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Ruscitti P, Feist E, Canon-Garcia V, Rabijns H, Toennessen K, Bartlett C, Gregg E, Miller P, McGonagle D. Burden of adult-onset Still's disease: A systematic review of health-related quality of life, utilities, costs and resource use. Semin Arthritis Rheum 2023; 63:152264. [PMID: 37802002 DOI: 10.1016/j.semarthrit.2023.152264] [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: 06/21/2023] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
Adult-onset Still's disease (AOSD) poses a not well estimated burden on patients and healthcare systems. To assess this burden, a systematic review (SR) was undertaken to identify health-related quality of life (HRQoL), utilities, costs and healthcare resource use data. Searches of twelve databases, four conferences, and three key technology assessment and regulatory agency websites were conducted in August 2022. Reference lists of retrieved SRs published since 2017 were also checked. Overall, 16 studies were eligible for inclusion. Eight studies reported HRQoL outcomes, one of which also reported utilities data. Two studies reported direct costs outcomes, and seven reported healthcare resource use data. No indirect costs were identified. A range of outcomes were reported, thus limiting the comparability of results across studies. SF-36 data were impaired in AOSD on most scales, especially those concerning physical activity. Mean SF-36 data were lower across all subscales in patients with active AOSD compared with inactive AOSD. Biologic therapy showed improvements in the SF-36 physical health summary. Utility scores (one study) were significantly lower for AOSD than for healthy controls. Limited direct economic costs data were identified but were substantial where reported. Hospital length of stay ranged from 6.1 to 23.5 days. The SR showed there is a paucity of research reporting the HRQoL and cost burden of AOSD.
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Affiliation(s)
- Piero Ruscitti
- Department of Applied Clinical Sciences and Biotechnology, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy
| | - Eugen Feist
- Helios Specialist Clinic Vogelsang-Gommern, Department of Rheumatology, Helios Fachklinik, Sophie-von-Boetticher-Straße 1, 39245, Vogelsang-Gommern, Germany
| | | | - Hilde Rabijns
- Novartis NV/SA, Medialaan 40, B-1800 Vilvoorde, Belgium
| | | | - Chris Bartlett
- York Health Economics Consortium (YHEC), Enterprise House, Innovation Way University of, York YO10 5NQ, England.
| | - Emily Gregg
- York Health Economics Consortium (YHEC), Enterprise House, Innovation Way University of, York YO10 5NQ, England
| | - Paul Miller
- York Health Economics Consortium (YHEC), Enterprise House, Innovation Way University of, York YO10 5NQ, England
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Bertini E, Gregg E, Bartlett C, Senthilnathan V, Arber M, Watkins D, Graziadio S, Tomazos I. The burden of mitochondrial disease with associated seizures: systematic literature reviews of health-related quality of life, utilities, costs and healthcare resource use data. Orphanet J Rare Dis 2023; 18:320. [PMID: 37821990 PMCID: PMC10568748 DOI: 10.1186/s13023-023-02945-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Mitochondrial disease is a degenerative, progressive, heterogeneous group of genetic disorders affecting children and adults. Mitochondrial disease is associated with morbidity and mortality, with predominantly neurological and neuromuscular symptoms including dystonia, weakness, encephalopathy, developmental delay and seizures. Seizures are one of the most common and severe manifestations of mitochondrial disease. These seizures are typically refractory to common anti-seizure therapies. There are no approved disease-modifying treatments for mitochondrial disease. Our objective was to conduct two systematic literature reviews to identify health-related quality of life (HRQoL), utilities, costs and healthcare resource use data in mitochondrial disease with associated seizures. METHODS A range of databases and information sources were searched up to July 2022 to identify eligible studies. Search strategies included a range of variant terms for mitochondrial disease and HRQoL, utilities, cost and healthcare resource use outcomes. Two reviewers independently assessed articles against the eligibility criteria; studies were extracted by one reviewer and checked by a second. Risk of bias was assessed for studies reporting HRQoL data. Results were narratively assessed. RESULTS Seven studies were eligible for the HRQoL and utilities review. The studies used different tools to report data, and despite the variability in methods, HRQoL scores across the studies showed moderate/severe disease in patients with mitochondrial disease with associated seizures. Parents of patients with mitochondrial disease with associated seizures were characterised by high total parenting stress. No studies reported utilities data. Two case reports and one retrospective review of medical records of children who died in hospital were eligible for the costs and resource use review. These provided limited information on the duration of hospital stay, in an intensive care unit (ICU), on mechanical ventilation. No studies reported costs data. CONCLUSION These reviews highlight the limited HRQoL, utilities, costs and resource use data and the variability of instruments used in mitochondrial disease with associated seizures. However, the data available indicate that mitochondrial disease with associated seizures affects patients' and caregivers' HRQoL alike. No robust conclusion can be drawn on the impact of mitochondrial disease with associated seizures on hospital or ICU length of stay. Trial registration PROSPERO: CRD42022345005.
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Affiliation(s)
- Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, IRCCS, Rome, Italy
| | | | | | | | - Mick Arber
- York Health Economics Consortium, York, UK
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Sprigle S, Deshpande Y, Bartlett C. The design of a family of parametric anatomically-based compliant buttock models to evaluate wheelchair cushion performance. J Rehabil Assist Technol Eng 2023; 10:20556683231182324. [PMID: 37325811 PMCID: PMC10262629 DOI: 10.1177/20556683231182324] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
The evaluation of wheelchair cushion performance is of interest to a variety of stakeholders, including standards organizations, cushion manufacturers, clinicians, users and payers. The objective of this project was to develop a family of compliant buttock models that are based upon the anatomical parameters of persons with varying body sizes. The models are parametrically designed so can be scaled to evaluate different sized cushions. This paper will detail the designs, describe the anatomical basis for the design and provide the rationale for the design decisions. The manuscript also serves a secondary purpose to illustrate how anthropometric data can be applied to the design of anatomical phantoms that reflect both soft tissue and skeletal anthropometry. Supplemental material includes greater detail and the full CAD files and model fabrication instructions are available in an open access repository for persons who wish to fabricate the models.
