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Guirguis A, Chiappini S, Papanti P GD, Vickers-Smith R, Harris D, Corkery JM, Arillotta D, Floresta G, Martinotti G, Schifano F. Exploring the association between suicidal thoughts, self-injury, and GLP-1 receptor agonists in weight loss treatments: Insights from pharmacovigilance measures and unmasking analysis. Eur Neuropsychopharmacol 2024; 82:82-91. [PMID: 38508100 DOI: 10.1016/j.euroneuro.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The study addresses concerns about potential psychiatric side effects of Glucagon-like peptide-1 receptor agonists (GLP-1 RA). AIM The aim of this work was to analyse adverse drug reports (ADRs) from the Food and Drug Administration Adverse Events Reporting System (FAERS) using metformin and orlistat as comparators. METHODS Descriptive and pharmacovigilance disproportionality analyses was performed. RESULTS A total of 209,354 ADRs were reported, including 59,300 serious cases. Of those, a total of 5378 psychiatric disorder cases, including 383 'serious' cases related to selected ADRs were registered during 2005-2023. After unmasking, 271 cases where individual GLP-1 RA were implicated showing liraglutide (n = 90; Reported Odds Ratio (ROR) = 1.64), exenatide (n = 67; ROR = 0.80), semaglutide (n = 61; ROR = 2.03), dulaglutide (n = 45; ROR = 0.84), tirzepatide (n = 5; ROR = 1.76) and albiglutide (n = 2; ROR = 0.04). A greater association between these ADRs with metformin was observed, but not orlistat. With regards to selected preferred terms (PTs), 42 deaths including 13 completed suicides were recorded. Suicidal ideation was recorded in n = 236 cases for 6/7 GLP-1 RA (excluding lixisenatide). DISCUSSION Suicide/self-injury reports pertaining to semaglutide; tirzepatide; and liraglutide were characterised, although lower than metformin. It is postulated that rapid weight loss achieved with GLP-1 RA can trigger significant emotional, biological, and psychological responses, hence possibly impacting on suicidal and self-injurious ideations. CONCLUSIONS With the current pharmacovigilance approach, no causality link between suicidal ideation and use of any GLP-1 RA can be inferred. There is a need for further research and vigilance in GLP-1 RA prescribing, particularly in patients with co-existing psychiatric disorders.
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Affiliation(s)
- A Guirguis
- Swansea University, Singleton Campus, The Grove, SA2 8PP, Wales, UK.
| | - S Chiappini
- UniCamillus University, Via di S. Alessandro 8, 00131, Rome, Italy; Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
| | - G D Papanti P
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; Tolmezzo Community Mental Health Centre, ASUFC Mental Health Department, Via Giuliano Bonanni, 2, 33028 Tolmezzo, UD, Italy
| | - R Vickers-Smith
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
| | - D Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 289 South Limestone Street, Lexington, KY 40536, USA; Center for Clinical and Translational Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40506, USA
| | - J M Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
| | - D Arillotta
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; Department of Clinical Pharmacology and Toxicology, University of Florence, Italy
| | - G Floresta
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; Department of Drug and Health Sciences, University of Catania, Italy
| | - G Martinotti
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK; Department of Neurosciences, Imaging, and Clinical Sciences, University of Chieti-Pescara, Via di Vestini 31, 66100, Chieti, Italy
| | - F Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
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Yang MC, Clayton C, Harris D, Pelletier C, Schmidt J, Zwicker JG, Sakakibara BM. A Qualitative Investigation on Chronic Disease Management and Prevention Among Older Adults During the COVID-19 Pandemic. Am J Health Promot 2024; 38:384-393. [PMID: 38000140 PMCID: PMC10903114 DOI: 10.1177/08901171231218681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
PURPOSE To qualitatively describe experiences of chronic disease management and prevention in older adults (age ≥65 years) during COVID-19. APPROACH Qualitative descriptive approach. SETTING Data collected online via telephone and video-conferencing technologies to participants located in various cities in British Columbia, Canada. Data analyzed by researchers in the cities of Vancouver and Kelowna in British Columbia. PARTICIPANTS Twenty-four community-living older adults (n = 24) age ≥65 years. METHODS Each participant was invited to complete a 30-to-45-minute virtual, semi-structured, one-on-one interview with a trained interviewer. Interview questions focused on experiences managing health prior to COVID-19 and transitioning experiences of practicing health management and prevention strategies during COVID-19. Audio recordings of interviews were transcribed verbatim and analyzed thematically. RESULTS The sample's mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (12.5% none, 12.5% one). Three themes described participants' strategies for chronic disease management and prevention: (1) having a purpose to optimize health (i.e., managing health challenges and maintaining independence); (2) internal self-control strategies (i.e., self-accountability and adaptability); and (3) external support strategies (i.e., informational support, motivational support, and emotional support). CONCLUSION Helping older adults identify purposes for their own health management, developing internal control strategies, and optimizing social support opportunities may be important person-centred strategies for chronic disease management and prevention during unprecedented times like COVID-19.
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Affiliation(s)
- Michelle C. Yang
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, Canada
| | - Cam Clayton
- Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC, Canada
| | - Devin Harris
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jill G. Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Brodie M. Sakakibara
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Heran M, Lindsay P, Gubitz G, Yu A, Ganesh A, Lund R, Arsenault S, Bickford D, Derbyshire D, Doucette S, Ghrooda E, Harris D, Kanya-Forstner N, Kaplovitch E, Liederman Z, Martiniuk S, McClelland M, Milot G, Minuk J, Otto E, Perry J, Schlamp R, Tampieri D, van Adel B, Volders D, Whelan R, Yip S, Foley N, Smith EE, Dowlatshahi D, Mountain A, Hill MD, Martin C, Shamy M. Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7 th Edition Practice Guidelines Update, 2022. Can J Neurol Sci 2024; 51:1-31. [PMID: 36529857 DOI: 10.1017/cjn.2022.344] [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] [Indexed: 12/23/2022]
Abstract
The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.
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Affiliation(s)
- Manraj Heran
- Division of Neuroradiology, University of British Columbia, Vancouver, Canada
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - Amy Yu
- Division of Neurology, Department of Medicine, and Regional Stroke Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aravind Ganesh
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Rebecca Lund
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Sacha Arsenault
- Stroke Services BC, Provincial Health Systems Authority, Vancouver, Canada
| | - Doug Bickford
- London Health Sciences Centre, London, Canada (Previous Appointment at Time of Participation)
| | - Donnita Derbyshire
- Saskatchewan College of Paramedics, Paramedic Practice Committee, Saskatoon, Canada
| | - Shannon Doucette
- Enhanced District Stroke Program, Royal Victoria Regional Health Centre, Barrie, Canada (Previous Appointment at Time of Participation)
| | - Esseddeeg Ghrooda
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Devin Harris
- Quality and Patient Safety Division, Interior Health, Kelowna, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Nick Kanya-Forstner
- Northern Ontario School of Medicine, Sudbury, Canada
- Timmins & District Hospital, Timmins, Canada
| | - Eric Kaplovitch
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Zachary Liederman
- Faculty of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Department of Medicine (Hematology), Toronto, Canada
| | - Shauna Martiniuk
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Schwartz-Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Canada
| | | | - Genevieve Milot
- Department of Surgery, Laval University, Quebec City, Canada
| | - Jeffrey Minuk
- Division of Neurology, The Integrated Health and Social Services, University Network for West Central Montreal, Montreal, Canada
| | - Erica Otto
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Rob Schlamp
- British Columbia Emergency Health Services, Vancouver, Canada
| | | | - Brian van Adel
- Department of Neurointerventional Surgery, McMaster University, Hamilton, Canada
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada
| | - Ruth Whelan
- Royal University Hospital Stroke Program, Saskatoon, Canada
| | - Samuel Yip
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Norine Foley
- WorkHORSE Consulting Group, Epidemiology, London, Canada
| | - Eric E Smith
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Dar Dowlatshahi
- Department of Neurology, University of Ottawa, Ottawa, Canada
| | - Anita Mountain
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Michael D Hill
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences and Community Health Sciences, Calgary, Canada
| | - Chelsy Martin
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Michel Shamy
- Department of Neurology, University of Ottawa, Ottawa, Canada
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Sakelaris V, Sullivan EE, Harris D. The impact of physician leadership development on behaviour and work-related changes. Healthc Manage Forum 2023; 36:373-377. [PMID: 37387618 DOI: 10.1177/08404704231185550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
In this article, we present findings from a retrospective survey of 117 physician leadership development program graduates at the Sauder School of Business at the University of British Columbia in Vancouver. The survey was designed to assess how the program contributed to graduates' leadership development, specifically in terms of behaviour change and work-related changes. The themes resulting from the analysis of the open-ended questions reflected that the program led to changes in graduates' leadership behaviour and their ability to lead change in their respective organizations. The study highlighted the benefits of investment in training for physician leaders to advance transformation and improvement initiatives in a changing world.
