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Oladimeji OI, Harding J, Gamble G, Crowther C, Lin L. Maternal ethnicity and gestational age at birth predict hypoglycaemia among neonates of mothers with gestational diabetes. Acta Paediatr 2024; 113:183-190. [PMID: 37926866 DOI: 10.1111/apa.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/05/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIM Hypoglycaemia is common in neonates born to mothers with gestational diabetes mellitus (GDM). We aimed to determine predictors of hypoglycaemia among neonates of women with GDM and association with short-term outcomes. METHODS We conducted a secondary cohort analysis of data from a multi-centre randomised trial (the TARGET trial) conducted across ten maternity hospitals in New Zealand between May 2015 and November 2017. Data were analysed using univariate analysis and multivariable forward stepwise logistic regression. RESULTS Among 1085 neonates, those born to Asian mothers had reduced odds of hypoglycaemia (OR [95% CI]: 0.54 [0.38, 0.75], p = 0.001), as did those born at higher gestational ages (0.76 [0.68, 0.85], p < 0.001). Neonates born to Pacific mothers had increased odds of hypoglycaemia (OR [95% CI]: 1.57 [1.04, 2.39], p = 0.034). Neonates who experienced hypoglycaemia were more likely to experience neonatal intensive care unit admission (8.3% vs. 2.1%; p ≤ 0.001), hyperbilirubinaemia (8.6% vs. 3.3%; p ≤ 0.001) and receive respiratory support (11.4% vs. 4.8%; p ≤ 0.001) and less likely to be breastfed at discharge (92.4% vs. 96.2%; p = 0.009). CONCLUSION Among neonates of women with GDM, maternal ethnicity and gestation at birth are independent predictors of hypoglycaemia, and hypoglycaemia is associated with short-term comorbidities. Additional surveillance may be appropriate for neonates in these high-risk groups.
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Affiliation(s)
| | - Jane Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Caroline Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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2
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Stewart S, Gamble G, Doyle AJ, Son CN, Aati O, Latto K, Horne A, Stamp LK, Dalbeth N. The statistical challenge of analysing changes in dual energy computed tomography (DECT) urate volumes in people with gout. Semin Arthritis Rheum 2023; 63:152303. [PMID: 37939600 DOI: 10.1016/j.semarthrit.2023.152303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/12/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Dual energy computed tomography (DECT) allows direct visualization of monosodium urate crystal deposition in gout. However, DECT urate volume data are often highly skewed (mostly small volumes with the remainder considerably larger), making statistical analyses challenging in longitudinal research. The aim of this study was to explore the ability of various analysis methods to normalise DECT urate volume data and determine change in DECT urate volumes over time. METHODS Simulated datasets containing baseline and year 1 DECT urate volumes for 100 people with gout were created from two randomised controlled trials. Five methods were used to transform the DECT urate volume data prior to analysis: log-transformation, Box-Cox transformation, log(X-(min(X)-1)) transformation; inverse hyperbolic sine transformation, and rank order. Linear regression analyses were undertaken to determine the change in DECT urate volume between baseline and year 1. Cohen's d were calculated as a measure of effect size for each data treatment method. These analyses were then tested in a validation clinical trial dataset containing baseline and year 1 DECT urate volumes from 91 people with gout. RESULTS No data treatment method successfully normalised the distribution of DECT urate volumes. For both simulated and validation data sets, significant reductions in DECT urate volumes were observed between baseline and Year 1 across all data treatment methods and there were no significant differences in Cohen's d effect sizes. CONCLUSIONS Normalising highly skewed DECT urate volume data is challenging. Adopting commonly used transformation techniques may not significantly improve the ability to determine differences in measures of central tendency when comparing the change in DECT urate volumes over time.
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Affiliation(s)
- Sarah Stewart
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote Auckland 0627, New Zealand; Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand.
| | - Greg Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anthony J Doyle
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand; Te Whatu Ora Health New Zealand, Te Toka Tumai Auckland, Radiology, Private Bag 92 024, Auckland 1142, New Zealand
| | - Chang-Nam Son
- Department of Rheumatology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712 Dongil-ro, Uijeongbu 11749, South Korea
| | - Opetaia Aati
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Kieran Latto
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, 2 Riccarton Avenue, Christchurch 8011, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Cao C, Gamble G, Horne A, Aati O, Doyle A, Drake J, Stamp LK, Dalbeth N. The Tophus Impact Questionnaire (TIQ-20): responsiveness to change during urate-lowering therapy. Rheumatology (Oxford) 2023:kead468. [PMID: 37688559 DOI: 10.1093/rheumatology/kead468] [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: 07/03/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVES In 2015, the 20-item Tophus Impact Questionnaire (TIQ-20) was developed as a tophus-specific patient reported outcome measure. The aim of this study was to determine whether TIQ-20 scores change during urate-lowering therapy. METHODS We analysed data from a two-year clinical trial of allopurinol dose escalation using a treat-to-target serum urate approach. For participants with tophaceous gout, the longest diameter of up to three index tophi was measured using Vernier calipers and the TIQ-20 was recorded at study visits. Participants at the one site were invited into a dual energy CT (DECT) sub-study. Participants were included in this analysis if they had tophaceous gout and TIQ-20 scores available at baseline, Year 1, and Year 2 (n = 58, 39 with DECT data). Data were analysed using mixed model approach to repeated measures. RESULTS Improvements were observed in all tophus measures over the two-year period. The mean (SD) TIQ-20 scores reduced over two years from 3.59 (1.77)-2.46 (1.73), P< 0.0001, and the mean (95%CI) TIQ-20 change over the two years was -1.13 (-1.54, -0.71). Effect size (Cohen's d) for the change in the sum of the index tophi diameter over two years was 0.68, for DECT urate volume was 0.50, and for the TIQ-20 was 0.71. CONCLUSION For people with tophaceous gout treated with allopurinol using a treat to target serum urate approach, improvements in TIQ-20 occur, as well as improvements in physical and imaging tophus measures. These findings demonstrate that the TIQ-20 is a responsive patient-reported instrument of tophus impact.
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Affiliation(s)
- Cindy Cao
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Opetaia Aati
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Doyle
- Department of Radiology, Auckland District Health Board
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jill Drake
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Roy S, Petrie KJ, Gamble G, Edwards MA. Did a nocebo effect contribute to the rise in special education enrollment following the Flint, Michigan water crisis? Clin Psychol Eur 2023; 5:e9577. [PMID: 37065004 PMCID: PMC10103158 DOI: 10.32872/cpe.9577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background
Exposure to waterborne lead during the Flint Water Crisis during April 2014-October 2015 is believed to have caused increased special education enrollment in Flint children.
