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Legrand M, Bagshaw SM, Bhatraju PK, Bihorac A, Caniglia E, Khanna AK, Kellum JA, Koyner J, Harhay MO, Zampieri FG, Zarbock A, Chung K, Liu K, Mehta R, Pickkers P, Ryan A, Bernholz J, Dember L, Gallagher M, Rossignol P, Ostermann M. Sepsis-associated acute kidney injury: recent advances in enrichment strategies, sub-phenotyping and clinical trials. Crit Care 2024; 28:92. [PMID: 38515121 PMCID: PMC10958912 DOI: 10.1186/s13054-024-04877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Acute kidney injury (AKI) often complicates sepsis and is associated with high morbidity and mortality. In recent years, several important clinical trials have improved our understanding of sepsis-associated AKI (SA-AKI) and impacted clinical care. Advances in sub-phenotyping of sepsis and AKI and clinical trial design offer unprecedented opportunities to fill gaps in knowledge and generate better evidence for improving the outcome of critically ill patients with SA-AKI. In this manuscript, we review the recent literature of clinical trials in sepsis with focus on studies that explore SA-AKI as a primary or secondary outcome. We discuss lessons learned and potential opportunities to improve the design of clinical trials and generate actionable evidence in future research. We specifically discuss the role of enrichment strategies to target populations that are most likely to derive benefit and the importance of patient-centered clinical trial endpoints and appropriate trial designs with the aim to provide guidance in designing future trials.
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Affiliation(s)
- Matthieu Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF, 521 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Pavan K Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, USA
- Kidney Research Institute, University of Washington, Seattle, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL, USA
| | - Ellen Caniglia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
- Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jay Koyner
- University Section of Nephrology, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Department of Biostatistics, Epidemiology, and Informatics, PAIR (Palliative and Advanced Illness Research) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando G Zampieri
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | | | - Kathleen Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Ravindra Mehta
- Department of Medicine, University of California, San Diego, USA
| | - Peter Pickkers
- Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Abigail Ryan
- Chronic Care Policy Group, Division of Chronic Care Management, Center for Medicare and Medicaid Services, Center for Medicare, Baltimore, MD, USA
| | | | - Laura Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Patrick Rossignol
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Université de Lorraine, Nancy, France
- Medicine and Nephrology-Hemodialysis Departments, Monaco Private Hemodialysis Centre, Princess Grace Hospital, Monaco, Monaco
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
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Ryan A, Stone RG, Gavin PJ, James A, Walsh M, McMahon CJ. Rheumatic Fever and Rheumatic Heart Disease. Ir Med J 2023; 116:777. [PMID: 37555534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Lazzareschi D, Mehta RL, Dember LM, Bernholz J, Turan A, Sharma A, Kheterpal S, Parikh CR, Ali O, Schulman IH, Ryan A, Feng J, Simon N, Pirracchio R, Rossignol P, Legrand M. Overcoming barriers in the design and implementation of clinical trials for acute kidney injury: a report from the 2020 Kidney Disease Clinical Trialists meeting. Nephrol Dial Transplant 2023; 38:834-844. [PMID: 35022767 PMCID: PMC10064977 DOI: 10.1093/ndt/gfac003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI) is a growing epidemic and is independently associated with increased risk of death, chronic kidney disease (CKD) and cardiovascular events. Randomized-controlled trials (RCTs) in this domain are notoriously challenging and many clinical studies in AKI have yielded inconclusive findings. Underlying this conundrum is the inherent heterogeneity of AKI in its etiology, presentation and course. AKI is best understood as a syndrome and identification of AKI subphenotypes is needed to elucidate the disease's myriad etiologies and to tailor effective prevention and treatment strategies. Conventional RCTs are logistically cumbersome and often feature highly selected patient populations that limit external generalizability and thus alternative trial designs should be considered when appropriate. In this narrative review of recent developments in AKI trials based on the Kidney Disease Clinical Trialists (KDCT) 2020 meeting, we discuss barriers to and strategies for improved design and implementation of clinical trials for AKI patients, including predictive and prognostic enrichment techniques, the use of pragmatic trials and adaptive trials.
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Affiliation(s)
- Daniel Lazzareschi
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | | | - Alparslan Turan
- Department of Anesthesiology, Lerner College of Medicine of Case Western University, Cleveland, OH, USA
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chirag R Parikh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Omar Ali
- Verpora Ltd, Nottingham, UK
- University of Portsmouth, UK
| | - Ivonne H Schulman
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Abigail Ryan
- Division of Chronic Care Management, Centers for Medicare & Medicaid Services, Woodlawn, MD, USA
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Noah Simon
- Department of Biostatistics, University of Washington (UW), Seattle, WA, USA
| | - Romain Pirracchio
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Patrick Rossignol
- INI-CRCT Network, Nancy, France
- University of Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116, Nancy, France
| | - Matthieu Legrand
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- INI-CRCT Network, Nancy, France
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Phelan A, Louise D, Alice C, Kent S, Naughton C, Tuohy D, Ryan A, Byrne M. 79 EXPERIENCES OF DIRECTORS OF NURSING IN RESIDENTIAL CARE OF OLDER PEOPLE DURING COVID 19. Age Ageing 2022. [PMCID: PMC9620292 DOI: 10.1093/ageing/afac218.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background COVID-19 was a global public health crisis and deaths in the over 65 age group represented a disproportionate number of deaths in older people. In particular, nursing homes experienced clusters of infection and high mortality rates. This paper discusses experiences of care homes’ Directors of Nursing/Persons in Charge (DoN) in their preparedness, management and control of care during COVID-19. Methods A mixed methods approach was used (survey- n=122) and semi-structured interviews (n=20) were conducted with DoNs in private and voluntary older person care homes in the Republic of Ireland. Survey data was analysed using descriptive and inferential statistics. Interviews were analysed using Braun & Clarke's thematic analysis. Results DoNs demonstrated an initial challenge in protecting residents from infection and also managing infection outbreak. However, over time they experienced more effectiveness in managing infection prevention and control as demanded at the level of a pandemic. Fifty percent of respondents experienced an infection outbreak and the data does not demonstrate any significant difference in preparedness and management in care homes which had outbreaks and those who had no outbreaks. Other challenges were related to financial sustainability of their facility while 47% of DoNs were either actively seeking other work, or thinking of leaving their post. In the interviews, the DoNs spoke of persistent concerns with the well-being of the staff and residents and a constant worry about meeting regulatory requirements and ensuring adequate staff cover for residents care needs. Moreover, the DoNs spoke of the difficulties when the media sensationalized poor care leading to a reduction of public confidence in the sector. Conclusion The DoNs were under constant alert and although had acclimatized to high level of infection control and prevention and managing emerging issues, the strain of the pandemic remained evident. Recommendations are given related to care homes and related to system level management for future public health crisis.
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Affiliation(s)
- A Phelan
- Trinity College Dublin , Dublin, Ireland
| | - D Louise
- Trinity College Dublin , Dublin, Ireland
| | - C Alice
- University of Limerick , Limerick, Ireland
| | - S Kent
- Dublin City University , Dublin, Ireland
| | - C Naughton
- University College Dublin , Dublin, Ireland
| | - D Tuohy
- University of Limerick , Limerick, Ireland
| | - A Ryan
- Ulster University , Belfast, Ireland
| | - M Byrne
- Trinity College Dublin , Dublin, Ireland
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Josephy P, Elder R, Allen-Vercoe E, Kelly L, Ryan A, Harvey J, Ackerley D, Keyzers R. S-32-02 Characterization and toxicology of azo dye metabolites. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Legrand M, Bagshaw SM, Koyner JL, Schulman IH, Mathis MR, Bernholz J, Coca S, Gallagher M, Gaudry S, Liu KD, Mehta RL, Pirracchio R, Ryan A, Steubl D, Stockbridge N, Erlandsson F, Turan A, Wilson FP, Zarbock A, Bokoch MP, Casey JD, Rossignol P, Harhay MO. Optimizing the Design and Analysis of Future AKI Trials. J Am Soc Nephrol 2022; 33:1459-1470. [PMID: 35831022 PMCID: PMC9342638 DOI: 10.1681/asn.2021121605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AKI is a complex clinical syndrome associated with an increased risk of morbidity and mortality, particularly in critically ill and perioperative patient populations. Most AKI clinical trials have been inconclusive, failing to detect clinically important treatment effects at predetermined statistical thresholds. Heterogeneity in the pathobiology, etiology, presentation, and clinical course of AKI remains a key challenge in successfully testing new approaches for AKI prevention and treatment. This article, derived from the "AKI" session of the "Kidney Disease Clinical Trialists" virtual workshop held in October 2021, reviews barriers to and strategies for improving the design and implementation of clinical trials in patients with, or at risk of, developing AKI. The novel approaches to trial design included in this review span adaptive trial designs that increase the knowledge gained from each trial participant; pragmatic trial designs that allow for the efficient enrollment of sufficiently large numbers of patients to detect small, but clinically significant, treatment effects; and platform trial designs that use one trial infrastructure to answer multiple clinical questions simultaneously. This review also covers novel approaches to clinical trial analysis, such as Bayesian analysis and assessing heterogeneity in the response to therapies among trial participants. We also propose a road map and actionable recommendations to facilitate the adoption of the reviewed approaches. We hope that the resulting road map will help guide future clinical trial planning, maximize learning from AKI trials, and reduce the risk of missing important signals of benefit (or harm) from trial interventions.
