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Bourne RRA, Moledina M, Azuara-Blanco A, Saleh GM, Self JE, Sivaprasad S, Sharma SM, Ross A, Gilbert RM, Abdalla Elsayed MEA, Moon WY, Doug M, Mulholland PJ, Day AC, Romano V, Hoad GV, Kara M, Murray A, Gow L, Ghanchi F, Patel PJ, Gale RP, Dinah C, Valentine K, Yelf C, Poustie V. The UK clinical eye research strategy: refreshing research priorities for clinical eye research in the UK. Eye (Lond) 2024:10.1038/s41433-024-03049-6. [PMID: 38806699 DOI: 10.1038/s41433-024-03049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES To validate and update the 2013 James Lind Alliance (JLA) Sight Loss and Vision Priority Setting Partnership (PSP)'s research priorities for Ophthalmology, as part of the UK Clinical Eye Research Strategy. METHODS Twelve ophthalmology research themes were identified from the JLA report. They were allocated to five Clinical Study Groups of diverse stakeholders who reviewed the top 10 research priorities for each theme. Using an online survey (April 2021-February 2023), respondents were invited to complete one or more of nine subspecialty surveys. Respondents indicated which of the research questions they considered important and subsequently ranked them. RESULTS In total, 2240 people responded to the survey (mean age, 59.3 years), from across the UK. 68.1% were female. 68.2% were patients, 22.3% healthcare professionals or vision researchers, 7.1% carers, and 2.1% were charity support workers. Highest ranked questions by subspecialty: Cataract (prevention), Cornea (improving microbial keratitis treatment), Optometric (impact of integration of ophthalmic primary and secondary care via community optometric care pathways), Refractive (factors influencing development and/or progression of refractive error), Childhood onset (improving early detection of visual disorders), Glaucoma (effective and improved treatments), Neuro-ophthalmology (improvements in prevention, diagnosis and treatment of neurodegeneration affecting vision), Retina (improving prevention, diagnosis and treatment of dry age-related macular degeneration), Uveitis (effective treatments for ocular and orbital inflammatory diseases). CONCLUSIONS A decade after the initial PSP, the results refocus the most important research questions for each subspecialty, and prime targeted research proposals within Ophthalmology, a chronically underfunded specialty given the substantial burden of disability caused by eye disease.
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Affiliation(s)
- Rupert R A Bourne
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK.
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK.
| | | | | | - George M Saleh
- Research, Cataract and Adnexal Dept, Moorfields Eye Hospital, London, UK
| | | | - Sobha Sivaprasad
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, UK
| | - Srilakshmi M Sharma
- Dept of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Ross
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
- Aswan University Hospital, Aswan, Egypt
| | - Rose M Gilbert
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | | | - Won Young Moon
- Dept of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Manjo Doug
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Pádraig J Mulholland
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Centre for Optometry & Vision Sciences, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Alexander C Day
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Ailish Murray
- Moorfields Eye Charity, Moorfields Eye Hospital, London, UK
| | - Louise Gow
- Eye care and living well services, Royal National Institute of Blind people, London, UK
| | - Faruque Ghanchi
- Bradford Teaching Hospitals, Royal Infirmary, Bradford, West Yorkshire, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Christiana Dinah
- Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK
- Brain Sciences, Imperial College London, London, UK
| | | | | | - Vanessa Poustie
- NIHR Clinical Research Network, University of Liverpool, Liverpool, UK
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2
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Ho L, Lloyd K, Taylor-Rowan M, Dawson S, Logan M, Leitch S, Quinn TJ, Shenkin SD, Parry SW, Jarman H, Henderson EJ. Comparing Research Priority-Setting Partnerships for Older Adults Across International Health Care Systems: A Systematic Review. J Am Med Dir Assoc 2023; 24:1726-1745. [PMID: 37848169 DOI: 10.1016/j.jamda.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Priority setting partnerships (PSPs) attempt to shape the research agenda to address the needs of local populations of interest. We reviewed the PSPs for older adults, with a focus on exemplar health care systems: United Kingdom (UK; publicly funded), United States (private health insurance-based), South Korea (national health insurance-based), and Africa (out-of-pocket). DESIGN Systematic review. SETTING AND PARTICIPANTS We searched databases and sources (January 2011-October 202l; updated in February 2023) for PSPs of older adults' health care. METHODS Based on the British geriatric medicine curriculum, we extracted and categorized the PSP topics by areas and the research priorities by themes, and generated evidence maps depicting and comparing the research gaps across the systems. We evaluated PSP quality using the Nine Common Themes of Good Clinical Practice. RESULTS We included 32 PSPs (United Kingdom: n = 25; United States: n = 7; South Korea and Africa: n = 0) and identified priorities regarding 27 conditions or service arrangements in the United Kingdom and 9 in the United States (predominantly in neurology/psychiatry). The UK priorities focused on treatments and interventions whereas the US on prognostic/predictive factors. There were notable research gaps within the existing PSPs, including common geriatric conditions like continence and frailty. The PSP quality evaluation revealed issues around lacking inclusion of ethnic minorities. CONCLUSIONS AND IMPLICATIONS Research priorities for older adult health care vary internationally, but certain health care systems/countries have no available PSPs. Where PSPs are available, fundamental aspects of geriatric medicine have not been included. Future researchers should conduct prioritizations in different countries, focus on core geriatric syndromes, and ensure the inclusion of all relevant stakeholder groups.
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Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | - Katherine Lloyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Martin Taylor-Rowan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Monica Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Stephanie Leitch
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Steve W Parry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Heather Jarman
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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3
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Kellett S, Rahi JS, Dick AD, Knowles R, Tadić V, Solebo AL. UNICORNS: Uveitis in childhood prospective national cohort study protocol. F1000Res 2023; 9:1196. [PMID: 38435080 PMCID: PMC10905007 DOI: 10.12688/f1000research.26689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 03/05/2024] Open
Abstract
Background: Childhood uveitis is a rare inflammatory eye disease which is typically chronic, relapsing-remitting in nature, with an uncertain aetiology (idiopathic). Visual loss occurs due to structural damage caused by uncontrolled inflammation. Understanding of the determinants of long term outcome is lacking, including the predictors of therapeutic response or how to define disease control. Aims: To describe disease natural history and outcomes amongst a nationally representative group of children with non-infectious uveitis, describe the impact of disease course on quality of life for both child and family, and identify determinants of adverse visual, structural and developmental outcomes. Methods: UNICORNS is a prospective longitudinal multicentre cohort study of children newly diagnosed with uveitis about whom a core minimum clinical dataset will be collected systematically. Participants and their families will also complete patient-reported outcome measures annually from recruitment. The association of patient (child- and treatment- dependent) characteristics with outcome will be investigated using logistic and ordinal regression models which incorporate adjustment for within-child correspondence between eyes for those with bilateral disease and repeated outcomes measurement. Discussion: Through this population based, prospective longitudinal study of childhood uveitis, we will describe the characteristics of childhood onset disease. Early (1-2 years following diagnosis) outcomes will be described in the first instance, and through the creation of a national inception cohort, longer term studies will be enabled of outcome for affected children and families.
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Affiliation(s)
- Salomey Kellett
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
| | - Jugnoo S Rahi
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
| | - Andrew D. Dick
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Translational Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, BS8 1QU, UK
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, BS1 2LX, UK
| | - Rachel Knowles
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
| | - Valerija Tadić
- School of Human Sciences, University of Greenwich, Greenwich, London, SE10 9LS, UK
| | - Ameenat Lola Solebo
- National Institute for Health Research Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, WC1N 1EH, UK
- Ulverscroft Vision Research Group, Institute of Child Health, University College London, London, WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK
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4
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Sahebjada S, Chan E, Sutton G, Pang CPC, Kerdraon Y, Natarajan S, Meteoukki W, Ang A, Daniell M, Baird PN. Keratoconus International Consortium (KIC)- advancing keratoconus research. BMC Ophthalmol 2023; 23:337. [PMID: 37501133 PMCID: PMC10375634 DOI: 10.1186/s12886-023-03087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
CLINICAL RELEVANCE The Keratoconus International Consortium (KIC) will allow better understanding of keratoconus. BACKGROUND Keratoconus is a disorder characterised by corneal elevation and thinning, leading to reduced vision. The current gaps in understanding of this disease will be discussed and the need for a multi-pronged and multi-centre engagement to enhance our understanding of keratoconus will be highlighted. DESIGN KIC has been established to address the gaps in our understanding of keratoconus with the aim of collecting baseline as well as longitudinal data on several fields. PARTICIPANTS Keratoconus and control (no corneal condition) subjects from different sites globally will be recruited in the study. METHODS KIC collects data using an online, secure database, which enables standardised data collection at member sites. Data fields collected include medical history, clinical features, quality of life and economic burden questionnaires and possible genetic sample collection from patients of different ethnicities across different geographical locations. RESULTS There are currently 40 Australian and international clinics or hospital departments who have joined the KIC. Baseline data has so far been collected on 1130 keratoconus patients and indicates a median age of 29.70 years with 61% being male. A total of 15.3% report a positive family history of keratoconus and 57.7% self-report a history of frequent eye rubbing. CONCLUSION The strength of this consortium is its international, collaborative design and use of a common data collection tool. Inclusion and analyses of cross-sectional and longitudinal data will help answer many questions that remain in keratoconus, including factors affecting progression and treatment outcomes.