Method
This retrospective population-based cohort study utilized de-identified data for children under six years of age who had their blood lead tested during 2011 to 2019, and special education outcomes data for children enrolled in public schools for corresponding academic years (2011-12 to 2019-20) in Flint, Detroit (control city) and the State of Michigan. Trends in the following crisis-related covariates were also evaluated: waterborne contaminants, poverty, nutrition, city governance, school district policies, negative community expectations, media coverage and social media interactions.
Results
Between 2011 and 2019, including the 2014-15 crisis period, the incidence of elevated blood lead in Flint children (≥ 5µg/dL) was always at least 47% lower than in the control city of Detroit (p < .0001) and was also never significantly higher than that for all children tested in Michigan (p = 0.33). Nonetheless, special education enrollment in Flint spiked relative to Detroit and Michigan (p < .0001). There is actually an inverse relationship between childhood blood lead and special education enrollment in Flint.
Conclusion
This study failed to confirm any positive association between actual childhood blood lead levels and special education enrollment in Flint. Negative psychological effects associated with media predictions of brain damage could have created a self-fulfilling prophecy via a nocebo effect. The findings demonstrate a need for improved media coverage of complex events like the Flint Water Crisis.
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Teng THK, Tay WT, Ouwerkerk W, Tromp J, Richards AM, Gamble G, Greene SJ, Yiu KH, Poppe K, Ling LH, Lund M, Sim D, Devlin G, Loh SY, Troughton R, Ren QW, Jaufeerally F, Lee SGS, Tan RS, Soon DKN, Leong G, Ong HY, Yeo DPS, Lam CSP, Doughty RN. Titration of medications and outcomes in multi-ethnic heart failure cohorts (with reduced ejection fraction) from Singapore and New Zealand. ESC Heart Fail 2023; 10:1280-1293. [PMID: 36722315 PMCID: PMC10053276 DOI: 10.1002/ehf2.14275] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS We investigated titration patterns of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs) and beta-blockers, quality of life (QoL) over 6 months, and associated 1 year outcome [all-cause mortality/heart failure (HF) hospitalization] in a real-world population with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Participants with HFrEF (left ventricular ejection fraction <40%) from a prospective multi-centre study were examined for use and dose [relative to guideline-recommended maintenance dose (GRD)] of ACEis/ARBs and beta-blockers at baseline and 6 months. 'Stay low' was defined as <50% GRD at both time points, 'stay high' as ≥50% GRD, and 'up-titrate' and 'down-titrate' as dose trajectories. Among 1110 patients (mean age 63 ± 13 years, 16% women, 26% New York Heart Association Class III/IV), 714 (64%) were multi-ethnic Asians from Singapore and 396 were from New Zealand (mainly European ethnicity). Baseline use of either ACEis/ARBs or beta-blockers was high (87%). Loop diuretic was prescribed in >80% of patients, mineralocorticoid receptor antagonist in about half of patients, and statins in >90% of patients. At baseline, only 11% and 9% received 100% GRD for each drug class, respectively, with about half (47%) achieving ≥50% GRD for ACEis/ARBs or beta-blockers. At 6 months, a large majority remained in the 'stay low' category, one third remained in 'stay high', whereas 10-16% up-titrated and 4-6% down-titrated. Patients with lower (vs. higher) N-terminal pro-beta-type natriuretic peptide levels were more likely to be up-titrated or be in 'stay high' for ACEis/ARBs and beta-blockers (P = 0.002). Ischaemic aetiology, prior HF hospitalization, and enrolment in Singapore (vs. New Zealand) were independently associated with higher odds of 'staying low' (all P < 0.005) for prescribed doses of ACEis/ARBs and beta-blockers. Adjusted for inverse probability weighting, ≥100% GRD for ACEis/ARBs [hazard ratio (HR) = 0.42; 95% confidence interval (CI) 0.24-0.73] and ≥50% GRD for beta-blockers (HR = 0.58; 95% CI 0.37-0.90) (vs. Nil) were associated with lower hazards for 1 year composite outcome. Country of enrolment did not modify the associations of dose categories with 1 year composite outcome. Higher medication doses were associated with greater improvements in QoL. CONCLUSIONS Although HF medication use at baseline was high, most patients did not have these medications up-titrated over 6 months. Multiple clinical factors were associated with changes in medication dosages. Further research is urgently needed to investigate the causes of lack of up-titration of HF therapy (and its frequency), which could inform strategies for timely up-titration of HF therapy based on clinical and biochemical parameters.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Jasper Tromp
- Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - A Mark Richards
- National University Heart Centre, Singapore.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Greg Gamble
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Katrina Poppe
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - David Sim
- National Heart Centre Singapore, Singapore
| | - Gerard Devlin
- School of Medicine, University of Auckland, Auckland, New Zealand.,Tairāwhiti District Health Board, Gisborne, New Zealand
| | | | | | - Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | - Ru San Tan
- National Heart Centre Singapore, Singapore
| | | | | | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob N Doughty
- School of Medicine, University of Auckland, Auckland, New Zealand
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6
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Bolam SM, Konar S, Gamble G, Paine SJ, Dalbeth N, Monk AP, Coleman B, Cornish J, Munro JT, Musson DS. Ethnicity, sex, and socioeconomic disparities in the treatment of traumatic rotator cuff injuries in Aotearoa/New Zealand. J Shoulder Elbow Surg 2023; 32:121-132. [PMID: 35926830 DOI: 10.1016/j.jse.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/28/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Traumatic rotator cuff injuries can be a leading cause of prolonged shoulder pain and disability and contribute to significant morbidity and health care costs. Previous studies have shown evidence of sociodemographic disparities with these injuries. The purpose of this nationwide study was to better understand these disparities based on ethnicity, sex, and socioeconomic status, in order to inform future health care strategies. METHODS Accident Compensation Corporation (ACC) is a no-fault comprehensive compensation scheme encompassing all of Aotearoa/New Zealand (population in 2018, 4.7 million). Using the ACC database, traumatic rotator cuff injuries were identified between January 2010 and December 2018. Injuries were categorized by sex, ethnicity, age, and socioeconomic deprivation index of the claimant. RESULTS During the 9-year study period, there were 351,554 claims accepted for traumatic rotator cuff injury, which totaled more than NZ$960 million. The greatest proportion of costs was spent on vocational support (49.8%), then surgery (26.3%), rehabilitation (13.1%), radiology (8.1%), general practitioner (1.6%), and "Other" (1.1%). Asian, Māori (indigenous New Zealanders), and Pacific peoples were under-represented in the age-standardized proportion of total claims and had lower rates of surgery than Europeans. Māori had higher proportion of costs spent on vocational support and lower proportions spent on radiology, rehabilitation, and surgery than Europeans. Males had higher number and costs of claims and were more likely to have surgery than females. There were considerably fewer claims from areas of high socioeconomic deprivation. DISCUSSION AND CONCLUSION This large nationwide study demonstrates the important and growing economic burden of rotator cuff injuries. Indirect costs, such as vocational supports, are a major contributor to the cost, suggesting improving treatment and rehabilitation protocols would have the greatest economic impact. This study has also identified sociodemographic disparities that need to be addressed in order to achieve equity in health outcomes.