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Affiliation(s)
- Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California San Francisco, San Francisco, California
- French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Trialists, Nancy, France
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ivonne H Schulman
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Michael R Mathis
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Steven Coca
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Stéphane Gaudry
- French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Trialists, Nancy, France
- Département de Réanimation, Medical and surgical intensive care unit, Assistance Publique-Hôpitaux de Paris Hôpital Avicenne, Bobigny, France
- Common and Rare Kidney Diseases, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 1155, Paris, France
| | - Kathleen D Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
| | - Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego, California
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California San Francisco, San Francisco, California
| | - Abigail Ryan
- Division of Chronic Care Management, Chronic Care Policy Group, Center for Medicare, Center for Medicare and Medicaid Services, Baltimore, Maryland
| | - Dominik Steubl
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
- Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Norman Stockbridge
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Alparslan Turan
- Department of Anesthesiology, Lerner College of Medicine of Case Western University, Cleveland, Ohio
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - F Perry Wilson
- Section of Nephrology and Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Michael P Bokoch
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California San Francisco, San Francisco, California
| | - Jonathan D Casey
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick Rossignol
- French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Trialists, Nancy, France
- University of Lorraine, INSERM CIC 1433, Nancy, France
- Nancy CHRU, INSERM U1116, Nancy, French national institute of Health and Medical Research, unit 1116, Nancy, France
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Laboratory, PAIR (Palliative and Advanced Illness Research) Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mehta R, Shardell M, Ryan A, Dong Y, Beamer B, Gallo J, Stuart E, Schuler M, Hochberg M, Rathbun A. POS1138 PERSISTENCY OF DEPRESSIVE SYMPTOMS AND PHYSICAL PERFORMANCE IN KNEE OSTEOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundKnee osteoarthritis (OA) is the most prevalent arthritic disorder, characterized by joint paint, which is exacerbated by chronic depressive episodes. Depression in knee OA is also associated with declines in physical activity level and greater disability; however, the impact of persistent depressive symptoms on physical performance remains unclear.ObjectivesTo determine how the persistence of depressive symptoms affects functional capacity in knee OA.MethodsParticipants (n=2,212) were from the Osteoarthritis Initiative cohort and included individuals with radiographic disease (Kellgren-Lawrence grade ≥ 2) and complete data on study measures at baseline. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D; range 0-60) at baseline and the first three follow-up visits. Physical Performance was measured using 20-meter gait speed (meters per second) during follow-up at the first four annual visits. Persistency of depressive symptoms was operationalized as a cumulative exposure using average severity over time. Gait speed was standardized so that outcome estimates could be interpreted in standard deviations. Time-invariant confounders measured at study enrollment included demographic, socioeconomic, and lifestyle factors. Time-varying confounders assessed concurrent to CES-D scores were body mass index, analgesic medications, pain, and other knee OA signs and symptoms. Marginal structural models accounting for time-dependent confounding and selective attrition were the primary method of analysis. The outcome model included all potential statistical interactions between depressive symptoms and follow-up time indicators. Post-estimation linear combinations estimated time-specific effects of time-averaged CES-D scores on standardized gait speed and differences in physical performance between participants with (i.e., CES-D=16) and without (i.e., CES-D=0) depressive symptoms satisfying screening criteria for major depression.ResultsThe interaction between depressive symptoms and time was statistically significant (P=<0.001). Time-specific associations indicated that the largest negative impact of depressive symptoms on physical performance was from baseline through year one (β = -0.0077; 95% CI: -0.0125, 0.0030). However, the effect of persistent depressive symptoms decreased over time and reversed in magnitude and directionality, evidenced by the time-specific associations between time-averaged CES-D scores from baseline through year one and year two and gait speed at year two (β = -0.0033; 95% CI: -0.0084, 0.0019) and year three (β = 0.0014; 95% CI: -0.0046, 0.0074), respectively. Consequently, the strongest negative affect of depressive symptoms on gait speed (β = -0.1232; 95% CI: -0.1998, -0.0473) between participants with and without depressive symptoms satisfying screening criteria for major depression was when depressive symptoms were first measured closest to the initial gait speed assessment.ConclusionIn the contrast to the dose-dependent relationship between chronic depressive episodes and pain in knee OA, study findings imply that the negative effect of depressive symptoms on physical performance decreases over time with increasing depression persistency. These results may reflect diminishing marginal effects, where the largest impact on physical performance in knee OA is during the first depressive episode closest to initial gait speed assessment, especially when averaged against improvement in symptoms over the same duration.AcknowledgementsThe OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.Disclosure of InterestsRhea Mehta: None declared, Michelle Shardell: None declared, Alice Ryan: None declared, Yu Dong: None declared, Brock Beamer: None declared, Joseph Gallo: None declared, Elizabeth Stuart: None declared, Megan Schuler: None declared, Marc Hochberg Shareholder of: Dr. Marc C. Hochberg is the President of Rheumcon Corporation., Consultant of: Dr. Marc C. Hochberg receives consulting fees from Bioiberica SA, Bristol-Myers Squibb, Eli Lilly, EMD Serono, Galapagos, IBSA Biotechniq SA, Novartis Pharma AG, Pfizer, Plexxikon, Samumed LLC, Theralogix LLC, and TissueGene Inc., Alan Rathbun: None declared
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Ivanovska A, Mancuso P, Hennessy C, McLoughlin S, Reilly J, Raman S, Dooley C, Ritter T, Ryan A, Kamath R, Levesque M, van Riet D, Barry F, Murphy M. Mesenchymal Stem/Stromal Cells: TRANSCRIPTOME PROFILE OF RETRIEVED MESENCHYMAL STEM/STROMAL CELLS IN A COLLAGENASE INDUCED MURINE OSTEOARTHRITIS MODEL. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Varghese A, Ryan A, Wells C, Li G, Baer D, Parker E, Buko A, Kaza V, Banga A, Bollineni S, Mahan L, Mohanka M, Lawrence A, Joerns J, Torres F, Wait M, Iacono A, Verceles A, Terada L, Terrin M, Timofte I. Post-Transplant Metabolomics Profiles in Patients Undergoing Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Nath LC, Forbes G, Elliott AD, Tomren V, Ryan A, Franklin SH. Application of an electrocardiography device (iECG) for heart rhythm analysis after exercise in Thoroughbred horses. Aust Vet J 2021; 100:114-120. [PMID: 34859419 DOI: 10.1111/avj.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/08/2021] [Accepted: 11/14/2021] [Indexed: 12/01/2022]
Abstract
AliveCor is a smartphone electrocardiography device (iECG) providing automated heart rate (HR) and rhythm determination. Atrial fibrillation (AF) in horses often is paroxysmal and rapid ECG acquisition is needed for diagnostic confirmation. iECGs were collected post-race from 15 horses with AF and 64 horses in sinus rhythm (SR). Results of manual assessment were compared to 3 commercial algorithms for HR and rhythm. Agreement between manually derived HR (HRM ) and HR derived by the AliveECG Vet (HRVET ) and Kardia version-1 (KV1 HR) and Kardia advanced (KADV HR) algorithms was quantified by the Bland-Altman limits of agreement test. Agreement between manual rhythm classification and KV1 and KADV algorithms for AF and SR was calculated by the Kappa statistical coefficient. The agreement (bias, 95% limits), between HRM and HRVET was 7.1 BPM (-29 to 43) in AF and -4.2 BPM (-38 to 30) in SR, between HRM and KV1 HR, was -0.3 BPM (-31 to 30) in AF and 0.2 BPM (-3 to 4) in SR, and between HRM and KADV HR was 7.0 BPM (-29 to 43) in AF and 0.2 BPM (-3.9 to 4.2) in SR. Agreement between manual rhythm classification and KV1 was 0.36 (0.13-0.59), and KADV was 0.84 (0.68-0.99). Sensitivity and specificity for identification of AF and SR of the KV1 algorithm were 60, 100% and 83, 100%, respectively, and of KADV was 87, 100% and 93, 100% respectively. The Kardia algorithms improved precision for HR determination in SR but not AF. The advanced algorithm accurately distinguished between AF and SR. The iECG is suitable for recording episodes of AF following exercise.
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Affiliation(s)
- L C Nath
- University of Adelaide, Roseworthy, South Australia, Australia
| | - G Forbes
- Racing Victoria, Flemington, Victoria, Australia
| | - A D Elliott
- University of Adelaide, Adelaide, South Australia, Australia
| | - V Tomren
- Racing Victoria, Flemington, Victoria, Australia
| | - A Ryan
- University of Adelaide, Roseworthy, South Australia, Australia
| | - S H Franklin
- University of Adelaide, Roseworthy, South Australia, Australia
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Tariq S, Stroiescu A, Mannion J, Caples N, O'Callaghan P, O'Reilly M, Ryan A, Owens P. Protection of bone mineral density in heart failure patients:audit on current clinical practice in a busy tertiary care hospital cardiology department in Ireland. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The strong association between heart failure (HF) and osteoporosis is well recognised. Heart failure, due to its multiple risk factors and common pathogenesis with osteoporosis can lead to low bone mineral density (BMD) and increase the risk of fragility fractures. The mortality of HF patients following these fractures is high. Current National Osteoporosis Foundation Guidelines recommend that pharmacological therapy should be reserved for postmenopausal women and men aged 50 years or older who present with a hip or vertebral fracture, where the vertebral fractures may be clinical or identified on a radiograph alone.
Methods
Most HF patients have frequent chest radiographs over their course years. We aimed to audit the prevalence of osteoporosis and current practice of prescribing BMD-protection in patients attending the HF clinic in a busy tertiary care hospital in Ireland. 100 patients attending the clinic in the last one year were randomly selected and clinical, medication and chest radiograph information on this cohort was collected via the hospital electronic information system. All those patients with Radiologist confirmed vertebral compression fractures (VCF) on their plain chest radiographs were audited regarding osteoporosis screening and bone protection prescription.