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Affiliation(s)
- Srujana Sahebjada
- Centre for Eye Research Australia, Level 7, 32 Gisborne St, East Melbourne, Victoria, 3002, Australia.
- Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Australia.
| | - Elsie Chan
- Centre for Eye Research Australia, Level 7, 32 Gisborne St, East Melbourne, Victoria, 3002, Australia
- Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Gerard Sutton
- Sydney Medical School, The University of Sydney, Sydney, Australia
- NSW Tissue Banks, Sydney, Australia
| | | | - Yves Kerdraon
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Envision Eye Centre, Sydney, Australia
| | | | - Wafaa Meteoukki
- Molecular and Cellular Genetics Laboratory, Oran University of Science and Technology - Mohamed Boudiaf (USTOMB), Oran, Algeria
| | | | - Mark Daniell
- Centre for Eye Research Australia, Level 7, 32 Gisborne St, East Melbourne, Victoria, 3002, Australia
- Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Australia
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Morton RL, Tuffaha H, Blaya-Novakova V, Spencer J, Hawley CM, Peyton P, Higgins A, Marsh J, Taylor WJ, Huckson S, Sillett A, Schneemann K, Balagurunanthan A, Cumpston M, Scuffham PA, Glasziou P, Simes RJ. Approaches to prioritising research for clinical trial networks: a scoping review. Trials 2022; 23:1000. [PMID: 36510214 PMCID: PMC9743749 DOI: 10.1186/s13063-022-06928-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prioritisation of clinical trials ensures that the research conducted meets the needs of stakeholders, makes the best use of resources and avoids duplication. The aim of this review was to identify and critically appraise approaches to research prioritisation applicable to clinical trials, to inform best practice guidelines for clinical trial networks and funders. METHODS A scoping review of English-language published literature and research organisation websites (January 2000 to January 2020) was undertaken to identify primary studies, approaches and criteria for research prioritisation. Data were extracted and tabulated, and a narrative synthesis was employed. RESULTS Seventy-eight primary studies and 18 websites were included. The majority of research prioritisation occurred in oncology and neurology disciplines. The main reasons for prioritisation were to address a knowledge gap (51 of 78 studies [65%]) and to define patient-important topics (28 studies, [35%]). In addition, research organisations prioritised in order to support their institution's mission, invest strategically, and identify best return on investment. Fifty-seven of 78 (73%) studies used interpretative prioritisation approaches (including Delphi surveys, James Lind Alliance and consensus workshops); six studies used quantitative approaches (8%) such as prospective payback or value of information (VOI) analyses; and 14 studies used blended approaches (18%) such as nominal group technique and Child Health Nutritional Research Initiative. Main criteria for prioritisation included relevance, appropriateness, significance, feasibility and cost-effectiveness. CONCLUSION Current research prioritisation approaches for groups conducting and funding clinical trials are largely interpretative. There is an opportunity to improve the transparency of prioritisation through the inclusion of quantitative approaches.
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Affiliation(s)
- Rachael L. Morton
- grid.1013.30000 0004 1936 834XNational Health and Medical Research Council Clinical Trials Centre (NHMRC CTC), University of Sydney, Sydney, Australia
| | - Haitham Tuffaha
- grid.1003.20000 0000 9320 7537Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - Vendula Blaya-Novakova
- grid.1013.30000 0004 1936 834XNational Health and Medical Research Council Clinical Trials Centre (NHMRC CTC), University of Sydney, Sydney, Australia
| | - Jenean Spencer
- Australian Clinical Trials Alliance (ACTA), Melbourne, Victoria Australia
| | - Carmel M. Hawley
- grid.1003.20000 0000 9320 7537Australasian Kidney Trials Network (AKTN), Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Phil Peyton
- grid.418175.e0000 0001 2225 7841Australian and New Zealand College of Anaesthetists (ANZCA), Melbourne, Australia
| | - Alisa Higgins
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Victoria Australia
| | - Julie Marsh
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, West Perth, Australia
| | - William J. Taylor
- grid.29980.3a0000 0004 1936 7830University of Otago, Rehabilitation Teaching and Research Unit, Dunedin, New Zealand
| | - Sue Huckson
- grid.489411.10000 0004 5905 1670Australian and New Zealand Intensive Care Society (ANZICS), Camberwell, Victoria Australia
| | - Amy Sillett
- grid.467202.50000 0004 0445 3920AstraZeneca Australia, Macquarie Park, New South Wales Australia
| | - Kieran Schneemann
- Australian Clinical Trials Alliance (ACTA), Melbourne, Victoria Australia ,grid.467202.50000 0004 0445 3920AstraZeneca Australia, Macquarie Park, New South Wales Australia
| | | | - Miranda Cumpston
- Australian Clinical Trials Alliance (ACTA), Melbourne, Victoria Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Paul A. Scuffham
- grid.1003.20000 0000 9320 7537Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - Paul Glasziou
- grid.1033.10000 0004 0405 3820Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Robert J. Simes
- grid.1013.30000 0004 1936 834XNational Health and Medical Research Council Clinical Trials Centre (NHMRC CTC), University of Sydney, Sydney, Australia
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Barbeau VI, Madani L, Al Ameer A, Tanjong Ghogomu E, Beecher D, Conde M, Howe TE, Marcus S, Morley R, Nasser M, Smith M, Thompson Coon J, Welch VA. Research priority setting related to older adults: a scoping review to inform the Cochrane-Campbell Global Ageing Partnership work programme. BMJ Open 2022; 12:e063485. [PMID: 36123060 PMCID: PMC9486333 DOI: 10.1136/bmjopen-2022-063485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore and map the findings of prior research priority-setting initiatives related to improving the health and well-being of older adults. DESIGN Scoping review. DATA SOURCES Searched MEDLINE, EMBASE, AgeLine, CINAHL and PsycINFO databases from January 2014 to 26 April 2021, and the James Lind Alliance top 10 priorities. ELIGIBILITY CRITERIA We included primary studies reporting research priorities gathered from stakeholders that focused on ageing or the health of older adults (≥60 years). There were no restrictions by setting, but language was limited to English and French. DATA EXTRACTION AND SYNTHESIS We used a modified Reporting Guideline for Priority Setting of Health Research (REPRISE) guideline to assess the transparency of the reported methods. Population-intervention-control-outcome (PICO) priorities were categorised according to their associated International Classification of Health Interventions (ICHI) and International Classification of Functioning (ICF) outcomes. Broad research topics were categorised thematically. RESULTS Sixty-four studies met our inclusion criteria. The studies gathered opinions from various stakeholder groups, including clinicians (n=56 studies) and older adults (n=35), and caregivers (n=24), with 75% of the initiatives involving multiple groups. None of the included priority-setting initiatives reported gathering opinions from stakeholders located in low-income or middle-income countries. Of the priorities extracted, 272 were identified as broad research topics, while 217 were identified as PICO priorities. PICO priorities that involved clinical outcomes (n=165 priorities) and interventions concerning health-related behaviours (n=59) were identified most often. Broad research topics on health services and systems were identified most often (n=60). Across all these included studies, the reporting of six REPRISE elements was deemed to be critically low. CONCLUSION Future priority setting initiatives should focus on documenting a more detailed methodology with all initiatives eliciting opinions from caregivers and older adults to ensure priorities reflect the opinions of all key stakeholder groups.
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Affiliation(s)
| | - Leen Madani
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | | | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership, Portimao, Portugal
- University of Oxford Centre for Evidence-Based Medicine, Oxford, UK
| | - Tracey E Howe
- Cochrane Campbell Global Ageing Partnership, Glasgow, UK
| | - Sue Marcus
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Jo Thompson Coon
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
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7
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O'Donovan C, Panthagani J, Aiyegbusi OL, Liu X, Bayliss S, Calvert M, Pesudovs K, Denniston A, Moore D, Braithwaite T. Evaluating patient-reported outcome measures (PROMs) for clinical trials and clinical practice in adult patients with uveitis or scleritis: a systematic review. J Ophthalmic Inflamm Infect 2022; 12:29. [PMID: 36063293 PMCID: PMC9443634 DOI: 10.1186/s12348-022-00304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/09/2022] [Indexed: 12/01/2022] Open
Abstract
Patient reported outcome measures (PROMs) capture impact of disease and treatment on quality of life, and have an emerging role in clinical trial outcome measurement. This study included a systematic review and quality appraisal of PROMs developed or validated for use in adults with uveitis or scleritis. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature sources, to 5 November 2021. We used established quality criteria to grade each PROM instrument in multiple domains from A (high quality) to C (low quality), and assessed content development, validity, reliability and responsiveness. For instruments developed using classic test theory-based psychometric approaches, we assessed acceptability, item targeting and internal consistency. For instruments developed using Item Response Theory (IRT) (e.g. Rasch analysis), we assessed response categories, dimensionality, measurement precision, item fit statistics, differential item functioning and targeting. We identified and appraised four instruments applicable to certain uveitis types, but none for scleritis. Specifically, the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ), a 3-part PROM for Birdshot retinochoroiditis (Birdshot Disease & Medication Symptoms Questionnaire [BD&MSQ], the quality of life (QoL) impact of Birdshot Chorioretinopathy [QoL BCR], and the QoL impact of BCR medication [QoL Meds], the Kings Sarcoidosis Questionnaire (KSQ), and a PROM for cytomegalovirus retinitis. These instruments had limited coverage for these heterogeneous conditions, with a focus on very rare subtypes. Psychometric appraisal revealed considerable variability between instruments, limited content development, and only one developed using Item Response Theory. In conclusion, there are few validated PROMs for patients with uveitis and none for scleritis, and existing instruments have suboptimal psychometric performance. We articulate why we do not recommend their inclusion as clinical trial outcome measures for drug licensing purposes, and highlight an unmet need for PROMs applicable to uveitis and scleritis.
