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Williams R, Kemp V, Burgess J, Murray E, Stokes S, Wood A, Batt-Rawden S, Bland L, Lockey D. Practical psychosocial care for providers of pre-hospital care: a summary of the report 'valuing staff, valuing patients'. Scand J Trauma Resusc Emerg Med 2023; 31:77. [PMID: 37946286 PMCID: PMC10636848 DOI: 10.1186/s13049-023-01141-6] [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: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently. METHOD FPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA). RESULTS The Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems. CONCLUSION This paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.
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Affiliation(s)
- Richard Williams
- Welsh Institute for Health and Social Care, Faculty of Pre-Hospital Care, University of South Wales, Edinburgh, UK
- Director of the Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Verity Kemp
- Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Jennifer Burgess
- Cumbria, Northumberland, Tyne and Wear NHS Trust and Newcastle University, Newcastle Upon Tyne, UK
| | - Esther Murray
- Institute for Health Sciences Education, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzy Stokes
- Emergency Medicine and Pre-Hospital Emergency Medicine, Oxford University Hospitals and Thames Valley Air Ambulance, Stokenchurch, UK
| | - Andrew Wood
- Anaesthesia and Pre-Hospital Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Samantha Batt-Rawden
- Intensive Care Medicine and Pre-Hospital Emergency Medicine, Ashford and St Peter's NHS Foundation Trust, Cambridge, UK
| | - Laura Bland
- Pre-Hospital and Emergency Medicine, Somerset Foundation Trust and Dorset and Somerset Air Ambulance, Henstridge, UK
- Faculty of Pre-Hospital Care, Intercollegiate Board for Training in Pre-Hospital Emergency Medicine, Edinburgh, UK
| | - David Lockey
- Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK.
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Vafapour P, Murray E. Exploring the lived experiences of debilitating period pain management in the UK. Br J Pain 2023; 17:408-419. [PMID: 37538945 PMCID: PMC10395394 DOI: 10.1177/20494637231172674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background Five to ten percent of women experience period pains that disrupt their lives yet 4 in 5 women believe that their claims for their dysmenorrhea are not taken seriously. Within the process of seeking support and understanding about their pain, they face various barriers that prevent them from finding the answers they deserve. Methods Semi-structured interviews were conducted with 8 women aged 20-28 to discuss their experiences with dysmenorrhea throughout their time since menarche. Results Using Scheper-Hughes and Lock understanding of the mindful body, this research explores women's experiences of dysmenorrhea through their physical body (relationship with the body and needing control), the social body (cultural concepts and comparisons to others) and the body politic (medicalisation, the medical team and the transvaginal ultrasound). Conclusions The impact of these aspects of their mindful bodies developed arguments showing how different actors had an impact on preventing them obtaining the patient-centred care they required without resistance. More must be done to honour the experience of pain women have regarding their periods, especially by healthcare professionals. There must be consistency in the way women are approached for their dysmenorrhea to prevent discrepancies of support. This must be done with clearer guidance on what is offered to women with dysmenorrhea, especially in the primary care setting.
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Affiliation(s)
- Parmis Vafapour
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Esther Murray
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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Snowden A, Young J, Roberge D, Schipani S, Murray E, Richard C, Lussier MT, White C. Holistic needs assessment in outpatient cancer care: a randomised controlled trial. BMJ Open 2023; 13:e066829. [PMID: 37142317 PMCID: PMC10163480 DOI: 10.1136/bmjopen-2022-066829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
DESIGN Analyst blinded, parallel, multi-centre, randomised controlled trial (RCT). PARTICIPANTS People with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020. INTERVENTION Holistic needs assessment (HNA) or care as usual during consultation. OBJECTIVE To establish whether incorporating HNA into consultations would increase patient participation, shared decision making and postconsultation self-efficacy. OUTCOME MEASURES Patient participation in the consultations examined was measured using (a) dialogue ratio (DR) and (b) the proportion of consultation initiated by patient. Shared decision making was measured with CollaboRATE and self-efficacy with Lorig Scale. Consultations were audio recorded and timed. RANDOMISATION Block randomisation. BLINDING Audio recording analyst was blinded to study group. RESULTS 147 patients were randomised: 74 control versus 73 intervention. OUTCOME No statistically significant differences were found between groups for DR, patient initiative, self-efficacy or shared decision making. Consultations were on average 1 min 46 s longer in the HNA group (respectively, 17 m 25 s vs 15 min 39 s). CONCLUSION HNA did not change the amount of conversation initiated by the patient or the level of dialogue within the consultation. HNA did not change patient sense of collaboration or feelings of self-efficacy afterwards. HNA group raised more concerns and proportionally more emotional concerns, although their consultations took longer than treatment as usual. IMPLICATIONS FOR PRACTICE This is the first RCT to test HNA in medically led outpatient settings. Results showed no difference in the way the consultations were structured or received. There is wider evidence to support the roll out of HNA as part of a proactive, multidisciplinary process, but this study did not support medical colleagues facilitating it. TRIAL REGISTRATION NUMBER NCT02274701.
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Affiliation(s)
- Austyn Snowden
- Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK
| | - Jenny Young
- Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK
| | - Denis Roberge
- Département de médecine de famille et de médecine d'urgence, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Stefano Schipani
- Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Esther Murray
- Psychology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Claude Richard
- MEDICODE, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Marie-Therese Lussier
- Faculté de médecine - Département de médecine de famille et de médecine d'urgence, University of Montreal, Montreal, Quebec, Canada
| | - Craig White
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
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Bond N, McLafferty M, Lapsley C, Ennis E, Murray E, Heenan D, O’Neill S. Familial and Bullying Victimisation: The Impact of Early Adversity Within the Home and Peer Settings on Late Adolescence and Adult Psychopathology. J Child Adolesc Trauma 2023; 16:43-53. [PMID: 36776629 PMCID: PMC9908779 DOI: 10.1007/s40653-022-00481-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Awareness of adverse childhood experiences and their impact on adult psychopathology primarily focuses on adversities within the home. There is limited insight into the impact of adversities across peer environments. OBJECTIVE This study investigates 19 items related to adverse experiences across the home, school and peer environments and their relationship to 12-month and lifetime psychopathology. DATA Secondary analysis of the Ulster University Student Well-being Study. The dataset included completed responses across all selected variables for 729 participants. METHOD AND RESULTS Latent profile analysis identified a low adversity profile, bullying adversity profile and higher prevalence adversity profile. Regression analysis of the three profiles and demographics variables indicated their impact on adult psychopathology lifetime and 12-month prevalence rates. CONCLUSION Schools and HE institutions should acknowledge the impact of childhood adversities. In doing so, it is important to consider the deeper impact of bullying due to its links with psychopathology across the lifespan. Educational institutions should take appropriate steps to mitigate continued exposure as students' progress through the education system.