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Affiliation(s)
- Scott M Bolam
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand; Department of Orthopedic Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand
| | - Subhajit Konar
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Maori, University of Auckland, Grafton, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Grafton, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopedic Surgery, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand
| | - Jacob T Munro
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand; Department of Orthopedic Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand
| | - David S Musson
- Department of Medicine, University of Auckland, Grafton, Auckland, New Zealand; Department of Nutrition and Dietetics, University of Auckland, Grafton, Auckland, New Zealand.
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7
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Harding JE, Rajay AB, Alsweiler JM, Brown G, Crowther CA, Franke N, Gamble G, McKinlay C, Milne B, Rogers J, Wouldes T. Different Approaches to requesting Consent for Routine data linkage in Neonatal follow-up (ACORN): protocol for a 2×2 factorial randomised trial. BMJ Open 2022; 12:e060476. [PMID: 35831046 PMCID: PMC9280877 DOI: 10.1136/bmjopen-2021-060476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Routinely collected data can be linked to research data to create a rich dataset and inform practice. However, consent is normally required to link identifiable data. Reported rates of consent to data linkage for children ranged from 21% to 96%, but no studies have investigated different approaches to seeking consent for data linkage for school-age children. METHODS AND ANALYSIS The Approaches to Consent for Routine Data Linkage in Neonatal Follow-up (ACORN) trial is a 2×2 factorial randomised trial to assess whether, for children who participated in neonatal randomised trials (pre-hypoglycaemia Prevention with Oral Dextrose Gel (hPOD), hPOD and The Impact of Protein Intravenous Nutrition on Development in Extremely Low Birth Weight Babies (ProVIDe)) and are approached to participate in an in-person assessment at 6-7 years of age, parental consent to data linkage is higher if consent is sought (1) after the in-person assessment (delayed) or concurrently and (2) for health and education data combined or separately. The primary outcomes will be rates of consent to linkage of (1) either health or education data and (2) both health and education data. A pilot study indicates the potentially available cohort size of 2110 (80% follow-up of the neonatal trial cohorts) would be adequate to detect an absolute difference of 6%-5%-4% from a baseline consent rate of 70%-85%-90%, respectively (2-tailed alpha 0.05, 90% power). With at least 1136 participants, the ACORN trial would have 90% power to detect an absolute difference of 5% in the primary outcome for each factor, assuming a consent rate of 90% in the control groups and alpha 0.05. Data are categorical and will be presented as number and per cent. The effects of factors will be tested using generalised linear models and presented as ORs and 95% CIs. ETHICS AND DISSEMINATION Ethics approval by the New Zealand Health and Disability Ethics Committee (19/STH/202). Dissemination will be via peer-reviewed publications, scientific meetings, educational sessions and public fora. TRIAL REGISTRATION NUMBER ACTRN12621000571875 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Jane E Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - Jane Marie Alsweiler
- Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Gavin Brown
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | | | - Nike Franke
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Christopher McKinlay
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- Centre of Methods and Policy Application in the Social Sciences, The University of Auckland, Auckland, New Zealand
| | - Jenny Rogers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Trecia Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Mueller M, Thompson B, Poppe T, Alsweiler J, Gamble G, Jiang Y, Leung M, Tottman AC, Wouldes T, Harding JE, Duerden EG. Amygdala subnuclei volumes, functional connectivity, and social–emotional outcomes in children born very preterm. Cereb Cortex Commun 2022; 3:tgac028. [PMID: 35990310 PMCID: PMC9383265 DOI: 10.1093/texcom/tgac028] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Children born very preterm can demonstrate social-cognitive impairments, which may result from limbic system dysfunction. Altered development of the subnuclei of the amygdala, stress-sensitive regions involved in emotional processing, may be key predictors of social-skill development. In a prospective cohort study, 7-year-old children born very preterm underwent neurodevelopmental testing and brain MRI. The Child Behavioral Checklist was used to assess social–emotional outcomes. Subnuclei volumes were extracted automatically from structural scans (n = 69) and functional connectivity (n = 66) was examined. General Linear Models were employed to examine the relationships between amygdala subnuclei volumes and functional connectivity values and social–emotional outcomes. Sex was a significant predictor of all social–emotional outcomes (P < 0.05), with boys having poorer social–emotional outcomes. Smaller right basal nuclei volumes (B = -0.043, P = 0.014), smaller right cortical volumes (B = -0.242, P = 0.02) and larger right central nuclei volumes (B = 0.85, P = 0.049) were associated with increased social problems. Decreased connectivity strength between thalamic and amygdala networks and smaller right basal volumes were significant predictors of greater social problems (both, P < 0.05), effects which were stronger in girls (P = 0.025). Dysregulated maturation of the amygdala subnuclei, along with altered connectivity strength in stress-sensitive regions, may reflect stress-induced dysfunction and can be predictive of social–emotional outcomes.
