1
|
Chapman A, Bardsley E, Card H, Marshall E, Olsson-Brown A. Evaluation of an established oncology triage hotline in a model of emergency department avoidance: assessing the UKONS triage tool and call outcomes. Support Care Cancer 2023; 32:6. [PMID: 38051438 DOI: 10.1007/s00520-023-08167-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE In response to a demonstrable need for 24/7, specialist oncology advice for patients undergoing systemic anti-cancer therapy, many healthcare institutions have adopted a telephone triage (TT) service. This is true of the Clatterbridge Cancer Centre which uses the UKONS framework to guide its decisions. This study aims to investigate the utilisation and outcomes of this TT service, with a focus on the most unwell call outcomes and factors leading to referrals to accident and emergency departments that could be mitigated with service development and modifications. METHODS A retrospective evaluation study was conducted of calls occurring between 1st September 2021 and 31st August 2022. A descriptive analysis of call UKONS grading, triage outcome and primary complaint was performed. RESULTS The TT hotline received 23,766 calls of which only 9066 were for clinical advice. Of the clinical calls, 45.2% were UKONS red. The majority of red calls 53.3% were directed to AED. The proportion of red calls going to AED changed drastically depending on the timing of call and the corresponding services available at those times, with 38.3% of reds being sent to AED in hours but 72.3% out of hours. The profile of complaints also showed significant differences in hours versus out of hours. CONCLUSION Significant use of the hotline supports a genuine demand for oncology TT services. In order to reduce referrals to AED, this study supports the creation of alternative destinations of emergency care, especially out of hours.
Collapse
Affiliation(s)
- A Chapman
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK.
| | - E Bardsley
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - H Card
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - E Marshall
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - A Olsson-Brown
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| |
Collapse
|
2
|
Backhouse MR, Halstead J, Roddy E, Dhukaram V, Chapman A, Arnold S, Bruce J. A multi-professional survey of UK practice in the use of intra-articular corticosteroid injection for symptomatic first metatarsophalangeal joint osteoarthritis. J Foot Ankle Res 2023; 16:71. [PMID: 37845758 PMCID: PMC10580568 DOI: 10.1186/s13047-023-00672-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA. METHODS A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media. RESULTS One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%). CONCLUSIONS Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA.
Collapse
Affiliation(s)
- Michael R Backhouse
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill, CV4 7AL, UK.
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
| | | | - Edward Roddy
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Staffordshire, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, Stoke-on-Trent, UK
| | - Vivek Dhukaram
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Anna Chapman
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Susanne Arnold
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill, CV4 7AL, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill, CV4 7AL, UK
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
3
|
Chapman A, Rankin NM, Jongebloed H, Yoong SL, White V, Livingston PM, Hutchinson AM, Ugalde A. Overcoming challenges in conducting systematic reviews in implementation science: a methods commentary. Syst Rev 2023; 12:116. [PMID: 37420258 PMCID: PMC10327144 DOI: 10.1186/s13643-023-02285-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Consolidation of the literature using systematic reviews is a critical way to advance a discipline and support evidence-based decision-making in healthcare. However, unique challenges exist that impact the conduct of systematic reviews in implementation science. In this commentary, we reflect on our combined experience to describe five key challenges unique to systematic reviews of primary implementation research. These challenges include (1) descriptors used in implementation science publications, (2) distinction between evidence-based interventions and implementation strategies, (3) assessment of external validity, (4) synthesis of implementation studies with substantial clinical and methodological diversity, and (5) variability in defining implementation 'success'. We outline possible solutions and highlight resources that can be used by authors of primary implementation research, as well as systematic review and editorial teams, to overcome the identified challenges and optimise the utility of future systematic reviews in implementation science.
Collapse
Affiliation(s)
- Anna Chapman
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Nicole M. Rankin
- School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, VIC Australia
| | - Hannah Jongebloed
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia
| | - Patricia M. Livingston
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Alison M. Hutchinson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
- Barwon Health, Geelong, VIC Australia
| | - Anna Ugalde
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| |
Collapse
|
4
|
Tsakok T, Saklatvala J, Rispens T, Loeff FC, de Vries A, Allen MH, Barbosa IA, Baudry D, Dasandi T, Duckworth M, Meynell F, Russell A, Chapman A, McBride S, McKenna K, Perera G, Ramsay H, Ramesh R, Sands K, Shipman A, Burden AD, Griffiths CE, Reynolds NJ, Warren RB, Mahil S, Barker J, Dand N, Smith C, Simpson MA. Development of antidrug antibodies against adalimumab maps to variation within the HLA-DR peptide-binding groove. JCI Insight 2023; 8:e156643. [PMID: 36810251 PMCID: PMC9977494 DOI: 10.1172/jci.insight.156643] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2023] [Indexed: 02/23/2023] Open
Abstract
Targeted biologic therapies can elicit an undesirable host immune response characterized by the development of antidrug antibodies (ADA), an important cause of treatment failure. The most widely used biologic across immune-mediated diseases is adalimumab, a tumor necrosis factor inhibitor. This study aimed to identify genetic variants that contribute to the development of ADA against adalimumab, thereby influencing treatment failure. In patients with psoriasis on their first course of adalimumab, in whom serum ADA had been evaluated 6-36 months after starting treatment, we observed a genome-wide association with ADA against adalimumab within the major histocompatibility complex (MHC). The association signal mapped to the presence of tryptophan at position 9 and lysine at position 71 of the HLA-DR peptide-binding groove, with both residues conferring protection against ADA. Underscoring their clinical relevance, these residues were also protective against treatment failure. Our findings highlight antigenic peptide presentation via MHC class II as a critical mechanism in the development of ADA against biologic therapies and downstream treatment response.
Collapse
Affiliation(s)
- Teresa Tsakok
- Department of Medical and Molecular Genetics and
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | | | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Floris C. Loeff
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Michael H. Allen
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Ines A. Barbosa
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - David Baudry
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Tejus Dasandi
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Michael Duckworth
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Freya Meynell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Alice Russell
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Anna Chapman
- Department of Dermatology, Queen Elizabeth Hospital, London, United Kingdom
| | - Sandy McBride
- Department of Dermatology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Kevin McKenna
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Gayathri Perera
- Department of Dermatology, Chelsea and Westminster Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Helen Ramsay
- Department of Dermatology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Raakhee Ramesh
- Department of Dermatology, Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom
| | - Kathleen Sands
- Department of Dermatology, East Kent Hospitals University National Health Service Foundation Trust, Kent, United Kingdom
| | - Alexa Shipman
- Department of Dermatology, Portsmouth Hospitals National Health Service Trust, Portsmouth, United Kingdom
| | | | - A. David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Christopher E.M. Griffiths
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Nick J. Reynolds
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Translational and Clinical Medicine, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard B. Warren
- Dermatology Centre, Salford Royal National Health Service Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Satveer Mahil
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Jonathan Barker
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics and
- Health Data Research UK, London, United Kingdom
| | - Catherine Smith
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- St John’s Institute of Dermatology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | | |
Collapse
|
5
|
Stevens J, Kostalas M, Chapman A, Prabhudesai S, Ratnasingham K. P-114 INVESTIGATING THE ROLE OF BOTOX IN THE EMERGENCY MANAGEMENT OF COMPLEX ABDOMINAL WALL HERNIAS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.212] [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: 11/12/2022]
Abstract
Abstract
Aims
Botulinum toxin (Botox) has an established role in the elective management of complex abdominal wall hernia, but its role in the emergency setting has not been investigated. Clinical effects of Botox peak at 2–3 weeks after injection, but effects become apparent within 48 hours. We aimed to determine if these early effects can facilitate the acute reduction of irreducible hernia.
Materials and methods
Patients with irreducible abdominal wall hernias over a 30 month period were considered for Botox therapy. Suitable patients were given 300 units of Botox under ultrasound guidance into the anterolateral muscles bilaterally. Data were collected on outcomes.
Results
Twelve patients received Botox. All had incisional hernias and an ASA of 3 or more. Six were on antiplatelets and/or anticoagulation. All received Botox with standard conservative management. In ten patients, the hernia was reduced and symptoms resolved. One patient required surgery at 48 hours due to bowel ischaemia from inter-sac adhesions. A second patient experienced recurrent obstruction despite successful hernia reduction but was palliated due to advanced age and frailty.
Conclusions
This case series is the first study to investigate the role of Botox in the acute management of irreducible hernias. Our findings suggest that in selected patients, Botox can aid hernia reduction and avoid the morbidity of emergency repair. This is of particular value in high risk patients and those with complex defects who benefit from preoperative optimisation techniques. The accurate identification of strangulation is crucial however, as it excludes patients from this approach.
Collapse
Affiliation(s)
- J Stevens
- General Surgery, St Peters Hospital , Chertsey , United Kingdom
| | - M Kostalas
- General Surgery, St Peters Hospital , Chertsey , United Kingdom
| | - A Chapman
- Interventional Radiology, St Peters Hospital , Chertsey , United Kingdom
| | - S Prabhudesai
- Interventional Radiology, St Peters Hospital , Chertsey , United Kingdom
| | - K Ratnasingham
- General Surgery, St Peters Hospital , Chertsey , United Kingdom
| |
Collapse
|
6
|
Lowry M, Doudesis D, Kimenai D, Bularga A, Taggart C, Wereski R, Ferry A, Stewart S, Tuck C, Lee K, Chapman A, Shah A, Newby D, Anand A, Mills N. Impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1346] [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: 11/13/2022] Open
Abstract
Abstract
Background
High-sensitivity cardiac troponin has enabled the rapid rule-out and rule-in of myocardial infarction at presentation. However, increases in cardiac troponin may not be detectable early after symptom onset, and uncertainty remains as to how time of symptom onset influences diagnostic performance.