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Affiliation(s)
- N.I. Bond
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - M. McLafferty
- Centre for Personalised Medicine, Ulster University, Derry/Londonderry, Northern Ireland
| | - C. Lapsley
- Centre for Personalised Medicine, Ulster University, Derry/Londonderry, Northern Ireland
| | - E. Ennis
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - E. Murray
- Centre for Personalised Medicine, Ulster University, Derry/Londonderry, Northern Ireland
| | - D. Heenan
- School of Applied Social and Policy Sciences, Ulster University, Jordanstown, Northern Ireland
| | - S.M. O’Neill
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Skene I, Power H, Murray E. 1423 The positives, the challenges and the impact: an exploration of early careers nurses experiences in the Emergency Department. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-rcem2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims, Objectives and BackgroundThe intense working environment of the Emergency Department (ED) is exciting and rewarding; but is renowned for high staff turnover and burnout. The wellbeing and retention of the existing workforce is imperative. The purpose of this study was to explore the experiences of early careers nurses in the ED; identify aspects of ED they enjoyed, the challenges and explore potential coping mechanisms used to mitigate negative situations.Method and DesignA qualitative design was used. Eleven semi-structured interviews were conducted with adult and paediatric emergency nurses who had worked in the ED for less than three years. Data were transcribed, coded and analysed using thematic analysis. The setting for this study was an emergency department in a major trauma centre. Data was collected between January-August 2020 following ethical approval.Results and ConclusionFour key themes emerged; (1) Drawn to ED Nursing’ ; (2) ‘Teamwork’; (3)‘Time to care’ and (4) ‘Psychological impact’’. Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief were identified as helping to mitigate challenging aspects of the jobBy identifying the factors that maintain wellbeing and sustain the workforce, we can promote and support them. The benefits to a stable and well supported workforce in ED are many; improved and sustainable patient care, reduced staff turnover and alleviating pressures on the existing workforce. Research is now drawing on how we can provide psychological support to those who have been faced with caring for patients in a way that challenges their own moral framework.
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Power H, Skene I, Murray E. The positives, the challenges and the impact; an exploration of early career nurses experiences in the Emergency Department. Int Emerg Nurs 2022; 64:101196. [PMID: 36108493 DOI: 10.1016/j.ienj.2022.101196] [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: 10/29/2021] [Revised: 05/02/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The intense working environment of the Emergency Department (ED) is exciting and rewarding; but is renowned for high staff turnover and burnout. The wellbeing and retention of the existing workforce is imperative. The purpose of this study was to explore the experiences of early careers nurses in the ED; identify aspects of ED they enjoyed, the challenges and explore potential coping mechanisms used to mitigate negative situations. METHODS A qualitative design was used. Eleven semi-structured interviews were conducted with adult and paediatric emergency nurses who had worked in the ED for less than three years. Data were transcribed, open coded and analysed using thematic analysis. RESULTS Four key themes emerged; (1) Drawn to emergency nursing; (2) Teamwork; (3) Time to care; and (4) Reflections on the impact. CONCLUSION Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief were identified as helping to mitigate challenging aspects of the job.
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Affiliation(s)
| | | | - Esther Murray
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Dunphy E, Button K, Hamilton F, Murray E. A feasibility RCT comparing TRAK-ACL digital rehabilitation intervention plus TAU versus TAU for knee anterior cruciate ligament reconstruction patients. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bondaronek P, Slee A, Hamilton F, Murray E. The public health potential of two popular apps to increase physical activity. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.506] [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
Background
The rise of health apps created novel prospects for public health intervention on a wide scale. Despite the popularity of publicly available physical activity (PA) apps, little is known about their effectiveness. This study aimed to investigate the potential of the apps to increase PA. The objectives were: 1) to determine the feasibility of the trial, 2) explore the effects of the apps on behavioural and psychological outcomes
Methods
Feasibility randomised crossover trial of two popular apps. Inactive adults residing in London (UK) were eligible. The two interventions were: App A - 7 Minute Workout Challenge by Fitness Guide Inc., App B - One You Couch to 5k by Public Health England. After 1-week run-in period, participants were randomly allocated to one of the two assessment sequence (App A, B or App B, A).
Results
Out of 104 participants who were eligible and consented, 63.5% (66/104) were enrolled and randomised. The primary analysis of the accelerometer data showed that there were no significant differences between baseline and the interventions using the continuous variables. Sixteen of 51 participants (31.4%) increased their time in moderate to vigorous PA (MVPA) by 20% from baseline following the introduction of the intervention (95% CI = 19.1% to 45.39). Self-reported PA outcomes showed significant increase and sedentary behaviour decreased. Exercise self-efficacy and intentions increased whilst PA outcome expectancy decreased.
Conclusions
The impact of this two PA apps showed promising results with an impact observed for 20% increase in MVPA, self-reported PA, intentions and exercise self-efficacy. Yet, there was a variability in the outcomes observed.
Key messages
This pragmatic trial with participants classed as inactive showed that physical activity apps can increase physical activity. There was a variability of the physical activity outcome and there is a need to tailor digital tools to the users to impact physical activity on a wide scale.
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Affiliation(s)
- P Bondaronek
- Research, Translation & Innovation, Public Health England, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - A Slee
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - F Hamilton
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - E Murray
- Research Department of Primary Care & Population Health, University College London, London, UK
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Sayed MA, Murray E, Soueid A. 603 VTE Prophylaxis Compliance on The Burns Unit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.071] [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: 11/12/2022]
Abstract
Abstract
Aim
To assess if VTE risk assessments are correctly completed and implemented on the Burns Unit.
Method
2-week prospective analysis of all inpatients admitted to the adult Burns Unit. Data was collected from patient files and drug Kardexs. Variables including TBSA, date of injury, date of admission, date of VTE risk assessment score, correct prescription according to score and implementation were compiled in an excel spread sheet. Audited against Trust and NICE Guideline 89.
Results
The first cycle identified errors in risk assessment completion related to inaccurate BMI assessment and failure to identify the burn as a risk factor. The risk assessment was only re-assessed 71% of the time post operatively or following change in condition. An action plan included re-education of medical staff, reminder posters in theatre and re-designing the burns operation note to include a VTE re-assessment tick box. A re-audit showed an improvement in correct VTE scoring from 65% to 100% and VTE reassessment from 71% to 100%.
Conclusions
Following the first cycle, Wythenshawe Hospital Burns Unit has improved in compliance with the NICE and Trust Guidelines. The two most frequent errors identified on completion of the risk assessment form have not been seen in the second cycle following education of medical staff. All patients should continue to be prescribed the prophylaxis indicated, unless contraindicated. For those patients who cannot wear AES due to a burn to their lower legs, flowtrons and/or enoxaparin should be considered instead. For those patients who refuse treatment an incident form must be completed.
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Affiliation(s)
- M A Sayed
- Manchester University Foundation Trust, Manchester, United Kingdom
| | - E Murray
- Manchester University Foundation Trust, Manchester, United Kingdom
| | - A Soueid
- Manchester University Foundation Trust, Manchester, United Kingdom
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Mackenzie J, Murray E. Socially Constructing Healthy Eating: A Foucauldian Discourse Analysis of Healthy Eating Information and Advice. Qual Health Res 2021; 31:2135-2146. [PMID: 34166148 DOI: 10.1177/10497323211023436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A variety of materials offering healthy eating advice have been produced in the United Kingdom to encourage people to eat well and avoid diet-related health issues. By applying a Foucauldian discourse analysis, this research aimed to uncover the discourses used in six healthy eating texts (two state-produced and four commercial texts), how people positioned themselves in relation to these discourses, and the power relations between institutions and the U.K. public. Ten discourses including scientific, thermodynamics, natural, family/caring, emotional, medical, and moral discourses were uncovered and offered up subject positions in relation to moral citizenship and personal responsibility. Through the use of biopower, foods appeared to be categorized as "good" or "bad" foods in which bad foods were considered to be risky to health due to their nutritional composition. Most texts assumed people have the agency to follow the advice provided and failed to consider the readers' personal contexts.
