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Dobreva I, Thomas J, Marr A, O'Connell R, Roche M, Hannaway N, Dore C, Rose S, Liu K, Bhome R, Baldwin-Jones S, Roberts J, Archibald N, Alston D, Amar K, Edwards E, Foley JA, Haunton VJ, Henderson EJ, Jha A, Lindop F, Magee C, Massey L, Ruiz-Mendoza E, Mohamed B, Patterson K, Ramaswamy B, Schrag A, Silverdale M, Suárez-González A, Subramanian I, Foltynie T, Williams-Gray CH, Yarnall AJ, Carroll C, Bale C, Hugill C, Weil RS. Improving Conversations about Parkinson's Dementia. Mov Disord Clin Pract 2024. [PMID: 38696333 DOI: 10.1002/mdc3.14054] [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: 11/17/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) have an increased risk of dementia, yet patients and clinicians frequently avoid talking about it due to associated stigma, and the perception that "nothing can be done about it". However, open conversations about PD dementia may allow people with the condition to access treatment and support, and may increase participation in research aimed at understanding PD dementia. OBJECTIVES To co-produce information resources for patients and healthcare professionals to improve conversations about PD dementia. METHODS We worked with people with PD, engagement experts, artists, and a PD charity to open up these conversations. 34 participants (16 PD; 6 PD dementia; 1 Parkinsonism, 11 caregivers) attended creative workshops to examine fears about PD dementia and develop information resources. 25 PD experts contributed to the resources. RESULTS While most people with PD (70%) and caregivers (81%) shared worries about cognitive changes prior to the workshops, only 38% and 30%, respectively, had raised these concerns with a healthcare professional. 91% of people with PD and 73% of caregivers agreed that PD clinicians should ask about cognitive changes routinely through direct questions and perform cognitive tests at clinic appointments. We used insights from the creative workshops, and input from a network of PD experts to co-develop two open-access resources: one for people with PD and their families, and one for healthcare professionals. CONCLUSION Using artistic and creative workshops, co-learning and striving for diverse voices, we co-produced relevant resources for a wider audience to improve conversations about PD dementia.
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Affiliation(s)
- Ivelina Dobreva
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Joanne Thomas
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Anne Marr
- Central Saint Martins, University of the Arts, London, United Kingdom
| | | | - Moïse Roche
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naomi Hannaway
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Charlotte Dore
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Sian Rose
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Ken Liu
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
| | - Rohan Bhome
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | | | | | - Neil Archibald
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | - Khaled Amar
- Royal Bournemouth Hospital, NHS Foundation Trust, Bournemouth, United Kingdom
| | | | - Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older People's Unit, Royal United Hospitals NHS Foundation Trust, Bath, United Kingdom
| | - Ashwani Jha
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
| | - Fiona Lindop
- Parkinson's UK, London, United Kingdom
- Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Cathy Magee
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Luke Massey
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Eladia Ruiz-Mendoza
- North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, United Kingdom
| | - Biju Mohamed
- University Hospital of Wales, Cardiff, United Kingdom
| | - Katherine Patterson
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Bhanu Ramaswamy
- Parkinson's UK, London, United Kingdom
- Sheffield Hallam University, Sheffield, United Kingdom
| | - Anette Schrag
- Department of Clinical Neuroscience, Institute of Neurology, UCL, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Aida Suárez-González
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, California, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, California, USA
| | - Tom Foltynie
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Caroline H Williams-Gray
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Camille Carroll
- Faculty of Health, University of Plymouth, Drake Circus, Plymouth, United Kingdom
| | | | | | - Rimona S Weil
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, Russell Square House, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, London, United Kingdom
- UCL Queen Square Institute of Neurology, Univeristy College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Toader AM, Campbell MK, Quint JK, Robling M, Sydes MR, Thorn J, Wright-Hughes A, Yu LM, Abbott TEF, Bond S, Caskey FJ, Clout M, Collinson M, Copsey B, Davies G, Driscoll T, Gamble C, Griffin XL, Hamborg T, Harris J, Harrison DA, Harji D, Henderson EJ, Logan P, Love SB, Magee LA, O'Brien A, Pufulete M, Ramnarayan P, Saratzis A, Smith J, Solis-Trapala I, Stubbs C, Farrin A, Williamson P. Using healthcare systems data for outcomes in clinical trials: issues to consider at the design stage. Trials 2024; 25:94. [PMID: 38287428 PMCID: PMC10823676 DOI: 10.1186/s13063-024-07926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Healthcare system data (HSD) are increasingly used in clinical trials, augmenting or replacing traditional methods of collecting outcome data. This study, PRIMORANT, set out to identify, in the UK context, issues to be considered before the decision to use HSD for outcome data in a clinical trial is finalised, a methodological question prioritised by the clinical trials community. METHODS The PRIMORANT study had three phases. First, an initial workshop was held to scope the issues faced by trialists when considering whether to use HSDs for trial outcomes. Second, a consultation exercise was undertaken with clinical trials unit (CTU) staff, trialists, methodologists, clinicians, funding panels and data providers. Third, a final discussion workshop was held, at which the results of the consultation were fed back, case studies presented, and issues considered in small breakout groups. RESULTS Key topics included in the consultation process were the validity of outcome data, timeliness of data capture, internal pilots, data-sharing, practical issues, and decision-making. A majority of consultation respondents (n = 78, 95%) considered the development of guidance for trialists to be feasible. Guidance was developed following the discussion workshop, for the five broad areas of terminology, feasibility, internal pilots, onward data sharing, and data archiving. CONCLUSIONS We provide guidance to inform decisions about whether or not to use HSDs for outcomes, and if so, to assist trialists in working with registries and other HSD providers to improve the design and delivery of trials.
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Affiliation(s)
- Alice-Maria Toader
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK.
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Jennifer K Quint
- School of Public Health &, National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
- BHF Data Science Centre, Health Data Research UK, London, UK
| | - Joanna Thorn
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alexandra Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Ly-Mee Yu
- Oxford Primary Care CTU, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - Fergus J Caskey
- BHF Data Science Centre, Health Data Research UK, London, UK
| | - Madeleine Clout
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Gwyneth Davies
- UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | | | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Xavier L Griffin
- Barts Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, E1 2AB, UK
| | - Jessica Harris
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Deena Harji
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, UK
- Older People's Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Pip Logan
- School of Medicine, University of Nottingham and Nottingham City Care Partnership, Nottingham, UK
| | - Sharon B Love
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Laura A Magee
- Department of Women and Children's Health, King's College London, London, UK
| | - Alastair O'Brien
- Division of Medicine, UCL Institute for Liver and Digestive Health, Royal Free Campus, Upper 3Rd FloorRowland Hill Street, London, NW3 2PF, UK
| | - Maria Pufulete
- Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jo Smith
- Keele Clinical Trials Unit, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Ivonne Solis-Trapala
- Keele Clinical Trials Unit, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Clive Stubbs
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research College of Medical and Dental Sciences, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research,, University of Leeds, Leeds, LS2 9JT, UK
| | - Paula Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
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Ó Breasail M, Smith MD, Tenison E, Henderson EJ, Lithander FE. Parkinson's disease: the nutrition perspective - CORRIGENDUM. Proc Nutr Soc 2023; 82:487. [PMID: 35115062 DOI: 10.1017/s0029665122000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mícheál Ó Breasail
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK
| | - Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK
| | - Emma Tenison
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK
- Royal United Hospital Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Fiona E Lithander
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK
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Ho L, Lloyd K, Taylor-Rowan M, Dawson S, Logan M, Leitch S, Quinn TJ, Shenkin SD, Parry SW, Jarman H, Henderson EJ. Comparing Research Priority-Setting Partnerships for Older Adults Across International Health Care Systems: A Systematic Review. J Am Med Dir Assoc 2023; 24:1726-1745. [PMID: 37848169 DOI: 10.1016/j.jamda.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Priority setting partnerships (PSPs) attempt to shape the research agenda to address the needs of local populations of interest. We reviewed the PSPs for older adults, with a focus on exemplar health care systems: United Kingdom (UK; publicly funded), United States (private health insurance-based), South Korea (national health insurance-based), and Africa (out-of-pocket). DESIGN Systematic review. SETTING AND PARTICIPANTS We searched databases and sources (January 2011-October 202l; updated in February 2023) for PSPs of older adults' health care. METHODS Based on the British geriatric medicine curriculum, we extracted and categorized the PSP topics by areas and the research priorities by themes, and generated evidence maps depicting and comparing the research gaps across the systems. We evaluated PSP quality using the Nine Common Themes of Good Clinical Practice. RESULTS We included 32 PSPs (United Kingdom: n = 25; United States: n = 7; South Korea and Africa: n = 0) and identified priorities regarding 27 conditions or service arrangements in the United Kingdom and 9 in the United States (predominantly in neurology/psychiatry). The UK priorities focused on treatments and interventions whereas the US on prognostic/predictive factors. There were notable research gaps within the existing PSPs, including common geriatric conditions like continence and frailty. The PSP quality evaluation revealed issues around lacking inclusion of ethnic minorities. CONCLUSIONS AND IMPLICATIONS Research priorities for older adult health care vary internationally, but certain health care systems/countries have no available PSPs. Where PSPs are available, fundamental aspects of geriatric medicine have not been included. Future researchers should conduct prioritizations in different countries, focus on core geriatric syndromes, and ensure the inclusion of all relevant stakeholder groups.
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Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | - Katherine Lloyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Martin Taylor-Rowan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Monica Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Stephanie Leitch
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Steve W Parry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Heather Jarman
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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5
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Henderson EJ, Rutt JN, Albertini LW. What Parents Should Know About Bugs and Bug Repellents. JAMA Pediatr 2023:2807917. [PMID: 37523201 DOI: 10.1001/jamapediatrics.2023.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This Patient Page describes how to protect children against insect bites, how to choose a bug repellent, and tips for applying bug repellent.
