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Cullen LA, Grange Z, Antal K, Waugh L, Alsina MS, Gibbons CL, MacDonald LE, Robertson C, Cameron JC, Stockton D, O'Leary MC. COVID-19 vaccine safety in Scotland - background rates of adverse events of special interest. Public Health 2023; 224:1-7. [PMID: 37688806 DOI: 10.1016/j.puhe.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES Mass COVID-19 vaccination commenced in December 2020 in Scotland. Monitoring vaccine safety relies on accurate background incidence rates (IRs) for health outcomes potentially associated with vaccination. This study aimed to quantify IRs in Scotland of adverse events of special interest (AESI) potentially associated with COVID-19 vaccination. STUDY DESIGN AND METHODS IRs and 95% confidence intervals (CIs) for 36 AESI were calculated retrospectively for the pre-COVID-19 pandemic period (01 January 2015-31 December 2019) and the COVID-19 pandemic period (01 April 2020-30 November 2020), with age-sex stratification, and separately by calendar month and year. Incident cases were determined using International Classification of Diseases-10th Revision (ICD-10)-coded hospitalisations. RESULTS Prepandemic population-wide IRs ranged from 0.4 (0.3-0.5 CIs) cases per 100,000 person-years (PYRS) for neuromyelitis optica to 478.4 (475.8-481.0 CIs) cases per 100,000 PYRS for acute renal failure. Pandemic population-wide IRs ranged from 0.3 (0.2-0.5 CIs) cases per 100,000 PYRS for Kawasaki disease to 483.4 (473.2-493.7 CIs) cases per 100,000 PYRS for acute coronary syndrome. All AESI IRs varied by age and sex. Ten AESI (acute coronary syndrome, acute myocardial infarction, angina pectoris, heart failure, multiple sclerosis, polyneuropathies and peripheral neuropathies, respiratory failure, rheumatoid arthritis and polyarthritis, seizures and vasculitis) had lower pandemic than prepandemic period IRs overall. Only deep vein thrombosis and pulmonary embolism had a higher pandemic IR. CONCLUSION Lower pandemic IRs likely resulted from reduced health-seeking behaviours and healthcare provision. Higher IRs may be associated with SARS-CoV-2 infections. AESI IRs will facilitate future vaccine safety studies in Scotland.
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Affiliation(s)
- L A Cullen
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - Z Grange
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - K Antal
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - L Waugh
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M S Alsina
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - C L Gibbons
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | | | - C Robertson
- University of Strathclyde and Public Health Scotland, Glasgow, UK.
| | - J C Cameron
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - D Stockton
- Public Health Scotland, Glasgow, Edinburgh, UK.
| | - M C O'Leary
- Public Health Scotland, Glasgow, Edinburgh, UK.
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van Dongen J, Prokhorov L, Cooper SJ, Barton MA, Bonilla E, Dooley KL, Driggers JC, Effler A, Holland NA, Huddart A, Kasprzack M, Kissel JS, Lantz B, Mitchell AL, O'Dell J, Pele A, Robertson C, Mow-Lowry CM. Publisher's Note: "Reducing control noise in gravitational wave detectors with interferometric local damping of suspended optics" [Rev. Sci. Instrum. 94, 054501 (2023)]. Rev Sci Instrum 2023; 94:069901. [PMID: 37862549 DOI: 10.1063/5.0159530] [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] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 10/22/2023]
Affiliation(s)
- J van Dongen
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - L Prokhorov
- School of Physics and Astronomy and Institute for Gravitational Wave Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - S J Cooper
- School of Physics and Astronomy and Institute for Gravitational Wave Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - M A Barton
- Institute for Gravitational Research, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - E Bonilla
- Stanford University, Stanford, California 94305, USA
| | - K L Dooley
- Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - J C Driggers
- LIGO Hanford Observatory, Richland, Washington 99352, USA
| | - A Effler
- LIGO Livingston Observatory, Livingston, Louisiana 70754, USA
| | - N A Holland
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - A Huddart
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - M Kasprzack
- LIGO, California Institute of Technology, Pasadena, California 91125, USA
| | - J S Kissel
- LIGO Hanford Observatory, Richland, Washington 99352, USA
| | - B Lantz
- Stanford University, Stanford, California 94305, USA
| | - A L Mitchell
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - J O'Dell
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - A Pele
- LIGO, California Institute of Technology, Pasadena, California 91125, USA
| | - C Robertson
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - C M Mow-Lowry
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, The Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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van Dongen J, Prokhorov L, Cooper SJ, Barton MA, Bonilla E, Dooley KL, Driggers JC, Effler A, Holland NA, Huddart A, Kasprzack M, Kissel JS, Lantz B, Mitchell AL, O'Dell J, Pele A, Robertson C, Mow-Lowry CM. Reducing control noise in gravitational wave detectors with interferometric local damping of suspended optics. Rev Sci Instrum 2023; 94:054501. [PMID: 37191465 DOI: 10.1063/5.0144865] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Abstract
Control noise is a limiting factor in the low-frequency performance of the Advanced Laser Interferometer Gravitational-Wave Observatory (LIGO). In this paper, we model the effects of using new sensors called Homodyne Quadrature Interferometers (HoQIs) to control the suspension resonances. We show that if we were to use HoQIs, instead of the standard shadow sensors, we could suppress resonance peaks up to tenfold more while simultaneously reducing the noise injected by the damping system. Through a cascade of effects, this will reduce the resonant cross-coupling of the suspensions, allow for improved stability for feed-forward control, and result in improved sensitivity of the detectors in the 10-20 Hz band. This analysis shows that improved local sensors, such as HoQIs, should be used in current and future detectors to improve low-frequency performance.
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Affiliation(s)
- J van Dongen
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
| | - L Prokhorov
- School of Physics and Astronomy and Institute for Gravitational Wave Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - S J Cooper
- School of Physics and Astronomy and Institute for Gravitational Wave Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - M A Barton
- Institute for Gravitational Research, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - E Bonilla
- Stanford University, Stanford, California 94305, USA
| | - K L Dooley
- Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - J C Driggers
- LIGO Hanford Observatory, Richland, Washington 99352, USA
| | - A Effler
- LIGO Livingston Observatory, Livingston, Louisiana 70754, USA
| | - N A Holland
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
| | - A Huddart
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - M Kasprzack
- LIGO, California Institute of Technology, Pasadena, California 91125, USA
| | - J S Kissel
- LIGO Hanford Observatory, Richland, Washington 99352, USA
| | - B Lantz
- Stanford University, Stanford, California 94305, USA
| | - A L Mitchell
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
| | - J O'Dell
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - A Pele
- LIGO, California Institute of Technology, Pasadena, California 91125, USA
| | - C Robertson
- STFC Rutherford Appleton Laboratory, Chilton, Didcot OX11 OQX, United Kingdom
| | - C M Mow-Lowry
- Dutch National Institute for Subatomic Physics, Nikhef, 1098 XG Amsterdam, Netherlands
- Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
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Robertson C, Shaikh S, Hudson J, Roberts PG, Beard D, Mackie T, Matthew C, Ramsay C, Gillies K, Campbell M. The RoboCOS Study: Development of an international core outcome set for the comprehensive evaluation of patient, surgeon, organisational and population level impacts of robotic assisted surgery. PLoS One 2023; 18:e0283000. [PMID: 36996257 PMCID: PMC10062593 DOI: 10.1371/journal.pone.0283000] [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] [Received: 03/29/2022] [Accepted: 02/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The introduction of robot-assisted surgery is costly and requires whole system transformation, which makes the assessment of benefits (or drawbacks) complex. To date, there has been little agreement on which outcomes should be used in this regard. The aim of the RoboCOS study was to develop a core outcome set for the evaluation of robot-assisted surgery that would account for its impact on the whole system. METHODS Identification of a long-list of potentially relevant outcomes through systematic review of trials and health technology assessments; interviews with individuals from a range of stakeholder groups (surgeons, service managers, policy makers and evaluators) and a focus group with patients and public; prioritisation of outcomes via a 2-round online international Delphi survey; consensus meeting. RESULTS 721 outcomes were extracted from the systematic reviews, interviews and focus group which were conceptualised into 83 different outcome domains across four distinct levels (patient, surgeon, organisation and population) for inclusion in the international Delphi prioritisation survey (128 completed both rounds). The consensus meeting led to the agreement of a 10-item core outcome set including outcomes at: patient level (treatment effectiveness; overall quality of life; disease-specific quality of life; complications (including mortality); surgeon level (precision/accuracy; visualisation); organisation (equipment failure; standardisation of operative quality; cost-effectiveness); and population (equity of access). CONCLUSION The RoboCOS core outcome set, which includes the outcomes of importance to all stakeholders, is recommended for use in all future evaluations of robot-assisted surgery to ensure relevant and comparable reporting of outcomes.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Shafaque Shaikh
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics, Surgical Interventions Trials Unit, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Surgical Interventions Trials Unit, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Cameron Matthew
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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Robertson C, Johnson N, Bird R, Key J. Using Early Exam Results to Predict Online MLS Program Success. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.255] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
The objective of this effort is to demonstrate the impact of early didactic exam results for potential early intervention for students in an online medical laboratory science bridge program.
Methods/Case Report
For this study, we took retrospective data of 299 students from 2018 to 2021 who took MLSC 4312, Hematology, in their first semester. We then analyzed their first exam score and then used this data to evaluate its potential use as an early predictor of overall student success in both this course and the program. Specifically, the exam one score in the course was used to evaluate progression to the second semester, graduation, UAMS GPA, and ASCP Board of Certification total score and Hematology sub-score. Descriptive statistics and 2-sample T-tests were calculated using Number Cruncher Statistical System. Fisher’s exact test was performed using Graphpad software.