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Affiliation(s)
- Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yogesh Deshpande
- Department of Medicine, Brigham and Women’s Hospital, Brookline, MA, USA
| | - Chris Bartlett
- Applied Systems Lab, Georgia Tech Research Institute, Atlanta, GA, USA
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Silver R, Silva M, Maloney M, Brate A, El-Sayes N, Ozay E, Parwanda D, Bartlett C, Sharei A, Loughhead S, Gilbert J, Bridgen D. 761P Tumor infiltrating lymphocytes expressing membrane-bound IL-2 and IL-12 exhibit enhanced proliferation, function, and persistence without requiring exogenous IL-2 support. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.887] [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] Open
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Abstract
There has been no extensive synthesis of studies evaluating the cost of chronic hand eczema (CHE). This review evaluated the societal costs, healthcare resource utilisation, missed work time and job loss due to CHE. MEDLINE and 16 other databases and websites were searched in October 2020 for studies meeting prespecified inclusion criteria. Studies conducted in Europe, Australia, New Zealand or the Americas were included. Two reviewers independently assessed titles and abstracts, and full-text papers published in English between 2000 and 2020, for relevance. Data extraction was carried out by one reviewer and checked by a second reviewer. All data were based on costs between 2001 and 2013 but have been inflated to 2020 prices and converted to US dollars and Euros. A total of 30 studies (reported in 33 publications) were included in the synthesis. Mean total societal costs per year per patient ranged from $2549 (€1813) to $10,883 (€7738). Pharmacological therapy was, on average, $28.34 (€20.15) per month in Italy and $36.49 (€25.94) per month for emollients in Switzerland. Yearly treatment costs were $599.05 (€425.92) for drugs, including topical corticosteroids, topical calcineurin inhibitors, other topical treatments and oral treatments, and $178.40 for emollients, in Germany. CHE was associated with hospitalisation costs ranging from $81.86 (€58.20) per patient per month (US) to $105.04 (€74.68) per patient per month (Italy) and $639.59 (€454.75) per year (Germany). Up to 57% of patients took sick leave and up to 25% reported job loss/job change due to CHE. This review confirms the significant cost burden of CHE. Given the paucity of studies estimating the monetary costs of absenteeism, presenteeism and job loss associated with CHE, current mean societal costs are likely underestimated. Uncontrolled disease may also lead to increased costs to patients and society.
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Affiliation(s)
- April Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | | | - Chris Bartlett
- York Health Economics Consortium Ltd, York, YO10 5NQ, UK.
| | | | - Jacob P Thyssen
- Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Perkins DJ, Villescas S, Wu TH, Muller T, Bradfute S, Hurwitz I, Cheng Q, Wilcox H, Weiss M, Bartlett C, Langsjoen J, Seidenberg P. COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators. Exp Biol Med (Maywood) 2020; 245:933-939. [PMID: 32397762 PMCID: PMC7235442 DOI: 10.1177/1535370220925768] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/18/2022] Open
Abstract
IMPACT STATEMENT There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.
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Affiliation(s)
- Douglas J Perkins
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
| | - Steven Villescas
- Facilities Safety, University of New Mexico Hospital, Albuquerque, NM 87131, USA
| | - Terry H Wu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Center for Infectious Disease and Immunity, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Timothy Muller
- Office of Research, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Steven Bradfute
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Ivy Hurwitz
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Hannah Wilcox
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Myissa Weiss
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Chris Bartlett
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Phil Seidenberg
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
- Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
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Perkins DJ, Villescas S, Wu TH, Muller T, Bradfute S, Hurwitz I, Cheng Q, Wilcox H, Weiss M, Bartlett C, Langsjoen J, Seidenberg P. COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators. Exp Biol Med (Maywood) 2020; 245:933-939. [PMID: 32397762 DOI: 10.1101/2020.04.09.20060129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.
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Affiliation(s)
- Douglas J Perkins
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
| | - Steven Villescas
- Facilities Safety, University of New Mexico Hospital, Albuquerque, NM 87131, USA
| | - Terry H Wu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Center for Infectious Disease and Immunity, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Timothy Muller
- Office of Research, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Steven Bradfute
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Ivy Hurwitz
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Qiuying Cheng
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Hannah Wilcox
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Myissa Weiss
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Chris Bartlett
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Jens Langsjoen
- Division of Hospital Medicine, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
| | - Phil Seidenberg
- University of New Mexico-Kenya Programs, Kisumu and Siaya, 40100, Kenya
- Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM 87131, USA
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Cao H, Ouyang H, Laselva O, Bartlett C, Bear C, Gonska T, Moraes T, Hu J. WS13-6 Adenoviral vector gene therapy results in a wild type CFTR functional pattern in class I mutation cystic fibrosis cells. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Retzler J, Hex N, Bartlett C, Webb A, Wood S, Star C, Griffiths P, Jones CE. Economic cost of congenital CMV in the UK. Arch Dis Child 2019; 104:559-563. [PMID: 30472664 DOI: 10.1136/archdischild-2018-316010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 08/08/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK. DESIGN The study collated available secondary data to develop a static cost model. SETTING The model aimed to estimate costs of cCMV in the UK for the year 2016. PATIENTS Individuals of all ages with cCMV. MAIN OUTCOME MEASURES Direct (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae. RESULTS The model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV. CONCLUSIONS The cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.
