Daben Dawam - Academia.edu (original) (raw)
Papers by Daben Dawam
Objective: The objective of this study was to measure and describe the national patient experienc... more Objective: The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy-Pathway Assessment Tool (C-PAT). Patients and Methods: A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C-PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi-square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open-text responses in the C-PAT tool were analysed and coded using NVivo software. Results: In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (p < 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% (n = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres.
Annals of the Royal College of Surgeons of England, May 24, 2024
Journal of Clinical Oncology, Feb 20, 2021
236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided rad... more 236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided radiotherapy have revolutionized radiotherapy delivery. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities remain a significant issue. Currently there is no European consensus on the timing of high-dose rate (HDR) brachytherapy in relation to EBRT. Schedules of HDR boost before or after EBRT vary significantly between institutions.The incidence of GI and GU toxicities was assessed in patients receiving HDR brachytherapy before and after EBRT. Methods: Men with Intermediate/high risk localized prostate cancer were randomized to Arm A (HDR brachytherapy before EBRT) or Arm B (HDR brachytherapy after EBRT). Both arms received a HDR boost of 15Gy and 46Gy in 23 fractions of EBRT. All patients received neoadjuvant and adjuvant hormone therapy for up to 2 years. Patients were followed quarterly up to a year. CTCAE scores for GU and GI toxicities were taken. IPSS, IEFL and FACT-P scores were collected. Fisher’s exact test was used to analyze the association between GU and GI toxicities. The T-test compared the mean differences in IPSS total scores at each follow-up. Analysis of variance evaluated the difference at follow up. Post-hoc testing and Bonferroni correction was applied. Results: 100 patients were randomized between 2015 and 2017. Data for 88 patients was available at cutoff. Mean age was 69 years (SD: 4.6). Age, Gleason score, TNM and clinical staging were similar in each arm. Mean IPSS Score was similar between both arms at baseline Arm A (6.52) &amp; Arm B (6.57). 12 months follow up showed mild worsening of symptoms in both arms, but no significant difference noticed between Arm A (8.02) &amp; Arm B (8.14) p=0.55. At 12 months, Grade 1 and 2 GU toxicities were more frequent in Arm A (22.88% &amp; 5.28%, p=0.669) compared to Arm B (19.36% and 2.64%, p=0.485). Grade 1 GI toxicity was more common in Arm B (23.76%) than Arm A (21.2%), p=0.396. Grade 2 GI toxicities were more common in Arm A 5.28% vs 3.52%, p=0.739. Baseline mean IIEF scores were 10.9 and 10.53 in Arm A and B respectively. At 12 months this was 6.6 in Arm A and 7.11 in Arm B, but not statistically significant. FACT-P scores were not different in either arm, with good QOL scores maintained throughout. Mean score at baseline (125.18) was observed to be similar at 12 months follow up at (126.10). The PTV, CTV &amp; OAR dose were compared and no significant differences were found. Conclusions: There were no significant differences in GI and GU related toxicities up to a year between patients receiving HDR brachytherapy before or after EBRT. There were no grade 3 or 4 toxicities. Treatment was well tolerated in both arms with good QOL scores. Longer follow up and a phase III multicenter RCT would be needed to validate findings. Clinical trial information: NCT02618161.
European Urology Supplements, 2005
BJU International, 2008
Objective To study the aetiological factors and clinical presentation of haematuria as seen in a ... more Objective To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. Patients and methods The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7‐year period from 1985 to 1991. Results Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6–80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto‐urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). Conclusion Recurrent haematuria in patients over 30 years of age in this e...
