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Harris D, Frampton C, Patel S, White D, Arad U. Acute calcium pyrophosphate crystal arthritis is associated with an increased rate of hip and knee joint surgery. Rheumatology (Oxford) 2024; 63:977-982. [PMID: 37338569 DOI: 10.1093/rheumatology/kead305] [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: 11/20/2022] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Acute calcium pyrophosphate (CPP) crystal arthritis is a distinct manifestation of calcium pyrophosphate crystal deposition (CPPD). No studies have specifically examined whether acute CPP crystal arthritis is associated with progressive structural joint damage. The objective of this retrospective cohort study was to evaluate the relative rate of hip and knee joint arthroplasties as an estimate of structural joint damage accrual, in a population of patients with acute CPP crystal arthritis. METHODS Data were collected from Waikato District Health Board (WDHB) to identify an acute CPP crystal arthritis cohort with clinical episodes highly characteristic of acute CPP crystal arthritis. Data on hip and knee joint arthroplasties were collected from the New Zealand Orthopaedic Association's Joint Registry. The rate of arthroplasties in the cohort was compared with the age-ethnicity-matched New Zealand population. Additional analysis was performed for age, obesity (BMI) and ethnicity. RESULTS The acute CPP crystal arthritis cohort included 99 patients; 63 were male and the median age was 77 years (interquartile range, 71-82). The obesity rate was 36% with a median BMI of 28.4 kg/m2 (interquartile range, 25.8-32.2), comparable to the New Zealand population. The standardized surgical rate ratio in the cohort vs the age-ethnicity-matched New Zealand population was 2.54 (95% CI: 1.39, 4.27). CONCLUSION Our study identified a considerable increase in the rate of hip and knee joint arthroplasties in patients with episodes of acute CPP crystal arthritis. This suggests CPP crystal arthritis may be a chronic condition, leading to progressive joint damage.
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Affiliation(s)
- David Harris
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
| | | | - Sandeep Patel
- Orthopaedic Department, Waikato Hospital, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Uri Arad
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
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Calfee CS, Harhay MO, Schenck EJ, Ferguson ND, Heunks L, White D, Brochard LJ. Critical Care: A Second Special Issue of the Blue Journal. Am J Respir Crit Care Med 2024; 209:769-771. [PMID: 38501798 PMCID: PMC10995575 DOI: 10.1164/rccm.202402-0460ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Carolyn S Calfee
- Department of Medicine
- Department of Anesthesia University of California, San Francisco San Francisco, California
| | - Michael O Harhay
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania
| | - Edward J Schenck
- Joan and Sanford I. Weill Department of Medicine Weill Cornell Medicine New York, New York
- NewYork-Presbyterian Hospital Weill Cornell Medical Center New York, New York
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine University of Toronto Toronto, Ontario, Canada
- Department of Medicine Toronto General Hospital Toronto, Ontario, Canada
| | - Leo Heunks
- Department of Intensive Care Radboud University Medical Center Nijmegen, the Netherlands
| | - Douglas White
- Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine University of Toronto Toronto, Ontario, Canada
- Keenan Research Center Unity Health Toronto Toronto, Ontario, Canada
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van Dantzig P, Quincey V, Kurz J, Ming C, Kamalaksha S, White D. Epidemiology of giant cell arteritis in Waikato, Aotearoa New Zealand. N Z Med J 2024; 137:14-21. [PMID: 38513200 DOI: 10.26635/6965.6379] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM Giant cell arteritis (GCA) is the most common primary vasculitis in adults over 50 years of age. Our primary objective was to assess the incidence and prevalence of GCA in Waikato in a bid to deepen our understanding of the epidemiology of GCA in Aotearoa New Zealand. METHODS From January 2014 to December 2022, cases of GCA were identified prospectively and retrospectively through temporal artery ultrasound request lists and temporal artery biopsy histology reports. Using electronic health records, data were collected retrospectively on patient demographics and clinical features. These were used to calculate the incidence, prevalence and standardised mortality ratio (SMR) of GCA in Waikato. RESULTS There were 214 patients diagnosed with GCA over the 9-year period. The majority of patients were European (93.9%, 201/214) with Māori patients being significantly younger than European patients. The mean annual incidence of clinical GCA was 14.7 per 100,000 people over 50 years (95% confidence interval [CI] 12.7-16.6). The SMR was 1.18 (95% CI 0.83-1.52). CONCLUSION This is the largest study to date on the epidemiology of GCA in Aotearoa New Zealand. The incidence of GCA is comparable to other studies performed in Aotearoa New Zealand and appears to be stable over time. GCA is uncommon in Māori, Pacific Islander and Asian ethnic groups.
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Affiliation(s)
| | - Vicki Quincey
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
| | - Jason Kurz
- University of Waikato, Hamilton, New Zealand
| | - Caroline Ming
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand
| | - Sujatha Kamalaksha
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Douglas White
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
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van Dantzig P, White D, Kurz J, Ming C, Kamalaksha S, Quincey V. Performance of a fast-track pathway for giant cell arteritis in Waikato, Aotearoa New Zealand. N Z Med J 2024; 137:31-42. [PMID: 38513202 DOI: 10.26635/6965.6376] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIMS Giant cell arteritis (GCA) is the most common primary vasculitis in adults over 50 years of age. To facilitate early diagnosis and reduce harms from corticosteroids and temporal artery biopsies, fast-track pathways have been established. We review the benefits of the fast-track pathway set up in Waikato, Aotearoa New Zealand. METHODS Patients were collected prospectively as part of the fast-track pathway from 2014 to 2022. Their records were then reviewed retrospectively to collect data on clinical features, investigations and treatment. RESULTS There were 648 individual patients over the study period who had a colour Doppler ultrasound (CDUS) of the temporal arteries. There were 17 true positive CDUS, giving a sensitivity of 10.3% (95% confidence interval [CI] 6.3-15.5%) and specificity of 99.8% (95% CI 99.1-100%). Patients with GCA and a positive scan had significantly fewer steroids than those with GCA and a negative scan (p=0.0037). There were 376 patients discharged after a CDUS who did not have a diagnosis of GCA, resulting in reduced corticosteroid and temporal artery biopsy exposure. CONCLUSIONS This is a real-life study that reflects the benefits of fast-track pathways in Aotearoa New Zealand to patients and healthcare systems. It also shows the effect of corticosteroids on positive CDUS, an important consideration when setting up an fast-track pathway.
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Affiliation(s)
| | - Douglas White
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
| | - Jason Kurz
- University of Waikato, Hamilton, New Zealand
| | - Caroline Ming
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand
| | - Sujatha Kamalaksha
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Vicki Quincey
- Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand; Waikato Clinical School, The University of Auckland, Hamilton, New Zealand
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Carter K, Lippe R, Photowala H, Drogaris L, Soliman AM, Chen M, Padilla B, Behrens F. Efficacy and Safety of Risankizumab for Active Psoriatic Arthritis: 100-Week Results from the Phase 3 KEEPsAKE 1 Randomized Clinical Trial. Rheumatol Ther 2024:10.1007/s40744-024-00654-5. [PMID: 38498141 DOI: 10.1007/s40744-024-00654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Patients with psoriatic arthritis (PsA) require treatment providing durable long-term efficacy in different disease domains as well as safety. We present 100-week efficacy and safety results of risankizumab in patients with active PsA and previous inadequate response/intolerance to ≥ 1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR). METHODS KEEPsAKE 1 (NCT03675308) is a global phase 3 study, including a 24-week, double-blind, placebo-controlled and ongoing open-label extension periods. Patients were randomized 1:1 to receive risankizumab 150 mg or placebo at baseline and weeks 4 and 16. After week 24, all patients received open-label risankizumab every 12 weeks thereafter. Patients were evaluated through 100 weeks. Endpoints included achieving ≥ 20% reduction in American College of Rheumatology criteria for symptoms of rheumatoid arthritis (ACR20), minimal disease activity (MDA; defined as ≥ 5/7 criteria of low disease activity and extent), and other measures. RESULTS Overall, 828/964 (85.9%) patients completed week 100. For patients receiving continuous risankizumab, 57.3%, 70.6%, and 64.3% achieved ACR20 at weeks 24, 52, and 100, respectively. For the placebo/risankizumab cohort, 33.5% achieved ACR20 at week 24 but increased after switching to active treatment at weeks 52 (63.7%) and 100 (62.1%). In ACR20 responders at week 52, 81.2% of both treatment cohorts maintained response at week 100. MDA was achieved by 25.0%, 38.3%, and 38.2% of the continuous risankizumab cohort at weeks 24, 52, and 100. In the placebo/risankizumab cohort, 10.2% achieved MDA at week 24, increasing at weeks 52 (28.0%) and 100 (35.2%). MDA response was maintained at week 100 in week 52 responders in the continuous risankizumab (75.5%) and placebo/risankizumab cohorts (78.2%). Similar trends were observed for other efficacy measures. Risankizumab was generally well tolerated through 100 weeks. CONCLUSIONS For patients with active PsA who are csDMARD-IR, risankizumab demonstrated durable long-term efficacy and was generally well tolerated, with a consistent long-term safety profile. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57 Road 8, Entrance 19, 2000, Frederiksberg, Copenhagen, Denmark.
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research and Alliance Clinical Trials, Waterloo, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | | | | | | | | | - Frank Behrens
- Rheumatology, Immunology, Inflammation Medicine, University Hospital and Fraunhofer Institute for Translational Medicine & Pharmacology ITMP, Fraunhofer Cluster of Excellence Immune-Mediated Diseases CIMD, Goethe University, Frankfurt Am Main, Germany
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Lao C, Van Dantzig P, White D, Rabindranath K, Foxall D, Lawrenson R. Prevalence and outcomes of end-stage kidney disease in patients with systemic lupus erythematous: a population-based study. Rheumatol Int 2024; 44:469-475. [PMID: 37580433 PMCID: PMC10867043 DOI: 10.1007/s00296-023-05409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
This study aims to examine the prevalence and outcomes of end-stage kidney disease (ESKD) among systemic lupus erythematosus (SLE) patients. SLE patients identified from the national administrative datasets were linked to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) to identify the ESKD cases. Period prevalence of ESKD among SLE patients was calculated. The risk of developing ESKD by ethnicity was explored with Cox Proportional Hazards model. The adjusted hazard ratio (HR) of all-cause mortality for Māori, Pacific, Asian compared to European/others was estimated. Of the 2837 SLE patients, 210 (7.4%) developed ESKD. The average period prevalence of ESKD among SLE patients was 5.7%. Men had twice the prevalence rate of ESKD than women (10.0% vs 5.2%). Māori and Pacific had higher prevalence rate than Asian and European/others (9.4%, 9.8% vs 4.4% and 3.8%). The adjusted HR of developing ESKD for men compared to women was 3.37 (95% CI 1.62-7.02). The adjusted HR of developing ESKD for Māori and Pacific compared to European/others was 4.63 (95% CI 1.61-13.29) and 4.66 (95% CI 1.67-13.00), respectively. Compared to European/others, Māori had an HR of 2.17 (95% CI 1.18-4.00) for all-cause mortality. SLE patients had a high prevalence rate of ESKD. Men, Māori, and Pacific patients with SLE were more likely to develop ESKD. Māori patients with ESKD had poorer survival than other patients. Interventions are needed to reduce the risk of ESKD and to improve the survival of ESKD patients for the disadvantaged groups.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | | | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
| | | | - Donna Foxall
- Te Huataki Waiora, School of Health, The University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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7
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Lopes TSB, Shi H, White D, Araújo ICS, Kim WK. Effects of 25-hydroxycholecalciferol on performance, gut health, and bone quality of broilers fed with reduced calcium and phosphorus diet during Eimeria challenge. Poult Sci 2024; 103:103267. [PMID: 38113706 PMCID: PMC10770761 DOI: 10.1016/j.psj.2023.103267] [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: 07/15/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023] Open
Abstract
This study evaluated the effects of 25-hydroxycholecalciferol (25-OHD) on performance, gut health, and bone quality of broilers fed with reduced calcium (Ca) and phosphorus (P) diet during Eimeria spp. challenge. A total of 576 fourteen-day-old Cobb 500 male chicks were randomly distributed in a 2 × 2 × 2 factorial arrangement, with 6 replicates of 12 birds each. The main factors were 25-OHD level (0 or 3,000 IU/kg of feed), mineral level (0.84% of Ca/0.42% of P, the levels recommended for the grower phase (NOR) or 0.64% of Ca/0.22% of P (RED), and mid-high mixed Eimeria challenge or nonchallenge. 25-OHD improved phosphorus retention (P = 0.019), bone ash weight (P = 0.04), cortical bone trabecular connectivity (P = 0.043) during coccidiosis. For birds fed with reduced mineral levels, 25-OHD supplementation increased bone ash weight (P = 0.04). However, 25-OHD did not improve bone ash weight when birds were challenged and fed with reduced mineral levels. The dietary 3,000 IU of 25-OHD supplementation did not improve performance or gut morphology but support bone health during coccidiosis. Future investigations are needed for better understand 25-OHD role on bone microarchitecture and oxidative metabolism during coccidiosis.