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Affiliation(s)
- Megan Mueller
- Applied Psychology , Faculty of Education, , London N6G 1G7 , Canada
- Western University , Faculty of Education, , London N6G 1G7 , Canada
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo , Waterloo , Canada
- Centre for Eye and Vision Research , 17W Science Park , Hong Kong
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Tanya Poppe
- Liggins Institute, University of Auckland , Auckland , New Zealand
- Centre for the Developing Brain, King’s College London , London , UK
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland , Auckland , New Zealand
| | - Greg Gamble
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Myra Leung
- Department of Paediatrics: Child and Youth Health, University of Auckland , Auckland , New Zealand
- Discipline of Optometry and Vision Science, University of Canberra , Canberra , Australia
| | - Anna C Tottman
- Liggins Institute, University of Auckland , Auckland , New Zealand
- Neonatal Services, Royal Women’s Hospital , Melbourne , Australia
| | - Trecia Wouldes
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland , Auckland , New Zealand
| | - Emma G Duerden
- Applied Psychology , Faculty of Education, , London N6G 1G7 , Canada
- Western University , Faculty of Education, , London N6G 1G7 , Canada
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9
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Grey A, Bolland MJ, Horne A, Mihov B, Gamble G, Reid IR. Bone Mineral Density and Bone Turnover 10 Years After a Single 5 mg Dose or Two 5-Yearly Lower Doses of Zoledronate in Osteopenic Older Women: An Open-Label Extension of a Randomized Controlled Trial. J Bone Miner Res 2022; 37:3-11. [PMID: 34585780 DOI: 10.1002/jbmr.4453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/07/2022]
Abstract
Intravenous zoledronate reduces fracture risk (5 mg at 18-month intervals) and prevents bone loss (doses of 1 to 5 mg for 3 to >5 years), but the duration of action of a single 5 mg dose and the effects of lower doses beyond 5 years are unknown. We report the second open-label extension (years 5 to 10) of a 2-year randomized, multidose, placebo-controlled, double-blinded trial. A total of 116 older women who completed 5 years of participation either continued observation without further treatment (zoledronate 5 mg and placebo at baseline) or received repeat doses of 1 or 2.5 mg zoledronate (zoledronate 1 mg and zoledronate 2.5 mg at baseline, respectively). Outcomes were spine, hip, and total body bone mineral density (BMD) and serum markers of bone turnover. After a single 5 mg dose of zoledronate, mean BMD at the lumbar spine and total hip was maintained at or above baseline levels for 9 and 10 years, respectively. The mean level of the bone resorption marker β-C-terminal telopeptide of type I collagen (β-CTX) was at least 25% lower than that in the placebo group for 9 years. In women administered 5-yearly doses of 2.5 mg zoledronate, mean BMD at the total hip and lumbar spine was maintained at or above baseline levels for 9 and 10 years, respectively. Redosing with 1 or 2.5 mg zoledronate at 5 years reduced bone turnover markers for 3 to 4 years. BMD increased for 3 to 4 years after redosing with 1 mg zoledronate. In the group given 5-yearly 2.5 mg zoledronate, β-CTX was at least 20% lower than that in the placebo group for 10 years. Both a single baseline 5 mg dose of zoledronate and 5-yearly doses of 1 and 2.5 mg zoledronate prevented bone loss at hip and spine for 8 to 10 years in older postmenopausal women. Clinical trials to evaluate the effects on fracture risk of these very infrequent and lower doses of zoledronate are justified. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Borislav Mihov
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand
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10
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Dai DWT, Franke N, Wouldes TA, Brown GTL, Tottman AC, Harding JE, Alsweiler J, Biggs J, Bevan C, Black J, Bloomfield F, Fredell K, Gamble G, Harding J, Huth S, Jiang Y, Kevan C, Leung M, Phillips G, Poppe T, Rogers J, Stewart H, Thompson B, Tottman A, Williamson K, Wouldes T. The contributions of intelligence and executive function to behaviour problems in school-age children born very preterm. Acta Paediatr 2021; 110:1827-1834. [PMID: 33459419 DOI: 10.1111/apa.15763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
AIM To examine the contributions of specific neurocognitive skills to behaviour problems in children born very preterm. METHODS We assessed children born <30 weeks' gestation or <1500 g at age 7 years using subtests of the Wechsler Intelligence Scale for Children Fourth Edition, performance and questionnaire-based measures of executive function, and Child Behavior Checklist and Teacher Rating Form. We evaluated the contributions of IQ and executive function to behaviour problems and the moderating effect of sex using multiple regression. RESULTS The 129 children (mean age = 7.2 years) had lower IQ, inferior executive function and increased internalising problems compared with normative samples. Verbal comprehension skills and working memory were associated with total, internalising and externalising problems at school. Performance-based and questionnaire-based executive function were associated with total and externalising behaviour problems both at home and school. Sex moderated the relationships between information processing and parent-reported total problems, and between teacher-rated executive function and total problems. CONCLUSION Both IQ and executive function are related to behaviour problems in children born very preterm, but the relationships are different in boys and girls. Executive function may be a useful target for intervention.
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Affiliation(s)
| | - Nike Franke
- Liggins Institute University of Auckland Auckland New Zealand
| | - Trecia A. Wouldes
- Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Gavin T. L. Brown
- Faculty of Education & Social Work University of Auckland Auckland New Zealand
| | - Anna C. Tottman
- Liggins Institute University of Auckland Auckland New Zealand
- Neonatal Services Royal Women's Hospital Melbourne Vic. Australia
| | - Jane E. Harding
- Liggins Institute University of Auckland Auckland New Zealand
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11
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Duerden EG, Thompson B, Poppe T, Alsweiler J, Gamble G, Jiang Y, Leung M, Tottman AC, Wouldes T, Miller SP, Harding JE. Early protein intake predicts functional connectivity and neurocognition in preterm born children. Sci Rep 2021; 11:4085. [PMID: 33602973 PMCID: PMC7892564 DOI: 10.1038/s41598-021-83125-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/25/2021] [Indexed: 01/31/2023] Open
Abstract
Nutritional intake can promote early neonatal brain development in very preterm born neonates (< 32 weeks’ gestation). In a group of 7-year-old very preterm born children followed since birth, we examined whether early nutrient intake in the first weeks of life would be associated with long-term brain function and neurocognitive skills at school age. Children underwent resting-state functional MRI (fMRI), intelligence testing (Wechsler Intelligence Scale for Children, 5th Ed) and visual-motor processing (Beery-Buktenica, 5th Ed) at 7 years. Relationships were assessed between neonatal macronutrient intakes, functional connectivity strength between thalamic and default mode networks (DMN), and neuro-cognitive function using multivariable regression. Greater functional connectivity strength between thalamic networks and DMN was associated with greater intake of protein in the first week (β = 0.17; 95% CI 0.11, 0.23, p < 0.001) but lower intakes of fat (β = − 0.06; 95% CI − 0.09, − 0.02, p = 0.001) and carbohydrates (β = − 0.03; 95% CI − 0.04, − 0.01, p = 0.003). Connectivity strength was also associated with protein intake during the first month (β = 0.22; 95% CI 0.06, 0.37, p = 0.006). Importantly, greater thalamic-DMN connectivity strength was associated with higher processing speed indices (β = 26.9; 95% CI 4.21, 49.49, p = 0.02) and visual processing scores (β = 9.03; 95% CI 2.27, 15.79, p = 0.009). Optimizing early protein intake may contribute to promoting long-term brain health in preterm-born children.
