James Michael Kilgour
Affiliate, Department Funds
Resident in Dermatology
Bio
James grew up in Oxford in the United Kingdom. He graduated from Cardiff University School of Medicine with honours in 2017, and has a BSc in Medical Education. Following graduation, he completed two years as a clinical academic in Dermatology at the University of Oxford, conducting research investigating patient-reported outcome measures and quality of life in patients with Graft-versus-Host-Disease following allogenic stem cell transplant. He subsequently completed a two year precision medicine fellowship at the Stanford University Department of Dermatology, focusing on cutaneous oncology and hidradenitis suppurativa. He has also extensively published in medical education, and co-founded a novel peer reviewed medical journal targeted at encouraging medical students to publish and peer review. He is currently completing his residency in Dermatology at Stanford.
All Publications
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Treatment of Cutaneous Squamous Cell Carcinoma With the Topical Histone Deacetylase Inhibitor Remetinostat.
JAMA dermatology
2021
View details for DOI 10.1001/jamadermatol.2021.4549
View details for PubMedID 34787644
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Phase II Open-Label, Single-Arm Trial to Investigate the Efficacy and Safety of Topical Remetinostat Gel in Patients with Basal Cell Carcinoma.
Clinical cancer research : an official journal of the American Association for Cancer Research
2021
Abstract
PURPOSE: The mainstay of treatment for basal cell carcinoma (BCC) is surgical excision, which can result in significant associated morbidity, particularly for patients with recurrent tumors. We previously conducted a drug repositioning screen using molecular data from human BCCs and identified histone deacetylase (HDAC) inhibitors as a potential treatment for BCC. Here we conduct the first proof-of-principle study of a topical pan-HDAC inhibitor, remetinostat, in human BCC.PATIENTS AND METHODS: We conducted a phase II, open-label, single-arm, single-institution trial of a topical HDAC inhibitor. Participants with at least one BCC were recruited. All participants applied 1% remetinostat gel three times daily for 6 weeks, with measurements of tumor diameter conducted at baseline and week 8. Surgical excision of the remaining tumor was conducted at the end of the study and microscopic evaluation was performed.RESULTS: Thirty-three per-protocol tumors from 25 participants were included in the analysis. The overall response rate, defined as the proportion of tumors achieving more than 30% decrease in the longest diameter from baseline to week 8, was 69.7% [90% confidence interval (CI), 54%-82.5%]. On pathologic examination, 54.8% of tumors demonstrated complete resolution. Pharmacodynamic analysis demonstrated similar levels of acetylated histone H3 in skin tissue before and after treatment, however, phosphorylation was increased. No systemic adverse events were reported.CONCLUSIONS: The HDAC inhibitor remetinostat is a well-tolerated and effective topical treatment for reducing BCC disease burden in a clinically significant manner. This provides in-human validation of HDAC inhibitors as a therapy for BCC.
View details for DOI 10.1158/1078-0432.CCR-21-0560
View details for PubMedID 34362809
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Direct-to-Consumer Genetic Risk Scoring for Melanoma Improves Adherence to Sun-Protective Behaviors Among Increased-Risk Groups: Results from a Prospective U.S. Cohort Study.
Journal of the American Academy of Dermatology
2021
View details for DOI 10.1016/j.jaad.2021.01.042
View details for PubMedID 33476728
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"Is this the GVHD?" A qualitative exploration of quality of life issues in individuals with graft-versus-host disease following allogeneic stem cell transplant and their experiences of a specialist multidisciplinary bone marrow transplant service.
Health and quality of life outcomes
2021; 19 (1): 11
Abstract
Graft-versus-host disease (GVHD) is a significant cause of morbidity and mortality following allogeneic stem cell transplantation. These patients face unique challenges due to the complexity of GVHD which can affect multiple organ systems, and the toxicity of treatments. Despite the known impact on quality of life (QOL), qualitative data within the bone marrow transplantation (BMT) literature is rare, and there has been no qualitative work exploring patient experience of specialist healthcare provision for GVHD in the United Kingdom.We conducted a primary explorative qualitative study of the experience of QOL issues and multidisciplinary care in patients with chronic GVHD following allogeneic stem cell transplantation. Eight patients were identified using convenience sampling from specialist BMT outpatient clinics. Following consent, patients were interviewed individually via telephone. Transcripts of interviews were analyzed using an inductive thematic approach.Mean participant age was 61-years-old (range 45-68), with a mean time post-transplant of 3 years at time of interview (range 3 months-15 years). Five key QOL themes were identified: (1) 'Restricted as to what I can do'; (2) Troubling symptoms-'you can sort of get GVHD anywhere'; (3) Confusion/uncertainty over GVHD symptoms-'Is this the GVHD?'; (4) Unpredictable course and uncertainty about the future; and (5) Adapting to the sick role. In addition, four themes related to experience of service provision were identified: (1) personal care and close relationship with BMT nurses; (2) efficiency versus long waits-'On the case straight away'; (3) information provision-'went into it with a bit of a rosy view'; and (4) the role of support groups.These qualitative data reflect the heterogeneity of experiences of the GVHD patient population, reflecting the need for a flexible and nuanced approach to patient care with emphasis on comprehensive information provision. We have identified the key role that BMT specialist nurses within the multidisciplinary team play in supporting patients. We advocate future research should focus on ways to meet the complex needs of this patient group and ensure that the personal care and close relationships are not lost in service redesigns embracing remote consultations.