Results
Due to limited penetration,18 out of 100 chest radiographs were inconclusive,reducing the sample size to 82. 9 out of the remaining 82 patients had radiologist confirmed VCF on their plain chest radiographs whereas 2 patients had VCF incidentally picked up on their lumbar spine x-rays. All patients were aged more than 50. 4 were female and 7 male. Median ejection fraction calculated was 35%. 3 out of 11 were smokers,8 had atrial fibrillation and were on anticoagulation,4 had DM-II and 2 had CKD. 10 were on loop diuretics. Of note,4 patients were on calcium and vitamin D supplements but only 1 patient was on antiresorptive therapy for osteoporosis.
Conclusion
Despite its strong association with heart failure,Osteoporosis remains undertreated in this patient cohort.Due to the significant mortality and morbidity associated with major osteoporotic fractures, doctors should carefully assess and screen heart failure patients for osteoporosis and initiate specific therapy where indicated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tariq
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - A Stroiescu
- University Hospital Waterford, Radiology, Waterford, Ireland
| | - J Mannion
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - N Caples
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - P O'Callaghan
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - M O'Reilly
- University Hospital Waterford, Cardiology, Waterford, Ireland
| | - A Ryan
- University Hospital Waterford, Radiology, Waterford, Ireland
| | - P Owens
- University Hospital Waterford, Cardiology, Waterford, Ireland
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Heijkoop B, Bolton D, Katz D, Ryan A, Epstein J, Appu S. Cystic papillary adenoma of the seminal vesicle – A distinct histological entity. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Timofte I, Wells C, Hersi K, Ryan A, Varghese A, Vesselinov R, Iacono A, Assadi J, Davis D, Li G, Herr D, Harrington T, Griffith B, Lau C, Krupnick A, Madathil R, Rabin J, Alon G, Parker E, Baer D, Magder L, Terrin M, Verceles A. Nutritional Supplementation and Neuromuscular Electrical Stimulation in Lung Transplant Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Van Den Heuvel F, Petersson K, Vojnovic B, Hill M, Vella A, Ryan A, Brooke M, Maughan T, Giaccia A. Oxygen Related Factors in FLASH Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Squire T, Ryan A, Bernard S. Radioprotective effects of induced astronaut torpor and advanced propulsion systems during deep space travel. Life Sci Space Res (Amst) 2020; 26:105-113. [PMID: 32718676 DOI: 10.1016/j.lssr.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Human metabolic suppression is not a new concept, with 1950s scientific literature and movies demonstrating its potential use for deep space travel (Hock, 1960). An artificially induced state of metabolic suppression in the form of torpor would improve the amount of supplies required and therefore lessen weight and fuel required for missions to Mars and beyond (Choukèr et al., 2019). Transfer habitats for human stasis to Mars have been conceived (Bradford et al., 2018). Evidence suggests that animals, when hibernating, demonstrate relative radioprotection compared to their awake state. Experiments have also demonstrated relative radioprotection in conditions of hypothermia as well as during sleep (Bellesi et al., 2016 and Andersen et al., 2009). Circadian rhythm disrupted cells also appear to be more susceptible to radiation damage compared to those that are under a rhythmic control (Dakup et al., 2018). An induced torpor state for astronauts on deep space missions may provide a biological radioprotective state due to a decreased metabolism and hypothermic conditions. A regular enforced circadian rhythm might further limit DNA damage from radiation. The As Low As Reasonably Achievable (A.L.A.R.A.) radiation protection concept defines time, distance and shielding as ways to decrease radiation exposure. Whilst distance cannot be altered in space and shielding either passively or actively may be beneficial, time of exposure may be drastically decreased with improved propulsion systems. Whilst chemical propulsion systems have superior thrust to other systems, they lack high changes in velocity and fuel efficiency which can be achieved with nuclear or electric based propulsion systems. Radiation toxicity could be limited by reduced transit times, combined with the radioprotective effects of enforced circadian rhythms during a state of torpor or hibernation. OBJECTIVES 1. Investigate how the circadian clock and body temperature may contribute to radioprotection during human torpor on deep space missions. 2. Estimate radiation dose received by astronauts during a transit to Mars with varying propulsion systems. METHODS We simulated three types of conditions to investigate the potential radioprotective effect of the circadian clock and decreased temperature on cells being exposed to radiation such that may be the case during astronaut torpor. These conditions were: - Circadian clock strength: strong vs weak. - Light exposure: dark-dark vs light-dark cycle - Body temperature: 37C vs hypothermia vs torpor. We estimated transit times for a mission to Mars from Earth utilizing chemical, nuclear and electrical propulsion systems. Transit times were generated using the General Mission Analysis Tool (GMAT) and Matlab. These times were then input into the National Aeronautics and Space Administration (NASA) Online Tool for the Assessment of Radiation In Space (OLTARIS) computer simulator to estimate doses received by an astronaut for the three propulsion methods. RESULTS Our simulation demonstrated an increase in radioprotection with decreasing temperature. The greatest degree of radioprotection was shown in cells that maintained a strong circadian clock during torpor. This was in contrast to relatively lower radioprotection in cells with a weak clock during normothermia. We were also able to demonstrate that if torpor weakened the circadian clock, a protective effect could be partially restored by an external drive such as lighting schedules to aid entrainment i.e.: Blue light exposure for periods of awake and no light for rest times For the propulsion simulation, estimated transit times from Earth to Mars were 258 days for chemical propulsion with 165.9mSv received, 209 days for nuclear propulsion with 134.4mSv received and 80 days for electrical propulsion with 51.4mSv received. CONCLUSION A state of torpor for astronauts on deep space missions may not only improve weight, fuel and storage requirements but also provide a potential biological radiation protection strategy. Moreover, maintaining a controlled circadian rhythm during torpor conditions may aid radioprotection. In the not too distant future, propulsion techniques will be improved to limit transit time and hence decrease radiation dose to astronauts. Limiting exposure time and enhancing physiological radioprotection during transit could provide superior radioprotection benefits compared with active and passive radiation shielding strategies alone.
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Affiliation(s)
- T Squire
- The Canberra Hospital, Department of Radiation Oncology. Garran. Australian Capital Territory, Australia; University of Notre Dame Australia, School of Medicine. Darlinghurst, New South Wales, Australia.
| | - A Ryan
- University of Sydney, Applied and Plasma Physics Research Group. School of Aerospace Mechanical and Mechatronic Engineering, Camperdown, NSW 2006. Australia
| | - S Bernard
- Université de Lyon. CNRS UMR5208 Institut Camille Jordan. Villeurbanne, France & Inria Grenoble, France
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Burnell M, Gentry‐Maharaj A, Glazer C, Karpinskyj C, Ryan A, Apostolidou S, Kalsi J, Parmar M, Campbell S, Jacobs I, Menon U. Serial endometrial thickness and risk of non-endometrial hormone-dependent cancers in postmenopausal women in UK Collaborative Trial of Ovarian Cancer Screening. Ultrasound Obstet Gynecol 2020; 56:267-275. [PMID: 31614036 PMCID: PMC7496247 DOI: 10.1002/uog.21894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation, which is assessed routinely as endometrial thickness (ET) using transvaginal ultrasound (TVS). Only one previous study, restricted to endometrial and breast cancer, has considered ET and the risk of non-endometrial cancer. The aim of this study was to explore the association between baseline and serial ET measurements and nine non-endometrial hormone-sensitive cancers, in postmenopausal women, using contemporary statistical methodology that attempts to minimize the biases typical of endogenous serial data. METHODS This was a cohort study nested within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). In the ultrasound arm of UKCTOCS, 50639 postmenopausal women, aged 50-74, underwent annual TVS examination, of whom 38 105 had a valid ET measurement, no prior hysterectomy and complete covariate data, and were included in this study. All women were followed up through linkage to national cancer registries. The effect of ET on the risk of six estrogen-dependent cancers (breast, ovarian, colorectal, bladder, lung and pancreatic) was assessed using joint models for longitudinal biomarker and time-to-event data, and Cox models were used to assess the association between baseline ET measurement and these six cancers in addition to liver cancer, gastric cancer and non-Hodgkin's lymphoma (NHL). All models were adjusted for current hormone-replacement therapy (HRT) use, body mass index, age at last menstrual period, parity and oral contraceptive pill use. RESULTS The 38 105 included women had a combined total of 267 567 (median, 8; interquartile range, 5-9) valid ET measurements. During a combined total of 407 838 (median, 10.9) years of follow-up, 1398 breast, 351 endometrial, 381 lung, 495 colorectal, 222 ovarian, 94 pancreatic, 79 bladder, 62 gastric, 38 liver cancers and 52 NHLs were registered. Using joint models, a doubling of ET increased significantly the risk of breast (hazard ratio (HR), 1.21; 95% CI, 1.09-1.36; P = 0.001), ovarian (HR, 1.39; 95% CI, 1.06-1.82; P = 0.018) and lung (HR, 1.25; 95% CI, 1.02-1.54; P = 0.036) cancers. There were no statistically significant associations between ET and the remaining six cancers. CONCLUSION Postmenopausal women with high/increasing ET on TVS are at increased risk of breast, ovarian and lung cancer. It is important that clinicians are aware of these risks, as TVS is a common investigation. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. Burnell
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - C. Glazer
- Department of Occupational and Environmental MedicineFrederiksberg‐Bispebjerg University HospitalCopenhagenNVDenmark
| | - C. Karpinskyj
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - A. Ryan
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - S. Apostolidou
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | - J. Kalsi
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - M. Parmar
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
| | | | - I. Jacobs
- Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyAustralia
| | - U. Menon
- MRC CTU, Institute of Clinical Trials and MethodologyUniversity College LondonLondonUK
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Faivre-Finn C, Brown S, Ryan A, Greystoke A. The UK at the Forefront of Innovative Drug-Radiotherapy Combination Clinical Trials: Introducing the CONCORDE Platform. Clin Oncol (R Coll Radiol) 2020; 32:358-362. [PMID: 32107107 DOI: 10.1016/j.clon.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Affiliation(s)
- C Faivre-Finn
- The Christie NHS Foundation Trust/University of Manchester, Manchester, UK.
