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Plattner P, Wood E, Al Ayoubi L, Beliuskina O, Bissell ML, Blaum K, Campbell P, Cheal B, de Groote RP, Devlin CS, Eronen T, Filippin L, Garcia Ruiz RF, Ge Z, Geldhof S, Gins W, Godefroid M, Heylen H, Hukkanen M, Imgram P, Jaries A, Jokinen A, Kanellakopoulos A, Kankainen A, Kaufmann S, König K, Koszorús Á, Kujanpää S, Lechner S, Malbrunot-Ettenauer S, Müller P, Mathieson R, Moore I, Nörtershäuser W, Nesterenko D, Neugart R, Neyens G, Ortiz-Cortes A, Penttilä H, Pohjalainen I, Raggio A, Reponen M, Rinta-Antila S, Rodríguez LV, Romero J, Sánchez R, Sommer F, Stryjczyk M, Virtanen V, Xie L, Xu ZY, Yang XF, Yordanov DT. Nuclear Charge Radius of ^{26m}Al and Its Implication for V_{ud} in the Quark Mixing Matrix. Phys Rev Lett 2023; 131:222502. [PMID: 38101341 DOI: 10.1103/physrevlett.131.222502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023]
Abstract
Collinear laser spectroscopy was performed on the isomer of the aluminium isotope ^{26m}Al. The measured isotope shift to ^{27}Al in the 3s^{2}3p ^{2}P_{3/2}^{○}→3s^{2}4s ^{2}S_{1/2} atomic transition enabled the first experimental determination of the nuclear charge radius of ^{26m}Al, resulting in R_{c}=3.130(15) fm. This differs by 4.5 standard deviations from the extrapolated value used to calculate the isospin-symmetry breaking corrections in the superallowed β decay of ^{26m}Al. Its corrected Ft value, important for the estimation of V_{ud} in the Cabibbo-Kobayashi-Maskawa matrix, is thus shifted by 1 standard deviation to 3071.4(1.0) s.
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Affiliation(s)
- P Plattner
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Universität Innsbruck, Innrain 52, 6020 Innsbruck, Austria
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - E Wood
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - L Al Ayoubi
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - O Beliuskina
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M L Bissell
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - K Blaum
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - P Campbell
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - B Cheal
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - R P de Groote
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - C S Devlin
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - T Eronen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L Filippin
- Spectroscopy, Quantum Chemistry and Atmospheric Remote Sensing (SQUARES), Université libre de Bruxelles, 1050 Brussels, Belgium
| | - R F Garcia Ruiz
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, Massachusetts 02139, USA
| | - Z Ge
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Geldhof
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - W Gins
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M Godefroid
- Spectroscopy, Quantum Chemistry and Atmospheric Remote Sensing (SQUARES), Université libre de Bruxelles, 1050 Brussels, Belgium
| | - H Heylen
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - M Hukkanen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - P Imgram
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - A Jaries
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Jokinen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Kanellakopoulos
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - A Kankainen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Kaufmann
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - K König
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - Á Koszorús
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - S Kujanpää
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Lechner
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
| | - S Malbrunot-Ettenauer
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - P Müller
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - R Mathieson
- Department of Physics, University of Liverpool, Liverpool L69 7ZE, United Kingdom
| | - I Moore
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - W Nörtershäuser
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - D Nesterenko
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - R Neugart
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- Institut für Kernchemie, Universität Mainz, Fritz-Straßmann-Weg 2, 55128 Mainz, Germany
| | - G Neyens
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - A Ortiz-Cortes
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - H Penttilä
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - I Pohjalainen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - A Raggio
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - M Reponen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - S Rinta-Antila
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L V Rodríguez
- ISOLDE, CERN Experimental Physics Department, Geneva 23, 1211 Genevè, Switzerland
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
- IJCLab, CNRS/IN2P3, Université Paris-Saclay, 91400 Orsay, France
| | - J Romero
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - R Sánchez
- GSI Helmholtzzentrum für Schwerionenforschung, Planckstraße 1, 64291 Darmstadt, Germany
| | - F Sommer
- Institut für Kernphysik, Technische Universität Darmstadt, Schlossgartenstraße 9, 64289 Darmstadt, Germany
| | - M Stryjczyk
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - V Virtanen
- Department of Physics, University of Jyväskylä, P.O. Box 35 FI-40014, Jyväskylä, Finland
| | - L Xie
- Department of Physics and Astronomy, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Z Y Xu
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
| | - X F Yang
- Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
- School of Physics and State Key Laboratory of Nuclear Physics and Technology, Peking University, 209 Chengfu Road, 100871 Beijing, China
| | - D T Yordanov
- IJCLab, CNRS/IN2P3, Université Paris-Saclay, 91400 Orsay, France
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Pijeira Perez Y, Wood E, Hughes DA. Costs of orphan medicinal products: longitudinal analysis of expenditure in Wales. Orphanet J Rare Dis 2023; 18:342. [PMID: 37915031 PMCID: PMC10621215 DOI: 10.1186/s13023-023-02956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The Orphan Regulation ((EC) No 141/2000) has successfully redirected private and public investment towards previously neglected areas through incentives, regulatory obligations and rewards. However, the growth in the number of licensed orphan medicinal products (OMPs) has led to concerns about increased costs. The aims were to investigate the trend in the costs of OMPs to the National Health Service in Wales, to attribute costs of medicines within and outside periods of marketing exclusivity, and estimate the contribution of individual medicines to the overall costs of OMPs. METHODS Expenditure on OMPs in Wales was analysed between the 2014/15 and 2019/20 financial years using data on prescriptions dispensed in primary care, secondary care, and specialised commissioned services. OMP spend was calculated as a proportion of total medicines expenditure, whether it was incurred during, or outside the marketing exclusivity period (MEP), and by therapeutic area and medicine. RESULTS Overall spend on OMPs and all medicines increased from £32 m to £82 m, and from £1,030 m to £1,198 m, respectively, with the proportion of spend on OMPs more than doubling from 3.1% to 6.9% per annum. Average year-on-year growth in the costs of OMPs was 21%, compared to 2% for other medicines. Costs following MEP expiry contributed significantly to overall OMP costs, increasing from £8 m to £30 m, corresponding to an increase from 24% to 37%. Treatments for 'malignant disease and immunosuppression', 'nutrition and blood' and the 'respiratory system' accounted for 90% of all OMP spend. Half of total OMP annual expenditure was on just 4 medicines in 2014/15, increasing to 8 in 2019/20. CONCLUSIONS Both the number of OMPs and the amount spent on OMPs in Wales has increased over time, possibly as a consequence of favourable licensing conditions, permissive health technology assessment policies and dedicated funding.
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Affiliation(s)
- Yankier Pijeira Perez
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK.
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Dinesh K, White N, Baker L, Sowden JE, Behrens-Spraggins S, Wood E, Charles J, Herrmann DN, Sharma G, Eichinger K. Disease-specific wearable sensor algorithms for profiling activity, gait, and balance in individuals with Charcot-Marie-Tooth disease type 1A. J Peripher Nerv Syst 2023; 28:368-381. [PMID: 37209301 DOI: 10.1111/jns.12562] [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: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND/AIMS Charcot-Marie-Tooth Disease type 1A (CMT1A), the most common inherited peripheral neuropathy, is characterized by progressive sensory loss and weakness, which results in impaired mobility. Increased understanding of the genetics and pathophysiology of CMT1A has led to development of potential therapeutic agents, necessitating clinical trial readiness. Wearable sensors may provide useful outcome measures for future trials. METHODS Individuals with CMT1A and unaffected controls were recruited for this 12-month study. Participants wore sensors for in-clinic assessments and at-home, from which activity, gait, and balance metrics were derived. Mann-Whitney U tests were used to analyze group differences for activity, gait, and balance parameters. Test-retest reliability of gait and balance parameters and correlations of these parameters with clinical outcome assessments (COAs) were examined. RESULTS Thirty individuals, 15 CMT1A, and 15 controls, participated. Gait and balance metrics demonstrated moderate to excellent reliability. CMT1A participants had longer step durations (p < .001), shorter step lengths (p = .03), slower gait speeds (p < .001), and greater postural sway (p < .001) than healthy controls. Moderate correlations were found between CMT-Functional Outcome Measure and step length (r = -0.59; p = .02), and gait speed (r = 0.64; p = .01); 11 out of 15 CMT1A participants demonstrated significant increases in stride duration between the first and last quarter of the 6-min walk test, suggesting fatigue. INTERPRETATION In this initial study, gait and balance metrics derived from wearable sensors were reliable and associated with COAs in individuals with CMT1A. Larger longitudinal studies are needed to confirm our findings and evaluate sensitivity and utility of these disease-specific algorithms for clinical trial use.
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Affiliation(s)
- K Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - N White
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - L Baker
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J E Sowden
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - S Behrens-Spraggins
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - E Wood
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - J Charles
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - D N Herrmann
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - G Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - K Eichinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Casas-Orozco D, Laky D, Wang V, Abdi M, Feng X, Wood E, Reklaitis GV, Nagy ZK. Techno-economic analysis of dynamic, end-to-end optimal pharmaceutical campaign manufacturing using PharmaPy. AIChE J 2023; 69:e18142. [PMID: 38179085 PMCID: PMC10765457 DOI: 10.1002/aic.18142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/16/2023] [Indexed: 01/06/2024]
Abstract
Increased interest in the pharmaceutical industry to transition from batch to continuouos manufacturing motivates the use of digital frameworks that allow systematic comparison of candidate process configurations. This paper evaluates the technical and economic feasibility of different end-to-end optimal process configurations, viz. batch, hybrid and continuous, for small-scale manufacturing of an active pharmaceutical ingredient. Production campaigns were analyzed for those configurations containing continuous equipment, where significant start-up effects are expected given the relatively short campaign times considered. Hybrid operating mode was found to be the most attractive process configuration at intermediate and large annual production targets, which stems from combining continuous reactors and semi-batch vaporization equipment. Continuous operation was found to be more costly, due to long stabilization times of continuous crystallization, and thermodynamic limitations of flash vaporization. Our work reveals the benefits of systematic digital evaluation of process configurations that operate under feasible conditions and compliant product quality attributes.