View details for DOI 10.1186/s12955-020-01651-2
View details for PubMedID 33413414
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Academic medicine: the continuing challenges
CLINICAL TEACHER
2020; 17 (1): 81-85
Abstract
Numbers of academic medicine trainees have been declining internationally. Many countries have taken differing approaches to improving recruitment, with some having established pathways. In the UK, the academic foundation programme (AFP) is one such pathway aimed towards those interested in an academic medical career. Variation exists amongst universities with respect to application and success rates. As a group of AFP doctors, we aimed to explore these issues. Numbers of academic medicine trainees have been declining internationally METHODS: We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP. It was evaluated via pre- and post-course questionnaires using a Likert scale, ranging from 1 to 5. We created and implemented a 1-day national course, comprising lectures and small group workshops, geared towards informing applicants about the AFP RESULTS: A total of 150 attendees were present from 16 different medical schools; 95% (143/150) of the attendees filled in both questionnaires. Attendees appeared unaware of the stages involved in the application process and felt underprepared. Following the course, learners reported median scores (with interquartile limits) that demonstrated increased overall knowledge, from 2 (1) to 4 (1) (p < 0.01), and increased preparedness, from 2 (1) to 3 (1) (p < 0.01).Our findings indicate that recruitment remains challenging, even in countries with established pathways. In the UK, the awareness of these pathways appears to be poor and courses such as ours may remedy that. Further exploration into the most effective methods to increase recruitment is necessary. The effect of institutional disparities in research culture and impact on application success needs investigation. Perhaps medical schools should introduce students to the prospect of academic careers earlier in training. Globally, efforts still need to be concentrated largely towards establishing integrated pathways.
View details for DOI 10.1111/tct.13023
View details for Web of Science ID 000509496900014
View details for PubMedID 31025798
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Systematic Review of Patient-Reported Outcome Measures in Graft-versus-Host-Disease.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
2020
Abstract
Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality after allogeneic stem cell transplantation. These patients face a unique challenge due to the complexity of GVHD and the toxicity of treatments received. GVHD has significant impact on quality of life (QOL), but this is not routinely evaluated formally. Despite the availability of patient-reported outcome measures (PROMs) to assess QOL, there is currently no consensus regarding the optimal PROMs that should be used to evaluate the impact of GVHD. We undertook a systematic review to determine the current evidence for the use of PROMs in assessment of QOL, symptom burden, and disease severity of patients with GVHD. A comprehensive systematic review based on the COSMIN guidelines was conducted to identify studies using PROMs (including those for QOL and symptom burden) in acute and chronic GVHD (cGVHD) patients. The following databases were searched: OVID Medline, AMED, CINAHL, Embase, PROQOLID, ProQuest, PsychINFO, and Social Sciences Citation Index from inception to May 2018. Hand searches updated the search to December 2018. Articles were screened by 2 independent reviewers, with discrepancies resolved by a third independent reviewer. Included articles were critically appraised using the COSMIN Risk of Bias tool, and relevant data on measurement properties for the included PROMs were extracted from within the target population. A total of 4545 articles were identified, and 64 articles reporting on 27 PROMs were included in this review. PROMs were separated into 5 groups; generic patient-reported measures (n = 7), cancer-specific measures (n = 4), bone marrow transplant-specific measures (n = 2), cGVHD-specific measures (n = 4), and dimension-specific measures (n = 10). Three PROMs (Human Activity Profile, Lee Symptom Scale, National Institutes of Health Eleven Point Scale) had evidence to support strong reliability (including internal consistency), responsiveness, and aspects of validity within the cGVHD population. Only 5 included PROMs were used in patients with acute GVHD. This review summarizes the current evidence regarding the use of 27 included PROMs in the context of GVHD. The choice of the most optimal PROM depends on the clinical or research context of use. Future research should comprehensively validate these tools in the GVHD population, including the testing and possible development of a PROM for use in acute GVHD, which remains a current critical gap in the existing literature.