Results (if a Case Study enter NA)
Of the 296 students whose records were examined, 49 scored below a 76% on Hematology exam 1. 247 students scored above 75%.35 students who scored below 76% progressed to the second semester and of those, 33 (94.2%) graduated on time. 14 students were dismissed from the program after the first semester. The overall graduation rate of students who started the program and scored less than 76% on the first hematology exam was 67%. Of the 247 students who scored above 76% on exam 1, 229 (93%) progressed to the second semester and of those, 214 graduated on time (93.4%). 18 of these students were dismissed from the program. The overall graduation rate of students who started the program and scored greater than 76% on the first hematology exam was 86.70%. The overall ASCP Board of Certification pass rate was almost 19 percent higher, 81.7% vs. 62.9% in those who scored greater than 76% on the first hematology exam. Each of the comparisons was statistically significant (P=<0.05) using a 2-sample T-test or Fisher’s exact test as appropriate.
Conclusion
This study revealed the importance of doing well on the first major didactic exam in the Medical Laboratory Sciences program. Students who score < 76% on their first exam fail to progress to the second semester at four times the rate of those who score >76%. In addition, those who score <76% and progress fail the ASCP Board of Certification Exam at almost double the rate of those who score >76% on the first hematology exam. In the future, we will reach out earlier and offer targeted help to these students.
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Affiliation(s)
- C Robertson
- Medical Laboratory Sciences Program, University of Arkansas for Medical Sciences , Little Rock, Arkansas , United States
| | - N Johnson
- Medical Laboratory Sciences Program, University of Arkansas for Medical Sciences , Little Rock, Arkansas , United States
| | - R Bird
- Medical Laboratory Sciences Program, University of Arkansas for Medical Sciences , Little Rock, Arkansas , United States
| | - J Key
- Medical Laboratory Sciences Program, University of Arkansas for Medical Sciences , Little Rock, Arkansas , United States
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Chen Y, Tiddens H, Byrnes C, Carlin J, Cheney J, Cooper P, Grimwood K, Kemner-van de Corput M, Massie J, Robertson C, Sly P, Vidmar S, Wainwright C. 183 Chest computed tomography assessment to monitor cystic fibrosis structural lung disease progression in bronchiectasis during late childhood and adolescence. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00873-6] [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: 11/06/2022]
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7
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Robertson C, Mortimer A. Quantitative EEG (qEEG) guided transcranial magnetic stimulation (TMS) treatment for depression and anxiety disorders: An open, observational cohort study of 210 patients. J Affect Disord 2022; 308:322-327. [PMID: 35439465 DOI: 10.1016/j.jad.2022.04.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/17/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Major depression and anxiety disorders represent a substantial burden of morbidity. Neither antidepressant medication nor psychological interventions are fully effective, the former beset with side effects, interactions and compliance issues, and the latter requiring patient engagement, effort and a degree of psychological mindedness. Both treatments are lengthy. TMS by contrast is virtually free of side effects and compliance issues, relatively brief, and requires no patient effort. Nevertheless, remission rates are only about 1 in 3 with standard left frontal rapid (rTMS) stimulation, and up to 30 treatment sessions may be required. Our aim was to improve the effectiveness of TMS treatment using bespoke as opposed to standard left frontal rTMS, including theta burst stimulation (TBS). METHODS 210 male and female patients were treated: regions and frequencies of TMS were guided by quantitative EEG analysis (qEEG) to elicit recognisable phenotypes, neuromarkers integral to the genesis of major depression and anxiety disorder, dictating treatment parameters. RESULTS 98 patients (47%) achieved at least 50% reduction in Hamilton depression rating scale scores, while a further 60 (29%) patients achieved a 30-50% reduction, over a mean of 7.03 ± 0.3 treatment sessions. Theta burst stimulation (TBS) almost halved treatment time within session compared to rTMS. The effect size (Cohen's d) for both treatments was large (>0.8) with rTMS at 1.43 (1.16-1.70) and TBS at 1.87 (1.48-2.25). CONCLUSIONS qEEG guided TMS treatment is a safe and effective treatment in depression and anxiety disorders.
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Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Gregory L, Garikipati S, Thornton J, Tahir B, White S, Foran B, Robertson C. The length of time taken from gastrostomy tube insertion to removal and the factors influencing this following curative head and neck cancer treatment: a service evaluation at a single tertiary oncology centre. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.02.027] [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: 10/18/2022]
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Bradley DT, Murphy S, McWilliams P, Arnold S, Lavery S, Murphy J, de Lusignan S, Hobbs R, Tsang RSM, Akbari A, Torabi F, Beggs J, Chuter A, Shi T, Vasileiou E, Robertson C, Sheikh A, Reid H, O'Reilly D. Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration. Public Health 2022; 203:110-115. [PMID: 35038629 PMCID: PMC8683272 DOI: 10.1016/j.puhe.2021.12.010] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN We undertook an ecological study using routinely available national data. METHODS We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.
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Affiliation(s)
- D T Bradley
- Public Health Agency, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - S Murphy
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - S Arnold
- Public Health Agency, Belfast, UK
| | - S Lavery
- Public Health Agency, Belfast, UK
| | - J Murphy
- Public Health Agency, Belfast, UK
| | - S de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R Hobbs
- Nuffield Department of Health Care Sciences, University of Oxford, Oxford, UK
| | - R S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - F Torabi
- Population Data Science, Swansea University Medical School, UK
| | - J Beggs
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - A Chuter
- BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - T Shi
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Vasileiou
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Robertson
- Public Health Scotland, UK; University of Strathclyde, Glasgow, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK; BREATHE- The Health Data Research Hub For Respiratory Health, UK
| | - H Reid
- Public Health Agency, Belfast, UK
| | - D O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Brazzelli M, Aucott L, Aceves-Martins M, Robertson C, Jacobsen E, Imamura M, Poobalan A, Manson P, Scotland G, Kaye C, Sawhney S, Boyers D. Biomarkers for assessing acute kidney injury for people who are being considered for admission to critical care: a systematic review and cost-effectiveness analysis. Health Technol Assess 2022; 26:1-286. [PMID: 35115079 PMCID: PMC8859769 DOI: 10.3310/ugez4120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Acute kidney injury is a serious complication that occurs in the context of an acute critical illness or during a postoperative period. Earlier detection of acute kidney injury may facilitate strategies to preserve renal function, prevent further disease progression and reduce mortality. Acute kidney injury diagnosis relies on a rise in serum creatinine levels and/or fall in urine output; however, creatinine is an imperfect marker of kidney function. There is interest in the performance of novel biomarkers used in conjunction with existing clinical assessment, such as NephroCheck® (Astute Medical, Inc., San Diego, CA, USA), ARCHITECT® urine neutrophil gelatinase-associated lipocalin (NGAL) (Abbott Laboratories, Abbott Park, IL, USA), and urine and plasma BioPorto NGAL (BioPorto Diagnostics A/S, Hellerup, Denmark) immunoassays. If reliable, these biomarkers may enable earlier identification of acute kidney injury and enhance management of those with a modifiable disease course. OBJECTIVE The objective was to evaluate the role of biomarkers for assessing acute kidney injury in critically ill patients who are considered for admission to critical care. DATA SOURCES Major electronic databases, conference abstracts and ongoing studies were searched up to June 2019, with no date restrictions. MEDLINE, EMBASE, Health Technology Assessment Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, World Health Organization Global Index Medicus, EU Clinical Trials Register, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched. REVIEW METHODS A systematic review and meta-analysis were conducted to evaluate the performance of novel biomarkers for the detection of acute kidney injury and prediction of other relevant clinical outcomes. Random-effects models were adopted to combine evidence. A decision tree was developed to evaluate costs and quality-adjusted life-years accrued as a result of changes in short-term outcomes (up to 90 days), and a Markov model was used to extrapolate results over a lifetime time horizon. RESULTS A total of 56 studies (17,967 participants), mainly prospective cohort studies, were selected for inclusion. No studies addressing the clinical impact of the use of biomarkers on patient outcomes, compared with standard care, were identified. The main sources of bias across studies were a lack of information on blinding and the optimal threshold for NGAL. For prediction studies, the reporting of statistical details was limited. Although the meta-analyses results showed the potential ability of these biomarkers to detect and predict acute kidney injury, there were limited data to establish any causal link with longer-term health outcomes and there were considerable clinical differences across studies. Cost-effectiveness results were highly uncertain, largely speculative and should be interpreted with caution in the light of the limited evidence base. To illustrate the current uncertainty, 15 scenario analyses were undertaken. Incremental quality-adjusted life-years were very low across all scenarios, ranging from positive to negative increments. Incremental costs were also small, in general, with some scenarios generating cost savings with tests dominant over standard care (cost savings with quality-adjusted life-year gains). However, other scenarios generated results whereby the candidate tests were more costly with fewer quality-adjusted life-years, and were thus dominated by standard care. Therefore, it was not possible to determine a plausible base-case incremental cost-effectiveness ratio for the tests, compared with standard care. LIMITATIONS Clinical effectiveness and cost-effectiveness results were hampered by the considerable heterogeneity across identified studies. Economic model predictions should also be interpreted cautiously because of the unknown impact of NGAL-guided treatment, and uncertain causal links between changes in acute kidney injury status and changes in health outcomes. CONCLUSIONS Current evidence is insufficient to make a full appraisal of the role and economic value of these biomarkers and to determine whether or not they provide cost-effective improvements in the clinical outcomes of acute kidney injury patients. FUTURE WORK Future studies should evaluate the targeted use of biomarkers among specific patient populations and the clinical impact of their routine use on patient outcomes and management. STUDY REGISTRATION This study is registered as PROSPERO CRD42019147039. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Callum Kaye
- Anaesthetics and Intensive Care Medicine, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Simon Sawhney
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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12
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Malerba L, Caturla M, Gaganidze E, Kaden C, Konstantinović M, Olsson P, Robertson C, Rodney D, Ruiz-Moreno A, Serrano M, Aktaa J, Anento N, Austin S, Bakaev A, Balbuena J, Bergner F, Boioli F, Boleininger M, Bonny G, Castin N, Chapman J, Chekhonin P, Clozel M, Devincre B, Dupuy L, Diego G, Dudarev S, Fu CC, Gatti R, Gélébart L, Gómez-Ferrer B, Gonçalves D, Guerrero C, Gueye P, Hähner P, Hannula S, Hayat Q, Hernández-Mayoral M, Jagielski J, Jennett N, Jiménez F, Kapoor G, Kraych A, Khvan T, Kurpaska L, Kuronen A, Kvashin N, Libera O, Ma PW, Manninen T, Marinica MC, Merino S, Meslin E, Mompiou F, Mota F, Namburi H, Ortiz C, Pareige C, Prester M, Rajakrishnan R, Sauzay M, Serra A, Simonovski I, Soisson F, Spätig P, Tanguy D, Terentyev D, Trebala M, Trochet M, Ulbricht A, M.Vallet, Vogel K, Yalcinkaya T, Zhao J. Multiscale modelling for fusion and fission materials: The M4F project. Nuclear Materials and Energy 2021. [DOI: 10.1016/j.nme.2021.101051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Jacobsen E, Sawhney S, Brazzelli M, Aucott L, Scotland G, Aceves-Martins M, Robertson C, Imamura M, Poobalan A, Manson P, Kaye C, Boyers D. Cost-effectiveness and value of information analysis of NephroCheck and NGAL tests compared to standard care for the diagnosis of acute kidney injury. BMC Nephrol 2021; 22:399. [PMID: 34852765 PMCID: PMC8638090 DOI: 10.1186/s12882-021-02610-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compared with standard care to detect AKI in hospitalised UK adults. METHODS A 90-day decision tree and lifetime Markov cohort model predicted costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from a UK NHS perspective. Test accuracy was informed by a meta-analysis of diagnostic accuracy studies. Clinical trial and observational data informed the link between AKI and health outcomes, health state probabilities, costs and utilities. Value of information (VOI) analysis informed future research priorities. RESULTS Under base case assumptions, the biomarker tests were not cost-effective with ICERs of £105,965 (NephroCheck), £539,041 (NGAL urine BioPorto), £633,846 (NGAL plasma BioPorto) and £725,061 (NGAL urine ARCHITECT) per QALY gained compared to standard care. Results were uncertain, due to limited trial data, with probabilities of cost-effectiveness at £20,000 per QALY ranging from 0 to 99% and 0 to 56% for NephroCheck and NGAL tests respectively. The expected value of perfect information (EVPI) was £66 M, which demonstrated that additional research to resolve decision uncertainty is worthwhile. CONCLUSIONS Current evidence is inadequate to support the cost-effectiveness of general use of biomarker tests. Future research evaluating the clinical and cost-effectiveness of test guided implementation of protective care bundles is necessary. Improving the evidence base around the impact of tests on AKI staging, and of AKI staging on clinical outcomes would have the greatest impact on reducing decision uncertainty.