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Affiliation(s)
- Daniel Casas-Orozco
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Daniel Laky
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Vivian Wang
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Mesfin Abdi
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - X Feng
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - E Wood
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Gintaras V Reklaitis
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Zoltan K Nagy
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
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Jolley S, Lord J, Plant D, Wood E, Bracegirdle K, Browning S, Carter B, James K. A cluster randomised, 16-week, parallel-group multicentre trial to compare the effectiveness of a digital school-based cognitive behavioural resilience/wellbeing-building intervention targeting emotional and behavioural problems in vulnerable Year 4 primary school children in whole classes, to the usual school curriculum: a study protocol to the "CUES for Schools" trial. Trials 2023; 24:253. [PMID: 37013581 PMCID: PMC10071738 DOI: 10.1186/s13063-023-07267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Around 10% of school-aged children experience mental health difficulties. Many more are 'vulnerable': experiencing emotional and/or behavioural problems reaching clinical levels, and thus at greatest risk of future mental illness. The trial aim is to evaluate the effectiveness of the CUES for schools programme in reducing emotional and behavioural problems in vulnerable children. METHODS The "CUES for Schools" study is a multicentre cluster randomised controlled trial in primary schools in south east England. Schools will be randomised to receive the usual school curriculum, or the CUES programme (1:1). We aim to enrol 74 schools (5550 children including 2220 vulnerable children). CUES is a whole-class teacher-facilitated interactive digital cognitive-behavioural intervention, delivered as 24 short (20-min) modules over 12 weeks, targeting emotional/behavioural regulation skills. Children self-report emotional/behavioural problems at baseline, 8, and 16 weeks, and wellbeing and cognitive vulnerability at 0 and 16 weeks. Adverse events are assessed at 8 and 16 weeks. Teachers rate classroom behaviour at baseline and 16 weeks. School senior leadership teams and individual teachers consent to involvement in the study; parents can opt their child out of CUES sessions, assessments, or research. Children can similarly opt out and assent to research participation. The primary objective of this trial is to evaluate the effectiveness of CUES for schools compared to the usual school curriculum in improving emotional/behavioural problems for vulnerable Year 4 (8-9 years old) children at 16 weeks post-randomisation, as measured using a standardised questionnaire designed for primary schools. The secondary objective is to investigate the impact of the CUES for schools programme on both vulnerable and non-vulnerable children on wellbeing and teacher-rated classroom behaviour. DISCUSSION The study will show whether CUES for schools is more effective than the usual curriculum in reducing emotional and behavioural problems in vulnerable Year 4 children, and thus reducing the risk of mental health difficulties in later adolescent and adult life. As a digital, teacher-facilitated intervention, CUES for schools can be readily implemented, at minimal cost. If effective, CUES for schools therefore has the potential to reduce the impact of emotional/behavioural difficulties on children's learning, behaviour, and relationships and the burden of future mental health morbidity. TRIAL REGISTRATION Trial Registration ISRCTN11445338. Registered on September 12, 2022.
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Affiliation(s)
- S Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - J Lord
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - D Plant
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - E Wood
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - K Bracegirdle
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - S Browning
- South London and Maudsley NHS Foundation Trust, Snowfields Adolescent Unit, Mapother House, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - K James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Al-Najjar N, Bray L, Carter B, Castle AP, Collingwood A, Cook G, Crudgington H, Currier J, Dietz KC, Hardy WAS, Hiscock H, Hughes D, Morris C, Roberts D, Rouncefield-Swales A, Saron H, Spowart C, Stibbs-Eaton L, Tudur Smith C, Watson V, Whittle L, Wiggs L, Wood E, Gringras P, Pal DK. Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E: a protocol for a randomised controlled trial comparing an online behavioural sleep intervention with standard care in children with Rolandic epilepsy. BMJ Open 2023; 13:e065769. [PMID: 36898757 PMCID: PMC10008377 DOI: 10.1136/bmjopen-2022-065769] [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] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Sleep and epilepsy have an established bidirectional relationship yet only one randomised controlled clinical trial has assessed the effectiveness of behavioural sleep interventions for children with epilepsy. The intervention was successful, but was delivered via face-to-face educational sessions with parents, which are costly and non-scalable to population level. The Changing Agendas on Sleep, Treatment and Learning in Epilepsy (CASTLE) Sleep-E trial addresses this problem by comparing clinical and cost-effectiveness in children with Rolandic epilepsy between standard care (SC) and SC augmented with a novel, tailored parent-led CASTLE Online Sleep Intervention (COSI) that incorporates evidence-based behavioural components. METHODS AND ANALYSES CASTLE Sleep-E is a UK-based, multicentre, open-label, active concurrent control, randomised, parallel-group, pragmatic superiority trial. A total of 110 children with Rolandic epilepsy will be recruited in outpatient clinics and allocated 1:1 to SC or SC augmented with COSI (SC+COSI). Primary clinical outcome is parent-reported sleep problem score (Children's Sleep Habits Questionnaire). Primary health economic outcome is the incremental cost-effectiveness ratio (National Health Service and Personal Social Services perspective, Child Health Utility 9D Instrument). Parents and children (≥7 years) can opt into qualitative interviews and activities to share their experiences and perceptions of trial participation and managing sleep with Rolandic epilepsy. ETHICS AND DISSEMINATION The CASTLE Sleep-E protocol was approved by the Health Research Authority East Midlands (HRA)-Nottingham 1 Research Ethics Committee (reference: 21/EM/0205). Trial results will be disseminated to scientific audiences, families, professional groups, managers, commissioners and policymakers. Pseudo-anonymised individual patient data will be made available after dissemination on reasonable request. TRIAL REGISTRATION NUMBER ISRCTN13202325.
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Affiliation(s)
- Nadia Al-Najjar
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Bray
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Bernie Carter
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Advisory Panel Castle
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Georgia Cook
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Holly Crudgington
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Currier
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Kristina Charlotte Dietz
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will A S Hardy
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Harriet Hiscock
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Christopher Morris
- University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Deborah Roberts
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Alison Rouncefield-Swales
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Holly Saron
- Department of Nursing & Midwifery, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Catherine Spowart
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Stibbs-Eaton
- Liverpool Clinical Trials Centre, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Victoria Watson
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Liam Whittle
- Department of Health Data Science, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Luci Wiggs
- Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Paul Gringras
- Department of Sleep Medicine, Evelina London Children's Hospital, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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7
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Carter B, Bray L, al-Najjar N, Piella AT, Tudur-Smith C, Spowart C, Collingwood A, Crudgington H, Currier J, Hughes DA, Wood E, Martin R, Morris C, Roberts D, Rouncefield-Swales A, Sutherland H, Watson V, Cook G, Wiggs L, Gringras P, Pal D. The impact of parent treatment preference and other factors on recruitment: lessons learned from a paediatric epilepsy randomised controlled trial. Trials 2023; 24:83. [PMID: 36747248 PMCID: PMC9900533 DOI: 10.1186/s13063-023-07091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In paediatric epilepsy, the evidence of effectiveness of antiseizure treatment is inconclusive for some types of epilepsy. As with other paediatric clinical trials, researchers undertaking paediatric epilepsy clinical trials face a range of challenges that may compromise external validity MAIN BODY: In this paper, we critically reflect upon the factors which impacted recruitment to the pilot phase of a phase IV unblinded, randomised controlled 3×2 factorial trial examining the effectiveness of two antiseizure medications (ASMs) and a sleep behaviour intervention in children with Rolandic epilepsy. We consider the processes established to support recruitment, public and patient involvement and engagement (PPIE), site induction, our oversight of recruitment targets and figures, and the actions we took to help us understand why we failed to recruit sufficient children to continue to the substantive trial phase. The key lessons learned were about parent preference, children's involvement and collaboration in decision-making, potential and alternative trial designs, and elicitation of stated preferences pre-trial design. Despite pre-funding PPIE during the trial design phase, we failed to anticipate the scale of parental treatment preference for or against antiseizure medication (ASMs) and consequent unwillingness to be randomised. Future studies should ensure more detailed and in-depth consultation to ascertain parent and/or patient preferences. More intense engagement with parents and children exploring their ideas about treatment preferences could, perhaps, have helped predict some recruitment issues. Infrequent seizures or screening children close to natural remission were possible explanations for non-consent. It is possible some clinicians were unintentionally unable to convey clinical equipoise influencing parental decision against participation. We wanted children to be involved in decisions about trial participation. However, despite having tailored written and video information to explain the trial to children we do not know whether these materials were viewed in each consent conversation or how much input children had towards parents' decisions to participate. Novel methods such as parent/patient preference trials and/or discrete choice experiments may be the way forward. CONCLUSION The importance of diligent consultation, the consideration of novel methods such as parent/patient preference trials and/or discrete choice experiments in studies examining the effectiveness of ASMs versus no-ASMs cannot be overemphasised even in the presence of widespread clinician equipoise.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
| | - Lucy Bray
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Nadia al-Najjar
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Agnès Tort Piella
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catrin Tudur-Smith
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Amber Collingwood
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Holly Crudgington
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Dyfrig A. Hughes
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Eifiona Wood
- grid.7362.00000000118820937Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Rachael Martin
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Christopher Morris
- grid.8391.30000 0004 1936 8024University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Alison Rouncefield-Swales
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Heather Sutherland
- grid.255434.10000 0000 8794 7109Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Victoria Watson
- grid.10025.360000 0004 1936 8470Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Georgia Cook
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Luci Wiggs
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Paul Gringras
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK. .,Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Deb Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK. .,MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK. .,King's College Hospital, London, UK.