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Affiliation(s)
- Jo Mackenzie
- Hertfordshire County Council, Hertford, United Kingdom
| | - Esther Murray
- Queen Mary University of London, London, United Kingdom
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Murray E, Kaufman KR, Williams R. Let us do better: learning lessons for recovery of healthcare professionals during and after COVID-19. BJPsych Open 2021; 7:e151. [PMID: 34457351 PMCID: PMC8376907 DOI: 10.1192/bjo.2021.981] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic emphasises the need to rethink and restructure the culture of healthcare organisations if we are to ensure the long-term well-being and mental health of healthcare provider organisations and their staff. In this paper, we recognise the high levels of stress and distress among staff of healthcare services before the COVID-19 pandemic began. We identify lessons for care of healthcare staff and illustrate the paths by which support mobilises and later deteriorates. Although this paper focuses on NHS staff in the UK, we contend that similar effects are likely in most healthcare systems.
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Affiliation(s)
- Esther Murray
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Kenneth R. Kaufman
- Rutgers Robert Wood Johnson Medical School, New Jersey, USA; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, UK; Royal College of Psychiatrists, UK; and Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, UK
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Konior-Rozlachowska A, Siedlinski M, Szczepaniak P, Nosalski R, Murray E, Mikolajczyk TP. Systemic and vascular inflammation in experimental allergic asthma. J Physiol Pharmacol 2021; 72. [PMID: 34374654 DOI: 10.26402/jpp.2021.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022]
Abstract
Allergic asthma and atherosclerosis are inflammatory diseases characterized by similar sets of circulating inflammatory cells, in addition to mast cells in the airway and vessel wall. Animal models and human studies provide evidence of a potential interaction between the two apparently unrelated diseases. The main objective of this study was to determine whether experimental allergic asthma is accompanied by inflammatory responses, measured as the activation of the vasculature and the presence of immune cells in the perivascular adipose tissue. For this purpose, male Dunkin Hartley guinea pigs weighing 250 - 300 g were sensitized twice with 10 μg ovalbumin dissolved in aluminium hydroxide (Al(OH)3). Allergen inhalation was performed 10 days after the second immunization and continued 5 days a week for 2 months. After that period, T cell and macrophage content was measured by flow cytometry. The aortic expression of inflammatory markers was studied by real-time PCR. The number of T cells in the peripheral blood was significantly greater in the allergic group in comparison to the sham group. We did not find any significant differences in the leukocyte content of the perivascular adipose tissue between the groups. Nor did we identify significant changes in the expression of inflammatory markers (tumor necrosis factor, monocyte chemoattractant protein-1) and adhesion molecules (intercellular adhesion molecules and vascular cell adhesion molecules) in the aorta. Interestingly, we observed a significantly decreased expression of the endothelial nitric oxide synthase (eNOS) mRNA in the aortic vessel of the allergic group compared to the sham group.
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Affiliation(s)
- A Konior-Rozlachowska
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - M Siedlinski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - P Szczepaniak
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - R Nosalski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland.,BHF Centre for Excellence Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - E Murray
- BHF Centre for Excellence Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - T P Mikolajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland.
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Grailey KE, Murray E, Reader T, Brett SJ. The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis. BMC Health Serv Res 2021; 21:773. [PMID: 34353319 PMCID: PMC8344175 DOI: 10.1186/s12913-021-06740-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. METHODS We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. RESULTS We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. DISCUSSION This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual's psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.
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Affiliation(s)
- K. E. Grailey
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E. Murray
- Said Business School, University of Oxford, Oxford, UK
| | - T. Reader
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - S. J. Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Brown AG, Van Hardenbroek M, Fonville T, Davies K, Mackay H, Murray E, Head K, Barratt P, McCormick F, Ficetola GF, Gielly L, Henderson ACG, Crone A, Cavers G, Langdon PG, Whitehouse NJ, Pirrie D, Alsos IG. Ancient DNA, lipid biomarkers and palaeoecological evidence reveals construction and life on early medieval lake settlements. Sci Rep 2021; 11:11807. [PMID: 34083588 PMCID: PMC8175756 DOI: 10.1038/s41598-021-91057-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Direct evidence of ancient human occupation is typically established through archaeological excavation. Excavations are costly and destructive, and practically impossible in some lake and wetland environments. We present here an alternative approach, providing direct evidence from lake sediments using DNA metabarcoding, steroid lipid biomarkers (bile acids) and from traditional environmental analyses. Applied to an early Medieval Celtic settlement in Ireland (a crannog) this approach provides a site chronology and direct evidence of human occupation, crops, animal farming and on-site slaughtering. This is the first independently-dated, continuous molecular archive of human activity from an archeological site, demonstrating a link between animal husbandry, food resources, island use. These sites are under threat but are impossible to preserve in-situ so this approach can be used, with or without excavation, to produce a robust and full site chronology and provide direct evidence of occupation, the use of plants and animals, and activities such as butchery.
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Affiliation(s)
- A G Brown
- Tromsø Museum, Artic University of Norway, Tromsø, Norway. .,School of Geography and Environmental Science, University of Southampton, Southampton, UK.
| | - M Van Hardenbroek
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - T Fonville
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - K Davies
- School of Geography, Earth and Environmental Sciences, University of Plymouth, Plymouth, UK.,IMSET, Bournemouth University, Poole, UK
| | - H Mackay
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK.,Department of Geography, Durham University, Durham, UK
| | - E Murray
- Archaeology, Queens University, Belfast, Northern Ireland, UK
| | - K Head
- School of Geography, Earth and Environmental Sciences, University of Plymouth, Plymouth, UK
| | - P Barratt
- School of Geography, Earth and Environmental Sciences, University of Plymouth, Plymouth, UK
| | - F McCormick
- Archaeology, Queens University, Belfast, Northern Ireland, UK
| | - G F Ficetola
- Department of Environmental Science and Policy, University of Milan, Milan, Italy.,LECA, Laboratoire d'Ecologie Alpine, Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, Grenoble, France
| | - L Gielly
- LECA, Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, Grenoble, France
| | - A C G Henderson
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - A Crone
- AOC Group Ltd., Edinburgh, Scotland, UK
| | - G Cavers
- AOC Group Ltd., Edinburgh, Scotland, UK
| | - P G Langdon
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - N J Whitehouse
- Department of Archaeology, School of Humanities, University of Glasgow, Glasgow, UK
| | - D Pirrie
- School of Applied Sciences, University of South Wales, Pontypridd, UK
| | - I G Alsos
- Tromsø Museum, Artic University of Norway, Tromsø, Norway
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15
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Saadi JP, Carr E, Fleischmann M, Murray E, Head J, Steptoe A, Hackett RA, Xue B, Cadar D. The role of loneliness in the development of depressive symptoms among partnered dementia caregivers: Evidence from the English Longitudinal Study of Aging. Eur Psychiatry 2021; 64:e28. [PMID: 33766187 PMCID: PMC8080187 DOI: 10.1192/j.eurpsy.2021.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Depressive symptoms are highly prevalent among partnered dementia caregivers, but the mechanisms are unclear. This study examined the mediating role of loneliness in the association between dementia and other types of care on subsequent depressive symptoms. Methods Prospective data from partnered caregivers were drawn from the English Longitudinal Study of Aging. The sample consisted of 4,672 partnered adults aged 50–70 living in England and Wales, followed up between 2006–2007 and 2014–2015. Caregiving was assessed across waves 3 (2006–2007), 4 (2008–2009), and 5 (2010–2011), loneliness at wave 6 (2012–2013), and subsequent depressive symptoms at wave 7 (2014–15). Multivariable logistic regression models were used to assess the association between caregiving for dementia and depressive symptoms compared to caregiving for other illnesses (e.g., diabetes, coronary heart disease (CHD), cancer, and stroke). Binary mediation analysis was used to estimate the indirect effects of caregiving on depressive symptoms via loneliness. Results Care for a partner with dementia was associated with higher odds of depressive symptoms at follow-up compared to those not caring for a partner at all (odds ratio [OR] = 2.6, 95% confidence intervals [CI]: 1.4, 5.1). This association was partially mediated by loneliness (34%). Care for a partner with other conditions was also associated with higher odds of depressive symptoms compared to non-caregiving partners (OR = 1.7, 95% CI: 1.2, 2.5), but there was no evidence of an indirect pathway via loneliness. Conclusion Loneliness represents an important contributor to the relationship between dementia caregiving and subsequent depressive symptoms; therefore, interventions to reduce loneliness among partnered dementia caregivers should be considered.