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Affiliation(s)
- T S B Lopes
- Department of Animal Science, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - H Shi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - D White
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - I C S Araújo
- Department of Animal Science, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - W K Kim
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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8
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Singh R, White D, Romano G, Osenda E, Allen S, Dunstan M, Elangovan R, Jourdan I, Rockall T, Scala A. Factors affecting quality of life in rectal cancer survivors who have undergone laparoscopic surgery: patient-reported outcomes over 10 years at a single institution. Ann R Coll Surg Engl 2024; 106:13-18. [PMID: 36748787 PMCID: PMC10757878 DOI: 10.1308/rcsann.2022.0156] [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] [Accepted: 12/16/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Colorectal cancer survivors have many problems affecting their quality of life (QOL). Traditional follow-up focuses on the detection of recurrence rather than QOL. Efforts are being made to assess patient-reported outcomes (PROMS) more formally. Such changes may enable patients to consider QOL factors when deciding on treatment. METHODS Patients who underwent laparoscopic surgery for rectal cancer between 2005 and 2015 at a single institution were identified and sent European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 QOL questionnaires. QOL and the impact of radiotherapy, chemotherapy and formation of end colostomy were assessed. RESULTS Some 141 patients were identified: 12 died and 118 (83.7%) responded, of whom 101 completed the questionnaires and 17 declined to participate; 11 were lost to follow-up. Mean age was 67 years, median follow-up was 58 months. Median QOL score was 6 (maximum 7) and 4.5% of patients reported a poor QOL score (<4). Significant rectal/perianal pain, sexual dysfunction and urinary symptoms were reported in 3.6%, 10.9% and 2.7% of respondents, respectively. Significant differences between treatment groups were uncommon. All cohorts reported similar QOL, functional and symptom scores. CONCLUSIONS These results compare favourably with the published data. Future studies may benefit from baseline assessment to better assess treatment impact, prescient in an increasingly elderly and comorbid population. This paper establishes that good PROMs are achievable with laparoscopic surgery for rectal cancer. It identifies limited differences in QOL between treatment modalities. Restoration of intestinal continuity and end colostomy result in similar QOL. This may address common concerns regarding stomata, sexual function and low anterior resection syndrome in this cohort.
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Affiliation(s)
- R Singh
- Royal Surrey NHS Foundation Trust, UK
| | - D White
- Royal Surrey NHS Foundation Trust, UK
| | - G Romano
- Royal Surrey NHS Foundation Trust, UK
| | - E Osenda
- Royal Surrey NHS Foundation Trust, UK
| | - S Allen
- Royal Surrey NHS Foundation Trust, UK
| | - M Dunstan
- Royal Surrey NHS Foundation Trust, UK
| | | | - I Jourdan
- Royal Surrey NHS Foundation Trust, UK
| | - T Rockall
- Royal Surrey NHS Foundation Trust, UK
| | - A Scala
- Royal Surrey NHS Foundation Trust, UK
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Visram A, De La Torre A, White D, Su J, Masih-Khan E, Chu M, Jimenez-Zepeda V, McCurdy A, LeBlanc R, Song K, Mian H, Louzada M, Sebag M, Bergstrom D, Stakiw J, Reiman A, Kotb R, Aslam M, Venner C, Kaedbey R, Gul E, Reece D. Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database. Blood Cancer J 2023; 13:181. [PMID: 38065967 PMCID: PMC10709576 DOI: 10.1038/s41408-023-00946-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.
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Affiliation(s)
- A Visram
- Department of Medicine, The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A De La Torre
- Division of Hematology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - D White
- Division of Hematology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - J Su
- Canadian Myeloma Research Group, Toronto, ON, Canada
| | - E Masih-Khan
- Canadian Myeloma Research Group, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M Chu
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Edmonton, AB, Canada
| | - V Jimenez-Zepeda
- Tom Baker Cancer Center, Department of Hematology, University of Calgary, Calgary, AB, Canada
| | - A McCurdy
- Department of Medicine, The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R LeBlanc
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - K Song
- The Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, Vancouver, Canada
| | - H Mian
- Juravinski Cancer Centre (Hamilton-CCO), Hamilton, ON, Canada
| | - M Louzada
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | - M Sebag
- Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
| | - D Bergstrom
- Division of Hematology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - J Stakiw
- Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - A Reiman
- Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | - R Kotb
- Medical Oncology and Hematology, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - M Aslam
- Allan Blair Cancer Center, Regina, SK, Canada
| | - C Venner
- BC Cancer - Vancouver Centre, Lymphoma and Myeloma Program, University of British Columbia, Vancouver, BC, Canada
| | - R Kaedbey
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Montreal, QC, Canada
| | - E Gul
- Canadian Myeloma Research Group, Toronto, ON, Canada
| | - D Reece
- Canadian Myeloma Research Group, Toronto, ON, Canada.
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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10
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Arad U, Werren C, White D. Paraneoplastic sacroiliitis. BMJ Case Rep 2023; 16:e252572. [PMID: 37652573 PMCID: PMC10476127 DOI: 10.1136/bcr-2022-252572] [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] [Indexed: 09/02/2023] Open
Abstract
A man in his early 70s presented with stiffness and aching in the shoulder and pelvic girdles. His C reactive protein level was elevated at 116 mg/L, leading to an initial diagnosis of polymyalgia rheumatica. Treatment with prednisone at 20 mg/day provided limited improvement and relapses recurred despite concomitant immunosuppressive agents. Extensive investigations failed to reveal an underlying aetiology.Five years later, gross painless haematuria led to the detection of an invasive papillary urothelial carcinoma. A review of the staging CT scan revealed findings compatible with bilateral erosive sacroiliitis, which had developed since his initial presentation. Radical cystoprostatectomy provided temporary relief but after a further 9 months, symptoms relapsed, and metastatic spread was discovered.Paraneoplastic sacroiliitis is a rare clinical entity; and to the best of our knowledge, this is the first reported case associated with a solid tumour.
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Affiliation(s)
- Uri Arad
- Rheumatology, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Douglas White
- Rheumatology, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
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11
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Lao C, White D, Rabindranath K, Van Dantzig P, Foxall D, Lawrenson R. Mortality and causes of death in systemic lupus erythematosus in New Zealand: A population-based study. Rheumatology (Oxford) 2023:kead427. [PMID: 37632770 DOI: 10.1093/rheumatology/kead427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES This study aims to assess the mortality of systemic lupus erythematosus (SLE) patients and examine whether there are variations by subgroup. METHODS SLE patients from 2005-2021 were identified from the national administrative datasets. The underlying causes of death were examined. Standardised mortality ratio (SMR) was estimated to compare the relative rate of observed deaths in SLE patients to expected deaths in the general population. The hazard ratios (HR) and 95% confidence intervals (CI) of all-cause mortality and SLE specific mortality by ethnicity were estimated after adjustment for age using a Cox proportional hazards model. RESULTS Of the 2,802 patients included for analysis, 699 (24.9%) died with 209 (29.9%) SLE deaths. The age-standardised mortality rate of SLE was 0.29 per 100 000 for women and 0.05 for men. The mean age at death was 65.3 ± 17.1 years. Younger patients were more likely to have SLE as the underlying cause of death, from 78.9% for those under 20 years old to 18.7% for those aged 70-79 years. Compared with the general population, SLE patients were four times more likely to die (SMR: 4.0; 95% CI: 3.7-4.3). Young patients had higher SMRs than older patients. Māori had worse all-cause mortality (HR: 1.72; 95% CI: 1.10-2.67) and SLE specific mortality (HR: 2.60; 95% CI: 1.29-5.24) than others. CONCLUSIONS The outcomes of SLE in New Zealand were still very poor compared with the general population. Māori with SLE had worse survival than others. Further research is needed to identify the reasons to this disparity.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
| | | | | | - Donna Foxall
- Te Huataki Waiora-School of Health, The University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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White D, Poppelwell D. Impact of a non-medical switch from tocilizumab to upadacitinib in a cohort of patients with rheumatoid arthritis in routine clinical practice. N Z Med J 2023; 136:74-78. [PMID: 37619231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Douglas White
- Rheumatologist, Rheumatology Clinic, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand
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Lao C, White D, Rabindranath K, Van Dantzig P, Foxall D, Aporosa A, Lawrenson R. Incidence and prevalence of systemic lupus erythematosus in New Zealand from the national administrative datasets. Lupus 2023:9612033231182203. [PMID: 37268603 DOI: 10.1177/09612033231182203] [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: 06/04/2023]
Abstract
OBJECTIVES This study aims to provide updated data on the incidence and prevalence of systemic lupus erythematosus (SLE) in New Zealand and to examine the difference between ethnic groups. METHODS We identified the SLE cases from the national administrative datasets. The date of first identification of SLE was the earliest date of a related inpatient event or the earliest date of a related outpatient event. The crude incidence and prevalence of SLE in 2010-2021 were estimated by gender, age group and ethnicity. The WHO (World Health Organization) age-standardised rate (ASR) of incidence and prevalence of SLE was calculated, after stratifying the cases by ethnicity and gender. RESULTS The average ASR of incidence and prevalence of SLE in 2010-2021 was 2.1 and 42.1 per 100,000 people in New Zealand. The average ASR of incidence for women was 3.4 per 100,000 for women and 0.6 for men. It was highest for Pacific women (9.8), followed by Asian women (5.3) and Māori women (3.6), and was lowest for Europeans/Others (2.1). The average ASR of prevalence was 65.2 per 100,000 for women and 8.5 for men. It was highest for Pacific women (176.2), followed by Māori women (83.7) and Asian women (72.2), and was lowest for Europeans/Others (48.5). The ASR of prevalence of SLE has been increasing slightly over time: from 60.2 in 2010 to 66.1 per 100,000 in 2021 for women and from 7.6 in 2010 to 8.8 per 100,000 in 2021 for men. CONCLUSION The incidence and prevalence of SLE in New Zealand were comparable to the rates in European countries. Pacific people had the highest incidence and prevalence of SLE, more than three times the rates for Europeans/others. The high incidence of SLE in Māori and Asian people also has implications for the future as these populations increase as a proportion to the total population.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
| | | | | | - Donna Foxall
- Te Huataki Waiora - School of Health, The University of Waikato, Hamilton, New Zealand
| | - Apo Aporosa
- School of Psychology, The University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Hamilton, New Zealand
- Strategy and Funding, Waikato Hospital, Hamilton, New Zealand
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 52-week results from the KEEPsAKE 1 study. Rheumatology (Oxford) 2023; 62:2113-2121. [PMID: 36282530 PMCID: PMC10234205 DOI: 10.1093/rheumatology/keac607] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/15/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE PsA is a chronic disease with heterogeneous clinical manifestations requiring treatment options with long-term efficacy and safety. In this follow-up analysis, the 52-week efficacy and safety of risankizumab 150 mg in patients with active PsA who had previous inadequate response/intolerance to one or more conventional synthetic DMARDs (csDMARD-IR) were evaluated. METHODS KEEPsAKE 1 is an ongoing, global, phase 3 study with a 24-week, double-blind, placebo-controlled period (period 1) and an open-label extension period (period 2). In period 1, eligible patients were randomized 1:1 to receive subcutaneous risankizumab 150 mg or placebo at weeks 0, 4 and 16. At week 24 (period 2), all continuing patients received open-label risankizumab 150 mg every 12 weeks through week 208. RESULTS At week 24, 57.3% of risankizumab-treated patients (n = 483) achieved ≥20% improvement in ACR criteria (ACR20) vs 33.5% of placebo-treated patients (n = 481; P < 0.001). At week 52, 70.0% of patients who were randomized to receive continuous risankizumab therapy and 63.0% of patients who were randomized to receive placebo in period 1 and then receive risankizumab at week 24 achieved ACR20. Similar result trends were observed for other efficacy measures. Risankizumab was well tolerated through 52 weeks of treatment with a consistent safety profile from week 24 through week 52. CONCLUSION In patients with active PsA who were csDMARD-IR, continuous risankizumab treatment demonstrated robust long-term efficacy and was well tolerated through 52 weeks of treatment. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, KEEPsAKE1, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research–K Papp Clinical Research, Waterloo, ON, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | | | - Frank Behrens
- Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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O'Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, de Filippi CR, Forfang D, Hicks KA, Jha V, Mahaffey KW, Mark PB, Rossignol P, Scholes-Robertson N, Jaure A, Viecelli AK, Wang AY, Wheeler DC, White D, Winkelmayer WC, Herzog CA. Defining Myocardial Infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working group. Kidney Int 2023; 103:1028-1037. [PMID: 37023851 DOI: 10.1016/j.kint.2023.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Currently there is no standardized definition of myocardial infarction (MI) for patients receiving hemodialysis. Through an international consensus process MI was established as the core CVD measure for this population in clinical trials. The Standardised Outcomes in Nephrology Group - Hemodialysis (SONG-HD) initiative convened a multidisciplinary, international working group to address the definition of MI in this population.Based on current evidence, the working group recommends using the 4th Universal Definition of MI with specific caveats with regard to the interpretation of "ischemic symptoms" and performing a baseline 12-lead electrocardiogram to facilitate interpretation of acute changes on subsequent tracings. The working group does not recommend obtaining baseline cardiac troponin values, though does recommend obtaining serial cardiac biomarkers in settings where ischemia is suspected. Application of an evidence-based uniform definition should increase the reliability and accuracy of trial results.