Purpose
To evaluate the impact of time from symptom onset on the diagnostic performance of high-sensitivity cardiac troponin for type 1 myocardial infarction.
Methods
In a secondary analysis of a prospective multicentre randomised controlled trial of consecutive patients with suspected acute coronary syndrome, we evaluated the diagnostic performance of high-sensitivity cardiac troponin I measurements at presentation stratified by time of symptom onset to blood sampling. Diagnostic performance was evaluated in four groups (≤3 hours, 4–6 hours, 7–12 hours and >12 hours from symptom onset) for recommended thresholds to rule-out (sex-specific 99th centile and optimised threshold [64 ng/L]) type 1 myocardial infarction.
Results
This analysis included 41,104 patients (median 60 [interquartile range 49–74] years, 46% female) of which 12,595 (31%), 10,298 (25%), 7,171 (17%) and 11,040 (27%) presented ≤3 hours, 4–6 hours, 7–12 hours and >12 hours, respectively. Type 1 myocardial infarction was the adjudicated diagnosis in 3,692 (9%) patients. For the rule-out of type 1 myocardial infarction, sensitivity was highest in those tested 7–12 hours from symptom onset and lowest in those tested ≤3 hours. In early presenters, a threshold of <2 ng/L had greater sensitivity and negative predictive value (99.4% [95% CI 98.9 to 99.7%] and 99.7% [95% CI 99.5 to 99.9%]) compared to <5 ng/L (96.7% [95% CI 95.7 to 97.6%] and 99.3% [95% CI 99.1 to 99.5%], respectively). In those tested >3 hrs from symptom onset, the sensitivity and negative predictive value for both thresholds were similar, but a threshold of <5 ng/L correctly ruled out more patients (60% [17,056/28,506] versus 29% [8,316/28,506]). For the rule-in of myocardial infarction, the sensitivity of the 99th centile and 64 ng/L was lowest in patients tested within 3 hours (71.7% [95% CI 69.3 to 74.1%] and 46.5% [95% CI 44.1 to 49.2%], respectively), and increased in those tested later from symptom onset. The specificity and positive predictive value were highest when testing was performed 7–12 hours from symptom onset for the sex-specific 99th centile (92.4% [95% CI 91.8 to 93.0%] and 51.3% [95% CI 48.2–54.5%]) and 64 ng/L (96.2% [95% CI 95.7 to 96.7%] and 61.2% [95% CI 57.3 to 65.2%]).
Conclusions
The diagnostic performance of cardiac troponin for myocardial infarction is strongly influenced by the time from symptom onset to testing. In early presenters the limit of detection may facilitate immediate rule-out of myocardial infarction, but otherwise testing at least 3 hours from symptom onset is needed with the optimal time to rule-in myocardial infarction being 7–12 hours from the onset of symptoms.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation (BHF)Medical Research council UK (MRC)
Collapse
Affiliation(s)
- M Lowry
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Doudesis
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Bularga
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Taggart
- University of Edinburgh , Edinburgh , United Kingdom
| | - R Wereski
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Ferry
- University of Edinburgh , Edinburgh , United Kingdom
| | - S Stewart
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Tuck
- University of Edinburgh , Edinburgh , United Kingdom
| | - K Lee
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Chapman
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Shah
- University of Edinburgh , Edinburgh , United Kingdom
| | - D Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - A Anand
- University of Edinburgh , Edinburgh , United Kingdom
| | - N Mills
- University of Edinburgh , Edinburgh , United Kingdom
| |
Collapse
|
7
|
Rutter E, Ying J, Nevers M, Chapman A, Jones M, Peterson K, Jones B. 194 Discordance of Pneumonia Diagnoses from Admission to Discharge: A Retrospective Cohort Analysis of 118 Veterans Affairs Emergency Departments. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.218] [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: 11/01/2022]
|
8
|
Chapman A, Behravesh M. P.183 Parafalcine subdural haemorrhage after accidental dural puncture; a reminder to consider alternative differentials for post dural puncture headaches. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103479] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
9
|
Schulz K, Amy S, Kavsak P, Jaffe A, Ordóñez-Llanos J, Collinson P, Lindgren B, Ler R, Sexter A, Chapman A, Apple F. M173 Total imprecision of 8 high sensitivity cardiac troponin assays within sex-specific reference limits: Clinical implications. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.055] [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]
|
10
|
Young LM, Moylan S, John T, Turner M, Opie R, Hockey M, Saunders D, Bruscella C, Jacka F, Teychenne M, Rosenbaum S, Banker K, Mahoney S, Tembo M, Lai J, Mundell N, McKeon G, Yucel M, Speight J, Absetz P, Versace V, Chatterton ML, Berk M, Manger S, Mohebbi M, Morgan M, Chapman A, Bennett C, O’Shea M, Rocks T, Leach S, O’Neil A. Evaluating telehealth lifestyle therapy versus telehealth psychotherapy for reducing depression in adults with COVID-19 related distress: the curbing anxiety and depression using lifestyle medicine (CALM) randomised non-inferiority trial protocol. BMC Psychiatry 2022; 22:219. [PMID: 35346115 PMCID: PMC8958477 DOI: 10.1186/s12888-022-03840-3] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. METHODS The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. DISCUSSION If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021.
Collapse
Affiliation(s)
- Lauren M. Young
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Steve Moylan
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Tayla John
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Megan Turner
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Rachelle Opie
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Meghan Hockey
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Dean Saunders
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Courtney Bruscella
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice Jacka
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Megan Teychenne
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Simon Rosenbaum
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Khyati Banker
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Sophie Mahoney
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Monica Tembo
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Jerry Lai
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,grid.474047.4Intersect Australia, Sydney, Australia
| | - Niamh Mundell
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Grace McKeon
- grid.1005.40000 0004 4902 0432University of New South Wales, Sydney, Australia
| | - Murat Yucel
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Jane Speight
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia ,Diabetes Victoria, Melbourne, Australia
| | - Pilvikki Absetz
- grid.502801.e0000 0001 2314 6254Tampere University, Tampere, Finland
| | - Vincent Versace
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Michael Berk
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia ,grid.414257.10000 0004 0540 0062Barwon Health, Geelong, Australia
| | - Sam Manger
- grid.1011.10000 0004 0474 1797James Cook University, Townsville, Australia
| | | | - Mark Morgan
- grid.1033.10000 0004 0405 3820Bond University, Gold Coast, Australia
| | - Anna Chapman
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | | | - Melissa O’Shea
- grid.1021.20000 0001 0526 7079Deakin University, Geelong, Australia
| | - Tetyana Rocks
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | | | - Adrienne O’Neil
- grid.414257.10000 0004 0540 0062Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| |
Collapse
|
11
|
Meyer C, Chapman A, Klattenhoff Reyes K, Joe A. Profiling the risk factors associated with falls in older people with diabetes receiving at-home nursing care: Retrospective analysis of an Australian aged care provider database. Health Soc Care Community 2022; 30:762-775. [PMID: 33084170 DOI: 10.1111/hsc.13194] [Citation(s) in RCA: 1] [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: 04/13/2020] [Revised: 08/18/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Falls among older people with diabetes mellitus (DM) are a major health concern. Preventive measures can be implemented to reduce the likelihood of falls. The aim of this study was to determine the factors most strongly associated with falls in older people living with DM who receive at-home care support services. This will inform home-visiting nurses to prioritise falls prevention strategies in the care of clients who are at high risk of falls. A retrospective analysis of routinely collected data from a large not-for-profit community aged care service provider was undertaken. The sample comprised adults aged ≥65 years residing in Victoria, Australia, with a recorded diagnosis of DM, and who received at least one episode of care by the aged care provider during July 1, 2014 and June 30, 2015. Self-reported data on falls in previous 6 months was obtained via the Comprehensive Health Assessment Tool (CHAT). Selection of factors associated with falls was guided by the Falls Risk for Older People in the Community (FROP-Com) assessment tool. For the study population, data for these factors were obtained from clients' self-reported CHAT data, and from International Classification of Disease codes obtained from medical records. Descriptive statistics were used to identify the demographic and clinical profile; logistic regression was used to assess the strength of association between various factors and the occurrence of a fall. Data were obtained for 1,574 older adults; overall prevalence of falls was 30.6% (n = 482). Significant factors displaying the highest odds of falling were gait issues (OR: 2.11, p = 0.002); needing help to walk (OR: 1.91, p = <0.001); and cognitive dysfunction (OR: 1.55, p = 0.001). Interpreted with caution, several factors contribute to an increased odds of falling in older people with DM. Home-visiting nurses are uniquely placed to introduce preventive interventions to reduce the likelihood of debilitating falls in this population.