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Affiliation(s)
- Emily J Henderson
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jennifer N Rutt
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laurie W Albertini
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Goodwin VA, Low MSA, Quinn TJ, Cockcroft EJ, Shepherd V, Evans PH, Henderson EJ, Mahmood F, Ni Lochlainn M, Needham C, Underwood BR, Arora A, Witham MD. Including older people in health and social care research: best practice recommendations based on the INCLUDE framework. Age Ageing 2023; 52:afad082. [PMID: 37261448 PMCID: PMC10234283 DOI: 10.1093/ageing/afad082] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/19/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Older people are often explicitly or implicitly excluded from research, in particular clinical trials. This means that study findings may not be applicable to them, or that older people may not be offered treatments due to an absence of evidence. AIMS The aim of this work was to develop recommendations to guide all research relevant to older people. METHODS A diverse stakeholder group identified barriers and solutions to including older people in research. In parallel, a rapid literature review of published papers was undertaken to identify existing papers on the inclusion of older people in research. The findings were synthesised and mapped onto a socio-ecological model. From the synthesis we identified themes that were developed into initial recommendations that were iteratively refined with the stakeholder group. RESULTS A range of individual, interpersonal, organisational, community and policy factors impact on the inclusion of older people in research. A total of 14 recommendations were developed such as removing upper age limits and comorbidity exclusions, involving older people, advocates and health and social care professionals with expertise in ageing in designing the research, and considering flexible or alternative approaches to data collection to maximise opportunities for participation. We also developed four questions that may guide those developing, reviewing and funding research that is inclusive of older people. CONCLUSION Our recommendations provide up to date, practical advice on ways to improve the inclusion of older people in health and care research.
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Affiliation(s)
| | - Mikaela S A Low
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Emma J Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Philip H Evans
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- National Institute for Health and Care Research, Clinical Research Network, UK
| | - Emily J Henderson
- Ageing and Movement Disorders Research Group, Bristol Medical School, University of Bristol, Bristol, UK
| | - Farhat Mahmood
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mary Ni Lochlainn
- National Institute for Health and Care Research, Clinical Research Network, UK
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | | | | | - Amit Arora
- Elderly Care Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle, UK
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Lithander FE, Tenison E, Ypinga J, Halteren A, Smith MD, Lloyd K, Richfield EW, Brazier DE, Breasail MÓ, Smink AJ, Metcalfe C, Hollingworth W, Bloem B, Munneke M, Ben-Shlomo Y, Darweesh SKL, Henderson EJ. Proactive and Integrated Management and Empowerment in Parkinson's Disease protocol for a randomised controlled trial (PRIME-UK) to evaluate a new model of care. Trials 2023; 24:147. [PMID: 36849987 PMCID: PMC9969590 DOI: 10.1186/s13063-023-07084-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/21/2021] [Accepted: 12/20/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People living with Parkinson's disease experience progressive motor and non-motor symptoms, which negatively impact on health-related quality of life and can lead to an increased risk of hospitalisation. It is increasingly recognised that the current care models are not suitable for the needs of people with parkinsonism whose care needs evolve and change as the disease progresses. This trial aims to evaluate whether a complex and innovative model of integrated care will increase an individual's ability to achieve their personal goals, have a positive impact on health and symptom burden and be more cost-effective when compared with usual care. METHODS This is a single-centre, randomised controlled trial where people with parkinsonism and their informal caregivers are randomised into one of two groups: either PRIME Parkinson multi-component model of care or usual care. Adults ≥18 years with a diagnosis of parkinsonism, able to provide informed consent or the availability of a close friend or relative to act as a personal consultee if capacity to do so is absent and living in the trial geographical area are eligible. Up to three caregivers per patient can also take part, must be ≥18 years, provide informal, unpaid care and able to give informed consent. The primary outcome measure is goal attainment, as measured using the Bangor Goal Setting Interview. The duration of enrolment is 24 months. The total recruitment target is n=214, and the main analyses will be intention to treat. DISCUSSION This trial tests whether a novel model of care improves health and disease-related metrics including goal attainment and decreases hospitalisations whilst being more cost-effective than the current usual care. Subject to successful implementation of this intervention within one centre, the PRIME Parkinson model of care could then be evaluated within a cluster-randomised trial at multiple centres.
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Affiliation(s)
- Fiona E. Lithander
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, 1142 New Zealand ,grid.9654.e0000 0004 0372 3343Department of Nutrition and Dietetics, University of Auckland, Auckland, 1142 New Zealand
| | - Emma Tenison
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Jan Ypinga
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Angelika Halteren
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Matthew D. Smith
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Katherine Lloyd
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Edward W. Richfield
- grid.416201.00000 0004 0417 1173North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Danielle E. Brazier
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Mícheál Ó. Breasail
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Agnes J. Smink
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Chris Metcalfe
- grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - William Hollingworth
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.5337.20000 0004 1936 7603Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, BS8 2PS UK
| | - Bas Bloem
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marten Munneke
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK
| | - Sirwan K. L. Darweesh
- grid.10417.330000 0004 0444 9382Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Emily J. Henderson
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU UK ,grid.413029.d0000 0004 0374 2907Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG UK
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Pearson GME, Winter R, Henderson EJ. How can medical schools help in this crisis of care? BMJ 2023; 380:318. [PMID: 36796828 DOI: 10.1136/bmj.p318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Grace M E Pearson
- Ageing and Movement Research Group, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol BS8 1NU, UK
| | - Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol BS8 1NU, UK
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Pearson GME, Winter R, Blundell A, Masud T, Gough J, Gordon AL, Henderson EJ, Christopher G, Hart D, Sanders J, Jennings J, Watson A, Miller-Molloy F, Miles E, Mohammed B, Wilkinson I, Al-Jawad M, Vassallo M, Henderson EJ. Updating the British Geriatrics Society recommended undergraduate curriculum in geriatric medicine: a curriculum mapping and nominal group technique study. Age Ageing 2023; 52:7028004. [PMID: 36746388 PMCID: PMC9902152 DOI: 10.1093/ageing/afac325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND medical education must adapt to meet the challenges and demands of an ageing population, ensuring that graduates are equipped to look after older patients with complex health and social care needs. Recommended curricula in geriatric medicine in the United Kingdom and Europe offer guidance for optimal undergraduate education in ageing. The UK version, written by the British Geriatrics Society (BGS), requires updating to take account of innovations in the specialty, changing guidance from the General Medical Council (GMC), and the need to support medical schools preparing for the introduction of the national Medical Licensing Assessment (MLA). METHODS the BGS recommended curriculum was mapped to the most recent European curriculum (2014) and the MLA content map, to compare and contrast between current recommendations and nationally mandated guidance. These maps were used to guide discussion through a virtual Nominal Group Technique (NGT), including 21 expert stakeholders, to agree consensus on the updated BGS curriculum. RESULTS the curriculum has been re-structured into seven sections, each with 1-2 overarching learning outcomes (LOs) that are expanded in multiple sub-LOs. Crucially, the curriculum now reflects the updated GMC/MLA requirements, having incorporated items flagged as missing in the mapping stages. CONCLUSION the combined mapping exercise and NGT have enabled appropriate alignment and benchmarking of the UK national curriculum. These recommendations will help to standardise and enhance teaching and learning around the care of older persons with complexity.
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Affiliation(s)
| | - Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Adrian Blundell
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK,School of Medicine, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanna Gough
- British Geriatrics Society, Marjory Warren House, London, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK,British Geriatrics Society, Marjory Warren House, London, UK,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, UK,Older People’s Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK,British Geriatrics Society, Marjory Warren House, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol , Bristol , UK
- Older People’s Unit, Royal United Hospitals NHS Foundation Trust , Bath , UK
- British Geriatrics Society, Marjory Warren House , London , UK
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10
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Tenison E, Cullen A, Pendry-Brazier D, Smith MD, Ben-Shlomo Y, Henderson EJ. 1219 INFORMAL CAREGIVERS OF PEOPLE WITH PARKINSONISM IN THE PRIME-UK CROSS-SECTIONAL STUDY. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Many people with parkinsonism require care as the disease progresses with much provided unpaid by family and friends. Caring for someone can have a negative impact on physical and psychosocial wellbeing. Caregiver burden can impact ability to continue this role, which can precipitate hospitalisation or institutionalisation of the recipient.
Methods
In this single-site study, primary, informal caregivers, defined as those providing any care or support, were enrolled alongside the person with parkinsonism or individually. Self-reported questionnaires included the 22-item Zarit Burden Interview (ZBI), which can range from 0-88, with higher scores representing greater burden. Linear regression was used to explore the association between recipient characteristics/need and caregiver burden.
Results
Of 1,032 eligible patients approached, 813 participants indicated whether they had an informal caregiver (708) or not (105). 376 caregivers consented (53.1%), of whom 321 have returned questionnaires, with patient data available for 296. The median age of caregivers was 73.0 (range 27.0- 91.1 years), 237 (73.8%) female. 274 (85.4%) were the spouse/partner of the patient. 215 (67.0%) were the sole caregiver. The median time per week spent caring was 21 hours (interquartile range 7, 41 hours). 18 (5.6%) of caregivers provided 24-hour care daily and 113 (35.2%) had provided support for over 5 years. Median ZBI score was 17, (interquartile range 7-29). The care recipient’s duration of parkinsonism was associated with higher burden score (0.38 increase per year of parkinsonism; 95% CI 0.07, 0.69; p value 0.015), as was the time per week spent caring (0.16 increase for each additional hour; 95% CI 0.11, 0.20; p value <0.0001).
Conclusions
Many informal caregivers in this study were the sole caregiver and many were themselves older adults. Burden increased with increasing duration of parkinsonism and as time spent caring increased. This highlights the ongoing need to improve support for this group.