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8
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Pandolfo S, Wu Z, Giuseppe S, Ferro M, Sundaram C, Yong C, Derweesh I, Dhanji S, Margulis V, Taylor J, Tozzi M, Davis M, Wood E, Mehrazin R, Gonzalgo M, Eilender B, Mendiola D, Wang L, Tuderti G, Checcucci E, Verze P, Djaladat H, Porpiglia F, Abdollah F, Autorino R. Predictive factors of complications in patients undergoing minimally invasive radical nephroureterectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00955-7] [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: 02/12/2023]
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Klimas J, Gorfinkel LR, Hamilton M, Lail M, Krupchanka D, Cullen W, Wood E, Fairbairn N. Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting. Subst Use Misuse 2022; 57:2134-2141. [PMID: 36315582 PMCID: PMC9970042 DOI: 10.1080/10826084.2022.2137815] [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] [Indexed: 11/22/2022]
Abstract
Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 - August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.
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Affiliation(s)
- J. Klimas
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Addictology, First Faculty of Medicine, Charles University, Czech Republic
| | - Lauren R. Gorfinkel
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M.A. Hamilton
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - M. Lail
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - D. Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - W. Cullen
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - E. Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - N. Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
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10
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Nosyk B, Min JE, Pearce LA, Zhou H, Homayra F, Wang L, Piske M, McCarty D, Gardner G, O'Briain W, Wood E, Daly P, Walsh T, Henry B. Development and validation of health system performance measures for opioid use disorder in British Columbia, Canada. Drug Alcohol Depend 2022; 233:109375. [PMID: 35231716 DOI: 10.1016/j.drugalcdep.2022.109375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance measurement provides an evidence-based means to inform development of interventions to improve the quality of care for people who use opioids. We aimed to develop and assess the predictive validity of health system performance measures for opioid use disorder (OUD) in British Columbia (BC), Canada. METHODS Performance measures were generated using retrospective population-level administrative datasets (both provincial and regional) and publicly-reported retrospective data according to four domains (care engagement, clinical guideline compliance, integration, and healthcare utilization). The adjusted odds ratio was estimated via generalized linear mixed models to determine predictive validity for all-cause hospitalization or mortality within 6 months of measurement. FINDINGS A total of 102 performance measures were constructed. We identified 55,470 diagnosed PWOUD, and 39,456 ever engaged in opioid agonist treatment (OAT). We found divergent rates of treatment for concurrent conditions (7.4% for alcohol use disorder to 80.1% for HIV/AIDS), low levels of linkage to OAT and other outpatient care following acute care, and increasing levels of service provision, including increases in OAT prescribers and pharmacies, naloxone kit distribution and overdose prevention site visitation. Our analyses on the predictive validity measures largely supported a priori hypotheses on the direction of effect on the outcome. CONCLUSIONS We identified a range of priorities to improve the quality of care for PWOUD, with critical gaps in linkage to care through acute care settings and long-term engagement in OAT. The proposed measures can be derived for geographic and clinical subgroups and updated over time, providing a basis to monitor and evaluate efforts to address the public health burden of OUD.
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Affiliation(s)
- B Nosyk
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Rm 11300 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | - J E Min
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L A Pearce
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - H Zhou
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - F Homayra
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - M Piske
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - D McCarty
- Oregon Health & Science University, 1810 SW 5th Ave, Flrs 2 5 and 6, Portland, OR 97201, USA
| | - G Gardner
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - W O'Briain
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada
| | - E Wood
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 -2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - P Daly
- Vancouver Coastal Health Authority, 601 West Broadway, Vancouver, British Columbia V5Z 4C2, Canada
| | - T Walsh
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - B Henry
- Office of the Provincial Health Officer, PO Box 9648, Stn Prov Govt, Victoria, British Columbia V8W 9P4, Canada
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11
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Kim R, Chaoul J, Wood E, Ascher-Walsh C. Patient and Surgical Characteristics Associated with Delay or Cancellation of Elective Gynecologic Surgeries Due to the COVID-19 Pandemic. J Minim Invasive Gynecol 2021. [PMCID: PMC8518383 DOI: 10.1016/j.jmig.2021.09.058] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Study Objective This study aims to identify patient characteristics associated with length of delay or not returning for elective benign gynecologic surgical procedures that were canceled due to the COVID-19 pandemic. Design Retrospective review of electronic medical records. Setting Academic, urban, tertiary hospital system. Patients or Participants Between March 15, 2020, and May 15, 2020, all elective surgical procedures were canceled due to resource limitations. Electronic medical records were reviewed through November 15, 2020, to assess whether patients rescheduled or did not come back for surgery within the following six-month period. Interventions N/A. Measurements and Main Results 219 benign gynecologic surgeries were canceled between March 15 and May 15, 2020. 158 (72%) patients returned within the following six months for their procedure, and 61 patients (28%) did not return. Among patients who rescheduled, the length of delay was not correlated with age, race/ethnicity, or route of surgery. There was, however, sufficient data to conclude that length of delay differed by primary indication of surgery (p=.0173). There was an association between not returning for surgery and primary indication of pelvic organ prolapse/ incontinence repair (p=.0203). Conclusion The majority of patients rescheduled their procedure within six months following the peak of the COVID-19 crisis. The primary indication of pelvic organ prolapse and incontinence was associated with a decreased likelihood of returning for surgery within six months.
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12
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Casas-Orozco D, Laky D, Wang V, Abdi M, Feng X, Wood E, Laird C, Reklaitis GV, Nagy ZK. PharmaPy: An object-oriented tool for the development of hybrid pharmaceutical flowsheets. Comput Chem Eng 2021; 153:107408. [PMID: 38235368 PMCID: PMC10793241 DOI: 10.1016/j.compchemeng.2021.107408] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Process design and optimization continue to provide computational challenges as the chemical engineering and process optimization communities seek to address more complex and larger scale applications. Software tools for digital design and flowsheet simulation are readily available for traditional chemical processing applications such as in commodity chemicals and hydrocarbon processing; however, tools for pharmaceutical manufacturing are much less well developed. This paper introduces, PharmaPy, a Python-based modelling platform for pharmaceutical manufacturing systems design and optimization. The versatility of the platform is demonstrated in simulation and optimization of both continuous and batch processes. The structure and features of a Python-based modeling platform, PharmaPy are presented. Illustrative examples are shown to highlight key features of the platform and framework.