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Affiliation(s)
- Jenny Retzler
- York Health Economics Consortium, University of York, York, UK.,Department of Psychology, University of Huddersfield, Huddersfield, UK
| | - Nick Hex
- York Health Economics Consortium, University of York, York, UK
| | - Chris Bartlett
- York Health Economics Consortium, University of York, York, UK
| | - Anne Webb
- York Health Economics Consortium, University of York, York, UK
| | | | | | | | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Abstract
Dialysis dose is given by the index KT/V, where K is the dialyser urea clearance, T the duration of dialysis and V the notional urea distribution volume. KT/V may be calculated using the single pool model and an iterative calculation which requires a computer program. Three estimates of KT/V, each based on simple correction of the log ratio in (C0/C1), where C0, C1 denote the pre- and post-dialysis blood urea concentrations in mg/ml, were developed and compared with the values of KT/V given by iteration. The first estimate was given by adding two terms to the log ratio to account for the effect of ultrafiltration and urea generation while the second and third estimates were given by increasing the log ratio by 12.5% and 15% respectively. All estimates gave good agreement when compared with the iterative technique by Bland-Altman analysis for 27 patients on standard 4 hour dialysis treatment using 4 different dialysers (0.71<KT/V<1.62). The mean difference in all cases was less than 0.025 and the differences were not clinically significant. The use of these approximate formulae to estimate dialysis efficiency avoids the need for complex calculation or additional blood samples.
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Affiliation(s)
- S.W. Smye
- Departments of Medical Physics and St James's University Hospital, Leeds - UK
| | - D. Lewis
- Renal Medicine, St James's University Hospital, Leeds - UK
| | - E. Will
- Renal Medicine, St James's University Hospital, Leeds - UK
| | - C. Bartlett
- Renal Medicine, St James's University Hospital, Leeds - UK
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Baxter M, Hudson R, Mahon J, Bartlett C, Samyshkin Y, Alexiou D, Hex N. Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the number of clinical complications and the associated financial benefit. Diabet Med 2016; 33:1575-1581. [PMID: 26773733 DOI: 10.1111/dme.13062] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [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: 01/11/2016] [Indexed: 12/18/2022]
Abstract
AIM To estimate potential cost avoidance through modest and achievable improvements in glycaemic control in adults with Type 1 or Type 2 diabetes mellitus in the UK healthcare system. METHODS The IMS Core Diabetes Model was used to examine the impact of improved glycaemic control (indicated by reduction in HbA1c level), in a representative cohort of adults with Type 1 or Type 2 diabetes. The cumulative incidence of microvascular and macrovascular complications was modelled across 5-year periods to a 25-year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance. RESULTS Significant cost avoidance of ~£340 m is apparent in the first 5 years, increasing to ~£5.5bn after 25 years of sustained improvement in control. The overwhelming majority of cost avoidance arises from reductions in microvascular complications. In people with Type 1 diabetes the greatest cost avoidance comes from a reduction in renal disease (74% of cost avoidance), while in people with Type 2 diabetes it is generated by a reduction in foot ulcers, amputations and neuropathy: 57% cost avoidance). Greater cost reduction is accrued more rapidly in people with higher starting HbA1c levels. CONCLUSION Modest improvements in glycaemic control generate significant reductions in the incidence and, therefore, cost of microvascular complications in people with Type 1 or Type 2 diabetes. This study provides clear support for the premise that prioritized and sustained investment in early and better intervention can provide concrete financial benefits in both the short and longer term.
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Affiliation(s)
| | | | - J Mahon
- York Health Economics Consortium Ltd, University of York, York, UK
| | - C Bartlett
- York Health Economics Consortium Ltd, University of York, York, UK
| | | | | | - N Hex
- York Health Economics Consortium Ltd, University of York, York, UK
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Bartlett C, Atkinson D, Walker R, Silva F, Patel A. Umbilical Cord Derived Sub-Epithelial Cells Improve Heart Function Post Myocardial Infarction. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patel A, Atkinson D, Walker R, Bartlett C, Silva F. Hypoxic Cultured Umbilical Cord Derived Sub-Epithelial Cells: Moving Towards and Optimal Cell Source and Culture Method. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patel A, Bartlett C, Atkinson D, Walker R, Silva F. Next Generation Xenogeneic-Free Biologics/Reagents. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Proctor DM, Suh M, Mittal L, Hirsch S, Valdes Salgado R, Bartlett C, Van Landingham C, Rohr A, Crump K. Inhalation cancer risk assessment of hexavalent chromium based on updated mortality for Painesville chromate production workers. J Expo Sci Environ Epidemiol 2016; 26:224-31. [PMID: 26669850 PMCID: PMC4756268 DOI: 10.1038/jes.2015.77] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 05/05/2023]
Abstract
The exposure-response for hexavalent chromium (Cr(VI))-induced lung cancer among workers of the Painesville Ohio chromate production facility has been used internationally for quantitative risk assessment of environmental and occupational exposures to airborne Cr(VI). We updated the mortality of 714 Painesville workers (including 198 short-term workers) through December 2011, reconstructed exposures, and conducted exposure-response modeling using Poisson and Cox regressions to provide quantitative lung cancer risk estimates. The average length of follow-up was 34.4 years with 24,535 person-years at risk. Lung cancer was significantly increased for the cohort (standardized mortality ratio (SMR)=186; 95% confidence interval (CI) 145-228), for those hired before 1959, those with >30-year tenure, and those with cumulative exposure >1.41 mg/m(3)-years or highest monthly exposures >0.26 mg/m(3). Of the models assessed, the linear Cox model with unlagged cumulative exposure provided the best fit and was preferred. Smoking and age at hire were also significant predictors of lung cancer mortality. Adjusting for these variables, the occupational unit risk was 0.00166 (95% CI 0.000713-0.00349), and the environmental unit risk was 0.00832 (95% CI 0.00359-0.0174), which are 20% and 15% lower, respectively, than values developed in a previous study of this cohort.