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Affiliation(s)
- E Tenison
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
| | - A Cullen
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
| | - D Pendry-Brazier
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
| | - M D Smith
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
| | - Y Ben-Shlomo
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
| | - E J Henderson
- University of Bristol Department of Population Health Sciences, Bristol Medical School, , Bristol, BS8 1NU, UK
- Royal United Hospitals Bath NHS Foundation Trust Older People’s Unit, , Combe Park, Bath, UK
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11
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Linden R, Vassilaki M, Henderson EJ, Mohan D. Editorial: Multimorbidity in the context of neurodegenerative disorders. Front Neurosci 2022; 16:1076486. [DOI: 10.3389/fnins.2022.1076486] [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] [Received: 10/21/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
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12
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Smith MD, Tenison E, Drake MJ, Ben-Shlomo Y, Henderson EJ. Stimulation of the Tibial nerve Repetitively to Improve Incontinence in Parkinson's Electronically (STRIPE trial): a randomised control trial of tibial nerve stimulation for bladder symptoms in Parkinson's disease using a self-contained wearable device. Trials 2022; 23:912. [PMID: 36307874 PMCID: PMC9617363 DOI: 10.1186/s13063-022-06827-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Bladder symptoms are common in Parkinson’s disease (PD), affecting half of all individuals. These have significant impact on quality of life as well as implications for morbidity, contributing to falls and hospital admission. The treatment of bladder symptoms can be complicated by the tendency to side-effects in people with PD including cognitive impairment and gait instability with anti-muscarinics. The development of new, better treatments is therefore warranted. Tibial nerve stimulation is a form of neuromodulation demonstrated to improve overactive bladder symptoms in non-neurogenic cohorts. Previously requiring hospital attendance, we aim to explore the use of this intervention using a simple device that can be used by patients at home. Methods STRIPE is a phase II randomised control trial of tibial nerve stimulation delivered by the Geko™ device, a small, self-adhesive neuromuscular stimulation device currently used for thromboembolism prophylaxis post-surgery. Active tibial nerve stimulation will be compared to sham stimulation, with participants blinded to treatment allocation and undertaking outcome assessment whilst still blinded. Participants will be asked to self-administer stimulation at home twice per week, for 30 min per session, over the course of 3 months. Primary outcome measure will be the International Consultation on Incontinence Overactive Bladder Questionnaire (OAB) at week 12. Secondary outcomes will include pre- and post-intervention bladder diary (frequency, urgency episodes, nocturia), patient perception of global change, bowel function and bladder-related quality of life. Participants will be recruited from the Proactive Integrated Management and Empowerment (PRIME) cross-sectional trial in which participants have been screened for bladder symptoms and invited to take part, as well as clinician referral from around the region. Discussion This trial will involve a randomised control trial of a novel and easy to use method of delivering tibial nerve stimulation for PD in the patient’s own home. This may potentially have huge benefit, avoiding the problems with side effects that can be seen with anti-muscarinics and providing a new potential modality of treatment. Trial registration ISRCTN11484954. Registered on 22 June 2021.
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Affiliation(s)
- Matthew D Smith
- Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Emma Tenison
- Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Yoav Ben-Shlomo
- Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Emily J Henderson
- Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
Hyperpyrexia syndrome in Parkinson's disease (PD) is a medical emergency requiring prompt
action. This can be precipitated by numerous provoking factors, in particular withdrawal
of dopaminergic medication. We report a case of a patient with PD presenting with confusion, dramatic worsening of PD
symptoms and pyrexia in the context of a heatwave, potentially mediating its effect
through dehydration and impaired medication absorption. Precipitous cooling and
conversion of dopaminergic medication to a rotigotine patch due to drowsiness led to her
rapid improvement. The possibility of infection was covered however no source of infection
or evidence of inflammatory response was found, but remained an important
differential. This case highlights the importance of recognising and managing hyperpyrexia syndrome in
PD and the possibility of uncharacteristically hot weather being a cause.
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Affiliation(s)
- Elizabeth Mooney
- Older people's unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Matthew D Smith
- Older people's unit, Royal United Hospital NHS Foundation Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Older people's unit, Royal United Hospital NHS Foundation Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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14
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Pearson GM, Wege SE, Rosen SA, Gaunt DM, Henderson EJ. Using a checklist within simulation improves trainees' confidence on ward rounds. Future Healthc J 2022; 9:171-173. [PMID: 35928185 DOI: 10.7861/fhj.2021-0195] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ward rounds are integral to maintaining patient safety in everyday clinical care. Junior doctors are often expected to conduct independent rounds on graduation, but many feel ill-equipped to do so. We developed a safety checklist and simulation sessions to improve junior-led ward round practice at one district general hospital. We found that embedding a checklist within simulation is an effective way to teach ward round skills and increase confidence among undergraduate and postgraduate medical trainees.
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Affiliation(s)
- Grace Me Pearson
- Bristol Medical School, Bristol, UK and honorary trust grade doctor, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sally E Wege
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah A Rosen
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Emily J Henderson
- Bristol Medical School, Bristol, UK and honorary consultant geriatrician, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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15
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Tenison E, Lithander FE, Smith MD, Pendry-Brazier D, Ben-Shlomo Y, Henderson EJ. Needs of patients with parkinsonism and their caregivers: a protocol for the PRIME-UK cross-sectional study. BMJ Open 2022; 12:e057947. [PMID: 35545401 PMCID: PMC9096540 DOI: 10.1136/bmjopen-2021-057947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION People with parkinsonism are a highly heterogeneous group and the disease encompasses a spectrum of motor and non-motor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. While parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe the broad range of health needs for people with parkinsonism and their carers in relation to their symptomatology, disability, disease stage, comorbidities and sociodemographic characteristics. METHODS AND ANALYSIS In this single site cross-sectional study, people with parkinsonism will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support, if required, to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes. Results will be displayed as descriptive statistics and regression models will be used to test simple associations and interactions. ETHICS AND DISSEMINATION This protocol was approved by the London-Brighton & Sussex Research Ethics Committee (REC reference 20/LO/0890). The results of this protocol will be disseminated through publication in an international peer-reviewed journal; presentation at academic meetings and conferences; and a lay summary uploaded to the PRIME-Parkinson website. TRIAL REGISTRATION NUMBER ISRCTN11452969; Pre-results.
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Affiliation(s)
- Emma Tenison
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Fiona E Lithander
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Matthew D Smith
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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16
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Tenison E, James A, Ebenezer L, Henderson EJ. A Narrative Review of Specialist Parkinson’s Nurses: Evolution, Evidence and Expectation. Geriatrics (Basel) 2022; 7:geriatrics7020046. [PMID: 35447849 PMCID: PMC9027740 DOI: 10.3390/geriatrics7020046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Extended nursing roles have existed since the 1940s. The first specialist nurse for Parkinson’s disease, a complex neurodegenerative disease, was appointed in the United Kingdom (UK) in 1989. A review was undertaken using MEDLINE and Cumulative Index to the Nursing and Allied Health Literature (CINAHL), relating to the role and evidence for Parkinson’s disease nurse specialists (PDNSs). PDNSs fulfil many roles. Trials of their effectiveness have failed to show a positive benefit on health outcomes, but their input appears to improve the wellbeing of people with Parkinson’s. Now embedded in the UK Parkinson’s multidisciplinary team, this care model has since been adopted widely, including successful dissemination of training to countries in Sub-Saharan Africa. The lack of evidence to support the benefit of PDNSs may reflect an insufficient duration and intensity of the intervention, the outcome measures selected or the need to combine PDNS input with other evidence-based interventions. Whilst the current evidence base for their effectiveness is limited, their input appears to improve subjective patient wellbeing and they are considered a vital resource in management. Better evidence in the future will support the development of these roles and may facilitate the application of specialist nurses to other disease areas.
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Affiliation(s)
- Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
- Correspondence:
| | - Alice James
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
| | - Louise Ebenezer
- Cwm Taf Morgannwg University Health Board, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK;
| | - Emily J. Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1NU, UK; (A.J.); (E.J.H.)
- Older People’s Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
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17
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Jackson MG, Brennan LJ, Henderson EJ, Robinson ESJ. Modelling falls in Parkinson’s disease and normal ageing in mice using a complex motor task. Brain Neurosci Adv 2022; 6:23982128221088794. [PMID: 35341069 PMCID: PMC8943449 DOI: 10.1177/23982128221088794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022] Open
Abstract
Falls resulting from multifactorial deficits are common in both normal ageing and
Parkinson’s disease. Resultant injuries can lead to increased hospitalisation
and excess mortality. As the disease progresses, gait and balance deficits are
relatively refractory to dopaminergic treatments suggesting another system is
involved. Attentional impairment is a significant risk factor for falls, and
disruption to both the cortical cholinergic system and striatal dopaminergic
system increases falls in rats undergoing a complex motor task with high
attentional load. However, it is unclear whether this translates to mice and
whether normal ageing induces similar deficits. In this study, we use a complex
motor task to test the effects of acute dopaminergic and cholinergic antagonism
using alpha-flupentixol and scopolamine, respectively, in mice. We also test the
effects of normal ageing on complex motor performance and whether these changes
are sensitive to a clinical dose of the non-steroidal anti-inflammatory Rimadyl.
Consistent with previous work, we show that cholinergic but not dopaminergic
antagonism impaired task performance. However, a combined approach did not
potentiate the deficit beyond observed with cholinergic antagonism alone. We
also show that task performance is impaired in aged mice relative to younger
controls, and that Rimadyl reduces number of foot slips in an age-specific
manner. Overall, these data support prior work showing the importance of the
cholinergic system in falls. The studies in aged mice found age-related
impairments and a role for inflammation but did not find evidence of an
interaction with attentional load, although only one manipulation was
tested.