| | - S Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - A Ryan
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, The Department of Oncology, University of Oxford, Oxford, UK
| | - A Greystoke
- Newcastle University, Newcastle upon Tyne, UK
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O'Brien S, Garvey P, Baker K, Brennan M, Cormican M, Cuddihy J, De Lappe N, Ellard R, Fallon Ú, Irvine N, Murphy S, O'Brien D, O'Connor M, O'Hare C, O'Sullivan MB, Part AM, Rooney P, Ryan A, Waldron G, Ward M, McKeown PJ. Investigation of a foodborne outbreak of Shigella sonnei in Ireland and Northern Ireland, December 2016: the benefits of cross-border collaboration and commercial sales data. Public Health 2020; 182:19-25. [PMID: 32120067 DOI: 10.1016/j.puhe.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a cross-border foodborne outbreak of Shigella sonnei that occurred in Ireland and Northern Ireland (NI) in December 2016 whilst also highlighting the valuable roles of sales data and international collaboration in the investigation and control of this outbreak. STUDY DESIGN A cross-border outbreak control team was established to investigate the outbreak. METHODS Epidemiological, microbiological, and environmental investigations were undertaken. Traditional analytical epidemiological studies were not feasible in this investigation. The restaurant chain provided sales data, which allowed assessment of a possible increased risk of illness associated with exposure to a particular type of heated food product (product A). RESULTS Confirmed cases demonstrated sole trimethoprim resistance: an atypical antibiogram for Shigella isolates in Ireland. Early communication and the sharing of information within the outbreak control team facilitated the early detection of the international dimension of this outbreak. A joint international alert using the European Centre for Disease Control's confidential Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) did not reveal further cases outside of the island of Ireland. The outbreak investigation identified that nine of thirteen primary case individuals had consumed product A from one of multiple branches of a restaurant chain located throughout the island of Ireland. Product A was made specifically for this chain in a food production facility in NI. S. sonnei was not detected in food samples from the food production facility. Strong statistical associations were observed between visiting a branch of this restaurant chain between 5 and 9 December 2016 and eating product A and developing shigellosis. CONCLUSIONS This outbreak investigation highlights the importance of international collaboration in the efficient identification of cross-border foodborne outbreaks and the value of using sales data as the analytical component of such studies.
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Affiliation(s)
- S O'Brien
- HSE-Health Protection Surveillance Centre, Dublin, Ireland; Department of Public Health HSE-NW, Sligo, Ireland.
| | - P Garvey
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - K Baker
- Food Standards Agency Northern Ireland, Belfast, Northern Ireland, Ireland
| | - M Brennan
- Food Safety Authority of Ireland, Dublin, Ireland
| | - M Cormican
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - J Cuddihy
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | - N De Lappe
- National Salmonella, Shigella and Listeria Reference Laboratory, Galway, Ireland
| | - R Ellard
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Ú Fallon
- Department of Public Health HSE-Midlands, Co Offaly, Ireland
| | - N Irvine
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - S Murphy
- Environmental Health Department, Newry, Mourne & Down District Council, Northern Ireland, UK
| | - D O'Brien
- HSE Environmental Health Service Dublin Specialist Section, Dublin, Ireland
| | - M O'Connor
- Department of Public Health HSE-E, Dublin, Ireland
| | - C O'Hare
- Department of Public Health HSE-SE, Kilkenny, Ireland
| | | | - A M Part
- HSE Environmental Health Service Dublin Mid Leinster, Dublin, Ireland
| | - P Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - A Ryan
- Department of Public Health HSE-NW, Sligo, Ireland
| | - G Waldron
- Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK
| | - M Ward
- Department of Public Health HSE-E, Dublin, Ireland
| | - P J McKeown
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
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Ryan A, Bates E, Danson S, Das T, Fisher P, Hatton M, Lee C, Young R, Taylor F, Marshall R. Outcomes of patients in South Yorkshire with advanced non-small-cell lung cancer treated with second-line atezolizumab following induction with chemotherapy. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bates T, Ryan A, Schoeffler K, Ayoub R, Onyiego S, Sims G, Shah U. Safeguarding Against Prescription Drug Misuse: Educational Resources to Properly Secure and Dispose of Medication. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hudson A, Brown S, Chalmers A, Dive C, Franks K, Hanna G, Hannaway N, Harrow S, Haswell T, Hiley C, Hinsley S, Krebs M, Murden G, Reed S, Ryan A, Sebag-Montefiore D, Shaw P, Smith A, Walls G, Young R, Faivre-Finn C, Greystoke A. P2.01-08 Clinical Trial in Progress: CONCORDE - A Phase 1B Study of Novel Agents in Combination with Conventional Radiotherapy in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Puckrein G, Xu L, Ryan A, Campbell K, Balu S. Abstract P5-15-06: Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among breast cancer patients: A simulation model analysis. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-15-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Rationale & Objective: Granulocyte colony-stimulating factors (G-CSFs) are utilized to decrease the incidence of febrile neutropenia (FN) in patients with cancers undergoing chemotherapy treatments. In 2015 biosimilar filgrastim-sndz was the first biosimilar to be approved and launched in the US market. Limited data exists in ascertaining the impact of biosimilars on patient out-of-pocket (OOP) expenditures. The objective of this simulation model was to estimate potential OOP cost savings through use of filgrastim-sndz over reference filgrastim from a Medicare breast cancer patient perspective.
Methods: An Excel simulation analysis was conducted among breast cancer patients treated with biosimilar filgrastim-sndz or the branded reference filgrastim (identified through HCPCS codes). Data from the 2016 Medicare Limited Data Set (5% sample of the carrier file) was used to populate the model. The payment calculation worksheet within the Medicare carrier file was used to calculate the average Medicare payment to the provider and the average beneficiary OOP responsibility per claim of either filgrastim-sndz or reference filgrastim. The average OOP reduction per claim for a filgrastim-sndz beneficiary relative to a reference filgrastim beneficiary was multiplied to a hypothetical FN prevalent population of 100,000 beneficiaries (average of 10 claims per beneficiary) to estimate the potential OOP savings.
Results: Data for 616 filgrastim-sndz and 1,064 reference filgrastim claims were used to populate the model. The average Medicare allowed charge amount per claim for a filgrastim-sndz beneficiary was $362.8 versus $406.9 for a reference filgrastim beneficiary, while corresponding average Medicare payments to the provider were $284.1 and $316.9, respectively. On an average, OOP responsibility for a filgrastim-sndz beneficiary was lower compared to a reference filgrastim beneficiary ($72.9 versus $82.5) leading to a cost saving per claim of $9.60. When extrapolated to 100,000 beneficiaries (1,000,000 claims), the overall cost saving was projected to be around $9.6 million.
Conclusions: Our simulation model estimated a potential OOP Medicare breast cancer beneficiary saving of around $9.6 million, based on a hypothetical population of 100,000 FN beneficiaries, with the use of biosimilar filgrastim-sndz over reference filgrastim. Further real-world analyses are required to evaluate the true cost saving potential from a breast cancer patient perspective with the use of biosimilars over reference biologics.
Citation Format: Puckrein G, Xu L, Ryan A, Campbell K, Balu S. Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among breast cancer patients: A simulation model analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-06.