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Affiliation(s)
- Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Callum Kaye
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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14
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Robertson C, Al-Moasseb Z, Noonan Z, Boyle JG. The 3-D Skills Model: a Randomised Controlled Pilot Study Comparing a Novel 1-1 Near-Peer Teaching Model to a Formative OSCE with Self-regulated Practice. Med Sci Educ 2021; 31:1789-1801. [PMID: 34950527 PMCID: PMC8651955 DOI: 10.1007/s40670-021-01369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Near-peer teaching is a popular pedagogical teaching tool, with well-recognised benefits for students and tutors. There are multiple existing models to structure these interventions, but it is often unclear how they translate to academic attainment. We designed a novel near-peer teaching model that expands on previous research. METHODS Our model was piloted in a formative Objective Structured Clinical Examination (OSCE) setting, trialled on 22 pre-clinical medical students to establish feasibility, acceptability and descriptive outcomes that could inform the design of a larger study. Students were randomly assigned to intervention or control cohorts. Each cohort undertook 5 min formative OSCE assessments with either 3 additional minutes of structured teaching or 3 min of self-regulated practice before reattempting the first OSCE station. Checklist marking sheets for 1st and 2nd sittings were collected by independent external markers, in addition to a global assessment rating in which we used the Borderline Regression Method to establish the station pass mark. RESULTS A quantitative and qualitative result analysis was performed, demonstrating that students gained on average 3 additional marks after teaching with this model. Students and student-tutors reported increased confidence, high course satisfaction and evidence of reflective practice. DISCUSSION We established acceptability and feasibility outcomes. The descriptive outcomes will support the design of a larger, adequately powered study required to demonstrate translation to summative exam performance. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01369-w.
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Affiliation(s)
- C. Robertson
- NHS Greater Glasgow and Clyde, Glasgow, Scotland
- Undergraduate Medical School, The University of Glasgow, Glasgow, Scotland
- Anaesthetics Department, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF Scotland
| | - Z. Al-Moasseb
- NHS Greater Glasgow and Clyde, Glasgow, Scotland
- Undergraduate Medical School, The University of Glasgow, Glasgow, Scotland
| | - Z. Noonan
- Undergraduate Medical School, The University of Glasgow, Glasgow, Scotland
| | - J. G. Boyle
- Undergraduate Medical School, The University of Glasgow, Glasgow, Scotland
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland
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15
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Chantreau Majerus R, Robertson C, Habershon S. Assessing and rationalizing the performance of Hessian update schemes for reaction path Hamiltonian rate calculations. J Chem Phys 2021; 155:204112. [PMID: 34852478 DOI: 10.1063/5.0064685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The reaction path Hamiltonian (RPH) can be used to calculate chemical reaction rate constants, going beyond transition-state theory in taking account of recrossing by providing an approximation to the dynamic transmission coefficient. However, the RPH necessitates the calculation of the Hessian matrix at a number of points along the minimum energy path; the associated computational cost stands as a bottleneck in RPH calculations, especially if one is interested in using high-accuracy electronic structure methods. In this work, four different Hessian update schemes (symmetric rank-1, Powell-symmetric Broyden, Bofill, and TS-BFGS updates) are assessed to see whether or not they reliably reproduce calculated transmission coefficients for three different chemical reactions. Based on the reactions investigated, the symmetric rank-1 Hessian update was the least appropriate for RPH construction, giving different transmission coefficients from the standard analytical Hessian approach, as well as inconsistent frequencies and coupling properties. The Bofill scheme, the Powell-symmetric Broyden scheme, and the TS-BFGS scheme were the most reliable Hessian update methods, with transmission coefficients that were in good agreement with those calculated by the standard RPH calculations. The relative accuracy of the different Hessian update schemes is further rationalized by investigating the approximated Coriolis and curvature coupling terms along the reaction-path, providing insight into when these schemes would be expected to work well. Furthermore, the associated computational cost associated with the RPH calculations was substantially reduced by the tested update schemes. Together, these results provide useful rules-of-thumb for using Hessian update schemes in RPH simulations.
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Affiliation(s)
- R Chantreau Majerus
- Molecular Analytical Science Centre for Doctoral Training, Senate House, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - C Robertson
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - S Habershon
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
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16
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O’Connor J, Wagner B, Harris J, Robertson C, Laguna T. 452: Contribution of fungus to the airway microbiome in children with and without cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01876-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Singh K, Robertson C, Bhaduri A. Irradiation in BCC materials: Defect-induced changes of the effective dislocation mobility and their relation with the dose-dependent fracture response. Progress in Nuclear Energy 2021. [DOI: 10.1016/j.pnucene.2021.103926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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McAuley A, Gousias P, Hasan T, Rashid L, Richardson C, Reid G, Templeton K, McGuire J, Wise H, McVicar L, Jenks S, Gunn R, Dickson E, Stock SJ, Stockton A, Waugh C, Wood R, McMenamin J, Robertson C, Goldberg DJ, Palmateer NE. National population prevalence of antibodies to SARS-CoV-2 among pregnant women in Scotland during the second wave of the COVID-19 pandemic: a prospective national serosurvey. Public Health 2021; 199:17-19. [PMID: 34517289 PMCID: PMC8364809 DOI: 10.1016/j.puhe.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to determine SARS-CoV-2 seroprevalence among pregnant women in the Scottish population during the second wave of the COVID-19 pandemic. STUDY DESIGN Prospective national serosurvey. METHODS We tested 13,428 residual samples retrieved from pregnant women participating in the first trimester combined ultrasound and biochemical screening for fetal trisomy across Scotland for SARS-CoV-2 antibodies over a 6-month period from November 2020 to April 2021. Seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. RESULTS Seroprevalence rates in the antenatal samples significantly increased from 5.5% (95% confidence interval [CI] 4.7%-6.5%) in the 5-week period up to and including International Organization for Standardization (ISO) Week 51 (w/b Monday 14 December 2020) to 11.3% (95% CI 10.1%-12.6%) in the 5-week period up to and including ISO Week 14 (w/b Monday 5 April 2021). Increasing seroprevalence trends across the second wave were observed among all age groups. CONCLUSIONS By the end of the second wave of the COVID-19 pandemic, approximately one in 10 women tested around the end of the first trimester of pregnancy had antibodies to SARS-CoV-2, suggesting that the vast majority were still susceptible to COVID-19 as they progressed to the later stages of pregnancy, when risks from infection are elevated for both mother and baby.
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Affiliation(s)
- A McAuley
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - P Gousias
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - T Hasan
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - L Rashid
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - C Richardson
- University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - G Reid
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - K Templeton
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - J McGuire
- University Hospital Monklands, NHS Lanarkshire, Airdrie, UK
| | - H Wise
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - L McVicar
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - S Jenks
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - R Gunn
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - E Dickson
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - S J Stock
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - A Stockton
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - C Waugh
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - R Wood
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - J McMenamin
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
| | - C Robertson
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D J Goldberg
- Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - N E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical&Protecting Health Division, Public Health Scotland, Glasgow, UK
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19
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Boyers D, Retat L, Jacobsen E, Avenell A, Aveyard P, Corbould E, Jaccard A, Cooper D, Robertson C, Aceves-Martins M, Xu B, Skea Z, de Bruin M. Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. Int J Obes (Lond) 2021; 45:2179-2190. [PMID: 34088970 PMCID: PMC8455321 DOI: 10.1038/s41366-021-00849-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases. METHODS An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results. RESULTS RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption. CONCLUSIONS RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.