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Affiliation(s)
- Megan G. Jackson
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| | - Laura J. Brennan
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
| | - Emily J. Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - Emma S. J. Robinson
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK
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18
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Tenison E, Lithander FE, Brazier D, Smith M, Ben-Shlomo Y, Henderson EJ. 697 PATIENTS WITH PARKINSONISM AND THEIR CAREGIVERS: A PROTOCOL FOR THE PRIME-UK CROSS-SECTIONAL STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
People with parkinsonism (PwP) are a highly heterogeneous group and the condition encompasses a spectrum of motor and nonmotor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. Whilst parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe a broad range of PwP in relation to their symptomatology, disability, health needs, disease stage, comorbidities and sociodemographics.
Methods
In this cross-sectional study, performed at one site, PwP (excluding those with drug-induced parkinsonism) will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support if required to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes.
Results
Our primary outcome is the frequency of various health outcomes (e.g. depression) and how they cluster together. Linear and logistic regression models will be used to test simple associations and interactions with gender, age group and socio-economic status.
Conclusion
It is necessary to consider the multifaceted problems that PwP experience, together with frailty and comorbidities, in order to fully appreciate the clinical complexity as well as the impact on caregiver well-being. This information is necessary to inform the development of a person-centered, individualised multicomponent intervention to target patients and caregivers most at risk of adverse outcomes. We hope that these findings will inform future intervention trials and improve accessibility to research participation.
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Affiliation(s)
- E Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - F E Lithander
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - D Brazier
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - M Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - Y Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - E J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
- Older People’s Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom
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Smith MD, Tenison E, Hashim H, Ben-Shlomo Y, Henderson EJ. Neuromodulation for Storage Lower Urinary Tract Symptoms in Parkinson Disease: A Systematic Review. Neuromodulation 2022; 25:1076-1085. [PMID: 35300922 DOI: 10.1016/j.neurom.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder symptoms are common in Parkinson disease (PD), affecting quality of life. Medications commonly used such as antimuscarinics can cause frequently intolerable side effects, and therefore, new, better tolerated approaches are needed. Neuromodulation techniques have an established role in urologic disorders; these techniques include tibial nerve stimulation (TNS) and sacral neuromodulation (SNM), which are localized therapies lacking the side effects associated with medication. OBJECTIVES This study aimed to undertake a systematic review of the literature reporting the use of neuromodulation techniques for the treatment of bladder symptoms in PD and related conditions. MATERIALS AND METHODS A systematic search of data bases was conducted including MEDLINE, CENTRAL, and Web of Science. Studies were required to present specific outcomes for individuals with PD for neuromodulation interventions. RESULTS Ten primary studies were identified concerning detailed outcomes of neuromodulation on bladder symptoms in PD, including seven for TNS, one for SNM, and one using transcranial magnetic stimulation (TMS). Two further mixed cohort studies documented minimal data on individuals with PD. All studies demonstrated benefit in a range of outcome measures following neuromodulation. Two randomized sham-controlled studies were carried out using TNS, with one clearly demonstrating superiority over sham, although difficulties with achieving believable yet ineffective sham treatment are highlighted. Further studies reported limited, uncontrolled outcomes of SNM in patients with PD, demonstrating benefit. CONCLUSIONS Evidence from case series suggests benefit from TNS in PD, with limited literature on SNM or TMS. Placebo effect from neuromodulation is a concern, and only limited controlled data exist. Future well-designed and sham-controlled studies need to be completed to provide definitive data on the benefit of neuromodulation in PD. Definitively proving the utility of a neuromodulation modality will allow better treatment of bladder symptoms without the need for pharmacologic measures that cause side effects.
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Smith M, Dawson S, Andrews RC, Eriksson SH, Selsick H, Skyrme-Jones A, Udayaraj U, Rees J, Strong E, Henderson EJ, Drake MJ. Evaluation and Treatment in Urology for Nocturia Caused by Nonurological Mechanisms: Guidance from the PLANET Study. Eur Urol Focus 2022; 8:89-97. [PMID: 35101453 DOI: 10.1016/j.euf.2022.01.007] [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] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
Patients with nocturia are commonly referred to urology clinics, including many for whom a nonurological medical condition is responsible for their symptoms. The PLanning Appropriate Nocturia Evaluation and Treatment (PLANET) study was established to develop practical approaches to equip healthcare practitioners to deal with the diverse causes of nocturia, based on systematic reviews and expert consensus. Initial assessment and therapy need to consider the possibility of one or more medical conditions falling into the "SCREeN" areas of Sleep medicine (insomnia, periodic limb movements of sleep, parasomnias, and obstructive sleep apnoea), Cardiovascular (hypertension and congestive heart failure), Renal (chronic kidney disease), Endocrine (diabetes mellitus, thyroid disease, pregnancy/menopause, and diabetes insipidus), and Neurology. Medical and medication causes of xerostomia should also be considered. Some key indicators for these conditions can be identified in urology clinics, working in partnership with the primary care provider. Therapy of the medical condition in some circumstances lessens the severity of nocturia. However, in many cases there is a conflict between the two, in which case the medical condition generally takes priority on safety grounds. It is important to provide patients with a realistic expectation of therapy and awareness of limitations of current therapeutic options for nocturia. PATIENT SUMMARY: Nocturia is the symptom of waking at night to pass urine. Commonly, this problem is referred to urology clinics. However, in some cases, the patient does not have a urological condition but actually a condition from a different speciality of medicine. This article describes how best the urologist and the primary care doctor can work together to assess the situation and make sensible and safe treatment suggestions. Unfortunately, there is sometimes no safe or effective treatment choice for nocturia, and treatment needs to focus instead on supportive management of symptoms.
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Affiliation(s)
- Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert C Andrews
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, University College London Hospitals, London, UK
| | - Andrew Skyrme-Jones
- Cardiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Udaya Udayaraj
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK; Oxford Kidney Unit, Churchill Hospital, Oxford, UK
| | | | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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van Merode NAM, Dawson S, Coulthard E, Henderson EJ, Rice CM, Rees J, Smith M, Strong E, Cotterill N, Huntley AL, Drake MJ. Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:33-41. [PMID: 35031351 DOI: 10.1016/j.euf.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired. OBJECTIVE To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation. EVIDENCE SYNTHESIS Thirteen studies (seven in Parkinson's disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered. CONCLUSIONS Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed. PATIENT SUMMARY People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
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Affiliation(s)
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
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Reyes PBG, Butcher K, Cotterill N, Drake MJ, Gimson A, Gogola L, Henderson EJ, Huntley AL, Rees J, Strong E, Wong C, Skyrme-Jones A, Dawson S. Implications of Cardiovascular Disease for Assessment and Treatment of Nocturia in Primary Care: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:26-32. [PMID: 35031352 DOI: 10.1016/j.euf.2021.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Heart conditions affect salt and water homeostasis as a consequence of the underlying condition, compensatory processes, and therapy, and can result in nocturnal polyuria. These processes need to be identified as part of a full evaluation of nocturia. OBJECTIVE To conduct a systematic review of nocturia in cardiovascular disease and achieve expert consensus for primary care management. Primary care was defined as a health care setting in which the expertise did not include specialist cardiology. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 3524 titles and abstracts were screened and 27 studies underwent full-text screening. Of these, eight studies were included in the analysis. The nominal group technique (NGT) was used to achieve consensus among an expert panel incorporating public involvement. EVIDENCE SYNTHESIS Most studies focused on nocturia related to blood pressure (BP), while one investigated leg oedema. Hypertension, particularly overnight blood pressure above normal, corresponds with higher risk of nocturia. NGT identified fluid and salt overload, nondipping hypertension, and some therapeutic interventions as key nocturia contributors. History taking and examination should identify raised jugular venous pressure/ankle swelling, with relevant investigations including measurement of BP, resting electrocardiogram, and B-type natriuretic peptide. Treatment recommends reducing salt (including substitutes), alcohol and caffeine. Heart failure is managed according to local guidance and controlling fluid intake to 1-2 l daily. If there is no fluid retention, reduce or discontinue diuretics or calcium channel blockers and follow up to reassess the condition. The target clinic blood pressure is 140/90 mm Hg. CONCLUSIONS Cardiovascular disease and its treatment are influential for understanding nocturia. Management aims to identify and treat heart failure and/or hypertension. PATIENT SUMMARY People with cardiovascular disease can suffer severe sleep disturbance because of a need to pass urine at night due to increased overnight blood pressure or heart failure. Following a detailed evaluation of the published research, a group of experts recommended practical approaches for assessing and treating these issues.