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Affiliation(s)
- Charles O'Donovan
- School of Immunology and Microbiology, King's College London, London, England.
| | | | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, Birmingham Health Partners for Regulatory Science and Innovation, and NIHR, Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, B15 2TT, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, University of Birmingham, University Hospitals Birmingham, Birmingham, England.,Health Data Research UK, London, England
| | - Susan Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, Birmingham Health Partners for Regulatory Science and Innovation, NIHR, Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Centre and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, B15 2TT, UK
| | - Konrad Pesudovs
- University of New South Wales, Kensington, Australia.,Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Alastair Denniston
- Institute of Inflammation and Ageing, University of Birmingham, University Hospitals Birmingham, Birmingham, England.,Health Data Research UK, London, England
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Tasanee Braithwaite
- School of Immunology and Microbiology, King's College London, London, England.,Institute of Applied Health Research, University of Birmingham, Birmingham, England.,The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, England
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8
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Karamchandani U, Ahmed U, Rufai SR, Tan N, Tan W, Petrushkin H, Solebo AL. Long-term ocular and visual outcomes following symptomatic and asymptomatic congenital CMV infection: a systematic review protocol. BMJ Open 2022; 12:e059038. [PMID: 35584878 PMCID: PMC9119163 DOI: 10.1136/bmjopen-2021-059038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cytomegalovirus (CMV) is one of the most common congenitally acquired infections worldwide. Visual impairment is a common outcome for symptomatic infants, with long-term ophthalmic surveillance often recommended. However, there are no clear guidelines for ophthalmic surveillance in infants with asymptomatic disease. We aim to conduct a systematic review to establish the overall prevalence and incidence of eye and vision related disorders following congenital CMV infection (cCMV). METHODS AND ANALYSIS A systematic review and meta-analysis (pending appropriate data for analysis) of cross-sectional and longitudinal studies will be conducted. The PubMed, Embase and CINAHL databases will be searched up to 29 March 2022 without date or language restrictions. Studies will be screened by at least two independent reviewers. Methodological quality of included studies will be assessed using the Joanna Briggs Institute tool. The primary outcome measures will be incidence and/or prevalence of vision impairment or ophthalmic disorders in patients with symptomatic and asymptomatic cCMV infection. A narrative synthesis will be conducted for all included studies. The overall prevalence will be estimated by pooling data using a random-effects model. Heterogeneity between studies will be estimated using Cochran's Q and the I2 statistics. Egger's test will be used to assess for publication bias. ETHICS AND DISSEMINATION Ethical approval is not required as there is no primary data collection. Study findings will be disseminated at scientific meetings and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER This is not a clinical trial, but the protocol has been registered: CRD42021284678 (PROSPERO).
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Affiliation(s)
| | - Umar Ahmed
- Imperial College London, London, UK
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Sohaib R Rufai
- Ulverscroft Eye Unit, University of Leicester, Leicester, Leicestershire, UK
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
| | - Naomi Tan
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Weijen Tan
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
| | - Harry Petrushkin
- Department of Uveitis, Moorfields Eye Hospital NHS Trust, London, UK
- Department of Rheumatology, Great Ormond Street Hospital, London, UK
| | - Ameenat Lola Solebo
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
- Department of Rheumatology, Great Ormond Street Hospital, London, UK
- UCL GOS Institute of Child Health, University College London, London, UK
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9
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Ramke J, Evans JR, Habtamu E, Mwangi N, Silva JC, Swenor BK, Congdon N, Faal HB, Foster A, Friedman DS, Gichuhi S, Jonas JB, Khaw PT, Kyari F, Murthy GVS, Wang N, Wong TY, Wormald R, Yusufu M, Taylor H, Resnikoff S, West SK, Burton MJ. Grand Challenges in global eye health: a global prioritisation process using Delphi method. THE LANCET. HEALTHY LONGEVITY 2022; 3:e31-e41. [PMID: 35028632 PMCID: PMC8732284 DOI: 10.1016/s2666-7568(21)00302-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. METHODS Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. FINDINGS Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. INTERPRETATION This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. FUNDING The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. TRANSLATIONS For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Eyu-Ethiopia: Eye Health Research, Training and Service Centre, Bahirdar, Ethiopia
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Kenya Medical Training College, Nairobi, Kenya
| | | | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Orbis International, New York, NY, USA
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
- Africa Vision Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Indian Institute of Public Health, Hyderabad, India
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Hugh Taylor
- Melbourne School of Population Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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10
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Bicket AK, Le JT, Azuara-Blanco A, Gazzard G, Wormald R, Bunce C, Hu K, Jayaram H, King A, Otárola F, Nikita E, Shah A, Stead R, Tóth M, Li T. Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews and Network Meta-analysis. JAMA Ophthalmol 2021; 139:983-989. [PMID: 34264292 PMCID: PMC8283665 DOI: 10.1001/jamaophthalmol.2021.2351] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)-lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary for clinicians and patients. OBJECTIVE To summarize data from randomized clinical trials of MIGS for open-angle glaucoma, which were evaluated in a suite of Cochrane reviews. DATA SOURCES The Cochrane Database of Systematic Reviews including studies published before June 1, 2021. STUDY SELECTION Reviews of randomized clinical trials comparing MIGS with cataract extraction alone, other MIGS, traditional glaucoma surgery, laser trabeculoplasty, or medical therapy. DATA EXTRACTION AND SYNTHESIS Data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines by one investigator and confirmed by a second. Methodologic rigor was assessed using the AMSTAR 2 appraisal tool and random-effects network meta-analyses were conducted. MAIN OUTCOMES AND MEASURES The proportion of participants who did not need to use medication to reduce intraocular pressure (IOP) postsurgery (drop-free). Outcomes were analyzed at short-term (<6 months), medium-term (6-18 months), and long-term (>18 months) follow-up. RESULTS Six eligible Cochrane reviews were identified discussing trabecular bypass with iStent or Hydrus microstents, ab interno trabeculotomy with Trabectome, subconjunctival and supraciliary drainage devices, and endoscopic cyclophotocoagulation. Moderate certainty evidence indicated that adding a Hydrus safely improved the likelihood of drop-free glaucoma control at medium-term (relative risk [RR], 1.6; 95% CI, 1.4 to 1.8) and long-term (RR, 1.6; 95% CI, 1.4 to 1.9) follow-up and conferred 2.0-mm Hg (95% CI, -2.7 to -1.3 mm Hg) greater IOP reduction at long-term follow-up, compared with cataract surgery alone. Adding an iStent also safely improved drop-free disease control compared with cataract surgery alone (RR, 1.4; 95% CI, 1.2 to 1.6), but the short-term IOP-lowering effect of the iStent was not sustained. Addition of a CyPass microstent improved drop-free glaucoma control compared with cataract surgery alone (RR, 1.3; 95% CI, 1.1 to 1.5) but was associated with an increased risk of vraision loss. Network meta-analyses supported the direction and magnitude of these results. CONCLUSIONS AND RELEVANCE Based on data synthesized in Cochrane reviews, some MIGS may afford patients with glaucoma greater drop-free disease control than cataract surgery alone. Among the products currently available, randomized clinical trial data associate the Hydrus with greater drop-free glaucoma control and IOP lowering than the iStent; however, these effect sizes were small.
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Affiliation(s)
- Amanda K. Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Jimmy T. Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, United Kingdom
| | - Richard Wormald
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Research and Development Department & NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London & Surrey, United Kingdom
| | - Kuang Hu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, United Kingdom
| | - Anthony King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Francisco Otárola
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centro de la Visión, Clínica las Condes, Santiago, Chile
| | - Eleni Nikita
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anupa Shah
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Stead
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Márta Tóth
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora
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11
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Evans JR, Gordon I, Lawrenson JG, Parker R, Rowe FJ, Virgili G, Li T, Ramke J. Identifying priority review questions for Cochrane Eyes and Vision: protocol for a priority setting exercise. BMJ Open 2021; 11:e046319. [PMID: 34172546 PMCID: PMC8237719 DOI: 10.1136/bmjopen-2020-046319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews. METHODS AND ANALYSIS The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal.