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Affiliation(s)
- Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, ON, Canada. .,Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada.,School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Tanya Poppe
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Myra Leung
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Anna C Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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12
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Narang RK, Gamble G, Phipps-Green AJ, Topless R, Cadzow M, Stamp LK, Merriman TR, Dalbeth N. Do Serum Urate-associated Genetic Variants Influence Gout Risk in People Taking Diuretics? Analysis of the UK Biobank. J Rheumatol 2020; 47:1704-1711. [PMID: 32007933 DOI: 10.3899/jrheum.191005] [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] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether serum urate (SU)-associated genetic variants differ in their influence on gout risk in people taking a diuretic compared to those not taking a diuretic. METHODS This research was conducted using the UK Biobank Resource (n = 359,876). Ten SU-associated single-nucleotide polymorphisms (SNP) were tested for their association with gout according to diuretic use. Gene-diuretic interactions for gout association were tested using a genetic risk score (GRS) and individual SNP by logistic regression adjusting for relevant confounders. RESULTS After adjustment, use of a loop diuretic was positively associated with prevalent gout (OR 2.34, 95% CI 2.08-2.63), but thiazide diuretics were inversely associated with prevalent gout (OR 0.60, 95% CI 0.55-0.66). Compared with a lower GRS (< mean), a higher GRS (≥ mean) was positively associated with gout in those not taking diuretics (OR 2.63, 2.49-2.79), in those taking loop diuretics (OR 2.04, 95% CI 1.65-2.53), in those taking thiazide diuretics (OR 2.70, 2.26-3.23), and in those taking thiazide-like diuretics (OR 2.11, 95% CI 1.37-3.25). No nonadditive gene-diuretic interactions were observed. CONCLUSION In people taking diuretics, SU-associated genetic variants contribute strongly to gout risk, with a similar effect to that observed in those not taking a diuretic. These findings suggest that the contribution of genetic variants is not restricted to people with "primary" gout, and that genetic variants can play an important role in gout susceptibility in the presence of other risk factors.
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Affiliation(s)
- Ravi K Narang
- R.K. Narang, MBChB, G. Gamble, MSc, N. Dalbeth, FRACP, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Greg Gamble
- R.K. Narang, MBChB, G. Gamble, MSc, N. Dalbeth, FRACP, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Amanda J Phipps-Green
- A.J. Phipps-Green, MSc, R. Topless, BSc, M. Cadzow, PhD, T.R. Merriman, PhD, Department of Biochemistry, University of Otago, Dunedin
| | - Ruth Topless
- A.J. Phipps-Green, MSc, R. Topless, BSc, M. Cadzow, PhD, T.R. Merriman, PhD, Department of Biochemistry, University of Otago, Dunedin
| | - Murray Cadzow
- A.J. Phipps-Green, MSc, R. Topless, BSc, M. Cadzow, PhD, T.R. Merriman, PhD, Department of Biochemistry, University of Otago, Dunedin
| | - Lisa K Stamp
- L.K. Stamp, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tony R Merriman
- A.J. Phipps-Green, MSc, R. Topless, BSc, M. Cadzow, PhD, T.R. Merriman, PhD, Department of Biochemistry, University of Otago, Dunedin
| | - Nicola Dalbeth
- R.K. Narang, MBChB, G. Gamble, MSc, N. Dalbeth, FRACP, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland;
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13
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Pang B, Bowker B, Gamble G, Zhang J, Yang Y, Yu X, Sun JX, Zhuang H. Muscle water properties in raw intact broiler breast fillets with the woody breast condition. Poult Sci 2020; 99:4626-4633. [PMID: 32868007 PMCID: PMC7598021 DOI: 10.1016/j.psj.2020.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to investigate the relationships between muscle water properties, water-holding capacity (WHC), and woody breast (WB) severity in intact raw broiler breast fillets. Broiler pectoralis major deboned at 3 h postmortem was collected from a commercial plant and categorized as normal (NORM), moderate WB, or severe WB (SEV). Meat drip loss was calculated based on weight loss during overnight storage at 4°C. Water properties of the intact fillets were determined with time domain nuclear magnetic resonance and the T2 relaxation times were determined using an inverse Laplace algorithm (CONTIN). Three T2 water components, hydration water (T2b), intra-myofibrillar water (T21), and extra-myofibrillar water (T22), were identified. With increasing WB severity, the time constant of each water component and the relative content of T22 (P22) increased while the relative areas of T2b and T21 (P2b and P21, respectively) decreased. Spearman correlation analysis showed that there were significant correlations between the WB condition score and either the time constant or normalized area for each T2 component. T22 normalized areas (A22) were most strongly correlated with the WB score (r = 0.75); however, the weakest correlation was found between the WB score and T21 areas (A21). Pearson correlation analysis revealed that the strongest correlation (r = 0.64) was found between A22 and drip loss; however, there was no correlation between A21 and drip loss. Within the NORM group, drip loss was significantly correlated to the time constants for both T2b and T21. Within the SEV group, only A22 was significantly correlated to drip loss. These data indicate that the WB condition has a significant impact on the distribution of water within the intact muscle tissue. The content of extra-myofibrillar water in broiler breast fillets may be a key factor responsible for the poor WHC measurements in WB meat.
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Affiliation(s)
- B Pang
- College of Food Science and Engineering, Qingdao Agricultural University, Qingdao 266109, China
| | - B Bowker
- USDA, Agricultural Research Service, U.S. National Poultry Research Center, Athens 30605, GA, USA
| | - G Gamble
- USDA, Agricultural Research Service, U.S. National Poultry Research Center, Athens 30605, GA, USA
| | - J Zhang
- Institute of Animal Husbandry and Veterinary Medicine, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Y Yang
- College of Engineering, China Agricultural University, Beijing 100083, China
| | - X Yu
- College of Life Science, Hubei Normal University, Huangshi 435000, China
| | - J-X Sun
- College of Food Science and Engineering, Qingdao Agricultural University, Qingdao 266109, China
| | - H Zhuang
- USDA, Agricultural Research Service, U.S. National Poultry Research Center, Athens 30605, GA, USA.