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Affiliation(s)
- G Puckrein
- National Minority Quality Forum, Washington, DC; Sandoz Inc., Princeton
| | - L Xu
- National Minority Quality Forum, Washington, DC; Sandoz Inc., Princeton
| | - A Ryan
- National Minority Quality Forum, Washington, DC; Sandoz Inc., Princeton
| | - K Campbell
- National Minority Quality Forum, Washington, DC; Sandoz Inc., Princeton
| | - S Balu
- National Minority Quality Forum, Washington, DC; Sandoz Inc., Princeton
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McKanna T, Ryan A, Krinshpun S, Kareht S, Marchand K, Grabarits C, Ali M, McElheny A, Gardiner K, LeChien K, Hsu M, Saltzman D, Stosic M, Martin K, Benn P. Fetal fraction-based risk algorithm for non-invasive prenatal testing: screening for trisomies 13 and 18 and triploidy in women with low cell-free fetal DNA. Ultrasound Obstet Gynecol 2019; 53:73-79. [PMID: 30014528 PMCID: PMC6587793 DOI: 10.1002/uog.19176] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To identify pregnancies at increased risk for trisomy 13, trisomy 18 or triploidy attributable to low fetal fraction (FF). METHODS A FF-based risk (FFBR) model was built using data from more than 165 000 singleton pregnancies referred for single-nucleotide polymorphism (SNP)-based non-invasive prenatal testing (NIPT). Based on maternal weight and gestational age (GA), FF distributions for normal, trisomy 13, trisomy 18 and triploid pregnancies were constructed and used to adjust prior risks for these abnormalities. A risk cut-off of ≥ 1% was chosen to define pregnancies at high risk for trisomy 13, trisomy 18 or triploidy (high FFBR score). The model was evaluated on an independent blinded set of pregnancies for which SNP-based NIPT did not return a result, and for which pregnancy outcome information was gathered retrospectively. RESULTS The evaluation cohort comprised 1148 cases, of which approximately half received a high FFBR score. Compared with rates expected based on maternal age (MA) and GA, cases with a high FFBR score had a significantly increased rate of trisomy 13, trisomy 18 or triploidy combined (5.7% vs 0.7%; P < 0.001) and also of unexplained pregnancy loss (14.7% vs 10.4%; P < 0.001). For cases that did not receive a high FFBR score, the incidence of a chromosomal abnormality or pregnancy loss was not significantly different from that expected based on MA and GA. In this study cohort, the sensitivity of the FFBR model for detection of trisomy 13, trisomy 18 or triploidy was 91.4% (95% CI, 76.9-98.2%) with a positive predictive value of 5.7% (32/564; 95% CI, 3.9-7.9%). CONCLUSIONS For pregnancies with a FF too low to receive a result on standard NIPT, the FFBR algorithm identified a subset of cases at increased risk for trisomy 13, trisomy 18 or triploidy. For the remainder of cases, the risk of a fetal chromosomal abnormality was unchanged from that expected based on MA and GA. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
| | | | | | | | - K. Marchand
- Beth Israel Deaconess Medical CenterBostonMAUSA
| | - C. Grabarits
- Vanderbilt University Medical CenterNashvilleTNUSA
| | - M. Ali
- Weill Cornell MedicineNew YorkNYUSA
| | - A. McElheny
- St Louis University School of MedicineSt LouisMOUSA
| | | | | | - M. Hsu
- Northshore University Health SystemChicagoILUSA
| | - D. Saltzman
- Icahn School of Medicine at Mount SinaiNew YorkNYUSA
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Ryan A, Penney S, Meyer J, Dewar B. THE ‘MY HOME LIFE’ LEADERSHIP SUPPORT AND COMMUNITY DEVELOPMENT PROGRAMME. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ryan
- Ulster University, Londonderry, England, United Kingdom
| | - S Penney
- Ulster University, Northern Irel
| | - J Meyer
- City University, London, Engl
| | - B Dewar
- University of the West of Scotland, Scotl
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Rathbun A, Gallo J, Stuart E, Shardell M, Gruber-Baldini A, Orwig D, Ryan A, Magaziner J. DEPRESSIVE SYMPTOM SUBTYPES IN OLDER ADULTS AFTER HIP FRACTURE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - J Gallo
- Johns Hopkins Bloomberg School of Public Health
| | - E Stuart
- Johns Hopkins Bloomberg School of Public Health
| | | | | | - D Orwig
- Department of Epidemiology & Public Health University of Maryland School of Medicine
| | - A Ryan
- University of Maryland School of Medicine
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O’Cearbhaill R, Wolfer A, Disilvestro P, O’Malley D, Sabbatini P, Shohara L, Schwarzenberger P, Ricciardi T, Macri M, Ryan A, Venhaus R, Bryan J, Wong P, Homicsko K, Kandalaft L, Rusakiewicz S, Harari A, Monk B, Coukos G. A phase I/II study of chemo-immunotherapy with durvalumab (durva) and pegylated liposomal doxorubicin (PLD) in platinum-resistant recurrent ovarian cancer (PROC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Akram F, Fuchs D, Daue M, Nijjar G, Ryan A, Benros ME, Okusaga O, Baca‐Garcia E, Brenner LA, Lowry CA, Ryan KA, Pavlovich M, Mitchell BD, Snitker S, Postolache TT. Association of plasma nitrite levels with obesity and metabolic syndrome in the Old Order Amish. Obes Sci Pract 2018; 4:468-476. [PMID: 30338117 PMCID: PMC6180710 DOI: 10.1002/osp4.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Plasma nitrite is a metabolite of nitric oxide and reflects endogenous nitric oxide synthase (NOS) activity. Although plasma nitrites were previously linked with obesity and metabolic syndrome (MetS), the direction of association remains inconsistent, possibly due to sample heterogeneity. In a relatively homogeneous population, we hypothesized that nitrite levels will be positively associated with overweight/obesity and MetS. METHODS Fasting nitrite levels were measured in 116 Old Order Amish (78% women). We performed age-and-sex-adjusted ancovas to compare nitrite levels between three groups (a) overweight/obese(-)MetS(-), (b) overweight/obese(+)MetS(-) and (c) overweight/obese(+)MetS)(+). Multivariate linear regressions were conducted on nitrite associations with continuous metabolic variables, with successive adjustments for demographics, body mass index, C-reactive protein and neopterin. RESULTS Nitrite levels were higher in the obese/overweight(+)MetS(+) group than in the other two groups (p < 0.001). Nitrites were positively associated with levels of triglycerides (p < 0.0001), total cholesterol (p = 0.048), high-density lipoprotein/cholesterol ratio (p < 0.0001) and fasting glucose (p < 0.0001), and negatively correlated with high-density lipoprotein-cholesterol (p < 0.0001). These associations were robust to adjustments for body mass index and inflammatory markers. CONCLUSION Further investigation of the connection between obesity/MetS and plasma nitrite levels may lead to novel dietary and pharmacological approaches that ultimately may contribute to reducing the increasing burden of obesity, MetS and cardiovascular morbidity and mortality.
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Affiliation(s)
- F. Akram
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Psychiatry Residency Training ProgramSt. Elizabeth's HospitalWashingtonDCUSA
| | - D. Fuchs
- Division of Biological Chemistry, BiocenterInnsbruck Medical UniversityInnsbruckAustria
| | - M. Daue
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - G. Nijjar
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - A. Ryan
- Department of Veterans AffairsVISN 5 Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreMDUSA
| | - M. E. Benros
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - O. Okusaga
- Michael E DeBakey VA Medical CenterHoustonTXUSA
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTXUSA
| | - E. Baca‐Garcia
- Department of Psychiatry, Fundación Jimenez Diaz HospitalAutónoma University, Centro de Investigacion en Red Salud MentalMadridSpain
| | - L. A. Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
- Department of Integrative Physiology and Center for NeuroscienceUniversity of Colorado BoulderBoulderCO80309USA
| | - C. A. Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
- Department of Integrative Physiology and Center for NeuroscienceUniversity of Colorado BoulderBoulderCO80309USA
| | - K. A. Ryan
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - M. Pavlovich
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - B. D. Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - S. Snitker
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - T. T. Postolache
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Department of Veterans AffairsVISN 5 Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreMDUSA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
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Ryan A, Cruz S, Miller R, Kristeleit R. PARP inhibitor (PARPi) monotherapy treatment in non-BRCA and/or non-serous gynaecological cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, Burnell M, Menon U, Rosenberg WM. Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS). BMC Public Health 2018; 18:409. [PMID: 29587697 PMCID: PMC5870222 DOI: 10.1186/s12889-018-5308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background We investigated the association between self-reported skirt size (SS) and change in SS, and incidence of chronic liver disease (CLD) in a prospective cohort study of women recruited to the UKCTOCS trial. Methods Women recruited to UKCTOCS in England without documented CLD self-reported their current UK SS during trial participation and were asked to recall their SS when aged in 20s (via completion of a questionnaire 3–5 years after recruitment). Participants were followed up via electronic health record linkage and hazard ratios (HR) calculated for incident liver-related events (LRE). Results Three hundred twenty-two (0.3%) of 94,124 women experienced a first LRE. Compared to SS ≤ 16, rates of LRE were higher in the SS ≥ 18 groups (both when aged in 20s and at questionnaire completion). Event rates were higher if there was no change in SS or an increase in SS, compared to a decrease in SS. In the models adjusted for potential confounders, HRs for LRE were higher in the groups of women reporting SS ≥ 18 both when aged in 20s (HR = 1.39 (95% CI; 0.87–2.23)) and at questionnaire completion (HR = 1.37 (95% CI; 1.07–1.75)). Compared to a decrease in SS, HRs were higher in the no change (HR = 1.78 (95% CI; 0.95–3.34)) and increase (HR = 1.80 (95% CI; 1.01–3.21)) groups. Conclusion CLD is associated with high SS and an increase in SS over time. These data suggest SS can be used in simple public health messages about communicating the risk of liver disease. Trial Registration UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000. Electronic supplementary material The online version of this article (10.1186/s12889-018-5308-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P M Trembling
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK.