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Affiliation(s)
- D Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
| | | | - E Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - A Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
- NIHR Oxford Biomedical Research Centre (BRC) Obesity, Diet and Lifestyle Theme, Oxford, UK
- NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, Oxford, UK
| | | | | | - D Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M Aceves-Martins
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - B Xu
- UK Health Forum, London, UK
| | - Z Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M de Bruin
- Health Psychology, University of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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20
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Khoury M, Hajihosseini M, Joffe A, Bond G, Dinu I, Makarchuk S, Robertson C, Atallah J. EVALUATING THE PREVALENCE AND FACTORS ASSOCIATED WITH AN OPTIMAL NEURODEVELOPMENTAL OUTCOME IN CHILDREN WITH FONTAN CIRCULATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.062] [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] Open
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21
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Stewart S, Robertson C, Pan J, Kennedy S, Haahr L, Manoukian S, Mason H, Kavanagh K, Graves N, Dancer SJ, Cook B, Reilly J. Impact of healthcare-associated infection on length of stay. J Hosp Infect 2021; 114:23-31. [PMID: 34301393 DOI: 10.1016/j.jhin.2021.02.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increased length of stay (LOS) for patients is an important measure of the burden of healthcare-associated infection (HAI). AIM To estimate the excess LOS attributable to HAI. METHODS This was a one-year prospective incidence study of HAI observed in one teaching hospital and one general hospital in NHS Scotland as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. All adult inpatients with an overnight stay were included. HAI was diagnosed using European Centres for Disease Prevention and Control definitions. A multi-state model was used to account for the time-varying nature of HAI and the competing risks of death and discharge. FINDINGS The excess LOS attributable to HAI was 7.8 days (95% confidence interval (CI): 5.7-9.9). Median LOS for HAI patients was 30 days and for non-HAI patients was 3 days. Using a simple comparison of duration of hospital stay for HAI cases and non-cases would overestimate the excess LOS by 3.5 times (27 days compared with 7.8 days). The greatest impact on LOS was due to pneumonia (16.3 days; 95% CI: 7.5-25.2), bloodstream infections (11.4 days; 5.8-17.0) and surgical site infection (SSI) (9.8 days; 4.5-15.0). It is estimated that 58,000 bed-days are occupied due to HAI annually. CONCLUSION A reduction of 10% in HAI incidence could make 5800 bed-days available. These could be used to treat 1706 elective patients in Scotland annually and help reduce the number of patients awaiting planned treatment. This study has important implications for investment decisions in infection prevention and control interventions locally, nationally, and internationally.
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Affiliation(s)
- S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- HPS Stats Support, Public Health Scotland, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - N Graves
- Duke-NUS Medical School, Singapore
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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22
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Manoukian S, Stewart S, Graves N, Mason H, Robertson C, Kennedy S, Pan J, Kavanagh K, Haahr L, Adil M, Dancer SJ, Cook B, Reilly J. Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK. J Hosp Infect 2021; 114:43-50. [PMID: 34301395 DOI: 10.1016/j.jhin.2020.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Healthcare-associated infection (HAI) is associated with increased morbidity and mortality resulting in excess costs. AIM To investigate the impact of all types of HAI on the inpatient cost of HAI using different approaches. METHODS The incidence, types of HAI, and excess length of stay were estimated using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. Scottish NHS reference costs were used to estimate unit costs for bed-days. Variable (cash) costs associated with infection prevention and control (IPC) measures and treatment were calculated for each HAI type and overall. The inpatient cost of HAI is presented in terms of bed-days lost, bed-day costs, and cash costs. FINDINGS In Scotland 58,010 (95% confidence interval: 41,730-74,840) bed-days were estimated to be lost to HAI during 2018/19, costing £46.4 million (19m-129m). The total annual cost in the UK is estimated to be £774 million (328m-2,192m). Bloodstream infection and pneumonia were the most costly HAI types per case. Cash costs are a small proportion of the total cost of HAI, contributing 2.4% of total costs. CONCLUSION Reliable estimates of the cost burden of HAI management are important for assessing the cost-effectiveness of IPC programmes. This unique study presents robust economic data, demonstrating that HAI remains a burden to the UK NHS and bed-days capture the majority of inpatient costs. These findings can be used to inform the economic evaluation and decision analytic modelling of competing IPC programmes at local and national level.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - N Graves
- Duke-NUS Medical School, Singapore
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- HPS Stats Support, Public Health Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - M Adil
- Public Health Scotland, Edinburgh, UK
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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23
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Stewart S, Robertson C, Pan J, Kennedy S, Dancer S, Haahr L, Manoukian S, Mason H, Kavanagh K, Cook B, Reilly J. Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: considerations for infection prevention and control planning. J Hosp Infect 2021; 114:10-22. [PMID: 34301392 DOI: 10.1016/j.jhin.2021.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The measure of disease frequency most widely used to report healthcare-associated infection (HAI) is the point-prevalence survey. Incidence studies are rarely performed due to time and cost constraints; they show which patients are affected by HAI, when and where, and inform planning and design of infection prevention and control (IPC) measures. AIM To determine the epidemiology of HAI within a general and a teaching hospital in Scotland. METHODS A prospective observational incidence study was undertaken for one year from April 2018 using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. A novel, robust approach was undertaken, using record linkage to national administrative data to provide full admission and discharge information. Cases were recorded if they met international HAI definitions. FINDINGS Incidence of HAI for the combined hospitals was 250 HAI cases per 100,000 acute occupied bed-days (AOBD). Highest frequency was in urinary tract (51.2 per 100,000 AOBD), bloodstream (44.7), and lower respiratory tract infection (42.2). The most frequently reported organisms were Escherichia coli, Staphylococcus aureus, and norovirus. Incidence of HAI was higher in older people and emergency cases. There was an increase in the rate of HAI in summer months (pneumonia, respiratory, surgical, and gastrointestinal infection) and in winter months norovirus gastrointestinal infection (P < 0.0001). The highest incidence specialties were intensive care, renal medicine, and cardiothoracic surgery. HAI occurred at a median of 9 days (interquartile range: 4-19) after admission. Incidence data were extrapolated to provide an annual national estimate of HAI in NHS Scotland of 7437 (95% confidence interval: 7021-7849) cases. CONCLUSION This study provides a unique overview of incidence of HAI and identifies the burden of HAI at the national level for the first time. Understanding the incidence in different clinical settings, at different times, will allow targeting of IPC measures to those patients who would benefit the most.
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Affiliation(s)
- S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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24
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Stewart S, Robertson C, Kennedy S, Kavanagh K, Haahr L, Manoukian S, Mason H, Dancer S, Cook B, Reilly J. Personalized infection prevention and control: identifying patients at risk of healthcare-associated infection. J Hosp Infect 2021; 114:32-42. [PMID: 34301394 DOI: 10.1016/j.jhin.2021.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few healthcare-associated infection (HAI) studies focus on risk of HAI at the point of admission. Understanding this will enable planning and management of care with infection prevention at the heart of the patient journey from the point of admission. AIM To determine intrinsic characteristics of patients at hospital admission and extrinsic events, during the two years preceding admission, that increase risk of developing HAI. METHODS An incidence survey of adults within two hospitals in NHS Scotland was undertaken for one year in 2018/19 as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. The primary outcome measure was developing any HAI using recognized case definitions. The cohort was derived from routine hospital episode data and linkage to community dispensed prescribing data. FINDINGS The risk factors present on admission observed as being the most significant for the acquisition of HAI were: being treated in a teaching hospital, increasing age, comorbidities of cancer, cardiovascular disease, chronic renal failure and diabetes; and emergency admission. Relative risk of developing HAI increased with intensive care unit, high-dependency unit, and surgical specialties, and surgery <30 days before admission and a total length of stay of >30 days in the two years to admission. CONCLUSION Targeting patients at risk of HAI from the point of admission maximizes the potential for prevention, especially when extrinsic risk factors are known and managed. This study proposes a new approach to infection prevention and control (IPC), identifying those patients at greatest risk of developing a particular type of HAI who might be potential candidates for personalized IPC interventions.
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Affiliation(s)
- S Stewart
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK.
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - L Haahr
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
| | - S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK; School of Applied Science, Edinburgh Napier University, Edinburgh, UK
| | - B Cook
- Departments of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Reilly
- Safeguarding Health through Infection Prevention Research Group, Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK; National Services Scotland (NSS), UK
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25
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Conway D, Culshaw S, Edwards M, Clark C, Watling C, Robertson C, Braid R, O’Keefe E, McGoldrick N, Burns J, Provan S, VanSteenhouse H, Hay J, Gunson R. SARS-CoV-2 Positivity in Asymptomatic-Screened Dental Patients. J Dent Res 2021; 100:583-590. [PMID: 33779355 PMCID: PMC8138329 DOI: 10.1177/00220345211004849] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Indexed: 12/11/2022] Open
Abstract
Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium-containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%-0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.