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Affiliation(s)
- J P Saadi
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - E Carr
- Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M Fleischmann
- Faculty of Science, Methodology and Applied Biostatistics, University of Amsterdam, Amsterdam, The Netherlands
| | - E Murray
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - J Head
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - R A Hackett
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,Department of Psychology, King's College London, London, United Kingdom
| | - B Xue
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - D Cadar
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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16
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Khadjesari Z, Stevenson F, Toner P, Linke S, Milward J, Murray E. 'I'm not a real boozer': a qualitative study of primary care patients' views on drinking and its consequences. J Public Health (Oxf) 2020; 41:e185-e191. [PMID: 29912419 DOI: 10.1093/pubmed/fdy067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The public health message around alcohol is complex, with benefits versus harms, the confusing concept of risk and drinking guidance changing over time. This provides a difficult context for alcohol screening in primary care, with established barriers from the practitioner perspective, but less is known about the patients' perspective. This study explores patients' views on drinking. METHODS Eligible participants were recorded as drinking above low risk levels in primary care. Six practices in North London participated. Interviews were in-depth, semi-structured, transcribed verbatim and underwent detailed thematic analysis. FINDINGS Interviews were conducted with 8 women and 12 men, aged 26-83 years, mostly educated to undergraduate level and of 'White' ethnicity. UK drinking guidance was viewed as irrelevant for reasons related to life stage, lifestyle and absence of harm. Dependence, loss of functionality and control were perceived as key features of problematic drinking. Healthy lifestyles, in terms of diet, exercise and not smoking, were thought to mitigate potential problems associated with alcohol intake. CONCLUSION The findings suggest that public health messages and brief advice should focus on harm experienced at different life stages, among people with different lifestyles, to challenge the ubiquitous view that 'I'm not a real boozer'.
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Affiliation(s)
- Z Khadjesari
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, 16 De Crespigny Park, Camberwell, London, UK
| | - F Stevenson
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
| | - P Toner
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK
| | - S Linke
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Camden and Islington Mental Health Trust, 4 St Pancras Way, Kings Cross, London, UK
| | - J Milward
- Addictions Department, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, UK
| | - E Murray
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
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17
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Dunphy E, Hamilton FL, Button K, Murray E. A scoping review of the resources needed to deliver anterior cruciate ligament physiotherapy rehabilitation in randomised controlled trials. Physical Therapy Reviews 2020. [DOI: 10.1080/10833196.2020.1762521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E. Dunphy
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - F. L. Hamilton
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - K. Button
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - E. Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
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18
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Greaves J, Murray E, Sharp E. Is return to work following joint replacement related to fitness level of the patient pre surgery? Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020; 9:241-247. [PMID: 32342698 PMCID: PMC7189614 DOI: 10.1177/2048872620922795] [Citation(s) in RCA: 399] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource.
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Affiliation(s)
- Matthew Walton
- Northwick Park Hospital (Accident and Emergency Department), London North West University Healthcare NHS Trust, UK
| | - Esther Murray
- Centre for Medical Education, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
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20
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Murray E, Smyth R, McCue B, Crilly N, Rice K, Coulson R, O’Brien A, Burns C, Loughrey C, Turner G, Rafferty G. ST3OP! Stop TPN, Test and Treat on Pyrexia! A quality improvement project to improve management of inpatients on TPN who develop a pyrexia. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Khan K, Hollis C, Hall CL, Davies EB, Mataix-Cols D, Andrén P, Murphy T, Brown BJ, Murray E, Glazebrook C. Protocol for the Process Evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) randomized controlled trial for children and young people. Trials 2020; 21:6. [PMID: 31898510 PMCID: PMC6941346 DOI: 10.1186/s13063-019-3974-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivered education programme aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation. METHODS The process evaluation will have a mixed-methods design following the UK Medical Research Council 2015 guidelines, comprising both quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments put into the online therapy platform by participants at the end of treatment. Qualitative data will be analysed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care. DISCUSSION This process evaluation will explore the experiences of participants, therapists and supervisors and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number, ISRCTN70758207. Registered on 20 March 2018. ClinicalTrials.gov, NCT03483493. Registered on 30 March 2018.
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Affiliation(s)
- K Khan
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - C Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - C L Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - E B Davies
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - D Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - P Andrén
- Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - T Murphy
- Tic Disorder Clinic, Psychological Medicine Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - B J Brown
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - C Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
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22
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Murray E, Valabhji J, Lavida A, Henley W, Daff K, Irwin J, Brownlee L, McGough B. A National Digital Diabetes Prevention Programme: Feasible, acceptable and effective? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.149] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 2 Diabetes (T2DM) is a global public health priority affecting 425 million adults with 352 million more at risk of developing T2DM. Intensive group programmes focusing on weight loss and physical activity can prevent or postpone the development of T2DM, but certain groups (e.g working age) find it difficult to attend sessions. Digital options offer a flexible alternative with the potential to widen access and increase uptake. The National Health Service of England (NHSE) has initiated a pilot of a national digital Diabetes Prevention Programme (DPP) to determine its feasibility, acceptability and impact. This is the first national digital DPP in the world, and lessons learnt will be of interest internationally.
Methods
Single arm, pre-post design located in 9 geographic areas with a total population of 5.6 million adults. Adults identified in primary care as being at risk of T2DM were referred to a digital diabetes prevention intervention (DDPI). Baseline data included demographic details (age, gender, ethnicity, highest level of education achieved) and clinical data (weight (kg), Body Mass Index (BMI) and glycated haemoglobin (HbA1c mmol/mol)). Clinical data were collected at baseline, 6 and 12 months, with the primary outcome change in HbA1c at 12 months.
Results
The programme was effectively implemented in all 9 areas with a total of 5,053 referrals. 3,228 (64%) of those referred registered with a DDPI. Mean baseline values for registered patients was BMI 31.1, Weight 87.7 kg and HbA1c 43.4 mmol/mol. To date, 2,687 patients have reached the 6 month point, of whom 867 dropped out. Mean (95% CI) HbA1c change was -1.6 (-1.8 to -1.4) mmol/mol (n = 1,264) and mean (95% CI) weight change was -4 (-4.3 to -3.7) kg (n = 1,184).
Conclusions
A national digital DPP is feasible, acceptable to patients and healthcare providers, and appears to be associated with beneficial impacts on HbA1c and weight in those who participate.
Key messages
A digital DPP is feasible, acceptable and associated with reductions in weight and HbA1c amongst participants. A digital DPP could be a useful part of a public health strategy to combat T2DM.