Collapse
Affiliation(s)
- Claudia Meyer
- Bolton Clarke Research Institute, Bentleigh, VIC, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, VIC, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, VIC, Australia
| | - Anna Chapman
- Faculty of Health, Centre for Quality & Patient Safety, Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, VIC, Australia
- Monash Health, Clayton, VIC, Australia
| | | | - Angela Joe
- Bolton Clarke Research Institute, Bentleigh, VIC, Australia
| |
Collapse
|
12
|
Andres-Ejarque R, Ale HB, Grys K, Tosi I, Solanky S, Ainali C, Catak Z, Sreeneebus H, Saklatvala J, Dand N, de Rinaldis E, Chapman A, Nestle FO, Barnes MR, Warren RB, Reynolds NJ, Griffiths CEM, Barker JN, Smith CH, Di Meglio P. Author Correction: Enhanced NF-κB signaling in type-2 dendritic cells at baseline predicts non-response to adalimumab in psoriasis. Nat Commun 2021; 12:7358. [PMID: 34916493 PMCID: PMC8677717 DOI: 10.1038/s41467-021-27447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rosa Andres-Ejarque
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
| | - Hira Bahadur Ale
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
| | - Katarzyna Grys
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Isabella Tosi
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Shane Solanky
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
| | - Chrysanthi Ainali
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- DIGNOSIS Limited, London, UK
| | - Zeynep Catak
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Hemawtee Sreeneebus
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Jake Saklatvala
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | - Nick Dand
- Department of Medical and Molecular Genetics, Kings College London, London, UK
| | - Emanuele de Rinaldis
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
- Sanofi, Cambridge, MA, USA
| | - Anna Chapman
- Dermatology Department, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - Frank O Nestle
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
- Sanofi, Cambridge, MA, USA
| | - Michael R Barnes
- Centre for Translational Bioinformatics, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Richard B Warren
- Dermatology Centre, Salford Royal Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nick J Reynolds
- Institute of Translational and Clinical Medicine, Newcastle University Medical School and Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jonathan N Barker
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Catherine H Smith
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK
| | - Paola Di Meglio
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom.
- NIHR Biomedical Research Centre, Guys & St Thomas NHS Foundation Trust & King's College London, London, UK.
| | | |
Collapse
|
13
|
Chapman A, Swartz K, Hersh L, Lasota M. Feasibility of a nursing led outpatient implementation of the G8 Screening Tool. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00406-9] [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: 11/26/2022]
|
14
|
Wineski RE, Panico E, Karas A, Rosen P, Van Diver B, Norwood TG, Grayson JW, Beltran-Ale G, Dimmitt R, Kassel R, Rogers A, Leonard M, Chapman A, Boehm L, Wiatrak B, Harris WT, Smith N. Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients. Int J Pediatr Otorhinolaryngol 2021; 150:110874. [PMID: 34392101 DOI: 10.1016/j.ijporl.2021.110874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. METHODS A 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. RESULTS 449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). CONCLUSION In pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.
Collapse
Affiliation(s)
- R E Wineski
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - E Panico
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Karas
- Department of Otorhinolaryngology- Head and Neck Surgery, Rush University School of Medicine, Chicago, IL, USA
| | - P Rosen
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - B Van Diver
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - T G Norwood
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - J W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - G Beltran-Ale
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - R Dimmitt
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - R Kassel
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Rogers
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - M Leonard
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - A Chapman
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - L Boehm
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - B Wiatrak
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - W T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - N Smith
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| |
Collapse
|
15
|
Flynn M, Park H, Aguilaresguerra K, Fawzi A, Saikia S, Chapman A, Sharma S. The role of CT Thorax scans in triaging suspected cases of Covid-19. Imaging 2021. [DOI: 10.1183/13993003.congress-2021.pa3246] [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: 11/05/2022] Open
|
16
|
Cro S, Cornelius V, Pink A, Wilson R, Pushpa‐Rajah A, Patel P, Abdul‐Wahab A, August S, Azad J, Becher G, Chapman A, Dunnill G, Ferguson A, Fogo A, Ghaffar S, Ingram J, Kavakleiva S, Ladoyanni E, Leman J, Macbeth A, Makrygeorgou A, Parslew R, Ryan A, Sharma A, Shipman A, Sinclair C, Wachsmuth R, Woolf R, Wright A, McAteer H, Barker J, Burden A, Griffiths C, Reynolds N, Warren R, Lachmann H, Capon F, Smith C. Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT). Br J Dermatol 2021; 186:245-256. [PMID: 34411292 PMCID: PMC9255857 DOI: 10.1111/bjd.20653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1. OBJECTIVES To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP. METHODS This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. RESULTS A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred. CONCLUSIONS No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.
Collapse
Affiliation(s)
- S. Cro
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - V.R. Cornelius
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - A.E. Pink
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - R. Wilson
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Pushpa‐Rajah
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - P. Patel
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Abdul‐Wahab
- St George’s University Hospitals NHS Foundation TrustLondonSW17 0QTUK
| | - S. August
- Poole Hospital NHS Foundation Trust University Hospitals DorsetPooleBH15 2JBUK
| | - J. Azad
- South Tees Hospitals NHS Foundation TrustMiddlesbroughTS4 3BWUK
| | - G. Becher
- West Glasgow Ambulatory Care HospitalGlasgowG3 8SJUK
| | - A. Chapman
- Homerton University HospitalLondonE9 6SRUK
| | | | - A.D. Ferguson
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyDE22 3NEUK
| | - A. Fogo
- Kingston HospitalKingston upon ThamesKT2 7QBUK
| | - S.A. Ghaffar
- Ninewells Hospital and Medical SchoolDundeeDD1 9SYUK
| | - J.R. Ingram
- Division of Infection and ImmunitySchool of MedicineCardiff UniversityUniversity Hospital of WalesCardiffCF14 4XNUK
| | | | | | | | - A.E. Macbeth
- Norfolk and Norwich University Hospitals NHS Foundation TrustNorwichNR4 7UYUK
| | | | - R. Parslew
- Liverpool University Hospitals NHS Foundation TrustLiverpoolL9 7ALUK
| | - A.J. Ryan
- King’s College HospitalLondonSE5 9RSUK
| | - A. Sharma
- Nottingham University Hospitals NHS TrustNottinghamNG7 2UHUK
| | - A.R. Shipman
- Portsmouth Hospitals Universities NHS TrustSt Mary’s Community Health CampusPortsmouthPO3 6ADUK
| | | | - R. Wachsmuth
- Royal Devon and Exeter NHS Foundation TrustExeterEX2 5DWUK
| | - R.T. Woolf
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Wright
- Bradford Teaching Hospitals NHS Foundation TrustBradfordBD9 6RJUK
| | - H. McAteer
- The Psoriasis AssociationNorthamptonNN4 7BFUK
| | - J.N.W.N. Barker
- St John’s Institute of DermatologySchool of Basic and Medical BiosciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonSE1 9RTUK
| | - A.D. Burden
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowG12 8TAUK
| | - C.E.M. Griffiths
- Dermatology CentreSalford Royal NHS Foundation TrustUniversity of ManchesterNIHR Manchester Biomedical Research CentreManchesterM6 8HDUK
| | - N.J. Reynolds
- Institute of Translational and Clinical MedicineMedical SchoolUniversity of NewcastleDepartment of DermatologyRoyal Victoria Infirmary and NIHR Newcastle Biomedical Research CentreNewcastle Hospitals NHS Foundation TrustNewcastle upon TyneNE2 4HHUK
| | - R.B. Warren
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - H.J. Lachmann
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - F. Capon
- Department of Medical and Molecular GeneticsKing’s College LondonLondonSE1 9RTUK
| | - C.H. Smith
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| |
Collapse
|
17
|
Meah M, Bularga A, Chapman A, Gray A, Newby D, Dey D, Williams M. Differences In Quantitative Coronary Computed Tomography Angiography Between Type 1 And Type 2 Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Blackmur J, Chew E, Trail M, Brodie K, Santoni N, Rodger F, Hamilton D, Gaba F, Randall S, Chapman A, Laird A. Assessment of the lower ureteric excision technique associated oncological outcomes for upper urinary tract urothelial carcinoma: Retrospective, updated interim analysis from the Scottish Renal Cancer Network. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01169-6] [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]
|
19
|
Lombardo J, Ronghe A, Chapman A, Swartz K, Denton M, Simone N. Single Institution Evaluation of Social Determinates Affecting Cancer Outcomes in a Geriatric Oncology Clinic. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2465] [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: 10/23/2022]
|
20
|
Gladding P, Young R, Cooper M, Holland U, Loader S, Chapman L, Chapman A, Smith K, Zarate E, Villas-Boas S, Green S, Thorstensen E, Keven C. Metabolomics and a breath sensor identify acetone as a biomarker for heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0920] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Metabolomics delivers more biological and clinical insight than targeted investigations. We applied metabolomics to patients with heart failure (HF) with reduced ejection fraction (HFrEF).
Methods
46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LC-MS/GC-MS), nuclear magnetic resonance (NMR) metabolomics and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudal strain (GLS) <18%, ejection fraction <50% and NTproBNP ≥35 pmol/L. A low cost consumer breath acetone (BrACE) sensor validated SPME results in 69 patients.