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Affiliation(s)
- E O'Lone
- The University of Sydney, Camperdown, Sydney, Australia.
| | - F S Apple
- Departments of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - J O Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - F J Caskey
- Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - J C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - C R de Filippi
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - D Forfang
- The National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC) WI USA
| | - K A Hicks
- Division of Cardiology and Nephrology, Office of Cardiology, Hematology, Endocrinology, and Nephrology, Center for Drug Evaluation and Research (CDER), United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - V Jha
- George Institute of Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K W Mahaffey
- The Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - P B Mark
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - P Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433 -INSERM- CHRU de Nancy, Inserm U1116 & FCRIN INI-CRCT (Cardiovascular and RenalClinical Trialists), Vandoeuvre-les-Nancy, France; Medical specialties and nephrology -hemodialysis departments, Princess Grace Hospital, and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - N Scholes-Robertson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - A Jaure
- The University of Sydney, Camperdown, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - A Y Wang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - D C Wheeler
- University College London, London, United Kingdom
| | - D White
- American Association of Kidney Patients, Tampa, Florida
| | - W C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - C A Herzog
- Chronic Disease Research Group, Hennepin Healthcare Research Institute,Minneapolis, Minnesota; Division of Cardiology, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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16
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Cohen MG, Althouse AD, Arnold RM, White D, Chu E, Rosenzweig M, Smith KJ, Schenker Y. Primary Palliative Care Improves Uptake of Advance Care Planning Among Patients With Advanced Cancers. J Natl Compr Canc Netw 2023; 21:383-390. [PMID: 37015338 PMCID: PMC10477933 DOI: 10.6004/jnccn.2023.7002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/06/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Palliative care specialists are experts in conducting advance care planning (ACP) but are a limited resource. Oncology nurses often have special relationships with their patients and thus may be poised to provide primary palliative care. We sought to determine the impact of a nurse-led primary palliative care intervention on ACP uptake among patients with advanced cancer. METHODS We performed a secondary analysis of a cluster randomized controlled trial examining the impact of nurse-based primary palliative care. In the parent trial, patients with advanced cancer received either monthly primary palliative care visits with trained nurses within their cancer center or standard care. Nurses in the intervention arm received special training in ACP. ACP uptake was assessed at enrollment and 3 months later evaluating (1) whether an end-of-life conversation (EOLC) occurred with one's oncologist, and (2) completion of an advance directive (AD). Multivariable logistic regression tested differences in ACP uptake by treatment arm adjusted for age, religious importance, education, time with current oncologist, and performance status. RESULTS Of 672 patients enrolled, 182/336 (54%) patients in the intervention arm and 196/336 (58%) in the standard care arm lacked an EOLC at baseline and completed the 3-month assessment. Of those, 82/182 (45.1%) patients in the intervention arm and 29/196 (14.8%) in the standard care arm reported having an EOLC at 3 months (adjusted odds ratio, 5.28; 95% CI, 3.10-8.97; P<.001). Similarly, 111/336 (33%) patients in the intervention arm and 105/336 (31%) in the standard care arm lacked an AD at baseline and completed the 3-month assessment. Of those, 48/111 (43.2%) patients in the intervention arm and 19/105 (18.1%) in the standard care arm completed an AD over the study period (adjusted odds ratio, 3.68; 95% CI, 1.89-7.16; P<.001). CONCLUSIONS Nurse-led primary palliative care increased ACP uptake among patients with advanced cancer. Training oncology nurses embedded within community cancer centers to provide primary palliative care may help improve ACP access.
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Affiliation(s)
- Michael G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew D. Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M. Arnold
- Section of Palliative Care and Medical Ethics, Palliative Research Center and Division of General Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - Douglas White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Kenneth J. Smith
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Palliative Research Center and Division of General Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
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17
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Semere W, Althouse AD, Arnold R, White D, Smith TJ, Chu E, Rosenzweig MQ, Schenker Y. Examining Caregiver Outcomes in the CONNECT Intervention for Patients With Advanced Cancer. J Pain Symptom Manage 2023; 65:173-182. [PMID: 36503155 DOI: 10.1016/j.jpainsymman.2022.11.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Palliative care offers patient and family centered approaches that may mitigate risk of caregiver burden and poor mood. OBJECTIVES To determine whether a palliative care intervention (CONNECT) improved burden, mood, and self-efficacy among caregivers of patients with advanced cancer. METHODS In this cluster randomized trial, patients and their caregivers were recruited from 17 Oncology clinics in Pennsylvania. Participants attended nurse-led monthly visits, addressing patient symptoms, goals of care, and advance care planning. At baseline and three months, we measured caregiver burden using Zarit Burden Interview (ZBI-12; range 0-48), caregiver anxiety and depression using Hospital Anxiety and Depression Scales (HADS-A, range 0-21; HADS-D, range 0-21). We measured caregiver self-efficacy at three months using Caregiver Inventory (CGI; range 0-189). RESULTS We enrolled 441 caregivers and 381 completed three-month assessments. We found no significant differences in caregiver burden (adjusted mean difference -0.39; 95% CI -1.07-0.29, P = 0.90), depression (adjusted mean difference -0.22, 95% CI -0.97-0.55, P = 0.26), or anxiety (adjusted mean difference 0.09; 95% CI -1.25-1.43, P = 0.58), between the intervention and standard care at three months. Caregiver self-efficacy was higher at three months in the intervention compared to standard care (adjusted mean difference 9.36; 95% CI 0.95-17.77, P = 0.030). CONCLUSION Caregivers in CONNECT did not experience improved burden or mood, however, they reported higher self-efficacy compared to caregivers receiving standard care. This study highlights the need for strategies to optimize caregiver outcomes in palliative care interventions.
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Affiliation(s)
- Wagahta Semere
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco (W.S.), San Francisco, California, USA.
| | - Andrew D Althouse
- University of Pittsburgh School of Medicine (A.D.A., Y.S.), Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics (R.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine (D.W.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Palliative Medicine Program (T.J.S.), The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Edward Chu
- Albert Einstein Cancer Center (E.C.), New York, New York
| | | | - Yael Schenker
- University of Pittsburgh School of Medicine (A.D.A., Y.S.), Pittsburgh, Pennsylvania, USA; Palliative Research Center (PaRC) (Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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18
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Andersen P, Barksdale S, Barclay RA, Smith N, Fernandes J, Besse K, Goldfarb D, Barbero R, Dunlap R, Jones-Roe T, Kelly R, Miao S, Ruhunusiri C, Munns A, Mosavi S, Sanson L, Munns D, Sahoo S, Swahn O, Hull K, White D, Kolb K, Noroozi F, Seelam J, Patnaik A, Lepene B. Magnetic hydrogel particles improve nanopore sequencing of SARS-CoV-2 and other respiratory viruses. Sci Rep 2023; 13:2163. [PMID: 36750714 PMCID: PMC9903261 DOI: 10.1038/s41598-023-29206-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Presented here is a magnetic hydrogel particle enabled workflow for capturing and concentrating SARS-CoV-2 from diagnostic remnant swab samples that significantly improves sequencing results using the Oxford Nanopore Technologies MinION sequencing platform. Our approach utilizes a novel affinity-based magnetic hydrogel particle, circumventing low input sample volumes and allowing for both rapid manual and automated high throughput workflows that are compatible with Nanopore sequencing. This approach enhances standard RNA extraction protocols, providing up to 40 × improvements in viral mapped reads, and improves sequencing coverage by 20-80% from lower titer diagnostic remnant samples. Furthermore, we demonstrate that this approach works for contrived influenza virus and respiratory syncytial virus samples, suggesting that it can be used to identify and improve sequencing results of multiple viruses in VTM samples. These methods can be performed manually or on a KingFisher automation platform.
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Affiliation(s)
- P Andersen
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA.
| | - S Barksdale
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - R A Barclay
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - N Smith
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - J Fernandes
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - K Besse
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - D Goldfarb
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - R Barbero
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - R Dunlap
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - T Jones-Roe
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - R Kelly
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - S Miao
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - C Ruhunusiri
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - A Munns
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - S Mosavi
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - L Sanson
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - D Munns
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - S Sahoo
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - O Swahn
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - K Hull
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - D White
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - K Kolb
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - F Noroozi
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - J Seelam
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - A Patnaik
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA
| | - B Lepene
- Ceres Nanosciences, Inc., Manassas, VA, 20110, USA.