Journal of Clinical Oncology, Feb 20, 2023
Background: The aim if this single institute UK-based study was to look at 3-year and 5-year bRFS... more Background: The aim if this single institute UK-based study was to look at 3-year and 5-year bRFS and toxicity profiles. Methods: It is a prospective data study with a total number of 174 patients who were treated with single-fraction HDR monotherapy between July 2014 and February 2017. Biochemical recurrence is defined using Phoenix criteria. Results: The median age was 67.5 years with the median presenting PSA of 8. Majority of patients were lower risk group with 55% for combined low and favourable intermediate risks. 81 patients had Gleason score 6(3+3) and 77 patients had GS 7(3+4). Total hormone duration was 8 months and median duration of hormone prior to HDR monotherapy was 4 months. Overall bRFS at 3 years was 96% and 5 years was 88%. 5-year bRFS as per risk stratification was 100% in low risk, 92% in favourable intermediate risk, 83% in unfavourable intermediate risk and 79% in high-risk groups. This study had better 5-year overall bRFS compared to published data in single fraction HDR monotherapy (88% vs 73.5%, p value 0.001) (Morton et al., 2020). Despite inferior 5-year overall bRFS in compared to 2-fractionated HDR monotherapy (88% vs 95%) (p value 0.001), no difference in 5-year bRFS noted in low and favourable intermediate risk groups (100% vs 100% and 92% vs 93% respectively) (Morton et al., 2020). Two-thirds (71%) of biochemically recurred patients found to have local recurrence disease. The median time of biochemical recurrence was 47 months. Higher risk groups had higher 5-year biochemical recurrence risk. Acute and late toxicity profiles were minimum with acute G2 GU toxicity (2%) and GI toxicity (1%); late G2 GU toxicity (2%) and GI toxicity (0%) with no G3, G4 GU or GI toxicities. Conclusions: This prospective study had shown better overall 5-year bRFS especially in low and favourable intermediate risk groups with minimal toxicities. Therefore, single-fraction HDR monotherapy could be considered for elderly or patients with significant comorbidities who are more suitable for single treatment rather than 2 fractions in these risk groups. Further randomised multicentre studies in these risk groups are suggested.
While urine cytology is a specific test (from 90 percent-100 percent), its sensitivity is lower, ... more While urine cytology is a specific test (from 90 percent-100 percent), its sensitivity is lower, ranging from 50 percent-60 percent overall and is considered even lower for low-grade tumours. Therefore, there has been interest in identifying tumour markers in voided urine that would provide a more sensitive and objective test for tumour recurrence.
Tropical Doctor, 1993
Greenhalg T. Drug prescription and self-medication in India: an exploratory survey. Soc Sci Med 1... more Greenhalg T. Drug prescription and self-medication in India: an exploratory survey. Soc Sci Med 1987;25:307-18 2 Hardon AP. The use of modern pharmaceuticals in a Fillipino village: doctors' prescriptions and self-medication. Soc Sci Med 1987;25:277-92 3 Rashid HU, Chowdhury SAR, Islam N. Pattern of antibiotic use in two teaching hospitals. Trop Doct 1986;16:152-4 4 Laing RO. Rational drug use: an unsolved problem. Trop Doct 1990;20:101-3
East African medical journal
Very little had been reported about childhood appendicitis from Africa. This retrospective report... more Very little had been reported about childhood appendicitis from Africa. This retrospective report comprises two parts. One part is an overview of appendicitis in 207 children operated upon between January, 1981 and December, 1990 and the other involved a detailed study of 44 patients seen in the last 2 years of that decade. Overall, there were 135 males and 72 females, aged 4 years and younger than 15 years. 78 children were operated upon between 1989 and 1990 and only the records of 44 patients had detailed enough information for inclusion in this study. The common symptoms of appendicitis in children were: vague abdominal pain, vomiting, constipation and fever. The common signs were high grade pyrexia, dehydration, generalized or localized abdominal tenderness. In the larger group, 105 patients presented with perforation, 47 with gangrene, only 26.6% presented with uncomplicated appendicitis. In the smaller group 45.5% presented with perforation, 8 patients had wound infection. Four patients died; giving a mortality of 9%.
Tropical Doctor
Between 1982 and 1994 13 patients have needed surgery for priapism persisting after conservative ... more Between 1982 and 1994 13 patients have needed surgery for priapism persisting after conservative measures using the technique described by Quackel.
British Journal of Urology
nine children with no diBculty, the last being 4 years Case reports earlier. Examination showed a... more nine children with no diBculty, the last being 4 years Case reports earlier. Examination showed a woman of average nutrition and no other abnormalities. The swelling in the A 40-year-old woman presented with a 10-year history of swelling in the left groin which began as a small left groin (Fig. 1) was 15×10 cm, had no visible or palpable pulse, was not reducible and was attached by a swelling and gradually increased over that period, but remained asymptomatic. There was no change in the size narrow pedicle to the underlying structures. Exploration of the swelling showed that it contained straw-coloured of the swelling when recumbent. She had given birth to fluid and arose from the canal of Nuck (Fig. 2). Five litres of fluid were aspirated and the pedicle and sac excised easily; the wound was closed in layers, with a corrugated drain. The patient was seen 3 months later and had a normal skin contour in the groin, and a light incision scar.