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Affiliation(s)
- Jennifer R Evans
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Iris Gordon
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, UK
| | - Roses Parker
- Cochrane MOSS Network, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Surgery and Translational Medicine, University of Florence, Firenze, Toscana, Italy
| | - Tianjing Li
- Anschutz Medical Campus, University of Colorado, Denver, Colorado, USA
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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12
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 463] [Impact Index Per Article: 154.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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13
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Dean CR, Bierma H, Clarke R, Cleary B, Ellis P, Gadsby R, Gauw N, Lodge K, MacGibbon K, McBride M, Munro D, Nelson-Piercy C, O'Hara M, Penny H, Shorter K, Spijker R, Trovik J, Watford E, Painter RC. A patient-clinician James Lind Alliance partnership to identify research priorities for hyperemesis gravidarum. BMJ Open 2021; 11:e041254. [PMID: 33452191 PMCID: PMC7813320 DOI: 10.1136/bmjopen-2020-041254] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE There are many uncertainties surrounding the aetiology, treatment and sequelae of hyperemesis gravidarum (HG). Prioritising research questions could reduce research waste, helping researchers and funders direct attention to those questions which most urgently need addressing. The HG priority setting partnership (PSP) was established to identify and rank the top 25 priority research questions important to both patients and clinicians. METHODS Following the James Lind Alliance (JLA) methodology, an HG PSP steering group was established. Stakeholders representing patients, carers and multidisciplinary professionals completed an online survey to gather uncertainties. Eligible uncertainties related to HG. Uncertainties on nausea and vomiting of pregnancy and those on complementary treatments were not eligible. Questions were verified against the evidence. Two rounds of prioritisation included an online ranking survey and a 1-hour consensus workshop. RESULTS 1009 participants (938 patients/carers, 118 professionals with overlap between categories) submitted 2899 questions. Questions originated from participants in 26 different countries, and people from 32 countries took part in the first prioritisation stage. 66 unique questions emerged, which were evidence checked according to the agreed protocol. 65 true uncertainties were narrowed via an online ranking survey to 26 unranked uncertainties. The consensus workshop was attended by 19 international patients and clinicians who reached consensus on the top 10 questions for international researchers to address. More patients than professionals took part in the surveys but were equally distributed during the consensus workshop. Participants from low-income and middle-income countries noted that the priorities may be different in their settings. CONCLUSIONS By following the JLA method, a prioritised list of uncertainties relevant to both HG patients and their clinicians has been identified which can inform the international HG research agenda, funders and policy-makers. While it is possible to conduct an international PSP, results from developed countries may not be as relevant in low-income and middle-income countries.
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Affiliation(s)
- Caitlin R Dean
- Pregnancy Sickness Support, Bodmin, UK
- Obstetrics and Gynecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Hyke Bierma
- Obstetrics and Gynecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Ria Clarke
- Obstetrics and Gynaecology, Frimley Park Hospital, Frimley, UK
| | - Brian Cleary
- Hyperemesis Ireland, Dublin, Ireland
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Roger Gadsby
- Pregnancy Sickness Support, Bodmin, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Kimber MacGibbon
- Hyperemesis Education and Research Foundation, Damascus, Oregon, USA
| | - Marian McBride
- Hyperemesis Ireland, Dublin, Ireland
- Strategic Planning and Transformation, Health Service Executive, Dublin, Ireland
| | - Deirdre Munro
- Hyperemesis Ireland, Dublin, Ireland
- Portiuncula University Hospital Galway, Galway, Ireland
| | | | | | - Helen Penny
- School of Psychology, Cardiff University, Cardiff, UK
| | - Katherine Shorter
- Early Pregnancy Unit, QMC, Nottingham University Hospital Trust, Nottingham, UK
| | - René Spijker
- Medical Library, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Jone Trovik
- Department Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | | | - Rebecca C Painter
- Obstetrics and Gynecology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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14
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Skilton AM, Low LG, Dimaras H. Patients, Public and Service Users are Experts by Experience: An Overview from Ophthalmology Research in Canada, UK and Beyond. Ophthalmol Ther 2020; 9:207-213. [PMID: 32114666 PMCID: PMC7196098 DOI: 10.1007/s40123-020-00237-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
Discussion of the positive impact on research and mutual benefit that arises through genuine researcher and expert by experience collaboration has been noticeably absent from global sight loss and vision conferences. This article is co-authored by a parent advocate whose children have bilateral retinoblastoma, an eye health researcher and a practitioner in patient and public involvement in research who came together at the 2019 annual meeting of the Association for Research in Vision and Ophthalmology to share their first-hand experiences. The aim of this commentary is to highlight good practice and encourage colleagues to pursue steps towards a more engaged ophthalmology research landscape globally.
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Affiliation(s)
- Andrew M Skilton
- NIHR Biomedical Research Center, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
- NIHR Clinical Research Network Coordinating Center, London, UK.
| | - Leslie G Low
- The Canadian Retinoblastoma Research Advisory Board, Toronto, ON, Canada
| | - Helen Dimaras
- The Canadian Retinoblastoma Research Advisory Board, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The University of Toronto, Toronto, ON, Canada
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15
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Rowe FJ, Hepworth LR, Howard C, Hanna KL, Helliwell B. Developing a stroke-vision care pathway: a consensus study. Disabil Rehabil 2020; 44:487-495. [DOI: 10.1080/09638288.2020.1768302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R. Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L. Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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16
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Evans J, Mwangi N, Burn H, Ramke J. Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract. J Clin Epidemiol 2020; 125:57-63. [PMID: 32389807 DOI: 10.1016/j.jclinepi.2020.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/18/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to understand the extent to which Cochrane Eyes and Vision systematic reviews of interventions for cataract, and primary studies, consider equity. STUDY DESIGN AND SETTING This is a review of Cochrane Eyes and Vision systematic reviews (CSRs) on cataract published on the Cochrane Library (end of March 2019) (n = 23), and recently published primary studies included in those reviews (n = 62), using the PROGRESSPlus framework. RESULTS One CSR considered equity as a topic. Four (17%) CSRs included a low- and middle-income country (LMIC) author; one of them was a first author. The CSR with equity as a main topic restricted primary studies to those conducted in LMICs; otherwise none of the systematic reviews used PROGRESS factors as inclusion or exclusion criteria. None of the CSRs reported subgroup analyses by any PROGRESS factor, although these were planned in two. Two of the primary studies were led by an LMIC author; 42% involved LMIC authors; 37% were conducted in LMICs; 73% of studies reported on gender/sex of participants, but other PROGRESS factors were less frequently reported. Three studies reported subgroup analyses by sex; one reported subgroup analyses by race/ethnicity. CONCLUSION PROGRESS factors and equity are rarely considered in studies of interventions for cataract, and this is reflected in the associated Cochrane reviews.
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Affiliation(s)
- Jennifer Evans
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nyawira Mwangi
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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17
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Flegg K, Gelkopf MJ, Johnson SA, Dimaras H. The top 10 retinoblastoma research priorities in Canada as determined by patients, clinicians and researchers: a patient-oriented priority-setting partnership. CMAJ Open 2020; 8:E420-E428. [PMID: 32518094 PMCID: PMC7286623 DOI: 10.9778/cmajo.20190221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood cancer of the eye that can have lifelong effects on patients and families. The purpose of this study was for people affected by retinoblastoma, clinicians and researchers to jointly determine the top 10 retinoblastoma research priorities in Canada. METHODS An adaptation of the James Lind Alliance Priority Setting Partnership (PSP) methodology was employed. People were invited to participate in any stage of the priority-setting process if they were a resident of Canada, and were a patient with retinoblastoma (or a family member or friend of someone diagnosed with retinoblastoma) or a clinician or researcher interested in retinoblastoma. Patients were full partners in study design and implementation, and result dissemination, through involvement in a national working group (1 patient and 9 nonpatients) and steering committee (4 patients and 11 nonpatients). In phase 1 of the study, participants responded to an online survey that asked, "What questions about retinoblastoma would you like to see answered by research?" In phase 2, the steering committee reviewed and refined the list of survey responses and decided on a list of 30 questions to be ranked by means of the nominal group technique in phase 3, a priority-setting workshop. RESULTS In total, 175 retinoblastoma research questions were suggested by 59 survey participants (38 patients and 21 nonpatients). The categories with the greatest number of questions were genetics and molecular (45 [25.7%]), second cancer (29 [16.6%]) and psychosocial (27 [15.4%]). The top 10 questions as ranked by the workshop participants (10 patients and 10 nonpatients) fell into 7 categories: second cancer (2 questions), follow-up (2), psychosocial (2), treatment (1), diagnosis (1), global health (1) and miscellaneous (1). The early diagnosis of retinoblastoma was identified as the top retinoblastoma research priority in Canada. INTERPRETATION The list of priorities will serve as a resource for advocacy groups, research teams and funding agencies that focus on retinoblastoma. The inclusion of researchers as participants was an adaptation of the James Lind Alliance PSP methodology and enriched the research prioritization process.
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Affiliation(s)
- Kaitlyn Flegg
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Maxwell J Gelkopf
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Sarah A Johnson
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont.
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18
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Wormald R, Virgili G, Azuara-Blanco A. Systematic reviews and randomised controlled trials on open angle glaucoma. Eye (Lond) 2020; 34:161-167. [PMID: 31796882 PMCID: PMC7002425 DOI: 10.1038/s41433-019-0687-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 11/05/2019] [Indexed: 01/07/2023] Open
Abstract
Evidence for the effectiveness of interventions to prevent the progression of optic nerve damage in open angle glaucoma has evolved over the last 25 years. We describe that evolution through the systematic reviews on various aspects of the topic and how those reviews have highlighted the need for new trials. Though we can be confident that lowering pressure does indeed reduce the risk of progression, we still lack good evidence on the comparative effectiveness of different treatments not so much on lowering pressure but on preventing progression of the disease. This is true for different medicines, types of laser and especially for different surgical interventions. As always there is a need for more research, but this needs to be focussed on key uncertainties using core outcome sets which avoid research waste. Ultimately, our guidelines can be based on sound and comprehensive evidence of effectiveness.