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Affiliation(s)
- Daniel Casas-Orozco
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Daniel Laky
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Vivian Wang
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Mesfin Abdi
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - X. Feng
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - E. Wood
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, Food & Drug Administration, Silver Spring, MD, USA
| | - Carl Laird
- Sandia National Laboratories, Albuquerque, NM 87123, USA
| | - Gintaras V. Reklaitis
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
| | - Zoltan K. Nagy
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47906, USA
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13
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Wilby MJ, Best A, Wood E, Burnside G, Bedson E, Short H, Wheatley D, Hill-McManus D, Sharma M, Clark S, Bostock J, Hay S, Baranidharan G, Price C, Mannion R, Hutchinson PJ, Hughes DA, Marson A, Williamson PR. Microdiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by prolapsed intervertebral disc: the NERVES RCT. Health Technol Assess 2021; 25:1-86. [PMID: 33845941 DOI: 10.3310/hta25240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of microdiscectomy with transforaminal epidural steroid injection for the management of radicular pain secondary to lumbar prolapsed intervertebral disc for non-emergency presentation of sciatica of < 12 months' duration. INTERVENTIONS Patients were randomised to either (1) microdiscectomy or (2) transforaminal epidural steroid injection. DESIGN A pragmatic, multicentre, randomised prospective trial comparing microdiscectomy with transforaminal epidural steroid injection for sciatica due to prolapsed intervertebral disc with < 1 year symptom duration. SETTING NHS services providing secondary spinal surgical care within the UK. PARTICIPANTS A total of 163 participants (aged 16-65 years) were recruited from 11 UK NHS outpatient clinics. MAIN OUTCOME MEASURES The primary outcome was participant-completed Oswestry Disability Questionnaire score at 18 weeks post randomisation. Secondary outcomes were visual analogue scores for leg pain and back pain; modified Roland-Morris score (for sciatica), Core Outcome Measures Index score and participant satisfaction at 12-weekly intervals. Cost-effectiveness and quality of life were assessed using the EuroQol-5 Dimensions, five-level version; Hospital Episode Statistics data; medication usage; and self-reported cost data at 12-weekly intervals. Adverse event data were collected. The economic outcome was incremental cost per quality-adjusted life-year gained from the perspective of the NHS in England. RESULTS Eighty-three participants were allocated to transforaminal epidural steroid injection and 80 participants were allocated to microdiscectomy, using an online randomisation system. At week 18, Oswestry Disability Questionnaire scores had decreased, relative to baseline, by 26.7 points in the microdiscectomy group and by 24.5 points in the transforaminal epidural steroid injection. The difference between the treatments was not statistically significant (estimated treatment effect -4.25 points, 95% confidence interval -11.09 to 2.59 points). Nor were there significant differences between treatments in any of the secondary outcomes: Oswestry Disability Questionnaire scores, visual analogue scores for leg pain and back pain, modified Roland-Morris score and Core Outcome Measures Index score up to 54 weeks. There were four (3.8%) serious adverse events in the microdiscectomy group, including one nerve palsy (foot drop), and none in the transforaminal epidural steroid injection group. Compared with transforaminal epidural steroid injection, microdiscectomy had an incremental cost-effectiveness ratio of £38,737 per quality-adjusted life-year gained and a probability of 0.17 of being cost-effective at a willingness to pay threshold of £20,000 per quality-adjusted life-year. LIMITATIONS Primary outcome data was invalid or incomplete for 24% of participants. Sensitivity analyses demonstrated robustness to assumptions made regarding missing data. Eighteen per cent of participants in the transforaminal epidural steroid injection group subsequently received microdiscectomy prior to their primary outcome assessment. CONCLUSIONS To the best of our knowledge, the NErve Root Block VErsus Surgery trial is the first trial to evaluate the comparative clinical effectiveness and cost-effectiveness of microdiscectomy and transforaminal epidural steroid injection. No statistically significant difference was found between the two treatments for the primary outcome. It is unlikely that microdiscectomy is cost-effective compared with transforaminal epidural steroid injection at a threshold of £20,000 per quality-adjusted life-year for sciatica secondary to prolapsed intervertebral disc. FUTURE WORK These results will lead to further studies in the streamlining and earlier management of discogenic sciatica. TRIAL REGISTRATION Current Controlled Trials ISRCTN04820368 and EudraCT 2014-002751-25. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin J Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust (member of Liverpool Health Partners), Liverpool, UK
| | - Ashley Best
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girvan Burnside
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Emma Bedson
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Hannah Short
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Dianne Wheatley
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
| | - Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Manohar Sharma
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust (member of Liverpool Health Partners), Liverpool, UK
| | | | - Sally Hay
- Patient and public involvement representative, Norfolk, UK
| | | | - Cathy Price
- Pain Clinic, Solent NHS Trust, Southampton, UK
| | | | - Peter J Hutchinson
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool and The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool (member of Liverpool Health Partners), Liverpool, UK
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14
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Wilby MJ, Best A, Wood E, Burnside G, Bedson E, Short H, Wheatley D, Hill-McManus D, Sharma M, Clark S, Baranidharan G, Price C, Mannion R, Hutchinson PJ, Hughes DA, Marson A, Williamson PR. Surgical microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation. Lancet Rheumatol 2021; 3:e347-e356. [PMID: 33969319 PMCID: PMC8080892 DOI: 10.1016/s2665-9913(21)00036-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The optimal invasive treatment for sciatica secondary to herniated lumbar disc remains controversial, with a paucity of evidence for use of non-surgical treatments such as transforaminal epidural steroid injection (TFESI) over surgical microdiscectomy. We aimed to investigate the clinical and cost-effectiveness of these options for management of radicular pain secondary to herniated lumbar disc. Methods We did a pragmatic, multicentre, phase 3, open-label, randomised controlled trial at 11 spinal units across the UK. Eligible patients were aged 16–65 years, had MRI-confirmed non-emergency sciatica secondary to herniated lumbar disc with symptom duration between 6 weeks and 12 months, and had leg pain that was not responsive to non-invasive management. Participants were randomly assigned (1:1) to receive either TFESI or surgical microdiscectomy by an online randomisation system that was stratified by centre with random permuted blocks. The primary outcome was Oswestry Disability Questionnaire (ODQ) score at 18 weeks. All randomly assigned participants who completed a valid ODQ at baseline and at 18 weeks were included in the analysis. Safety analysis included all treated participants. Cost-effectiveness was estimated from the EuroQol-5D-5L, Hospital Episode Statistics, medication usage, and self-reported resource-use data. This trial was registered with ISRCTN, number ISRCTN04820368, and EudraCT, number 2014-002751-25. Findings Between March 6, 2015, and Dec 21, 2017, 163 (15%) of 1055 screened patients were enrolled, with 80 participants (49%) randomly assigned to the TFESI group and 83 participants (51%) to the surgery group. At week 18, ODQ scores were 30·02 (SD 24·38) for 63 assessed patients in the TFESI group and 22·30 (19·83) for 61 assessed patients in the surgery group. Mean improvement was 24·52 points (18·89) for the TFESI group and 26·74 points (21·35) for the surgery group, with an estimated treatment difference of −4·25 (95% CI −11·09 to 2·59; p=0·22). There were four serious adverse events in four participants associated with surgery, and none with TFESI. Compared with TFESI, surgery had an incremental cost-effectiveness ratio of £38 737 per quality-adjusted life-year gained, and a 0·17 probability of being cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life-year. Interpretation For patients with sciatica secondary to herniated lumbar disc, with symptom duration of up to 12 months, TFESI should be considered as a first invasive treatment option. Surgery is unlikely to be a cost-effective alternative to TFESI. Funding Health Technology Assessment programme of the National Institute for Health Research (NIHR), UK.
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Affiliation(s)
- Martin John Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Correspondence to: Mr Martin J Wilby, Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Ashley Best
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girvan Burnside
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Emma Bedson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hannah Short
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Dianne Wheatley
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Manohar Sharma
- Department of Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Cathy Price
- Pain Clinic, Solent NHS Trust, Highpoint Venue, Bursledon, Southampton, UK
| | - Richard Mannion
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Hutchinson
- Academic Division of Neurosurgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
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15
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Ramanan AV, Dick AD, Jones AP, Hughes DA, McKay A, Rosala-Hallas A, Williamson PR, Hardwick B, Hickey H, Rainford N, Hickey G, Kolamunnage-Dona R, Culeddu G, Plumpton C, Wood E, Compeyrot-Lacassagne S, Woo P, Edelsten C, Beresford MW. Adalimumab in combination with methotrexate for refractory uveitis associated with juvenile idiopathic arthritis: a RCT. Health Technol Assess 2020; 23:1-140. [PMID: 31033434 DOI: 10.3310/hta23150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) are at risk of uveitis. The role of adalimumab (Humira®; AbbVie Inc., Ludwigshafen, Germany) in the management of uveitis in children needs to be determined. OBJECTIVE To compare the efficacy, safety and cost-effectiveness of adalimumab in combination with methotrexate (MTX) versus placebo with MTX alone, with regard to controlling disease activity in refractory uveitis associated with JIA. DESIGN This was a randomised (applying a ratio of 2 : 1 in favour of adalimumab), double-blind, placebo-controlled, multicentre parallel-group trial with an integrated economic evaluation. A central web-based system used computer-generated tables to allocate treatments. A cost-utility analysis based on visual acuity was conducted and a 10-year extrapolation by Markov modelling was also carried out. SETTING The setting was tertiary care centres throughout the UK. PARTICIPANTS Patients aged 2-18 years inclusive, with persistently active JIA-associated uveitis (despite optimised MTX treatment for at least 12 weeks). INTERVENTIONS All participants received a stable dose of MTX and either adalimumab (20 mg/0.8 ml for patients weighing < 30 kg or 40 mg/0.8 ml for patients weighing ≥ 30 kg by subcutaneous injection every 2 weeks based on body weight) or a placebo (0.8 ml as appropriate according to body weight by subcutaneous injection every 2 weeks) for up to 18 months. A follow-up appointment was arranged at 6 months. MAIN OUTCOME MEASURES Primary outcome - time to treatment failure [multicomponent score as defined by set criteria based on the Standardisation of Uveitis Nomenclature (SUN) criteria]. Economic outcome - incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the NHS in England and Personal Social Services providers. Full details of secondary outcomes are provided in the study protocol. RESULTS A total of 90 participants were randomised (adalimumab, n = 60; placebo, n = 30). There were 14 (23%) treatment failures in the adalimumab group and 17 (57%) in the placebo group. The analysis of the data from the double-blind phase of the trial showed that the hazard risk (HR) of treatment failure was significantly reduced, by 75%, for participants in the adalimumab group (HR 0.25, 95% confidence interval 0.12 to 0.51; p < 0.0001 from log-rank test). The cost-effectiveness of adalimumab plus MTX was £129,025 per QALY gained. Adalimumab-treated participants had a much higher incidence of adverse and serious adverse events. CONCLUSIONS Adalimumab in combination with MTX is safe and effective in the management of JIA-associated uveitis. However, the likelihood of cost-effectiveness is < 1% at the £30,000-per-QALY threshold. FUTURE WORK A clinical trial is required to define the most effective time to stop therapy. Prognostic biomarkers of early and complete response should also be identified. TRIAL REGISTRATION Current Controlled Trials ISRCTN10065623 and European Clinical Trials Database number 2010-021141-41. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 15. See the NIHR Journals Library website for further project information. This trial was also funded by Arthritis Research UK (grant reference number 19612). Two strengths of adalimumab (20 mg/0.8 ml and 40 mg/0.8 ml) and a matching placebo were manufactured by AbbVie Inc. (the Marketing Authorisation holder) and supplied in bulk to the contracted distributor (Sharp Clinical Services, Crickhowell, UK) for distribution to trial centres.