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White D, Garcia A. A rare case of immunotherapy-induced hemolytic anemia post-nivolumab. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00269-0] [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: 01/28/2023]
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20
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Kristensen LE, Soliman AM, Papp K, White D, Barcomb L, Lu W, Eldred A, Behrens F. Risankizumab improved health-related quality of life, fatigue, pain and work productivity in psoriatic arthritis: results of KEEPsAKE 1. Rheumatology (Oxford) 2023; 62:629-637. [PMID: 35801915 PMCID: PMC9891435 DOI: 10.1093/rheumatology/keac342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES PsA is a heterogeneous disease that impacts many aspects of social and mental life, including quality of life. Risankizumab, an antagonist specific for IL-23, is currently under investigation for the treatment of adults with active PsA. This study evaluated the impact of risankizumab vs placebo on health-related quality of life (HRQoL) and other patient-reported outcomes (PROs) among patients with active PsA and inadequate response or intolerance to conventional synthetic DMARD (csDMARD-IR) in the KEEPsAKE 1 trial. METHODS Adult patients with active PsA (n = 964) were randomized (1:1) to receive risankizumab 150 mg or placebo. PROs assessed included the 36-Item Short-Form Health Survey (SF-36, v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQoL-5 Dimension-5 Level (EQ-5D-5L), Patient's Assessment of Pain, Patient's Global Assessment (PtGA) of Disease Activity, and Work Productivity and Activity Impairment-PsA (WPAI-PsA) questionnaire. Least squares (LS) mean change from baseline at week 24 was compared between risankizumab and placebo. RESULTS At week 24, differences between groups were observed using LS mean changes from baseline in SF-36 physical component summary and mental component summary; FACIT-Fatigue; EQ-5D-5L; Patient's Assessment of Pain; PtGA; all eight SF-36 domains (all nominal P < 0.001); and the WPAI-PsA domains of impairment while working (presenteeism), overall work impairment and activity impairment (all nominal P < 0.01). CONCLUSION Risankizumab treatment resulted in greater improvements in HRQoL, fatigue, pain and work productivity in patients with active PsA who have csDMARD-IR, when compared with placebo. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Kim Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, Ontario, Canada
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton.,Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | | | | | | | - Frank Behrens
- Rheumatology, Fraunhofer Institute Translational Medicine and Pharmacology ITMP & Cluster of Excellence CIMD, Goethe University, Frankfurt, Germany
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21
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Kim B, Boukebous B, White D, Baker JF. Septic arthritis of the native hip joint: a multi-pattern, multi-outcome disease. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03477-2. [PMID: 36710273 PMCID: PMC10368560 DOI: 10.1007/s00590-023-03477-2] [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] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE Septic arthritis of the native hip joint (SANH) is an uncommon surgical and medical emergency with few reports. The aim of this study was to determine predictors of return to theatre (RTT), complications and mortality. METHODS Patients with SANH were identified from January 2009 to June 2022; 50 patients and three subgroups were identified: Pyogenic (surgical washout without systemic inflammatory disease), Systemic (surgical washout with SIDs) and patients managed non-surgically. Patterns of these groups were assessed with a principal component analysis. The cumulative incidences for death, any complication and RTT for repeat washout were calculated. The predictive variables associated with outcomes were selected with univariable models and then incorporated in multivariable CoxPH regressions. RESULTS The 1-year cumulative incidence was 14% for mortality and 48.5% for any complication. Amongst patients managed surgically, 1-year risk of RTT was 46% in Pyogenic subgroup and 21% in Systemic subgroup. Systemic subgroup had lower complications and RTT and higher rate of sterile aspirate, compared to Pyogenic. Charlson comorbidity index (CCI) (HR = 1.41, P value = 0.03), preoperative albumin (HR = 0.81, P value = 0.009) and preoperative haemoglobin (HR = 0.95, P value = 0.02) were significantly associated with 1-year mortality. Time between symptom onset and admission > 7 days (HR = 3.15, P value = 0.042), preoperative Hb (HR = 1.05, P value = 0.016), socioeconomic deprivation (HR = 1.18, P value = 0.04) and Systemic subgroup (HR = 0.25, P value = 0.04) were significantly associated with RTT. CONCLUSION Mortality was well predicted by the usual parameters including CCI, albumin, but also low haemoglobin. Patients presenting in a delayed fashion were more likely to have multiple lavages.
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Affiliation(s)
- Byungseob Kim
- Faculty of Medical and Health Science, University of Auckland, Grafton, Auckland, New Zealand.
| | - Baptiste Boukebous
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,ECAMO Team, CRESS, UMR1153, INSERM, Paris, France
| | - Douglas White
- Department of Rheumatology, Waikato Hospital, Hamilton, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Labarca G, Kwon Y, Vena D, Sands S, Messineo L, Gell L, White D, Redline S, Wellman A, Azarbarzin A. Heart rate response and Sleep Apnea Specific Hypoxic Burden to apneas and hypopneas predicts incident atrial fibrillation in moderate to severe Obstructive Sleep Apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Padala SD, Lao C, Solanki K, White D. Direct and indirect health-related costs of systemic sclerosis in New Zealand. Int J Rheum Dis 2022; 25:1386-1394. [PMID: 36135601 DOI: 10.1111/1756-185x.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
Abstract
AIM To study the economic impact of systemic sclerosis (SSc) in the patients attending Rheumatology clinics in Waikato Hospital, Hamilton, New Zealand (NZ). There is currently no bottom-up data on this in NZ. METHODS This is a retrospective cross-sectional questionnaire-based study, including demographics, costs related to SSc, quality of life measures including the short-form survey (SF-36) the scleroderma health assessment questionnaire-visual analog scale (SHAQ-VAS), the NZ index of Deprivation (NZiDep), and work limitations questionnaire (WLQ). Direct health costs include patient-reported costs and costs incurred by the public health system. Indirect costs include calculated loss of work productivity. Comparisons were made between age, gender, disease duration, and disease subtype (diffuse, limited, and overlap syndromes). RESULTS Participants fulfilled the 2013 ACR/EULAR criteria for SSc. The study was completed by 86 (65.5%) patients, 77 (90%) were females, 19 (22%) had diffuse cutaneous systemic sclerosis (dcSSc), 72 (83%) were NZ European (NZE), seven(8%) were Māori or NZE/Māori. Seventy-six (41.8%) were employed. The average total costs for 6 months were NZ$ 444.50 with the highest costs in the dcSSc sub-group at NZ$ 598.00. The costs incurred by the Hospital for the 2018/2019 fiscal year was NZ$ 3091 per patient. The SF-36 score was lower compared with the general population, mean SHAQ was 0.82. Mean summative WLQ scores were: Time management 21.7, Physical demands 62.5, Interpersonal 23.6, Output demands 23.8. The calculated percentage productivity loss was 46.5%. CONCLUSIONS This study has shown high health-related costs of SSc in NZ, with reduction in employment, work productivity, and quality of life. The contributors to the costs included physical disability and loss of productivity.
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Affiliation(s)
| | - Chunhuan Lao
- Senior Research Fellow, Medical Research Centre, School of Health, University of Waikato, Hamilton, New Zealand
| | - Kamal Solanki
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical School, University of Auckland, Hamilton, New Zealand
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Papp K, Soliman AM, Kaufmann C, Barcomb L, Wang Z, White D, Ostor A, Kristensen LE. 33236 Impact of risankizumab on improving symptoms and health-related quality of life and reducing fatigue and pain among psoriatic arthritis patients with moderate-to-severe skin involvement: Evidence from 2 phase III trials. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kristensen LE, Keiserman M, Papp K, Mccasland L, White D, Lu W, Soliman AM, Eldred A, Barcomb L, Behrens F. POS1024 EFFICACY AND SAFETY OF RISANKIZUMAB (RZB) FOR ACTIVE PSORIATIC ARTHRITIS (PsA): 52-WEEK RESULTS FROM KEEPsAKE 1. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRZB, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits the p19 subunit of the human cytokine IL-23, is being investigated as a treatment for PsA.ObjectivesTo compare efficacy and safety of RZB vs. placebo (PBO) in patients with PsA who had an inadequate response or intolerance to conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).MethodsKEEPsAKE 1 (NCT03675308) is an ongoing, phase 3 study that includes a screening period; a 24-week double-blinded, placebo-controlled, parallel-group period (period 1); and an open-label extension period (period 2). Eligible patients aged ≥18 years with active PsA (symptom onset ≥6 months prior to screening, meeting the Classification Criteria for PsA [CASPAR], and ≥5 swollen and ≥5 tender joints) and who had an inadequate response or intolerance to ≥1 csDMARD-IR, were randomized 1:1 to receive RZB 150 mg or placebo (PBO) at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology (ACR20) response at week 24. Period 2 started at week 24, and patients were switched to receive open-label RZB 150 mg every 12 weeks through week 208. Mixed-effect model repeated measures and nonresponder imputation methods were used to assess continuous and binary variables, respectively. Efficacy and safety were analyzed in all patients who received ≥1 dose of study drug through week 52. Treatment-emergent adverse events (TEAE) were summarized using exposure-adjusted event rates (EAERs, events/100 patient-years [PY]).ResultsAt week 24, a greater proportion of RZB-treated (N=483) vs PBO-treated (N=481) patients achieved ACR20 (55.3% and 32.8%, respectively). At week 52, 70% of patients who were randomized to receive RZB and 63% of patients who were randomized to receive PBO and switch to RZB at week 24 achieved ACR20. In patients with ≥3% of body surface area affected at baseline, 52.7% of RZB-treated patients (N=273) and 9.9% of PBO-treated patients (N=272) achieved ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at week 24; 67.8% who were randomized to receive RZB and 59.9% who were randomized to receive PBO and switch to RZB at week 24 achieved PASI 90 at week 52. Similar results were observed for other efficacy measures. RZB was well tolerated through 52 weeks of treatment. EAERs of adverse events were stable between weeks 24 and 52. At the week 52 data cut-off (19 April 2021), the total EAER of any TEAE in patients receiving RZB was 143.1/100 PY.ConclusionContinuous RZB treatment provided durable efficacy and a consistent safety profile through 52 weeks of treatment in patients with active PsA who were csDMARD-IR.AcknowledgementsAbbVie, Inc. participated in the study design; study research; collection, analysis, and interpretation of data. AbbVie funded the research for this study. Medical writing assistance, funded by AbbVie, was provided by Jay Parekh, PharmD, of JB Ashtin.Disclosure of InterestsLars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Biogen, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, MAURO KEISERMAN Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Kim Papp Speakers bureau: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Dermavant, Dermira, Incyte, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Sandoz, Sanofi Genzyme, and UCB, Consultant of: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Meiji Seika Pharma, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Regeneron, Sandoz, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Grant/research support from: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Merck, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB, Leslie McCasland Consultant of: Lilly, Douglas White Speakers bureau: AbbVie and Novartis, Consultant of: AbbVie and Novartis, Wenjing Lu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Frank Behrens Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi
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Kristensen LE, Soliman AM, Papp K, Barcomb L, Eldred A, Wang Z, White D, Behrens F. POS1042 IMPACT OF RISANKIZUMAB ON IMPROVING HEALTH-RELATED QUALITY OF LIFE, WORK PRODUCTIVITY, AND REDUCING FATIGUE AMONG PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: A POOLED ANALYSIS OF TWO PHASE 3 CLINICAL TRIALS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRisankizumab (RZB) has been approved in the UK and Europe for the treatment of adults with active PsA. Patient-reported outcomes (PROs) are important tools for understanding a therapy’s efficacy from the patient’s perspective.ObjectivesThis study evaluated the impact of RZB versus placebo on health-related quality of life (HRQoL), fatigue, and work productivity in patients with psoriatic arthritis (PsA) and inadequate response to 1 or 2 biologics and/or ≥1 conventional synthetic DMARDs in two Phase 3 trials (KEEPsAKE 1&2).MethodsEligible patients with active PsA (n=1402) were randomized (1:1) to receive risankizumab 150 mg (n=706) or placebo (n=696). Patient-reported outcomes assessed were 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue), EQ-5D-5L, and Work Productivity and Activity Impairment–PsA questionnaire. Least squares (LS) mean changes from baseline at Week 24 were compared between risankizumab versus placebo by mixed-effects repeated regression modeling.ResultsAt Week 24, risankizumab- versus placebo-treated patients reported greater improvements in LS mean changes with between-group differences (all nominal P<0.001) in SF-36 physical component score (mean difference=3.5, 95% confidence interval [CI] 2.7, 4.2) and mental component score (mean difference=1.8, 95% CI 0.9, 2.6), FACIT-Fatigue (mean difference=2.5, 95% CI 1.5, 3.4), EQ-5D-5L index score (mean=0.07, 95% CI 0.05, 0.09), and EQ-5D-5L visual analogue scale score (mean difference=5.8, 95% CI 3.6, 8.0). In addition, risankizumab- versus placebo-treated patients reported greater reductions with between-group differences (all nominal P<0.001) in overall work impairment (mean difference= −8.9%, 95% CI −13.1, −4.7), activity impairment (mean difference= −7.7%, 95% CI −10.3, −5.2), and presenteeism (mean difference= −9.8%, 95% CI −13.3, −6.3).ConclusionCompared to placebo, risankizumab resulted in greater improvements in HRQoL, fatigue, and work productivity among patients with PsA.AcknowledgementsThis work/study was funded by AbbVie Inc. AbbVie participated in the study design, research, data collection, analysis and interpretation of data. No honoraria or payments were made for authorship. Medical writing services provided by Natalie Mitchell of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.Disclosure of InterestsLars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kim Papp Speakers bureau: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Consultant of: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Grant/research support from: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie, Novartis, and Roche., Consultant of: AbbVie, Novartis, and Roche., Frank Behrens Speakers bureau: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Consultant of: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Grant/research support from: AbbVie, Chugai, Janssen, Pfizer, and Roche