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Affiliation(s)
| | | | - Devin Harris
- British Columbia Patient Safety and Quality Council, Vancouver, British Columbia, Canada
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Cowan R, Stark-Inbar A, Rabany L, Harris D, Vizel M, Ironi A, Vieira JR, Galen M, Treppendahl C. Clinical benefits and economic cost-savings of Remote Electrical Neuromodulation (REN) for migraine prevention. J Med Econ 2023; 26:656-664. [PMID: 37083448 DOI: 10.1080/13696998.2023.2205751] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
AIMS Assess the clinical benefits and associated direct and indirect cost-savings from Remote Electrical Neuromodulation (REN) for migraine prevention. METHODS REN, a prescribed, wearable, FDA-cleared neuromodulation-device for the acute and/or treatment of migraine, recently demonstrated efficacy for migraine prevention when used every-other-day, in a prospective, randomized, double-blind, placebo-controlled, multi-center study. Following baseline (4-weeks), subjects underwent treatment with REN (or placebo; 8-weeks), and electronically reported migraine symptoms and acute treatments daily. Therapeutic-gain was the between-groups difference (REN minus placebo) in change from baseline to the second month of intervention. Health-economics impact was derived as cost-savings associated with REN's clinical benefits. RESULTS Out of 248 subjects randomized (128 active, 120 placebo), 179 (95:84) qualified for modifiedintention-to-treat (mITT) analysis. Significant therapeutic gains favoring REN vs placebo were found (Tepper et al., 2023), including mean (±SD) reduction in number of acute medication days (3.4 ± 0.4 vs 1.2 ± 0.5; gain = 2.2; p = 0.001) and presenteeism days (2.7 ± 0.3 vs 1.1 ± 0.4; p = 0.001). Mean changes of provider visits (reduction of 0.09 ± 0.1 vs increase of 0.08 ± 0.2; p = 0.297), and reduction of absenteeism days (0.07 ± 0.1 vs 0.07 ± 0.2; p = 0.997) were not significant. Mean annual cost-saving for one patient using REN for migraine prevention estimated $10,000 (±$1,777) from reductions in these four clinical outcomes relative to baseline without REN treatment. Extrapolated to a hypothetical US commercial health-plan of one-million covered lives, assuming the national prevalence of migraine patients on preventive treatment, annual mean (±SE) cost-saving from using REN migraine prevention estimated $560.0 million (±$99.5 million) from reduction in direct and indirect metrics measured. LIMITATIONS Clinical and cost-savings benefits presented are conservative, assessed only from endpoints measured in the clinical trial. Moreover, some of the endpoints had only scarce or no occurrences during the study period. CONCLUSIONS Demonstrated significant and meaningful clinical, and cost-savings benefits for patients, health insurance systems, and employers, from utilizing REN for migraine prevention.
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Affiliation(s)
- R Cowan
- Division of Headache Medicine, Stanford University, Palo Alto, CA, USA
| | | | - L Rabany
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - D Harris
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - M Vizel
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - A Ironi
- Theranica Bio-Electronics LTD., Netanya, Israel
| | - J R Vieira
- Nuvance Health Neuroscience Institute, Kingston, NY, USA
- Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Bronx, NY, USA
| | - M Galen
- Deaconess Research Institute, Newburgh, IN, USA
| | - C Treppendahl
- Headache Neurology Research Institute, Ridgeland, MS, USA
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Yassi A, Barker S, Lockhart K, Taylor D, Harris D, Hundal H, Grant JM, Okpan AI, Pollock S, Sprague S, Sing CK. Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada. Can J Rural Med 2023; 28:47-58. [PMID: 37005988 DOI: 10.4103/cjrm.cjrm_24_22] [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] [Indexed: 04/04/2023]
Abstract
Introduction Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs. Methods We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear. Conclusions As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Stephen Barker
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Devin Harris
- Interior Health, Kelowna, British Columbia; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harsh Hundal
- Interior Health, Kelowna, British Columbia, Canada
| | - Jennifer M Grant
- Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnold Ikedichi Okpan
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sue Pollock
- School of Population and Public Health, University of British Columbia, Vancouver; Interior Health, Kelowna, British Columbia, Canada
| | - Stacy Sprague
- Employee Safety, Health and Wellness, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia; Medicine, Quality and Safety, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Evans R, Sharma S, Claure-Del Grando R, Cullis B, Burdmann E, Franca F, Aguiar J, Fredlund M, Hendricks K, Harris D, Rocco M. WCN23-0708 IDENTIFICATION AND MANAGEMENT OF KIDNEY DISEASE AS PART OF ROUTINE CLINICAL CARE IN LOW-RESOURCE SETTINGS: THE ISN KIDNEY CARE NETWORK PROJECT. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.027] [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: 03/22/2023] Open
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8
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Yang MC, Clayton C, Harris D, Pelletier C, Schmidt J, Zwicker JG, Sakakibara BM. Preliminary investigation of the student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH). Fam Pract 2023; 40:30-38. [PMID: 35899784 PMCID: PMC9384587 DOI: 10.1093/fampra/cmac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19 public health restrictions (i.e. physical distancing) compromise individuals' ability to self-manage their health behaviours and may increase the risks of adverse health events. OBJECTIVES To evaluate the student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) on health-directed behaviour (self-management) among older adults (≥65 years of age, n = 75). Secondary objectives estimated the influence of COACH on perceived depression, anxiety, and stress; social support; health-related quality of life; health promotion self-efficacy; and other self-management domains. METHODS COACH was developed to provide chronic disease management and prevention support among older adults via telephone or videoconferencing platforms (i.e. Zoom). In this single-group, pre-post study, our primary outcome was measured using the health-directed behaviour subscale of the Health Education Impact Questionnaire. Secondary measures included the Depression, Anxiety and Stress Scale, Medical Outcomes Study: Social Support Survey, MOS Short Form-36, and Self-Rated Abilities for Health Practices Scale. Paired sample t-tests were used to analyse outcome changes. RESULTS Mean age of participants was 72.4 years (58.7% female; 80% ≥2 chronic conditions). Health-directed behaviour significantly improved after COACH (P < 0.001, d = 0.45). Improved health promotion self-efficacy (P < 0.001, d = 0.44) and decreased mental health were also observed (P < 0.001, d = -1.69). DISCUSSION COACH likely contributed to improved health-directed behaviour and health promotion self-efficacy despite the diminished mental health-related quality of life during COVID-19. Our findings also highlight the benefits of using health professional students for the delivery of virtual health promotion programs. CLINICAL TRIAL INFORMATION ClinicalTrials.gov ID: NCT04492527.
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Affiliation(s)
- Michelle C Yang
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Cam Clayton
- Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC, Canada
| | - Devin Harris
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Quality and Patient Safety, Interior Health Authority, Kelowna, BC, Canada
| | - Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jill G Zwicker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Brodie M Sakakibara
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
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Watchorn A, Curran J, Heilman J, Balfour N, McCarroll K, Speers S, Harris D. Feasibility of patient-controlled analgesia (PCA) for rural and remote transfers. CAN J EMERG MED 2023; 25:157-163. [PMID: 36565428 DOI: 10.1007/s43678-022-00417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/11/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND In rural Canada, the majority of prehospital care is provided by basic life support paramedics, who cannot administer opioids or parenteral analgesics. Patients requiring transfer to a higher level of care have limited options for pain control. We aim to determine if ambulance-based patient-controlled analgesia (PCA) is feasible during inter-facility transfers. METHODS This is a prospective non-consecutive cohort feasibility study conducted in the East Kootenay region of British Columbia from 2016 to 2020. Patients in acute pain from an illness or injury requiring an opioid and transfer to a higher level of care were offered PCA. The study used respiratory depression as a marker of safety, assessed if PCA during transport provided efficacious analgesia, measured satisfaction scores from patients and paramedics, and tracked adverse events. RESULTS 84 patients received PCA. The majority had orthopaedic trauma and the average transfer time was 3 h 22 min. The average pain score at the start and end of the transfer was unchanged, at 4 out of 10. Patient and paramedic satisfaction scores at the end of the transfer were 4.6 and 4.7 out of 5, respectively. Three out of the 84 patients (3.6%) had desaturation episodes below or equal to 90% oxygen saturation; however, all resolved with supplemental oxygen. INTERPRETATION Ambulance-based PCA is feasible and has a high level of satisfaction among paramedics and patients. It has significant potential for inter-facility transport in rural regions in Canada where ambulances are staffed with paramedics who cannot administer opioids or other parenteral analgesics.
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Affiliation(s)
- Adam Watchorn
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.
- Interior Health Authority, Kelowna, BC, Canada.
| | | | - James Heilman
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Nick Balfour
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Kirk McCarroll
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
| | - Shauna Speers
- British Columbia Emergency Health Services, Saanichton, BC, Canada
| | - Devin Harris
- University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
- Interior Health Authority, Kelowna, BC, Canada
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Caperchione C, English M, Sharp P, Wallace L, Harris D, Ashton J. A family-based approach examining perceptions of a TRYathlon series on children’s health and development. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.025] [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: 11/17/2022]
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11
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Ritchie L, Harrison SL, Penson PE, Akbari A, Torabi F, Hollinghurst J, Harris D, Oke OB, Akpan A, Halcox JP, Rodgers SE, Lip GYH, Lane DA. Factors associated with prescription of oral anticoagulation for atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in this high-risk population who are under-represented in research studies.