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Affiliation(s)
- Richard Wormald
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
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19
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Lindsley KB, Hutfless S, Hawkins BS, Blim JF, Roberts D, Olsen TW, Lum F, Dickersin K. Evaluation of Clinical Questions and Patient-Important Outcomes Associated With the Treatment of Age-Related Macular Degeneration. JAMA Ophthalmol 2019; 136:1217-1225. [PMID: 30128539 DOI: 10.1001/jamaophthalmol.2018.3456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Identifying and prioritizing unanswered clinical questions may help to best allocate limited resources for research associated with the treatment of age-related macular degeneration (AMD). Objective To identify and prioritize clinical questions and outcomes for research associated with the treatment of AMD through engagement with professional and patient stakeholders. Design, Setting, and Participants Multiple cross-sectional survey questions were used in a modified Delphi process for panel members of US and international organizations, the American Academy of Ophthalmology (AAO) Retina/Vitreous Panel (n=7), health care professionals from the American Society of Retinal Specialists (ASRS) (n=90), Atlantic Coast Retina Conference (ACRC) and Macula 2017 meeting (n=34); and patients from MD (Macular Degeneration) Support (n=46). Data were collected from January 20, 2015, to January 9, 2017. Main Outcomes and Measures The prioritizing of clinical questions and patient-important outcomes for AMD. Results Seventy clinical questions were derived from the AAO Preferred Practice Patterns for AMD and suggestions by the AAO Retina/Vitreous Panel. The AAO Retina/Vitreous Panel assessed all 70 clinical questions and rated 17 of 70 questions (24%) as highly important. Health care professionals assessed the 17 highly important clinical questions and rated 12 of 17 questions (71%) as high priority for research to answer; 9 of 12 high-priority clinical questions were associated with aspects of anti-vascular endothelial growth factor agents. Patients assessed the 17 highly important clinical questions and rated all as high priority. Additionally, patients identified 6 of 33 outcomes (18%) as most important to them (choroidal neovascularization, development of advanced AMD, retinal hemorrhage, gain of vision, slowing vision loss, and serious ocular events). Conclusions and Relevance Input from 4 stakeholder groups suggests good agreement on which 12 priority clinical questions can be used to underpin research related to the treatment of AMD. The 6 most important outcomes identified by patients were balanced between intended effects of AMD treatment (eg, slowing vision loss) and adverse events. Consideration of these patient-important outcomes may help to guide clinical care and future areas of research.
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Affiliation(s)
- Kristina B Lindsley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Susan Hutfless
- Division of Gastroenterology & Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Barbara S Hawkins
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jill F Blim
- American Society of Retina Specialists, Chicago, Illinois
| | - Dan Roberts
- MD (Macular Degeneration) Support, Grandview, Missouri
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.,Preferred Practice Pattern Retina/Vitreous Panel and Secretary for Quality of Care, American Academy of Ophthalmology
| | - Flora Lum
- Quality and Data Science, American Academy of Ophthalmology, San Francisco, California
| | - Kay Dickersin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Reviews Editor
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20
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A systematic review of pharmacists' interventions to support medicines optimisation in patients with visual impairment. Int J Clin Pharm 2019; 41:1400-1407. [PMID: 31531815 DOI: 10.1007/s11096-019-00907-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 01/17/2023]
Abstract
Background People with visual impairment often report poorer health and encounter many challenges when using medicines. Pharmacists can play a significant role in optimising medicines use for these patients. However, little is known about pharmacists' current practices when providing services to this population nor the impact of such services, if any, on medicines optimisation-related outcomes. Aim of the review This systematic review aims to identify the types, and assess the effectiveness of, interventions provided by pharmacists on medicines optimisation-related outcomes. Method Systematic searches of the following electronic databases were carried out from date of inception to March 2018: Cochrane Library; MEDLINE; EMBASE; International Pharmaceutical Abstracts; Scopus; and Cumulative Index to Nursing and Allied Health Literature. Several trial registries and grey literature resources were also searched. Any randomised controlled trials, non-randomised controlled trials, controlled before-and-after studies, or interrupted time series analyses reporting on interventions provided by pharmacists to adult visually impaired patients and/or their caregivers in order to improve medicines optimisation-related outcomes of medicine safety, adherence, patient satisfaction, shared decision making, or quality of life were included. Results A total of 1877 titles/abstracts were screened, and 27 full text articles were assessed for eligibility. On examination of full texts, no studies met the inclusion criteria for this review. Conclusion This review highlights the need for future research that would be vital for promoting the safe and effective use of medicines and the delivery of pharmaceutical care services to people with visual impairment.
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21
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Murta FR, Waxman J, Skilton A, Wickwar S, Bonstein K, Cable R, Clipston J, Bates A, Mattocks R, Shelley J, McCullough P, Surry M, Matthews J, Worsfold S, Lorenzano D, Jayaprakasam A, Hamed Azzam S, Shafi F, Kwong Q, Koutroumanaos N, Manta A, Negretti G, Haridas A, Ezra DG. The first UK national blepharospasm patient and public involvement day; identifying priorities. Orbit 2019; 39:233-240. [PMID: 31466502 DOI: 10.1080/01676830.2019.1657469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We describe the planning and outcomes of the first 'Blepharospasm Day' in the UK. Blepharospasm is a distressing condition for patients and carers. Our 'patient and public involvement' event aimed to: cultivate a more informed patient group via active dialogue, help clinicians more effectively prioritise research and to facilitate peer-to-peer support for affected patients and public. DESIGN A national one-day event was organised by the oculoplastics department at Moorfields Eye Hospital. The event was divided into informative lectures delivered by professionals and a patient panel, during which patients shared their experiences and expectations. METHODS Data were collected from a variety of sources including: an interactive voting "LiveWall" poster, a pre-event questionnaire; "living with Blepharospasm", transcripts from patient panel discussions; and a feedback questionnaire. RESULTS The event was well-received with 100% of respondents rating it good or excellent. Four research themes were identified: "aetiology", "alternative treatments", "faster, more accurate diagnosis", and "symptom control". Delegates' self-reported knowledge of blepharospasm increased significantly after the event. Limitations of the BdSI severity-assessment tool were noted with 22% of respondents failing to utilise it appropriately. CONCLUSION Through our innovative "Blepharospasm Day", patient's priorities for research were identified, delegates understanding of blepharospasm increased and an independent blepharospasm patients-representatives' group was established; a first in the UK. Furthermore, short-fallings identified in the BdSI tool highlight the need for better severity-assessment tools. We demonstrate the benefits of the 'patient and public involvement' approach in the management of complex conditions such as blepharospasm. ABBREVIATIONS PPI: Patient and public involvement; SLV-PSP: sight loss and vision sector - priority setting partnership; BRC: Biomedical Research Centre; NIHR: National Institute for Health Research; BsDI: Blepharospasm Disability Index.
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Affiliation(s)
| | - Jacob Waxman
- Ophthalmology Department, Wolfson Medical Centre , Holon, Israel
| | - Andi Skilton
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Sadie Wickwar
- Centre for Health Services Research, School of Health Sciences, City University London , London, UK
| | - Karen Bonstein
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Richard Cable
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Jane Clipston
- The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
| | - Alan Bates
- Blepharospasm Steering Group , London, UK
| | | | | | | | - Marc Surry
- Blepharospasm Steering Group , London, UK
| | | | | | | | | | | | - Fariha Shafi
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Qiang Kwong
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | | | | | - Guy Negretti
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Anjana Haridas
- Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation Trust , London, UK.,The Moorfields NIHR Biomedical Research Centre & UCL Institute of Ophthalmology , London, UK
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22
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Nygaard A, Halvorsrud L, Linnerud S, Grov EK, Bergland A. The James Lind Alliance process approach: scoping review. BMJ Open 2019; 9:e027473. [PMID: 31473612 PMCID: PMC6720333 DOI: 10.1136/bmjopen-2018-027473] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To summarise study descriptions of the James Lind Alliance (JLA) approach to the priority setting partnership (PSP) process and how this process is used to identify uncertainties and to develop lists of top 10 priorities. DESIGN Scoping review. DATA SOURCES The Embase, Medline (Ovid), PubMed, CINAHL and the Cochrane Library as of October 2018. STUDY SELECTION All studies reporting the use of JLA process steps and the development of a list of top 10 priorities, with adult participants aged 18 years. DATA EXTRACTION A data extraction sheet was created to collect demographic details, study aims, sample and patient group details, PSP details (eg, stakeholders), lists of top 10 priorities, descriptions of JLA facilitator roles and the PSP stages followed. Individual and comparative appraisals were discussed among the scoping review authors until agreement was reached. RESULTS Database searches yielded 431 potentially relevant studies published in 2010-2018, of which 37 met the inclusion criteria. JLA process participants were patients, carers and clinicians, aged 18 years, who had experience with the study-relevant diagnoses. All studies reported having a steering group, although partners and stakeholders were described differently across studies. The number of JLA PSP process steps varied from four to eight. Uncertainties were typically collected via an online survey hosted on, or linked to, the PSP website. The number of submitted uncertainties varied across studies, from 323 submitted by 58 participants to 8227 submitted by 2587 participants. CONCLUSIONS JLA-based PSP makes a useful contribution to identifying research questions. Through this process, patients, carers and clinicians work together to identify and prioritise unanswered uncertainties. However, representation of those with different health conditions depends on their having the capacity and resources to participate. No studies reported difficulties in developing their top 10 priorities.