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Papp K, Soliman AM, Kaufmann C, Barcomb L, Wang Z, White D, Ostor A, Kristensen LE. AB0897 Impact of risankizumab on improving symptoms and health-related quality of life and reducing fatigue and pain among psoriatic arthritis patients with moderate-to-severe skin involvement: Evidence from two Phase III trials. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPsoriatic arthritis (PsA) greatly affects patient-reported health-related quality of life (HRQoL).ObjectivesTo assess the impact of risankizumab (RZB) on patient-reported outcomes (PROs) in patients with high skin burden using integrated efficacy data from two Phase III clinical trials (KEEPsAKE-1 and KEEPsAKE-2).MethodsAdult patients with PsA with inadequate response or intolerance to disease-modifying antirheumatic drugs were randomized 1:1 to receive RZB (150 mg) or placebo (PBO). Improvement from baseline in PROs (Patient’s Global Assessment of Disease Activity [PtGA] by visual analog scale [VAS], Short-Form 36 Health Questionnaire physical and mental component summary scores [SF-36 PCS and MCS], Health Assessment Questionnaire – Disability Index [HAQ-DI], EQ-5D 5-Level questionnaire [EQ-5D-5L] index and by VAS, Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-Fatigue], and pain by VAS) were assessed at Week 24 in patients with high skin burden (body surface area involvement ≥3% and Psoriasis Area Severity Index >10). Least squares mean (LSM) difference (95% confidence interval [CI]) between RZB and PBO groups based on mixed-model repeated measures regression is reported.ResultsRZB- vs PBO-treated patients demonstrated greater improvements in PROs with notable LSM differences (95% CI) between groups (P<0.01) in PtGA (-18.7 [-25.1, -12.2]), SF-36 PCS (6.3 [4.2, 8.4]) and MCS (4.4 [2.3, 6.6]), HAQ-DI (-0.4 [-0.5, -0.3]), EQ-5D-5L index (0.1 [0.1, 0.2]) and VAS (8.2 [2.5,13.9]), FACIT-Fatigue (4.9 [2.7, 7.2]), and pain (-18.9 [-25.1, -12.7]).ConclusionIn patients with PsA with high skin burden, 24 weeks of RZB treatment, as compared with PBO, improved patients’ HRQoL, including fatigue and pain.AcknowledgementsAbbVie funded the study and participated in interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing services were provided by Samantha Francis Stuart (Fishawack Facilitate Ltd) and funded by AbbVie.Disclosure of InterestsKim Papp Speakers bureau: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Consultant of: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Grant/research support from: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Christian Kaufmann Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie and Novartis., Consultant of: AbbVie and Novartis., Andrew Ostor Speakers bureau: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Consultant of: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Grant/research support from: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Consultant of: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Grant/research support from: UCB, Novartis, Pfizer, Eli Lilly, Biogen, AbbVie, and Janssen Pharmaceuticals and UCB.
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Sigler LE, Althouse AD, Thomas TH, Arnold RM, White D, Smith TJ, Chu E, Rosenzweig M, Smith KJ, Schenker Y. Effects of an Oncology Nurse-Led, Primary Palliative Care Intervention (CONNECT) on Illness Expectations Among Patients With Advanced Cancer. JCO Oncol Pract 2022; 18:e504-e515. [PMID: 34767474 PMCID: PMC9014423 DOI: 10.1200/op.21.00573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with advanced cancer often have unrealistic expectations about prognosis and treatment. This study assessed the effect of an oncology nurse-led primary palliative care intervention on illness expectations among patients with advanced cancer. METHODS This study is a secondary analysis of a cluster-randomized trial of primary palliative care conducted at 17 oncology clinics. Adult patients with advanced solid tumors for whom the oncologist would not be surprised if died within 1 year were enrolled. Monthly visits were designed to foster realistic illness expectations by eliciting patient concerns and goals for their medical care and empowering patients and families to engage in discussions with oncologists about treatment options and preferences. Baseline and 3-month questionnaires included questions about life expectancy, treatment intent, and terminal illness acknowledgment. Odds of realistic illness expectations at 3 months were adjusted for baseline responses, patient demographic and clinical characteristics, and intervention dose. RESULTS Among 457 primarily White patients, there was little difference in realistic illness expectations at 3 months between intervention and standard care groups: 12.8% v 11.4% for life expectancy (adjusted odds ratio [aOR] = 1.15; 95% CI, 0.59 to 2.22; P = .684); 24.6% v 33.3% for treatment intent (aOR = 0.76; 95% CI, 0.44 to 1.27; P = .290); 53.6% v 44.7% for terminal illness acknowledgment (aOR = 1.28; 95% CI, 0.81 to 2.00; P = .288). Results did not differ when accounting for variation in clinic sites or intervention dose. CONCLUSION Illness expectations are difficult to change among patients with advanced cancer. Additional work is needed to identify approaches within oncology practices that foster realistic illness expectations to improve patient decision making.
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Affiliation(s)
- Lauren E. Sigler
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Emory Palliative Care Center, Emory University School of Medicine, Atlanta, GA,Lauren E. Sigler, MD, Emory Palliative Care Center, Emory University School of Medicine, 1821 Clifton Road NE, Suite 1017 Atlanta, GA 30329; e-mail:
| | - Andrew D. Althouse
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Teresa H. Thomas
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Robert M. Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
| | - Douglas White
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Department of Critical Care Medicine, Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas J. Smith
- Division of General Internal Medicine, Section of Palliative Medicine, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, New York, NY
| | - Margaret Rosenzweig
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Kenneth J. Smith
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA
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Dray J, Licata M, Doherty E, Tully B, Williams B, Curtin S, White D, Lecathelinais C, Ward S, Hasson S, Elliott EJ, Wiggers J, Kingsland M. Enhancing clinician participation in quality improvement training: implementation and impact of an evidence-based initiative to maximise antenatal clinician participation in training regarding women’s alcohol consumption during pregnancy. BMC Health Serv Res 2022; 22:402. [PMID: 35351113 PMCID: PMC8962084 DOI: 10.1186/s12913-022-07717-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession. Methods A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession. Results Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (μ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles. Conclusions A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes. Trial registration Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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31
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White D, Lo B. Promoting equity with a multi-principle framework to allocate scarce ICU resources. J Med Ethics 2022; 48:133-135. [PMID: 34099542 PMCID: PMC8649043 DOI: 10.1136/medethics-2021-107456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
We wholeheartedly agree with Schmidt and colleagues' efforts to promote equity in intensive care unit (ICU) triage. We also take issue with their characterisation of the New Jersey (NJ) allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim-without evidence-that it will 'compound disadvantage for black patients'. However, the NJ triage framework-like the model allocation policy we developed-actually contains four allocation criteria: the two criteria that the authors mentioned (chances for survival and near-term prognosis) and two criteria that they failed to mention which we included to promote equity: giving priority to frontline essential workers and giving priority to younger patients. These omissions are problematic both for reasons of factual accuracy and because the two criteria they failed to acknowledge would likely mitigate rather than exacerbate racial disparities during triage.
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Affiliation(s)
- Douglas White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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32
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Kristensen LE, Keiserman M, Papp K, McCasland L, White D, Lu W, Wang Z, Soliman AM, Eldred A, Barcomb L, Behrens F. Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial. Ann Rheum Dis 2021; 81:225-231. [PMID: 34911706 PMCID: PMC8762015 DOI: 10.1136/annrheumdis-2021-221019] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/11/2021] [Indexed: 01/20/2023]
Abstract
Objective To evaluate risankizumab, a biological therapy that inhibits interleukin 23, in patients with active psoriatic arthritis (PsA) who have responded inadequately or are intolerant to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD). Methods In the randomised, placebo-controlled, double-blind KEEPsAKE 1 trial, 964 patients with active PsA were randomised (1:1) to receive risankizumab 150 mg or placebo at weeks 0, 4 and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology criteria (ACR20) at week 24. Here, we report the results from the 24-week double-blind period; the open-label period with all patients receiving risankizumab is ongoing. Results At week 24, a significantly greater proportion of patients receiving risankizumab achieved the primary endpoint of ACR20 (57.3% vs placebo, 33.5%; p<0.001). Significant differences were also observed for risankizumab versus placebo for the first eight ranked secondary endpoints, including skin and nail psoriasis endpoints, minimal disease activity and resolution of enthesitis and dactylitis (p<0.001). Adverse events and serious adverse events were reported at similar rates in the risankizumab and placebo groups. Serious infections were reported for 1.0% and 1.2% of patients receiving risankizumab and placebo, respectively. There was one death in the risankizumab group (urosepsis deemed unrelated to the study drug). Conclusions Risankizumab treatment results in significantly greater improvement of signs and symptoms of PsA compared with placebo and is well tolerated in patients with active PsA who have responded inadequately or are intolerant to ≥1 csDMARD. Trial registration number NCT03675308.
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Affiliation(s)
- Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Kim Papp
- Probity Medical Research-K Papp Clinical Research, Waterloo, Ontario, Canada
| | - Leslie McCasland
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA, and Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Douglas White
- Rheumatology Department, Waikato Hospital, Hamilton, New Zealand, and Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Wenjing Lu
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - Ann Eldred
- AbbVie Inc, North Chicago, Illinois, USA
| | | | - Frank Behrens
- CIRI/Rheumatology & Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Fraunhofer Cluster of Excellence for Immune-Mediated Disease (CIMD), Goethe University, Frankfurt, Germany
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33
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Burgess T, Edwards J, Drenth A, Massenbauer T, Cunnington J, Mostowfizadeh-Ghalamfarsa R, Dinh Q, Liew E, White D, Scott P, Barber P, O’Gara E, Ciampini J, McDougall K, Tan Y. Current status of Phytophthora in Australia. Persoonia 2021; 47:151-177. [PMID: 37693794 PMCID: PMC10486634 DOI: 10.3767/persoonia.2021.47.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022]
Abstract
Among the most economically relevant and environmentally devastating diseases globally are those caused by Phytophthora species. In Australia, production losses in agriculture and forestry result from several well-known cosmopolitan Phytophthora species and infestation of natural ecosystems by Phytophthora cinnamomi have caused irretrievable loss to biodiversity especially in proteaceous dominated heathlands. For this review, all available records of Phytophthora in Australia were collated and curated, resulting in a database of 7 869 records, of which 2 957 have associated molecular data. Australian databases hold records for 99 species, of which 20 are undescribed. Eight species have no records linked to molecular data, and their presence in Australia is considered doubtful. The 99 species reside in 10 of the 12 clades recognised within the complete phylogeny of Phytophthora. The review includes discussion on each of these species' status and additional information provided for another 29 species of concern. The first species reported in Australia in 1900 was Phytophthora infestans. By 2000, 27 species were known, predominantly from agriculture. The significant increase in species reported in the subsequent 20 years has coincided with extensive surveys in natural ecosystems coupled with molecular taxonomy and the recognition of numerous new phylogenetically distinct but morphologically similar species. Routine and targeted surveys within Australian natural ecosystems have resulted in the description of 27 species since 2009. Due to the new species descriptions over the last 20 years, many older records have been reclassified based on molecular identification. The distribution of records is skewed toward regions with considerable activity in high productivity agriculture, horticulture and forestry, and native vegetation at risk from P. cinnamomi. Native and exotic hosts of different Phytophthora species are found throughout the phylogeny; however, species from clades 1, 7 and 8 are more likely to be associated with exotic hosts. One of the most difficult challenges to overcome when establishing a pest status is a lack of reliable data on the current state of a species in any given country or location. The database compiled here for Australia and the information provided for each species overcomes this challenge. This review will aid federal and state governments in risk assessments and trade negotiations by providing a comprehensive resource on the current status of Phytophthora species in Australia. Citation: Burgess TI, Edwards J, Drenth A, et al. 2021. Current status of Phytophthora in Australia. Persoonia 47: 151-177. https://doi.org/10.3767/persoonia.2021.47.05.