Purpose
To explore the factors associated with OAC prescription for care home residents aged ≥65 years with AF.
Methods
Nationwide retrospective cohort study of people aged ≥65 years entering a care home in Wales between 1 January 2003 and 31 December 2018, using anonymised individual-level electronic health record and administrative data sources available within the Secure Anonymised Information Linkage Databank. Unadjusted and adjusted logistic regression models were used to explore the association between resident characteristics and OAC prescription or non-prescription.
Results
Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018), Figure 1. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval, 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry in the post-non-vitamin K antagonist oral anticoagulant (NOAC) era from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription, Figure 2.
Conclusions
The proportion of care home residents prescribed OAC therapy has increased over time with the introduction of NOACs in 2011, but OAC prescription rates are still sub-optimal. Although there is an expected rise in OAC prescribing for increasingly frail people, further work is needed to investigate the interaction with deprivation and other socio-economic and demographic factors to assess potential inequalities in prescribing across these groups. Targeted educational tools for clinicians are needed to address barriers to OAC prescription for AF, such as older age and separate indications for antiplatelet therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Ritchie
- University of Liverpool , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool , Liverpool , United Kingdom
| | - P E Penson
- Liverpool John Moores University , Liverpool , United Kingdom
| | - A Akbari
- Swansea University , Swansea , United Kingdom
| | - F Torabi
- Swansea University , Swansea , United Kingdom
| | | | - D Harris
- Swansea University , Swansea , United Kingdom
| | - O B Oke
- University of Liverpool , Liverpool , United Kingdom
| | - A Akpan
- University of Liverpool , Liverpool , United Kingdom
| | - J P Halcox
- Swansea University , Swansea , United Kingdom
| | - S E Rodgers
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
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Ritchie LA, Harrison SL, Penson PE, Akbari A, Torabi F, Hollinghurst J, Harris D, Oke OB, Akpan A, Halcox JP, Rodgers SE, Lip GYH, Lane DA. Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Older care home residents are a high-risk group of people with atrial fibrillation (AF) who are under-represented in clinical trials. Improved understanding of AF epidemiology and management in this population is paramount for health and social care organisations to strategically plan services.
Purpose
To determine the trends in AF prevalence and compare adverse health outcomes in older care home residents aged ≥65 years with AF compared to those without AF.
Methods
Retrospective cohort study of people entering a care home between 2003–2018 using nationwide, population-scale anonymised health and administrative data, provisioned from the Secure Anonymised Information Linkage (1 January 2000–31st December 2018). Direct standardisation was used to calculate AF prevalence by year of care entry (2010–2018). Cox regression analyses were used to estimate the risk of adverse health outcomes.
Results
Between 2003 and 2018, 86,602 people aged ≥65 years became new residents in care homes in Wales. Residents with AF (n=14,493) had a significantly higher risk (adjusted hazard ratio [aHR], 95% confidence interval [CI]) of cardiovascular (aHR 1.27 [1.17 to 1.37], p<0.001) and all-cause mortality (aHR 1.14 [1.11 to 1.17], p<0.001), Figure 1. The risk (sub-distribution hazard ratio [sHR], 95% CI) of ischaemic stroke (adjusted sHR 1.55 [1.36 to 1.76], p<0.001) and cardiovascular hospitalisation (adjusted sHR 1.28 [1.22 to 1.34], p<0.001) was also higher in residents with AF, even when mortality was considered a competing event, Figure 1. There was no significant change in age- and sex-standardised prevalence of AF between 2010 and 2018, 16.79% (95% CI 15.85 to 17.94) and 17.02% (95% CI 16.05 to 17.98), respectively (absolute change 2010–2018: 0.06% [95% CI: −1.38 to 1.50], p=0.93), Figure 2.
Conclusions
This study demonstrates unique data on the epidemiology of AF and associated outcomes in older care home residents. Whilst the prevalence of AF remained stable between 2010–2018, residents with AF had significantly higher risk of adverse health events. Treatment of AF in accordance with guidelines is critical in this population to optimise management and reduce adverse health outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L A Ritchie
- University of Liverpool , Liverpool , United Kingdom
| | - S L Harrison
- University of Liverpool , Liverpool , United Kingdom
| | - P E Penson
- Liverpool John Moores University , Liverpool , United Kingdom
| | - A Akbari
- Swansea University , Swansea , United Kingdom
| | - F Torabi
- Swansea University , Swansea , United Kingdom
| | | | - D Harris
- Swansea University , Swansea , United Kingdom
| | - O B Oke
- University of Liverpool , Liverpool , United Kingdom
| | - A Akpan
- University of Liverpool , Liverpool , United Kingdom
| | - J P Halcox
- Swansea University , Swansea , United Kingdom
| | - S E Rodgers
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
| | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Jesse E, Sellke N, Muncey W, Callegari M, Harris D, Kim T, Ghayda RA, Loeb A, Thirumavalavan N. Is Reddit a Reliable Source for Information on Erectile Dysfunction Treatment? J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.402] [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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15
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Banerji A, Bernstein JA, Johnston DT, Lumry WR, Magerl M, Maurer M, Martinez‐Saguer I, Zanichelli A, Hao J, Inhaber N, Yu M, Riedl MA, Hébert J, Ritchie B, Sussman G, Yang W, Aygören‐Pürsün E, Magerl M, Martinez‐Saguer I, Staubach P, Cicardi M, Shennak M, Zaragoza‐Urdaz R, Kiani‐Alikhan S, Anderson J, Banerji A, Baptist A, Bernstein J, Busse P, Craig T, Davis‐Lorton M, Gierer S, Gower R, Harris D, Jacobs J, Johnston D, Li H, Lockey R, Lugar P, Lumry W, Manning M, McNeil D, Melamed I, Otto W, Rehman S, Riedl M, Schwartz L, Shapiro R, Sher E, Smith A, Soteres D, Tachdjian R, Wedner H, Weinstein M, Zafra H. Long-term prevention of hereditary angioedema attacks with lanadelumab: The HELP OLE Study. Allergy 2022; 77:979-990. [PMID: 34287942 PMCID: PMC9292251 DOI: 10.1111/all.15011] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 03/22/2021] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
Background The aim was to evaluate long‐term effectiveness and safety of lanadelumab in patients ≥12 y old with hereditary angioedema (HAE) 1/2 (NCT02741596). Methods Rollover patients completing the HELP Study and continuing into HELP OLE received one lanadelumab 300 mg dose until first attack (dose‐and‐wait period), then 300 mg q2wks (regular dosing stage). Nonrollovers (newly enrolled) received lanadelumab 300 mg q2wks from day 0. Baseline attack rate for rollovers: ≥1 attack/4 weeks (based on run‐in period attack rate during HELP Study); for nonrollovers: historical attack rate ≥1 attack/12 weeks. The planned treatment period was 33 months. Results 212 patients participated (109 rollovers, 103 nonrollovers); 81.6% completed ≥30 months on study (mean [SD], 29.6 [8.2] months). Lanadelumab markedly reduced mean HAE attack rate (reduction vs baseline: 87.4% overall). Patients were attack free for a mean of 97.7% of days during treatment; 81.8% and 68.9% of patients were attack free for ≥6 and ≥12 months, respectively. Angioedema Quality‐of‐Life total and domain scores improved from day 0 to end of study. Treatment‐emergent adverse events (TEAEs) (excluding HAE attacks) were reported by 97.2% of patients; most commonly injection site pain (47.2%) and viral upper respiratory tract infection (42.0%). Treatment‐related TEAEs were reported by 54.7% of patients. Most injection site reactions resolved within 1 hour (70.2%) or 1 day (92.6%). Six (2.8%) patients discontinued due to TEAEs. No treatment‐related serious TEAEs or deaths were reported. Eleven treatment‐related TEAEs of special interest were reported by seven (3.3%) patients. Conclusion Lanadelumab demonstrated sustained efficacy and acceptable tolerability with long‐term use in HAE patients.