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Affiliation(s)
| | - Mina Suh
- ToxStrategies, Mission Viejo, California, USA
| | | | | | | | | | | | - Annette Rohr
- Electric Power Research Institute, Palo Alto, California, USA
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Centanni TM, Sanmann JN, Green JR, Iuzzini-Seigel J, Bartlett C, Sanger WG, Hogan TP. The role of candidate-gene CNTNAP2 in childhood apraxia of speech and specific language impairment. Am J Med Genet B Neuropsychiatr Genet 2015; 168:536-43. [PMID: 26097074 DOI: 10.1002/ajmg.b.32325] [Citation(s) in RCA: 23] [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: 12/17/2014] [Accepted: 05/13/2015] [Indexed: 01/24/2023]
Abstract
Childhood apraxia of speech (CAS) is a debilitating pediatric speech disorder characterized by varying symptom profiles, comorbid deficits, and limited response to intervention. Specific Language Impairment (SLI) is an inherited pediatric language disorder characterized by delayed and/or disordered oral language skills including impaired semantics, syntax, and discourse. To date, the genes associated with CAS and SLI are not fully characterized. In the current study, we evaluated behavioral and genetic profiles of seven children with CAS and eight children with SLI, while ensuring all children were free of comorbid impairments. Deletions within CNTNAP2 were found in two children with CAS but not in any of the children with SLI. These children exhibited average to high performance on language and word reading assessments in spite of poor articulation scores. These findings suggest that genetic variation within CNTNAP2 may be related to speech production deficits.
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Affiliation(s)
- T M Centanni
- MGH Institute of Health Professions, Boston, Massachusetts
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - J N Sanmann
- University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
| | - J R Green
- MGH Institute of Health Professions, Boston, Massachusetts
| | - J Iuzzini-Seigel
- MGH Institute of Health Professions, Boston, Massachusetts
- Marquette University, Milwaukee, Michigan
| | - C Bartlett
- The Ohio State University, Columbus, Ohio
| | - W G Sanger
- University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska
| | - T P Hogan
- MGH Institute of Health Professions, Boston, Massachusetts
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Tuma J, Silva F, Winters A, Bartlett C, Patel A. Optimized Mesenchymal Stem Cell Therapy for Chronic Obstructive Pulmonary Disease. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.681] [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] Open
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Gupta D, Nicholson J, Bartlett C, Ottersen D, Reichel F, Hoffman E, Rodeghier M, Schultz A, Markman M, Lis C. Emergency Department Utilization Patterns Among Adult Cancer Patients: A Retrospective Cohort Study. Ann Epidemiol 2013. [DOI: 10.1016/j.annepidem.2013.06.020] [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]
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Velloso CP, Aperghis M, Godfrey R, Blazevich AJ, Bartlett C, Cowan D, Holt RIG, Bouloux P, Harridge SDR, Goldspink G. The effects of two weeks of recombinant growth hormone administration on the response of IGF-I and N-terminal pro-peptide of collagen type III (P-III-NP) during a single bout of high resistance exercise in resistance trained young men. Growth Horm IGF Res 2013; 23:76-80. [PMID: 23433656 DOI: 10.1016/j.ghir.2013.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Received: 07/24/2012] [Revised: 12/09/2012] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Recombinant human growth hormone (rhGH) is used by some athletes and body builders with the aim of enhancing performance, building muscle and improving physique. Detection of the misuse of rhGH has proved difficult for a number of reasons. One of these is the effect of preceding exercise. In this randomised, double blind placebo-controlled study, we determined the effects of rhGH administration in male amateur athletes on two candidate markers of rhGH abuse, IGF-I and N-terminal pro-peptide of collagen type III (P-III-NP), following a bout of weightlifting exercise. DESIGN Sixteen men entered a four-week general weight training programme to homogenise their activity profile. They then undertook repeated bouts of standardised leg press weightlifting exercise (AHRET-acute heavy resistance exercise test). Blood samples were taken before and up to one hour after the AHRET. After the first laboratory visit (Test 1), the subjects were randomly assigned to receive daily injections of either rhGH (0.1 IU kg(-1) day(-1)) or placebo for two weeks. The AHRET was repeated after the two-week dosing period (Test 2) and a further test was undertaken following a one-week washout (Test 3). RESULTS There was no effect of exercise on either IGF-I or P-III-NP in any test. Both markers were markedly elevated at Test 2 (p<0.001), with P-III-NP remaining elevated at Test 3 in the GH administration group (p<0.05). Application of the GH-2000 discriminant function positively identified GH administration in 17 of 40 blood samples taken at Test 2 from the rhGH group and none from the placebo group. CONCLUSION The data show that rhGH results in elevated levels of IGF-I and P-III-NP in well-trained individuals and that leg press weightlifting exercise does not affect these markers. The GH-2000 discriminant function identified four of eight subjects taking rhGH with no false positive results.
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Affiliation(s)
- C P Velloso
- Department of Surgery and Interventional Science, University College London, London, United Kingdom.