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Affiliation(s)
- E Murray
- Primary Care and Population Health, University College London, London, UK
| | - J Valabhji
- Medical Directorate, NHS England, London, UK
- Diabetes and Endocrinology, Imperial College Healthcare Trust, London, UK
| | - A Lavida
- Primary Care and Population Health, University College London, London, UK
| | - W Henley
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - K Daff
- RSM UK Consulting LLP, London, UK
| | - J Irwin
- RSM UK Consulting LLP, London, UK
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23
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McGough B, Murray E, Brownlee L, Barron E, Smith J, Valabhji J. The Healthier You: NHS Diabetes Prevention Programme: digital modes of delivery engage younger people. Diabet Med 2019; 36:1510-1511. [PMID: 31325370 PMCID: PMC7004145 DOI: 10.1111/dme.14083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - E Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - L Brownlee
- Economics Consulting, RSM UK Consulting LLP, Belfast, UK
| | - E Barron
- Public Health England, London, UK
| | - J Smith
- Public Health England, London, UK
| | - J Valabhji
- NHS England, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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24
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Ross RB, Juloori A, Varra V, Ward MC, Campbell S, Woody NM, Murray E, Xia P, Greskovich JF, Koyfman SA, Joshi NP. Five-year outcomes of sparing level IB in node-positive, human papillomavirus-associated oropharyngeal carcinoma: A safety and efficacy analysis. Oral Oncol 2019; 89:66-71. [PMID: 30732961 DOI: 10.1016/j.oraloncology.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The conformality of modern intensity modulated radiation therapy (IMRT) allows avoidance of the submandibular glands (SMG) in select patients, potentially improving late xerostomia. This study explores the safety and efficacy of this approach in select oropharyngeal carcinoma (OPC) patients. METHODS Patients with T1-2N+ human papillomavirus (HPV)-associated OPC treated with definitive IMRT at one institution from 2009 to 2014 were identified. Patients were divided into 3 groups: bilateral level IB targeted (A, n = 16), a single level IB targeted (B, n = 61), and bilateral IB spared (C, n = 9). Outcomes were reviewed to identify the rate of level IB regional recurrence. Odds ratios were calculated for xerostomia between groups. RESULTS Level Ib was targeted in 93 instances (54.1%) and avoided in 79 instances (45.9%). Mean SMG doses were significantly lower when level IB was spared compared to when targeted (37.5 Gy vs 67.5 Gy; P < 0.0001). Median doses to oral cavity decreased with increasing level Ib sparing (40.7 Gy [A] vs 35.4 Gy [B] vs 30.7 [C]; P = 0.002). The rate of late grade ≥2 xerostomia was significantly lower in patients with bilateral 1b sparing (53% in A vs 0% in C; P = 0.007). Sparing 1b unilaterally resulted in a non-significant decrease in late grade ≥2 xerostomia (P = 0.181). No regional failures were identified in levels IB (median follow up = 59.3 months). CONCLUSION Sparing level IB is safe in T1-2N+ HPV+ OPC. Avoiding level Ib translates into significantly lower SMG and oral cavity doses. Larger studies are needed to validate these findings and the impact of this technique.
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Affiliation(s)
- R B Ross
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
| | - A Juloori
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - V Varra
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
| | - M C Ward
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC 28204, USA; Southeast Radiation Oncology Group, 200 Queens Road, Suite 400, Charlotte, NC 28204, USA.
| | - S Campbell
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - N M Woody
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - E Murray
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - P Xia
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - J F Greskovich
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - S A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
| | - N P Joshi
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Ave, CA Building, Cleveland, OH 44195, USA.
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25
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Warde P, Gutierriez E, Glicksman R, Murray E, Ang M, Gilbert J, Himmelman J, Lockhart E, Simniceanu C. Improving Quality of Radiotherapy Care Across Ontario Using a Community of Practice Approach. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.24800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Communities of Practice (CoPs) are defined as “a group of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis”. This concept was developed by Wegner and Lave in 1991, based on the theory that learning is more than just acquiring knowledge, but rather involves being socialized into a practice and developing an identity within a community. Cancer Care Ontario (CCO) is the provincial governments advisor on the cancer system and this work documents CCO's use of CoPs to help advance the quality of care in radiotherapy in Ontario, Canada. Aim: After the divestment of radiotherapy care from a centralised structure into individual hospitals in 2003/2004, there was a marked decrease in communication between the 14 Regional Cancer Centres (RCCs) in Ontario. As a means to rebuild the sense of community among radiation medicine programs (encompassing oncologists, physicists and radiation therapists), and to facilitate communication between the RCCs, the Radiation Treatment Program (RTP) at CCO developed and organized a CoP program. The three aims were knowledge creation, knowledge transfer and exchange (KTE), and community building. The ultimate goal was to improve the safety and quality of radiotherapy by reducing variation in practice between centers. Methods: Seven CoPs have been established since 2010; 3 are disease specific (head and neck, gynecologic and lung cancers) with multidisciplinary representation from oncologists, physicists, and radiation therapists. The other 4 CoPs are single-discipline (radiation therapy, physics, radiation safety officers, clinical specialist radiation therapists) to allow for practice specific knowledge-sharing and innovation. All CoPs are led and driven by volunteer members who identify and prioritize key quality issues and select corresponding projects to pursue. Results: CCO's CoPs have produced several knowledge products, including endorsed clinical guidance documents (5), and practical implementation tools (5), with over 20 additional products currently in development. Members have delivered numerous international and national KTE presentations and hosted 51 workshops. CoP guidance documents have 1: Improved safety ( “Implementation Strategy for Radiation Safety Straps” with 100% implementation across RCCs) 2: Standardized care ( “Contouring Nomenclature - Head and Neck Cancer”) with adoption of recommendations province-wide 3: Supported infrastructure improvements (“ MRI Simulation guideline document”). Conclusion: Overall, the RTP's CoP program has been effective in achieving its main three aims: knowledge creation, KTE, and community building. This approach of a member-driven voluntary CoP should be explored and modeled in other healthcare settings as a means to develop and share knowledge, reduce variation in care, standardize practice and improve patient care.
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26
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Murray E, Gidwani S. Posttraumatic Stress Disorder in Emergency Medicine Residents: A Role for Moral Injury? Ann Emerg Med 2018; 72:322-323. [DOI: 10.1016/j.annemergmed.2018.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/29/2022]
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Murray E, Krahé C, Goodsman D. Are medical students in prehospital care at risk of moral injury? Emerg Med J 2018; 35:590-594. [PMID: 29945983 PMCID: PMC6173814 DOI: 10.1136/emermed-2017-207216] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 09/27/2017] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/06/2022]
Abstract
Background The term ‘moral injury’ may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them. Methods Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis. Results Concepts of moral injury such as witnessing events which contravene one’s moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard. Conclusions The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma.
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Affiliation(s)
- Esther Murray
- Centre for Medical Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Danë Goodsman
- Centre for Medical Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Minami K, El-Banayosy A, Posival H, Seggewiβ H, Murray E, Körner M, Körfer R. Improvement of Survival Rate in Patients with Cardiogenic Shock by Using Nonpulsatile and Pulsatile Ventricular Assist Device. Int J Artif Organs 2018. [DOI: 10.1177/039139889201501206] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Between January 1988 and January 1992, 65 patients (pts) had a ventricle assist device (VAD) inserted in our clinic. In 24 pts a VAD was applied because of primarily unsuccessful weaning from cardiopulmonary bypass (Group A). In a further 24 pts (Group B) a VAD was installed for the therapy of refractive cardiogenic shock (CS) after initially successful cardiac surgery (n=21) and after acute myocardial infarction (n=3). Twelve pts were bridged to heart transplantation (Group C) and five had a VAD inserted for various other reasons (Group D). In 36 (55.4%) of the total 65 pts a nonpulsatile VAD (Biomedicus® 540) was used: 10 in Group A; 20 in B, 3 in C and 3 in D. In 29 pts (44.6%) a pulsatile VAD (Abiomed® BVS 5000) was used: 14 in Group A, 4 in B, 9 in C and 2 in D. Weaning rate and long-term survival rates were 50% and 46% respectively in Group A and 38% and 42% in Group B. Seven pts from Group C were transplanted and six are long-term survivors. Two pts (40%) in Group D were discharged from hospital. Major postoperative complications were bleeding (46%), thromboembolism (14%), multiple organ failure (11%), renal failure (11%), arterial embolism (4.6%), sepsis (3%). The results indicate that application of a VAD can be recommended in pts with postcardiotomy CS to allow recovery of cardiac function and in pts with irreversible ventricular damage as bridging to HTX.