Results
34 metabolites were identified by GCMS, 33 by LCMS and 2 volatiles by SPME (acetone, 2-pentanone in plasma and urine). Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r=0.59, 95% CI 0.4 to 0.7), triacylglycerol (55:9), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE >1.5 ppm discriminated HF from other cardiac pathology (AUC 0.88, 95% CI 0.77 to 0.99, P<0.0001).
Conclusion
Breath acetone was detectable in HFrEF patients using a consumer sensor ($1/test) and although not cardiac specific, discriminated HF from other cardiac pathology.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Research Council of New Zealand
Collapse
Affiliation(s)
- P.A Gladding
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - R Young
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - M Cooper
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - U Holland
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - S Loader
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - L Chapman
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - A Chapman
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - K Smith
- Waitemata District Health Board, Cardiology, Auckland, New Zealand
| | - E Zarate
- The University of Auckland, School of Biological Science, Auckland, New Zealand
| | - S Villas-Boas
- The University of Auckland, School of Biological Science, Auckland, New Zealand
| | - S Green
- The University of Auckland, School of Biological Science, Auckland, New Zealand
| | - E Thorstensen
- The University of Auckland, Liggins Institute, Auckland, New Zealand
| | - C Keven
- The University of Auckland, Liggins Institute, Auckland, New Zealand
| |
Collapse
|
21
|
Hutchinson AM, Brotto V, Chapman A, Sales AE, Mohebbi M, Bucknall TK. Use of an audit with feedback implementation strategy to promote medication error reporting by nurses. J Clin Nurs 2020; 29:4180-4193. [PMID: 32757427 DOI: 10.1111/jocn.15447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/15/2019] [Revised: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To outline the development and effect of an audit with feedback implementation strategy that intended to increase the rate of voluntary medication error reporting by nurses. BACKGROUND Medication errors are a serious global health issue. Audit with feedback is a widely used implementation strategy that has potential to modify nurses' reporting behaviour and improve medication error reporting rates. DESIGN Quasi-experimental implementation study (fulfilling the TIDieR checklist) with two pairs of matched wards at a private hospital in Australia was conducted from March 2015-September 2016. One ward from each pair was randomised to either the intervention or control group. METHOD Nurses within intervention wards received audit with feedback on a quarterly basis over a 12-month implementation period. Control wards underwent quarterly audits only (without feedback). Feedback consisted of a one-page infographic poster, with content based on medication error data obtained from audits and the hospitals' risk management system (RiskMan). The primary outcome-rate of medication errors reported per month-was determined in both groups at pre-implementation, implementation and postimplementation phases. Differences between groups were compared using generalised linear mixed models with Poisson distribution and log link. RESULTS A nonsignificant intervention effect was found for rate of medication errors reported per month. Interestingly, when combining data from both groups, a significant increasing time trend was observed for medication errors reported per month across pre-implementation and implementation phases (80% increase). CONCLUSIONS The audit with feedback strategy developed in the present study did not effectively influence the voluntary reporting of medication errors by nurses. RELEVANCE TO CLINICAL PRACTICE Despite the lack of intervention effects, the use of a published checklist to optimise the reporting quality of this study will contribute to the field by furthering the understanding of how to enhance audit with feedback implementation strategies for nurses.
Collapse
Affiliation(s)
- Alison M Hutchinson
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Vanessa Brotto
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anna Chapman
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Monash Health, Clayton, VIC, Australia
| | - Anne E Sales
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Tracey K Bucknall
- School of Nursing & Midwifery, Centre for Quality & Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
22
|
Thomas SA, Qiu Z, Chapman A, Liu S, Browning CJ. Editorial: Chronic Illness and Ageing in China. Front Public Health 2020; 8:104. [PMID: 32328473 PMCID: PMC7160676 DOI: 10.3389/fpubh.2020.00104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shane Andrew Thomas
- Research School in Population Health, Australian National University, Canberra, BC, Australia.,International Primary Health Care Research Institute, Shenzhen, China
| | - Zeqi Qiu
- Department of Sociology, Peking University, Beijing, China
| | - Anna Chapman
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, Burwood, VIC, Australia
| | - Shuo Liu
- Key Laboratory of Carcinogenesis and Translational Research, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
| | - Colette Joy Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia
| |
Collapse
|
23
|
Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, Zarachiah C, Wagner G, Siebert U, Christof C, Gartlehner G. The Effectiveness of Quarantine alone or in Combination with Other Public Health Measures to Control Coronavirus Disease 2019: a Rapid Review. CDSR 2020. [DOI: 10.1002/14651858.cd202001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Farrera C, Melchiotti R, Petrov N, Weng Teng KW, Wong MT, Loh CY, Villanova F, Tosi I, Chen J, Grys K, Sreeneebus H, Chapman A, Perera GK, Heck S, Gracio F, de Rinaldis E, Barker JN, Smith CH, Nestle FO, Newell EW, Di Meglio P. T-cell phenotyping uncovers systemic features of atopic dermatitis and psoriasis. J Allergy Clin Immunol 2020; 145:1021-1025.e15. [DOI: 10.1016/j.jaci.2019.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
|
25
|
Parkes C, Bezzina O, Chapman A, Luteran A, Freeston MH, Robinson LJ. Jumping to conclusions in persistent pain using a somatosensory modification of the beads task. J Psychosom Res 2019; 126:109819. [PMID: 31491534 DOI: 10.1016/j.jpsychores.2019.109819] [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] [Received: 04/14/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is theoretical and empirical evidence that persistent pain occurs because of a distortion in top-down perceptual processes. 'Jumping to conclusions' (JTC) tasks, such as the beads task, purportedly capture these processes and have yet to be studied in people with chronic pain. However, the beads task uses visual stimuli, whereas tasks involving processing in the somatosensory domain seem at least more face valid in this population. This study uses a novel somatosensory adaptation of the beads task to explore whether a JTC reasoning style is more common in people with persistent pain compared controls. METHODS 30 persistent pain patients and 30 age-, gender- and education-matched controls completed the visual beads JTC task and a novel somatosensory version of the JTC task that used tactile stimuli (vibrations to the fingertip). FINDINGS Patients with persistent pain showed a 'jumping to conclusions' reasoning style on both tasks compared to the control group and there was no significant difference in the effect sizes on the two tasks. INTERPRETATION This preliminarily study demonstrated that individuals with persistent pain show a JTC reasoning style to both visual and somatosensory stimuli. Future research should focus on establishing how or whether this bias directly influences the experience of persistent pain.
Collapse
Affiliation(s)
- C Parkes
- Newcastle University, United Kingdom
| | - O Bezzina
- Newcastle University, United Kingdom
| | - A Chapman
- Newcastle University, United Kingdom
| | - A Luteran
- Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | | |
Collapse
|
26
|
Nightingale G, Lama J, Khalaf M, Bhattacharya S, Rovner B, Swartz K, Chapman A. POTENTIALLY INAPPROPRIATE MEDICATION (PIM) USE AND COGNITION IN OLDER WOMEN WITH BREAST CANCER: A PROSPECTIVE PILOT STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31237-8] [Citation(s) in RCA: 1] [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: 11/29/2022]
|
27
|
Yao G, Nikita N, Keith S, Nightingale G, Gandhi K, Rebbeck T, Chapman A, Kantoff P, Cullen J, Kelly W. SHORT-TERM OUTCOMES FOLLOWING ORAL HORMONAL PROSTATE CANCER THERAPIES BY PRE-EXISTING CARDIOVASCULAR CONDITIONS: A POPULATION-BASED STUDY. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31238-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: 11/24/2022]
|
28
|
Chapman A, Nagle C, Bick D, Lindberg R, Kent B, Calace J, Hutchinson A. Organisational interventions to reduce caesarean section: A systematic review and meta-analyses. Women Birth 2019. [DOI: 10.1016/j.wombi.2019.07.188] [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: 10/26/2022]
|
29
|
Abstract
Gut microbiota research is an emerging field that improves our understanding of the ecological and functional dynamics of gut environments. The honey bee gut microbiota is a highly rewarding community to study, as honey bees are critical pollinators of many crops for human consumption and produce valuable commodities such as honey and wax. Most significantly, unique characteristics of the Apis mellifera gut habitat make it a valuable model system. This review discusses methods and pipelines used in the study of the gut microbiota of Ap. mellifera and closely related species for four main purposes: identifying microbiota taxonomy, characterizing microbiota genomes (microbiome), characterizing microbiota-microbiota interactions and identifying functions of the microbial community in the gut. The purpose of this contribution is to increase understanding of honey bee gut microbiota, to facilitate bee microbiota and microbiome research in general and to aid design of future experiments in this growing field.