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Affiliation(s)
| | | | - Joel M Gelfand
- Departments of Dermatology, and Biostatistics and Epidemiology, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce Bebo
- National Psoriasis Foundation, Portland, Oregon
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Hex N, Taylor M, Bartlett C. Comments on Waldeyer et al. 'Response to Hex et al. Estimating the current and future costs for Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs'. Diabet Med 2013; 30:503-4. [PMID: 23331120 DOI: 10.1111/dme.12113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
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Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med 2012; 29:855-62. [PMID: 22537247 DOI: 10.1111/j.1464-5491.2012.03698.x] [Citation(s) in RCA: 535] [Impact Index Per Article: 44.6] [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] [Indexed: 01/11/2023]
Abstract
AIMS To estimate the current and future economic burdens of Type 1 and Type 2 diabetes in the UK. METHODS A top-down approach was used to estimate costs for 2010/2011 from aggregated data sets and literature. Prevalence and population data were used to project costs for 2035/2036. Direct health costs were estimated from data on diagnosis, lifestyle interventions, ongoing treatment and management, and complications. Indirect costs were estimated from data on mortality, sickness, presenteeism (potential loss of productivity among people who remain in work) and informal care. RESULTS Diabetes cost approximately £ 23.7bn in the UK in 2010/2011: £ 9.8bn in direct costs (£1bn for Type 1 diabetes and £ 8.8bn for Type 2 diabetes) and £ 13.9bn in indirect costs (£ 0.9bn and £ 13bn). In real terms, the 2035/2036 cost is estimated at £ 39.8bn: £ 16.9bn in direct costs (£ 1.8bn for Type 1 diabetes and £ 15.1bn for Type 2 diabetes) and £ 22.9bn in indirect costs (£ 2.4bn and £ 20.5bn). Sensitivity analysis applied to the direct costs produced a range of costs: between £ 7.9bn and £ 11.7bn in 2010/2011 and between £ 13.8bn and £20bn in 2035/2036. Diabetes currently accounts for approximately 10% of the total health resource expenditure and is projected to account for around 17% in 2035/2036. CONCLUSIONS Type 1 and Type 2 diabetes are prominent diseases in the UK and are a significant economic burden. Data differentiating between the costs of Type 1 and Type 2 diabetes are sparse. Complications related to the diseases account for a substantial proportion of the direct health costs. As prevalence increases, the cost of treating complications will grow if current care regimes are maintained.
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Affiliation(s)
- N Hex
- York Health Economics Consortium Ltd, University of York, York, UK.
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23
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Affiliation(s)
- G Srivastava
- Department of Obstetrics, and Gynaecology, Basildon and Thurrock University Hospital, Basildon, UK.
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Shram MJ, Schoedel KA, Bartlett C, Shazer RL, Anderson CM, Sellers EM. Evaluation of the Abuse Potential of Lorcaserin, a Serotonin 2C (5-HT2C) Receptor Agonist, in Recreational Polydrug Users. Clin Pharmacol Ther 2011; 89:683-92. [DOI: 10.1038/clpt.2011.20] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kay RG, Barton C, Velloso CP, Brown PR, Bartlett C, Blazevich AJ, Godfrey RJ, Goldspink G, Rees R, Ball GR, Cowan DA, Harridge SD, Roberts J, Teale P, Creaser CS. High-throughput ultra-high-performance liquid chromatography/tandem mass spectrometry quantitation of insulin-like growth factor-I and leucine-rich alpha-2-glycoprotein in serum as biomarkers of recombinant human growth hormone administration. Rapid Commun Mass Spectrom 2009; 23:3173-3182. [PMID: 19718777 DOI: 10.1002/rcm.4237] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Insulin-like growth factor-I (IGF-I) is a known biomarker of recombinant human growth hormone (rhGH) abuse, and is also used clinically to confirm acromegaly. The protein leucine-rich alpha-2-glycoprotein (LRG) was recently identified as a putative biomarker of rhGH administration. The combination of an ACN depletion method and a 5-min ultra-high-performance liquid chromatography/tandem mass spectrometry (uHPLC/MS/MS)-based selected reaction monitoring (SRM) assay detected both IGF-I and LRG at endogenous concentrations. Four eight-point standard addition curves of IGF-I (16-2000 ng/mL) demonstrated good linearity (r(2) = 0.9991 and coefficients of variance (CVs) <13%). Serum samples from two rhGH administrations were extracted and their uHPLC/MS/MS-derived IGF-I concentrations correlated well against immunochemistry-derived values. Combining IGF-I and LRG data improved the separation of treated and placebo states compared with IGF-I alone, further strengthening the hypothesis that LRG is a biomarker of rhGH administration. Artificial neural networks (ANNs) analysis of the LRG and IGF-I data demonstrated an improved model over that developed using IGF-I alone, with a predictive accuracy of 97%, specificity of 96% and sensitivity of 100%. Receiver operator characteristic (ROC) analysis gave an AUC value of 0.98. This study demonstrates the first large scale and high throughput uHPLC/MS/MS-based quantitation of a medium abundance protein (IGF-I) in human serum. Furthermore, the data we have presented for the quantitative analysis of IGF-I suggest that, in this case, monitoring a single SRM transition to a trypsin peptide surrogate is a valid approach to protein quantitation by LC/MS/MS.
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Affiliation(s)
- R G Kay
- Drug Development Services, Quotient Bioresearch Ltd., Fordham CB7 5WW, UK.