View details for DOI 10.1016/j.bbmt.2020.01.022
View details for PubMedID 32028026
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A five-year review of quality of reporting of research using clinician surveys in high-ranked dermatology journals
BRITISH JOURNAL OF DERMATOLOGY
2019; 181 (4): 845-847
View details for DOI 10.1111/bjd.17942
View details for Web of Science ID 000474744900001
View details for PubMedID 30920644
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Power of the patient voice in medical education
CLINICAL TEACHER
2016; 13 (6): 451-453
View details for DOI 10.1111/tct.12487
View details for Web of Science ID 000389761800013
View details for PubMedID 26749474
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Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear
INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY
2016; 89: 6-12
Abstract
Otitis media with effusion (OME) is a common cause of hearing loss and possible developmental delay in children, and there are a range of 'preference sensitive' treatment options. We aimed to evaluate the attitudes and beliefs of parents of affected children to treatment options including watchful-waiting, hearing aids, grommets, and, oral steroids with the intention of developing our understanding of decision-making and the factors influencing it, sources of parental information, and satisfaction with information provision.We recruited a convenience sample of twelve parents of eleven children with OME at a single ENT department of a teaching hospital into a qualitative research study. The children of the parents interviewed had already been recruited into the Oral Steroids for the Resolution of Otitis Media with effusion In Children (OSTRICH) study. Semi structured interviews were audio recorded, transcribed and then coded using an inductive, thematic approach.Parents were satisfied with the verbal provision of information during the treatment consultation, although many were keen to receive supplementary printed information. Discussion with family and friends helped the decision-making process, whereas insufficient information and a paternalistic approach were viewed as obstacles. Parents were particularly influenced by the following: the immediacy of the treatment option effect, perceived efficacy, perceived risks and adverse effects, social implications (especially with hearing aids) and past personal and informant experience.Parents appreciate clinicians tailoring information provision to parents' information needs and preferred format. Clinicians should also elicit parental attitudes towards the different management options for OME and the factors influencing their decisions, in order to optimise shared-decision making and ultimately provide a better standard of clinical care.
View details for DOI 10.1016/j.ijporl.2016.07.021
View details for Web of Science ID 000383933500002
View details for PubMedID 27619020
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An investigation into the optimal number of distractors in single-best answer exams
ADVANCES IN HEALTH SCIENCES EDUCATION
2016; 21 (3): 571-585
Abstract
In UK medical schools, five-option single-best answer (SBA) questions are the most widely accepted format of summative knowledge assessment. However, writing SBA questions with four effective incorrect options is difficult and time consuming, and consequently, many SBAs contain a high frequency of implausible distractors. Previous research has suggested that fewer than five-options could hence be used for assessment, without deterioration in quality. Despite an existing body of empirical research in this area however, evidence from undergraduate medical education is sparse. The study investigated the frequency of non-functioning distractors in a sample of 480 summative SBA questions at Cardiff University. Distractor functionality was analysed, and then various question models were tested to investigate the impact of reducing the number of distractors per question on examination difficulty, reliability, discrimination and pass rates. A survey questionnaire was additionally administered to 108 students (33 % response rate) to gain insight into their perceptions of these models. The simulation of various exam models revealed that, for four and three-option SBA models, pass rates, reliability, and mean item discrimination remained relatively constant. The average percentage mark however consistently increased by 1-3 % with the four and three-option models, respectively. The questionnaire survey revealed that the student body had mixed views towards the proposed format change. This study is one of the first to comprehensively investigate distractor performance in SBA examinations in undergraduate medical education. It provides evidence to suggest that using three-option SBA questions would maximise efficiency whilst maintaining, or possibly improving, psychometric quality, through allowing a greater number of questions per exam paper.