Collapse
Affiliation(s)
- S Romero
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - A Nastasa
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - A Chapman
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| | - W K Kwong
- Biodiversity Research Centre, Department of Botany, University of British Columbia, Vancouver, BC, Canada
| | - L J Foster
- Michael Smith Laboratories and Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Chapman A, Nagle C, Bick D, Lindberg R, Kent B, Calache J, Hutchinson AM. Maternity service organisational interventions that aim to reduce caesarean section: a systematic review and meta-analyses. BMC Pregnancy Childbirth 2019; 19:206. [PMID: 31286892 PMCID: PMC6615143 DOI: 10.1186/s12884-019-2351-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/29/2018] [Accepted: 06/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. Method A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. Results Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. Conclusion Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews. PROSPERO registration CRD42016039458; prospectively registered. Electronic supplementary material The online version of this article (10.1186/s12884-019-2351-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Chapman
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.,Monash Medical Centre, Monash Health, Level 2 I Block, 246 Clayton Rd, Clayton, 3168, VIC, Australia
| | - Cate Nagle
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Queensland, Australia.,Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rebecca Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Bridie Kent
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK
| | - Justin Calache
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.,Monash Medical Centre, Monash Health, Level 2 I Block, 246 Clayton Rd, Clayton, 3168, VIC, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia. .,Monash Medical Centre, Monash Health, Level 2 I Block, 246 Clayton Rd, Clayton, 3168, VIC, Australia.
| |
Collapse
|
31
|
Affiliation(s)
| | - Anna Chapman
- Centre for Employment and Labour Relations Law, Law School, University of Melbourne
| |
Collapse
|
32
|
Gadodia G, Martin C, Yanof J, Al-Nimer S, Chapman A, Hanlon A, Weunski C, West K. Abstract No. 506 Holographic visualization for performance of percutaneous ablation of solid liver tumors: from development, to bench testing, to first-in-human evaluation. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.587] [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: 10/27/2022] Open
|
33
|
Paisley AN, Beynon J, Fullwood C, Hindle A, Alam T, Urwin A, Chapman A, Morris J, Thabit H, Rutter MK, Leelarathna L. Impact of social deprivation, demographics and centre on HbA 1c outcomes with continuous subcutaneous insulin infusion. Diabet Med 2019; 36:383-387. [PMID: 30307056 DOI: 10.1111/dme.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/09/2018] [Indexed: 01/16/2023]
Abstract
AIMS To assess the impact of social deprivation, demographics and centre on HbA1c outcomes with continuous subcutaneous insulin infusion (CSII) in adults with Type 1 diabetes. METHODS Demographic data, postcode-derived English Index of Multiple Deprivation data and 12-month average HbA1c (mmol/mol) pre- and post-CSII were collated from three diabetes centres in the north west of England, University Hospital of South Manchester (UHSM), Salford Royal Foundation Hospital (SRFT) and Manchester Royal Infirmary (MRI). Univariable and multivariable regression models explored relationships between demographics, Index of Multiple Deprivation, centre and HbA1c outcomes. RESULTS Data were available for 693 (78%) individuals (UHSM, n = 90; SRFT, n = 112; and MRI, n = 491) of whom 59% were women. Median age at CSII start was 39 (IQR 29.5-49.0) years and median diabetes duration was 20 (11-29) years. Median Index of Multiple Deprivation was 15 193 (6313-25 727). Overall median HbA1c improved from 69 to 64 mmol/mol (8.5% to 8.0%) within the first year of CSII. In multivariable analysis, higher pre-CSII HbA1c was significantly associated with higher deprivation (P = 0.036), being female (P < 0.001), and centre (MRI; P = 0.005). Following pre-CSII HbA1c adjustment, post-CSII HbA1c or HbA1c change were not related to demographic factors and deprivation, but remained significantly related to the centre; UHSM and SRFT had larger reductions in HbA1c with CSII compared with MRI [median -7.0 (-0.6%) vs. -6.0 (-0.55%) vs. -4.5 (-0.45%) mmol/mol; P = 0.005]. CONCLUSIONS Higher pre-CSII HbA1c levels were associated with higher deprivation and being female. CSII improves HbA1c irrespective of social deprivation and demographics. Significant differences in HbA1c improvements were observed between centres. Further work is warranted to explain these differences and minimize variation in clinical outcomes with CSII.
Collapse
Affiliation(s)
| | - J Beynon
- University Hospital of South Manchester, Manchester, UK
| | - C Fullwood
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Manchester, UK
| | - A Hindle
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - T Alam
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - A Urwin
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Chapman
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Morris
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Thabit
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - M K Rutter
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - L Leelarathna
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| |
Collapse
|
34
|
Holtsche MM, Goletz S, van Beek N, Zillikens D, Benoit S, Harman K, Walton S, English J, Sticherling M, Chapman A, Levell NJ, Groves R, Williams HC, König IR, Schmidt E. Prospective study in bullous pemphigoid: association of high serum anti-BP180 IgG levels with increased mortality and reduced Karnofsky score. Br J Dermatol 2018; 179:918-924. [PMID: 29607480 DOI: 10.1111/bjd.16553] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is a subepidermal blistering disease characterized by autoantibodies against the two hemidesmosomal proteins, BP180 (type XVII collagen) and BP230. The multicentre prospective BLISTER (Bullous Pemphigoid Steroids and Tetracyclines) trial randomized 253 patients with BP to compare the benefits and harms between initial treatment with doxycycline or prednisolone. OBJECTIVES To analyse distinct autoantibody profiles for the prediction of the disease course in a well-characterized cohort of BP sera. METHODS One hundred and forty-three patients of the BLISTER trial consented to participate in this serological study. Sera taken at baseline were analysed by (i) indirect immunofluorescence, (ii) anti-BP180 NC16A (16th noncollagenous domain) and anti-BP230 enzyme-linked immunosorbent assay and (iii) immunoblotting with various substrates. Results were then linked with clinical parameters including age, Karnofsky score, number of blisters, related adverse events and mortality. RESULTS Disease activity correlated with immunoglobulin (Ig)G anti-BP180 levels but not with levels of anti-BP230 IgG and anti-BP180 IgE. High levels of both anti-BP180 IgG and anti-BP230 IgG were associated with a low Karnofsky score. The presence of anti-BP230 IgG was more frequent in older patients. Those with higher total IgE serum levels suffered from fewer adverse events. Higher IgG anti-BP180 levels were associated with an increased 1-year mortality rate. CONCLUSIONS Analysis of the autoantibody profile is not only of diagnostic relevance but may also be helpful in predicting the course of the disease.
Collapse
Affiliation(s)
- M M Holtsche
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - N van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - K Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Leicester, U.K
| | - S Walton
- Castle Hill Hospital, Cottingham, U.K
| | - J English
- Queen's Medical Centre, University Hospital, Nottingham, U.K
| | - M Sticherling
- Department of Dermatology, University of Erlangen, Erlangen, Germany
| | - A Chapman
- Queen Elizabeth Hospital, Greenwich, London, U.K
| | - N J Levell
- Norfolk and Norwich University Hospital, Norwich, U.K
| | - R Groves
- Department of Immunodermatology, St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| |
Collapse
|
35
|
Betz M, Chapman A, Peterson S. Autosomal Dominant Polycystic Kidney Disease Patients are Not Meeting Nutrition Recommendations. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.036] [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]
|
36
|
Allan C, Chapman A, Parker C, Boltong A, Millar J. Missing Evidence: Exploring Unpublished Trials in Victoria, Australia. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.28700] [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: 11/20/2022] Open
Abstract
Background: Clinical trial registries were established to improve the transparency and completeness of clinical trial reporting and a number of policies have been introduced to encourage or mandate their use. While prospective trial registration has been endorsed in Australia, there is currently no legal requirement for researchers to register or communicate findings from clinical trials. There has also been, to the best of our knowledge, no analysis previously undertaken on publication rates for clinical trials performed in Australia. Aim: We aimed to determine the proportion of clinical trials that remain 'unpublished' in Victoria, Australia´s second most populous state, between 2009 and 2013. Methods: We used data reported to Cancer Council Victoria's Cancer Trials Management Scheme (CTMS) between 2009 and 2013, to identify trials that had recruited a new patient or recorded any follow-up patient activity in the specified time period. Using this data, we conducted a systematic search of ClinicalTrials.gov , the Australia and New Zealand Clinical Trials Registry (ANZCTR), PubMed and Google for records of the trial. Trial registration numbers, acronyms and scientific titles were used as primary search terms. Results were characterized by type of publication (i.e., whether it was an accredited scientific paper or other) and source location. Results: Of the trials reported to the CTMS between 2009 and 2013, 777 trials were included in this investigation; the majority (58.8%) were randomized controlled trials (RCTs). Compared with previously published findings, communication of trial results in this study was high; 70% of trials published results in an accredited scientific journal and a further 10% in alternate form, such as a conference abstract or media release. Publication rates were higher for trials with a commercial sponsor (85%) compared with trials sponsored by a cooperative group (77%). Nearly 8% of trials in this study had not been registered on an international clinical trials register. Only 39% of unregistered trials had published results. Of the registered trials, those registered on ClinicalTrials.gov were more likely to be published (86%) compared with trials listed on ANZCTR (68%). Between 2009 and 2013 , 8% of trials registered on ClinicalTrials.gov , in our data set, were terminated; 70% of these trials published results. Conclusion: Although the rate at which clinical trial findings were published in Victoria was higher in this investigation compared with equivalent overseas data, trials registered on ClinicalTrials.gov were more likely to publish results than unregistered trials or trials registered on ANZCTR. This suggests a potential need for trial registration and publication guidelines in Australia, similar to that of the United States where the requirements and procedures for submitting registration and summary result information for clinical trials on ClinicalTrials.gov have been compulsory for the last decade.