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Affiliation(s)
- Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section Department of Internal Medicine University of Cincinnati, and Bernstein Clinical Research Center Cincinnati Ohio USA
| | | | | | - Markus Magerl
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | | | - Andrea Zanichelli
- Department of Internal Medicine ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco‐University of Milan Milan Italy
| | - James Hao
- Takeda Development Center Americas, Inc. Lexington Massachusetts USA
| | - Neil Inhaber
- Takeda Development Center Americas, Inc. Lexington Massachusetts USA
| | - Ming Yu
- Takeda Development Center Americas, Inc. Lexington Massachusetts USA
| | - Marc A. Riedl
- Division of Rheumatology, Allergy and Immunology University of California San Diego La Jolla California USA
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16
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Narayan S, Pietrusz A, Allen J, Docherty K, Emery N, Ennis M, Flesher R, Foo W, Freebody J, Gallagher E, Grose N, Harris D, Hewamadduma C, Holmes S, James M, Maidment L, Mayhew A, Moat D, Moorcroft N, Muni-Lofra R, Nevin K, Quinlivan R, Sodhi J, Stuart D, White N, Yvonne J. Adult North Star Network (ANSN): Consensus Document for Therapists Working with Adults with Duchenne Muscular Dystrophy (DMD) - Therapy Guidelines. J Neuromuscul Dis 2022; 9:365-381. [PMID: 35124658 DOI: 10.3233/jnd-210707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Narayan
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - A Pietrusz
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Allen
- Neuromuscular Complex Care Centre (NMCCC), National Hospital for Neurology and Neurosurgery, UK
| | - K Docherty
- University Hospitals Dorset NHS Foundation Trust, UK
| | - N Emery
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - M Ennis
- The Walton Centre NHS Foundation Trust, UK
| | - R Flesher
- The Walton Centre NHS Foundation Trust, UK
| | - W Foo
- Manchester University NHS Foundation Trust, UK
| | - J Freebody
- John Radcliffe Hospital -OxfordUniversity Hospitals NHS Foundation Trust, UK
| | | | - N Grose
- North Bristol NHS Foundation Trust, The South West Neuromuscular Operational Delivery Network (SWNODN), UK
| | - D Harris
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - C Hewamadduma
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, UK
| | - S Holmes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UK
| | - M James
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - L Maidment
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Mayhew
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - D Moat
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - N Moorcroft
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - R Muni-Lofra
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - K Nevin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Quinlivan
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Sodhi
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | | | - N White
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - J Yvonne
- University Hospitals of Leicester Emergency and Specialist Medicine, UK
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Thiessen M, Harris D, Pinches A, Vaska M, Moules N, Raffin Bouchal S, Sinclair S. Qualitative Studies Conducted Alongside Randomized Controlled Trials in Oncology: A Scoping Review of Use and Rigour of Reporting. Int J Nurs Stud 2022; 128:104174. [DOI: 10.1016/j.ijnurstu.2022.104174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 01/08/2023]
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18
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Maguire K, Harris D, Barbic D. Does the Canadian TIA Score adequately risk stratify patients for subsequent stroke and revascularization in the emergency department? CAN J EMERG MED 2021; 24:131-132. [PMID: 34734377 DOI: 10.1007/s43678-021-00221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kaitlyn Maguire
- Royal College Emergency Medicine Training Program, University of British Columbia, Vancouver, BC, Canada.
| | - Devin Harris
- Department of Emergency Medicine, Kelowna General Hospital, Kelowna, BC, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Barbic
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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19
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Grunau B, Bashir J, Cheung A, Boone R, McDonald K, Scheuermeyer F, Singer J, Jenneson S, Straight R, Twaites B, Harris L, Haig S, Harris D, Vandegriend R, Kanji H, Christenson J. Corrigendum to "A pragmatic parallel group implementation study of a prehospital-activated ECPR protocol for refractory out-of-hospital cardiac arrest". [Resuscitation 167 (2021) 22-28]. Resuscitation 2021; 169:312-313. [PMID: 34716062 DOI: 10.1016/j.resuscitation.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Brian Grunau
- St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada.
| | - Jamil Bashir
- St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada
| | - Anson Cheung
- St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada
| | - Robert Boone
- St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiology, University of British Columbia, Canada
| | - Ken McDonald
- St. Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
| | - Frank Scheuermeyer
- St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada
| | - Sandra Jenneson
- Department of Emergency Medicine, University of British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Royal Columbian Hospital, New Westminster, B.C., Canada
| | - Ron Straight
- British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada
| | - Brian Twaites
- British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada
| | - Luke Harris
- St. Paul's Hospital, Vancouver, BC, Canada; Division of Cardiovascular Surgery, University of British Columbia, Canada
| | - Scott Haig
- British Columbia Emergency Health Services, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada
| | - Devin Harris
- Department of Emergency Medicine, University of British Columbia, Canada; Kelowna General Hospital, Kelowna, B.C., Canada
| | - Richard Vandegriend
- Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada
| | - Hussein Kanji
- Royal Columbian Hospital, New Westminster, B.C., Canada; Division of Critical Care, University of British Columbia, Canada; Vancouver General Hospital, Vancouver, B.C., Canada
| | - Jim Christenson
- St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada
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20
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Laghzaoui EM, Perera A, Harris D, Mouden EHE. Putative intranuclear coccidium in Mauremys leprosa (Schweigger) from Morocco. Folia Parasitol (Praha) 2021; 68. [PMID: 34642290 DOI: 10.14411/fp.2021.021] [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] [Received: 01/13/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022]
Abstract
Although intranuclear coccidiosis was first identified in chelonians less than 30 years ago, it is now considered an important emerging disease. Symptoms include anorexia, weakness and weight loss, potentially leading to death of the infected animal. The use of molecular tools has led to improved diagnosis and has also led to an increase in known host species. Here we report a putative intranuclear coccidium in Mauremys leprosa (Schweigger), from Morocco, based on 18S rDNA sequence analysis. This is, to the best of our knowledge, the first report of this parasite from a freshwater terrapin species.
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Affiliation(s)
- El-Mustapha Laghzaoui
- Laboratory of Water, Biodiversity and Climate Change, Faculty of Sciences, Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Ana Perera
- CIBIO-InBIO, Centro de Investigacao em Biodiversidade e Recursos Geneticos, Universidade do Porto, Campus de Vairao, Vairao, Portugal
| | - D Harris
- CIBIO-InBIO, Centro de Investigacao em Biodiversidade e Recursos Geneticos, Universidade do Porto, Campus de Vairao, Vairao, Portugal
| | - El Hassan El Mouden
- Laboratory of Water, Biodiversity and Climate Change, Faculty of Sciences, Semlalia, Cadi Ayyad University, Marrakech, Morocco
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Gwilym B, Waldron C, Thomas-Jones E, Pallmann P, Preece R, Brookes-Howell L, Milosevic S, Edwards A, Twine C, Massey I, Burton J, Harris D, Samuel K, Dilaver N, Day S, Bosanquet D. P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study. BJS Open 2021. [PMCID: PMC8030154 DOI: 10.1093/bjsopen/zrab032.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.
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Affiliation(s)
- B Gwilym
- South East Wales Vascular Network
| | | | | | | | - R Preece
- South East Wales Vascular Network
| | | | | | | | - C Twine
- South East Wales Vascular Network
| | - I Massey
- South East Wales Vascular Network
| | - J Burton
- South East Wales Vascular Network
| | - D Harris
- South East Wales Vascular Network
| | - K Samuel
- South East Wales Vascular Network
| | | | - S Day
- South East Wales Vascular Network
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Evans R, Sharma S, Claure-Del Granado R, Cullis B, Burdmann E, Hendricks K, Harris D, Rocco M. POS-016 IDENTIFYING KIDNEY DYSFUNCTION IN THE COMMUNITY SETTING: THE ISN KIDNEY CARE NETWORK PROJECT. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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23
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Evans R, Sharma S, Claure-Del Granado R, Cullis B, Burdmann E, Hendricks K, Harris D, Rocco M. POS-018 TREATMENT OF ACUTE KIDNEY INJURY IN THE COMMUNITY SETTING: THE ISN KIDNEY CARE NETWORK PROJECT. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Gilsenan A, Harris D, Reynolds M, McSorley D, Midkiff K, Jackson L, Muldavin B, Kellier-Steele N, Andrews E. Long-term cancer surveillance: results from the Forteo Patient Registry Surveillance Study. Osteoporos Int 2021; 32:645-651. [PMID: 33151378 PMCID: PMC8026426 DOI: 10.1007/s00198-020-05718-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Forteo Patient Registry estimated the incidence of osteosarcoma in US patients treated with teriparatide and enrolled in the study between 2009 and 2019. No incident cases of osteosarcoma were identified among patients registered, and the crude incidence rate was 0 (95% confidence interval [CI], 0-10.2) cases per million person-years. PURPOSE The prospective, voluntary Forteo Patient Registry was established to estimate the incidence of osteosarcoma in patients who have received treatment with teriparatide (Forteo). METHODS Information on US adults prescribed teriparatide and enrolled in the Forteo Patient Registry 2009-2019 was linked with data from participating state cancer registries annually (2010-2019) to identify incident osteosarcoma cases using a standardized linkage algorithm. Teriparatide exposure was ascertained from self-reported data that included teriparatide initiation and demographics necessary to complete linkage. Osteosarcoma cases diagnosed on or after January 1, 2009, were identified by participating state cancer registries. The crude incidence rate (IR) and standardized incidence ratio (SIR) of observed cases to the expected number of cases adjusted to the background rate (3 per million person-years) and corresponding 95% CIs for the occurrence of osteosarcoma were calculated whereby the cumulative amount of person-time observed was adjusted for mortality. RESULTS Data for 75,247 enrolled patients (representing 361,763 cumulative person-years) were linked to each of 42 participating state cancer registries (covering 93% of the US population), which included information on 6180 cases of osteosarcoma. No matches with incident cases of osteosarcoma following registry enrollment were found. The crude IR was 0 (95% CI, 0-10.2) cases per million person-years and the SIR was 0 (95% CI, 0-3.0). CONCLUSIONS The ability to draw conclusions about the incidence of osteosarcoma among patients participating in the registry was limited due to the smaller than expected amount of patient follow-up time and the fact that no cases were identified.