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Affiliation(s)
- Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew D Dick
- Bristol Eye Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK.,University College London Institute of Ophthalmology and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Ashley P Jones
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Andrew McKay
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna Rosala-Hallas
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ben Hardwick
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Graeme Hickey
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ruwanthi Kolamunnage-Dona
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | | | | | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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16
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Brar R, Grant C, DeBeck K, Milloy MJ, Fairbairn N, Wood E, Kerr T, Hayashi K. Changes in drug use behaviors coinciding with the emergence of illicit fentanyl among people who use drugs in Vancouver, Canada. Am J Drug Alcohol Abuse 2020; 46:625-631. [PMID: 32689810 DOI: 10.1080/00952990.2020.1771721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: With the emergence of illicitly-manufactured fentanyl, drug overdose deaths have risen in unprecedented numbers. In this context, there is an urgent need to characterize potential changes in drug use behaviors among people who use drugs (PWUD). Objective: To examine changes in drug use behaviors following the emergence of illicit fentanyl among people who use drugs (PWUD). Methods: Data for this cross-sectional analysis was derived from three prospective cohorts of PWUD between December 2016 and May 2017 in Vancouver, Canada. Multivariable logistic regression was used to determine factors associated with self-reported behavior changes (binary variable "yes" or "no") following the emergence of illicit fentanyl. Results: Among 999 participants [363 (36.3%) females], 388 (38.8%) reported some behavior change. The remaining 611 (61.2%) reported no change in behavior; 240 (39.3%) of these individuals had recently been exposed to fentanyl. In multivariable analyses, factors independently associated with behavior change included recent non-fatal overdose (Adjusted Odds Ratio [AOR] = 2.28), active injection drug use (AOR = 1.96), being on opioid agonist therapy (AOR = 1.80), and urine drug screen positive for fentanyl (AOR = 1.45), (all p < .05). Conclusion: The majority of PWUD in our sample did not change their drug use behavior despite a high prevalence of fentanyl exposure, indicating a need for targeted behavior change messaging and overdose prevention efforts such as naloxone and addiction treatment for this sub-population of PWUD. Further, the high fentanyl exposure observed in our sample suggests a need to address upstream structural factors shaping the overdose risk in addition to individual behavioral change.
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Affiliation(s)
- R Brar
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - C Grant
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA
| | - K DeBeck
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,School of Public Policy, Simon Fraser University , Vancouver, BC, CANADA
| | - M-J Milloy
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - N Fairbairn
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - E Wood
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - T Kerr
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Department of Medicine, University of British Columbia , Vancouver, BC, CANADA
| | - Kanna Hayashi
- British Columbia Centre for Substance Use , Vancouver, BC, CANADA.,Faculty of Health Sciences, Simon Fraser University , Burnaby, BC, Canada
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Baldwin N, Gray R, Goel A, Wood E, Buxton J, Rieb L. Corrigendum to "Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: An observational analysis" [Drug Alcohol Depend. 185 (2018) 322-327]. Drug Alcohol Depend 2019; 197:48. [PMID: 30772782 DOI: 10.1016/j.drugalcdep.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N Baldwin
- Department of Family Practice, University of British Columbia, Canada
| | - R Gray
- Department of Family Practice, University of British Columbia, Canada
| | - A Goel
- Department of Family Practice, University of British Columbia, Canada
| | - E Wood
- Department of Medicine, University of British Columbia, Canada
| | - J Buxton
- School of Population and Public Health, University of British Columbia, Canada
| | - L Rieb
- Department of Family Practice, University of British Columbia, Canada.
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18
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Hughes DA, Culeddu G, Plumpton C, Wood E, Dick AD, Beresford MW, Ramanan AV. Reply. Ophthalmology 2019; 126:e24-e25. [PMID: 30803529 DOI: 10.1016/j.ophtha.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK.
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - Andrew D Dick
- Bristol Eye Hospital, Bristol, UK; Bristol Medical School, University of Bristol, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK
| | - Athimalaipet V Ramanan
- Bristol Medical School, University of Bristol, UK; University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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19
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Wood E, Catlin C, Connors H, Teaster P. CLINICIAN, GUARDIAN, AND COUNSEL PERSPECTIVES ON GUARDIANSHIP FOR ADULTS WHO ARE INCAPACITATED AND ALONE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Wood
- VA Medical Center, Jamaica Plain, Massachusetts, United States
- American Bar Association, Washington DC USA
| | - C Catlin
- Boston VA Research Institute, Boston MA USA
| | - H Connors
- Guardianship Community Trust, Andover MA USA
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20
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Hughes DA, Culeddu G, Plumpton CO, Wood E, Dick AD, Jones AP, McKay A, Williamson PR, Compeyrot Lacassagne S, Hardwick B, Hickey H, Woo P, Beresford MW, Ramanan AV. Cost-Effectiveness Analysis of Adalimumab for the Treatment of Uveitis Associated with Juvenile Idiopathic Arthritis. Ophthalmology 2018; 126:415-424. [PMID: 30336181 DOI: 10.1016/j.ophtha.2018.09.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/26/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the cost effectiveness of adalimumab in combination with methotrexate, compared with methotrexate alone, for the management of uveitis associated with juvenile idiopathic arthritis (JIA). DESIGN A cost-utility analysis based on a clinical trial and decision analytic model. PARTICIPANTS Children and adolescents 2 to 18 years of age with persistently active uveitis associated with JIA, despite optimized methotrexate treatment for at least 12 weeks. METHODS The SYCAMORE (Randomised controlled trial of the clinical effectiveness, SafetY and Cost effectiveness of Adalimumab in combination with MethOtRExate for the treatment of juvenile idiopathic arthritis associated uveitis) trial (identifier, ISRCTN10065623) of methotrexate (up to 25 mg weekly) with or without fortnightly administered adalimumab (20 or 40 mg, according to body weight) provided data on resource use (based on patient self-report and electronic records) and health utilities (from the Health Utilities Index questionnaire). Surgical event rates and long-term outcomes were based on data from a 10-year longitudinal cohort. A Markov model was used to extrapolate the effects of treatment based on visual impairment. MAIN OUTCOME MEASURES Medical costs to the National Health Service in the United Kingdom, utility of defined health states, quality-adjusted life-years (QALYs), and incremental cost per QALY. RESULTS Adalimumab in combination with methotrexate resulted in additional costs of £39 316, with a 0.30 QALY gain compared with methotrexate alone, resulting in an incremental cost-effectiveness ratio of £129 025 per QALY gained. The probability of cost effectiveness at a threshold of £30 000 per QALY was less than 1%. Based on a threshold analysis, a price reduction of 84% would be necessary for adalimumab to be cost effective. CONCLUSIONS Adalimumab is clinically effective in uveitis associated with JIA; however, its cost effectiveness is not demonstrated compared with methotrexate alone in the United Kingdom setting.
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Affiliation(s)
- Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom.
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Catrin O Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Andrew D Dick
- Bristol Eye Hospital, Bristol, United Kingdom; Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ashley P Jones
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Andrew McKay
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Paula R Williamson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sandrine Compeyrot Lacassagne
- UCL Institute of Ophthalmology and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Ben Hardwick
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Helen Hickey
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Patricia Woo
- UCL Institute of Ophthalmology and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Athimalaipet V Ramanan
- Bristol Medical School, University of Bristol, Bristol, United Kingdom; University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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21
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Schiff ER, Frampton M, Ben-Yosef N, Avila BE, Semplici F, Pontikos N, Bloom SL, McCartney SA, Vega R, Lovat LB, Wood E, Hart A, Israeli E, Crespi D, Furman MA, Mann S, Murray CD, Segal AW, Levine AP. Rare coding variant analysis in a large cohort of Ashkenazi Jewish families with inflammatory bowel disease. Hum Genet 2018; 137:723-734. [PMID: 30167848 PMCID: PMC6153494 DOI: 10.1007/s00439-018-1927-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/31/2018] [Indexed: 02/08/2023]
Abstract
Rare variants are thought to contribute to the genetics of inflammatory bowel disease (IBD), which is more common amongst the Ashkenazi Jewish (AJ) population. A family-based approach using exome sequencing of AJ individuals with IBD was employed with a view to identify novel rare genetic variants for this disease. Exome sequencing was performed on 960 Jewish individuals including 513 from 199 multiplex families with up to eight cases. Rare, damaging variants in loci prioritized by linkage analysis and those shared by multiple affected individuals within the same family were identified. Independent evidence of association of each variant with disease was assessed. A number of candidate variants were identified, including in genes involved in the immune system. The ability to achieve statistical significance in independent case/control replication data was limited by power and was only achieved for variants in the well-established Crohn's disease gene, NOD2. This work demonstrates the challenges of identifying disease-associated rare damaging variants from exome data, even amongst a favorable cohort of familial cases from a genetic isolate. Further research of the prioritized rare candidate variants is required to confirm their association with the disease.
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Affiliation(s)
- E R Schiff
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - M Frampton
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Ben-Yosef
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - B E Avila
- Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - F Semplici
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - N Pontikos
- UCL Genetics Institute, Division of Biosciences, University College London, London, UK
| | - S L Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
| | - S A McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - R Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - L B Lovat
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - E Wood
- Gastroenterology Department, Homerton University Hospital, London, UK
| | - A Hart
- Gastroenterology Department, St Mark's Hospital, London, UK
| | - E Israeli
- Inflammatory Bowel Disease Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Crespi
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - M A Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - S Mann
- Gastroenterology Department, Barnet General Hospital, London, UK
| | - C D Murray
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - A W Segal
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - A P Levine
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK.