Collapse
Affiliation(s)
- C. Allan
- Cancer Council Victoria, Melbourne, Australia
| | - A. Chapman
- Cancer Council Victoria, Melbourne, Australia
| | - C. Parker
- Cancer Council Victoria, Melbourne, Australia
| | - A. Boltong
- Cancer Council Victoria, Melbourne, Australia
| | - J. Millar
- Cancer Council Victoria, Melbourne, Australia
| |
Collapse
|
37
|
Holtsche M, Goletz S, van Beek N, Zillikens D, Benoit S, Harman K, Walton S, English J, Sticherling M, Chapman A, Levell N, Groves R, Williams H, K€onig I, Schmidt E. BP:血清抗 BP180 IgG 水平、死亡率和卡式评分. Br J Dermatol 2018. [DOI: 10.1111/bjd.17174] [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: 11/26/2022]
|
38
|
Holtsche M, Goletz S, van Beek N, Zillikens D, Benoit S, Harman K, Walton S, English J, Sticherling M, Chapman A, Levell N, Groves R, Williams H, König I, Schmidt E. BP: serum anti-BP180 IgG levels, mortality and Karnofsky score. Br J Dermatol 2018. [DOI: 10.1111/bjd.17163] [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]
|
39
|
Chapman A, Poliakoff E, Chew-Graham CA, Brown RJ. Attending away from the body predicts increased physical symptom reports at six months in primary care patients. J Psychosom Res 2018; 113:81-88. [PMID: 30190054 DOI: 10.1016/j.jpsychores.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE High symptom reporting (HSR) and medically unexplained symptoms (MUS) are associated with considerable distress, disability, healthcare utilization and costs, but are poorly understood, and current treatments are of limited benefit. Most models of HSR and MUS implicate cognitive-perceptual factors, such as increased body-focused attention, reduced perceptual thresholds and a tendency to experience somatic misperception, but little is known about the causal role of these variables. We investigated this issue by studying whether there is a longitudinal relationship between perceptual-attentional variables and later clinical outcomes in primary care patients. METHOD Primary care patients (N = 102) completed clinical (physical symptom reporting, health anxiety and healthcare utilization) and perceptual-attentional (body-focused attention, perceptual threshold, somatic misperception) measures at baseline and then again six months later (N = 72). Hierarchical regression was used to examine cross-lagged relationships between baseline and follow-up scores. RESULTS Contrary to expectation, attending away from the body at baseline predicted increased not decreased symptom reporting six months later. Neither perceptual threshold nor somatic misperception predicted clinical outcomes at six months. CONCLUSIONS These findings suggest that body avoidance, rather than increased body focus, contribute to the development of HSR. Future studies should consider the potential clinical benefits of reducing bodily avoidance, via techniques that promote adaptive engagement with bodily sensations.
Collapse
Affiliation(s)
- Anna Chapman
- Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | | | | | - Richard J Brown
- University of Manchester, United Kingdom; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
| |
Collapse
|
40
|
Chapman A, Browning CJ, Enticott JC, Yang H, Liu S, Zhang T, Thomas SA. Effect of a Health Coach Intervention for the Management of Individuals With Type 2 Diabetes Mellitus in China: A Pragmatic Cluster Randomized Controlled Trial. Front Public Health 2018; 6:252. [PMID: 30283767 PMCID: PMC6156528 DOI: 10.3389/fpubh.2018.00252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/20/2018] [Accepted: 08/15/2018] [Indexed: 12/31/2022] Open
Abstract
Aim: To determine the effect of a health coach intervention for the management of glycemic control, as well as physiological, psychological and self-care outcomes of patients with type 2 diabetes mellitus (T2DM), compared with usual care. Methods: This pragmatic cluster RCT was conducted in the Fengtai district of Beijing from August 2011 to December 2013. Forty-one community health stations (CHSs) were cluster randomized (stratified geographically, 1:1 ratio) and eligible, randomly selected T2DM patients were sequentially contacted by CHSs. Control participants received usual care according to the Chinese Guideline for Diabetes Prevention and Management. Intervention participants received 18-months of health coaching based on principles of Motivational Interviewing (MI) plus usual care. Medical and pathology fees were waived for both groups. Outcome assessment was performed at baseline, 6, 12, and 18-months. The primary outcome was glycated hemoglobin (HbA1c); secondary outcomes encompassed a suite of physiological, psychological and self-care measures. Results: No differential treatment effect was found at 18-months for HbA1c (adj. difference -0.07, 95% CI -0.53 to 0.39, p = 0.769) or any specified secondary outcomes. Interestingly, both groups displayed a statistically and clinically significant within-group improvement of the same magnitude at 18-months for HbA1c (intervention: mean change -3.65, 95% CI -3.92 to -3.37; control: mean change -3.38, 95% CI -3.67 to -3.08). Conclusions: The lack of differential treatment effects observed indicate that it may be premature to recommend the routine delivery of health coach interventions based on MI principles for the management of T2DM in China. However, the large, comparable within-group improvement in mean HbA1c promotes the establishment of free, regular clinical health assessments for individuals with T2DM in China. TRIAL REGISTRATION ISRCTN registry - ISRCTN01010526 (https://doi.org/10.1186/ISRCTN01010526).
Collapse
Affiliation(s)
- Anna Chapman
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia
- Monash Health, Clayton, VIC, Australia
- International Institute for Primary Health Care Research, Shenzhen, China
| | - Colette J. Browning
- International Institute for Primary Health Care Research, Shenzhen, China
- Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Joanne C. Enticott
- School of Primary and Allied Health Care, Monash University, Notting Hill, VIC, Australia
- School of Clinical Sciences, Monash University, Dandenong, VIC, Australia
| | - Hui Yang
- International Institute for Primary Health Care Research, Shenzhen, China
- School of Primary and Allied Health Care, Monash University, Notting Hill, VIC, Australia
| | - Shuo Liu
- Key Laboratory of Carcinogenesis and Translational Research, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tuohong Zhang
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Shane A. Thomas
- International Institute for Primary Health Care Research, Shenzhen, China
- Research School of Population Health, Australian National University, Acton, ACT, Australia
| |
Collapse
|
41
|
O'Connor T, Soto-Perez-de-Celis E, Blanchard S, Chapman A, Kimmick G, Muss H, Luu T, Waisman JR, Li D, Mortimer J, Yuan Y, Somlo G, Stewart D, Katheria V, Levi A, Hurria A. Abstract P5-21-08: Tolerability of the combination of lapatinib and trastuzumab in older patients with HER2 positive metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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
Background: Older adults are less likely to be included in clinical trials leading to the approval of novel cancer treatments. The Institute of Medicine and ASCO have identified therapeutic phase II trials as a key research priority to increase the evidence base for older adults with cancer. While targeted therapies may represent a less toxic option for older patients, few trials have studied their tolerability and efficacy in older adults. Here, we present a phase II study (NCT01273610) of the combination of trastuzumab and lapatinib in older patients with HER2+ metastatic breast cancer (MBC), incorporating geriatric oncology principles in the study design.
Methods: Patients age ≥ 60 years with MBC and any number of prior chemotherapy (CT) lines received trastuzumab (either 4mg/kg loading dose followed by 2mg/kg weekly or 8mg/kg followed by 6mg/kg q/3 weeks) plus lapatinib 1000 mg/m2 daily in 21-day cycles. Patients completed a pre-treatment geriatric assessment including measures of function, comorbidity, cognition, nutrition, and psychosocial status. A toxicity risk score developed for older adults receiving cytotoxic CT was calculated for each patient (Hurria et al. JCO 2011 & 2016). Relationships between tolerability (dose reductions and grade (G) ≥ 3 toxicity attributed to treatment) and risk score analyzed using a log2 transformation were assessed using generalized linear models, Student's t tests, and Fisher's exact test. Response rate (RR) and progression free survival (PFS) were evaluated.
Results: 40 patients (mean age 72 [60-92]) were accrued from 04/11 to 05/15. 25% (n = 10) were ≥ 75 years of age. 65% of patients (n = 26) had HR+ tumors and 35% (n = 14) were receiving ≥ 3rd line treatment. Median number of cycles was 4 (0-28). RR was 23% (n = 9, 95% CI 11-38%; 1 complete, 8 partial). 23% (n = 9) achieved stable disease. PFS was 2.7 months (95% CI 2.5-12). Based on the toxicity risk score, 21% (n = 8), 54% (n = 21), and 26% (n = 10) were at low, intermediate, and high risk. 70% (n = 28) of patients had G ≥ 2 toxicities and 20% (n = 8) G ≥ 3 toxicities. G 2 and 3 diarrhea occurred in 28% (n = 11) and 5% (n = 2) respectively. 5% (n = 2) were hospitalized due to treatment-related toxicity. No G ≥ 3 cardiac toxicities were observed. 23% of patients (n = 9) had treatment delays, and 43% (n = 17) required a lapatinib dose reduction. The mean toxicity risk score was higher in patients who required dose reductions (Student's t: p = 0.02). No statistically significant relationship was found between toxicity risk scores and the presence of G ≥ 3 treatment toxicity (logistic regression: OR = 3.08, 95% CI [0.54, 21.2], p = 0.22).