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Affiliation(s)
- Agnete Nygaard
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Center for Development of Institutional and Home Care, Lørenskog, Akershus
| | - Liv Halvorsrud
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Siv Linnerud
- Center for Development of Institutional and Home Care, Lørenskog, Akershus
| | - Ellen Karine Grov
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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23
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Liu X, Kolli S, McDonnell P, Patel A, Quinlan M, Skym K, Denniston AK, Shah P, Williams GP. Patient priorities in herpes simplex keratitis. BMJ Open Ophthalmol 2019; 4:e000177. [PMID: 31179387 PMCID: PMC6528774 DOI: 10.1136/bmjophth-2018-000177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective Herpes simplex keratitis (HSK) is a sight-threatening disease and a leading cause of infectious corneal blindness. Involving patients in setting the research agenda maximises patient benefit and minimises research waste. With no published patient involvement exercises, patients' priorities in HSK are unclear. The objective of this study is to explore patients' priorities for research in HSK. Methods A literature review of publications in the year preceding recruitment of patients identified nine domains of research interest. A questionnaire was sent to participants asking them to rank these in order of priority. The ranking results were given a weighted-average score, and a thematic analysis was undertaken for the narrative data. Results Thirty-seven patients participated in the survey. Top priorities for patients were risk factors for recurrence of infection, diagnostic tests and treatment failure. The narrative data revealed three key clinical needs: difficulties in long-term symptom control, the need for rapid access care in acute infection and the desire for more accessible information. Conclusion This study highlighted three major issues in our current approach to HSK. First, there may be a misalignment between research efforts and patient priorities. Second, high-quality patient information is not widely available. This may hamper patients' abilities to make informed decisions and contribute towards research. Third, clinical service priorities are of equal importance to patients as research. Researchers and clinicians are encouraged to address both needs in parallel.
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Affiliation(s)
- Xiaoxuan Liu
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sai Kolli
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter McDonnell
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Amit Patel
- Department of Ophthalmology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Michael Quinlan
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Kevin Skym
- Herpes Simplex Keratitis Patient Group, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Shah
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Geraint P Williams
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Ophthalmology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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24
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Moutray T, Evans JR, Lois N, Armstrong DJ, Peto T, Azuara‐Blanco A. Different lasers and techniques for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2018; 3:CD012314. [PMID: 29543992 PMCID: PMC6494342 DOI: 10.1002/14651858.cd012314.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is a chronic progressive disease of the retinal microvasculature associated with prolonged hyperglycaemia. Proliferative DR (PDR) is a sight-threatening complication of DR and is characterised by the development of abnormal new vessels in the retina, optic nerve head or anterior segment of the eye. Argon laser photocoagulation has been the gold standard for the treatment of PDR for many years, using regimens evaluated by the Early Treatment of Diabetic Retinopathy Study (ETDRS). Over the years, there have been modifications of the technique and introduction of new laser technologies. OBJECTIVES To assess the effects of different types of laser, other than argon laser, and different laser protocols, other than those established by the ETDRS, for the treatment of PDR. We compared different wavelengths; power and pulse duration; pattern, number and location of burns versus standard argon laser undertaken as specified by the ETDRS. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 8 June 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) of pan-retinal photocoagulation (PRP) using standard argon laser for treatment of PDR compared with any other laser modality. We excluded studies of lasers that are not in common use, such as the xenon arc, ruby or Krypton laser. DATA COLLECTION AND ANALYSIS We followed Cochrane guidelines and graded the certainty of evidence using the GRADE approach. MAIN RESULTS We identified 11 studies from Europe (6), the USA (2), the Middle East (1) and Asia (2). Five studies compared different types of laser to argon: Nd:YAG (2 studies) or diode (3 studies). Other studies compared modifications to the standard argon laser PRP technique. The studies were poorly reported and we judged all to be at high risk of bias in at least one domain. The sample size varied from 20 to 270 eyes but the majority included 50 participants or fewer.Nd:YAG versus argon laser (2 studies): very low-certainty evidence on vision loss, vision gain, progression and regression of PDR, pain during laser treatment and adverse effects.Diode versus argon laser (3 studies): very-low certainty evidence on vision loss, vision gain, progression and regression of PDR and adverse effects; moderate-certainty evidence that diode laser was more painful (risk ratio (RR) troublesome pain during laser treatment (RR 3.12, 95% CI 2.16 to 4.51; eyes = 202; studies = 3; I2 = 0%).0.5 second versus 0.1 second exposure (1 study): low-certainty evidence of lower chance of vision loss with 0.5 second compared with 0.1 second exposure but estimates were imprecise and compatible with no difference or an increased chance of vision loss (RR 0.42, 95% CI 0.08 to 2.04, 44 eyes, 1 RCT); low-certainty evidence that people treated with 0.5 second exposure were more likely to gain vision (RR 2.22, 95% CI 0.68 to 7.28, 44 eyes, 1 RCT) but again the estimates were imprecise . People given 0.5 second exposure were more likely to have regression of PDR compared with 0.1 second laser PRP again with imprecise estimate (RR 1.17, 95% CI 0.92 to 1.48, 32 eyes, 1 RCT). There was very low-certainty evidence on progression of PDR and adverse effects.'Light intensity' PRP versus classic PRP (1 study): vision loss or gain was not reported but the mean difference in logMAR acuity at 1 year was -0.09 logMAR (95% CI -0.22 to 0.04, 65 eyes, 1 RCT); and low-certainty evidence that fewer patients had pain during light PRP compared with classic PRP with an imprecise estimate compatible with increased or decreased pain (RR 0.23, 95% CI 0.03 to 1.93, 65 eyes, 1 RCT).'Mild scatter' (laser pattern limited to 400 to 600 laser burns in one sitting) PRP versus standard 'full' scatter PRP (1 study): very low-certainty evidence on vision and visual field loss. No information on adverse effects.'Central' (a more central PRP in addition to mid-peripheral PRP) versus 'peripheral' standard PRP (1 study): low-certainty evidence that people treated with central PRP were more likely to lose 15 or more letters of BCVA compared with peripheral laser PRP (RR 3.00, 95% CI 0.67 to 13.46, 50 eyes, 1 RCT); and less likely to gain 15 or more letters (RR 0.25, 95% CI 0.03 to 2.08) with imprecise estimates compatible with increased or decreased risk.'Centre sparing' PRP (argon laser distribution limited to 3 disc diameters from the upper temporal and lower margin of the fovea) versus standard 'full scatter' PRP (1 study): low-certainty evidence that people treated with 'centre sparing' PRP were less likely to lose 15 or more ETDRS letters of BCVA compared with 'full scatter' PRP (RR 0.67, 95% CI 0.30 to 1.50, 53 eyes). Low-certainty evidence of similar risk of regression of PDR between groups (RR 0.96, 95% CI 0.73 to 1.27, 53 eyes). Adverse events were not reported.'Extended targeted' PRP (to include the equator and any capillary non-perfusion areas between the vascular arcades) versus standard PRP (1 study): low-certainty evidence that people in the extended group had similar or slightly reduced chance of loss of 15 or more letters of BCVA compared with the standard PRP group (RR 0.94, 95% CI 0.70 to 1.28, 270 eyes). Low-certainty evidence that people in the extended group had a similar or slightly increased chance of regression of PDR compared with the standard PRP group (RR 1.11, 95% CI 0.95 to 1.31, 270 eyes). Very low-certainty information on adverse effects. AUTHORS' CONCLUSIONS Modern laser techniques and modalities have been developed to treat PDR. However there is limited evidence available with respect to the efficacy and safety of alternative laser systems or strategies compared with the standard argon laser as described in ETDRS.
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Affiliation(s)
- Tanya Moutray
- Royal Victoria HospitalOphthalmology DepartmentGrosvenor RoadBelfastUKBT12 6BA
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Noemi Lois
- Queen's UniversityWellcome‐Wolfson Institute for Experimental MedicineBelfastUK
| | - David J Armstrong
- Royal Victoria HospitalOphthalmology DepartmentGrosvenor RoadBelfastUKBT12 6BA
| | - Tunde Peto
- Queen's University BelfastCentre for Public HealthBelfastUKBT12 6BA
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Gray TA, Dumville JC, Christie J, Cullum NA. Rapid research and implementation priority setting for wound care uncertainties. PLoS One 2017; 12:e0188958. [PMID: 29206884 PMCID: PMC5716549 DOI: 10.1371/journal.pone.0188958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/10/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION People with complex wounds are more likely to be elderly, living with multimorbidity and wound related symptoms. A variety of products are available for managing complex wounds and a range of healthcare professionals are involved in wound care, yet there is a lack of good evidence to guide practice and services. These factors create uncertainty for those who deliver and those who manage wound care. Formal priority setting for research and implementation topics is needed to more accurately target the gaps in treatment and services. We solicited practitioner and manager uncertainties in wound care and held a priority setting workshop to facilitate a collaborative approach to prioritising wound care-related uncertainties. METHODS We recruited healthcare professionals who regularly cared for patients with complex wounds, were wound care specialists or managed wound care services. Participants submitted up to five wound care uncertainties in consultation with their colleagues, via an on-line survey and attended a priority setting workshop. Submitted uncertainties were collated, sorted and categorised according professional group. On the day of the workshop, participants were divided into four groups depending on their profession. Uncertainties submitted by their professional group were viewed, discussed and amended, prior to the first of three individual voting rounds. Participants cast up to ten votes for the uncertainties they judged as being high priority. Continuing in the professional groups, the top 10 uncertainties from each group were displayed, and the process was repeated. Groups were then brought together for a plenary session in which the final priorities were individually scored on a scale of 0-10 by participants. Priorities were ranked and results presented. Nominal group technique was used for generating the final uncertainties, voting and discussions. RESULTS Thirty-three participants attended the workshop comprising; 10 specialist nurses, 10 district nurses, seven podiatrists and six managers. Participants had been qualified for a mean of 20.7 years with a mean of 16.8 years of wound care experience. One hundred and thirty-nine uncertainties were submitted electronically and a further 20 were identified on the day of the workshop following lively, interactive group discussions. Twenty-five uncertainties from the total of 159 generated made it to the final prioritised list. These included six of the 20 new uncertainties. The uncertainties varied in focus, but could be broadly categorised into three themes: service delivery and organisation, patient centred care and treatment options. Specialist nurses were more likely to vote for service delivery and organisation topics, podiatrists for patient centred topics, district nurses for treatment options and operational leads for a broad range. CONCLUSIONS This collaborative priority setting project is the first to engage front-line clinicians in prioritising research and implementation topics in wound care. We have shown that it is feasible to conduct topic prioritisation in a short time frame. This project has demonstrated that with careful planning and rigor, important questions that are raised in the course of clinicians' daily decision making can be translated into meaningful research and implementation initiatives that could make a difference to service delivery and patient care.