| | - S Apostolidou
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - J Parkes
- Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - S Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - W M Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
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Stott W, Campbell S, Franchini A, Blyuss O, Zaikin A, Ryan A, Jones C, Gentry‐Maharaj A, Fletcher G, Kalsi J, Skates S, Parmar M, Amso N, Jacobs I, Menon U. Sonographers' self-reported visualization of normal postmenopausal ovaries on transvaginal ultrasound is not reliable: results of expert review of archived images from UKCTOCS. Ultrasound Obstet Gynecol 2018; 51:401-408. [PMID: 28796383 PMCID: PMC5888153 DOI: 10.1002/uog.18836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), self-reported visualization rate (VR) of the ovaries by the sonographer on annual transvaginal sonographic (TVS) examinations was a key quality control (QC) metric. The objective of this study was to assess self-reported VR using expert review of a random sample of archived images of TVS examinations from UKCTOCS, and then to develop software for measuring VR automatically. METHODS A single expert reviewed images archived from 1000 TVS examinations selected randomly from 68 931 TVS scans performed in UKCTOCS between 2008 and 2011 with ovaries reported as 'seen and normal'. Software was developed to identify the exact images used by the sonographer to measure the ovaries. This was achieved by measuring caliper dimensions in the image and matching them to those recorded by the sonographer. A logistic regression classifier to determine visualization was trained and validated using ovarian dimensions and visualization data reported by the expert. RESULTS The expert reviewer confirmed visualization of both ovaries (VR-Both) in 50.2% (502/1000) of the examinations. The software identified the measurement image in 534 exams, which were split 2:1:1 providing training, validation and test data. Classifier mean accuracy on validation data was 70.9% (95% CI, 70.0-71.8%). Analysis of test data (133 exams) provided a sensitivity of 90.5% (95% CI, 80.9-95.8%) and specificity of 47.5% (95% CI, 34.5-60.8%) in detecting expert confirmed visualization of both ovaries. CONCLUSIONS Our results suggest that, in a significant proportion of TVS annual screens, the sonographers may have mistaken other structures for normal ovaries. It is uncertain whether or not this affected the sensitivity and stage at detection of ovarian cancer in the ultrasound arm of UKCTOCS, but we conclude that QC metrics based on self-reported visualization of normal ovaries are unreliable. The classifier shows some potential for addressing this problem, though further research is needed. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W. Stott
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - A. Franchini
- London School of Hygiene and Tropical MedicineLondonUK
| | - O. Blyuss
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Zaikin
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - A. Ryan
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - C. Jones
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | | | - G. Fletcher
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - J. Kalsi
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
| | - S. Skates
- Biostatistics CenterMassachusetts General HospitalBostonMAUSA
| | - M. Parmar
- Medical Research Council Clinical Trials Unit at UCLLondonUK
| | - N. Amso
- School of Medicine, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - I. Jacobs
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
- University of New South Wales, SydneyAustralia
| | - U. Menon
- Women's CancerUCL EGA Institute for Women's HealthLondonUK
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Dunkel B, Ryan A, Haggett E, Knowles EJ. Atypical myopathy in the South‐East of England: Clinicopathological data and outcome in hospitalised horses. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B. Dunkel
- Department of Clinical Science and Services The Royal Veterinary College North Mymms Hertfordshire UK
| | - A. Ryan
- Department of Clinical Science and Services The Royal Veterinary College North Mymms Hertfordshire UK
| | - E. Haggett
- Rossdales Equine Hospital and Diagnostic Centre Newmarket Suffolk UK
| | - E. J. Knowles
- Bell Equine Veterinary Clinic Mereworth Maidstone Kent UK
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32
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Martin K, Iyengar S, Kalyan A, Lan C, Simon AL, Stosic M, Kobara K, Ravi H, Truong T, Ryan A, Demko ZP, Benn P. Clinical experience with a single-nucleotide polymorphism-based non-invasive prenatal test for five clinically significant microdeletions. Clin Genet 2017; 93:293-300. [PMID: 28696552 DOI: 10.1111/cge.13098] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023]
Abstract
Single-nucleotide polymorphism (SNP)-based non-invasive prenatal testing (NIPT) can currently predict a subset of submicroscopic abnormalities associated with severe clinical manifestations. We retrospectively analyzed the performance of SNP-based NIPT in 80 449 referrals for 22q11.2 deletion syndrome and 42 326 referrals for 1p36, cri-du-chat, Prader-Willi, and Angelman microdeletion syndromes over a 1-year period, and compared the original screening protocol with a revision that reflexively sequenced high-risk calls at a higher depth of read. The prevalence of these microdeletion syndromes was also estimated in the referral population. The positive predictive value of the original test was 15.7% for 22q11.2 deletion syndrome, and 5.2% for the other 4 disorders combined. With the revised protocol, these values increased to 44.2% for 22q11.2 and 31.7% for the others. The 0.33% false-positive rate (FPR) for 22q11.2 deletion syndrome decreased to 0.07% with the revised protocol. Similarly, the FPR for the other 4 disorders combined decreased from 0.56% to 0.07%. Minimal prevalences were estimated to be 1 in 1255 for 22q11.2 deletion syndrome and 1 in 1464 for 1p36, cri-du-chat, and Angelman syndromes combined. Our results show that these microdeletions are relatively common in the referral population, and that the performance of SNP-based NIPT is improved with high-depth resequencing.
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Affiliation(s)
- K Martin
- Natera, Inc., San Carlos, California
| | - S Iyengar
- Natera, Inc., San Carlos, California
| | - A Kalyan
- Natera, Inc., San Carlos, California
| | - C Lan
- Natera, Inc., San Carlos, California
| | - A L Simon
- Natera, Inc., San Carlos, California
| | - M Stosic
- Natera, Inc., San Carlos, California
| | - K Kobara
- Natera, Inc., San Carlos, California
| | - H Ravi
- Natera, Inc., San Carlos, California
| | - T Truong
- Natera, Inc., San Carlos, California
| | - A Ryan
- Natera, Inc., San Carlos, California
| | - Z P Demko
- Natera, Inc., San Carlos, California
| | - P Benn
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, Connecticut
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Kuznetsova V, Visheratina A, Ryan A, Martynenko I, Loudon A, Maguire C, Purcell-Milton F, Orlova A, Baranov A, Fedorov A, Prina-Mello A, Volkov Y, Gun'Ko Y. Enantioselective cytotoxicity of ZnS:Mn quantum dots in A549 cells. Chirality 2017; 29:403-408. [DOI: 10.1002/chir.22713] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - A.K. Visheratina
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
| | - A. Ryan
- Chemistry School, Trinity College Dublin; Dublin Ireland
| | - I.V. Martynenko
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
| | - A. Loudon
- Chemistry School, Trinity College Dublin; Dublin Ireland
| | - C.M. Maguire
- Clinical Medicine, School of Medicine; Trinity College Dublin; Dublin Ireland
| | | | - A.O. Orlova
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
| | - A.V. Baranov
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
| | - A.V. Fedorov
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
| | - A. Prina-Mello
- Clinical Medicine, School of Medicine; Trinity College Dublin; Dublin Ireland
| | - Y. Volkov
- Clinical Medicine, School of Medicine; Trinity College Dublin; Dublin Ireland
| | - Y.K. Gun'Ko
- Chemistry School, Trinity College Dublin; Dublin Ireland
- Optical Physics and Modern Natural Science; ITMO University; Saint Petersburg Russia
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Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Bailey K, Apostolidou S, Ryan A, Lanceley A, Fraser L, Jacobs I, Hunter MS, Menon U. Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening. Climacteric 2017; 20:240-247. [PMID: 28326899 PMCID: PMC5448394 DOI: 10.1080/13697137.2017.1301919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/26/2017] [Accepted: 02/19/2017] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The negative publicity about menopausal hormone therapy (MHT) has led to increased use of complementary and alternative medicines (CAM) and non-pharmacological interventions (NPI) for menopausal symptom relief. We report on the prevalence and predictors of CAM/NPI among UK postmenopausal women. METHOD Postmenopausal women aged 50-74 years were invited to participate in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). A total of 202 638 women were recruited and completed a baseline questionnaire. Of these, 136 020 were sent a postal follow-up-questionnaire between September 2006 and May 2009 which included ever-use of CAM/NPI for menopausal symptom relief. Both questionnaires included MHT use. RESULTS A total of 88 430 (65.0%) women returned a completed follow-up-questionnaire; 22 206 (25.1%) reported ever-use of one or more CAM/NPI. Highest use was reported for herbal therapies (43.8%; 9725/22 206), vitamins (42.6%; 9458/22 206), lifestyle approaches (32.1%; 7137/22 206) and phytoestrogens (21.6%; 4802/22 206). Older women reported less ever-use of herbal therapies, vitamins and phytoestrogens. Lifestyle approaches, aromatherapy/reflexology/acupuncture and homeopathy were similar across age groups. Higher education, Black ethnicity, MHT or previous oral contraceptive pill use were associated with higher CAM/NPI use. Women assessed as being less hopeful about their future were less likely to use CAM/NPI. CONCLUSION One in four postmenopausal women reported ever-use of CAM therapies/NPI for menopausal symptom relief, with lower use reported by older women. Higher levels of education and previous MHT use were positive predictors of CAM/NPI use. UKCTOCS Trial registration: ISRCTN22488978.
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Affiliation(s)
- A. Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Karpinskyj
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - C. Glazer
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Institute of Public Health, University of CopenhagenCopenhagenDenmark
| | - M. Burnell
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - K. Bailey
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - S. Apostolidou
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Ryan
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - A. Lanceley
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - L. Fraser
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
- UNSW AustraliaSydneyAustralia
- Centre for Women's Health, Institute of Human Development, University of ManchesterManchesterUK
| | - M. S. Hunter
- Department of Psychology, Institute of Psychiatry, Guy’s Campus, King's College LondonLondonUK
| | - U. Menon
- Gynaecological Cancer Research Centre, Department of Women’s Cancer, Institute for Women's Health, University College LondonLondonUK
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Ryan A, MacHale D, Cohen Y. George Boole and Childhood Mortality in the Cork Union Workhouse. Ir Med J 2017; 110:503. [PMID: 28657280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A Ryan
- Department of Neonatology, Cork University Maternity Hospital
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - D MacHale
- School of Mathematical Sciences, University College Cork (UCC), Ireland
| | - Y Cohen
- Chartered Accountant, Declan O'Connell & Co, Cork, Ireland
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da Silva RAG, Churchward CP, Karlyshev AV, Eleftheriadou O, Snabaitis AK, Longman MR, Ryan A, Griffin R. The role of apolipoprotein N-acyl transferase, Lnt, in the lipidation of factor H binding protein of Neisseria meningitidis strain MC58 and its potential as a drug target. Br J Pharmacol 2016; 174:2247-2260. [PMID: 27784136 DOI: 10.1111/bph.13660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE The level of cell surface expression of the meningococcal vaccine antigen, Factor H binding protein (FHbp) varies between and within strains and this limits the breadth of strains that can be targeted by FHbp-based vaccines. The molecular pathway controlling expression of FHbp at the cell surface, including its lipidation, sorting to the outer membrane and export, and the potential regulation of this pathway have not been investigated until now. This knowledge will aid our evaluation of FHbp vaccines. EXPERIMENTAL APPROACH A meningococcal transposon library was screened by whole cell immuno-dot blotting using an anti-FHbp antibody to identify a mutant with reduced binding and the disrupted gene was determined. KEY RESULTS In a mutant with markedly reduced binding, the transposon was located in the lnt gene which encodes apolipoprotein N-acyl transferase, Lnt, responsible for the addition of the third fatty acid to apolipoproteins prior to their sorting to the outer membrane. We provide data indicating that in the Lnt mutant, FHbp is diacylated and its expression within the cell is reduced 10 fold, partly due to inhibition of transcription. Furthermore the Lnt mutant showed 64 fold and 16 fold increase in susceptibility to rifampicin and ciprofloxacin respectively. CONCLUSION AND IMPLICATIONS We speculate that the inefficient sorting of diacylated FHbp in the meningococcus results in its accumulation in the periplasm inducing an envelope stress response to down-regulate its expression. We propose Lnt as a potential novel drug target for combination therapy with antibiotics. LINKED ARTICLES This article is part of a themed section on Drug Metabolism and Antibiotic Resistance in Micro-organisms. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.14/issuetoc.