Conclusions: Among older patients with MBC (79% at intermediate or high risk of G ≥ 3 cytotoxic CT toxicity), trastuzumab and lapatinib were well tolerated, with only 20% experiencing G3 toxicities. The toxicity risk score was not found to be significantly related with treatment toxicity, which may be explained by the very low incidence of G3 events. Patients with a low toxicity risk score were not likely to require a lapatinib dose reduction.
Citation Format: O'Connor T, Soto-Perez-de-Celis E, Blanchard S, Chapman A, Kimmick G, Muss H, Luu T, Waisman JR, Li D, Mortimer J, Yuan Y, Somlo G, Stewart D, Katheria V, Levi A, Hurria A. Tolerability of the combination of lapatinib and trastuzumab in older patients with HER2 positive metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-08.
Collapse
Affiliation(s)
- T O'Connor
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - E Soto-Perez-de-Celis
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - S Blanchard
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Chapman
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - G Kimmick
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - H Muss
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - T Luu
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - JR Waisman
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - D Li
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - J Mortimer
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - Y Yuan
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - G Somlo
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - D Stewart
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - V Katheria
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Levi
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| | - A Hurria
- City of Hope, Duarte, CA; UNC Lineberger Cancer Center, Chapel Hill, NC; Thomas Jefferson University Hospital, Philadelphia, PA; Duke Cancer Center, Durham, NC; Roswell Park Cancer Institute, Buffalo, NY
| |
Collapse
|
42
|
Fernandez Del Ama L, Jones M, Walker P, Chapman A, Braun JA, Mohr J, Hurlstone AFL. Reprofiling using a zebrafish melanoma model reveals drugs cooperating with targeted therapeutics. Oncotarget 2018; 7:40348-40361. [PMID: 27248171 PMCID: PMC5130012 DOI: 10.18632/oncotarget.9613] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022] Open
Abstract
Phenotype-guided re-profiling of approved drug molecules presents an accelerated route to developing anticancer therapeutics by bypassing the target-identification bottleneck of target-based approaches and by sampling drugs already in the clinic. Further, combinations incorporating targeted therapies can be screened for both efficacy and toxicity. Previously we have developed an oncogenic-RAS-driven zebrafish melanoma model that we now describe display melanocyte hyperplasia while still embryos. Having devised a rapid method for quantifying melanocyte burden, we show that this phenotype can be chemically suppressed by incubating V12RAS transgenic embryos with potent and selective small molecule inhibitors of either MEK or PI3K/mTOR. Moreover, we demonstrate that combining MEK inhibitors (MEKi) with dual PI3K/mTOR inhibitors (PI3K/mTORi) resulted in a super-additive suppression of melanocyte hyperplasia. The robustness and simplicity of our novel screening assay inspired us to perform a modest screen of FDA approved compounds for their ability to potentiate MEKi PD184352 or PI3K/mTORi NVPBEZ235 suppression of V12RAS-driven melanocyte hyperplasia. Through this route, we confirmed Rapamycin as a compound that could synergize with MEKi and even more so with PI3K/mTORi to suppress melanoma development, including suppressing the growth of cultured human melanoma cells. Further, we discovered two additional compounds-Disulfiram and Tanshinone-that also co-operate with MEKi to suppress the growth of transformed zebrafish melanocytes and showed activity toward cultured human melanoma cells. In conclusion, we provide proof-of-concept that our phenotype-guided screen could be used to identify compounds that affect melanoma development and prompt further evaluation of Disulfiram and Tanshinone as possible partners for combination therapy.
Collapse
Affiliation(s)
| | - Mary Jones
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Paul Walker
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Anna Chapman
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Julia A Braun
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | - Jasmine Mohr
- Faculty of Life Sciences, The University of Manchester, Manchester, UK
| | | |
Collapse
|
43
|
Mason JM, Chalmers JR, Godec T, Nunn AJ, Kirtschig G, Wojnarowska F, Childs M, Whitham D, Schmidt E, Harman K, Walton S, Chapman A, Williams HC. Doxycycline compared with prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial. Br J Dermatol 2018; 178:415-423. [PMID: 28940316 DOI: 10.1111/bjd.16006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomized controlled trial (RCT). OBJECTIVES To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. METHODS Quality-of-life (EuroQoL-5D-3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis was performed using bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective. RESULTS In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline- with prednisolone-initiated therapy [net cost £959, 95% confidence interval (CI) -£24 to £1941; net QALYs -0·024, 95% CI -0·088 to 0·041]. However, the findings varied by baseline blister severity. For patients with mild or moderate blistering (≤ 30 blisters) net costs and outcomes were similar. For patients with severe blistering (> 30 blisters) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0·090 QALYs, 95% CI -0·22 to 0·042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1·5% at a willingness to pay of £20 000 per QALY. CONCLUSIONS Consistently with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of National Health Service resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering.
Collapse
Affiliation(s)
- J M Mason
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, U.K
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, U.K
| | - T Godec
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, U.K
| | - A J Nunn
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, U.K
| | - G Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, U.K
| | - F Wojnarowska
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7BN, U.K
| | - M Childs
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, QMC, Nottingham, NG7 2UH, U.K
| | - D Whitham
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, QMC, Nottingham, NG7 2UH, U.K
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - K Harman
- Dermatology Department, Leicester Royal Infirmary, University Hospitals Leicester, Leicester, LE1 5WW, U.K
| | - S Walton
- Castle Hill Hospital, Castle Road, Cottingham, Hull, HU16 5JQ, U.K
| | - A Chapman
- Queen Elizabeth Hospital, Greenwich, London, SE18 4QH, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, U.K
| | | |
Collapse
|
44
|
Batchelor JM, Chapman A, Craig FE, Harman KE, Kirtschig G, Martin-Clavijo A, Ormerod AD, Walton S, Williams HC. Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials. Br J Dermatol 2017; 177:e228-e234. [PMID: 29124728 DOI: 10.1111/bjd.15959] [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] [Accepted: 06/10/2017] [Indexed: 10/18/2022]
Abstract
Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.
Collapse
Affiliation(s)
- J M Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - A Chapman
- Department of Dermatology, Lewisham and Greenwich NHS Trust, London, U.K
| | - F E Craig
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - K E Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, U.K
| | - G Kirtschig
- Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - A Martin-Clavijo
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, U.K
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - S Walton
- Department of Dermatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| |
Collapse
|
45
|
Chalmers JR, Wojnarowska F, Kirtschig G, Mason J, Childs M, Whitham D, Harman K, Chapman A, Walton S, Schmidt E, Godec TR, Nunn AJ, Williams HC. A randomised controlled trial to compare the safety, effectiveness and cost-effectiveness of doxycycline (200 mg/day) with that of oral prednisolone (0.5 mg/kg/day) for initial treatment of bullous pemphigoid: the Bullous Pemphigoid Steroids and Tetracyclines (BLISTER) trial. Health Technol Assess 2017; 21:1-90. [PMID: 28406394 DOI: 10.3310/hta21100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune blistering skin disorder with increased morbidity and mortality in the elderly. OBJECTIVES To evaluate the effectiveness, safety and cost-effectiveness of a strategy of initiating BP treatment with oral doxycycline or oral prednisolone. We hypothesised that starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral prednisolone. DESIGN Pragmatic multicentre two-armed parallel-group randomised controlled trial with an economic evaluation. SETTING A total of 54 dermatology secondary care centres in the UK and seven in Germany. PARTICIPANTS Adults with BP [three or more blisters at two sites and positive direct and/or indirect immunofluorescence (immunoglobulin G and/or complement component 3 immunofluorescence at the dermal-epidermal junction)] and able to give informed consent. INTERVENTIONS Participants were allocated using online randomisation to initial doxycycline treatment (200 mg/day) or prednisolone (0.5 mg/kg/day). Up to 30 g/week of potent topical corticosteroids was permitted for weeks 1-3. After 6 weeks, clinicians could switch treatments or alter the prednisolone dose as per normal practice. MAIN OUTCOME MEASURES Primary outcomes: (1) the proportion of participants with three or fewer blisters at 6 weeks (investigator blinded) and (2) the proportion with severe, life-threatening and fatal treatment-related events at 52 weeks. A regression model was used in the analysis adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Secondary outcomes included the effectiveness of blister control after 6 weeks, relapses, related adverse events and quality of life. The economic evaluation involved bivariate regression of costs and quality-adjusted life-years (QALYs) from a NHS perspective. RESULTS In total, 132 patients were randomised to doxycycline and 121 to prednisolone. The mean patient age was 77.7 years and baseline severity was as follows: mild 31.6% (three to nine blisters), moderate 39.1% (10-30 blisters) and severe 29.3% (> 30 blisters). For those starting on doxycycline, 83 out of 112 (74.1%) had three or fewer blisters at 6 weeks, whereas for those starting on prednisolone 92 out of 101 (91.1%) had three or fewer blisters at 6 weeks, an adjusted difference of 18.6% in favour of prednisolone [90% confidence interval (CI) 11.1% to 26.1%], using a modified intention-to-treat (mITT) analysis. Per-protocol analysis showed similar results: 74.4% compared with 92.3%, an adjusted difference of 18.7% (90% CI 9.8% to 27.6%). The rate of related severe, life-threatening and fatal events at 52 weeks was 18.2% for those started on doxycycline and 36.6% for those started on prednisolone (mITT analysis), an adjusted difference of 19.0% (95% CI 7.9% to 30.1%; p = 0.001) in favour of doxycycline. Secondary outcomes showed consistent findings. There was no significant difference in costs or QALYs per patient at 1 year between doxycycline-initiated therapy and prednisolone-initiated therapy (incremental cost of doxycycline-initiated therapy £959, 95% CI -£24 to £1941; incremental QALYs of doxycycline-initiated therapy -0.024, 95% CI -0.088 to 0.041). Using a willingness-to-pay criterion of < £20,000 per QALY gained, the net monetary benefit associated with doxycycline-initiated therapy was negative but imprecise (-£1432, 95% CI -£3094 to £230). CONCLUSIONS A strategy of starting BP patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control and considerably safer in the long term. The limitations of the trial were the wide non-inferiority margin, the moderate dropout rate and that serious adverse event collection was unblinded. Future work might include inducing remission with topical or oral corticosteroids and then randomising to doxycycline or prednisolone for maintenance. TRIAL REGISTRATION Current Controlled Trials ISRCTN13704604. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 10. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Gudula Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - James Mason
- Durham University, School of Medicine, Pharmacy and Health, Stockton-on-Tees, UK
| | - Margaret Childs
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Nottingham, UK
| | - Diane Whitham
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Nottingham, UK
| | - Karen Harman
- University Hospitals Leicester, Dermatology Department, Leicester Royal Infirmary, Leicester, UK
| | | | | | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Thomas R Godec
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| |
Collapse
|
46
|
Leelarathna L, Roberts SA, Hindle A, Markakis K, Alam T, Chapman A, Morris J, Urwin A, Jinadev P, Rutter MK. Comparison of different insulin pump makes under routine care conditions in adults with Type 1 diabetes. Diabet Med 2017. [PMID: 28636773 DOI: 10.1111/dme.13412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 01/17/2023]
Abstract
AIMS To compare long-term HbA1c changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations. METHODS Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA1c changes associated with different pump makes. RESULTS The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA1c levels improved and improvements were maintained during a follow-up extending to 10 years (HbA1c : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA1c ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA1c lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA1c lowering in pre-specified subgroups stratified by pre-pump HbA1c , age or diabetes duration. HbA1c lowering was positively related to baseline HbA1c (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024). CONCLUSIONS Under routine care conditions, there were no covariate-adjusted differences in HbA1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA1c lowering.