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22
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Socias M, Ti L, Wood E, Nosova E, Hull M, Hayashi K, Debeck K, Milloy MJ. Uptake of HCV treatment among people who inject drugs in the direct-acting antiviral era in a Canadian setting. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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23
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Williams NH, Jenkins A, Goulden N, Hoare Z, Hughes DA, Wood E, Foster NE, Walsh D, Carnes D, Sparkes V, Hay EM, Isaacs J, Konstantinou K, Morrissey D, Karppinen J, Genevay S, Wilkinson C. Lessons learnt from a discontinued randomised controlled trial: adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica (Subcutaneous Injection of Adalimumab Trial compared with Control: SCIATiC). Trials 2018; 19:408. [PMID: 30064491 PMCID: PMC6069989 DOI: 10.1186/s13063-018-2801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adalimumab, a biological treatment targeting tumour necrosis factor α, might be useful in sciatica. This paper describes the challenges faced when developing a new treatment pathway for a randomised controlled trial of adalimumab for people with sciatica, as well as the reasons why the trial discussed was stopped early. METHODS A pragmatic, parallel group, randomised controlled trial with blinded (masked) participants, clinicians, outcome assessment and statistical analysis was conducted in six UK sites. Participants were identified and recruited from general practices, musculoskeletal services and outpatient physiotherapy clinics. They were adults with persistent symptoms of sciatica of 1 to 6 months' duration with moderate to high level of disability. Eligibility was assessed by research physiotherapists according to clinical criteria, and participants were randomised to receive two doses of adalimumab (80 mg then 40 mg 2 weeks later) or saline placebo subcutaneous injections in the posterior lateral thigh. Both groups were referred for a course of physiotherapy. Outcomes were measured at baseline, 6-week, 6-month and 12-month follow-up. The main outcome measure was disability measured using the Oswestry Disability Index. The planned sample size was 332, with the first 50 in an internal pilot phase. RESULTS The internal pilot phase was discontinued after 10 months from opening owing to low recruitment (two of the six sites active, eight participants recruited). There were several challenges: contractual delays; one site did not complete contract negotiations, and two sites signed contracts shortly before trial closure; site withdrawal owing to patient safety concerns; difficulties obtaining excess treatment costs; and in the two sites that did recruit, recruitment was slower than planned because of operational issues and low uptake by potential participants. CONCLUSIONS Improved patient care requires robust clinical research within contexts in which treatments can realistically be provided. Step changes in treatment, such as the introduction of biologic treatments for severe sciatica, raise complex issues that can delay trial initiation and retard recruitment. Additional preparatory work might be required before testing novel treatments. A randomised controlled trial of tumour necrosis factor-α blockade is still needed to determine its cost-effectiveness in severe sciatica. TRIAL REGISTRATION Current Controlled Trials, ISRCTN14569274 . Registered on 15 December 2014.
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Affiliation(s)
- Nefyn H. Williams
- Department of Health Services Research, University of Liverpool, Waterhouse Block B, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Alison Jenkins
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Eifiona Wood
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - David Walsh
- Arthritis Research UK Pain Centre and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, London, UK
| | - Valerie Sparkes
- School of Healthcare Science, Cardiff University, Cardiff, UK
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Isaacs
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jaro Karppinen
- Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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24
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Ekena J, Wood E, Manchester A, Chun R, Trepanier LA. Glutathione-S-transferase-theta genotypes and the risk of cyclophosphamide toxicity in dogs. Vet Comp Oncol 2018; 16:529-534. [PMID: 29984447 DOI: 10.1111/vco.12411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/15/2023]
Abstract
The antineoplastic agent cyclophosphamide (CP) has dose-limiting side effects including sterile haemorrhagic cystitis (SHC), bone marrow (BM) suppression and gastrointestinal (GI) toxicity in dogs. The metabolites acrolein and phosphoramide that mediate these toxicities are glutathione-S-transferase (GST) substrates, and low functioning GST alleles are associated with CP toxicity in humans. The aim of this study was to determine whether variants in 2 canine GST genes, GSTT1 and GSTT5, were over-represented in dogs that developed CP toxicity. Dogs undergoing pulse or metronomic CP chemotherapy were recruited (n = 101) and genotyped for 6 GSTT1 polymorphisms and 1 GSTT5 6-bp deletion that leads to non-functional enzyme. Median cumulative CP dosages for dogs with SHC (1350 mg/m2 ) were significantly higher than for dogs with GI/BM toxicity (871 mg/m2 ) or no toxicity (991 mg/m2 ; P = .0012). Dogs with SHC were more likely to have had metronomic (84.2%, 16 of 19 SHC cases) vs pulse (15.8%, 3 of 19 SHC cases) CP dosing (P < .0001). All dogs with BM or GI toxicity (n = 30) had pulse chemotherapy. GSTT1 and GSTT5 variant allele frequencies were not significantly different in CP-treated dogs with SHC or GI/BM toxicity compared to dogs without documented adverse effects. Work is underway to identify which canine GSTs detoxify acrolein and phosphoramide, so that better tools are available to predict the risk of CP toxicity in dogs.
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Affiliation(s)
- J Ekena
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Wood
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - A Manchester
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - R Chun
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - L A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Williams NH, Jenkins A, Goulden N, Hoare Z, Hughes DA, Wood E, Foster NE, Walsh DA, Carnes D, Sparkes V, Hay EM, Isaacs J, Konstantinou K, Morrissey D, Karppinen J, Genevay S, Wilkinson C. Subcutaneous Injection of Adalimumab Trial compared with Control (SCIATiC): a randomised controlled trial of adalimumab injection compared with placebo for patients receiving physiotherapy treatment for sciatica. Health Technol Assess 2017; 21:1-180. [PMID: 29063827 DOI: 10.3310/hta21600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Biological treatments such as adalimumab (Humira®; AbbVie Ltd, Maidenhead, UK) are antibodies targeting tumour necrosis factor alpha, released from ruptured intervertebral discs, which might be useful in sciatica. Recent systematic reviews concluded that they might be effective, but that a definitive randomised controlled trial was needed. Usual care in the NHS typically includes a physiotherapy intervention. OBJECTIVES To test whether or not injections of adalimumab plus physiotherapy are more clinically effective and cost-effective than injections of saline plus physiotherapy for patients with sciatica. DESIGN Pragmatic, parallel-group, randomised controlled trial with blinded participants and clinicians, and an outcome assessment and statistical analysis with concurrent economic evaluation and internal pilot. SETTING Participants were referred from primary care and musculoskeletal services to outpatient physiotherapy clinics. PARTICIPANTS Adults with persistent symptoms of sciatica of 1-6 months' duration and with moderate to high levels of disability. Eligibility was assessed by research physiotherapists according to clinical criteria for diagnosing sciatica. INTERVENTIONS After a second eligibility check, trial participants were randomised to receive two doses of adalimumab (80 mg and then 40 mg 2 weeks later) or saline injections. Both groups were referred for a course of physiotherapy. MAIN OUTCOME MEASURES Outcomes were measured at the start, and after 6 weeks' and 6 months' follow-up. The main outcome measure was the Oswestry Disability Index (ODI). Other outcomes: leg pain version of the Roland-Morris Disability Questionnaire, Sciatica Bothersomeness Index, EuroQol-5 Dimensions, 5-level version, Hospital Anxiety and Depression Scale, resource use, risk of persistent disabling pain, pain trajectory based on a single question, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia and adverse effects. SAMPLE SIZE To detect an effect size of 0.4 with 90% power, a 5% significance level for a two-tailed t-test and 80% retention rate, 332 participants would have needed to be recruited. ANALYSIS PLAN The primary effectiveness analysis would have been linear mixed models for repeated measures to measure the effects of time and group allocation. An internal pilot study would have involved the first 50 participants recruited across all centres. The primary economic analysis would have been a cost-utility analysis. RESULTS The internal pilot study was discontinued as a result of low recruitment after eight participants were recruited from two out of six sites. One site withdrew from the study before recruitment started, one site did not complete contract negotiations and two sites signed contracts shortly before trial closure. In the two sites that did recruit participants, recruitment was slow. This was partly because of operational issues, but also because of a low rate of uptake from potential participants. LIMITATIONS Although large numbers of invitations were sent to potential participants, identified by retrospective searches of general practitioner (GP) records, there was a low rate of uptake. Two sites planned to recruit participants during GP consultations but opened too late to recruit any participants. CONCLUSION The main failure was attributable to problems with contracts. Because of this we were not able to complete the internal pilot or to test all of the different methods for primary care recruitment we had planned. A trial of biological therapy in patients with sciatica still needs to be done, but would require a clearer contracting process, qualitative research to ensure that patients would be willing to participate, and simpler recruitment methods. TRIAL REGISTRATION Current Controlled Trials ISRCTN14569274. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 60. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, Bangor, UK
| | - Alison Jenkins
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Dyfrig A Hughes
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Eifiona Wood
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nadine E Foster
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - David A Walsh
- Arthritis Research UK Pain Centre Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Bart's and the London School of Medicine and Dentistry, London, UK
| | - Valerie Sparkes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Elaine M Hay
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Isaacs
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Kika Konstantinou
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jaro Karppinen
- Medical Research Centre Oulu, University of Oulu, Oulu, Finland
| | - Stephane Genevay
- Rheumatology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Klimas J, Small W, Ahamad K, Cullen W, Mead A, Rieb L, Wood E, McNeil R. Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors. Addict Sci Clin Pract 2017; 12:21. [PMID: 28927448 PMCID: PMC5606021 DOI: 10.1186/s13722-017-0086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/19/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. Methods We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.