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Affiliation(s)
- R A G da Silva
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - C P Churchward
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - A V Karlyshev
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - O Eleftheriadou
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - A K Snabaitis
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - M R Longman
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - A Ryan
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
| | - R Griffin
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, UK
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Daly L, Bhuachalla ÉN, Cushen S, Power D, O'Reilly S, McEneaney P, O'Mahony D, Bambury R, Ryan A. Malnutrition in 822 Irish cancer patients undergoing chemotherapy: prevalence and impact on quality of life and survival. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Daly L, Ní Bhuachalla É, Cushen S, Power D, MacEneaney P, O'Donovan F, Ryan A. MON-P066: Malnutrition and Body Composition Predicts Poor Quality of Life and Reduced Survival in Ambulatory Oncology Patients Receiving Chemotherapy: A Cross Sectional Study of 820 Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Healy L, Doyle S, Ni Buchalla E, Cushen S, Murphy T, Ryan A, Ravi N, Reynolds J. OR43: Double Blinded, Placebo Controlled Eicosapentaenoic Acid (EPA) Enriched Enteral Nutrition in the Surgical Treatment of Oesophageal Cancer Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Naicker P, Khonga M, Wojno J, Bamford C, Ntuli S, Oladokun R, Eley B, Ryan A, Gardiner S, Sooka A, Smith A, Keddy K. Five-year review of non-typhoidal salmonella meningitis in Cape Town, 2010 - 2015. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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O'Neill C, McCaughan E, Semple CJ, Ryan A. Fathers' experiences of living with cancer: a phenomenological study. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27001026 DOI: 10.1111/ecc.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
There is a paucity of knowledge about fathers' experiences of cancer. This study explored the experiences of fathers diagnosed and living with cancer while also having parental responsibility for children. A hermeneutic phenomenological approach guided the study. Data were generated through 22 in-depth interviews with 10 fathers throughout Northern Ireland. The findings evidenced that fathers' identities are challenged and frequently re-shaped by the cancer experience, in many cases leading to an improved lifestyle behaviour. Heightened engagement with their children can provide a protective effect from the illness. On the other hand a lack of involvement led to frustration and low mood. The findings also demonstrated that father/child relationships were adversely affected by the social complexities that exist in the variances and diversity of fathers parenting roles and status. This knowledge contributes to our understanding of the complex relationships of fathers in non-traditional roles. It extends our understanding of how, when stereotyped gendered roles are ascribed to fathers it can impact on a fathers' ability to fulfil the traditional breadwinner's role. This is knowledge that will inform health care professionals and enable them to provide gendered-sensitive care that takes account of the masculine psychological responses that can shape the cancer experience.
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Affiliation(s)
- C O'Neill
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - E McCaughan
- Institute of Nursing & Health Research, University of Ulster, Coleraine, Northern Ireland
| | - C J Semple
- South Eastern Health and Social Care Trust, Cancer Services Ulster Hospital, Belfast, Northern Ireland
| | - A Ryan
- Institute of Nursing and Health Research, University of Ulster, Coleraine, Northern Ireland
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Burnell M, Iyer R, Gentry-Maharaj A, Nordin A, Liston R, Manchanda R, Das N, Gornall R, Beardmore-Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Shanbhag S, Thackeray A, Wood N, Reynolds K, Ryan A, Menon U. Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study. BJOG 2016; 123:2171-2180. [DOI: 10.1111/1471-0528.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Affiliation(s)
- M Burnell
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Iyer
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Gentry-Maharaj
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - A Nordin
- East Kent Gynaecological Oncology Centre; Queen Elizabeth the Queen Mother Hospital; Margate UK
| | - R Liston
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - R Manchanda
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - N Das
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | - R Gornall
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - A Beardmore-Gray
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - K Hillaby
- Department of Gynaecological Oncology; Cheltenham General Hospital; Cheltenham UK
| | - S Leeson
- Department of Obstetrics and Gynaecology; BetsiCadwaladr University Health Board; Bangor UK
| | - A Linder
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - A Lopes
- Department of Gynaecological Cancer; Royal Cornwall Hospitals NHS Trust; Truro UK
| | | | - T Mould
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre; Birmingham City Hospital; Birmingham UK
| | - A Olaitan
- Department of Gynaecological Oncology; University College London Hospital NHS Foundation Trust; London UK
| | - B Rufford
- Department of Gynaecological Oncology; The Ipswich Hospital NHS Trust; Ipswich Suffolk UK
| | - S Shanbhag
- Department of Gynaecological Oncology; Glasgow Royal Infirmary; Glasgow UK
| | | | - N Wood
- Department of Gynaecological Oncology; Lancashire Teaching Hospitals NHS Foundation trust; Royal Preston Hospital; Preston UK
| | - K Reynolds
- Department of Gynaecological Cancer; Barts Cancer Centre; Barts and the London NHS Trust; London UK
| | - A Ryan
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
| | - U Menon
- Department of Women's Cancer; Gynaecological Cancer Research Centre; Institute for Women's Health; University College London; London UK
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Wainwright P, Oluwatowoju I, Ryan A, Abu E, Byrne CD. Glycaemic control and lipid concentrations in a cohort of people with diabetes over 7 years of follow-up: a regional audit of diabetes care in the UK. Diabet Med 2016; 33:386-90. [PMID: 26172344 DOI: 10.1111/dme.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
AIM To determine changes in glycaemic control and lipids over time since the introduction of the Quality and Outcomes Framework. METHODS In adults with diabetes (Hampshire, UK), HbA1c and lipid measurements were retrieved from a regional National Health Service biochemical database in 2006 and 2013 and analysed using anova and logistic regression modelling. RESULTS In 2006, 8568 people with diabetes were identified. In 2013, 5815 had follow-up data, 1207 people were lost to follow-up and 1546 had died. At baseline, HbA1c concentrations were 62.1 ± 16.1, 64.7 ± 16.7 and 64.5 ± 17.6 mmol/mol for those with follow-up data, those lost to follow-up and those who died, respectively. The mean age was 60.2 ± 14.5, 57.6 ± 18.0 and 73.9 ± 10.5 years, respectively, for the three groups. Total cholesterol, HDL cholesterol and triglyceride concentrations were similar between groups. The mean HbA1c concentration for those with complete follow-up data was 62.1 ± 16.1 mmol/mol in 2006 and 61.7 ± 17.3 mmol/mol in 2013. Quality and Outcomes Framework targets for cholesterol (< 5 mmol/l) were achieved by 79% of people in 2006 and 83% in 2013 (P < 0.001). Baseline age and HbA1c were associated with death at follow-up: the odds ratio per year increase in baseline age was 1.10 (95% CI 1.09-1.10; P < 0.001) and per unit increase in HbA1c it was 1.02 (95% CI 1.02-1.03; P < 0.001). CONCLUSIONS Glycaemic control showed remarkable stability over 7 years of follow-up, despite increasing patient age and duration of diabetes. More patients achieved lipid targets in 2013 than in 2006. Although baseline HbA1c was a predictor of death at follow-up, baseline HbA1c differed little between survivors, non-survivors and those lost to follow-up.
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Affiliation(s)
- P Wainwright
- Clinical Biochemistry, University Hospital Southampton, Southampton, UK
| | - I Oluwatowoju
- Clinical Biochemistry, University Hospital Southampton, Southampton, UK
| | - A Ryan
- Clinical Biochemistry, University Hospital Southampton, Southampton, UK
| | - E Abu
- Clinical Biochemistry, University Hospital Southampton, Southampton, UK
| | - C D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Sharma A, Burnell M, Gentry‐Maharaj A, Campbell S, Amso NN, Seif MW, Fletcher G, Brunell C, Turner G, Rangar R, Ryan A, Jacobs I, Menon U. Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Ultrasound Obstet Gynecol 2016; 47:228-35. [PMID: 26095052 PMCID: PMC4755159 DOI: 10.1002/uog.14929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the quality assurance (QA) processes and their impact on visualization of postmenopausal ovaries in the ultrasound arm of a multicenter screening trial for ovarian cancer. METHODS In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 50 639 women aged 50-74 years were randomized to the ultrasound arm and underwent annual transvaginal ultrasound (TVS) examinations. QA processes were developed during the course of the trial and included regular monitoring of the visualization rate (VR) of the right ovary. Non-subjective factors identified previously as impacting on VR of the right ovary were included in a generalized estimating equation model for binary outcomes to enable comparison of observed vs adjusted VR between individual sonographers who had undertaken > 1000 scans during the trial and comparison between centers. Observed and adjusted VRs of sonographers and centers were ranked according to the highest VR. Analysis of annual VRs of sonographers and those of the included centers was undertaken. RESULTS Between June 2001 and December 2010, 48 230 of 50 639 women attended one of 13 centers for a total of 270 035 annual TVS scans. One or both ovaries were seen in 228 145 (84.5%) TVS scans. The right ovary was seen on 196 426 (72.7%) of the scans. For the 78 sonographers included in the model, the median difference between observed and adjusted VR was -0.7% (range, -7.9 to 5.9%) and the median change in VR rank after adjustment was 3 (range, 0-18). For the 13 centers, the median difference between observed and adjusted VR was -0.5% (range, -2.2 to 1%), with no change in ranking after adjustment. The median adjusted VR was 73% (interquartile range (IQR), 65-82%) for sonographers and 74.7% (IQR, 67.1-79.0%) for centers. Despite the increasing age of the women being scanned, there was a steady decrease in the number of sonographers with VR < 60% (21.4% in 2002 vs 2.0% in 2010) and an increase in sonographers with VR > 80% (14.3% in 2002 vs 40.8% in 2010). The median VR of the centers increased from 65.5% (range, 55.7-81.0%) in 2001 to 80.3% (range, 74.5-90.9%) in 2010. CONCLUSIONS A robust QA program can improve visualization of postmenopausal ovaries and is an essential component of ultrasound-based ovarian cancer screening trials. While VR should be adjusted for non-subjective factors that impact on ovarian visualization, subjective factors are likely to be the largest contributors to differences in VR.