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Affiliation(s)
- K. Minami
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
| | - A. El-Banayosy
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
| | - H. Posival
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
| | - H. Seggewiβ
- Department of Cardiology, Heart Center NRW, Bad Oeynhausen, University of Bochum, Germany
| | - E. Murray
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
| | - M.M. Körner
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
| | - R. Körfer
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Germany
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Minami K, Posival H, El-Bynayosy A, Körner M, Schrofel H, Murray E, Körfer R. Mechanical ventricular support using pulsatile Abiomed BVS 5000 and centrifugal Biomedicus-pump in postcardiotomy shock. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700908] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since we started using ventricular assist devices (VAD) in July 1987 up to August 1993, 63 of 15,650 (0.4%) patients (pts) who underwent open heart sugery were supported postoperatively by VAD at out institution. Forty-three were male and 20 female, mean age 55.5 years. In 49 pts coronary artery bypass grafting (CABG), in 8 pts valve surgery, in 3 pts combined CABG and valve surgery and in 3 pts corrective procedures for congenital heart disease were performed. Perioperative myocardial infarction was the most frequent indication (73%). In 37 of the 63 pts (58.7%) a centrifugal (Biomedicus pump (group A) was used and in 26 pts (41.3%) a pulsatile Abiomed BVS 5000 (group B). Fourteen of 37 pts (38%) in group A were weaned from the VAD and all of them were discharged. Twenty-three pts were unable to be weaned and 19 of these pts died. The remaining 4 pts were transplanted successfully and subsequently 3 died and 1 was discharged. In all, 15 pts (39%) were long-term survivors. Sixteen of 26 pts (62%) in group B were weaned from VAD and 13 (50%) of them were discharged of whom 3 died. Ten patients were unable to be weaned and 7 of these died. The remaining 3 pts were transplanted successfully. In all, 16 pts (61.5%) were long-term survivors. The shorter the interval between beginning resuscitation and application of VAD the better the outcome. Younger age, VAD installation in OR, support time between 2 and 7 days and Abiomed pump, influence the survival rate positively. Because of higher recovery and survival rates in patients assisted by Abiomed compared to the Biomedicus pump, we recommend the Abiomed pump in postcardiotomy cardiac failure.
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Affiliation(s)
- K. Minami
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - H. Posival
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - A. El-Bynayosy
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - M.M. Körner
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - H. Schrofel
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - E. Murray
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
| | - R. Körfer
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, University of Bochum, Bochum - Germany
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Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. Abstract GS3-03: A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs3-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inhibition of COX-2 has been shown to attenuate the metastatic process in pre-clinical models of human breast cancer (BC). The primary aim of this study was to assess the effect of 2 years adjuvant therapy with the COX-2 inhibitor celecoxib compared with placebo in HER2-ve primary BC patients.
Patients & Methods
Patients were randomised in a 2:1 ratio to receive celecoxib 400mg once daily or placebo for 2 years. Patients had to have completely resected BC with prior local and systemic adjuvant treatment according to local practice. Concurrent radiotherapy was permitted and hormone receptor +ve patients received endocrine therapy according to local practice. Patients with HER2+ or node negative, T1 and grade 1 disease were excluded. Median age of patients was 55 years (IQR: 49-63). 50% of patients had tumours >2cm; 42% were grade 3; 48% had node +ve disease. According to local assessment 73% were ER/PgR +ve. Primary endpoint was Disease Free Survival (DFS); defined as time from randomisation to date of first event, with events contributing to analysis defined as recurrence (distant/local), new primary BC (ipsilateral/contralateral) and death. Secondary endpoints included Overall Survival (OS), toxicity, cardiovascular mortality and incidence of second primaries. Subgroup analysis by hormone receptor status was pre-planned. Survival endpoints are analysed using Cox-proportional hazards and log-rank tests; restricted mean survival is used where proportional hazards do not hold.
Results
Between January 2007 and November 2012, 2639 patients were randomised (1763 celecoxib; 876 placebo) from 181 centres across the UK and Germany. At 13th April 2017, median follow up was 60 months (IQR: 48-72) with 428 DFS events reported. Unadjusted survival analysis results are presented below, with hazard ratio<1 favouring celecoxib:
5 year survival estimate (95% CI)Hazard ratio (95% CI)p-valueDFS (all patients) Celecoxib83% (81, 85)1.02 (0.83 – 1.24)0.88Placebo83% (80, 86)1- DFS within ER+ Celecoxib87% (85, 89)0.89 (0.69 – 1.16)0.40Placebo86% (83, 89)1- DFS within ER- Celecoxib72% (68, 76)1.17 (0.85 – 1.61)0.33Placebo75% (69, 80)1- OS (all patients) Celecoxib90% (88, 91)0.97 (0.75 – 1.25)0.81Placebo90% (88, 92)1-
The interaction between ER status and treatment was not significant; p=0.36.
In the celecoxib and placebo groups there were 17 and 8 deaths respectively in patients who had not relapsed. These were due to cardiac (n=3; 2) and other (n=14; 6) in the celecoxib and placebo groups respectively; none were GI related. In total 304 serious adverse events were observed in 265 patients (186/1763 celecoxib; 79/876 placebo). In the celecoxib and placebo groups respectively these were related to cardiac (n=12; 7), GI (n=9; 2) and other (n=193; 81). Work is ongoing to determine whether a subset of ER+ patients whose primary tumours show the characteristics of a COX-2 signature receive greater benefit from celecoxib.
Conclusions
There is no benefit of celecoxib in the ITT population. Further exploratory studies focussing on the ER+ subpopulation are ongoing. Celecoxib treatment is not associated with significant toxicity when compared to placebo in this population of BC patients.
Citation Format: Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS3-03.