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Bartlett C, Galbraith S. Spence Galbraith. West J Med 2009. [DOI: 10.1136/bmj.b1827] [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: 11/04/2022]
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Howlett M, Wolfe H, Bartlett C, Burris D. 72: A Method for Review of Accuracy and Reliability of Canadian Emergency Department Triage Acuity Scale-Based Triage Process in a Community Emergency Department Setting: Starting the QI Process. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.039] [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: 10/22/2022]
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29
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Crofts JF, Bartlett C, Ellis D, Winter C, Donald F, Hunt LP, Draycott TJ. Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors. Qual Saf Health Care 2008; 17:20-4. [DOI: 10.1136/qshc.2006.021873] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moore THM, Bartlett C, Burke MA, Davey Smith G, Ebrahim SBJ. Statins for preventing cardiovascular disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd004816.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN A matched case-control study. SETTING Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.
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Affiliation(s)
- N Price
- Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, UK.
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Bartlett C, Doyal L, Ebrahim S, Davey P, Bachmann M, Egger M, Dieppe P. The causes and effects of socio-demographic exclusions from clinical trials. Health Technol Assess 2006; 9:iii-iv, ix-x, 1-152. [PMID: 16181564 DOI: 10.3310/hta9380] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the exclusion from trials of women, older people and minority ethnic groups, focusing on two drug exemplars, statins and non-steroidal anti-inflammatory drugs (NSAIDs). DATA SOURCES Medical and ethical databases. Workshops with stakeholders. REVIEW METHODS Literature was reviewed on exclusions in healthcare research and three workshops were held with stakeholders. Twenty-seven randomised controlled trials (RCTs) of statins use for secondary prevention of coronary heart disease (CHD) and 25 NSAIDs trials for pain in osteoarthritis (OA) were analysed. Using a Scottish cohort with record-linkage, profiling was carried out for 3188 people needing secondary prevention for CHD (1993-1996), ascertaining the independent effects of statins, and 131,410 people dispensed NSAIDs (1989-1996), examining adverse effects. Routine data sources were accessed to profile the need for secondary prevention of CHD in England and usage was estimated by consulting published surveys. The Somerset and Avon Survey of Health (SASH) 1996-97 and published data were accessed for information on potential need and usage of NSAIDs in OA. For both drugs, the socio-demographic profiles of trial samples, the population in potential need and those on treatment were compared. An evidence synthesis was produced to clarify the effects of statins on women and older people and the relationship of absolute effectiveness outcomes with underlying risk levels of disease events was modelled, examining the likely effects of trial exclusions. RESULTS The average age of statins trial participants was 58.5 years; only 16.3% were women. Statins reduced cardiovascular disease (CVD) incidence by about 25% in both men and women. Older people up to 75 years of age also benefited. Meta-analysis and two landmark trials confirmed these results. The average age of NSAIDs trial participants was 61.9 years and women were well represented (68.5%). Gastrointestinal (GI) adverse events were commonly reported, but renal side-effects were not. Outcomes were seldom reported according to socio-demographic group. For both drugs, USA trials were more inclusive than UK/European trials. Ethnicity was not well reported for either drug. Some 23% of the cohort were treated with statins. Users were younger than non-statins users (but no more likely to be male) and had superior outcomes. High current exposure to NSAIDs elevated the risk of GI side-effects by about 50% versus no current exposure and renal impairment risk by nearly 140%. Side-effect risk increased with age; being female diminished risk. Approximately 537,000 incident cases of CVD would qualify for statins use in England each year. Women constitute 45% of this population with need, two-thirds of whom are aged 65 years or over. Need varies by ethnic group. No sex bias in prescribing statins was detected, but use was commoner in younger people. For NSAIDs, 6.3% of adults aged 35+ years reported hip and/or knee pain associated with OA; 3.9% of adults used prescribed analgesics for this and they were more likely to be women and to be >65 years old. For statins, women formed almost half of the 'with need' and 'on treatment' populations, but were markedly under-represented in trials. Those aged 65+ years formed nearly two-thirds of the 'with need' population, but only one-fifth of trial samples, and were less likely to be treated than younger subjects. For NSAIDs, women formed similar proportions. Associations of side-effects with socio-demographic factors was revealed in cohort data but not in trials. CONCLUSIONS The issue of exclusion from trials of women, older people and ethnic minorities has been relatively neglected in the UK research community, and there is confusion about diversity issues. Under-representation occurs, but in drug trials at least this may not always affect the external validity of relative effect estimates. However, measures of absolute effectiveness, absolute harm and cost-effectiveness are associated with underlying risk levels in different socio-demographic groups. Under-representation will therefore bias absolute effect estimates. The following areas are suggested for future research: multi-disciplinary assessment of realistic options for trialists to address the issue of exclusions; clarification of the use of ethnic categories in health research and of the implications of the different dimensions of ageing and sex/gender; identification of barriers and facilitators to the involvement of different population groups in research, further investigation of the susceptibility of older men to NSAID adverse events, and the development of a 'register of registries and databases' and exploration of how linked health information systems in the UK could be improved.
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Affiliation(s)
- C Bartlett
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
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Moore THM, Bartlett C, Burke MA, Davey Smith G, Ebrahim SBJ. Statins for preventing cardiovascular disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear. OBJECTIVES To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials. SEARCH STRATEGY The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions. SELECTION CRITERIA Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available. DATA COLLECTION AND ANALYSIS Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed. MAIN RESULTS Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control. REVIEWER'S CONCLUSIONS Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.