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Affiliation(s)
- T.I. Burgess
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - J. Edwards
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; La Trobe University, Bundoora, VIC 3083, Australia
| | - A. Drenth
- Centre for Horticultural Science, The University of Queensland, Ecosciences Precinct, Dutton Park QLD, 4102, Brisbane, Australia
| | - T. Massenbauer
- TiloMass Environmental Services, PO Box 1148, Esperance WA, 6450, Australia
| | - J. Cunnington
- Department of Agriculture, Water and the Environment, 7 London Circuit, Canberra ACT 2600 Australia
| | | | - Q. Dinh
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; La Trobe University, Bundoora, VIC 3083, Australia
| | - E.C.Y. Liew
- Research Centre for Ecosystem Resilience, Royal Botanic Gardens and Domain Trust, Mrs Macquaries Rd, Sydney NSW 2000, Australia
| | - D. White
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - P. Scott
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
- Plant Pathologist, DPIRD Diagnostics and Laboratory Services, Sustainability and Biosecurity, Department of Primary Industries and Regional Development, 3 Baron-Hay Court, Kennsington WA 6151, Australia
| | - P.A. Barber
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
- Arbor Carbon P/L, ROTA Compound off Discovery Way, Murdoch University, Murdoch 6150, Australia
| | - E. O’Gara
- Department of Biodiversity, Conservation and Attractions, 17 Dick Perry Ave, Kensington WA 6151, Australia
| | - J. Ciampini
- Department of Biodiversity, Conservation and Attractions, 17 Dick Perry Ave, Kensington WA 6151, Australia
| | - K.L. McDougall
- Department of Ecology, Environment and Evolution, School of Life Sciences, La Trobe University, Bundoora VIC 3083, Australia
| | - Y.P. Tan
- Department of Agriculture and Fisheries, Ecosciences Precinct, Dutton Park QLD 4102; Centre for Crop Health, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Allen SK, Brown V, White D, King D, Hunt J, Wainwright J, Emery A, Hodge E, Kehinde A, Prabhu P, Rockall TA, Preston SR, Sultan J. ASO Visual Abstract: Multi-modal Prehabilitation During Neoadjuvant Therapy Before Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass, and Quality of Life-A Pilot Randomized Clinical Trial. Ann Surg Oncol 2021. [PMID: 34797478 DOI: 10.1245/s10434-021-11062-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S K Allen
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - V Brown
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - D White
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - D King
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - J Hunt
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - J Wainwright
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - A Emery
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - E Hodge
- The Fountain Centre, St Luke's Cancer Centre, Guildford, UK
| | - A Kehinde
- The Fountain Centre, St Luke's Cancer Centre, Guildford, UK
| | - P Prabhu
- Department of Anaesthetics, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK
| | - T A Rockall
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.,Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - S R Preston
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK
| | - Javed Sultan
- Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Guildford, UK.
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35
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Morgan R, Clamp A, Ryder W, Wheeler C, Buckley E, Truelove J, Murphy A, Hasan J, Mitchell C, Burghel G, White D, Price M, Bhaskar S, Shaw J, Dive C, Wallace A, O'Connor J, Rothwell D, Edmondson R, Jayson G. 731P Multi-maintenance olaparib in relapsed, platinum-sensitive BRCA-mutant high-grade serous ovarian carcinoma (MOLTO): A phase II feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Treharne GJ, Johnstone G, Fletcher BD, Lamar RSM, White D, Stebbings S, Harrison A. Fears about COVID-19 and perceived risk among people with rheumatoid arthritis or ankylosing spondylitis following the initial lockdown in Aotearoa New Zealand. Musculoskeletal Care 2021; 20:290-298. [PMID: 34388290 PMCID: PMC8441895 DOI: 10.1002/msc.1585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 12/23/2022]
Abstract
Background The COVID‐19 pandemic has disrupted all aspects of life and may raise particular fears for people with rheumatic disease. There is a need for research on fears and perceived risk of SARS‐CoV‐2 so as to understand the impact on wellbeing and inform service provision. Objectives The aim of this study was to examine the correlates of COVID‐19 fears and perceived risk of SARS‐CoV‐2 among people with rheumatoid arthritis or ankylosing spondylitis. Design A cross‐sectional survey design was applied in Aotearoa New Zealand in the period after initial nationwide lockdowns. Method An online survey was completed from July to September 2020 by 126 individuals with rheumatoid arthritis (n = 96) or ankylosing spondylitis (n = 30) who had previously been recruited to the Patient Opinion Real‐Time Anonymous Liaison (PORTAL) study in 2015 or 2018. The survey included demographics and health information as well as measures of COVID‐19 fears and experiences, functional disability and fatigue‐related disability. Results Fears about COVID‐19 were higher among younger participants, those who had been tested for SARS‐CoV‐2, and those who experienced more flares over the initial lockdown. Perceived risk of SARS‐CoV‐2 infection was also higher among individual who had been tested for SARS‐CoV‐2 and those taking biologic medications. Conclusion Fears about COVID‐19 and perceived risk of infection are related to age, health and medications among individuals with rheumatoid arthritis or ankylosing spondylitis. These findings inform how health professionals can help address the concerns of particular groups of people with rheumatic disease by providing relevant information about the ongoing effects of the pandemic.
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Affiliation(s)
- Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin, Aotearoa New Zealand
| | - Grace Johnstone
- Department of Psychology, University of Otago, Dunedin, Aotearoa New Zealand
| | - Benjamin D Fletcher
- Department of Psychology, University of Otago, Dunedin, Aotearoa New Zealand
| | - Roisin S M Lamar
- Department of Psychology, University of Otago, Dunedin, Aotearoa New Zealand
| | - Douglas White
- Department of Rheumatology, Waikato Clinical School, University of Auckland, Hamilton, Aotearoa New Zealand
| | - Simon Stebbings
- Department of Medicine, University of Otago, Dunedin, Aotearoa New Zealand
| | - Andrew Harrison
- Department of Medicine, University of Otago, Wellington, Aotearoa New Zealand
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37
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Burgess T, Edwards J, Drenth A, Massenbauer T, Cunnington J, Mostowfizadeh-Ghalamfarsa R, Dinh Q, Liew E, White D, Scott P, Barber P, O’Gara E, Ciampini J, McDougall K, Tan Y. Current status of Phytophthora in Australia. Persoonia 2021; 47:151-177. [PMID: 38352973 PMCID: PMC10784666 DOI: 10.3767/persoonia.2023.47.05] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/26/2021] [Indexed: 02/16/2024]
Abstract
Among the most economically relevant and environmentally devastating diseases globally are those caused by Phytophthora species. In Australia, production losses in agriculture and forestry result from several well-known cosmopolitan Phytophthora species and infestation of natural ecosystems by Phytophthora cinnamomi have caused irretrievable loss to biodiversity especially in proteaceous dominated heathlands. For this review, all available records of Phytophthora in Australia were collated and curated, resulting in a database of 7 869 records, of which 2 957 have associated molecular data. Australian databases hold records for 99 species, of which 20 are undescribed. Eight species have no records linked to molecular data, and their presence in Australia is considered doubtful. The 99 species reside in 10 of the 12 clades recognised within the complete phylogeny of Phytophthora. The review includes discussion on each of these species' status and additional information provided for another 29 species of concern. The first species reported in Australia in 1900 was Phytophthora infestans. By 2000, 27 species were known, predominantly from agriculture. The significant increase in species reported in the subsequent 20 years has coincided with extensive surveys in natural ecosystems coupled with molecular taxonomy and the recognition of numerous new phylogenetically distinct but morphologically similar species. Routine and targeted surveys within Australian natural ecosystems have resulted in the description of 27 species since 2009. Due to the new species descriptions over the last 20 years, many older records have been reclassified based on molecular identification. The distribution of records is skewed toward regions with considerable activity in high productivity agriculture, horticulture and forestry, and native vegetation at risk from P. cinnamomi. Native and exotic hosts of different Phytophthora species are found throughout the phylogeny; however, species from clades 1, 7 and 8 are more likely to be associated with exotic hosts. One of the most difficult challenges to overcome when establishing a pest status is a lack of reliable data on the current state of a species in any given country or location. The database compiled here for Australia and the information provided for each species overcomes this challenge. This review will aid federal and state governments in risk assessments and trade negotiations by providing a comprehensive resource on the current status of Phytophthora species in Australia. Citation: Burgess TI, Edwards J, Drenth A, et al. 2021. Current status of Phytophthora in Australia. Persoonia 47: 151-177. https://doi.org/10.3767/persoonia.2021.47.05.
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Affiliation(s)
- T.I. Burgess
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - J. Edwards
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; La Trobe University, Bundoora, VIC 3083, Australia
| | - A. Drenth
- Centre for Horticultural Science, The University of Queensland, Ecosciences Precinct, Dutton Park QLD, 4102, Brisbane, Australia
| | - T. Massenbauer
- TiloMass Environmental Services, PO Box 1148, Esperance WA, 6450, Australia
| | - J. Cunnington
- Department of Agriculture, Water and the Environment, 7 London Circuit, Canberra ACT 2600 Australia
| | | | - Q. Dinh
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; La Trobe University, Bundoora, VIC 3083, Australia
| | - E.C.Y. Liew
- Research Centre for Ecosystem Resilience, Royal Botanic Gardens and Domain Trust, Mrs Macquaries Rd, Sydney NSW 2000, Australia
| | - D. White
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
| | - P. Scott
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
- Plant Pathologist, DPIRD Diagnostics and Laboratory Services, Sustainability and Biosecurity, Department of Primary Industries and Regional Development, 3 Baron-Hay Court, Kennsington WA 6151, Australia
| | - P.A. Barber
- Phytophthora Science and Management, Harry Butler Institute, Murdoch University, Murdoch, WA 6150, Australia
- Arbor Carbon P/L, ROTA Compound off Discovery Way, Murdoch University, Murdoch 6150, Australia
| | - E. O’Gara
- Department of Biodiversity, Conservation and Attractions, 17 Dick Perry Ave, Kensington WA 6151, Australia
| | - J. Ciampini
- Department of Biodiversity, Conservation and Attractions, 17 Dick Perry Ave, Kensington WA 6151, Australia
| | - K.L. McDougall
- Department of Ecology, Environment and Evolution, School of Life Sciences, La Trobe University, Bundoora VIC 3083, Australia
| | - Y.P. Tan
- Department of Agriculture and Fisheries, Ecosciences Precinct, Dutton Park QLD 4102; Centre for Crop Health, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Kristensen LE, Keiserman M, Papp K, Mccasland L, White D, Barcomb L, Lu W, Wang Z, Soliman AM, Eldred A, Behrens F. AB0559 EFFICACY AND SAFETY OF RISANKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AFTER INADEQUATE RESPONSE OR INTOLERANCE TO DMARDs: 24-WEEK RESULTS FROM THE PHASE 3, RANDOMIZED, DOUBLE-BLIND KEEPsAKE 1 TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Risankizumab (RZB) is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit. RZB is being investigated as a treatment for adults with psoriatic arthritis (PsA).Objectives:To compare the efficacy and safety of RZB vs placebo (PBO) for the treatment of active PsA in patients who have had inadequate response or intolerance to ≥ 1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).Methods:In KEEPsAKE 1 (NCT03675308), eligible adults (csDMARD-IR with ≥ 5 swollen joints [SJC] and ≥ 5 tender joints [TJC]) were randomized (1:1) to receive blinded subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving 20% improvement in American College of Rheumatology score (ACR20) at week 24. Ranked secondary and other secondary endpoints are shown in the Table 1. Safety was assessed throughout the study. Results reported here are from the 24-week double-blind period; the open-label period with all patients receiving RZB is ongoing.Results:964 patients (RZB, N = 483; PBO, N = 481) were evaluated at week 24. Demographics and baseline characteristics were generally balanced between treatment groups (mean duration of PsA: 7.12 years; mean SJC: 12.2; mean TJC: 20.6; mean body surface area involved with psoriasis [BSA] in patients with BSA ≥ 3%: 16.7%). A significantly greater proportion of RZB- vs PBO-treated patients (57.3% and 33.5%, respectively) achieved the primary endpoint of ACR20 at week 24 (P < .001; Table 1). Significant differences were also observed for RZB vs PBO for the first 8 ranked secondary endpoints (P < .001 for all; Table 1). Serious adverse events were reported for 2.5% and 3.7% of RZB- and PBO-treated patients, respectively; serious infections were reported for 1.0% and 1.2%. There was 1 death in the RZB group.Conclusion:RZB resulted in significantly greater improvements in signs and symptoms of PsA compared with PBO and was well tolerated in patients who were csDMARD-IR.Disclosure of Interests:Lars Erik Kristensen Speakers bureau: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., Consultant of: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., MAURO KEISERMAN Speakers bureau: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Consultant of: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Grant/research support from: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Kim Papp Speakers bureau: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Consultant of: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Grant/research support from: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Leslie McCasland Speakers bureau: LM has received fees for serving on an advisory board from Lilly., Douglas White Speakers bureau: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Consultant of: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Lisa Barcomb Shareholder of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Wenjing Lu Shareholder of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Zailong Wang Shareholder of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ahmed M. Soliman Shareholder of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ann Eldred Shareholder of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Frank Behrens Speakers bureau: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Consultant of: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Grant/research support from: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi.