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Affiliation(s)
- RC Coombes
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - H Tovey
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - L Kilburn
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Mansi
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Palmieri
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bartlett
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Hicks
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Makris
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Evans
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Loibl
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Denkert
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - E Murray
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Grieve
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Coleman
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Schmidt
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - P Klare
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Rezai
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - B Rautenberg
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - N Klutinus
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - U Rhein
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - K Mousa
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Ricardo-Vitorino
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - G von Minckwitz
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bliss
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
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Mackenzie J, Murray E, Lusher J. Women's experiences of pregnancy related pelvic girdle pain: A systematic review. Midwifery 2018; 56:102-111. [DOI: 10.1016/j.midw.2017.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/20/2017] [Accepted: 10/15/2017] [Indexed: 12/31/2022]
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Lusher JM, Murray E, Chapman-Jones D. Changing the way we think about wounds: A challenge for 21st century medical practice. Int Wound J 2017; 15:311-312. [PMID: 29266777 DOI: 10.1111/iwj.12866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joanne M Lusher
- Institute for Research in Healthcare Policy and Practice, University of the West of Scotland, London Campus, UK
| | - Esther Murray
- Institute of Health Sciences Education at Queen Mary University of London
| | - David Chapman-Jones
- Institute for Research in Healthcare Policy and Practice, University of the West of Scotland, London Campus, UK
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Glicksman R, Ang M, Murray E, Simniceanu C, Lockhart E, Gilbert J, Gutierrez E, Warde P. Cancer Care Ontario’s Communities of Practice: A Scoping Evaluation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bisinotto RS, Filho JCO, Narbus C, Machado VS, Murray E, Bicalho RC. Identification of fimbrial subunits in the genome of Trueperella pyogenes and association between serum antibodies against fimbrial proteins and uterine conditions in dairy cows. J Dairy Sci 2017; 99:3765-3776. [PMID: 26947291 DOI: 10.3168/jds.2015-10401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/16/2016] [Indexed: 12/16/2022]
Abstract
Understanding the role of fimbrial subunits during bacterial adherence and the host's immunological response against anchorage proteins is critical for the development of strategies to prevent pathogens from thriving. The objectives of the present study were to locate fimbria-related proteins in the genome of Trueperella pyogenes (CP007519), define their importance for bacterial adherence, and evaluate the association between serum antibodies against fimbrial subunits and uterine health in dairy cows. Using a BLASTp search through the GenBank database, 4 putative clusters for fimbrial assembly were identified in the genome of T. pyogenes, namely FimA, FimC, FimE, and the novel major fimbriae FimJ. The fimbrial proteins FimA, FimC, FimE, and surface-anchored protein (SAP) were cloned into the pET 26b (+) vector, expressed in Escherichia coli BL21, and purified using affinity chromatography. Serum antibodies against FimA, FimC, FimE, and SAP were determined by ELISA on d 260±3 of gestation and at 2±1 and 35±3 d in milk (DIM) to assess the relationship between antigenicity against fimbrial proteins and parameters of uterine health. Antibodies against FimC and FimE were greater both pre- and postpartum in cows from which T. pyogenes was recovered by uterine flushing at 35±3 DIM, whereas T. pyogenes infection was not associated with differences in serum concentrations of FimA and SAP antibodies. Likewise, concentrations of FimC antibodies were consistently greater in cows diagnosed with clinical endometritis at 35±3 DIM compared with healthy counterparts. These results suggest that fimbrial proteins evaluated in the present study, particularly FimC and FimE, are important for maintenance of T. pyogenes in the uterus postpartum and development of uterine diseases in dairy cattle. Additional research is warranted to elucidate the mechanisms by which each fimbrial subunit contributes to the establishment of uterine diseases, evaluate its effect on fertility responses, and assess its relevance as a target for vaccine development.
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Affiliation(s)
- R S Bisinotto
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - J C Oliveira Filho
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - C Narbus
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - V S Machado
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - E Murray
- Department of Entomology, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY 14853
| | - R C Bicalho
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
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Abstract
The main objective of this study is to assess current hepatitis C services for female prisoners. The study design includes a retrospective audit of inmates’ contact with blood-borne virus (BBV) services and outcomes of service use. The study was carried out at a prison for women in the north of England with 179 prisoners and 69 service users. The outcome measures were proportions in contact with services and outcomes of service use (time to testing/treatment; proportion positive for hepatitis C; HIV status). Almost a quarter of those arriving at the prison have contact with BBV services; most of them report a history of intravenous drug use (75.4%), although one-fifth of such individuals decline testing. The average number of days from imprisonment to testing was 86-half this time if arriving since October 2006. Fifty percent were positive for the hepatitis C antibody, the majority of whom (83.3%) had an active virus and were suitable for treatment. The average number of days from testing to referral was 38. All tested for HIV were negative. Therefore, efficiency is necessary if prisoners are to access BBV services while incarcerated. This is being achieved, although some delays still occur.
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Affiliation(s)
- E Murray
- University of Glasgow (fourth year), Glasgow, Scotland
| | - D Jones
- BBV Services HMPS, London, UK
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Joshi N, Juloori A, Ward M, Qu H, Greskovich J, Murray E, Potter J, Dorfmeyer A, Xia P, Koyfman S. Sparing Level IB in Node-Positive, Human Papillomavirus–Associated Oropharyngeal Carcinoma: An Early Safety and Efficacy Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kittel J, Ward M, Cui T, Murray E, Joshi N, Greskovich J, Koyfman S, Xia P. After Transoral Resection for Early-Stage, Human Papillomavirus–Positive Base of Tongue Cancer, Could Omitting the Primary Bed Be Worth the Risk? A Dosimetric Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Murray E, Michael S, Youngren M, Androski C, Reznek M. 266 Sex Disparity in Door-to-CT Time in Acute Stroke Patients Presenting to the Emergency Department. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Murray E, Kutzer Y, Lusher J. Dentists' experiences of dentally anxious patients in a specialist setting: An interpretative phenomenological analysis. J Health Psychol 2016; 24:288-298. [PMID: 27613849 DOI: 10.1177/1359105316666655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Since dentists play an important role in the emergence and maintenance of dental anxiety in patients, it is imperative to understand how dentists themselves evaluate their work with anxious patients and how they perceive their environment. Semi-structured interviews explored the working lives of six dentists. Interpretative phenomenological analysis revealed four superordinate themes: Negotiating identities, Control, Perceptions of dentistry and being a dentist and Stress related to treating dentally anxious patients. Warranting investigation in other settings, specialist dentists experienced conflicts between being a helper and inflictor of pain, as well as dealing with conflicting views concerning their status as a dentist.
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Palmer T, Murray E. "Christ offered salvation, and not an easy life": How do port chaplains make sense of providing welfare for seafarers? An idiographic, phenomenological approach analysis. Int Marit Health 2016; 67:117-24. [PMID: 27364178 DOI: 10.5603/imh.2016.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The shipping industry has historically leaned towards a biomedical model of health when assessing, treating and caring for seafarers. In recent years there has been more concern for the mental health of seafarers in both the academic literature and the commercial world, however, the psychological and emotional well-being of seafarers still largely falls on the shoulders of the port chaplains. The aim of the study was to explore how port chaplains make sense of providing welfare for seafarers by taking an idiographic, phenomenological approach (IPA). MATERIALS AND METHODS Six male participants working as chaplains in United Kingdom ports took part in recorded face-to-face, semi-structured interviews covering three areas of questioning: role, identity and coping. Interviews were transcribed verbatim, and data analysed using interpretative phenomenological analysis. RESULTS Three super-ordinate themes were identified from participants accounts; "We walk a very strange and middle path", "Exploited" and "Patching up". Rich data emerged in relation to the personal impact chaplains felt they made, which was facilitated by the historical role of the Church; this led to the second super-ordinate theme of how chaplains felt towards seafarers. Lastly, the analysis demonstrates how chaplains adapt to the limitations forced upon them to provide welfare, and a degree of acceptance at the injustice. CONCLUSIONS Results were discussed in reference to theoretical models, including self-efficacy, empathic responding and the transactional model of stress and coping. Chaplains in ports perform their role autonomously with no input from healthcare professionals. Recommendations are made for a biopsychosocial model of health involving primary care, benefiting the health and well-being of seafarers and providing support and guidance for port chaplains at the frontline of welfare for seafarers.