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14
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Grey A, Avenell A, Gamble G, Bolland M. Assessing and Raising Concerns About Duplicate Publication, Authorship Transgressions and Data Errors in a Body of Preclinical Research. Sci Eng Ethics 2020; 26:2069-2096. [PMID: 31673984 DOI: 10.1007/s11948-019-00152-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/24/2019] [Indexed: 05/03/2023]
Abstract
Authorship transgressions, duplicate data reporting and reporting/data errors compromise the integrity of biomedical publications. Using a standardized template, we raised concerns with journals about each of these characteristics in 33 pairs of publications originating from 15 preclinical (animal) trials reported by a group of researchers. The outcomes of interest were journal responses, including time to acknowledgement of concerns, time to decision, content of decision letter, and disposition of publications at 1 year. Authorship transgressions affected 27/36 (75%) publications. The median proportion of duplicate data within pairs of publications was 45% (interquartile range 29-57). Data/reporting discrepancies [median 3 (1-5)] were present in 28/33 (85%) pairs. Journals acknowledged receipt of concerns for 53% and 94% of publications by 1 month and 9 months, respectively. After 1 year, journals had communicated decisions for 16/36 (44%) publications. None of the decision letters specifically addressed each of the concerns raised. Decisions were no action, correction and retraction for 9, 3 and 4 publications, respectively: the amounts of duplicate data reporting and data/reporting discrepancies were similar irrespective of journal decision. Authorship transgressions affected 6/9 (67%) publications for which no action was decided. Journal responses to concerns about duplicate publication, authorship transgressions, and data/reporting discrepancies were slow, opaque and inconsistent.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Greg Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
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15
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Abstract
OBJECTIVES To analyse variables associated with article placement order in serial rheumatology journals. DESIGN Content analysis. SETTING Original articles published in seven rheumatology journals from 2013 to 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The following data were extracted from 6787 articles: order number of article in issue, gender of first and last author, geographical region, industry funding, research design and disease category. Cumulative density function plots were used to determine whether article placement distribution was different from the expected distribution. ORs for articles published in the first three places of an issue compared with the last three places were calculated. Altmetric Score and downloads were meta-analysed. RESULTS Article placement order did not associate with author gender or geographical region but was associated with funding source and research design. In addition, articles about rheumatoid arthritis were more likely to be ordered at the front of issues (p<0.001). Articles about crystal arthritis, systemic lupus erythematosus, vasculitis, pain syndromes and paediatric rheumatic diseases were more likely to be ordered at the end of issues (all p<0.001). Association of article placement order with disease category was observed only in journals with tables of contents grouped by disease. Articles ordered in the first three places had higher Altmetric and download rates, than articles in the last three places. CONCLUSIONS Author gender and geographical region do not influence article placement order in serial rheumatology journals. However, bias for certain disease categories is reflected in article placement order. Editorial decisions about article placement order can influence the prominence of diseases.
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Affiliation(s)
- Sarah Stewart
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
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16
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Tai V, Narang RK, Gamble G, Cadzow M, Stamp LK, Merriman TR, Dalbeth N. Do Serum Urate-Associated Genetic Variants Differentially Contribute to Gout Risk According to Body Mass Index? Analysis of the UK Biobank. Arthritis Rheumatol 2020; 72:1184-1191. [PMID: 32017447 DOI: 10.1002/art.41219] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine whether urate-associated genetic variants differ in their influence on gout risk according to body mass index (BMI). METHODS This research was conducted using the UK Biobank Resource (n = 358,728). Participants were divided into 3 groups: BMI <25 kg/m2 (low/normal), BMI ≥25 kg/m2 -<30 kg/m2 (overweight), and BMI ≥30 kg/m2 (obese). Gene-BMI interactions for gout association were tested by logistic regression using a urate genetic risk score (GRS). RESULTS Compared to participants with a GRS less than the mean, the prevalence of gout was higher in those with a GRS greater than or equal to the mean in the low/normal BMI group (0.27% versus 0.77%), in the overweight BMI group (1.02% versus 3.02%), and in the obese BMI group (2.49% versus 6.23%). A GRS greater than or equal to the mean was positively associated with gout compared to a GRS less than the mean in the low/normal BMI group (odds ratio [OR] 2.89 [95% confidence interval (95% CI) 2.42-3.47]), in the overweight BMI group (OR 3.09 [95% CI 2.84-3.36]), and in the obese BMI group (OR 2.65 [95% CI 2.46-2.86]). There was a mildly attenuated effect of the GRS on gout risk in the obese BMI group compared to the overweight BMI group, but no difference in the effect of the GRS between the low/normal BMI and overweight BMI groups, nor between the low/normal BMI and obese BMI groups. CONCLUSION The association of a urate GRS with gout is mildly attenuated in obese individuals compared to overweight individuals. However, genetic variants have a strong effect on gout risk in those with overweight and obese BMIs, with an effect similar to that observed in low/normal BMI.
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Affiliation(s)
- Vicky Tai
- University of Auckland, Auckland, New Zealand
| | | | - Greg Gamble
- University of Auckland, Auckland, New Zealand
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17
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Grey A, Horne A, Gamble G, Mihov B, Reid IR, Bolland M. Ten Years of Very Infrequent Zoledronate Therapy in Older Women: An Open-Label Extension of a Randomized Trial. J Clin Endocrinol Metab 2020; 105:5722154. [PMID: 32016386 DOI: 10.1210/clinem/dgaa062] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Intravenous zoledronate prevents bone loss and reduces fracture risk in older adults but the optimal dosing strategy required to achieve each outcome is not known. OBJECTIVE To assess the effect of very infrequent zoledronate therapy on bone mineral density (BMD) and markers of bone turnover. DESIGN AND PARTICIPANTS An average of 5.5 years after randomization to either a single dose of 5 mg of zoledronateor placebo, 33 of the original cohort of 50 older women with osteopenia entered a 5-year open-label extension study. SETTING Academic research center. INTERVENTION A 5-mg dose of intravenous zoledronate was administered to all participants. MAIN OUTCOME MEASURES BMD and bone turnover were measured annually, generating data over almost 11 years in women who received 5 mg of zoledronate at 0 and 5.5 years (ZZ, n = 16), or placebo at baseline and 5 mg of zoledronate at 5.5 years (PZ, n = 17). RESULTS After redosing, BMD in ZZ remained stable, while BMD in PZ increased. At 11 years, changes from baseline BMD in ZZ and PZ were 3.8% (95% confidence interval (CI) 1.1,6.5) and 2.9% (0.3,5.5) at the lumbar spine (P = .61), 0.9% (-1.7,3.5) and -2.8% (-5.3,-0.3) at the total hip (P = .006), and 0.4% (-0.8,1.6) and -0.4% (-1.3,0.5) at the total body (P = .14). Bone turnover markers were similar in the PZ and ZZ groups throughout the 5 years after redosing. CONCLUSIONS These results suggest that zoledronate 5 mg administered at a 5.5-year interval prevents bone loss over almost 11 years. Clinical trials to investigate whether very infrequent treatment with zoledronate reduces fracture risk are justified.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
| | - Borislav Mihov
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Private Bag, Auckland, New Zealand
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18
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Lin L, Crowther C, Gamble G, Bloomfield F, Harding JE. Sex-specific effects of nutritional supplements in infants born early or small: protocol for an individual participant data meta-analysis (ESSENCE IPD-MA). BMJ Open 2020; 10:e033438. [PMID: 31919126 PMCID: PMC6955477 DOI: 10.1136/bmjopen-2019-033438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Preterm and small for gestational age (SGA) infants are at increased risk of poor growth, disability and delayed development. While growing up they are also at increased risk of obesity, diabetes and later heart disease. The risk of such adverse outcomes may be altered by how preterm and SGA infants are fed after birth. Faltering postnatal growth is common due to failure to achieve recommended high energy and protein intakes, and thus preterm and SGA infants are often provided with supplemental nutrition soon after birth. Enhanced nutrition has been associated with improved early growth and better cognitive development. However, limited evidence suggests that faster growth may increase the risk for later adiposity, metabolic and cardiovascular disease, and that such risks may differ between girls and boys. METHODS AND ANALYSIS We will search Ovid MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, controlled-trials.com, ClinicalTrials.gov and anzctr.org.au for randomised trials that studied the effects of macronutrient supplements for preterm and SGA infants on (i) developmental and metabolic and (ii) growth outcomes after hospital discharge. The outcomes will be (i) cognitive impairment and metabolic risk (co-primary) and (ii) body mass index. Individual participant data (IPD) from all available trials will be included using an intention-to-treat approach. A one-stage procedure for IPD meta-analysis (MA) will be used, accounting for clustering of participants within studies. Exploratory subgroup analyses will further investigate sources of heterogeneity, including sex and size of infants, different timing, duration and type of supplements. ETHICS AND DISSEMINATION This IPD-MA is approved by the University of Auckland Human Participants Ethics Committee (reference number: 019874). Individual studies have approval from relevant local ethics committees. Results will be disseminated in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017072683.