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Affiliation(s)
- A Gilsenan
- RTI Health Solutions, Research Triangle Park, NC, USA.
| | - D Harris
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - M Reynolds
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - D McSorley
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - K Midkiff
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - L Jackson
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - B Muldavin
- RTI International, Research Triangle Park, NC, USA
| | | | - E Andrews
- RTI Health Solutions, Research Triangle Park, NC, USA
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25
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Lumry WR, Weller K, Magerl M, Banerji A, Longhurst HJ, Riedl MA, Lewis HB, Lu P, Devercelli G, Jain G, Maurer M, Hébert J, Ritchie B, Sussman G, Yang WH, Martinez‐Saguer I, Staubach P, Cicardi M, Shennak M, Zaragoza‐Urdaz RH, Anderson J, Baptist AP, Bernstein JA, Boggs PB, Busse PJ, Craig T, Davis‐Lorton M, Gierer S, Gower RG, Harris D, Hong DI, Jacobs J, Johnston DT, Li HH, Lockey RF, Lugar P, Manning ME, McNeil DL, Melamed I, Mostofi T, Nickel T, Otto WR, Petrov AA, Radojicic C, Rehman SM, Schwartz LB, Shapiro R, Sher E, Smith AM, Soteres D, Tachdjian R, Wedner HJ, Weinstein ME, Zafra H. Impact of lanadelumab on health-related quality of life in patients with hereditary angioedema in the HELP study. Allergy 2021; 76:1188-1198. [PMID: 33258114 PMCID: PMC8247292 DOI: 10.1111/all.14680] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 06/22/2020] [Revised: 11/01/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
Background An objective of the phase 3 HELP Study was to investigate the effect of lanadelumab on health‐related quality of life (HRQoL) in patients with hereditary angioedema (HAE). Methods Patients with HAE‐1/2 received either lanadelumab 150 mg every 4 weeks (q4wks; n = 28), 300 mg q4wks (n = 29), 300 mg every 2 weeks (q2wks; n = 27), or placebo (n = 41) for 26 weeks (days 0–182). The Angioedema Quality of Life Questionnaire (AE‐QoL) was administered monthly, consisting of four domain (functioning, fatigue/mood, fears/shame, nutrition) and total scores. The generic EQ‐5D‐5L questionnaire was administered on days 0, 98, and 182. Comparisons were made between placebo and (a) all lanadelumab‐treated patients and (b) individual lanadelumab groups for changes in scores (day 0–182) and proportions achieving the minimal clinically important difference (MCID, −6) in AE‐QoL total score. Results Compared with the placebo group, the lanadelumab total group demonstrated significantly greater improvements in AE‐QoL total and domain scores (mean change, −13.0 to −29.3; p < 0.05 for all); the largest improvement was in functioning. A significantly greater proportion of the lanadelumab total group achieved the MCID (70% vs 37%; p = 0.001). The lanadelumab 300 mg q2wks group had the highest proportion (81%; p = 0.001) and was 7.2 times more likely to achieve the MCID than the placebo group. Mean EQ‐5D‐5L scores at day 0 were high in all groups, indicating low impairment, with no significant changes at day 182. Conclusion Patients with HAE‐1/2 experienced significant and clinically meaningful improvements in HRQoL measured by AE‐QoL following lanadelumab treatment in the HELP Study.
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Affiliation(s)
- William R. Lumry
- Allergy Asthma Research Associates Research Center Dallas TX USA
| | - Karsten Weller
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Markus Magerl
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Hilary J. Longhurst
- Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation TrustCambridge, and University College London Hospitals London UK
| | - Marc A. Riedl
- Division of Rheumatology Allergy & Immunology University of California San Diego La Jolla CA USA
| | | | - Peng Lu
- Takeda Pharmaceutical Company Limited Lexington MA USA
| | | | - Gagan Jain
- Takeda Pharmaceutical Company Limited Lexington MA USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
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26
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Evans R, Sharma S, Claure-Del Granado R, Cullis B, Burdmann E, Hendricks K, Harris D, Rocco M. POS-017 CAUSES OF ACUTE KIDNEY INJURY IN THE COMMUNITY SETTING: THE ISN KIDNEY CARE NETWORK PROJECT. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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27
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AZMI F, Cao Q, Zheng G, Ye P, Li H, Chen T, Duong H, Harris D, Wang Y. POS-220 DEVELOPING RENAL CLEARABLE NANOPARTICLES FOR THE TREATMENT OF RENAL CELL CARCINOMA. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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28
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Torabi F, Harris D, Akbari A, Bodger O, Lyons R, Gravenor M, Halcox J. Longitudinal study of adherence to anticoagulation guidelines in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Anticoagulation (AC) reduces the risk of stroke and systemic embolism (SSE) in patients with Atrial Fibrillation (AF). However, the association between changes in AF prevalence, risk factors for SSE, uptake of AC and incidence of SSE has not been documented specifically in these patients within a national population.
Purpose
Identifying antithrombotic prescribing and evaluating associations between changes in AF prevalence, SSE risk factors (CHA2DS2-VASC score) and uptake of AC. Evaluating relationships between changes in proportion of AF patients treated with AC and SSE rate at a population level. Developing a modelling tool which estimates rates of SSE (past and future) based on these factors, which can be used to drive improvements in health care.
Method
AF patients were identified in the population of Wales (SAIL databank) between 2012–2018. Temporal trends of AF, CHA2DS2-VASC scores, anti-thrombotic prescriptions and SSE events were evaluated. Multi-state Markov models were used to estimate SSE rates adjusted for AC and CHA2DS2-VASC scores. Simulation methods modelled SSE outcomes for the subsequent 7-years based on differing proportional population AC coverage.
Results
AF prevalence increased from 51,492 to 64,852 from 2012–18, with mean CHA2DS2-VASC score increasing from 3.0 to 3.9. AC prescription coverage increased (24,892 [48.3%] to 44,195 [68.1%]), whilst antiplatelet therapy alone or no antithrombotic therapy decreased (14,532 [28.0%] to 5,385 [8.3%] and 26,602 [52.0%] to 21,164 [33.0%] respectively). Hospitalisation rate for SSE in AF population decreased by over 20%, from 1,039 per 100,000 patients/quarter in 2012 to 809 per 100,000 patients/quarter in 2018.
Markov modelling demonstrated a 39% lower SSE rate with AC compared to no AC over time, after adjustment for individual CHA2DS2-VASC (HR=0.61, 95% CI [0.58, 0.63]). Using the estimated progression rates, simulation models shown that an expected 3,574 SSE events per 100,000 per year could have been reduced to 2,956 (17% reduction rate) if AC adherence had been at the now recommended 90% rate from 2012. This model also predicts that improving AC coverage to 90% of patients over the next 7-years would reduce SSE rates by 12% per year (assuming no further increase in mean CHA2DS2-VASC score).