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Affiliation(s)
- Paulina Bueno Garcia Reyes
- Urology Department, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Karen Butcher
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Marcus J Drake
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Laisha Gogola
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust, Combe Park, Bath, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chih Wong
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Ridgway A, Cotterill N, Dawson S, Drake MJ, Henderson EJ, Huntley AL, Rees J, Strong E, Dudley C, Udayaraj U. Nocturia and Chronic Kidney Disease: Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. Eur Urol Focus 2022; 8:18-25. [PMID: 35031353 DOI: 10.1016/j.euf.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT Reduced renal function impairs salt and water homeostasis, which can drive nocturnal or 24-h polyuria. Nocturia can arise early in chronic kidney disease (CKD). Evidence-based recommendations can facilitate management outside nephrology clinics. OBJECTIVE To conduct a systematic review (SR) of nocturia in CKD and achieve expert consensus for management in primary care and in specialist clinics outside nephrology. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 4011 titles and abstracts were screened, and 108 studies underwent full-text screening. Seven studies met the inclusion criteria and two were identified through other sources. Consensus was achieved among an expert panel with public involvement using the nominal group technique (NGT). EVIDENCE SYNTHESIS Several plausible mechanisms contribute to nocturnal or 24-h polyuria in CKD, but there is little evidence on interventions to improve nocturia. NGT assessment recommendations for nocturia (at least two voids per night) in patients with CKD or at risk of CKD being assessed in a non-nephrology setting are: history (thirst, fluid intake), medication review (diuretics, lithium, calcium channel antagonists, nonsteroidal anti-inflammatory medications), examination (oedematous state, blood pressure), urinalysis (haematuria and albumin/creatinine ratio), blood tests (blood urea, serum creatinine and electrolytes, estimated glomerular filtration rate), and a bladder diary. Renal ultrasound should follow local CKD guidelines. Treatment options include optimising blood pressure control, dietary adjustment to reduce salt intake, fluid advice, and a medication review. Referral to specialist nephrology services should follow local guidelines. CONCLUSIONS CKD should be considered when evaluating patients with nocturia. The aim of assessment is to identify mechanisms and instigate therapy, but the latter may be more applicable to reducing wider morbidity associated with CKD than nocturia itself. PATIENT SUMMARY People with kidney disease can suffer severe sleep disturbance because of a need to pass urine overnight. We looked at published research and found some useful information about the underlying mechanisms. A group of experts was able to develop practical approaches for assessing and treating this condition.
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Affiliation(s)
- Alex Ridgway
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Emily J Henderson
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Dudley
- Nephrology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Udaya Udayaraj
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Kidney Unit, Churchill Hospital, Oxford, UK
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Papworth E, Dawson S, Henderson EJ, Eriksson SH, Selsick H, Rees J, Gimson A, Strong E, Cotterill N, Huntley AL, Drake MJ. Association of Sleep Disorders with Nocturia: A Systematic Review and Nominal Group Technique Consensus on Primary Care Assessment and Treatment. Eur Urol Focus 2022; 8:42-51. [PMID: 35027331 DOI: 10.1016/j.euf.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT Sleep disorders affect responsiveness to sensory information and can cause nocturnal polyuria and reduced sleep depth; hence, these are potentially influential in understanding the mechanism of nocturia. OBJECTIVE To report the systematic review (SR) and expert consensus for primary care management of nocturia in sleep disorders. EVIDENCE ACQUISITION Four databases were searched from January to April 2020. A total of 1658 titles and abstracts were screened, and 23 studies potentially applicable were included for full-text screening. The nominal group technique (NGT) was used to derive a consensus on recommendations for management using an expert panel with public involvement. EVIDENCE SYNTHESIS Thirteen studies met the SR inclusion criteria, all of which studied obstructive sleep apnoea (OSA), with ten evaluating the effect of continuous positive airway pressure. The NGT consensus discussed the assessment of OSA with other key sleep disorders, notably insomnia, restless legs syndrome/periodic limb movements of sleep, and parasomnias, including non-rapid eye movement (non-REM) parasomnias and REM sleep behaviour disorder (RBD). The NGT considered that the use of screening questions to reach a clinical diagnosis is a sufficient basis for offering conservative therapy within primary care. Reasons for referral to a sleep clinic are suspected sleep disorder with substantially impaired daytime function despite conservative treatment. Suspected RBD should be referred, and if confirmed, neurology opinion is indicated. Referrals should follow local guidelines. Persisting nocturia is not currently considered an indication for referral to a sleep clinic. CONCLUSIONS Sleep disorders are potentially highly influential in nocturia, but are often overlooked. PATIENT SUMMARY People with sleep disorders can experience nocturia due to easy waking or increased bladder filling. We looked at published research, and information was limited to one form of sleep disturbance-obstructive sleep apnoea. We assembled a group of experts, to develop practical approaches for assessing and treating nocturia in the potentially relevant sleep disorders.
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Affiliation(s)
- Emma Papworth
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK
| | - Hugh Selsick
- Insomnia and Behavioural Sleep Medicine, University College London Hospitals, London, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, North Somerset, Bristol, UK
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Dawson S, Duncan L, Ahmed A, Gimson A, Henderson EJ, Rees J, Strong E, Drake MJ, Cotterill N, Huntley AL, Andrews RC. Assessment and Treatment of Nocturia in Endocrine Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:52-59. [PMID: 34996740 DOI: 10.1016/j.euf.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Salt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not consistently considered in primary care management of nocturia. OBJECTIVE To conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT). EVIDENCE SYNTHESIS Twelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity <600 mOsm/l after overnight fluid avoidance. CONCLUSIONS Endocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia. PATIENT SUMMARY People with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.
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Affiliation(s)
- Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna Duncan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ahmed Ahmed
- Endocrinology and Diabetes Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Amy Gimson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, Backwell Medical Centre, Bristol, UK
| | - Ed Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Nikki Cotterill
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert C Andrews
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Pearson GME, Welsh T, Pocock LV, Ben-Shlomo Y, Henderson EJ. Transforming undergraduate education in geriatric medicine: an innovative curriculum at Bristol Medical School. Eur Geriatr Med 2022; 13:1487-1491. [PMID: 36071347 PMCID: PMC9451112 DOI: 10.1007/s41999-022-00690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022]
Abstract
The World Health Organization (WHO) advocates investment in high-quality undergraduate education in geriatric medicine as a means of meeting the future needs of the aging population. However, there is a lack of evidence for the optimal delivery of training in this area. Rigorous pedagogical research is required to determine the most effective way to equip tomorrow's doctors with the skills and knowledge to care for older adults with complex health and social care needs. The transition between two undergraduate medical curricula meant that Bristol Medical School (BMS) was uniquely positioned to innovate and evaluate undergraduate education in geriatric medicine. This transition marked BMS' departure from a 'traditional' curriculum to case-based learning. The outgoing curriculum included a 4-week unit in geriatrics, whilst the new programme includes an 18-week clerkship titled 'Complex Medicine in Older People' (CMOP). CMOP is a clinical clerkship with 18 cases at its core, covering the fundamental aspects of geriatric medicine. The core cases and clinical learning are enhanced with five expert lectures, six tutorials and three journal clubs. Reflective practice is modelled and promoted with Balint groups and a book club. Consolidative workplace-based assessments and clinical portfolio mirror those used in postgraduate training, preparing students for professional practice. CMOP is iteratively improved in real-time using staff and student feedback. This marked shift in mode and duration of teaching affords the opportunity to evaluate the impact of differing education in geriatrics, providing an evidence-based model for teaching on aging.
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Affiliation(s)
- Grace M E Pearson
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK.
- Royal United Hospitals NHS Foundation Trust, Bath, UK.
| | - Tomas Welsh
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
- Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Lucy V Pocock
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Emily J Henderson
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
- Royal United Hospitals NHS Foundation Trust, Bath, UK
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27
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Drake MJ, Rees J, Henderson EJ. Nocturia Is an Orphan Symptom Seeking Caring Specialties Willing To Adopt. Eur Urol Focus 2022; 8:1-3. [DOI: 10.1016/j.euf.2022.01.006] [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] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
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Brock P, Oates LL, Gray WK, Henderson EJ, Mann H, Haunton VJ, Skelly R, Hand A, Davies ML, Walker RW. Driving and Parkinson's Disease: A Survey of the Patient's Perspective. J Parkinsons Dis 2022; 12:465-471. [PMID: 34542030 DOI: 10.3233/jpd-212686] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a multi-system disorder that can impact on driving ability. Little is known about how these changes in driving ability affect people with PD, making it difficult for clinicians and carers to offer appropriate support. OBJECTIVE To assess patient views concerning the effect of PD on their driving ability, the impact of these changes and how they manage them. METHOD An online survey was created by a team of clinicians, people with PD, their carers, and representatives from Parkinson's UK. People with PD throughout the United Kingdom were invited to participate through Parkinson's UK's website, newsletter and Parkinson's Excellence Network email list. RESULTS 805 people with PD took part in the survey. We found that the loss of a driving licence had an adverse impact on employment, socialisation, travel costs and spontaneous lifestyle choices. Multiple changes in driving ability related to PD were described, including that impulse control disorders can have an adverse impact on driving. Changes in driving ability caused people to change their driving practices including taking shorter journeys and being less likely to drive at night. Participants advised managing changes in driving ability through planning, vehicle adaptions, maintaining skills and self-assessment. CONCLUSION This study demonstrates the impact that changes in driving ability can have on the lifestyle of people with PD and reveals the strategies that individuals adopt to manage these changes.
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Affiliation(s)
- Peter Brock
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
| | - Lloyd L Oates
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
| | - Emily J Henderson
- Department of Population Health Sciences, University of Bristol, Beacon House, Queens Road, Bristol, United Kingdom
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom
| | - Helen Mann
- Driving and Mobility Centre (West of England), The Vassall Centre, Gill Avenue, Fishponds, Bristol, United Kingdom
| | - Victoria J Haunton
- University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, United Kingdom
| | - Rob Skelly
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Uttoxeter Road, Derby, United Kingdom
| | - Annette Hand
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
| | - Matthew L Davies
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, Rake Lane, Newcastle-upon-Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, United Kingdom
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29
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Breasail MÓ, Biswas B, Smith MD, Mazhar MKA, Tenison E, Cullen A, Lithander FE, Roudaut A, Henderson EJ. Wearable GPS and Accelerometer Technologies for Monitoring Mobility and Physical Activity in Neurodegenerative Disorders: A Systematic Review. Sensors (Basel) 2021; 21:8261. [PMID: 34960353 PMCID: PMC8705556 DOI: 10.3390/s21248261] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022]
Abstract
Neurodegenerative disorders (NDDs) constitute an increasing global burden and can significantly impair an individual's mobility, physical activity (PA), and independence. Remote monitoring has been difficult without relying on diaries/questionnaires which are more challenging for people with dementia to complete. Wearable global positioning system (GPS) sensors and accelerometers present a cost-effective and noninvasive way to passively monitor mobility and PA. In addition, changes in sensor-derived outcomes (such as walking behaviour, sedentary, and active activity) may serve as potential biomarkers of disease onset, progression, and response to treatment. We performed a systematic search across four databases to identify papers published within the past 5 years, in which wearable GPS or accelerometers were used to monitor mobility or PA in patients with common NDDs (Parkinson's disease, Alzheimer's disease, motor neuron diseases/amyotrophic lateral sclerosis, vascular parkinsonism, and vascular dementia). Disease and technology-specific vocabulary were searched singly, and then in combination, identifying 4985 papers. Following deduplication, we screened 3115 papers and retained 28 studies following a full text review. One study used wearable GPS and accelerometers, while 27 studies used solely accelerometers in NDDs. GPS-derived measures had been validated against current gold standard measures in one Parkinson's cohort, suggesting that the technology may be applicable to other NDDs. In contrast, accelerometers are widely utilised in NDDs and have been operationalised in well-designed clinical trials.