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Affiliation(s)
- D.I. Conway
- School of Medicine, Dentistry, Nursing,
University of Glasgow, Glasgow, UK
- Public Health Scotland, Glasgow,
UK
| | - S. Culshaw
- School of Medicine, Dentistry, Nursing,
University of Glasgow, Glasgow, UK
| | - M. Edwards
- Department of Public Health, NHS
Ayrshire and Arran, Ayr, UK
| | - C. Clark
- Public Health Scotland, Glasgow,
UK
| | | | - C. Robertson
- Public Health Scotland, Glasgow,
UK
- Mathematics and Statistics, Strathclyde
University, Glasgow, UK
| | - R. Braid
- Public Health Scotland, Glasgow,
UK
| | - E. O’Keefe
- Public Health Department, NHS Fife,
Leven, UK
| | | | - J. Burns
- Public Health Department, NHS Fife,
Leven, UK
| | - S. Provan
- Oral Health Directorate, NHS Greater
Glasgow & Clyde, Glasgow, UK
| | | | - J. Hay
- Lighthouse Lab in Glasgow, Glasgow,
UK
| | - R. Gunson
- West of Scotland Specialist Virology
Centre, Glasgow Royal Infirmary, Glasgow, UK
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26
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Flook M, Jackson C, Vasileiou E, Simpson CR, Muckian MD, Agrawal U, McCowan C, Jia Y, Murray JLK, Ritchie LD, Robertson C, Stock SJ, Wang X, Woolhouse MEJ, Sheikh A, Stagg HR. Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality. BMC Infect Dis 2021; 21:342. [PMID: 33845766 PMCID: PMC8040367 DOI: 10.1186/s12879-021-05992-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. METHODS Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. RESULTS One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. CONCLUSIONS The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. REGISTRATION This review was registered on PROSPERO as CRD42020177714 .
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Affiliation(s)
- M Flook
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - C Jackson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - E Vasileiou
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - C R Simpson
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - M D Muckian
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - U Agrawal
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - C McCowan
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | - Y Jia
- Freelance consultant, Beijing, People's Republic of China
| | - J L K Murray
- National Health Service Fife, Kirkcaldy, UK
- Public Health Scotland, Glasgow, UK
| | - L D Ritchie
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - S J Stock
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - X Wang
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - M E J Woolhouse
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - A Sheikh
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
| | - H R Stagg
- Usher Institute, University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK.
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27
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Hopkinson M, Nicholson G, Weaving D, Hendricks S, Fitzpatrick A, Naylor A, Robertson C, Beggs C, Jones B. Rugby league ball carrier injuries: The relative importance of tackle characteristics during the European Super League. Eur J Sport Sci 2021; 22:269-278. [PMID: 33210564 DOI: 10.1080/17461391.2020.1853817] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rugby league carries a high injury incidence with 61% of injuries occurring at tackles. The ball carrier has a higher injury incidence than the defender, therefore understanding mechanisms occurring during injurious tackles are important. Given the dynamic, open nature of tackling, characteristics influencing tackle outcome likely encompass complex networks of dependencies. This study aims to identify important classifying characteristics of the tackle related to ball carrier injurious and non-injurious events in rugby league and identify the characteristics capability to correctly classify those events. Forty-one ball carrier injuries were identified and 205 matched non-injurious tackles were identified as controls. Each case and control were analysed retrospectively through video analysis. Random forest models were built to (1) filter tackle characteristics possessing relative importance for classifying tackles resulting in injurious/non-injurious outcomes and (2) determine sensitivity and specificity of tackle characteristics to classify injurious and non-injurious events. Six characteristics were identified to possess relative importance to classify injurious tackles. This included 'tackler twisted ball carrier's legs when legs were planted on ground', 'the tackler and ball carrier collide heads', 'the tackler used body weight to tackle ball carrier', 'the tackler has obvious control of the ball carrier' 'the tackler was approaching tackle sub-maximally' and 'tackler's arms were below shoulder level, elbows were flexed'. The study identified tackle characteristics that can be modified in attempt to reduce injury. Additional injury data are needed to establish relationship networks of characteristics and analyse specific injuries. Sensitivity and specificity results of the random forest were 0.995 and 0.525.
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Affiliation(s)
- M Hopkinson
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - G Nicholson
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - D Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK
| | - S Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
| | - A Fitzpatrick
- Faculty of Health, The University of Bolton, Bolton, UK
| | - A Naylor
- Faculty of Health, The University of Bolton, Bolton, UK
| | - C Robertson
- Faculty of Health, The University of Bolton, Bolton, UK
| | - C Beggs
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - B Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK.,England Performance Unit, The Rugby Football League, Leeds, UK.,School of Science and Technology, University of New England, Armidale, Australia.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
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28
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Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, McCowan C, Agrawal U, Shah SA, Ritchie LD, Murray J, Pan J, Bradley DT, Stock SJ, Wood R, Chuter A, Beggs J, Stagg HR, Joy M, Tsang RSM, de Lusignan S, Hobbs R, Lyons RA, Torabi F, Bedston S, O’Leary M, Akbari A, McMenamin J, Robertson C, Sheikh A. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med 2021; 27:1290-1297. [PMID: 34108714 PMCID: PMC8282499 DOI: 10.1038/s41591-021-01408-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.
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Affiliation(s)
- C. R. Simpson
- grid.267827.e0000 0001 2292 3111School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand ,grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T. Shi
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Vasileiou
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - S. V. Katikireddi
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S. Kerr
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Moore
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. McCowan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - U. Agrawal
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - S. A. Shah
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - L. D. Ritchie
- grid.7107.10000 0004 1936 7291Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - J. Murray
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - J. Pan
- grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D. T. Bradley
- grid.4777.30000 0004 0374 7521Queen’s University Belfast, Belfast, UK ,grid.454053.30000 0004 0494 5490Public Health Agency, Belfast, Northern Ireland
| | - S. J. Stock
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R. Wood
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Chuter
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - J. Beggs
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - H. R. Stagg
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M. Joy
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. S. M. Tsang
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S. de Lusignan
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. Hobbs
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. A. Lyons
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - F. Torabi
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - S. Bedston
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - M. O’Leary
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Akbari
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - J. McMenamin
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. Robertson
- grid.508718.3Public Health Scotland, Glasgow, Scotland ,grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A. Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
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29
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Dickson E, Palmateer NE, Murray J, Robertson C, Waugh C, Wallace LA, Mathie L, Heatlie K, Mavin S, Gousias P, Von Wissman B, Goldberg DJ, McAuley A. Enhanced surveillance of COVID-19 in Scotland: population-based seroprevalence surveillance for SARS-CoV-2 during the first wave of the epidemic. Public Health 2020; 190:132-134. [PMID: 33453689 PMCID: PMC7685039 DOI: 10.1016/j.puhe.2020.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022]
Abstract
Objectives The impact of the COVID-19 pandemic in Scotland has been amongst the most severe in Europe. Serological surveillance is critical to determine the overall extent of infection across populations and to inform the public health response. This study aimed to estimate the proportion of people who have antibodies to SARS-CoV-2 (‘seroprevalence’) in the general population of Scotland and to see if this changes over time. Study design/Methods Between International Organization for Standardization (ISO) week 17 (i.e. week commencing 20th April) and ISO week 25 (week commencing 15 June), 4751 residual blood samples were obtained from regional biochemistry laboratories in six participating regional health authority areas covering approximately 75% of the Scottish population. Samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies using the LIAISON®SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Italy). Seroprevalence rates were adjusted for the sensitivity and specificity of the assay using Bayesian methods. Results The combined adjusted seroprevalence across the study period was 4.3% (95% confidence interval: 4.2%–4.5%). The proportion varied each week between 1.9% and 6.8% with no difference in antibody positivity by age, sex or geographical area. Conclusions At the end of the first wave of the COVID-19 pandemic, only a small fraction of the Scottish population had antibodies to SARS-CoV-2. Control of COVID-19 requires the ability to detect asymptomatic and mild infections that would otherwise remain undetected through existing surveillance systems. This is important to determine the true number of infections within the general population which, in turn, can help to understand transmission, inform control measures and provide a denominator for the estimation of severity measures such as the proportion of infected people who have been hospitalised and/or have died.
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Affiliation(s)
| | - N E Palmateer
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - J Murray
- Public Health Scotland, Glasgow, UK
| | - C Robertson
- Public Health Scotland, Glasgow, UK; Department of Mathematics and Statistics, University of Strathclyde, UK
| | - C Waugh
- Public Health Scotland, Glasgow, UK
| | | | - L Mathie
- Public Health Scotland, Glasgow, UK
| | | | - S Mavin
- Scottish Microbiology Reference Laboratory, NHS Highland, Inverness, UK
| | | | | | - D J Goldberg
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - A McAuley
- Public Health Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, UK.