Conclusion
Despite the increase in both prevalence of AF and CHA2DS2-VASC between 2012–18, we observed a progressive decrease in SSE events along with increasing AC prescribing. Our study suggests not only that improved AC coverage is associated with better clinical outcomes, but also that the rate of therapeutic implementation is likely a crucial factor. Reducing transition time between evidence-based guideline publication and widespread clinical uptake of the recommendations appears to be an important opportunity to improve clinical outcomes at a population level and should inform healthcare policy development and implementation.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Funded by research grant
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Affiliation(s)
- F Torabi
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - D Harris
- Swansea University Medical School, Swansea Bay University Health Board, Health Data Research UK, Swansea, United Kingdom
| | - A Akbari
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - O Bodger
- Swansea University Medical School, Swansea, United Kingdom
| | - R.A Lyons
- Swansea University Medical School, Health Data Research UK, Swansea, United Kingdom
| | - M Gravenor
- Swansea University Medical School, Swansea, United Kingdom
| | - J Halcox
- Swansea University Medical School, Swansea Bay University Health Board, Health Data Research UK, Swansea, United Kingdom
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Riedl MA, Maurer M, Bernstein JA, Banerji A, Longhurst HJ, Li HH, Lu P, Hao J, Juethner S, Lumry WR, Hébert J, Ritchie B, Sussman G, Yang WH, Escuriola Ettingshausen C, Magerl M, Martinez‐Saguer I, Maurer M, Staubach P, Zimmer S, Cicardi M, Perego F, Wu MA, Zanichelli A, Al‐Ghazawi A, Shennak M, Zaragoza‐Urdaz RH, Ghurye R, Longhurst HJ, Zinser E, Anderson J, Banerji A, Baptist AP, Bernstein JA, Boggs PB, Busse PJ, Christiansen S, Craig T, Davis‐Lorton M, Gierer S, Gower RG, Harris D, Hong DI, Jacobs J, Johnston DT, Levitch ES, Li HH, Lockey RF, Lugar P, Lumry WR, Manning ME, McNeil DL, Melamed I, Mostofi T, Nickel T, Otto WR, Petrov AA, Poarch K, Radojicic C, Rehman SM, Riedl MA, Schwartz LB, Shapiro R, Sher E, Smith AM, Smith TD, Soteres D, Tachdjian R, Wedner HJ, Weinstein ME, Zafra H, Zuraw BL. Lanadelumab demonstrates rapid and sustained prevention of hereditary angioedema attacks. Allergy 2020; 75:2879-2887. [PMID: 32452549 PMCID: PMC7689768 DOI: 10.1111/all.14416] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
Background Lanadelumab demonstrated efficacy in preventing hereditary angioedema (HAE) attacks in the phase 3 HELP Study. Objective To assess time to onset of effect and long‐term efficacy of lanadelumab, based on exploratory findings from the HELP Study. Methods Eligible patients with HAE type I/II received lanadelumab 150 mg every 4 weeks (q4wks), 300 mg q4wks, 300 mg q2wks, or placebo. Ad hoc analyses evaluated day 0‐69 findings using a Poisson regression model accounting for overdispersion. Least‐squares mean monthly HAE attack rate for lanadelumab was compared with placebo. Intrapatient comparisons for days 0‐69 versus steady state (days 70‐182) used a paired t test for continuous endpoints or Kappa statistics for categorical endpoints. Results One hundred twenty‐five patients were randomized and treated. During days 0‐69, mean monthly attack rate was significantly lower with lanadelumab (0.41‐0.76) vs placebo (2.04), including attacks requiring acute treatment (0.33‐0.61 vs 1.66) and moderate/severe attacks (0.31‐0.48 vs 1.33, all P ≤ .001). More patients receiving lanadelumab vs placebo were attack free (37.9%‐48.1% vs 7.3%) and responders (85.7%‐100% vs 26.8%). During steady state, the efficacy of lanadelumab vs placebo was similar or improved vs days 0‐69. Intrapatient differences were significant with lanadelumab 300 mg q4wks for select outcomes. Lanadelumab efficacy was durable—HAE attack rate was consistently lower vs placebo, from the first 2 weeks of treatment through study end. Treatment emergent adverse events were comparable during days 0‐69 and 70‐182. Conclusion Protection with lanadelumab started from the first dose and continued throughout the entire study period.
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Affiliation(s)
- Marc A. Riedl
- Division of Rheumatology, Allergy and Immunology University of California, San Diego San Diego CA USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section Department of Internal Medicine University of Cincinnati Cincinnati OH USA
- Bernstein Clinical Research Center Cincinnati OH USA
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - Hilary J. Longhurst
- Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge and University College London Hospitals London UK
| | - H. Henry Li
- Institute for Asthma and Allergy, P.C. Chevy Chase MD USA
| | - Peng Lu
- Shire, a Takeda company Lexington MA USA
| | - James Hao
- Shire, a Takeda company Lexington MA USA
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30
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Mansikka H, Virtanen K, Harris D, Jalava M. Measurement of team performance in air combat – have we been underperforming? Theoretical Issues in Ergonomics Science 2020. [DOI: 10.1080/1463922x.2020.1779382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Heikki Mansikka
- Department of Mathematics and Systems Analysis, Aalto University, Helsinki, Finland
- Insta DefSec, Tampere, Finland
| | - K. Virtanen
- Department of Mathematics and Systems Analysis, Aalto University, Helsinki, Finland
- Department of Military Technology, Finnish National Defence University, Helsinki, Finland
| | - D. Harris
- Faculty of Engineering, Environment and Computing, Coventry University, Coventry, UK
| | - M. Jalava
- Satakunta Air Command, Pirkkala, Finland
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31
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Ionescu A, Harris D, Selvaganapathy PR, Kishen A. Electrokinetic transport and distribution of antibacterial nanoparticles for endodontic disinfection. Int Endod J 2020; 53:1120-1130. [PMID: 32383495 DOI: 10.1111/iej.13321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/22/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022]
Abstract
AIM To assess a novel, noninvasive intervention capable of mobilizing charged antibacterial nanoparticles to the apical portions of the root canal system, utilizing the principles of electrokinetics. METHODS Experiments were conducted in three stages. Stage-1: A computer model was generated to predict and visualize the electric field and current density distribution generated by the proposed intervention. Stage-2: Transport of chitosan nanoparticles (CSnp) was evaluated qualitatively using a transparent microfluidic model with fluorescent-labelled CSnp. Stage-3: An ex vivo model was utilized to study the antimicrobial efficacy of the proposed treatment against 3-week-old monospecies E. faecalis biofilms. Scanning electron microscopy (SEM) was also utilized in this stage to confirm the deposition of CSnp. RESULTS The results of the computer simulations predicted an electric field and current density that reach their maxima at the apical constriction of the root canal. Correspondingly, the microfluidic experiments demonstrated rapid, controlled CSnp transport throughout the simulated root canal anatomy with subsequent distribution and deposition in the apical constriction as well as periapical regions. Infected root canals when subjected to the novel treatment method resulted in a mean bacterial reduction of 2.1 log CFU. SEM analysis revealed electrophoretic deposition of chitosan nanoparticles onto the root canal dentine walls in the apical region. CONCLUSION The findings from this study demonstrate that the combination of cationic antibacterial nanoparticles with a low-intensity electric field results in particle transportation (electrophoresis) and deposition within the root canal. This results in a synergistic antibiofilm efficacy and has the potential to enhance root canal disinfection.
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Affiliation(s)
- A Ionescu
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, ON, Canada
| | - D Harris
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, ON, Canada
| | - P R Selvaganapathy
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - A Kishen
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, ON, Canada
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Rocco M, Evans R, Sharma S, Claure-Del Granado R, Cullis B, Burdmann E, Hendricks K, Harris D. SUN-013 CAPACITY BUILDING FOR INTEGRATED CARE IN LOW RESOURCE SETTINGS: ISN KIDNEY CARE NETWORK PROJECT. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.535] [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: 10/24/2022] Open
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33
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Walton MK, Cappelleri JC, Byrom B, Goldsack JC, Eremenco S, Harris D, Potero E, Patel N, Flood E, Daumer M. Considerations for development of an evidence dossier to support the use of mobile sensor technology for clinical outcome assessments in clinical trials. Contemp Clin Trials 2020; 91:105962. [PMID: 32087341 DOI: 10.1016/j.cct.2020.105962] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/21/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mobile sensors offer enormous potential for the collection of informative clinical endpoints in clinical trials to support regulatory decision making and product labelling. There are currently no specific guidelines on the information needed to enable regulators to review and accept proposed endpoints derived from mobile sensors for use in drug development trials. OBJECTIVE The purpose of this working group report is to recommend the structure and content of an evidence dossier intended to support whether a clinical endpoint derived from mobile sensor data is fit-for-purpose for use in regulatory submissions for drug approvals. EVIDENCE DOSSIER The structure and content of a dossier to provide evidence supporting the use of a sensor-derived clinical endpoint is described. Sections include clinical endpoint definition and positioning, the concept of interest, the context of use, clinical validation and interpretation, study implementation, and analytical validity with sensor performance verification in support of the selected sensor. CONCLUSIONS In the absence of definitive regulatory guidance, this report provides a considered approach to compiling a comprehensive body of evidence to justify acceptance of mobile sensors for support of new drug applications.
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Affiliation(s)
- M K Walton
- Janssen Research and Development, Titusville, NJ, USA
| | | | | | - J C Goldsack
- Digital Medicine Society (DiMe), Sarasota, FL, USA
| | - S Eremenco
- Critical Path Institute, Tucson, AZ, USA
| | | | | | - N Patel
- AstraZeneca, Gaithersburg, MD, USA
| | - E Flood
- AstraZeneca, Gaithersburg, MD, USA
| | - M Daumer
- Sylvia Lawry Centre for Multiple Sclerosis Research, Munich, Germany
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Gassner A, Harris D, Mausch K, Terheggen A, Lopes C, Finlayson RF, Dobie P. Poverty eradication and food security through agriculture in Africa: Rethinking objectives and entry points. Outlook Agric 2019; 48:309-315. [PMID: 33281227 PMCID: PMC7684531 DOI: 10.1177/0030727019888513] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Agriculture in Africa is expected to meet the dual objectives of providing food and helping people to escape poverty. African agriculture is dominated by smallholdings and donors generally target their agricultural support at the smallholder sector. The expectation is that if the gap between actual and potential yields can be closed, smallholders will grow sufficient crops to feed their families, with a surplus to sell, thus meeting food security needs and bringing in an income to move them out of poverty. In practice, this is often not possible. While technologies already exist that can raise smallholder farmers' yields 3 or 4 times, even under rainfed conditions, the small size of land available to them limits how much can be grown and the per capita income from agriculture is insufficient to allow people to move above the current World Bank-defined poverty line of US$1.90 per day. We link this finding with farmer typologies to further explain that there are large differences between individual farming households themselves in terms of their investment incentives and capability to benefit from field-level technologies that are aimed at increasing farm productivity. We argue for more differentiated policies for agricultural development in Africa and suggest that policymakers should be much more aware of the heterogeneity of farms and target interventions accordingly. It is important to understand where and for whom agriculture will have the main purpose of ensuring food and nutritional security and where and for whom there is the potential for significant increases in incomes and a contribution to wider economic growth. Let us recognize the distinctiveness of these targets and underlying target groups and work towards solutions that address the underlying needs.