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Affiliation(s)
- Mícheál Ó. Breasail
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
| | - Bijetri Biswas
- Department of Electronic and Electrical Engineering, Computer Science and Mathematics, University of Bristol, Bristol BS8 1TH, UK
| | - Matthew D. Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
- Older Peoples Unit, Royal United Hospital NHS Foundation Trust, Bath BN1 3NG, UK
| | - Md Khadimul A. Mazhar
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
| | - Emma Tenison
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
| | - Anisha Cullen
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
| | - Fiona E. Lithander
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
| | - Anne Roudaut
- Department of Computer Science, University of Bristol, Bristol BS8 1TH, UK;
| | - Emily J. Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol BS8 1NU, UK; (M.Ó.B.); (M.D.S.); (M.K.A.M.); (E.T.); (A.C.); (F.E.L.); (E.J.H.)
- Older Peoples Unit, Royal United Hospital NHS Foundation Trust, Bath BN1 3NG, UK
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Neumann S, Taylor J, Bamford A, Metcalfe C, Gaunt DM, Whone A, Steeds D, Emmett SR, Hollingworth W, Ben-Shlomo Y, Henderson EJ. Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease. BMC Neurol 2021; 21:422. [PMID: 34715821 PMCID: PMC8556953 DOI: 10.1186/s12883-021-02430-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness. DISCUSSION This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. TRIAL REGISTRATION REC reference: 19/SW/0043. EudraCT: 2018-003219-23. ISCRTN 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.
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Affiliation(s)
- S Neumann
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - J Taylor
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Bamford
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - C Metcalfe
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - D M Gaunt
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Whone
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - D Steeds
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - S R Emmett
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - W Hollingworth
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - Y Ben-Shlomo
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - E J Henderson
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Neumann S, Bamford A, Lithander FE, Tenison E, Henderson EJ. Public attitudes to the use of remote data collection in clinical research. Contemp Clin Trials 2021; 111:106595. [PMID: 34653652 PMCID: PMC8511885 DOI: 10.1016/j.cct.2021.106595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Background/aims Coronavirus Disease 2019 (COVID-19) has presented an unprecedented challenge for delivering clinical research. The use of technology-assisted data collection for clinical research is desirable for many practitioners, but the acceptability of use in the general population has not been assessed. The aim of the study was to assess attitudes towards using technology-assisted remote methods in the delivery of clinical research in the UK and to understand the barriers to taking part in research with respect to both remote assessments and traditional research methods across different age ranges. Methods The study was conducted as an online anonymous survey with a 4-part questionnaire, between August 2020 and December 2020. Participants living in the UK aged 18 years and above were eligible to take part. Results A total 351 completed the survey and are included in the data analysis. In all age groups, participants identified that use of online assignments, video calls and telephone calls would make them more likely to take part in clinical research. Overall, the largest barrier to taking part in research was time commitments and timing of the appointment. COVID-19 has had a small, positive influence on the confidence of using technology in the general population. Conclusions The study found that there is a large interest in taking part in research using online, telephone and video call appointments, which could facilitate research delivery in light of ongoing COVID-19-related restrictions and also improve the accessibility and inclusivity of research.
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Affiliation(s)
- S Neumann
- University of Bristol, Faculty of Health Sciences, Bristol Medical School, Population Health Sciences, Bristol, UK.
| | - A Bamford
- University of Bristol, Faculty of Health Sciences, Bristol Medical School, Population Health Sciences, Bristol, UK
| | - F E Lithander
- University of Bristol, Faculty of Health Sciences, Bristol Medical School, Population Health Sciences, Bristol, UK
| | - E Tenison
- University of Bristol, Faculty of Health Sciences, Bristol Medical School, Population Health Sciences, Bristol, UK; Royal United Hospitals Bath NHS Foundation Trust, Older Peoples Unit, Bath, UK
| | - E J Henderson
- University of Bristol, Faculty of Health Sciences, Bristol Medical School, Population Health Sciences, Bristol, UK; Royal United Hospitals Bath NHS Foundation Trust, Older Peoples Unit, Bath, UK
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Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
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Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Abstract
Research into ageing covers opportunities and challenges posed by an older population, and research to understand the ageing processes across the lifespan. The evidence base for Comprehensive Geriatric Assessment (CGA) is well established and efforts should now shift to understanding how to implement its principles across different healthcare contexts. Research around syndromes common in older people has progressed with variable success; while effective therapies for falls and cognitive impairment have been identified, older people with advanced frailty have commonly been excluded from Parkinson's disease and continence research. Research to understand the mechanisms of ageing has potential to mitigate against or treat emerging sarcopenia and cognitive impairment, and thus modify frailty trajectories. Pharmacogenetics could individualise therapeutics to reduce polypharmacy. These issues can only be addressed with development of infrastructure, capacity and expertise in ageing research. Commonly used research methodologies must be adapted to take account of frailty, cognitive impairment and functional dependency.
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Affiliation(s)
- Adam L Gordon
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK and University of Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Miles D Witham
- British Geriatrics Society, London, UK, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Emily J Henderson
- British Geriatrics Society, London, UK, Bristol Medical School, Bristol, UK and Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Rowan H Harwood
- British Geriatrics Society, London, UK, University of Nottingham School of Health Sciences, Nottingham, UK and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tahir Masud
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Pelicioni PHS, Menant JC, Henderson EJ, Latt MD, Brodie MA, Lord SR. Mild and marked executive dysfunction and falls in people with Parkinson's disease. Braz J Phys Ther 2021; 25:437-443. [PMID: 33349526 PMCID: PMC8353304 DOI: 10.1016/j.bjpt.2020.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/26/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Executive dysfunction and risk of falling are hallmarks of Parkinson's disease (PD). However, it is unclear how executive dysfunction predisposes people with PD to falling. OBJECTIVES To: (i) identify sensorimotor, balance, and cardiovascular risk factors for falls that discriminate between those with normal executive function and those with mild and marked executive dysfunction in people with PD and (ii) determine whether mild and marked executive dysfunction are significant risk factors for falls when adjusting for PD duration and severity and freezing of gait (FOG). METHODS Using the Frontal Assessment Battery, 243 participants were classified into normal executive function (n = 87), mild executive dysfunction (n = 100), and marked executive dysfunction (n = 56) groups. Participants were asked if they had episodes of FOG in the last month and were assessed with the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr Scale, the physiological profile assessment, and tests of orthostatic hypotension, coordinated stability, and gait and were then followed-up prospectively for falls for 32-52 weeks. RESULTS Several PD-specific (elevated Hoehn and Yahr stage, higher MDS-UPDRS scale scores, a history of FOG, Postural Instability and Gait Difficulty subtype, and longer PD duration), sensorimotor (poor vision, knee extension weakness, slow simple reaction time), and balance (greater postural sway and poor controlled leaning balance) factors discriminated among the normal executive function and mild and marked executive dysfunction groups. Fall rates (mean ± SD) differed significantly among the groups (normal executive function: 1.0 ± 1.7; mild executive dysfunction: 2.8 ± 5.2; marked executive dysfunction: 4.7 ± 7.3) with the presence of both mild and marked executive dysfunction identified as significant risk factors for falls when adjusting for three measures of PD severity (Hoehn and Yahr scale scores, disease duration, and FOG). CONCLUSIONS Several PD-specific, sensorimotor, and balance factors differed significantly among the normal, mild, and marked executive dysfunction groups and both mild and marked executive dysfunction were identified as independent risk factors for falls in people with PD.
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Affiliation(s)
- Paulo H S Pelicioni
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
| | - Emily J Henderson
- Population Heath Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom
| | - Mark D Latt
- Department Geriatric Medicine, Royal Prince Alfred Hospital, and The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; Graduate School of Biomedical Engineering, University of New South Wales, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia.
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Abstract
Background Frailty and Parkinson’s disease (PD) are both highly prevalent in older people, but few studies have studied frailty in people with Parkinson’s. Identifying frailty in this population is vital, to target new interventions to those who would most benefit. Methods Data were collected as part of the double-blind randomised controlled rivastigmine to stabilise gait ReSPonD trial in 130 people with Hoehn and Yahr 2–3, idiopathic PD who had fallen in the year prior to enrolment. Individuals were assessed at baseline and followed up at eight months, including determination of frailty status. Results 120 patients attended for follow-up. At follow-up, the mean (SD) age was 70.2 years (8.0), MDS-UPDRS total score 91.5 (29.1), and MDS-UPDRS motor score (Part III) 42.7 (14.8). Median disease duration was 9.2 years (IQR 4.6 to 13.1), Geriatric Depression Score 4 (IQR 2 to 6). Using the Fried frailty criteria, 31 (26%) were frail and 70 (58%) pre-frail. In univariable analysis, being female, higher depression score, and MDS-UPDRS score were associated with greater frailty. Using ordinal regression, in the multivariable model, being female (odds ratio [OR] 3.10, 95%CI 1.53 to 6.26, p=.002), higher total MDS-UPDRS score (OR 2.02, 95%CI 1.42 to 2.87, p<.0001) and higher depression (OR 1.47, 95%CI 1.05 to 2.06, p=.03) were associated with higher number of frailty markers. Conclusion There was a high prevalence (84%) of pre-frail and frail individuals in patients participating in this RCT. Future research should determine the optimum tool to assess frailty in this at-risk population, and delineate the association between Parkinson’s, frailty, and health outcomes.