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Affiliation(s)
- Trish A. Gray
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jo C. Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Janice Christie
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Nicky A. Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Rowe FJ. Stroke survivors' views and experiences on impact of visual impairment. Brain Behav 2017; 7:e00778. [PMID: 28948075 PMCID: PMC5607544 DOI: 10.1002/brb3.778] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/08/2017] [Accepted: 06/14/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to determine stroke survivors' views on impact of stroke-related visual impairment to quality of life. MATERIALS AND METHODS Stroke survivors with visual impairment, more than 1 year post stroke onset, were recruited. Semistructured biographical narrative interviews were audio-recorded and transcribed verbatim. A thematic approach to analysis of the qualitative data was adopted. Transcripts were systematically coded using NVivo10 software. RESULTS Thirty-five stroke survivors were interviewed across the UK: 16 females, 19 males; aged 20-75 years at stroke onset. Five qualitative themes emerged: "Formal care," "Symptoms and self," "Adaptations," "Daily life," and "Information." Where visual problems existed, they were often not immediately recognized as part of the stroke syndrome and attributed to other causes such as migraine. Many participants did not receive early vision assessment or treatment for their visual problems. Visual problems included visual field loss, double vision, and perceptual problems. Impact of visual problems included loss in confidence, being a burden to others, increased collisions/accidents, and fear of falling. They made many self-identified adaptations to compensate for visual problems: magnifiers, large print, increased lighting, use of white sticks. There was a consistent lack of support and provision of information about visual problems. CONCLUSIONS Poststroke visual impairment causes considerable impact to daily life which could be substantially improved by simple measures including early formal visual assessment, management and advice on adaptive strategies and self-management options. Improved education about poststroke visual impairment for the public and clinicians could aid earlier diagnosis of visual impairments.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research University of Liverpool Liverpool UK
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Prior M, Bagness C, Brewin J, Coomarasamy A, Easthope L, Hepworth-Jones B, Hinshaw K, O'Toole E, Orford J, Regan L, Raine-Fenning N, Shakespeare J, Small R, Thornton J, Metcalf L. Priorities for research in miscarriage: a priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology. BMJ Open 2017; 7:e016571. [PMID: 28838896 PMCID: PMC5629698 DOI: 10.1136/bmjopen-2017-016571] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify and prioritise important research questions for miscarriage. DESIGN A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance. SETTING UK. PARTICIPANTS Women and those affected by miscarriage working alongside healthcare professionals. RESULTS In the initial survey, 1093 participants (932 women who have experienced miscarriage, 8 partners, 17 family members, friends or colleagues, 104 healthcare professionals and eight charitable organisations) submitted 3279 questions. A review of existing literature identified a further 64. Non-questions were removed, and the remaining questions were categorised and summarised into 58 questions. In an interim electronic survey, 2122 respondents chose their top 10 priorities from the 58 summary questions. The 25 highest ranked in the survey were prioritised at a final face-to-face workshop. In summary, the top 10 priorities were ranked as follows: research into preventative treatment, emotional aspects in general, investigation, relevance of pre-existing medical conditions, emotional support as a treatment, importance of lifestyle factors, importance of genetic and chromosomal causes, preconception tests, investigation after different numbers of miscarriage and male causal factors. CONCLUSIONS These results should be the focus of future miscarriage research. Presently, studies are being conducted to address the top priority; however, many other priorities, especially psychological and emotional support, are less well researched areas. We hope our results will encourage both researchers and funders to focus on these priorities.
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Affiliation(s)
- Matthew Prior
- Department of Child Health Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | | | | | - Arri Coomarasamy
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, UK
| | - Lucy Easthope
- University of Lincoln Law School, Lincoln, Lincolnshire, UK
| | | | - Kim Hinshaw
- Department of Obstetrician and Gynaecologist, Sunderland Royal Hospital, Sunderland, UK
| | - Emily O'Toole
- Royal College of Obstetricians and Gynaecologists Women's Voices Involvement Panel, London, UK
| | - Julie Orford
- Royal College of Obstetricians and Gynaecologists Women's Voices Involvement Panel, London, UK
| | - Lesley Regan
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nick Raine-Fenning
- Division of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Rachel Small
- Department of Gynaecology, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Leanne Metcalf
- The James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
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Hauck FR, McEntire BL, Raven LK, Bates FL, Lyus LA, Willett AM, Blair PS. Research Priorities in Sudden Unexpected Infant Death: An International Consensus. Pediatrics 2017; 140:peds.2016-3514. [PMID: 28751613 DOI: 10.1542/peds.2016-3514] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/24/2022] Open
Abstract
Despite the success of safe sleep campaigns and the progress in understanding risk factors, the rate of reduction in the cases of sudden infant death syndrome has now slowed and it remains a leading cause of postneonatal mortality in many developed countries. Strategic action is needed to tackle this problem and it is now vital to identify how the sudden infant death research community may best target its efforts. The Global Action and Prioritization of Sudden Infant Death Project was an international consensus process that aimed to define and direct future research by investigating the priorities of expert and lay members of the sudden unexpected infant death (SUID) community across countries. The aim was to identify which areas of research should be prioritized to reduce the number of SUID deaths globally. Scientific researchers, clinicians, counselors, educators, and SUID parents from 25 countries took part across 2 online surveys to identify potential research priorities. Workshops subsequently took place in the United Kingdom, United States, and Australia to reach consensus and 10 priority areas for research were established. Three main themes among the priorities emerged: (1) a better understanding of mechanisms underlying SUID, (2) ensuring best practice in data collection, management and sharing, and (3) a better understanding of target populations and more effective communication of risk. SUID is a global problem and this project provides the international SUID community with a list of shared research priorities to more effectively work toward explaining and reducing the number of sudden infant deaths.
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Affiliation(s)
- Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Leanne K Raven
- Faculty of Science, Health and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | | | | | | | - Peter S Blair
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Affiliation(s)
- Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Abstract
INTRODUCTION Patient involvement in healthcare has expanded from the clinical practice setting to include collaboration during the research process. There has been a growing international interest in patient and public involvement in setting research priorities to reduce the risk of discrepancy between what patients with cancer and their relatives experience as important unanswered questions and those which are actually researched. This study aims to challenge the conventional research process by inviting patients with life-threatening cancer (primary malignant brain tumours or acute leukaemia), relatives and patient organisations to join forces with clinical specialists and researchers to identify, discuss and prioritise supportive care and rehabilitation issues in future research. METHODS AND ANALYSIS This is an exploratory qualitative study comprising two sets of three focus group interviews (FGIs): one set for primary malignant brain tumours and the other for acute leukaemia. Separate FGIs will be carried out with patients and relatives including representation from patient organisations and clinical specialists to identify important unanswered questions and research topics within each group. The FGIs will be video/audio recorded, transcribed and thematically analysed. This study will contribute to a patient-centred research agenda that captures issues that patients, their relatives, clinical specialists and researchers consider important. ETHICS AND DISSEMINATION The study is registered at the Danish Data Protection Agency (number: 2012-58-0004) and the Scientific Ethics Review Committee of the Capital Region of Denmark (number: H-15001485). Papers will be published describing the methods applied and the supportive care and rehabilitation issues that are identified as important for future research. TRIAL REGISTRATION NUMBER ISRCTN57131943; Pre-results.