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Affiliation(s)
- L Hooper
- MANDEC, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
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35
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Baker AM, Bartlett C, Bunn SE, Goudkamp K, Sheldon F, Hughes JM. Cryptic species and morphological plasticity in long-lived bivalves (Unionoida: Hyriidae) from inland Australia. Mol Ecol 2003; 12:2707-17. [PMID: 12969474 DOI: 10.1046/j.1365-294x.2003.01941.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Molecular (mitochondrial DNA, isozyme) and morphological diversity of freshwater mussels (Family Hyriidae) was examined at 21 sites encompassing four large river systems, across southwest Queensland, Australia. Evidence was found for two major morphological groups. One group, which occurred in every river system, closely matched a recognized species (Velesunio ambiguus) both morphologically and in a well-supported lineage within a mitochondrial phylogeny generated from partial cytochrome c oxidase subunit I (COI) sequences. The second group most closely matched Velesunio wilsonii in shell morphology but formed three deeply divergent mitochondrial DNA lineages. All four lineages occurred sympatrically in some areas and displayed corresponding fixed differences at nuclear allozyme loci, which suggests an absence of recent hybridization and the presence of separate species.
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Affiliation(s)
- Andrew M Baker
- Cooperative Research Centre for Freshwater Ecology, Australian School of Environmental Studies, Griffith University, Nathan, Queensland 4111, Australia.
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36
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Harman AM, Rodger J, Ahmat A, Thomas C, Bartlett C, Chen P, Dunlop SA, Beazley LD. PSA-NCAM is up-regulated during optic nerve regeneration in lizard but not in goldfish. Exp Neurol 2003; 182:180-5. [PMID: 12821388 DOI: 10.1016/s0014-4886(03)00081-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The addition of polysialic acid (PSA) to neural cell adhesion molecule (NCAM) facilitates axon growth. Here we use Western blots and immunohistochemistry to examine expression of PSA-NCAM during optic nerve regeneration. In lizard, retinal ganglion cell axons become transiently PSA-NCAM positive. By contrast, goldfish RGC axons are PSA-NCAM negative both in normal animals and throughout regeneration with the exception of a PSA-NCAM-positive fascicle arising from newly generated RGCs. Transient sialylation of NCAM in lizard may assist regeneration in the nonpermissive reptilian visual pathway and facilitate the reestablishment of a crude topographic map; down-regulation in the long term may contribute to the breakdown in topography. The lack of sialylation in goldfish presumably reflects the permissive nature of the substrate allowing axon regeneration and the successful reestablishment of a topographic map.
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Affiliation(s)
- A M Harman
- Department of Psychology, University of Western Australia, Nedlands, Western Australia, Australia
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Egger M, Juni P, Bartlett C, Holenstein F, Sterne J. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess 2003; 7:1-76. [PMID: 12583822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Affiliation(s)
- M Egger
- Department of Social and Preventive Medicine, University of Berne, Switzerland
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39
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Bartlett C, Davey P, Dieppe P, Doyal L, Ebrahim S, Egger M. Women, older persons, and ethnic minorities: factors associated with their inclusion in randomised trials of statins 1990 to 2001. Heart 2003; 89:327-8. [PMID: 12591845 PMCID: PMC1767569 DOI: 10.1136/heart.89.3.327] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2002] [Indexed: 11/03/2022] Open
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40
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Egger M, Jüni P, Bartlett C, Holenstein F, Sterne J. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess 2003. [DOI: 10.3310/hta7010] [Citation(s) in RCA: 746] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Egger
- Department of Social and Preventive Medicine, University of Berne, Switzerland
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
| | - P Jüni
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
- IDepartment of Rheumatology and Clinical Immunology, University of Berne, Switzerland
| | - C Bartlett
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
| | - F Holenstein
- Department of Social and Preventive Medicine, University of Berne, Switzerland
| | - J Sterne
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK
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Abstract
BACKGROUND Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear. OBJECTIVES To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials. SEARCH STRATEGY The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions. SELECTION CRITERIA Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available. DATA COLLECTION AND ANALYSIS Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed. MAIN RESULTS Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control. REVIEWER'S CONCLUSIONS Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.
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Affiliation(s)
- L Hooper
- MANDEC, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH
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Lyons RA, Jones S, Kemp A, Sibert J, Shepherd J, Richmond P, Bartlett C, Palmer SR. Development and use of a population based injury surveillance system: the all Wales Injury Surveillance System (AWISS). Inj Prev 2002; 8:83-6. [PMID: 11928983 PMCID: PMC1730805 DOI: 10.1136/ip.8.1.83] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives.
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Affiliation(s)
- R A Lyons
- Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Cardiff, UK
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Bartlett C. I reflect, therefore I am. Nurs Stand 2001; 16:22. [PMID: 11974845 DOI: 10.7748/ns.16.11.22.s39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Egger M, Bartlett C, Jüni P. Are randomised controlled trials in the BMJ different? BMJ 2001; 323:1253-4. [PMID: 11719424 PMCID: PMC1121711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Tallal P, Hirsch LS, Realpe-Bonilla T, Miller S, Brzustowicz LM, Bartlett C, Flax JF. Familial aggregation in specific language impairment. J Speech Lang Hear Res 2001; 44:1172-1182. [PMID: 11708534 DOI: 10.1044/1092-4388(2001/091)] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A case-control family study design, in which the current language-related abilities of all biological, primary relatives (mother, father, siblings) of probands with specific language impairment (SLI) and matched controls were assessed, was used to investigate familial aggregation for language disorders. Current test data from each family member showed the rate of language impairment for mothers, fathers, sisters, and brothers of the SLI probands to be significantly higher than for members of control families. Impairment rates for fathers and mothers were approximately equal, whereas rates for brothers were significantly higher than for sisters. In SLI proband families, Language Impairment (LI) occurred in 13.0% of offspring (excluding proband) with neither parent affected, 40% of offspring with one parent affected, and 71.4% of offspring in families in which both parents were language impaired. Rates of impairment as determined in current testing were compared directly to impairment rates estimated from family-history questionnaires collected from the same families. Group data showed impairment rates estimated from the family-history questionnaires to be similar to the rates based on actual testing. Furthermore, both appeared in line with rates based primarily on questionnaire data as reported previously in the literature. However, case-by-case analyses showed poor intrasubject agreement on classification as language impaired on the basis of current testing as compared to history information.