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30
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Denison HJ, Worswick J, Bond CM, Grimshaw JM, Mayhew A, Gnani Ramadoss S, Robertson C, Schaafsma ME, Watson MC. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2020; 8:CD002845. [PMID: 32845024 PMCID: PMC8095055 DOI: 10.1002/14651858.cd002845.pub3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anti-fungals are available for oral and intra-vaginal treatment of uncomplicated vulvovaginal candidiasis. OBJECTIVES The primary objective of this review is to assess the relative effectiveness (clinical cure) of oral versus intra-vaginal anti-fungals for the treatment of uncomplicated vulvovaginal candidiasis. Secondary objectives include the assessment of the relative effectiveness in terms of mycological cure, in addition to safety, side effects, treatment preference, time to first relief of symptoms, and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two trials registers on 29 August 2019 together with reference checking and citation searching. SELECTION CRITERIA We included randomised controlled trials published in any language comparing at least one oral anti-fungal with one intra-vaginal anti-fungal in women (aged 16 years or over) with a mycological diagnosis (positive culture, microscopy for yeast, or both) of uncomplicated vulvovaginal candidiasis. We excluded trials if they solely involved participants who were HIV positive, immunocompromised, pregnant, breast feeding or diabetic. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. MAIN RESULTS This review includes 26 trials (5007 participants). Eight anti-fungals are represented. All but three trials included participants with acute vulvovaginal candidiasis. Trials were conducted in Europe: UK (3), Croatia (2). Finland (2), the Netherlands (2), Germany (1), Italy (1), Sweden (1) and one trial across multiple European countries, USA (7) Thailand (2), Iran (2), Japan (1) and Africa (Nigeria) (1). The duration of follow-up varied between trials. The overall risk of bias of the included trials was high. There was probably little or no difference shown between oral and intra-vaginal anti-fungal treatment for clinical cure at short-term follow-up (OR 1.14, 95% CI 0.91 to 1.43; 13 trials; 1859 participants; moderate-certainty evidence) and long-term follow-up (OR 1.07, 95% CI 0.77 to 1.50; 9 trials; 1042 participants; moderate-certainty evidence). The evidence suggests that if the rate of clinical cure at short-term follow-up with intra-vaginal treatment is 77%, the rate with oral treatment would be between 75% and 83%; if the rate of clinical cure at long term follow-up with intra-vaginal treatment is 84%, the rate with oral treatment would be between 80% and 89%. Oral treatment probably improves mycological cure over intra-vaginal treatment at short term (OR 1.24, 95% CI 1.03 to 1.50: 19 trials; 3057 participants; moderate-certainty evidence) and long-term follow-up (OR 1.29, 95% CI 1.05 to 1.60; 13 trials; 1661 participants; moderate-certainty evidence). The evidence suggests that if the rate of mycological cure at short-term follow-up with intra-vaginal treatment is 80%, the rate with oral treatment would be between 80% and 85%; if the rate of mycological cure at long-term follow-up with intra-vaginal treatment is 66%, the rate with oral treatment would be between 67% and 76%. In terms of patient safety, there is a low risk of participants withdrawing from the studies due to adverse drug effects for either treatment (23 trials; 4637 participants; high-certainty evidence). Due to the low certainty of evidence, it is undetermined whether oral treatments reduced the number of side effects compared with intra-vaginal treatments (OR 1.04, 95% CI 0.84 to 1.29; 16 trials; 3155 participants; low-certainty evidence). The evidence suggests that if the rate of side effects with intra-vaginal treatment is 12%, the rate with oral treatment would be between 10% and 15%. We noted that the type of side effects differed, with intra-vaginal treatments being more often associated with local reactions, and oral treatments being more often associated with systemic effects including gastro-intestinal symptoms and headaches. Oral treatment appeared to be the favoured treatment preference over intra-vaginal treatment or no preference (12 trials; 2206 participants), however the data were poorly reported and the certainty of the evidence was low. There was little or no difference in time to first relief of symptoms between oral and intra-vaginal treatments: four trials favoured the oral treatment, four favoured intra-vaginal, one study reported no difference and one was unclear. The measurements varied between the 10 trials (1910 participants) and the certainty of the evidence was low. Costs were not reported in any of the trials. AUTHORS' CONCLUSIONS Oral anti-fungal treatment probably improves short- and long-term mycological cure over intra-vaginal treatment for uncomplicated vaginal candidiasis. Oral treatment was the favoured treatment preference by participants, though the certainty of this evidence is low. The decision to prescribe or recommend an anti-fungal for oral or intra-vaginal administration should take into consideration safety in terms of withdrawals and side effects, as well as cost and treatment preference. Unless there is a previous history of adverse reaction to one route of administration or contraindications, women who are purchasing their own treatment should be given full information about the characteristics and costs of treatment to make their own decision. If health services are paying the treatment cost, decision-makers should consider whether the higher cost of some oral anti-fungals is worth the gain in convenience, if this is the patient's preference.
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Affiliation(s)
- Hayley J Denison
- Centre for Public Health Research, Massey University - Wellington Campus, Wellington, New Zealand
| | - Julia Worswick
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Christine M Bond
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Margaret C Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Hynes WF, Pepona M, Robertson C, Alvarado J, Dubbin K, Triplett M, Adorno JJ, Randles A, Moya ML. Examining metastatic behavior within 3D bioprinted vasculature for the validation of a 3D computational flow model. Sci Adv 2020; 6:eabb3308. [PMID: 32923637 PMCID: PMC7449690 DOI: 10.1126/sciadv.abb3308] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/14/2020] [Indexed: 05/02/2023]
Abstract
Understanding the dynamics of circulating tumor cell (CTC) behavior within the vasculature has remained an elusive goal in cancer biology. To elucidate the contribution of hydrodynamics in determining sites of CTC vascular colonization, the physical forces affecting these cells must be evaluated in a highly controlled manner. To this end, we have bioprinted endothelialized vascular beds and perfused these constructs with metastatic mammary gland cells under physiological flow rates. By pairing these in vitro devices with an advanced computational flow model, we found that the bioprinted analog was readily capable of evaluating the accuracy and integrated complexity of a computational flow model, while also highlighting the discrete contribution of hydrodynamics in vascular colonization. This intersection of these two technologies, bioprinting and computational simulation, is a key demonstration in the establishment of an experimentation pipeline for the understanding of complex biophysical events.
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Affiliation(s)
- W. F. Hynes
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - M. Pepona
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - C. Robertson
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - J. Alvarado
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - K. Dubbin
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - M. Triplett
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - J. J. Adorno
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - M. L. Moya
- Materials Engineering Division, Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
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Robertson C, Pan J, Kavanagh K, Ford I, McCowan C, Bennie M, Marwick C, Leanord A. Cost burden of Clostridioides difficile infection to the health service: A retrospective cohort study in Scotland. J Hosp Infect 2020; 106:554-561. [PMID: 32717202 DOI: 10.1016/j.jhin.2020.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs. AIM To evaluate the healthcare and economic burden of CDI in hospitalized patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland. METHODS A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalizations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards. FINDINGS Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalization, the cost associated with a CDI case was £5126 higher than for controls. CONCLUSION Using routinely collected national data, we demonstrated the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increased the costs of managing patients with CDI compared with matched controls.
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Affiliation(s)
- C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Public Health and Intelligence, NHS National Services Scotland, Edinburgh, UK
| | - C Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - A Leanord
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK; NHS Greater Glasgow and Clyde, Glasgow, UK.
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Corrigendum: Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2020; 22:247-250. [PMID: 32436840 DOI: 10.3310/hta22680-c202005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract
Correction to Declared competing interests of authors.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Aceves-Martins M, Robertson C, Cooper D, Avenell A, Stewart F, Aveyard P, de Bruin M. A systematic review of UK-based long-term nonsurgical interventions for people with severe obesity (BMI ≥35 kg m -2 ). J Hum Nutr Diet 2020; 33:351-372. [PMID: 32027072 PMCID: PMC7317792 DOI: 10.1111/jhn.12732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022]
Abstract
Introduction The aim of this project was to systematically review UK evidence on the effectiveness of long‐term (≥12 months) weight management services (WMSs) for weight loss and weight maintenance for adults (≥16 years) with severe obesity (body mass index ≥35 kg m−2), who would generally be eligible for Tier 3 services. Methods Four data sources were searched from 1999 to October 2018. Results Our searches identified 20 studies, mostly noncomparative studies: 10 primary care interventions, nine in secondary care specialist weight management clinics and one commercial setting intervention. A programme including a phase of low energy formula diet (810–833 kcal day−1) showed the largest mean (SD) weight change at 12 months of –12.4 (11.4) kg for complete cases, with 25.3% dropout. Limitations or differences in evaluation and reporting (particularly for denominators), unclear dropout rates, and differences between participant groups in terms of comorbidities and psychological characteristics, made comparisons between WMSs and inferences challenging. Conclusions There is a persistent and clear need for guidance on long‐term weight data collection and reporting methods to allow comparisons across studies and services for participants with severe obesity. Data could also include quality of life, clinical outcomes, adverse events, costs and economic outcomes. A randomised trial comparison of National Health Service Tier 3 services with commercial WMSs would be of value.
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Affiliation(s)
- M Aceves-Martins
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - D Cooper
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - A Avenell
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - F Stewart
- Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - M de Bruin
- IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Riley P, Glenny AM, Worthington HV, Jacobsen E, Robertson C, Durham J, Davies S, Petersen H, Boyers D. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-224. [PMID: 32065109 PMCID: PMC7049908 DOI: 10.3310/hta24070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). REVIEW METHODS Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. RESULTS Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. LIMITATIONS There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. CONCLUSIONS The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. FUTURE WORK There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068512. 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. 24, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Davies
- TMD Unit, University Dental Hospital of Manchester, Manchester, UK
| | - Helen Petersen
- University Dental Hospital of Manchester, Manchester, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Skea ZC, Aceves-Martins M, Robertson C, De Bruin M, Avenell A. Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review. BMJ Open 2019; 9:e029473. [PMID: 31511284 PMCID: PMC6738728 DOI: 10.1136/bmjopen-2019-029473] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity. DESIGN A systematic review of qualitative evidence. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017. ELIGIBILITY CRITERIA Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2 (and/or the views of providers involved in their care) and considered issues about weight management. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography. RESULTS 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status. CONCLUSIONS Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M De Bruin
- Health Psychology Department, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Kent AJ, Mayer N, Inman JL, Hochman-Mendez C, Bissell MJ, Robertson C. The microstructure of laminin-111 compensates for dystroglycan loss in mammary epithelial cells in downstream expression of milk proteins. Biomaterials 2019; 218:119337. [PMID: 31325803 DOI: 10.1016/j.biomaterials.2019.119337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 01/11/2023]
Abstract
Laminin-111 (Ln-1), an extracellular matrix (ECM) glycoprotein found in the basement membrane of mammary gland epithelia, is essential for lactation. In mammary epithelial cells (MECs), dystroglycan (Dg) is believed to be necessary for polymerization of laminin-111 into networks., thus we asked whether correct polymerization could compensate for Dg loss. Artificially polymerized laminin-111 and the laminin-glycoprotein mix Matrigel, both formed branching, spread networks with fractal dimensions from 1.7 to 1.8, whereas laminin-111 in neutral buffers formed small aggregates without fractal properties (a fractal dimension of 2). In Dg knockout cells, either polymerized laminin-111 or Matrigel readily attached to the cell surface, whereas aggregated laminin-111 did not. In contrast, polymerized and aggregated laminin-111 bound similarly to Dg knock-ins. Both polymerized laminin-111 and Matrigel promoted cell rounding, clustering, formation of tight junctions, and expression of milk proteins, whereas aggregated Ln-1 did not attach to cells or promote functional differentiation. These findings support that the microstructure of Ln-1 networks in the basement membrane regulates mammary epithelial cell function.