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Affiliation(s)
- A Gassner
- World Agroforestry (ICRAF), 2/F Khush Hall, International Rice Research
Institute (IRRI), Los Baños, Laguna, Philippines
| | - D Harris
- International Crops Research Institute for the Semi-Arid Tropics (ICRISAT),
Nairobi, Kenya
- School of Natural Sciences, Bangor University, Bangor, UK
| | - K Mausch
- World Agroforestry (ICRAF), Nairobi, Kenya
| | | | - C Lopes
- Oxford Martin School, Oxford, UK
| | | | - P Dobie
- World Agroforestry (ICRAF), Nairobi, Kenya
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Dansie K, Davies C, Hawley C, Johnson D, Craig J, Chapman J, Cooper B, Pollock C, Harris D, McDonald S. SAT-022 ASSOCIATION BETWEEN PUBLICATION OF THE INITIATING DIALYSIS EARLY AND LATE (IDEAL) STUDY AND CHANGE IN DIALYSIS INITIATION PRACTICE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Harris D, Thomas K, Jutkowitz E. DOES TECHNOLOGY USE PROTECT AGAINST COGNITIVE DECLINE? RESULTS FROM A RETROSPECTIVE COHORT STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Harris
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - K Thomas
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - E Jutkowitz
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
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Gilsenan A, Harding A, Kellier-Steele N, Harris D, Midkiff K, Andrews E. The Forteo Patient Registry linkage to multiple state cancer registries: study design and results from the first 8 years. Osteoporos Int 2018; 29:2335-2343. [PMID: 29978254 PMCID: PMC6154045 DOI: 10.1007/s00198-018-4604-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 11/05/2022]
Abstract
UNLABELLED The Forteo Patient Registry (FPR) aims to estimate the incidence of osteosarcoma in US patients treated with teriparatide. Enrollment began in 2009 and will continue through 2019, with linkage planned through 2024. To date, no incident cases of osteosarcoma have been identified among patients registered in the FPR. INTRODUCTION The Forteo Patient Registry (FPR) was established in 2009 to estimate the incidence of osteosarcoma in US patients treated with teriparatide. The objective of this paper is to describe study methods, challenges encountered, and progress to date. METHODS The FPR is a prospective US registry designed to link data from participants annually with state cancer registries. Patient enrollment is planned for 10 years (2009-2019) and annual linkage with US state cancer registries for 15 years (2010-2024). All US state cancer registries and DC were invited to participate. Patients are recruited using pre-enrollment materials included in teriparatide device packaging, kits, and brochures distributed by health-care providers; a toll-free number; and a study website. A linkage algorithm is used to match data from enrolled participants with cancer registry data. RESULTS For the eighth annual linkage in 2017, information necessary for linkage with 63,270 patients in the FPR was submitted to each of the 42 participating registries. These patients contributed approximately 242,782 person-years of follow-up. A total of 5268 adult osteosarcoma cases diagnosed since January 1, 2009, were available for linkage from participating state cancer registries. To date, no incident cases of osteosarcoma have been identified among patients registered in the FPR. CONCLUSIONS Based on the estimated 242,782 person-years of observation as of the eighth annual linkage and projecting current enrollment rate to study end in 2024, it is anticipated that the completed study will be able to detect a fourfold increase in the risk of osteosarcoma if one exists.
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Affiliation(s)
- A Gilsenan
- RTI Health Solutions, 200 Park Offices Drive, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - A Harding
- RTI Health Solutions, 200 Park Offices Drive, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - N Kellier-Steele
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - D Harris
- RTI Health Solutions, 200 Park Offices Drive, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - K Midkiff
- RTI Health Solutions, 200 Park Offices Drive, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - E Andrews
- RTI Health Solutions, 200 Park Offices Drive, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
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Jones HG, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans MD, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Colorectal Dis 2018; 33:857-862. [PMID: 29705942 DOI: 10.1007/s00384-018-3061-3] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The inflammatory response is known to have an important role in tumourigenesis and the response to treatment. Previous studies have demonstrated that inflammatory cell ratios such as the neutrophil-to-lymphocyte ratio (NLR) can predict survival and recurrence following surgery for various cancers. The objective of this study was to demonstrate if pre-operative NLR has a role in predicting post-operative septic complications in patients undergoing rectal cancer surgery. METHODOLOGY Consecutive patients undergoing scheduled resection for rectal cancer in a tertiary centre from July 2007 to Dec 2015 were included. Data was gathered from a prospectively held database of rectal cancer. Normally distributed data were compared with paired t tests (mean ± standard error in the mean (SEM)), and proportions were compared with Fisher's exact test. A p value of < 0.05 was considered statistically significant. RESULTS Three hundred fourteen patients were identified in this study. Sixty nine (22.0%) patients had a major septic complication following surgery for rectal cancer, which was associated with a poor survival outcome (p < 0.01) Both pre and post-operative NLR and PLR (platelet lymphocyte ratio) were associated with post-operative septic complications (both p < 0.01). A pre-operative NLR threshold level of 4 was chosen from ROC analysis, and this provided a relatively specific test to predict post-operative septic complications in these patients (specificity = 83.7%, negative predictive value (NPV) = 74.8%). DISCUSSION In this study, the pre-operative NLR and PLR were both predictive of major post-operative septic complications. A pre-operative NLR of less than 4 was strongly negative predictor of post-operative complications in rectal cancer surgery. It can be regarded as a predictive and prognostic factor for these patients.
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Affiliation(s)
- H G Jones
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK.
| | - E Qasem
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - N Dilaver
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Egan
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - O Bodger
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Kokelaar
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M D Evans
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M Davies
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - J Beynon
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - D Harris
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
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Harris D, Visser J, Hurwitz P, Dietze D. 253 Physician- and Patient-reported Outcomes Following Use of a Compounded Scar/Burn Gel: Results from a Prospective Observational Survey Study. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- D Harris
- Clarity Science, Austin, TX; Mid-West Podiatry and Associates, LLC, Creve Coeur, MO; Metrics for Learning, LLC, Queen Creek, AZ
| | - J Visser
- Clarity Science, Austin, TX; Mid-West Podiatry and Associates, LLC, Creve Coeur, MO; Metrics for Learning, LLC, Queen Creek, AZ
| | - P Hurwitz
- Clarity Science, Austin, TX; Mid-West Podiatry and Associates, LLC, Creve Coeur, MO; Metrics for Learning, LLC, Queen Creek, AZ
| | - D Dietze
- Clarity Science, Austin, TX; Mid-West Podiatry and Associates, LLC, Creve Coeur, MO; Metrics for Learning, LLC, Queen Creek, AZ
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O'Dwyer D, Williams A, Khan U, Harris D, Evans M, Davies M. NELA - Identifying Factors to Improve Mortality Rates. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.045] [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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Tang A, Radwan R, Harris D. Conservative Management of Colovesical Fistulas Secondary to Diverticular Disease: A Systematic Review. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kondo K, Shaim H, Thompson PA, Burger JA, Keating M, Estrov Z, Harris D, Kim E, Ferrajoli A, Daher M, Basar R, Muftuoglu M, Imahashi N, Alsuliman A, Sobieski C, Gokdemir E, Wierda W, Jain N, Liu E, Shpall EJ, Rezvani K. Ibrutinib modulates the immunosuppressive CLL microenvironment through STAT3-mediated suppression of regulatory B-cell function and inhibition of the PD-1/PD-L1 pathway. Leukemia 2017; 32:960-970. [PMID: 28972595 DOI: 10.1038/leu.2017.304] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Ibrutinib, a covalent inhibitor of Bruton Tyrosine Kinase (BTK), is approved for treatment of patients with relapsed/refractory or treatment-naïve chronic lymphocytic leukemia (CLL). Besides directly inhibiting BTK, ibrutinib possesses immunomodulatory properties through targeting multiple signaling pathways. Understanding how this ancillary property of ibrutinib modifies the CLL microenvironment is crucial for further exploration of immune responses in this disease and devising future combination therapies. Here, we investigated the mechanisms underlying the immunomodulatory properties of ibrutinib. In peripheral blood samples collected prospectively from CLL patients treated with ibrutinib monotherapy, we observed selective and durable downregulation of PD-L1 on CLL cells by 3 months post-treatment. Further analysis showed that this effect was mediated through inhibition of the constitutively active signal transducer and activator of transcription 3 (STAT3) in CLL cells. Similar downregulation of PD-1 was observed in CD4+ and CD8+ T cells. We also demonstrated reduced interleukin (IL)-10 production by CLL cells in patients receiving ibrutinib, which was also linked to suppression of STAT3 phosphorylation. Taken together, these findings provide a mechanistic basis for immunomodulation by ibrutinib through inhibition of the STAT3 pathway, critical in inducing and sustaining tumor immune tolerance. The data also merit testing of combination treatments combining ibrutinib with agents capable of augmenting its immunomodulatory effects.