View details for DOI 10.1007/s10459-015-9652-7
View details for Web of Science ID 000379168800006
View details for PubMedID 26597452
View details for PubMedCentralID PMC4923093
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Founding an undergraduate society: a student-led initiative to improve dermatology education
BRITISH JOURNAL OF DERMATOLOGY
2016; 174 (6): 1415-1416
View details for DOI 10.1111/bjd.14473
View details for Web of Science ID 000378047100047
View details for PubMedID 26873769
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A Rapid Review of the Factors Affecting Healthcare Students' Satisfaction with Small-Group, Active Learning Methods
TEACHING AND LEARNING IN MEDICINE
2016; 28 (1): 15-25
Abstract
PHENOMENON: Problem-based learning (PBL) and other small-group, active learning methodologies have been widely adopted into undergraduate and postgraduate healthcare curricula across the world. Although much research has examined student perceptions of these innovative teaching pedagogies, there are still questions over which factors influence these views. This article aims to identify these key elements that affect healthcare student satisfaction with PBL and other small-group learning methods, including case-based and team-based learning.A systematic rapid review method was used to identify high-quality original research papers from the healthcare education literature from between 2009 and 2014. All papers were critically appraised before inclusion in line with published guidelines. Narrative synthesis was achieved using an inductively developed, thematic framework approach.Fifty-four papers were included in the narrative synthesis. The evidence suggests that, despite an initial period of negative emotion and anxiety, the perspectives of healthcare students toward small-group, active learning methods are generally positive. The key factors influencing this satisfaction level include (a) the facilitator role, (b) tutorial structure, (c) individual student factors, (d) case authenticity, (e) increased feedback, (f) group harmony, and (g) resource availability. Insights: Student satisfaction is an important determinant of healthcare education quality, and the findings of this review may be of value in future curriculum design. The evidence described here suggests that an ideal curriculum may be based on an expert-led, hybrid PBL model.
View details for DOI 10.1080/10401334.2015.1107484
View details for Web of Science ID 000368713700002
View details for PubMedID 26787081
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Conflicts of interest in dermatology: a medical student and mentor perspective
BRITISH JOURNAL OF DERMATOLOGY
2015; 173 (6): 1518-1521
Abstract
Conflict of interest (COI) in medicine is well defined, but is seldom discussed in the field of dermatology. This perspective sheds light on this topic in dermatology and provides suggestions on how better to approach COI in medical school and residency.
View details for DOI 10.1111/bjd.14225
View details for Web of Science ID 000367232300075
View details for PubMedID 26708549
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Comments on "Shame, guilt, and the medical learner'
MEDICAL EDUCATION
2015; 49 (12): 1272
View details for DOI 10.1111/medu.12827
View details for Web of Science ID 000365720300015
View details for PubMedID 26611192
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The medical student view of curriculum change
CLINICAL TEACHER
2014; 11 (7): 559-560
View details for DOI 10.1111/tct.12189
View details for Web of Science ID 000213008900015
View details for PubMedID 25417988
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Impact of postoperative non-steroidal anti-inflammatory drugs on adverse events after gastrointestinal surgery
BRITISH JOURNAL OF SURGERY
2014; 101 (11): 1413-1423
Abstract
Recent evidence has suggested an association between postoperative non-steroidal anti-inflammatory drugs (NSAIDs) and increased operation-specific complications. This study aimed to determine the safety profile following gastrointestinal surgery across a multicentre setting in the UK.This multicentre study was carried out during a 2-week interval in September-October 2013. Consecutive adults undergoing elective or emergency gastrointestinal resection were included. The study was powered to detect a 10 per cent increase in major complications (grade III-V according to the Dindo-Clavien classification). The effect of administration of NSAIDs on the day of surgery or the following 2 days was risk-adjusted using propensity score matching and multivariable logistic regression to produce adjusted odds ratios (ORs). The type of NSAID and the dose were registered.Across 109 centres, early postoperative NSAIDs were administered to 242 (16·1 per cent) of 1503 patients. Complications occurred in 981 patients (65·3 per cent), which were major in 257 (17·1 per cent) and minor (Dindo-Clavien grade I-II) in 724 (48·2 per cent). Propensity score matching created well balanced groups. Treatment with NSAIDs was associated with a reduction in overall complications (OR 0·72, 95 per cent confidence interval 0·52 to 0·99; P = 0·041). This effect predominantly comprised a reduction in minor complications with high-dose NSAIDs (OR 0·57, 0·39 to 0·89; P = 0·009).Early use of NSAIDs is associated with a reduction in postoperative adverse events following major gastrointestinal surgery.
View details for DOI 10.1002/bjs.9614
View details for Web of Science ID 000342911600013
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Comments on "Defining professionalism in medical education: A systematic review"
MEDICAL TEACHER
2014; 36 (6): 545-546
View details for DOI 10.3109/0142159X.2014.909019
View details for Web of Science ID 000336908900016
View details for PubMedID 24786975