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Affiliation(s)
- A J Kent
- Division of Biological Systems and Engineering, Lawrence Berkeley National Lab, 1 Cyclotron Rd. MS 977, Berkeley, CA, 94720, USA
| | - N Mayer
- Division of Biological Systems and Engineering, Lawrence Berkeley National Lab, 1 Cyclotron Rd. MS 977, Berkeley, CA, 94720, USA
| | - J L Inman
- Division of Biological Systems and Engineering, Lawrence Berkeley National Lab, 1 Cyclotron Rd. MS 977, Berkeley, CA, 94720, USA
| | - C Hochman-Mendez
- Regenerative Medicine Research, Texas Heart Institute, Houston TX 77030, USA
| | - M J Bissell
- Division of Biological Systems and Engineering, Lawrence Berkeley National Lab, 1 Cyclotron Rd. MS 977, Berkeley, CA, 94720, USA
| | - C Robertson
- Division of Biological Systems and Engineering, Lawrence Berkeley National Lab, 1 Cyclotron Rd. MS 977, Berkeley, CA, 94720, USA; Materials Engineering Division, Lawrence Livermore National Lab. 7000 East Ave. Livermore, CA 94550, USA.
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Pan J, Kavanagh K, Marwick C, Davey P, Wuiff C, Bryson S, Robertson C, Bennie M. Residual effect of community antimicrobial exposure on risk of hospital onset healthcare-associated Clostridioides difficile infection: a case-control study using national linked data. J Hosp Infect 2019; 103:259-267. [PMID: 31173780 DOI: 10.1016/j.jhin.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Associations between antimicrobial exposure in the community and community-associated Clostridioides difficile infection (CA-CDI) are well documented but associations with healthcare-associated CDI (HA-CDI) are less clear. This study estimates the association between antimicrobial prescribing in the community and HA-CDI. METHODS A matched case-control study was conducted by linking three national patient level datasets covering CDI cases, community prescriptions and hospitalizations. All validated cases of HA-CDI (August 2010 to July 2013) were extracted and up to three hospital-based controls were matched to each case on the basis of gender, age, hospital and date of admission. Conditional logistic regression was applied to estimate the association between antimicrobial prescribing in the community and HA-CDI. A sensitivity analysis was conducted to consider the impact of unmeasured hospital antimicrobial prescribing. RESULTS Nine-hundred and thirty unique cases of HA-CDI with onset in hospital and no hospital discharge in the 12 weeks prior to index admission were linked with 1810 matched controls. Individuals with prior prescription of any antimicrobial in the community had an odds ratio (OR) = 1.41 (95% confidence interval (CI) 1.13-1.75) for HA-CDI compared with those without. Individuals exposed to high-risk antimicrobials (cephalosporins, clindamycin, co-amoxiclav or fluoroquinolones) had an OR = 1.86 (95% CI: 1.33-2.59). After accounting for the likely impact of unmeasured hospital prescribing, the community exposure, particulary to high-risk antimicrobials, was still associated with elevated HA-CDI risk. CONCLUSIONS Community antimicrobial exposure is an independent risk factor for HA-CDI and should be considered as part of the risk assessment of patients developing diarrhoea in hospital.
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Affiliation(s)
- J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK.
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK; Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
| | - C Marwick
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - P Davey
- Population Health Sciences, School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - C Wuiff
- Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, UK
| | - S Bryson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK; Health Protection Scotland, NHS National Services Scotland, Glasgow, Scotland, UK; International Prevention Research Institute, Lyon, France
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK; Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
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Brazzelli M, Hernández R, Sharma P, Robertson C, Shimonovich M, MacLennan G, Fraser C, Jamieson R, Vallabhaneni SR. Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation. Health Technol Assess 2019; 22:1-220. [PMID: 30543179 DOI: 10.3310/hta22720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy. Colour duplex ultrasound (CDU) and, more recently, contrast-enhanced ultrasound (CEU) have been suggested as possible, safer, alternatives to CTA. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of imaging strategies, using either CDU or CEU alone or in conjunction with plain radiography, compared with CTA for EVAR surveillance. DATA SOURCES Major electronic databases were searched, including MEDLINE, EMBASE, Science Citation Index, Scopus' Articles-in-Press, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database from 1996 onwards. We also searched for relevant ongoing studies and conference proceedings. The final searches were undertaken in September 2016. METHODS We conducted a systematic review of randomised controlled trials and cohort studies of patients with AAAs who were receiving surveillance using CTA, CDU and CEU with or without plain radiography. Three reviewers were involved in the study selection, data extraction and risk-of-bias assessment. We developed a Markov model based on five surveillance strategies: (1) annual CTA; (2) annual CDU; (3) annual CEU; (4) CDU together with CTA at 1 year, followed by CDU on an annual basis; and (5) CEU together with CTA at 1 year, followed by CEU on an annual basis. All of these strategies also considered plain radiography on an annual basis. RESULTS We identified two non-randomised comparative studies and 25 cohort studies of interventions, and nine systematic reviews of diagnostic accuracy. Overall, the proportion of patients who required reintervention ranged from 1.1% (mean follow-up of 24 months) to 23.8% (mean follow-up of 32 months). Reintervention was mainly required for patients with thrombosis and types I-III endoleaks. All-cause mortality ranged from 2.7% (mean follow-up of 24 months) to 42% (mean follow-up of 54.8 months). Aneurysm-related mortality occurred in < 1% of the participants. Strategies based on early and mid-term CTA and/or CDU and long-term CDU surveillance were broadly comparable with those based on a combination of CTA and CDU throughout the follow-up period in terms of clinical complications, reinterventions and mortality. The economic evaluation showed that a CDU-based strategy generated lower expected costs and higher quality-adjusted life-year (QALYs) than a CTA-based strategy and has a 63% probability of being cost-effective at a £30,000 willingness-to-pay-per-QALY threshold. A CEU-based strategy generated more QALYs, but at higher costs, and became cost-effective only for high-risk patient groups. LIMITATIONS Most studies were rated as being at a high or moderate risk of bias. No studies compared CDU with CEU. Substantial clinical heterogeneity precluded a formal synthesis of results. The economic model was hindered by a lack of suitable data. CONCLUSIONS Current surveillance practice is very heterogeneous. CDU may be a safe and cost-effective alternative to CTA, with CTA being reserved for abnormal/inconclusive CDU cases. FUTURE WORK Research is needed to validate the safety of modified, more-targeted surveillance protocols based on the use of CDU and CEU. The role of radiography for surveillance after EVAR requires clarification. STUDY REGISTRATION This study is registered as PROSPERO CRD42016036475. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rodolfo Hernández
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pawana Sharma
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Manoukian S, Stewart S, Dancer S, Graves N, Mason H, McFarland A, Robertson C, Reilly J. Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology. J Hosp Infect 2018; 100:222-235. [PMID: 29902486 DOI: 10.1016/j.jhin.2018.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Healthcare-associated infection (HCAI) affects millions of patients worldwide. HCAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HCAI is essential to ensure that we invest in cost-effective infection prevention and control (IPC) measures. AIM To identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HCAI; to highlight and discuss potential biases of all statistical approaches. METHODS A systematic review from 1997 to April 2017 was conducted in PubMed, CINAHL, ProQuest and EconLit databases. Studies were quality-assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorized as time-fixed or time-varying, with the former exhibiting time-dependent bias. Two examples of meta-analysis were used to illustrate how estimates of excess LOS differ between different studies. FINDINGS Ninety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HCAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms, and susceptibilities. CONCLUSION Methodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK.
| | - S Stewart
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK
| | - N Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - A McFarland
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Reilly
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Leonard K, Robertson C, Hayes S, McNamara K. P2.15-15 Differentiating Characteristics of Patients Seeking a Second Opinion: A Survey on Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1456] [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: 10/28/2022]
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Israels SJ, McMillan EM, Robertson C, Singhroy S, McNicol A. The Lysosomal Granule Membrane Protein, Lamp-2, Is also Present in Platelet Dense Granule Membranes. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650333] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryLysosomal Associated Membrane Protein-2 (LAMP-2) is an inherent component of lysosomal granule membranes in diverse cell types, including platelets. We examined platelets for evidence of LAMP-2 in dense granule membranes as CD63 has previously been shown to be present in both lysosomal and dense granule membranes. Immunological techniques were used to examine the localization of LAMP-2 in control platelets and those from an individual with Hermansky-Pudlak syndrome (HPS), a condition characterised by platelet dense granule deficiency. Immunoblotting studies demonstrated that LAMP-2 was enriched in a dense granule preparation. Flow cytometry of thrombin-stimulated control platelets was consistent with biphasic surface expression of LAMP-2. The early expression was accompanied by dense granule, but minimal lysosomal granule, release. The late expression was accompanied by additional lysosomal granule release only. Thrombin stimulation of HPS platelets showed only late, lysosome-associated LAMP-2 expression. Immunoelectron microscopy indicated the presence of LAMP-2 in the membranes of serotonin-containing granules as identified by an anti-serotonin polyclonal antibody. These data indicate that LAMP-2 is present in the membranes of platelet dense granules in addition to lysosomal granules, and has a similar distribution to CD63.