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Harris H, Mitha Z, White D, Davies W. 342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures.
Rib fracture score = (number of fractures x number of sides) + age score1
In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation.
Method
All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death.
Results
The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar.
Conclusions
The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.
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Affiliation(s)
- H Harris
- Royal Sussex County hospital, Brighton, United Kingdom
| | - Z Mitha
- Royal Sussex County hospital, Brighton, United Kingdom
| | - D White
- Royal Sussex County hospital, Brighton, United Kingdom
| | - W Davies
- Royal Sussex County hospital, Brighton, United Kingdom
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Roberts L, White D, David L, Vadher B, Stoner N. The development and testing of a novel Cognitive Behavioural Therapy (CBT)-based intervention to support medicines-related consultations for healthcare professionals. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab016.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The cost to healthcare of wasted medicines has been estimated at around £300million per annum (1). In response to this figure and efforts to increase medicines management performance across pharmacy and patient outcomes, the practice of ‘medicines optimisation’ has developed into a key aspect of patient care. In particular, concerns exist around whether patients are deriving the optimum benefit from their medications and the extent to which adherence ‘drops off’ at varying intervals after prescription and collection.
In order to tackle medicines adherence and waste, a multi-disciplinary approach must be applied to ensure patients who are prescribed a new medicine take it as intended, experience no problems and receive as much information as they feel they need from healthcare professionals (HCP’s). Adapting Cognitive Behavioural Therapy (CBT)-based techniques to medicines-related consultations has proven effective in supporting medicines adherence in previous studies (2). Collectively, findings demonstrate scope for improving the way HCP’s communicate with patients around starting a new medication and monitoring ongoing use.
Aim
The study aim was to adapt an existing, Royal College of General Practitioners accredited ’10-minute CBT’ training package to be suitable for wider use by a range of healthcare professionals (HCP’s) (i.e. Practice Nurses, Community Pharmacists, Hospital Pharmacists and General Practitioners).
Methods
The research design adopted a repeated-measures, pre/ post questionnaire study that gathered data on HCP knowledge around the use of CBT-based techniques in consultations at the start and end of the training intervention. Two training days were attended by HCP’s that took place three weeks apart. The degree of satisfaction with the training intervention was assessed, along with a formulation exercise that was completed on a hypothetical patient case study pre- and post-training.
Results
Training of healthcare professionals took place at the Oxford Science Park and 105 NHS staff members participated. Feedback questionnaires were received by 96 HCP’s and 46 HCP’s provided additional follow-up questionnaires at 6-months, demonstrating favourable results regarding intervention content and delivery that were consistent with a prior feasibility study. Paired samples t-tests were performed on each formulation exercise rating scale domain and for total scores. There was a highly statistically significant increase in scores for all domains including total pre- and post-training scores as measured by the Formulation Rating Scale. Intra-class Correlation Coefficient for mean FRS ratings was 0.99 (p=.000) and there was no statistically significant change in any score when attendees repeated the skills assessment at 6 months, indicating once learning had been incorporated into practice, there was no recognisable training degradation over the 6-month period. See Table 1.
Conclusion
The training intervention was rated favourably by attendees and was reported by participants as providing a safe environment from which to increase knowledge of CBT-based techniques, practice implementation of formulation skills and access additional peer support to help integrate learning into medicines-related consultations. The study also demonstrates this group of HCP’s were able to integrate CBT-based techniques into hypothetical medicines-related scenarios and that learning was retained over a six-month period following training intervention.
References
1. York Health Economics Consortium and the School of Pharmacy, University of London. Evaluation of the Scale, Causes and Costs of Waste Medicines. 2010. http://php.york.ac.uk/inst/yhec/web/news/documents/Evaluation_of_NHS_Medicines_Waste_Nov_2010.pdf
2. Easthall C, Song F, Bhattacharya D. A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication Adherence. BMJ Open 2013;3:e002749.
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Affiliation(s)
- L Roberts
- Oxford University Hospitals NHS Foundation Trust, Department of Pharmacy, John Radcliffe Hospital, Old Road, Headington, OX3 9DU
| | - D White
- Oxford Health NHS Foundation Trust, Pharmacy Department, Warneford Hospital, Warneford Lane, Oxford OX3 7JX
| | | | - B Vadher
- Oxford University Hospitals NHS Foundation Trust, Department of Pharmacy, John Radcliffe Hospital, Old Road, Headington, OX3 9DU
| | - N Stoner
- Oxford University Hospitals NHS Foundation Trust, Department of Pharmacy, John Radcliffe Hospital, Old Road, Headington, OX3 9DU
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Rosenzweig MQ, Althouse AD, Sabik L, Arnold R, Chu E, Smith TJ, Smith K, White D, Schenker Y. The Association Between Area Deprivation Index and Patient-Reported Outcomes in Patients with Advanced Cancer. Health Equity 2021; 5:8-16. [PMID: 33564735 PMCID: PMC7868579 DOI: 10.1089/heq.2020.0037] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background: This analysis describes associations between area deprivation and patient-reported outcomes among patients with advanced cancer. Methods: This is a cross-sectional analysis of baseline data from a multisite primary palliative care intervention trial. Participants were adult patients with advanced cancer. Patient-level area deprivation scores were calculated using the Area Deprivation Index (ADI). Quality of life and symptom burden were measured. Uni- and multivariate regressions estimated associations between area deprivation and outcomes of interest. Results: Among 672 patients, ∼0.5 (54%) were women and most (94%) were Caucasian. Mean age was 69.3±10.2 years. Lung (36%), breast (13%), and colon (10%) were the most common malignancies. Mean ADI was 64.0, scale of 1 (low)-100 (high). In unadjusted univariate analysis, Functional Assessment of Cancer Therapy-Palliative (p=0.002), Edmonton Symptom Assessment Scale (p=0.025) and the Hospital Anxiety and Depression Scale anxiety (p=0.003) and depression (p=0.029) scores were significantly associated with residence in more deprived areas (p=0.003). In multivariate analysis, controlling for patient-level factors, living in more deprived areas was associated with more anxiety (p=0.019). Conclusion: Higher ADI was associated with higher levels of anxiety among patients with advanced cancer. Geographic information could assist clinicians with providing geographically influenced social support strategies.
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Affiliation(s)
- Margaret Quinn Rosenzweig
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Address correspondence to: Margaret Quinn Rosenzweig, PhD, CRNP, AOCNP, FAAN, Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building, Pittsburgh, PA 15261, USA,
| | - Andrew D. Althouse
- Center for Research on Health Care Data Center, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lindsay Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Division of General lnternal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas J. Smith
- Harry J. Duffey Family Professor of Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth Smith
- Division of General lnternal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas White
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Division of General lnternal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Dimopoulos M, Weisel K, Moreau P, Jr L, White D, Miguel J, Sonneveld P, Engelhardt M, Jenner M, Corso A, Dürig J, Pavic M, Salomo M, Casal E, Jiang R, Nguyen T, Peluso T, Richardson P. POMALIDOMIDE, BORTEZOMIB, DEXAMETHASONE AFTER 1 PRIOR LINE OF THERAPY IN RELAPSED OR REFRACTORY MULTIPLE MYELOMA: SUBANALYSIS OF OPTIMMISM BY AGE, PRIOR TRANSPLANT, AND HIGH-RISK CYTOGENETICS. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Foley R, Kaedbey R, Song K, Venner CP, White D, Doucette S, Christofides A, Reece DE. Canadian perspective on managing multiple myeloma during the COVID-19 pandemic: lessons learned and future considerations. Curr Oncol 2020; 27:270-274. [PMID: 33173379 PMCID: PMC7606044 DOI: 10.3747/co.27.7149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The coronavirus disease 2019 (covid-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 has necessitated changes to the way patients with chronic diseases are managed. Given that patients with multiple myeloma are at increased risk of covid-19 infection and related complications, national bodies and experts around the globe have made recommendations for risk mitigation strategies for those vulnerable patients. Understandably, because of the novelty of the virus, many of the proposed risk mitigation strategies have thus far been reactionary and cannot be supported by strong evidence. In this editorial, we highlight some of the risk mitigation strategies implemented at our institutions across Canada during the first wave of covid-19, and we discuss the considerations that should be made when managing patients during the second wave and beyond.
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Affiliation(s)
- R Foley
- McMaster University and Juravinski Hospital and Cancer Centre, Hamilton, ON
| | - R Kaedbey
- McGill University and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - K Song
- University of British Columbia and Vancouver General Hospital, Vancouver, BC
| | - C P Venner
- University of Alberta and Cross Cancer Institute, Edmonton, AB
| | - D White
- Dalhousie University and Queen Elizabeth ii Health Sciences Centre, Halifax, NS
| | | | | | - D E Reece
- University of Toronto and Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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Steinberg A, Grayek E, Fischhoff B, White D, Callaway C, Elmer J. Expert mental models for predicting outcomes after cardiac arrest. Resuscitation 2020. [DOI: 10.1016/j.resuscitation.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Acacia mangium plantations account for more than 50 % of the exotic plantations in Vietnam. A new black butt symptom was discovered in 2012, followed by the wilting sign in Acacia seedlings in Tuyen Quang Province. Isolations recovered two Phytophthora species, the well-known Acacia pathogen P. cinnamomi, and an unknown species. The new species is described here as Phytophthora acaciivora sp. nov. Phylogenetically this species resides in clade 2d and is most closely related to P. frigida. Phytophthora acaciivora is a heterothallic species, oospores are aplerotic and antheridia are amphigynous. It produces predominantly elongated ovoid, semi papillate, persistent sporangia, no hyphal swellings and no chlamydospores. Optimum temperature for the growth is 25-30 °C and the maximum temperature is over 37.5 °C. Studies are underway to determine the impact of this new species on Acacia plantations in Vietnam.