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Affiliation(s)
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alan Whone
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Royal United Hospitals Bath NHS Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Affiliation(s)
- Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational Clinical Research Institute, Newcastle University and Newcastle-upon-Tyne NHS Trust, Newcastle upon Tyne, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital Bath NHS Foundation Trust, Bath, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA
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Kobylecki C, Glasse H, Amin J, Gregson CL, Lyell V, Henderson EJ. Fracture Risk Assessment in Atypical Parkinsonian Syndromes. Mov Disord Clin Pract 2021; 8:385-389. [PMID: 33816667 PMCID: PMC8015890 DOI: 10.1002/mdc3.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/28/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Bone health and fracture risk reduction are increasingly recognized as important issues in Parkinson's disease (PD). However, the evidence for fracture risk management in atypical parkinsonism (AP) is less clear. Guidance on management of bone health in PD has recently been published. Objectives To evaluate the outcome of fracture risk assessment in a cohort of patients with AP, compared to a population with idiopathic PD. Methods We did a cross-sectional study of patients with PD or AP who had fracture risk assessed at two tertiary movement disorder centres. Data on fracture risk as assessed using QFracture and FRAX were collected. To assess for the effect of age on fracture risk we compared the risks of PD and AP patients aged ≤70 and >70 years. Results We assessed 71 patients with AP and 267 with PD. Age, sex and body mass index were similar between groups; patients with AP were more likely to have fallen in the previous year. Major osteoporotic fracture risk was greater in patients with AP aged ≤70 compared to PD; no differences between groups were seen in those aged >70 years. 76% of those with AP, and 63% with PD, had an estimated fracture risk indicating bone-sparing treatment, but only 33% of patients with AP were receiving this where it was indicated. Conclusion There is scope for considerable improvement in fracture risk assessment and treatment in atypical parkinsonism, taking into account the worse prognosis of this patient group.
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Affiliation(s)
- Christopher Kobylecki
- Department of Neurology, Manchester Centre for Clinical Neurosciences Salford Royal NHS Foundation Trust Salford United Kingdom.,Manchester Academic Health Sciences Centre University of Manchester Manchester United Kingdom
| | - Hannah Glasse
- Department of Neurology, Manchester Centre for Clinical Neurosciences Salford Royal NHS Foundation Trust Salford United Kingdom
| | - Jigisha Amin
- Faculty of Health Sciences, Bristol Medical School University of Bristol Bristol United Kingdom
| | - Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School University of Bristol Bristol United Kingdom
| | - Veronica Lyell
- Older People's Unit Royal United Hospitals Bath NHS Foundation Trust Bath United Kingdom
| | - Emily J Henderson
- Older People's Unit Royal United Hospitals Bath NHS Foundation Trust Bath United Kingdom.,Department of Population Health Sciences, Bristol Medical School University of Bristol Bristol United Kingdom
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Brazier DE, Perneta N, Lithander FE, Henderson EJ. Prone Positioning of Older Adults with COVID-19: A Brief Review and Proposed Protocol. J Frailty Aging 2021; 11:115-120. [PMID: 35122099 PMCID: PMC8384102 DOI: 10.14283/jfa.2021.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
COVID-19 disproportionately affects older people, with higher rates of infection and a higher risk of adverse outcomes. A brief review of literature was undertaken to inform development of a protocol describing the indications and process of prone positioning to aid the management of COVID-19 infection in non-mechanically ventilated, awake older adults. PubMed was searched up to 14th January 2021 to identify English language papers that described prone positioning procedures used in non-mechanically ventilated patients. Data were pooled to inform the development of a prone positioning protocol for use in hospital ward environments. The protocol was trialled and refined during routine clinical practice. Screening of 146 articles yielded five studies detailing a prone positioning protocol. Prone positioning is a potentially feasible and tolerated treatment adjunct for hypoxaemia in older adults with COVID-19. Future studies should further establish the efficacy, safety, and tolerability in respiratory illnesses in non-intensive care settings.
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Affiliation(s)
- D E Brazier
- Danielle Brazier, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom; Email :
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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Bloem BR, Henderson EJ, Dorsey ER, Okun MS, Okubadejo N, Chan P, Andrejack J, Darweesh SKL, Munneke M. Patient-centred management of Parkinson's disease - Authors' reply. Lancet Neurol 2020; 19:889-890. [PMID: 33098792 PMCID: PMC7577709 DOI: 10.1016/s1474-4422(20)30360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Emily J Henderson
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Ray Dorsey
- Centre for Health and Technology, Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Piu Chan
- Department of Neurobiology, Neurology and Geriatrics, National Clinical Research Centre for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing, China
| | | | - Sirwan K L Darweesh
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marten Munneke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, Netherlands
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Lloyd K, Gaunt D, Haunton V, Skelly R, Mann H, Ben-Shlomo Y, Henderson EJ. Driving in Parkinson's disease: a retrospective study of driving and mobility assessments. Age Ageing 2020; 49:1097-1101. [PMID: 32585014 DOI: 10.1093/ageing/afaa098] [Citation(s) in RCA: 5] [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: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To guide decision-making about driving ability, some patients with Parkinson's disease (PD) undergo specialist driving assessment. However, decisions about driving safety in most patients need to be made without this definitive test. There is no consensus on what predicts unsafe driving in PD nor a validated prediction tool to guide clinician decision-making and the need to refer for further assessment. OBJECTIVES To describe the characteristics of patients with PD assessed at a Driving Mobility Centre and investigate factors that predict driving assessment outcome. METHODS Retrospective cohort study of patients with PD assessed between 2012 and 2016. Descriptive analyses and logistic models to determine factors predicting a negative outcome. RESULTS There were 86 assessments of patients with PD. The mean age was 70 years (±9.2), 86% were male, median disease duration 7 years (interquartile range 5-12.5 years) and 59% were referred by the Driver and Vehicle Licensing Agency. In total, 62% had a negative 'not drive' outcome. The Rookwood Driving Battery (RDB), depth of vision deficit, usual driving frequency, age, duration license held and response time were all predictors in univariable analysis. The RDB was the best predictor of assessment failure, conditional on other variables in a backward stepwise model (odds ratio 1.29; 95% confidence interval 1.05, 1.60; P = 0.015). CONCLUSIONS This is the first study to describe patients with PD undergoing driving assessments in the UK. In this population, RDB performance was the best predictor of outcome. Future prospective studies are required to better determine predictors of driving ability to guide development of prediction tools for implementation into clinical practice.
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Affiliation(s)
- Katherine Lloyd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob Skelly
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton, Derby, UK
| | - Helen Mann
- Driving and Mobility Centre (West of England), The Vassal Centre, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Ginja S, Jackson K, Newham JJ, Henderson EJ, Smart D, Lingam R. Rural-urban differences in the mental health of perinatal women: a UK-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:464. [PMID: 32795335 PMCID: PMC7427846 DOI: 10.1186/s12884-020-03132-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND International data suggest that living in a rural area is associated with an increased risk of perinatal mental illness. This study tested the association between rurality and risk for two mental illnesses prevalent in perinatal women - depression and anxiety. METHODS Using a cross-sectional design, antenatal and postnatal women were approached by healthcare professionals and through other networks in a county in Northern England (UK). After providing informed consent, women completed a questionnaire where they indicated their postcode (used to determine rural-urban status) and completed three outcome measures: the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions (depression measure), and the Generalised Anxiety Disorder 2-item (GAD-2). Logistic regression models were developed, both unadjusted and adjusted for potential confounders, including socioeconomic status, social support and perinatal stage. RESULTS Two hundred ninety-five participants provided valid data. Women in rural areas (n = 130) were mostly comparable to their urban counterparts (n = 165). Risk for depression and/or anxiety was found to be higher in the rural group across all models: unadjusted OR 1.67 (0.42) 95% CI 1.03 to 2.72, p = .038. This difference though indicative did not reach statistical significance after adjusting for socioeconomic status and perinatal stage (OR 1.57 (0.40), 95% CI 0.95 to 2.58, p = .078), and for social support (OR 1.65 (0.46), 95% CI 0.96 to 2.84, p = .070). CONCLUSIONS Data suggested that women in rural areas were at higher risk of depression and anxiety than their urban counterparts. Further work should be undertaken to corroborate these findings and investigate the underlying factors. This will help inform future interventions and the allocation of perinatal services to where they are most needed.
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Affiliation(s)
- Samuel Ginja
- School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland, UK
| | - Katherine Jackson
- Department of Sociology, Durham University, 29 Old Elvet, Durham, DH1 3HN England, UK
| | - James J. Newham
- Department of Psychology, Faculty of Health and Life Sciences, Northumberland Building, Northumbria University, Newcastle upon Tyne, NE1 8ST England, UK
| | - Emily J. Henderson
- Children & Young People’s Mental Health & Wellbeing, Newcastle upon Tyne, NE7 7XA England, UK
- Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, NE7 7XA England, UK
| | - Debbie Smart
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX England, UK
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Rm 814, Level 8 The Bright Alliance, High St & Avoca Street, Randwick, NSW 2031 Australia
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43
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Lithander FE, Neumann S, Tenison E, Lloyd K, Welsh TJ, Rodrigues JCL, Higgins JPT, Scourfield L, Christensen H, Haunton VJ, Henderson EJ. COVID-19 in older people: a rapid clinical review. Age Ageing 2020; 49:501-515. [PMID: 32377677 PMCID: PMC7239238 DOI: 10.1093/ageing/afaa093] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials. METHODS we searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively. RESULTS screening of over 1,100 peer-reviewed and pre-print papers yielded n = 22 on COVID-19 testing, n = 15 on treatment and n = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period. CONCLUSION given the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research.