Anaesthesia and Intensive Care
Journal of Clinical Urology
IntroductionIn the United Kingdom, radiotherapy as opposed to cystectomy has been the preferred t... more IntroductionIn the United Kingdom, radiotherapy as opposed to cystectomy has been the preferred treatment modality in invasive bladder cancer [Bower M, Ma R, Savage P, Abel P, Waxman J. British urological surgery practice. 2. Renal, bladder and testis cancer. BJU 1998;81:513–7]. However, there appears to have been a recent shift from this approach in favour of radical cystectomy. Against this background, we conducted to postal survey of all full UK urologists to ascertain their practice.The aim of the study was to find out about the current practice of management of muscle invasive bladder cancer in the UK, in particular the shift from radiotherapy to radical surgery as the preferred method of treatment.Material and methodsA 19-point questionnaire on management of muscle invasive bladder cancer was posted to all UK based full BAUS members.Results478 questionnaires were sent and 139 valid responses received. Ninety percent used CT as the staging investigation; only 43% requested a bo...
Annals of tropical paediatrics, 1999
The complications of traditional male circumcision were studied in 48 boys seen between January 1... more The complications of traditional male circumcision were studied in 48 boys seen between January 1981 and December 1995. Their ages ranged from 3 days to 7 years (mean: 4 years). Haemorrhage, the commonest complication, was seen in 25 (52%) and infection in ten; one child had amputation of the penis. Other complications included meatal stenosis and urethro-cutaneous fistula. Sixty-four per cent of those with haemorrhage were neonates and their haemoglobin levels ranged between 6 and 15 g/dl. Three required blood transfusion, seven ligation of bleeding vessels and two required both. Overall, 21 patients required surgery and the average duration of hospital stay was 2-8 days. Most complications were seen between 1991 and 1995 when surgical fees had been introduced and the number of boys circumcized in our hospital decreased. We advocate the provision of adequate and safe facilities to cope with the increasing demand for circumcision in our society.
UroToday International Journal, 2011
Bladder Cancer - From Basic Science to Robotic Surgery, 2012
Objective: The objective of this study was to measure and describe the national patient experienc... more Objective: The objective of this study was to measure and describe the national patient experience of radical cystectomy (RC) pathways in the UK using the validated Cystectomy-Pathway Assessment Tool (C-PAT). Patients and Methods: A cohort of 1081 patients who underwent RC for bladder cancer, between 1 January 2021 and 31 July 2022 at 33 UK cystectomy centres, returned completed C-PAT responses. SPSS was employed for data summary statistics, including median, interquartile range, Mann Whitney U test or Chi-square test with a 95% confidence interval to assess statistical significance between potentially associated variables. Open-text responses in the C-PAT tool were analysed and coded using NVivo software. Results: In this cohort, the greatest perceived delay in the RC pathway, reported by 19% of patients (n = 208), was at the GP consultation to first hospital referral stage with suspected bladder cancer. Around 10% of patients perceived delays at each of the other stages in their pathway. Cancer nurse specialist (CNS) contact was strongly associated with an improved patient experience (p < 0.001); however, 9.5% of patients reported that they were not assigned a cancer nurse specialist in their pathway. Overall, 96% (n = 1028) reported their experience of RC pathway care to be good or excellent. There were no significant differences in reported patient experience found between cystectomy centres.
Annals of the Royal College of Surgeons of England, May 24, 2024
Journal of Clinical Oncology, Feb 20, 2021
236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided rad... more 236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided radiotherapy have revolutionized radiotherapy delivery. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities remain a significant issue. Currently there is no European consensus on the timing of high-dose rate (HDR) brachytherapy in relation to EBRT. Schedules of HDR boost before or after EBRT vary significantly between institutions.The incidence of GI and GU toxicities was assessed in patients receiving HDR brachytherapy before and after EBRT. Methods: Men with Intermediate/high risk localized prostate cancer were randomized to Arm A (HDR brachytherapy before EBRT) or Arm B (HDR brachytherapy after EBRT). Both arms received a HDR boost of 15Gy and 46Gy in 23 fractions of EBRT. All patients received neoadjuvant and adjuvant hormone therapy for up to 2 years. Patients were followed quarterly up to a year. CTCAE scores for GU and GI toxicities were taken. IPSS, IEFL and FACT-P scores were collected. Fisher’s exact test was used to analyze the association between GU and GI toxicities. The T-test compared the mean differences in IPSS total scores at each follow-up. Analysis of variance evaluated the difference at follow up. Post-hoc testing and Bonferroni correction was applied. Results: 100 patients were randomized between 2015 and 2017. Data for 88 patients was available at cutoff. Mean age was 69 years (SD: 4.6). Age, Gleason score, TNM and clinical staging were similar in each arm. Mean IPSS Score was similar between both arms at baseline Arm A (6.52) &amp; Arm B (6.57). 