Results We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Conclusions Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
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Affiliation(s)
- J Klimas
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - W Small
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - K Ahamad
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - W Cullen
- School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - A Mead
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - L Rieb
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - E Wood
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - R McNeil
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Crighton G, Wood E, Scarborough R, Ho PJ, Bowden D. Haemoglobin disorders in Australia: where are we now and where will we be in the future? Intern Med J 2017; 46:770-9. [PMID: 27040044 DOI: 10.1111/imj.13084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/16/2015] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
Inherited disorders of haemoglobin (Hb), such as thalassaemia and sickle cell disease (SCD) are common and responsible for significant morbidity and mortality on a global scale. As Australia becomes increasingly ethnically diverse, their prevalence will increase. However, we lack important demographic and epidemiological data to manage these disorders and their consequences and to support affected individuals and communities. Thalassaemia and SCD are lifelong conditions. Affected individuals have reduced life expectancies, poorer quality of life and complex healthcare needs. Treatment strategies currently focus on prenatal diagnosis, red blood cell transfusion, iron chelation, management of iron-related complications, haemopoietic stem cell transplantation (HSCT) and hydroxyurea. Currently, the only curative therapy is HSCT; however, gene therapy offers the possibility of cure and trials are currently underway. These therapies are associated with significant complications and substantial costs; there is also evidence of variation in approaches to diagnosis and care. Optimal strategies for many aspects of management are not yet defined and more research is necessary to inform clinical care and health service delivery.
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Affiliation(s)
- G Crighton
- Transfusion Outcomes Research Collaborative, Australian Red Cross Blood Service, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - E Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Medical Centre, Melbourne, Victoria, Australia
| | - R Scarborough
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - D Bowden
- Monash Medical Centre, Melbourne, Victoria, Australia
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Baxter A, Wood E, Kay DB, Higley JD, Suomi SJ. 0048 CEREBRAL SEROTONIN EXPRESSION PREDICTS DAYTIME SLEEP AND SLEEP DEVELOPMENT IN INFANT RHESUS MONKEYS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.047] [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: 11/14/2022] Open
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29
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Chapman K, Wood E, McKune S, Madsen V. Perceptions of Vaginal Illness Related to Water Quality in the Coastal
Ouest Region of Haiti. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.164] [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: 10/19/2022] Open
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30
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Wood E, Chapman K, Beau de Rochars V, McKune S. Community-Based Health Needs Assessment in Léogâne and Gressier, Haiti:
Six Years Post-Earthquake. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.337] [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: 10/19/2022] Open
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31
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Ti L, Dong H, Kerr T, Turje RB, Parashar S, Min JE, Montaner J, Wood E, Milloy MJ. The effect of engagement in an HIV/AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis. HIV Med 2017; 18:580-586. [PMID: 28317290 DOI: 10.1111/hiv.12493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load (VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre (DPC; an HIV/AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy (HAART)-exposed HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada. METHODS Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma. RESULTS Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients. CONCLUSIONS Our findings demonstrate that participating in an innovative HIV/AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
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Affiliation(s)
- L Ti
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Dong
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - T Kerr
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R B Turje
- Dr. Peter AIDS Foundation, Vancouver, BC, Canada
| | - S Parashar
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J E Min
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - J Montaner
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - E Wood
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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32
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Klimas J, McNeil R, Ahamad K, Mead A, Rieb L, Cullen W, Wood E, Small W. Two birds with one stone: experiences of combining clinical and research training in addiction medicine. BMC Med Educ 2017; 17:22. [PMID: 28114925 PMCID: PMC5260094 DOI: 10.1186/s12909-017-0862-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. METHODS We interviewed physicians from the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital's academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick's model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). RESULTS We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training. CONCLUSIONS Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.
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Affiliation(s)
- J Klimas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - R McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - K Ahamad
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - A Mead
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - L Rieb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - W Cullen
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - W Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
- Urban Health Research Initiative, B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Abstract
BACKGROUND Although people who inject drugs (IDU) often contend with various health-related harms, timely access to health care among this population remains low. We sought to identify specific individual, social and structural factors constraining healthcare access among IDU in Bangkok, Thailand. METHODS Data were derived from a community-recruited sample of IDU participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of healthcare avoidance due to one's drug use using multivariate logistic regression. RESULTS Among 437 participants, 112 (25.6%) reported avoiding health care because they were IDU. In multivariate analyses, factors independently associated with avoiding health care included having ever been drug tested by police [adjusted odds ratio (AOR) = 1.80], experienced verbal abuse (AOR = 3.15), been discouraged from engaging in usual family activities (AOR = 3.27), been refused medical care (AOR = 10.90), experienced any barriers to health care (AOR = 4.87) and received healthcare information and support at a drop-in centre (AOR = 1.92) (all P < 0.05). CONCLUSIONS These findings highlight the need to address the broader policy environment, which perpetuates the criminalization and stigmatization of IDU, and to expand peer-based interventions to facilitate access to health care for IDU in this setting.
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Affiliation(s)
- A J Heath
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
| | - T Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - L Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - K Kaplan
- Treatment Action Group, New York, NH 10016-7701, USA
| | - P Suwannawong
- Thai AIDS Treatment Action Group, Bangkok 10900, Thailand
| | - E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
| | - K Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6
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Hughes D, Charles J, Dawoud D, Edwards RT, Holmes E, Jones C, Parham P, Plumpton C, Ridyard C, Lloyd-Williams H, Wood E, Yeo ST. Conducting Economic Evaluations Alongside Randomised Trials: Current Methodological Issues and Novel Approaches. Pharmacoeconomics 2016; 34:447-61. [PMID: 26753558 DOI: 10.1007/s40273-015-0371-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Trial-based economic evaluations are an important aspect of health technology assessment. The availability of patient-level data coupled with unbiased estimates of clinical outcomes means that randomised controlled trials are effective vehicles for the generation of economic data. However there are methodological challenges to trial-based evaluations, including the collection of reliable data on resource use and cost, choice of health outcome measure, calculating minimally important differences, dealing with missing data, extrapolating outcomes and costs over time and the analysis of multinational trials. This review focuses on the state of the art of selective elements regarding the design, conduct, analysis and reporting of trial-based economic evaluations. The limitations of existing approaches are detailed and novel methods introduced. The review is internationally relevant but with a focus towards practice in the UK.
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Affiliation(s)
- Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK.
| | - Joanna Charles
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Dalia Dawoud
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Emily Holmes
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Paul Parham
- Department of Public Health and Policy, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Huw Lloyd-Williams
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Ardudwy, Bangor University, Holyhead Road, Wales, LL57 2PZ, UK
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35
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Blombery P, Kivivali L, Pepperell D, McQuilten Z, Engelbrecht S, Polizzotto M, Phillips L, Wood E, Cohney S. Diagnosis and management of thrombotic thrombocytopenic purpura (TTP) in Australia: findings from the first 5 years of the Australian TTP/thrombotic microangiopathy registry. Intern Med J 2016; 46:71-9. [DOI: 10.1111/imj.12935] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/20/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- P. Blombery
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - L. Kivivali
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - D. Pepperell
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Fiona Stanley Hospital; Perth Australia
| | - Z. McQuilten
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - S. Engelbrecht
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Gold Coast University Hospital; Queensland Australia
| | - M. N. Polizzotto
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- St Vincent's Hospital; Sydney Australia
- The Kirby Institute; University of New South Wales; Sydney Australia
| | - L. E. Phillips
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - E. Wood
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Monash Medical Centre; Melbourne Australia
| | - S. Cohney
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Department of Medicine; University of Melbourne; Melbourne Australia
- Departments of Nephrology; Western and Royal Melbourne Hospitals; Melbourne Australia
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Werb D, Kamarulzaman A, Meacham MC, Rafful C, Fischer B, Strathdee SA, Wood E. The effectiveness of compulsory drug treatment: A systematic review. Int J Drug Policy 2015; 28:1-9. [PMID: 26790691 DOI: 10.1016/j.drugpo.2015.12.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. METHODS We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. RESULTS Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. CONCLUSION There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.
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Affiliation(s)
- D Werb
- International Centre for Science in Drug Policy, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8; Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA.
| | - A Kamarulzaman
- Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - M C Meacham
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA
| | - C Rafful
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA
| | - B Fischer
- Social & Epidemiological Research Unit, Centre for Addiction & Mental Health (CAMH), 33 Russell Street, Toronto, ON, Canada M5S 3B1
| | - S A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA
| | - E Wood
- International Centre for Science in Drug Policy, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8; Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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Barker B, Alfred GT, Fleming K, Nguyen P, Wood E, Kerr T, DeBeck K. Aboriginal street-involved youth experience elevated risk of incarceration. Public Health 2015; 129:1662-8. [PMID: 26390949 DOI: 10.1016/j.puhe.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Past research has identified risk factors associated with incarceration among adult Aboriginal populations; however, less is known about incarceration among street-involved Aboriginal youth. Therefore, we undertook this study to longitudinally investigate recent reports of incarceration among a prospective cohort of street-involved youth in Vancouver, Canada. STUDY DESIGN Prospective cohort study. METHODS Data were collected from a cohort of street-involved, drug-using youth from September 2005 to May 2013. Multivariate generalized estimating equation analyses were employed to examine the potential relationship between Aboriginal ancestry and recent incarceration. RESULTS Among our sample of 1050 youth, 248 (24%) reported being of aboriginal ancestry, and 378 (36%) reported being incarcerated in the previous six months at some point during the study period. In multivariate analysis controlling for a range of potential confounders including drug use patterns and other risk factors, Aboriginal ancestry remained significantly associated with recent incarceration (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI]: 1.12-1.86). CONCLUSIONS Even after adjusting for drug use patterns and other risk factors associated with incarceration, this study found that Aboriginal street-involved youth were still significantly more likely to be incarcerated than their non-Aboriginal peers. Given the established harms associated with incarceration these findings underscore the pressing need for systematic reform including culturally appropriate interventions to prevent Aboriginal youth from becoming involved with the criminal justice system.
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Affiliation(s)
- B Barker
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Canada
| | - G T Alfred
- Indigenous Governance Program, University of Victoria, Canada
| | - K Fleming
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - P Nguyen
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - T Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - K DeBeck
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada.