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Affiliation(s)
- Fiona E Lithander
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sandra Neumann
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Tenison
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Lloyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tomas J Welsh
- Research Institute for the Care of Older People (RICE), Bath, UK
- Royal United Hospital Bath NHS Foundation Trust, Bath, UK
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | | | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital Bath NHS Foundation Trust, Bath, UK
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44
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Jones S, Torsney KM, Scourfield L, Berryman K, Henderson EJ. Neuropsychiatric symptoms in Parkinson's disease: aetiology, diagnosis and treatment. BJPsych advances 2020. [DOI: 10.1192/bja.2019.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
SUMMARYHistorically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.
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45
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Lord SR, Bindels H, Ketheeswaran M, Brodie MA, Lawrence AD, Close JCT, Whone AL, Ben-Shlomo Y, Henderson EJ. Freezing of Gait in People with Parkinson's Disease: Nature, Occurrence, and Risk Factors. J Parkinsons Dis 2020; 10:631-640. [PMID: 32116261 DOI: 10.3233/jpd-191813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD) which can result in falls and fall related injuries, poor quality of life and reduced functional independence. It is a heterogeneous phenomenon that is difficult to quantify and eludes a unified pathophysiological framework. OBJECTIVE Our aim was to document the occurrence and nature of freezing, cognitive stops and stumbles in people with PD during walks with varying cognitive loads and conditions designed to elicit FOG. METHODS 130 people with PD walked under four conditions (normal walking, walking plus easy and hard dual-tasks, and a FOG elicitation condition. Video and accelerometry recordings were examined to document freezes and other gait disruptions. RESULTS Participants experienced 391 freezes, 97 cognitive stops and 73 stumbles in the trial walks; with total gait disruptions increasing with task complexity. Most freezes in the FOG elicitation condition occurred during turning and approach destination. People who experienced freezing during the walks were more likely to have Postural Instability and Gait Difficulty (PIGD) subtype, longer disease duration and more severe UPDRS part II and part III sub-scores than people who did not freeze. They also took higher doses of levodopa, reported freezing in the past month, more prior falls, had poorer executive function, poorer proprioception, slower reaction time, poorer standing and leaning balance, more depressive symptoms, lower quality of life and greater fear of falling. PD disease duration, reduced controlled leaning balance and poor proprioception were identified as independent and significant determinants of freezing in logistic regression analysis. CONCLUSION The multiple motor and cognitive factors identified as being associated with freezing, including poor proprioception and impaired controlled leaning balance provide new insights into this debilitating PD symptom and may contribute to potential new targets for rehabilitation.
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Affiliation(s)
- Stephen R Lord
- Neuroscience Research Australia, UNSW, Sydney, Australia
| | - Helen Bindels
- Department of Applied Health Sciences, University of Applied Sciences, Bochum, Germany
| | | | | | - Andrew D Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, UK
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW, Sydney, Australia
- Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
| | - Alan L Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Royal United Hospitals NHS Bath Foundation Trust, Combe Park, Bath, UK
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Abstract
Parkinson's disease (PD) is a condition that predominantly affects older people. It is imperative that clinical management considers the other significant illnesses that people with PD accumulate as they age in conjunction with their resilience to cope with physiological change. Multimorbidity and frailty act synergistically to heighten the risk of adverse outcomes for older people with PD. These states are associated with increased likelihood of hospitalization, polypharmacy, adverse drug effects including the anticholinergic burden of medications, drug-disease and drug-drug interactions. Management should be integrated, holistic and individualised to meticulously balance the risks of interventions considering the vulnerability of the individual to recover from disturbance to their environmental, physical and cognitive equilibrium.
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Affiliation(s)
- Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily J. Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Older People’s Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom
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Henderson EJ, Lyell V, Bhimjiyani A, Amin J, Kobylecki C, Gregson CL. Management of fracture risk in Parkinson's: A revised algorithm and focused review of treatments. Parkinsonism Relat Disord 2019; 64:181-187. [PMID: 30992234 DOI: 10.1016/j.parkreldis.2019.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Falls and fractures are a cause of substantial morbidity in Parkinson's. Despite an excess risk of both falls and osteoporosis, people with Parkinson's perceive that they are less likely to fracture than their peers, despite actually being at higher fracture risk. Recognising this increased risk, in 2014 we published an algorithm to guide management of fracture risk in this high-risk population. Recently, the National Osteoporosis Guideline Group (NOGG) published new guidance revising the 10 year fracture probability intervention thresholds for those over 70 years old to 20.3% for major osteoporotic fracture and 5.4% for hip fracture. METHODS In light of the new guidance, we have reappraised the use of two fracture prediction tools, Qfracture and FRAX, and have updated the algorithm to guide the management of bone health and fracture risk in people with Parkinson's. RESULTS We outline the treatment options available with particular consideration given to Parkinson specific factors that influence treatment choices. CONCLUSION This guidance is relevant to all healthcare specialist managing Parkinson's including neurologists, geriatricians and primary care practitioners.
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Affiliation(s)
- Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom; Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
| | - Veronica Lyell
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK
| | - Arti Bhimjiyani
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Jigisha Amin
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Christopher Kobylecki
- Department of Neurology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, M6 8HD, United Kingdom
| | - Celia L Gregson
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
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Henderson EJ, Morgan GS, Amin J, Gaunt DM, Ben-Shlomo Y. The minimum clinically important difference (MCID) for a falls intervention in Parkinson's: A delphi study. Parkinsonism Relat Disord 2018; 61:106-110. [PMID: 30455158 DOI: 10.1016/j.parkreldis.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Falls are common in Parkinson's disease so any intervention that reduced falls risk would be of value. One potential intervention is the use of cholinesterase inhibitor (ChEi) drugs. OBJECTIVE To establish the minimum clinically important difference (MCID) for fall rates to inform the effect estimate for sample size calculations of future clinical trials. METHODS We performed a Delphi study assembling a panel of experts in Parkinson's disease from academic and clinical medicine in order to reach a consensus of opinion. Responses from a panel were summarised and resent to the group, until consensus was reached. RESULTS 780 clinicians, who had been caring for people with Parkinson's for an average of 14 years, were contacted via three routes. The median (Interquartile range (IQR)) MCID after round 1 was 25% (IQR 20-30%) which equates to the prevention of 5 (IQR 4-6) falls per year. Increasing consensus after round two confirmed the MCID of 25%, narrowing the (IQ) range to 20%-25%. This was unchanged when the panel were shown the number of participants that would need to be recruited to a clinical trial in order to achieve this difference. CONCLUSIONS We have established that an expert panel of PD specialists consider that an intervention that demonstrated a 25% (IQR 20-25%) relative reduction in falls rate would be clinically meaningful. This estimate can be used to help determine the sample size for any future clinical trial.
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Affiliation(s)
- Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom; Royal United Hospitals NHS Foundation Trust Bath, BA1 3NG, United Kingdom.
| | - Gemma S Morgan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Jigisha Amin
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, United Kingdom
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration (BRTC), Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
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Whateley JM, Huffman AJ, Henderson EJ. Acute inability to mobilise resulting from probable donepezil-induced myoclonus. Age Ageing 2018; 47:907-908. [PMID: 29939205 DOI: 10.1093/ageing/afy093] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Donepezil is a commonly prescribed cholinesterase inhibitor in Alzheimer's dementia. We present a case of probable donepezil-induced generalised myoclonus causing total inability to mobilise in a 93-year-old woman.
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Affiliation(s)
- Jennifer M Whateley
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Alice J Huffman
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Emily J Henderson
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK.,Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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50
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Learmonth AM, Henderson EJ, Hunter DJ. Securing systems leadership by local government through health and wellbeing strategies. J Public Health (Oxf) 2018; 40:467-475. [PMID: 29040618 DOI: 10.1093/pubmed/fdx127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study was to strengthen Health and Wellbeing Strategies (HWSs) by identifying potential areas for system leadership across local authorities in relation to specific aspects of health/illness, wider determinants of health and transformational change management. Method The work involved a document analysis of strengths of the first 12 HWSs produced in the North East of England applying principles of appreciative inquiry (AI), followed by a knowledge-to-action group approach with stakeholders. A summative event resulted in Health and Wellbeing Board (HWB) members identifying potential areas for collaboration. Results The study identified diverse examples of good practice, and considerable consensus in terms of key priorities, both wider determinants such as employment, transport and housing, and subject areas such as lifestyle issues and children having the best start in life. There was agreement in principle to work across local authority boundaries, with academic partners. Consideration of HWSs as part of a complex adaptive system was welcomed by HWB Members. Conclusions Collaborative working across HWBs could strengthen the effectiveness of HWSs in relation to inequalities in health, place-shaping and wider determinants of wellbeing. The co-production of identified areas to work toward health improvement was successful.
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Affiliation(s)
- Alyson M Learmonth
- Centre for Public Policy and Health, School of Medicine Pharmacy and Health, Durham University Queen's Campus, Stockton on Tees, UK
| | - Emily J Henderson
- Centre for Public Policy and Health, School of Medicine Pharmacy and Health, Durham University Queen's Campus, Stockton on Tees, UK.,Fuse the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - David J Hunter
- Centre for Public Policy and Health, School of Medicine Pharmacy and Health, Durham University Queen's Campus, Stockton on Tees, UK.,Fuse the Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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