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Affiliation(s)
- Luling Lin
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Caroline Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Alexander T, Conlon CA, Gamble G, von Hurst PR, van Dorp L, Ichhpuniani B, Housh R, Ke P, Bloomfield FH. Body composition of New Zealand-born term babies differs by ethnicity, gestational age and sex. Early Hum Dev 2019; 140:104924. [PMID: 31739266 DOI: 10.1016/j.earlhumdev.2019.104924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Body composition provides important information on nutrition and future metabolic risk. New Zealand has a diverse ethnic population for which there are no newborn body composition data. AIM To determine body composition in a cohort of New Zealand-born term babies. STUDY DESIGN Observational study. SUBJECTS Healthy, term infants between 37+0 and 41+6 weeks' gestation in two hospitals in Auckland, New Zealand. OUTCOME MEASURES Body composition by air displacement plethysmography and anthropometry measured within 5 days of birth. Parent-identified ethnicity was prioritised according to Ministry of Health criteria. Data were analysed using t-test, ANOVA with Tukey post-hoc tests, quantile regression and are mean(SD). RESULTS 440 babies (54% male) were included. Pacific Island/Māori (PI/M) were heavier at birth than Asian/Middle Eastern/Latin American/African (Asian+) babies (3403(506) vs 3181(485) g, p < .05). PI/M and European (E) babies were longer with larger head and waist circumferences than Asian+ babies (all p < .05). Absolute fat mass (FM) was not different amongst ethnicities (E, 365(156), PI/M, 347(183), Asian+, 357(188) g) but PI/M babies had significantly lower FM% than Asian+ (9.8(4.3) vs 10.9(4.5) %, p < .05). Fat-free mass (FFM) was greater in PI/M (3056(400) g) than E (2952(345) g (p < .05) and both PI/M and E had greater FFM than Asian+ (2824(363) g, p < .05). Early term babies had less FFM than term and late-term babies (2732(370), 3012(352), 3173(302)g, p < .001) respectively. CONCLUSIONS Asian+ babies were the smallest babies with the least FFM yet had similar FM and the highest FM%, indicative of a thin, fat phenotype from birth.
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Affiliation(s)
- T Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand; Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand.
| | - C A Conlon
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - G Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P R von Hurst
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - L van Dorp
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - B Ichhpuniani
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - R Housh
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, United States
| | - P Ke
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, United States
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Avenell A, Stewart F, Grey A, Gamble G, Bolland M. An investigation into the impact and implications of published papers from retracted research: systematic search of affected literature. BMJ Open 2019; 9:e031909. [PMID: 31666272 PMCID: PMC6830710 DOI: 10.1136/bmjopen-2019-031909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Analyses of the impact of a body of clinical trial reports subject to research misconduct have been few. Our objective was to examine the impact on clinically relevant research of a group of researchers' trial reports ('affected trial reports') affected by research misconduct, and whether identification of misconduct invoked a reappraisal. DESIGN In 2016, we used five databases and search engines to identify 'citing publications', that is, guidelines, systematic and other reviews, and clinical trials citing any of 12 affected trial reports, published 1998-2011, eventually retracted for research misconduct. The affected trial reports were assessed more likely to have had impact because they had hip fracture outcomes and were in journals with impact factor >4. Two authors assessed whether findings of the citing publications would change if the affected trial reports were removed. In 2018, we searched for evidence that the citing publications had undertaken a reassessment as a result of the potential influence of the affected trial reports. RESULTS By 2016 the affected trial reports were cited in 1158 publications, including 68 systematic reviews, meta-analyses, narrative reviews, guidelines and clinical trials. We judged that 13 guidelines, systematic or other reviews would likely change their findings if the affected trial reports were removed, and in another eight it was unclear if findings would change. By 2018, only one of the 68 citing publications, a systematic review, appeared to have undertaken a reassessment, which led to a correction. CONCLUSIONS We found evidence that this group of affected trial reports distorted the evidence base. Correction of these distortions is slow, uncoordinated and inconsistent. Unless there is a rapid, systematic, coordinated approach by bibliographic databases, authors, journals and publishers to mitigate the impact of known cases of research misconduct, patients, other researchers and their funders may continue to be adversely affected.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Taylor T, Wang Y, Rogerson W, Bavin L, Sharon C, Beban G, Evennett N, Gamble G, Cundy T. Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program. Obes Surg 2019. [PMID: 29525936 DOI: 10.1007/s11695-018-3195-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Factors such as ethnicity, gender, and socioeconomic status may play a role in both access to and attrition from bariatric programs before surgery is undertaken. New Zealand (NZ) has high rates of obesity in its Pacific population and the indigenous Māori. These groups also experience poorer health outcomes and therefore have the greatest need for surgery. METHODOLOGY A retrospective cross-sectional study of 704 people referred for and accepted onto a publicly funded bariatric surgery from 2007 to 2016. The demographic and clinical features of two groups were compared: those that completed surgery successfully (n = 326) and those that dropped out of the program before surgery (n = 378). We also attempted to identify factors associated with attrition. RESULTS The attrition rate was high (54%), with a significant difference according to gender (men 66% vs 45% women, p < 0.001) and ethnicity (39% in NZ Europeans, 50% in Māori, and 73% in Pacific patients, p < 0.001). Two out of three European women proceeded to surgery, but fewer than one in seven Pacific men. Attrition was associated with having a higher mean BMI and being a smoker. Logistic regression modeling showed that while employment seemed to be protective against attrition for NZ Europeans (p < 0.004), it was not for Pacific patients. CONCLUSIONS While there was no obvious bias in rates of referral, there is clearly a need for better ways to support Māori and Pacific people, and men in particular, to complete bariatric surgery. Further research is needed to clarify the socio-economic and cultural barriers that underlie this phenomenon.