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Affiliation(s)
- A. Sharma
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- Department of Gynaecological OncologyUniversity Hospital of WalesCardiffUK
| | - M. Burnell
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - A. Gentry‐Maharaj
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | | | - N. N. Amso
- Institute for Translation, Innovation, Methodology and Engagement, School of MedicineCardiff UniversityCardiffUK
| | - M. W. Seif
- Academic Unit of Obstetrics and GynaecologySt Mary's HospitalManchesterUK
| | - G. Fletcher
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - C. Brunell
- Department of RadiologyUniversity College London HospitalsLondonUK
| | - G. Turner
- Department of RadiologyRoyal Derby HospitalDerbyUK
| | - R. Rangar
- Northern Gynaecological Oncology CenterQueen Elizabeth HospitalGatesheadUK
| | - A. Ryan
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
| | - I. Jacobs
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
- University of New South WalesSydneyNSWAustralia
| | - U. Menon
- Gynaecological Cancer Research Center, Department of Women's Cancer, Institute for Women's HealthUniversity College LondonLondonUK
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Gross SJ, Stosic M, McDonald‐McGinn DM, Bassett AS, Norvez A, Dhamankar R, Kobara K, Kirkizlar E, Zimmermann B, Wayham N, Babiarz JE, Ryan A, Jinnett KN, Demko Z, Benn P. Clinical experience with single-nucleotide polymorphism-based non-invasive prenatal screening for 22q11.2 deletion syndrome. Ultrasound Obstet Gynecol 2016; 47:177-83. [PMID: 26396068 PMCID: PMC5064640 DOI: 10.1002/uog.15754] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To evaluate the performance of a single-nucleotide polymorphism (SNP)-based non-invasive prenatal test (NIPT) for the detection of fetal 22q11.2 deletion syndrome in clinical practice, assess clinical follow-up and review patient choices for women with high-risk results. METHODS In this study, 21 948 samples were submitted for screening for 22q11.2 deletion syndrome using a SNP-based NIPT and subsequently evaluated. Follow-up was conducted for all cases with a high-risk result. RESULTS Ninety-five cases were reported as high risk for fetal 22q11.2 deletion. Diagnostic testing results were available for 61 (64.2%) cases, which confirmed 11 (18.0%) true positives and identified 50 (82.0%) false positives, resulting in a positive predictive value (PPV) of 18.0%. Information regarding invasive testing was available for 84 (88.4%) high-risk cases: 57.1% (48/84) had invasive testing and 42.9% (36/84) did not. Ultrasound anomalies were present in 81.8% of true-positive and 18.0% of false-positive cases. Two additional cases were high risk for a maternal 22q11.2 deletion; one was confirmed by diagnostic testing and one had a positive family history. There were three pregnancy terminations related to screening results of 22q11.2 deletion, two of which were confirmed as true positive by invasive testing. CONCLUSIONS Clinical experience with this SNP-based non-invasive screening test for 22q11.2 deletion syndrome indicates that these deletions have a frequency of approximately 1 in 1000 in the referral population with most identifiable through this test. Use of this screening method requires the availability of counseling and other management resources for high-risk pregnancies.
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Affiliation(s)
| | | | - D. M. McDonald‐McGinn
- Division of Human Genetics, The Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - A. S. Bassett
- Clinical Genetics Research ProgramCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | | | | | | | | | | | | | | | | | | | - P. Benn
- Division of Human Genetics, Department of Genetics and Genome SciencesUniversity of Connecticut Health CenterFarmingtonCTUSA
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Horner D, Ryan A, Bennett P, Gillet A. THROMBOPROPHYLAXIS FOR AMBULATORY PATIENTS WITH IMMOBILISED LOWER LIMB TRAUMA: A CLOSED AUDIT LOOP. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Monagle K, Ryan A, Hepponstall M, Mertyn E, Monagle P, Ignjatovic V, Newall F. Inhalational use of antithrombotics in humans: Review of the literature. Thromb Res 2015; 136:1059-66. [PMID: 26475409 DOI: 10.1016/j.thromres.2015.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Off label use of anticoagulants is common. The association between fibrin deposition in the lungs and primary lung disease, injury or prematurity affords a strong theoretical basis for the potential benefit of antithrombotic therapies administered directly to the lung tissue. This review offers a critical appraisal of current evidence related to the inhalational administration of antithrombotic therapy in humans. MATERIALS AND METHODS An interrogation of 2 databases across a 13 year period of time was undertaken using key words selected a priori. Identified publications were categorized according to the following themes: 1. Inhaled antithrombotic therapy in healthy subjects 2. Inhaled antithrombotic therapy for vascular thromboprophylaxis 3. Inhaled antithrombotic therapy in smoke inhalation and lung injury 4. Inhaled antithrombotic therapy in asthma or allergy 5. Inhaled antithrombotic therapy for plastic bronchitis post-Fontan surgery 6. Inhaled antithrombotic therapy for other indications. RESULTS 33 articles were identified consistent with the inclusion criteria developed for this review. Unfractionated heparin, LMWH, activated protein C and thrombolytic agents have been administered via the respiratory track, with asthma and smoke inhalation/lung injury being the most frequently investigated clinical scenarios described. All studies reported had significant methodological limitations. CONCLUSIONS The safety and clinical utility of inhaled antithrombotic therapies have not been adequately investigated to support the generation of any firm evidence. This review highlights where inhaled antithrombotic therapies have shown promise and importantly, the further research required to confirm mechanism of action and a definitive risk: benefit profile.
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Affiliation(s)
- K Monagle
- Department of Paediatrics, The University of Melbourne, Australia
| | - A Ryan
- Department of Paediatrics, The University of Melbourne, Australia; Clinical Haematology Department, The Royal Children's Hospital, Australia
| | - M Hepponstall
- Department of Paediatrics, The University of Melbourne, Australia; Haematology Research Group, Murdoch Childrens Research Institute, Australia
| | - E Mertyn
- Department of Paediatrics, The University of Melbourne, Australia
| | - P Monagle
- Department of Paediatrics, The University of Melbourne, Australia; Haematology Research Group, Murdoch Childrens Research Institute, Australia; Clinical Haematology Department, The Royal Children's Hospital, Australia
| | - V Ignjatovic
- Department of Paediatrics, The University of Melbourne, Australia; Haematology Research Group, Murdoch Childrens Research Institute, Australia
| | - F Newall
- Department of Paediatrics, The University of Melbourne, Australia; Haematology Research Group, Murdoch Childrens Research Institute, Australia; Clinical Haematology Department, The Royal Children's Hospital, Australia; Department of Nursing, The University of Melbourne, Australia; Nursing Research Department, The Royal Children's Hospital, Australia.
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Rabinowitz M, McCoy R, Fischer E, Proctor G, Demko Z, Simon A, Ryan A, Kiehl M, Petrov D, Givens C, Bush M. Analyses of 37,000+ embryos with 24-chromosome single-nucleotide polymorphism (SNP)-based preimplantation genetic screening (PGS). Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Daly L, O'Reilly A, Donnellan P, Cushen S, Woodlock D, Twomey M, Ryan A, Power D. 3339 The impact of body composition parameters on ipilimumab toxicity in metastatic melanoma and longitudinal changes in body composition during treatment. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bamford C, Bonorchis K, Ryan A, Simpson J, Elliott E, Hoffmann R, Naicker P, Ismail N, Mbelle N, Nchabeleng M, Nana T, Sriruttan C, Seetharam S, Wadula J. Antimicrobial Susceptibility Patterns of Selected Bacteraemic Isolates from South African Public Sector Hospitals, 2010. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2011.11441461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Bamford
- National Health Laboratory Service (NHLS), Groote Schuur and University of Cape Town
| | - K Bonorchis
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - A Ryan
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - J Simpson
- National Health Laboratory Service (NHLS), Green Point and University of Cape Town
| | - E Elliott
- National Health Laboratory Service (NHLS), Universitas and University of the Free State
| | - R Hoffmann
- National Health Laboratory Service (NHLS), Tygerberg and Stellenbosch University
| | - P Naicker
- National Health Laboratory Service (NHLS), Tygerberg and Stellenbosch University
| | - N Ismail
- National Health Laboratory Service (NHLS), Steve Biko Academic and University of Pretoria
| | - N Mbelle
- National Health Laboratory Service (NHLS), Dr George Mukhari and University of Limpopo
| | - M Nchabeleng
- National Health Laboratory Service (NHLS), Dr George Mukhari and University of Limpopo
| | - T Nana
- National Health Laboratory Service (NHLS), Charlotte Maxeke Johannesburg Academic and University of the Witwatersrand
| | - C Sriruttan
- National Health Laboratory Service (NHLS), Charlotte Maxeke Johannesburg Academic and University of the Witwatersrand
| | - S Seetharam
- National Health Laboratory Service (NHLS), Chris Hani Baragwanath and University of the Witwatersrand
| | - J Wadula
- National Health Laboratory Service (NHLS), Chris Hani Baragwanath and University of the Witwatersrand
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