12 months follow up showed mild worsening of symptoms in both arms, but no significant difference noticed between Arm A (8.02) &amp; Arm B (8.14) p=0.55. At 12 months, Grade 1 and 2 GU toxicities were more frequent in Arm A (22.88% &amp; 5.28%, p=0.669) compared to Arm B (19.36% and 2.64%, p=0.485). Grade 1 GI toxicity was more common in Arm B (23.76%) than Arm A (21.2%), p=0.396. Grade 2 GI toxicities were more common in Arm A 5.28% vs 3.52%, p=0.739. Baseline mean IIEF scores were 10.9 and 10.53 in Arm A and B respectively. At 12 months this was 6.6 in Arm A and 7.11 in Arm B, but not statistically significant. FACT-P scores were not different in either arm, with good QOL scores maintained throughout. Mean score at baseline (125.18) was observed to be similar at 12 months follow up at (126.10). The PTV, CTV &amp; OAR dose were compared and no significant differences were found. Conclusions: There were no significant differences in GI and GU related toxicities up to a year between patients receiving HDR brachytherapy before or after EBRT. There were no grade 3 or 4 toxicities. Treatment was well tolerated in both arms with good QOL scores. Longer follow up and a phase III multicenter RCT would be needed to validate findings. Clinical trial information: NCT02618161.
European Urology Supplements, 2005
BJU International, 2008
Objective To study the aetiological factors and clinical presentation of haematuria as seen in a ... more Objective To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. Patients and methods The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7‐year period from 1985 to 1991. Results Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6–80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto‐urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). Conclusion Recurrent haematuria in patients over 30 years of age in this e...
Journal of Clinical Oncology, Feb 20, 2023
Background: The aim if this single institute UK-based study was to look at 3-year and 5-year bRFS... more Background: The aim if this single institute UK-based study was to look at 3-year and 5-year bRFS and toxicity profiles. Methods: It is a prospective data study with a total number of 174 patients who were treated with single-fraction HDR monotherapy between July 2014 and February 2017. Biochemical recurrence is defined using Phoenix criteria. Results: The median age was 67.5 years with the median presenting PSA of 8. Majority of patients were lower risk group with 55% for combined low and favourable intermediate risks. 81 patients had Gleason score 6(3+3) and 77 patients had GS 7(3+4). Total hormone duration was 8 months and median duration of hormone prior to HDR monotherapy was 4 months. Overall bRFS at 3 years was 96% and 5 years was 88%. 5-year bRFS as per risk stratification was 100% in low risk, 92% in favourable intermediate risk, 83% in unfavourable intermediate risk and 79% in high-risk groups. This study had better 5-year overall bRFS compared to published data in single fraction HDR monotherapy (88% vs 73.5%, p value 0.001) (Morton et al., 2020). Despite inferior 5-year overall bRFS in compared to 2-fractionated HDR monotherapy (88% vs 95%) (p value 0.001), no difference in 5-year bRFS noted in low and favourable intermediate risk groups (100% vs 100% and 92% vs 93% respectively) (Morton et al., 2020). Two-thirds (71%) of biochemically recurred patients found to have local recurrence disease. The median time of biochemical recurrence was 47 months. Higher risk groups had higher 5-year biochemical recurrence risk. Acute and late toxicity profiles were minimum with acute G2 GU toxicity (2%) and GI toxicity (1%); late G2 GU toxicity (2%) and GI toxicity (0%) with no G3, G4 GU or GI toxicities. Conclusions: This prospective study had shown better overall 5-year bRFS especially in low and favourable intermediate risk groups with minimal toxicities. Therefore, single-fraction HDR monotherapy could be considered for elderly or patients with significant comorbidities who are more suitable for single treatment rather than 2 fractions in these risk groups. Further randomised multicentre studies in these risk groups are suggested.
While urine cytology is a specific test (from 90 percent-100 percent), its sensitivity is lower, ... more While urine cytology is a specific test (from 90 percent-100 percent), its sensitivity is lower, ranging from 50 percent-60 percent overall and is considered even lower for low-grade tumours. Therefore, there has been interest in identifying tumour markers in voided urine that would provide a more sensitive and objective test for tumour recurrence.