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Affiliation(s)
- P Tallal
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark 07102, USA.
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Kawahata N, Yang MG, Luke GP, Shakespeare WC, Sundaramoorthi R, Wang Y, Johnson D, Merry T, Violette S, Guan W, Bartlett C, Smith J, Hatada M, Lu X, Dalgarno DC, Eyermann CJ, Bohacek RS, Sawyer TK. A novel phosphotyrosine mimetic 4'-carboxymethyloxy-3'-phosphonophenylalanine (Cpp): exploitation in the design of nonpeptide inhibitors of pp60(Src) SH2 domain. Bioorg Med Chem Lett 2001; 11:2319-23. [PMID: 11527723 DOI: 10.1016/s0960-894x(01)00446-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The novel phosphotyrosine (pTyr) mimetic 4'-carboxymethyloxy-3'-phosphonophenylalanine (Cpp) has been designed and incorporated into a series of nonpeptide inhibitors of the SH2 domain of pp60(c-Src) (Src) tyrosine kinase. A 2.2 A X-ray crystal structure of 1a bound to a mutant form of Lck SH2 domain provides insight regarding the structure-activity relationships and supports the design concept of this new pTyr mimetic.
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Affiliation(s)
- N Kawahata
- ARIAD Pharmaceuticals, Inc., Cambridge, MA 02139-4234, USA
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Abstract
The European Best Practice Guidelines for the management of anemia in patients with chronic renal failure recommend the percentage of hypochromic red blood cells (%HRCs) as the best measure of iron use by erythropoietic tissues. They suggest that "sufficient iron should be administered to attain: serum ferritin 100 ng/mL, HRCs <10%. In practice, to achieve these minimum criteria will mean aiming for optimal levels of serum ferritin 200-500 ng/mL, HRCs <2.5%." We increased prospectively the delivered dose of iron supplements to a large (n = 228) unselected hemodialysis cohort with a sustained (24-month) hemoglobin (Hb) outcome meeting the UK Renal Association minimum standard of 85%, greater than or equal to 10.0 g/dL. This was managed through a computer-aided decision support system for erythropoietin (EPO) and intravenous iron sucrose therapy. Hb outcome was maintained with medians between 11.3 and 11.8 g/dL. Median red blood cell hypochromia (%HRCs) decreased from 8% (interquartile range [IQR], 3 to 15) to 4% (IQR, 2 to 8; P < 0.001, U-Mann Whitney test). Serum ferritin level increased from a median of 188 (IQR, 115 to 256) to 480 ng/mL (IQR, 397 to 595; P < 0.001, U-Mann Whitney test). Median EPO dose decreased from 136 (IQR, 83 to 216) to 72 IU/kg/wk (IQR, 33 to 134), which strongly correlated with median %HRCs through the range less than 10% (Spearman's correlation, 0.73; P < 0.01). These data suggest that EPO responsiveness continues to improve toward the normal range for %HRCs (<2.5%) and aspiring to values much less than 10% is cost-effective. The ferritin outcome required to achieve these lower values for %HRC outcome is greater than the current recommended range, although in steady state, the mean iron treatment dose is similar to that in previous studies (ie, approximately 60 mg/wk).
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Affiliation(s)
- D Richardson
- Department of Renal Medicine, St James's University Hospital, Leeds, UK. drichardson@ doctors.org.uk
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Bartlett C, Hooper L, Ebrahim S. Dietary sodium and blood pressure. N Engl J Med 2001; 344:1717-8; author reply 1718-9. [PMID: 11386275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
CONTEXT Diagrams of the flow of participants through a clinical trial are recommended in the Consolidated Standards for Reporting of Trials (CONSORT) statement, but it is unclear whether such flow diagrams improve the quality of trial reports. OBJECTIVE To examine the information contributed by flow diagrams and the completeness of reporting overall in reports of randomized controlled trials (RCTs) published in 5 general and internal medicine journals. DESIGN AND SETTING Analysis of 270 reports of RCTs published in 1998 in the Annals of Internal Medicine (AIM; n = 19), BMJ (n = 42), JAMA (n = 45), The Lancet (n = 81), and The New England Journal of Medicine (NEJM; n = 83). MAIN OUTCOME MEASURES Proportion of reports that included a flow diagram, information provided in flow diagrams, and completeness of reporting about flow of participants overall in flow diagrams or text. RESULTS A total of 139 reports (51.5%) of RCTs included a flow diagram, but this varied widely among journals (AIM, 21.0%; BMJ, 38.1%; JAMA, 80.0%; The Lancet, 93.8%; and NEJM, 8.4%). Diagrams generally provided useful information, but only 73 (52.5%) included the number of participants who received allocated interventions and only 32 (23.0%) included the number of participants included in the analysis. In logistic regression analysis, overall completeness of reporting about flow of study participants was associated with publication of a flow diagram. CONCLUSIONS Flow diagrams are associated with improved quality of reporting of randomized controlled trials. However, the structure of current flow diagrams is less than ideal. We propose a revised flow diagram that includes all important counts through the stages of parallel group trials.
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Affiliation(s)
- M Egger
- Medical Research Council Health Services Research Collaboration, Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, England.
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