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Affiliation(s)
- T I Burgess
- Phytophthora Science and Management, Environmental and Conservation Sciences, Murdoch University, 90 South St, 6150, Australia
| | - Q N Dang
- Phytophthora Science and Management, Environmental and Conservation Sciences, Murdoch University, 90 South St, 6150, Australia.,Forest Protection Research Centre, Vietnamese Academy of Forest Sciences, 46 Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - B V Le
- Forest Protection Research Centre, Vietnamese Academy of Forest Sciences, 46 Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - N Q Pham
- Department of Plant and Soil Sciences, Forestry and Agricultural Biotechnology Institute, University of Pretoria, Pretoria 0028, South Africa
| | - D White
- Phytophthora Science and Management, Environmental and Conservation Sciences, Murdoch University, 90 South St, 6150, Australia
| | - T Q Pham
- Forest Protection Research Centre, Vietnamese Academy of Forest Sciences, 46 Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
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White D, MacDonald S, Bull T, Hayman M, de Monteverde-Robb R, Sapsford D, Lavinio A, Varley J, Johnston A, Besser M, Thomas W. Heparin resistance in COVID-19 patients in the intensive care unit. J Thromb Thrombolysis 2020; 50:287-291. [PMID: 32445064 PMCID: PMC7242778 DOI: 10.1007/s11239-020-02145-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Patients with COVID-19 have a coagulopathy and high thrombotic risk. In a cohort of 69 intensive care unit (ICU) patients we investigated for evidence of heparin resistance in those that have received therapeutic anticoagulation. 15 of the patients have received therapeutic anticoagulation with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH), of which full information was available on 14 patients. Heparin resistance to UFH was documented in 8/10 (80%) patients and sub-optimal peak anti-Xa following therapeutic LMWH in 5/5 (100%) patients where this was measured (some patients received both anticoagulants sequentially). Spiking plasma from 12 COVID-19 ICU patient samples demonstrated decreased in-vitro recovery of anti-Xa compared to normal pooled plasma. In conclusion, we have found evidence of heparin resistance in critically unwell COVID-19 patients. Further studies investigating this are required to determine the optimal thromboprophylaxis in COVID-19 and management of thrombotic episodes.
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Affiliation(s)
- D White
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S MacDonald
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T Bull
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Hayman
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R de Monteverde-Robb
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Sapsford
- Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Lavinio
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Varley
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Johnston
- Department of Intensive Care Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Besser
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Thomas
- Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Michelson KN, Charleston E, Aniciete DY, Sorce LR, Fragen P, Persell SD, Ciolino JD, Clayman ML, Rychlik K, Jones VA, Spadino P, Malakooti M, Brown M, White D. Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study. Am J Crit Care 2020; 29:271-282. [PMID: 32607571 DOI: 10.4037/ajcc2020478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes. OBJECTIVE To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families' and health care teams' perceptions of the intervention. METHODS This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a "navigator," met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups. RESULTS Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive. CONCLUSIONS The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.
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Affiliation(s)
- Kelly N. Michelson
- About the Authors: Kelly N. Michelson is an attending physician, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, and a professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elizabeth Charleston
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Danica Y. Aniciete
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Lauren R. Sorce
- Lauren R. Sorce is the Founders Board nurse scientist, Department of Nursing, Ann & Robert H. Lurie Children’s Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | | | - Stephen D. Persell
- Stephen D. Persell is an associate professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University
| | - Jody D. Ciolino
- Jody D. Ciolino is an associate professor, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Marla L. Clayman
- Marla L. Clayman is an adjunct faculty member at Northwestern University
| | - Karen Rychlik
- Karen Rychlik is a statistician, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, and an instructor, Feinberg School of Medicine, Northwestern University
| | - Virginia A. Jones
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Pamela Spadino
- Elizabeth Charleston is lead clinical research coordinator, Danica Y. Aniciete is a clinical research coordinator/navigator, Virginia A. Jones is a clinical research associate, and Pamela Spadino is a parent of a medically complex child, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Marcelo Malakooti
- Marcelo Malakooti is an atending physician and medical director, Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, and an assistant professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University
| | - Melanie Brown
- Melanie Brown is an associate professor of pediatric critical care medicine, Department of Pediatrics, University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | - Douglas White
- Douglas White is director, Program in Ethics and Decision Making in Critical Illness, and vice chair, professor, and Endowed Chair for Ethics, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Cohen MG, Althouse AD, Arnold RM, Bulls HW, White D, Chu E, Rosenzweig M, Smith K, Schenker Y. Is Advance Care Planning Associated With Decreased Hope in Advanced Cancer? JCO Oncol Pract 2020; 17:e248-e256. [PMID: 32530807 DOI: 10.1200/op.20.00039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Providers have cited fear of taking away hope from patients as one of the principal reasons for deferring advance care planning (ACP). However, research is lacking on the relationship between ACP and hope. We sought to investigate the potential association between ACP and hope in advanced cancer. METHODS This is a cross-sectional analysis of baseline data from a primary palliative care intervention trial. All patients had advanced solid cancers. Three domains of ACP were measured using validated questions to assess discussion with oncologists about end-of-life (EOL) planning, selection of a surrogate decision maker, and completion of an advance directive. Hope was measured using the Hearth Hope Index (HHI). Multivariable regression was performed, adjusting for variables associated with hope or ACP. RESULTS A total of 672 patients were included in this analysis. The mean age was 69.3 ± 10.2 years; 54% were female, and 94% were White. Twenty percent of patients (132 of 661) reported having a discussion about EOL planning, 51% (342 of 668) reported completing an advance directive, and 85% (565 of 666) had chosen a surrogate. There was no difference in hope between patients who had and had not had an EOL discussion (adjusted mean difference in HHI, 0.55; P = .181 for adjusted regression), chosen a surrogate (adjusted HHI difference, 0.31; P = .512), or completed an advance directive (adjusted HHI difference, 0.11; P = .752). CONCLUSION In this study, hope was equivalent among patients who had or had not completed 3 important domains of ACP. These findings do not support concerns that ACP is associated with decreased hope for patients with advanced cancer.
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Affiliation(s)
- Michael G Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Robert M Arnold
- Palliative Research Center, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA
| | - Hailey W Bulls
- Palliative Research Center, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA
| | - Douglas White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Edward Chu
- Division of Hematology-Oncology, Department of Medicine and Cancer Therapeutics Program, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | | | - Kenneth Smith
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yael Schenker
- Palliative Research Center, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, PA
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Lao C, Lees D, White D, Lawrenson R. FRI0514 USE OF OPIATE FOR HIP AND KNEE OSTEOARTHRITIS BEFORE AND AFTER JOINT REPLACEMENT SURGERY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Osteoarthritis of the hip and knee is one of the most common causes of reduced mobility. It also causes stiffness and pain. Opioids can offer pain relief but is usually used for severe acute pain caused by major trauma or surgery. The use of opioids for relief of chronic pain caused by arthritis has increased over the last few decades.[1]Objectives:This study aims to investigate the use of strong opiates for patients with hip and knee osteoarthritis before and after joint replacement surgery, over a 13 years period in New Zealand.Methods:This study included patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017 in New Zealand. These records were identified from the National Minimum Dataset (NMD). They were cross referenced with the NZJR data to exclude the admissions not for primary hip or knee replacement surgeries. Patients without a diagnosis of osteoarthritis were excluded.The PHARMS dataset was linked to the NMD to identify the use of strong opiates before and after surgeries. The strong opiates available for community dispensing in New Zealand and included in this study are: dihydrocodeine, fentanyl, methadone, morphine, oxycodone and pethidine. Use of opiate within three months prior to surgery and within 12 months post-surgery were examined by gender, age group, ethnicity, Charlson Comorbidity Index score and year of surgery. Differences by subgroup was examined with Chi- square test. Logistic regression model was used to calculate the adjusted odds ratios of strong opiate use before and after surgery compared with no opiate use.Results:We identified 53,439 primary hip replacements and 50,072 primary knee replacements with a diagnosis of osteoarthritis. Of patients with hip osteoarthritis, 6,251 (11.7%) had strong opiate before hip replacement surgeries and 11,939 (22.3%) had opiate after surgeries. Of patients with knee osteoarthritis, 2,922 (5.8%) had strong opiate before knee replacement surgeries and 15,252 (30.5%) had opiate after surgeries.The probability of patients with hip and knee osteoarthritis having opiate decreased with age, increased with Charlson comorbidity index score, and increased over time both before and after surgeries. Male patients with hip and knee osteoarthritis were less likely to have opiate than female patients both before and after surgeries. New Zealand Europeans with hip and knee osteoarthritis were more likely to receive opiate than other ethnic groups prior to surgeries, but were less likely to have opiate than Asians post-surgeries.Patients who had opiate before surgeries were more likely to have opiate after surgeries than those who did not have opiate before surgeries. The odds ratio was 8.34 (95% confidence interval (CI): 7.87-8.84) for hip osteoarthritis and 11.94 (95% CI: 10.84-13.16) for knee osteoarthritis after adjustment for age, gender, ethnicity, year of surgery and Charlson comorbidity index score. Having opiate prior to surgeries also increased the probability of having opiate for 6 weeks or more after surgeries substantially. The adjusted odds ratio was 21.46 (95% CI: 19.74-23.31) for hip osteoarthritis and 27.22 (95% CI: 24.95-29.68) for knee osteoarthritis.Conclusion:Preoperative opiate holidays should be encouraged. Multiple strategies need to be used to develop analgesic plans that allow adequate rehabilitation, without precipitating a chronic opiate dependence. Clinicians would also benefit from clear guidelines for prescribing strong opiates.References:[1] Nguyen, L.C., D.C. Sing, and K.J. Bozic,Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.J Arthroplasty, 2016.31(9 Suppl): p. 282-7.Disclosure of Interests:None declared
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Maclean W, Singh R, Mackenzie P, White D, Benton S, Stebbing J, Rockall T, Jourdan I. The two-week rule colorectal cancer pathway: an update on recent practice, the unsustainable burden on diagnostics and the role of faecal immunochemical testing. Ann R Coll Surg Engl 2020; 102:308-311. [PMID: 32081023 PMCID: PMC7099154 DOI: 10.1308/rcsann.2020.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Accepted: 01/09/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Survival for colorectal cancer is improved by earlier detection. Rapid assessment and diagnostic demand have created a surge in two-week rule referrals and have subsequently placed a greater burden on endoscopy services. Between 2009 and 2014, a mean of 709 patients annually were referred to Royal Surrey County Hospital with a detection rate of 53 cancers per year giving a positive predictive value for these patients of 7.5%. We aimed to assess what impact the 2015 changes in National Institute for Health and Care Excellence referral criteria had on local cancer detection rate and endoscopy services. METHODS A prospectively maintained database of patients referred under the two-week rule pathway for April 2017-2018 was sub-analysed and the data cross-referenced with all diagnostic reports. FINDINGS There were 1,414 referrals, which is double the number of previous years; 80.6% underwent endoscopy as primary investigation and 62 cancers were identified, 51 being of colorectal and anal origin (positive predictive value 3.6%). A total of 88 patients were diagnosed, with other significant colorectal disease defined as high-risk adenomas, colitis and benign ulcers. Overall, a total of 10.6% of our two-week rule patients had a significant finding.Since the 2015 referral criteria, despite a dramatic rise in two-week rule referrals, there has been no increase in cancer detection. It has placed significant pressure on diagnostic services. This highlights the need for a less invasive, cheaper yet sensitive test to rule out cancer such as faecal immunochemical testing that can enable clinicians to triage and reduce referral to endoscopy in symptomatic patients.
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Affiliation(s)
- W Maclean
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - R Singh
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - P Mackenzie
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - D White
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - S Benton
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - J Stebbing
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - T Rockall
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - I Jourdan
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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