Tropical Doctor, 1993
Greenhalg T. Drug prescription and self-medication in India: an exploratory survey. Soc Sci Med 1... more Greenhalg T. Drug prescription and self-medication in India: an exploratory survey. Soc Sci Med 1987;25:307-18 2 Hardon AP. The use of modern pharmaceuticals in a Fillipino village: doctors' prescriptions and self-medication. Soc Sci Med 1987;25:277-92 3 Rashid HU, Chowdhury SAR, Islam N. Pattern of antibiotic use in two teaching hospitals. Trop Doct 1986;16:152-4 4 Laing RO. Rational drug use: an unsolved problem. Trop Doct 1990;20:101-3
East African medical journal
Very little had been reported about childhood appendicitis from Africa. This retrospective report... more Very little had been reported about childhood appendicitis from Africa. This retrospective report comprises two parts. One part is an overview of appendicitis in 207 children operated upon between January, 1981 and December, 1990 and the other involved a detailed study of 44 patients seen in the last 2 years of that decade. Overall, there were 135 males and 72 females, aged 4 years and younger than 15 years. 78 children were operated upon between 1989 and 1990 and only the records of 44 patients had detailed enough information for inclusion in this study. The common symptoms of appendicitis in children were: vague abdominal pain, vomiting, constipation and fever. The common signs were high grade pyrexia, dehydration, generalized or localized abdominal tenderness. In the larger group, 105 patients presented with perforation, 47 with gangrene, only 26.6% presented with uncomplicated appendicitis. In the smaller group 45.5% presented with perforation, 8 patients had wound infection. Four patients died; giving a mortality of 9%.
Tropical Doctor
Between 1982 and 1994 13 patients have needed surgery for priapism persisting after conservative ... more Between 1982 and 1994 13 patients have needed surgery for priapism persisting after conservative measures using the technique described by Quackel.
British Journal of Urology
nine children with no diBculty, the last being 4 years Case reports earlier. Examination showed a... more nine children with no diBculty, the last being 4 years Case reports earlier. Examination showed a woman of average nutrition and no other abnormalities. The swelling in the A 40-year-old woman presented with a 10-year history of swelling in the left groin which began as a small left groin (Fig. 1) was 15×10 cm, had no visible or palpable pulse, was not reducible and was attached by a swelling and gradually increased over that period, but remained asymptomatic. There was no change in the size narrow pedicle to the underlying structures. Exploration of the swelling showed that it contained straw-coloured of the swelling when recumbent. She had given birth to fluid and arose from the canal of Nuck (Fig. 2). Five litres of fluid were aspirated and the pedicle and sac excised easily; the wound was closed in layers, with a corrugated drain. The patient was seen 3 months later and had a normal skin contour in the groin, and a light incision scar.
Anaesthesia and Intensive Care
Journal of Clinical Urology
IntroductionIn the United Kingdom, radiotherapy as opposed to cystectomy has been the preferred t... more IntroductionIn the United Kingdom, radiotherapy as opposed to cystectomy has been the preferred treatment modality in invasive bladder cancer [Bower M, Ma R, Savage P, Abel P, Waxman J. British urological surgery practice. 2. Renal, bladder and testis cancer. BJU 1998;81:513–7]. However, there appears to have been a recent shift from this approach in favour of radical cystectomy. Against this background, we conducted to postal survey of all full UK urologists to ascertain their practice.The aim of the study was to find out about the current practice of management of muscle invasive bladder cancer in the UK, in particular the shift from radiotherapy to radical surgery as the preferred method of treatment.Material and methodsA 19-point questionnaire on management of muscle invasive bladder cancer was posted to all UK based full BAUS members.Results478 questionnaires were sent and 139 valid responses received. Ninety percent used CT as the staging investigation; only 43% requested a bo...
Annals of tropical paediatrics, 1999
The complications of traditional male circumcision were studied in 48 boys seen between January 1... more The complications of traditional male circumcision were studied in 48 boys seen between January 1981 and December 1995. Their ages ranged from 3 days to 7 years (mean: 4 years). Haemorrhage, the commonest complication, was seen in 25 (52%) and infection in ten; one child had amputation of the penis. Other complications included meatal stenosis and urethro-cutaneous fistula. Sixty-four per cent of those with haemorrhage were neonates and their haemoglobin levels ranged between 6 and 15 g/dl. Three required blood transfusion, seven ligation of bleeding vessels and two required both. Overall, 21 patients required surgery and the average duration of hospital stay was 2-8 days. Most complications were seen between 1991 and 1995 when surgical fees had been introduced and the number of boys circumcized in our hospital decreased. We advocate the provision of adequate and safe facilities to cope with the increasing demand for circumcision in our society.
UroToday International Journal, 2011
Bladder Cancer - From Basic Science to Robotic Surgery, 2012