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Affiliation(s)
- S J Israels
- The Departments of Pediatrics and Oral Biology and the Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - E M McMillan
- The Departments of Pediatrics and Oral Biology and the Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Robertson
- The Departments of Pediatrics and Oral Biology and the Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Singhroy
- The Departments of Pediatrics and Oral Biology and the Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - A McNicol
- The Departments of Pediatrics and Oral Biology and the Manitoba Institute of Cell Biology, University of Manitoba, Winnipeg, Manitoba, Canada
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Smith J, Adams CE, King MF, Noakes CJ, Robertson C, Dancer SJ. Is there an association between airborne and surface microbes in the critical care environment? J Hosp Infect 2018; 100:e123-e129. [PMID: 29649556 DOI: 10.1016/j.jhin.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There are few data and no accepted standards for air quality in the intensive care unit (ICU). Any relationship between airborne pathogens and hospital-acquired infection (HAI) risk in the ICU remains unknown. AIM First, to correlate environmental contamination of air and surfaces in the ICU; second, to examine any association between environmental contamination and ICU-acquired staphylococcal infection. METHODS Patients, air, and surfaces were screened on 10 sampling days in a mechanically ventilated 10-bed ICU for a 10-month period. Near-patient hand-touch sites (N = 500) and air (N = 80) were screened for total colony count and Staphylococcus aureus. Air counts were compared with surface counts according to proposed standards for air and surface bioburden. Patients were monitored for ICU-acquired staphylococcal infection throughout. FINDINGS Overall, 235 of 500 (47%) surfaces failed the standard for aerobic counts (≤2.5 cfu/cm2). Half of passive air samples (20/40: 50%) failed the 'index of microbial air' contamination (2 cfu/9 cm plate/h), and 15/40 (37.5%) active air samples failed the clean air standard (<10 cfu/m3). Settle plate data were closer to the pass/fail proportion from surfaces and provided the best agreement between air parameters and surfaces when evaluating surface benchmark values of 0-20 cfu/cm2. The surface standard most likely to reflect hygiene pass/fail results compared with air was 5 cfu/cm2. Rates of ICU-acquired staphylococcal infection were associated with surface counts per bed during 72h encompassing sampling days (P = 0.012). CONCLUSION Passive air sampling provides quantitative data analogous to that obtained from surfaces. Settle plates could serve as a proxy for routine environmental screening to determine the infection risk in ICU.
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Affiliation(s)
- J Smith
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK
| | - C E Adams
- Department of Critical Care, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK
| | - M F King
- Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UK
| | - C J Noakes
- Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, Glasgow, UK; International Prevention Research Institute, Lyon, France
| | - S J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
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Cairns S, Gibbons C, Milne A, King H, Llano M, MacDonald L, Malcolm W, Robertson C, Sneddon J, Weir J, Reilly J. Results from the third Scottish National Prevalence Survey: is a population health approach now needed to prevent healthcare-associated infections? J Hosp Infect 2018; 99:312-317. [PMID: 29621601 DOI: 10.1016/j.jhin.2018.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are a major public health concern and a significant cause of morbidity and mortality. A robust and current evidence base that is specific to local, national and Europe-wide settings is necessary to inform the development of strategies to reduce HCAI and contain antimicrobial resistance. AIM To measure the prevalence of HCAI and antimicrobial prescribing and identify key priority areas for interventions to reduce the burden of infection. METHODS A national rolling point-prevalence survey (PPS) in National Health Service (NHS) acute, NHS non-acute, NHS paediatric, and independent hospitals was carried out between September and November 2016 using the European Centre for Disease Prevention and Control protocol designed for the European PPS. FINDINGS The prevalence of HCAI was 4.6%, 2.7%, and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The most frequent HCAI types reported in adult patients were urinary tract infection and pneumonia. The prevalence of antimicrobial prescribing was 35.7%, 29.3%, and 13.8% in acute adults, paediatric, and non-acute patient groups, respectively. Respiratory, skin and soft tissue, gastrointestinal, and urinary tract infections were the most common infections being treated at the time of survey. CONCLUSION HCAI continues to be a public health concern in Scotland. Urinary tract infection and pneumonia continue to place a significant burden on patients and on healthcare delivery, including those that develop in the community and require hospital admission. A broader population health approach which focuses on reducing the risk of infection upstream would reduce these infections in both community and hospital settings.
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Affiliation(s)
- S Cairns
- National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - C Gibbons
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A Milne
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - H King
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - M Llano
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - L MacDonald
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - W Malcolm
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - C Robertson
- National Services Scotland, Health Protection Scotland, Glasgow, UK; University of Strathclyde, Glasgow, UK
| | - J Sneddon
- Healthcare Improvement Scotland, Glasgow, UK
| | - J Weir
- National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - J Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, UK; Glasgow Caledonian University, Glasgow, UK
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46
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Affiliation(s)
- C Robertson
- Alcohol Research Centre, Churchill Hospital, Headington, Oxford
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47
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Pyper K, Eddleston M, Bateman DN, Lupton D, Bradberry S, Sandilands E, Thomas S, Thompson JP, Robertson C. Hospital usage of TOXBASE in Great Britain: Temporal trends in accesses 2008 to 2015. Hum Exp Toxicol 2018; 37:1207-1214. [PMID: 29460637 DOI: 10.1177/0960327118759405] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To examine temporal trends in accesses to the UK's National Poison Information Service's TOXBASE database in Britain. METHODS Generalized additive models were used to examine trends in daily numbers of accesses to TOXBASE from British emergency departments between January 2008 and December 2015. Day-of-the-week, seasonality and long-term trends were analysed at national and regional levels (Wales, Scotland and the nine English Government Office Regions). RESULTS The long-term trend in daily accesses increases from 2.8 (95% confidence interval (CI): 2.6-3.0) per user on 1 January 2008 to 4.6 (95% CI: 4.3-4.9) on 31 December 2015, with small but significant differences in population-corrected accesses by region ( p < 0.001). There are statistically significant seasonal and day of the week patterns ( p < 0.001) across all regions. Accesses are 18% (95% CI: 14-22%) higher in summer than in January and at the weekend compared to weekdays in all regions; there is a 7.5% (95% CI: 6.1-8.9%) increase between Friday and Sunday. CONCLUSIONS There are consistent in-year patterns in access to TOXBASE indicating potential seasonal patterns in poisonings in Britain, with location-dependent rates of usage. This novel descriptive work lays the basis for future work on the interaction of TOXBASE use with emergency admission of patients into hospital.
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Affiliation(s)
- K Pyper
- 1 Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - M Eddleston
- 2 Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK.,3 National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D N Bateman
- 2 Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
| | - D Lupton
- 3 National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Bradberry
- 4 National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham, UK
| | - E Sandilands
- 3 National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shl Thomas
- 5 National Poisons Information Service (Newcastle Unit), Wolfson Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J P Thompson
- 6 National Poisons Information Service (Cardiff Unit), University Hospital Llandough, Penarth, Vale of Glamorgan, UK
| | - C Robertson
- 1 Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.,7 Health Protection Scotland, Glasgow, UK
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Triasih R, Padmawati RS, Duke T, Robertson C, Sawyer SM, Graham SM. A mixed-methods evaluation of adherence to preventive treatment among child tuberculosis contacts in Indonesia. Int J Tuberc Lung Dis 2018; 20:1078-83. [PMID: 27393543 DOI: 10.5588/ijtld.15.0952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) can be prevented using isoniazid preventive therapy (IPT) among child contacts. However, the benefits of IPT depend on adherence to at least 6 months of daily treatment. A greater understanding of the barriers to and facilitators of adherence to IPT in resource-poor settings is required to optimise the benefits. METHODS We prospectively evaluated adherence to IPT and its associated factors among child contacts (age 0-5 years) eligible for IPT. We undertook in-depth interviews with care givers and a focus group discussion with health care workers, which were thematically analysed to explore barriers to and facilitators of adherence from the perspective of both care givers and health workers. RESULTS Of 99 eligible children, 49 (49.5%) did not complete 6 months of IPT. Children whose care giver collected their IPT medications from primary health centres were more likely to have incomplete adherence than those who collected them from hospitals (aOR 2.9, 95%CI 1.1-7.8). Thematic analyses revealed major barriers to and facilitators of adherence: regimen-related, care giver-related and health care-related factors, social support and access. Many of these factors are readily modifiable. CONCLUSION Providing information about IPT and improving accessibility for care givers to receive IPT at the primary health care facility should be priorities to facilitate implementation.
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Affiliation(s)
- R Triasih
- Department of Paediatrics, Faculty of Medicine, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - R S Padmawati
- Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - T Duke
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - C Robertson
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - S M Sawyer
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
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Abstract
Recent studies have highlighted deficiencies in ECT service delivery. This audit was set up to monitor and improve the ECT administered in a large psychiatric service. In the first phase of the audit Information was collected regarding stimulus adjustment in response to brief seizures. This highlighted inconsistencies In clinical practice and an education programme was instigated to correct these deficiencies and to bring practice into line with the Royal College of Psychiatrists guidelines. A repeat audit was performed and a marked improvement in the quality of stimulus adjustment was shown.
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Young E, Johnston M, Robertson C, Naguit I, Stevens P, Galashan D, Oskamp M, Brennan B, Ginsberg J, Chunilal S. The APTT Response of Pregnant Plasma to Unfractionated Heparin. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612949] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPregnancy is associated with a physiological increase in coagulation factors and heparin binding proteins; both can affect the activated partial thromboplastin time (APTT) in response to unfractionated heparin (UFH) invalidating the use of a non-pregnant APTT therapeutic range. We compared the anticoagulant response of UFH added in vitro to the plasma of 13 pregnant (third trimester) and 15 nonpregnant women to determine whether the measured APTT and antifactor Xa activities are lower in pregnancy. Increasing concentrations of UFH were added to platelet-poor plasma from each subject and the APTT and anti-factor Xa activity were measured. The amount of UFH which was reversibly bound and neutralised by plasma heparin binding proteins was assessed by comparing the anti-factor Xa activity before and after addition of low affinity heparin (LAH). Fibrinogen, von Willebrand factor antigen (vWF Ag) and factor VIII levels, were also measured. The APTT response, assessed by the slope of the regression line of log APTT versus added heparin concentration, was attenuated in pregnant plasma (0.76 s/U/mL versus 1.2 s/U/mL, p = 0.005) and was highly correlated to increased non-specific plasma protein binding (47% versus 35% p <0.01) and increased fibrinogen (5.1g/L versus 2.8 g/L, p <0.01) and factor VIII activity (2.7 U/mL versus 1.2 U/mL, p <0.01). Thus, to achieve the same heparin level, pregnant women require higher daily doses of UFH than non-pregnant women. However, if UFH dose adjustments during the third trimester are based upon a non-pregnant APTT therapeutic range, systematic overdosing of pregnant women will result, possibly increasing the risk of bleeding and osteoporosis.
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