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Affiliation(s)
- Karin Piil
- University Hospitals Center for Health Research (UCSF) and Center for Integrated Rehabilitation of Cancer Patients (CIRE), Copenhagen, Denmark
- Department of Neurosurgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Mary Jarden
- University Hospitals Center for Health Research (UCSF) and Center for Integrated Rehabilitation of Cancer Patients (CIRE), Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Macular disease research in the United Kingdom 2011-2014: a bibliometric analysis of outputs, performance and coverage. BMC Res Notes 2015; 8:833. [PMID: 26715430 PMCID: PMC4696132 DOI: 10.1186/s13104-015-1825-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/18/2015] [Indexed: 12/14/2022] Open
Abstract
Background Bibliometric indicators, based on measuring patterns of publications and citations, are widely used by universities and research funders to assess research performance. Our aims were to: (1) perform a bibliometric analysis of UK macular disease research publications from 2011 to 2014 and compare this with the other countries producing major output in the area, and (2) compare the pattern of UK macular disease publication with the priorities for age-related macular degeneration (AMD) developed by the Sight Loss and Vision Priority Setting Partnership (SLV-PSP). Methods We used the Scopus database to retrieve macular disease articles published from 2011 to 2014. Citations to articles from 2011 to 2013 and journal impact factors (JIFs) for 2014 articles were obtained. Articles with UK authors were allocated to the 10 SLV-PSP priorities for age-related macular degeneration (AMD), where possible. Results The UK, USA, and Germany and China were the top four producers of macular disease research from 2011 to 2013. All except China had a higher proportion of citations than articles. There were 421 articles with UK authors published from 2011 to 2014, of which 49 % had international collaborators. The UK produced 9.7 % of the world’s output of macular disease articles from 2011 to 2013, but received 14.2 % of the world’s share of citations. UK authors’ share of the world’s top 10 % of cited publications from 2011 to 2013 was 16.2 %. In 2014, 13.2 % of UK articles were in journals in the top 10 % when ranked by Journal Impact Factors (JIFs), while the overall UK article share for that year was 9.9 %. UK articles did not show a strong correlation between citations and JIFs. The SLV-PSP published a set of 10 priorities for research into age-related macular degeneration in October 2103. Only 8 % of the UK’s 2011–2014 publications matched the SLV-PSP top priority (treatment to stop dry AMD progressing) and 34 % did not match any of the SLV-PSP priorities, mainly because the priorities did not include invasive treatment of wet AMD. Conclusions The UK is performing well in macular research, based on bibliometric indicators. The distribution of past research topics does not match the priorities set by the SLV-PSP.
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Layton A, Eady EA, Peat M, Whitehouse H, Levell N, Ridd M, Cowdell F, Patel M, Andrews S, Oxnard C, Fenton M, Firkins L. Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership. BMJ Open 2015; 5:e008085. [PMID: 26187120 PMCID: PMC4513497 DOI: 10.1136/bmjopen-2015-008085] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National Health Service (NHS). SETTING The UK with international participation. PARTICIPANTS Teenagers and adults with acne, parents, partners, nurses, clinicians, pharmacists, private practitioners. METHODS Treatment uncertainties were collected via separate online harvesting surveys, embedded within the PSP website, for patients and professionals. A wide variety of approaches were used to promote the surveys to stakeholder groups with a particular emphasis on teenagers and young adults. Survey submissions were collated using keywords and verified as uncertainties by appraising existing evidence. The 30 most popular themes were ranked via weighted scores from an online vote. At a priority setting workshop, patients and professionals discussed the 18 highest-scoring questions from the vote, and reached consensus on the top 10. RESULTS In the harvesting survey, 2310 people, including 652 professionals and 1456 patients (58% aged 24 y or younger), made submissions containing at least one research question. After checking for relevance and rephrasing, a total of 6255 questions were collated into themes. Valid votes ranking the 30 most common themes were obtained from 2807 participants. The top 10 uncertainties prioritised at the workshop were largely focused on management strategies, optimum use of common prescription medications and the role of non-drug based interventions. More female than male patients took part in the harvesting surveys and vote. A wider range of uncertainties were provided by patients compared to professionals. CONCLUSIONS Engaging teenagers and young adults in priority setting is achievable using a variety of promotional methods. The top 10 uncertainties reveal an extensive knowledge gap about widely used interventions and the relative merits of drug versus non-drug based treatments in acne management.
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Affiliation(s)
- Alison Layton
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - E Anne Eady
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Maggie Peat
- Department of Dermatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | | | - Nick Levell
- Departmemt of Dermatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Matthew Ridd
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Fiona Cowdell
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Mahenda Patel
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
| | - Stephen Andrews
- Science Technology Medicine, The British Library, London, UK
| | | | - Mark Fenton
- UK Database of Uncertainties about the Effects of Treatment (UK DUETS), National Institute for Health and Care Excellence, London, UK
| | - Lester Firkins
- James Lind Alliance, NIHR Evaluation Trials and Studies Co-ordinating Centre, Southampton, UK
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New and emerging technologies for the treatment of inherited retinal diseases: a horizon scanning review. Eye (Lond) 2015; 29:1131-40. [PMID: 26113499 PMCID: PMC4565944 DOI: 10.1038/eye.2015.115] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/25/2015] [Indexed: 11/08/2022] Open
Abstract
The horizon scanning review aimed to identify new and emerging technologies in development that have the potential to slow or stop disease progression and/or reverse sight loss in people with inherited retinal diseases (IRDs). Potential treatments were identified using recognized horizon scanning methods. These included a combination of online searches using predetermined search terms, suggestions from clinical experts and patient and carer focus groups, and contact with commercial developers. Twenty-nine relevant technologies were identified. These included 9 gene therapeutic approaches, 10 medical devices, 5 pharmacological agents, and 5 regenerative and cell therapies. A further 11 technologies were identified in very early phases of development (typically phase I or pre-clinical) and were included in the final report to give a complete picture of developments 'on the horizon'. Clinical experts and patient and carer focus groups provided helpful information and insights, such as the availability of specialised services for patients, the potential impacts of individual technologies on people with IRDs and their families, and helped to identify additional relevant technologies. This engagement ensured that important areas of innovation were not missed. Most of the health technologies identified are still at an early stage of development and it is difficult to estimate when treatments might be available. Further, well designed trials that generate data on efficacy, applicability, acceptability, and costs of the technologies, as well as the long-term impacts for various conditions are required before these can be considered for adoption into routine clinical practice.
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Stephens RJ, Whiting C, Cowan K. Research priorities in mesothelioma: A James Lind Alliance Priority Setting Partnership. Lung Cancer 2015; 89:175-80. [PMID: 26115838 DOI: 10.1016/j.lungcan.2015.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/24/2015] [Accepted: 05/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the UK, despite the import and use of all forms of asbestos being banned more than 15 years ago, the incidence of mesothelioma continues to rise. Mesothelioma is almost invariably fatal, and more research is required, not only to find more effective treatments, but also to achieve an earlier diagnosis and improve palliative care. Following a debate in the House of Lords in July 2013, a package of measures was agreed, which included a James Lind Alliance Priority Setting Partnership, funded by the National Institute for Health Research. The partnership brought together patients, carers, health professionals and support organisations to agree the top 10 research priorities relating to the diagnosis, treatment and care of patients with mesothelioma. METHODS Following the established James Lind Alliance priority setting process, mesothelioma patients, current and bereaved carers, and health professionals were surveyed to elicit their concerns regarding diagnosis, treatment and care. Research questions were generated from the survey responses, and following checks that the questions were currently unanswered, an interim prioritisation survey was conducted to identify a shortlist of questions to take to a final consensus meeting. FINDINGS Four hundred and fifty-three initial surveys were returned, which were refined into 52 unique unanswered research questions. The interim prioritisation survey was completed by 202 responders, and the top 30 questions were taken to a final meeting where mesothelioma patients, carers, and health professionals prioritised all the questions, and reached a consensus on the top 10. INTERPRETATION The top 10 questions cover a wide portfolio of research (including assessing the value of immunotherapy, individualised chemotherapy, second-line treatment and immediate chemotherapy, monitoring patients with pleural thickening, defining the management of ascites in peritoneal mesothelioma, and optimising follow-up strategy). This list is an invaluable resource, which should be used to inform the prioritisation and funding of future mesothelioma research.
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Affiliation(s)
- R J Stephens
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Aviation House, 125 Kingsway, London WC2B 6NH, United Kingdom
| | - C Whiting
- James Lind Alliance, NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton SO16 7NS, United Kingdom.
| | - K Cowan
- James Lind Alliance, NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton SO16 7NS, United Kingdom
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Care provision for poststroke visual impairment. J Stroke Cerebrovasc Dis 2015; 24:1131-44. [PMID: 25920755 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/28/2014] [Accepted: 12/29/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We sought to explore the care provision for poststroke visual impairment and variations in this in the United Kingdom. METHODS Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems; how these were identified, treated, and followed up; care pathways in use; links with other professions; and referral options. The survey was accessed via a Weblink, which was circulated through UK professional organizations to multiprofessional members of ophthalmic and stroke teams. RESULTS A total of 548 completed electronic surveys were obtained. In all, 49.5% of respondents represented stroke teams, 42.5% eye teams, and 8% from other teams, for example, emergency care. Many respondents (41%) saw patients within 1 week of stroke. Nineteen percent did not personally test vision: 11% had a visiting clinician to test vision, and 22% used screening tools. Validated tests were used for the assessment of visual acuity (39.5%), visual field (57.5%), eye movement (48.5%), and visual function (58.5%). Visual problems suspected by family or professionals were high (88.5%). Typical overall follow-up period of vision care was less than 3 months. In all, 46% of respondents used designated care pathways for stroke survivors with visual problems; 33.5% of respondents did not provide visual information leaflets. CONCLUSIONS Significant inequality exists in care for stroke survivors who experience visual problems. There is great variability in how vision screening is undertaken, which vision tests are used, methods of referral to eye care services, how visual problems are managed, and what vision information is provided to stroke survivors/carers. Further work is required to ensure equality and effective care.
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