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Nosyk B, Krebs E, Min JE, Ahamad K, Buxton J, Goldsmith C, Hull M, Joe R, Krajden M, Lima VD, Olding M, Wood E, Montaner JSG. The 'Expanded HIV care in opioid substitution treatment' (EHOST) cluster-randomized, stepped-wedge trial: A study protocol. Contemp Clin Trials 2015; 45:201-209. [PMID: 26342295 DOI: 10.1016/j.cct.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022]
Abstract
The public health response to HIV/AIDS has turned its focus onto optimizing health care system delivery to maximize case identification, access and sustained engagement in antiretroviral treatment (ART). Opioid Agonist Treatment (OAT) provides a critical opportunity for HIV testing and linkage to ART. The EHOST study is a cluster-randomized, stepped-wedge trial to evaluate a prescriber-focused intervention to increase HIV testing rates, and optimize ART engagement and retention outcomes among individuals engaged in OAT. The study will encompass all drug treatment clinics currently admitting patients for the treatment of opioid use disorder across the province of British Columbia, encompassing an estimated 90% of the OAT caseload. The trial will be executed over a 24-month period, with groups of clinics receiving the intervention in 6-month intervals. Evaluation of the proposed intervention's effectiveness will focus on three primary outcomes: (i) the HIV testing rate among those not known to be HIV positive; (ii) the rate of ART initiation among those not on ART; and (iii) the rate of ART continuation among those on ART. A difference-in-differences analytical framework will be applied to estimate the intervention's effect. This approach will assess site-specific changes in primary outcomes across clusters while adjusting for potential residual heterogeneity in patient case mix, volume, and quality of care across clinics. Statistical analysis of outcomes will be conducted entirely with linked population-level administrative health datasets. Facilitated by established collaborations between key stakeholders across the province, the EHOST intervention promises to optimize HIV testing and care within a marginalized and hard-to-reach population.
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Affiliation(s)
- B Nosyk
- BC Centre for Excellence in HIV/AIDS, Canada; Faculty of Health Sciences, Simon Fraser University, Canada.
| | - E Krebs
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J E Min
- BC Centre for Excellence in HIV/AIDS, Canada
| | - K Ahamad
- BC Centre for Excellence in HIV/AIDS, Canada
| | - J Buxton
- BC Centre for Disease Control and Prevention, Canada; School of Population and Public Health, University of British Columbia, Canada
| | - C Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - M Hull
- BC Centre for Excellence in HIV/AIDS, Canada; Vancouver Coastal Health Authority, Canada
| | - R Joe
- Vancouver Coastal Health Authority, Canada
| | - M Krajden
- BC Centre for Disease Control and Prevention, Canada
| | - V D Lima
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - M Olding
- BC Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
| | - J S G Montaner
- BC Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Canada
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Moore E, Bergin K, McQuilten Z, Wood E, Augustson B, Blacklock H, Ho P, Horvath N, King T, McNeil J, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Spencer A. Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yazer MH, Lozano M, Crighton G, Greenway A, Comande M, Savoia H, Wood E, Gilli S, Castilho L, Saad STO, Galactéros F, Noizat-Pirenne F, Pazgal I, Stark P, Orlin Y, Perseghin P, Masera N, Cela E, Anguita J, Wikman A, Delaney M. Transfusion service management of sickle-cell disease patients. Vox Sang 2015; 110:288-94. [PMID: 26177989 DOI: 10.1111/vox.12296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE The aim of the study was to estimate the burden and direct medical costs of unintended pregnancy to the public payer in Spain. METHODS An economic model evaluating the costs and outcomes of contraceptive use over a 1-year period was constructed for women in Spain aged 15 to 44 years at risk of pregnancy. Model inputs were derived from published literature and national survey data. Outcomes evaluated included: (i) the annual number of unintended pregnancy events and their cost; (ii) the proportion of unintended pregnancy events and their cost due to non-adherence; and (iii) the use and cost of contraceptive methods in Spain. RESULTS Of the total number of pregnancies, 35% are estimated to be unintended and are associated with a direct cost burden of €292.8 million per year. Most unintended pregnancies (26%) occur in women aged 30 to 34 years, whilst 69% of the total cost burden is estimated to be attributable to poor adherence to contraceptive methods. CONCLUSIONS The cost associated with unintended pregnancy is high. The major proportion of the burden is estimated to be attributable to imperfect adherence and is likely avoidable. Shifts in patterns of contraceptive use, combined with measures to improve adherence, could have a substantial and positive impact on this burden.
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Affiliation(s)
- Iñaki Lete
- * Department of Gynaecology, Santiago Apostol Hospital , Vitoria , Spain
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Marshall BDL, DeBeck K, Simo A, Kerr T, Wood E. Gang involvement among street-involved youth in a Canadian setting: a gender-based analysis. Public Health 2014; 129:74-7. [PMID: 25542743 DOI: 10.1016/j.puhe.2014.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- B D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
| | - K DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Public Policy, Simon Fraser University, Harbour Centre 3240, 555 W Hastings St, Vancouver, BC, V6B 4N4, Canada
| | - A Simo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - T Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Hogg RS, Nosyk B, Harrigan PR, Lima VD, Chan K, Heath K, Wood E, Kerr T, Montaner JSG. Rates of new infections in British Columbia continue to decline at a faster rate than in other Canadian regions. HIV Med 2014; 14:581-2. [PMID: 24033869 DOI: 10.1111/hiv.12079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Wiersum-Osselton JC, Wood E, Bolton-Maggs PHB, Schipperus MR. Definitions in haemovigilance: guiding principles and current state of development of international reference definitions. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. C. Wiersum-Osselton
- TRIP National Hemovigilance and Biovigilance Office; The Hague the Netherlands
- Sanquin Blood Supply; Donor Services Unit; Leiden the Netherlands
| | - E. Wood
- Transfusion Research Unit; Monash University; Melbourne Vic. Australia
- Serious Transfusion Incident Reporting (STIR) program, Blood Matters; Melbourne Vic. Australia
| | | | - M. R. Schipperus
- TRIP National Hemovigilance and Biovigilance Office; The Hague the Netherlands
- Haga Teaching Hospital; The Hague the Netherlands
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Dougados M, Wood E, Gossec L, van der Heijde D, Dubanchet A, Logeart I. SAT0356 Discriminant Capacity of Clinical Efficacy Measures, Alone or in Combination with NSAID Intake, in Detecting Anti-TNF Treatment Effect in Spondyloarthritis: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1469] [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: 11/03/2022]
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Dougados M, Wood E, Combe B, Miceli-Richard C, Berenbaum F, Koppiker N, Dubanchet A, Logeart I. SAT0357 Evaluation of the Nonsteroidal Anti-Inflammatory Drug-Sparing Effect of Etanercept in Axial Spondyloarthritis: Results of the Multicenter Randomized, Double-Blind, Placebo-Controlled SPARSE Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1226] [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: 11/03/2022]
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Reddon H, Milloy MJ, Simo A, Montaner J, Wood E, Kerr T. Methadone maintenance therapy decreases the rate of antiretroviral therapy discontinuation among HIV-positive illicit drug users. AIDS Behav 2014; 18:740-6. [PMID: 23918244 PMCID: PMC4059183 DOI: 10.1007/s10461-013-0584-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We sought to examine whether methadone maintenance therapy (MMT) decreased rates of antiretroviral therapy (ART) discontinuation and was associated with plasma HIV RNA responses among a cohort of illicit drug users. Cumulative ART discontinuation rates were estimated using Kaplan-Meier methods and factors independently associated with ART discontinuation were identified using Cox proportional hazards regression. Engagement in MMT was negatively and independently associated with ART discontinuation [Adjusted Relative Hazard = 0.67 (95 % CI 0.54-0.83); p < 0.001]. Among participants receiving ART and MMT, 81.6 % of plasma HIV-1 RNA assessments were <500 copies/mL, while 65.81 % of HIV-1 RNA assessments among those prescribed ART without MMT were <500 copies/mL (p < 0.001). These results demonstrate that engagement in MMT conferred a protective benefit against ART discontinuation and was associated with a significant increase in plasma HIV RNA suppression among HIV-infected opioid-dependent drug users.
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Affiliation(s)
- H Reddon
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Ti L, Milloy M, Shannon K, Kerr T, Simo A, Montaner J, Wood E. P3.408 Sex Work Involvement Predicts Poor Viral Load Suppression Among People Who Inject Drugs in a Canadian Setting. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bailie J, Wood E, Connolly D, O’Rourke D, Hagan C. Urethral metastasis from renal cell carcinoma: an unusual cause of visible painless haematuria. Journal of Clinical Urology 2013. [DOI: 10.1016/j.bjmsu.2012.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urethral metastasis from renal cell carcinoma (RCC) is rare, with only six previously described cases.1–6 The authors report a case which presented eight months post laparoscopic radical nephrectomy with painless, visible haematuria. The epidemiology, potential pathophysiological mechanisms and treatment options are explored.
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Affiliation(s)
- J Bailie
- Department of Urology, Altnagelvin Area Hospital, Londonderry, Northern Ireland, UK
- Department of Urology, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - E Wood
- Department of Urology, Altnagelvin Area Hospital, Londonderry, Northern Ireland, UK
| | - D Connolly
- Department of Urology, Altnagelvin Area Hospital, Londonderry, Northern Ireland, UK
- Department of Urology, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - D O’Rourke
- Department of Histopathology, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - C Hagan
- Department of Urology, Belfast City Hospital, Belfast, Northern Ireland, UK
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