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Murray E. SP0092 Digital Interventions To Improve Self-Care for Long Term Conditions. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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King S, Rodrigues T, Watts A, Murray E, Wilson A, Abizaid A. Investigation of a role for ghrelin signaling in binge-like feeding in mice under limited access to high-fat diet. Neuroscience 2016; 319:233-45. [DOI: 10.1016/j.neuroscience.2016.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 12/25/2022]
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Joshi N, Juloori A, Ward M, Qu H, Greskovich J, Murray E, Potter J, Dorfmeyer A, Xia P, Koyfman S. Sparing Level IB in Node-Positive, Human Papillomavirus–Associated Oropharyngeal Carcinoma: An Early Safety and Efficacy Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Greskovich J, Joshi N, Juloori A, Ward M, Qu H, Murray E, Potter J, Dorfmeyer A, Xia P, Koyfman S. Selectively Sparing the Submandibular Gland When Level IB Lymph Nodes Are Included in the Radiation Target Volume: A Safety and Toxicity Analysis in Cancers of the Oropharynx and Oral Cavity. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malmberg LE, Lewis S, West A, Murray E, Sylva K, Stein A. The influence of mothers' and fathers' sensitivity in the first year of life on children's cognitive outcomes at 18 and 36 months. Child Care Health Dev 2016; 42:1-7. [PMID: 26538379 DOI: 10.1111/cch.12294] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 12/10/2014] [Revised: 08/21/2015] [Accepted: 09/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been increasing interest in the relative effects of mothers' and fathers' interactions with their infants on later development. However to date there has been little work on children's cognitive outcomes. METHODS We examined the relative influence of fathers' and mothers' sensitivity during interactions with their children at the end of the child's first year (10-12 months, n = 97), on child general cognitive development at 18 months and language at 36 months. RESULTS Both parents' sensitivity was associated with cognitive and language outcomes in univariate analyses. Mothers' sensitivity, however, appeared to be associated with family socio-demographic factors to a greater extent that fathers' sensitivity. Using path modelling the effect of paternal sensitivity on general cognitive development at 18 months and language at 36 months was significantly greater than the effect of maternal sensitivity, when controlling for socio-demographic background. In relation to language at 36 months, there was some evidence that sensitivity of one parent buffered the effect of lower sensitivity of the other parent. CONCLUSIONS These findings suggest that parental sensitivity can play an important role in children's cognitive and language development, and that higher sensitivity of one parent can compensate for the lower sensitivity of the other parent. Replication of these findings, however, is required in larger samples.
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Affiliation(s)
- L-E Malmberg
- Department of Education, University of Oxford, Oxford, UK
| | - S Lewis
- Simmons House Adolescent Unit, Whittington Health NHS, London, UK
| | - A West
- Berkshire Healthcare NHS Trust, Reading, UK
| | - E Murray
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - K Sylva
- Department of Education, University of Oxford, Oxford, UK
| | - A Stein
- Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
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Shen Z, Murray E, Yu N, Kolar M, Greskovich J, Koyfman S, Bzdusek K, Xia P. Automatic IMRT and VMAT Treatment Planning for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Wayal S, Bailey JV, Murray E, Rait G, Morris RW, Peacock R, Nazareth I. P02.01 Systematic review and meta-analysis of randomised control trials of interactive digital interventions for sexual health promotion. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Canney P, Murray E, Dixon-Hughes J, Lewsley LA, Paul J. A Prospective Randomised Phase III Clinical Trial Testing the Role of Prophylactic Cranial Radiotherapy in Patients Treated with Trastuzumab for Metastatic Breast Cancer - Anglo Celtic VII. Clin Oncol (R Coll Radiol) 2015; 27:460-4. [PMID: 25976296 DOI: 10.1016/j.clon.2015.04.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/11/2015] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
A high incidence of central nervous system (CNS) metastases has been reported in patients with HER2-positive tumours receiving trastuzumab therapy for metastatic breast cancer. This study tested whether prophylactic cranial irradiation (PCI) could reduce the incidence of CNS metastases in this setting. This was a prospective, randomised phase III trial. Patients were randomised 1:1 to no PCI or PCI delivered at around 6 weeks after study entry. Cognitive function was assessed prospectively. In total, 51 patients were randomised over a 3 year period; 25 received PCI and 26 did not. The cumulative incidence of CNS metastases at 2 years was 32.4% (standard error = 9.8%) on the no PCI arm and 21.0% (standard error = 8.6%) on the PCI arm; the associated hazard ratio was 0.57 (95% confidence interval 0.18-1.74; P = 0.32). There was no evidence of cognitive dysfunction in PCI patients.
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Affiliation(s)
- P Canney
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - E Murray
- NHS Ayrshire & Arran, Psychological Service, Irvine, UK
| | - J Dixon-Hughes
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - L-A Lewsley
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Paul
- NHS Ayrshire & Arran, Psychological Service, Irvine, UK
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Murray E, Fernandes M, Fazel M, Kennedy SH, Villar J, Stein A. Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review. BJOG 2015; 122:1062-72. [DOI: 10.1111/1471-0528.13435] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- E Murray
- Department of Psychiatry; Warneford Hospital; University of Oxford; Oxford UK
| | - M Fernandes
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - M Fazel
- Department of Psychiatry; Warneford Hospital; University of Oxford; Oxford UK
| | - SH Kennedy
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford UK
| | - A Stein
- Department of Psychiatry; Warneford Hospital; University of Oxford; Oxford UK
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50
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Snowden A, Young J, White C, Murray E, Richard C, Lussier MT, MacArthur E, Storey D, Schipani S, Wheatley D, McMahon J, Ross E. Evaluating holistic needs assessment in outpatient cancer care--a randomised controlled trial: the study protocol. BMJ Open 2015; 5:e006840. [PMID: 25967990 PMCID: PMC4431131 DOI: 10.1136/bmjopen-2014-006840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured discussion of patients' needs within a clinical consultation. However, there is little evidence on how HNA impacts on the dynamics of the clinical consultation. This study aims to establish (1) how HNA affects the type of conversation that goes on during a clinical consultation and (2) how these putative changes impact on shared decision-making and self-efficacy. METHODS AND ANALYSIS The study is hosted by 10 outpatient oncology clinics in the West of Scotland and South West England. Participants are patients with a diagnosis of head and neck, breast, urological, gynaecological and colorectal cancer who have received treatment for their cancer. Patients are randomised to an intervention or control group. The control group entails standard care--routine consultation between the patient and clinician. In the intervention group, the patient completes a holistic needs assessment prior to consultation. The completed assessment is then given to the clinician where it informs a discussion based on the patient's needs and concerns as identified by them. The primary outcome measure is patient participation, as determined by dialogue ratio (DR) and preponderance of initiative (PI) within the consultation. The secondary outcome measures are shared decision-making and self-efficacy. It is hypothesised that HNA will be associated with greater patient participation within the consultation, and that shared decision-making and feelings of self-efficacy will increase as a function of the intervention. ETHICS AND DISSEMINATION This study has been given a favourable opinion by the West of Scotland Research Ethics Committee and NHS Research & Development. Study findings will be disseminated through peer-reviewed publications and conference attendance. TRAIL REGISTRATION NUMBER Clinical Trials.gov NCT02274701.
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Affiliation(s)
| | - Jenny Young
- Department of Mental Health, University of the West of Scotland, Paisley, UK
| | - Craig White
- Quality Unit, Department of Health and Social Care, Scottish Government, Edinburgh, UK
| | | | | | | | - Ewan MacArthur
- Department of Statistics, University of the West of Scotland, Paisley, UK
| | - Dawn Storey
- Department of Colorectal, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Stefano Schipani
- Department of Head and Neck, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Jeremy McMahon
- Department of Oncology, The Southern General Hospital, Glasgow, UK
| | - Elaine Ross
- Department of Oncology, The Southern General Hospital, Glasgow, UK
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