Collapse
Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - S A Roberts
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A Hindle
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - K Markakis
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - T Alam
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - A Chapman
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - J Morris
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - A Urwin
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - P Jinadev
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - M K Rutter
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| |
Collapse
|
47
|
Chapman A, Kang Y, Ganong L, Coleman M. LONG-TERM AND LATER-LIFE STEPGRANDPARENT-STEPGRANDCHILD RELATIONSHIPS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2233] [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. Chapman
- Human Development and Family Science, University of Missouri, Columbia, Missouri
| | - Y. Kang
- Human Development and Family Science, University of Missouri, Columbia, Missouri
| | - L.H. Ganong
- Human Development and Family Science, University of Missouri, Columbia, Missouri
| | - M. Coleman
- Human Development and Family Science, University of Missouri, Columbia, Missouri
| |
Collapse
|
48
|
Browning C, Thomas S, Yang H, Zeqi Q, Chapman A. PRIMARY HEALTH CARE IN CHINA: ADDRESSING CHRONIC ILLNESS MANAGEMENT IN OLDER PEOPLE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2364] [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: 11/13/2022] Open
Affiliation(s)
- C. Browning
- RDNS Institute, St Kilda, Victoria, Australia,
- School of Primary Health Care, Monash University, Clayton, Victoria, Australia,
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China,
| | - S. Thomas
- School of Primary Health Care, Monash University, Clayton, Victoria, Australia,
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China,
| | - H. Yang
- School of Primary Health Care, Monash University, Clayton, Victoria, Australia,
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China,
| | - Q. Zeqi
- Center for China Sociological Research and Development Studies, Peking University, Beijing, China
| | - A. Chapman
- RDNS Institute, St Kilda, Victoria, Australia,
- School of Primary Health Care, Monash University, Clayton, Victoria, Australia,
| |
Collapse
|
49
|
Williams HC, Wojnarowska F, Kirtschig G, Mason J, Godec TR, Schmidt E, Chalmers JR, Childs M, Walton S, Harman K, Chapman A, Whitham D, Nunn AJ. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial. Lancet 2017; 389:1630-1638. [PMID: 28279484 PMCID: PMC5400809 DOI: 10.1016/s0140-6736(17)30560-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bullous pemphigoid is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral corticosteroids. METHODS We did a pragmatic, multicentre, parallel-group randomised controlled trial of adults with bullous pemphigoid (three or more blisters at two or more sites and linear basement membrane IgG or C3). Participants were randomly assigned to doxycycline (200 mg per day) or prednisolone (0·5 mg/kg per day) using random permuted blocks of randomly varying size, and stratified by baseline severity (3-9, 10-30, and >30 blisters for mild, moderate, and severe disease, respectively). Localised adjuvant potent topical corticosteroids (<30 g per week) were permitted during weeks 1-3. The non-inferiority primary effectiveness outcome was the proportion of participants with three or fewer blisters at 6 weeks. We assumed that doxycycline would be 25% less effective than corticosteroids with a 37% acceptable margin of non-inferiority. The primary safety outcome was the proportion with severe, life-threatening, or fatal (grade 3-5) treatment-related adverse events by 52 weeks. Analysis (modified intention to treat [mITT] for the superiority safety analysis and mITT and per protocol for non-inferiority effectiveness analysis) used a regression model adjusting for baseline disease severity, age, and Karnofsky score, with missing data imputed. The trial is registered at ISRCTN, number ISRCTN13704604. FINDINGS Between March 1, 2009, and Oct 31, 2013, 132 patients were randomly assigned to doxycycline and 121 to prednisolone from 54 UK and seven German dermatology centres. Mean age was 77·7 years (SD 9·7) and 173 (68%) of 253 patients had moderate-to-severe baseline disease. For those starting doxycycline, 83 (74%) of 112 patients had three or fewer blisters at 6 weeks compared with 92 (91%) of 101 patients on prednisolone, an adjusted difference of 18·6% (90% CI 11·1-26·1) favouring prednisolone (upper limit of 90% CI, 26·1%, within the predefined 37% margin). Related severe, life-threatening, and fatal events at 52 weeks were 18% (22 of 121) for those starting doxycycline and 36% (41 of 113) for prednisolone (mITT), an adjusted difference of 19·0% (95% CI 7·9-30·1), p=0·001. INTERPRETATION Starting patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control in bullous pemphigoid and significantly safer in the long-term. FUNDING NIHR Health Technology Assessment Programme.
Collapse
Affiliation(s)
- Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
| | | | - Gudula Kirtschig
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK; Institute of General Medicine and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas R Godec
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Margaret Childs
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Nottingham, UK
| | | | - Karen Harman
- Dermatology Department, Leicester Royal Infirmary, Leicester, UK
| | - Anna Chapman
- Dermatology Department, Queen Elizabeth Hospital, Greenwich, London, UK
| | - Diane Whitham
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Nottingham, UK
| | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| |
Collapse
|
50
|
Chapman A, Meyer C, Renehan E, Hill KD, Browning CJ. Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses. J Diabetes Complications 2017; 31:631-645. [PMID: 27765575 DOI: 10.1016/j.jdiacomp.2016.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/26/2016] [Accepted: 09/28/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Falls as a complication of diabetes mellitus (DM) can have a major impact on the health of older adults. Previous reviews have demonstrated that certain exercise interventions are effective at reducing falls in older people; however, no studies have quantified the effectiveness of exercise interventions on falls-related outcomes among older adults with DM. METHODS A systematic search for all years to September 2015 identified available literature. Eligibility criteria included: appropriate exercise intervention/s; assessed falls-related outcomes; older adults with DM. Effect sizes were pooled using a random effects model. Positive effect sizes favoured the intervention. RESULTS Ten RCTs were eligible for the meta-analyses. Exercise interventions were more effective than the control condition for static balance (0.53, 95% CI: 0.13 to 0.93), lower-limb strength (0.63, 95% CI: 0.09 to 1.18), and gait (0.59, 95% CI: 0.22 to 0.96). No RCTs assessed falls-risk; one RCT reported 12month falls-rate, with no differential treatment effect observed. CONCLUSION Exercise interventions can improve certain falls-related outcomes among older adults with DM. Substantial heterogeneity and limited numbers of studies should be considered when interpreting results. Among older adults, where DM burden is increasing, exercise interventions may provide promising approaches to assist the improvement of falls-related outcomes.
Collapse
Affiliation(s)
- Anna Chapman
- RDNS Institute, Victoria 3182, Australia; School of Primary Health Care, Monash University, Victoria 3168, Australia.
| | - Claudia Meyer
- RDNS Institute, Victoria 3182, Australia; Centre for Health Communication, School of Public Health and Human Biosciences, La Trobe University, Victoria 3086, Australia.
| | | | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia 6102, Australia.
| | - Colette J Browning
- RDNS Institute, Victoria 3182, Australia; School of Primary Health Care, Monash University, Victoria 3168, Australia.
| |
Collapse
|