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Affiliation(s)
- K Kondo
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H Shaim
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P A Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J A Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Harris
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Kim
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Daher
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Basar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Muftuoglu
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Imahashi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Alsuliman
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Sobieski
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Gokdemir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Liu
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Maitra R, Manke A, Wiethe R, Amato G, Snyder R, Vasukuttan V, Cortes R, Lefever T, Wiley J, Harris D, Runyon R. OR4-5DEVELOPMENT OF a peripherally restricted CB1 receptor antagonist FOR ALCOHOLIC STEATOSIS. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx074.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lawrence B, Blenkiron C, Parker K, Fitzgerald S, Shields P, Tsai P, James S, Poonawala N, Yeong M, Kramer N, Robinson B, Connor S, Ramsaroop R, Yozu M, Elston M, Jackson C, Carroll R, Harris D, Findlay M, Print C. Pancreatic neuroendocrine tumour (pNET) profiles in the NETwork! programme: clinic–enabled genomics for genomic-enabled clinical decisions. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cornish J, Harries RL, Bosanquet D, Rees B, Ansell J, Frewer N, Dhruva Rao PK, Parry C, Ellis-Owen R, Phillips SM, Morris C, Horwood J, Davies ML, Davies MM, Hargest R, Davies Z, Hilton J, Harris D, Ben-Sassi A, Rajagopal R, Hanratty D, Islam S, Watkins A, Bashir N, Jones S, Russell IR, Torkington J. Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial. Trials 2016; 17:454. [PMID: 27634489 PMCID: PMC5025615 DOI: 10.1186/s13063-016-1573-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/22/2016] [Accepted: 08/14/2016] [Indexed: 01/05/2023] Open
Abstract
Background Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision. Methods/design This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome. Discussion A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions. Trial registration Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Cornish
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R L Harries
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - D Bosanquet
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - B Rees
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Ansell
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - N Frewer
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - P K Dhruva Rao
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Parry
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Ellis-Owen
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - S M Phillips
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - C Morris
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Horwood
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M L Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - M M Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - R Hargest
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - Z Davies
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - J Hilton
- Princess of Wales Hospital, Bridgend, UK
| | | | | | | | - D Hanratty
- Royal Glamorgan Hospital, Llantrisant, UK
| | - S Islam
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - A Watkins
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - N Bashir
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - S Jones
- Involving People, Health and Care Research Wales, Cardiff, UK
| | - I R Russell
- Swansea Clinical Trials Unit, Swansea University, Swansea, UK
| | - J Torkington
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
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Sexton K, Harris D, Smolarek S. Laparoscopic use of a 90-degree cross-stapling device for low rectal division. Ann R Coll Surg Engl 2016; 99:176. [PMID: 27513795 DOI: 10.1308/rcsann.2016.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- K Sexton
- Singleton Hospital , Swansea , UK
| | - D Harris
- Singleton Hospital , Swansea , UK
| | - S Smolarek
- Colorectal Unit, level 7, Derriford Hospital Plymouth , UK
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Burdorf L, Riner A, Rybak E, Salles II, De Meyer SF, Shah A, Quinn KJ, Harris D, Zhang T, Parsell D, Ali F, Schwartz E, Kang E, Cheng X, Sievert E, Zhao Y, Braileanu G, Phelps CJ, Ayares DL, Deckmyn H, Pierson RN, Azimzadeh AM, Dandro A, Karavi K. Platelet sequestration and activation during GalTKO.hCD46 pig lung perfusion by human blood is primarily mediated by GPIb, GPIIb/IIIa, and von Willebrand Factor. Xenotransplantation 2016; 23:222-236. [PMID: 27188532 DOI: 10.1111/xen.12236] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/17/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Here, we ask whether platelet GPIb and GPIIb/IIIa receptors modulate platelet sequestration and activation during GalTKO.hCD46 pig lung xenograft perfusion. METHODS GalTKO.hCD46 transgenic pig lungs were perfused with heparinized fresh human blood. Results from perfusions in which αGPIb Fab (6B4, 10 mg/l blood, n = 6), αGPIIb/IIIa Fab (ReoPro, 3.5 mg/l blood, n = 6), or both drugs (n = 4) were administered to the perfusate were compared to two additional groups in which the donor pig received 1-desamino-8-d-arginine vasopressin (DDAVP), 3 μg/kg (to pre-deplete von Willebrand Factor (pVWF), the main GPIb ligand), with or without αGPIb (n = 6 each). RESULTS Platelet sequestration was significantly delayed in αGPIb, αGPIb+DDAVP, and αGPIb+αGPIIb/IIIa groups. Median lung "survival" was significantly longer (>240 vs. 162 min reference, p = 0.016), and platelet activation (as CD62P and βTG) were significantly inhibited, when pigs were pre-treated with DDAVP, with or without αGPIb Fab treatment. Pulmonary vascular resistance rise was not significantly attenuated in any group, and was associated with residual thromboxane and histamine elaboration. CONCLUSIONS The GPIb-VWF and GPIIb/IIIa axes play important roles in platelet sequestration and coagulation cascade activation during GalTKO.hCD46 lung xenograft injury. GPIb blockade significantly reduces platelet activation and delays platelet sequestration in this xenolung rejection model, an effect amplified by adding αGPIIb/IIIa blockade or depletion of VWF from pig lung.
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Affiliation(s)
- L Burdorf
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - A Riner
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - E Rybak
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - I I Salles
- Laboratory for Thrombosis Research, IRF-Ls, Kulak KU Leuven, Belgium.,Centre for Hematology, Imperial College London, UK
| | - S F De Meyer
- Laboratory for Thrombosis Research, IRF-Ls, Kulak KU Leuven, Belgium
| | - A Shah
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - K J Quinn
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - D Harris
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - T Zhang
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - D Parsell
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - F Ali
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - E Schwartz
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - E Kang
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - X Cheng
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - E Sievert
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - Y Zhao
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - G Braileanu
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - C J Phelps
- Revivicor, Inc., Blacksburg, VA, United States
| | - D L Ayares
- Revivicor, Inc., Blacksburg, VA, United States
| | - H Deckmyn
- Laboratory for Thrombosis Research, IRF-Ls, Kulak KU Leuven, Belgium
| | - R N Pierson
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
| | - A M Azimzadeh
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, and VA Maryland Health Care System, Baltimore, MD, United States
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Burdorf L, Laird C, O’Neill N, Dahi S, Kubicki N, Zhang T, Harris D, Parsell D, Rybak E, Rabin J, Tatarov I, Phelps C, Ayares D, Azimzadeh A, Pierson R. Xenogeneic Lung Transplantation: Extending Life-Supporting Organ Function Using Multi-Transgenic Donor Pigs and Targeted Drug Treatments. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Harris D, Desai S, Smieja M, Rutherford C, Mertz D, Pernica JM. What happened to enterovirus D68 infections in 2015? Can Commun Dis Rep 2016; 42:9-11. [PMID: 29769975 PMCID: PMC5864253 DOI: 10.14745/ccdr.v42i01a02] [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] [Indexed: 06/08/2023]
Abstract
BACKGROUND Enterovirus-D68 (EV-D68) was observed in association with severe respiratory disease in children in North America and around the world in the fall of 2014. OBJECTIVE To compare fall 2014 detection rates with fall 2015 detection rates of EV-D68 in nasopharyngeal swab (NPS) samples collected for routine clinical care from a large regional laboratory in south-central Ontario. METHOD Consecutive NPS samples submitted from inpatients and outpatients in Hamilton, Niagara Region and Burlington to the Regional Virology Laboratory were tested with multiplex polymerase chain reaction (PCR) for rhinovirus/enterovirus (as a single target) and for other common respiratory viruses. All NPS samples positive for rhinovirus/enterovirus were reflexed to a lab-developed single target PCR for EV-D68 detection. RESULTS In 2014, between August 1 and October 31, 566 of 1,497 (38%, 95%CI 35-40%) NPS samples were rhino/enterovirus positive, of which 177 (31%, 95%CI 27-35%) were confirmed as EV-D68. In 2015, between August 1 and October 31, 472 of 1,630 (29%, 95%CI 27-31%) NPS samples were rhino/enterovirus positive, of which none (0%, upper limit 97.5%CI 0.8%) were confirmed to be EV-D68. CONCLUSION Based on testing results, there appears to be much less circulating EV-D68 in south central Ontario in 2015 than in 2014. Further studies would be helpful to determine if detection rates have also dramatically decreased in other regions in Canada and internationally.
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Affiliation(s)
- D Harris
- Department of Medicine, McMaster University, Hamilton, ON
| | - S Desai
- Department of Pediat rics, McMaster University, Hamilton, ON
| | - M Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | | | - D Mertz
- Department of Medicine, McMaster University, Hamilton, ON
| | - JM Pernica
- Department of Pediat rics, McMaster University, Hamilton, ON
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