotrexate
pegaspargase /
crisantaspase*
Tablets or IMP oral
suspension
Injection
Injection
Injection
Maintenance A,B,C vincristine
dexamethasone
intrathecal
methotrexate
Injection
Tablets or syrup
Injection
30. RECRUITMENT TO R1
• 304 patients randomised as of 23.06.2013
• 233 patients randomised at data freeze DMC
(29.04.13)
– 223 ALL, 10 LBL
– 86 potential patients have not entered the trial
• 6 patients were not eligible
• 5 patients were not recruited due to staff shortages
• 75 due to patient parent or clinician preference
Randomisation rate 233/313 =74%
31. Reasons For Refusal OF
R1
0 2 4 6 8 10 12
No reason given
Parents wanted standard treatment
Language barrier
Unable to make a decision so soon after diagnosis
Unhappy with risks in PIS
No reason given
Patient wanted standard treatment
Didn't want to participate without information on outcomes
Language barrier - not ethical to obtain consent
Short dex would be inadequate treatment due to size of mass
Shared Care centre not open near patient
ParentdecisionPatientdecisionClinicaldecision
33. RECRUITMENT TO R2
• 173 screened for R2 to date
– 7 ineligible (2 Ph 3 MTX
encephalopathy)
– 48 patients declined
– 7 unknown
– 111 patients randomised
Randomisation rate 111/173 =64%
34. Reasons For Refusal
of R2
Reason N %
Logistics of HD MTX 10 48%
Toxicity of MTX 3 14%
Parent choice reason not stated 5 23%
Didn’t want reduced therapy 3 14%
35. Day 29 MRD results
• 232 patients reported to CRCTU at day 29
– 33 ‘missing data’
– 92 MRD Risk (46%)
– 95 MRD Low Risk (54%)
– 12 MRD No Result (6%)
• 2 inadequate at diagnosis 1 inadequate at
day 29
• 6 no targets 3 not to QR (oligoclonal)
• 2 MRD High Risk Cytogenetics (1%)
– 0 T-cell patient with MRD ≥ 10% (0%)
36. Week 14 MRD results
• 62 patients reported to
CRCTU at week 14
– 1 MRD High Risk (2%)
– 59 MRD Intermediate Risk (94%)
– 2 MRD No Result (4%)
• 1 inadequate sample
• 1 not to QR
38. POSCU’s
• All R&D’s at POSCU’s contacted
• Site contract agreement & CV and GCP
training by lead clinical and pharmacist
• Site Initiation Teleconference -28th August
• karen.howe@gosh.nhs.uk
• megan.wight@gosh.nhs.uk
39. Serious Adverse Events
• Please report within 24hours of admission
• Proforma for reporting emailed out
• saes.gosh.nhs.net