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Affiliation(s)
- Tamasin Taylor
- Faculty of Health and Environmental Sciences, AUT University, 90 Akoranga Drive, Northcote, Auckland, New Zealand.
| | - Yijiao Wang
- University of Auckland (UoA), Auckland, New Zealand
| | | | - Lynda Bavin
- University of Auckland (UoA), Auckland, New Zealand
| | - Cindy Sharon
- Auckland District Health Board (ADHB), Auckland, New Zealand
| | - Grant Beban
- Auckland District Health Board (ADHB), Auckland, New Zealand
| | | | - Greg Gamble
- University of Auckland (UoA), Auckland, New Zealand
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22
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Bolland MJ, Avenell A, Gamble G, Grey A. Reader response: Expression of Concern: Does compensatory hyperparathyroidism predispose to ischemic stroke? Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy; An alternative to vitamin D supplementation to prevent fractures in patients with MS; High prevalence of vitamin D deficiency and reduced bone mass in Parkinson's disease. Neurology 2019; 90:627-628. [PMID: 29581333 DOI: 10.1212/wnl.0000000000005203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Greg Gamble
- (Auckland, New Zealand).,(Aberdeen, UK).,(Auckland, New Zealand)
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23
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Grey A, Bolland M, Gamble G, Avenell A. Quality of reports of investigations of research integrity by academic institutions. Res Integr Peer Rev 2019; 4:3. [PMID: 30820354 PMCID: PMC6379959 DOI: 10.1186/s41073-019-0062-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/05/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Academic institutions play important roles in protecting and preserving research integrity. Concerns have been expressed about the objectivity, adequacy and transparency of institutional investigations of potentially compromised research integrity. We assessed the reports provided to us of investigations by three academic institutions of a large body of overlapping research with potentially compromised integrity. METHODS In 2017, we raised concerns with four academic institutions about the integrity of > 200 publications co-authored by an overlapping set of researchers. Each institution initiated an investigation. By November 2018, three had reported to us the results of their investigations, but only one report was publicly available. Two investigators independently assessed each available report using a published 26-item checklist designed to determine the quality and adequacy of institutional investigations of research integrity. Each assessor recorded additional comments ad hoc. RESULTS Concerns raised with the institutions were overlapping, wide-ranging and included those which were both general and publication-specific. The number of potentially affected publications at individual institutions ranged from 34 to 200. The duration of investigation by the three institutions which provided reports was 8-17 months. These investigations covered 14%, 15% and 77%, respectively, of potentially affected publications. Between-assessor agreement using the quality checklist was 0.68, 0.72 and 0.65 for each report. Only 4/78 individual checklist items were addressed adequately: a further 14 could not be assessed. Each report was graded inadequate overall. Reports failed to address publication-specific concerns and focussed more strongly on determining research misconduct than evaluating the integrity of publications. CONCLUSIONS Our analyses identify important deficiencies in the quality and reporting of institutional investigation of concerns about the integrity of a large body of research reported by an overlapping set of researchers. They reinforce disquiet about the ability of institutions to rigorously and objectively oversee integrity of research conducted by their own employees.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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24
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Narang RK, Topless R, Cadzow M, Gamble G, Stamp LK, Merriman TR, Dalbeth N. Interactions between serum urate-associated genetic variants and sex on gout risk: analysis of the UK Biobank. Arthritis Res Ther 2019; 21:13. [PMID: 30626429 PMCID: PMC6327586 DOI: 10.1186/s13075-018-1787-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sex-specific differences in the effect of genetic variants on serum urate levels have been described. The aim of this study was to systematically examine whether serum urate-associated genetic variants differ in their influence on gout risk in men and women. METHODS This research was conducted using the UK Biobank Resource. Thirty single nucleotide polymorphisms (SNPs) associated with serum urate were tested for their association with gout in men and women of European ancestry, aged 40-69 years. Gene-sex interactions for gout risk were analysed using an interaction analysis in logistic regression models. RESULTS Gout was present in 6768 (4.1%) men and 574 (0.3%) women, with an odds ratio (95% confidence interval) for men 13.42 (12.32-14.62) compared with women. In men, experiment-wide association with gout was observed for 21 of the 30 serum urate-associated SNPs tested, and in women for three of the 30 SNPs. Evidence for gene-sex interaction was observed for ABCG2 (rs2231142) and PDZK1 (rs1471633), with the interaction in ABCG2 driven by an amplified effect in men and in PDZK1 by an absence of effect in women. Similar findings were observed in a sensitivity analysis which excluded pre-menopausal women. For the other SNPs tested, no significant gene-sex interactions were observed. CONCLUSIONS In a large population of European ancestry, ABCG2 and PDZK1 gene-sex interactions exist for gout risk, with the serum urate-raising alleles exerting a greater influence on gout risk in men than in women. In contrast, other serum urate-associated genetic variants do not demonstrate significant gene-sex interactions for gout risk.
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Affiliation(s)
- Ravi K Narang
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Ruth Topless
- Department of Biochemistry, University of Otago, 710 Cumberland Street, Dunedin, 9012, New Zealand
| | - Murray Cadzow
- Department of Biochemistry, University of Otago, 710 Cumberland Street, Dunedin, 9012, New Zealand
| | - Greg Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, 710 Cumberland Street, Dunedin, 9012, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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25
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Legget ME, Toh M, Meintjes A, Fitzsimons S, Gamble G, Doughty RN. Digital devices for teaching cardiac auscultation - a randomized pilot study. Med Educ Online 2018; 23:1524688. [PMID: 30499380 PMCID: PMC6282469 DOI: 10.1080/10872981.2018.1524688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND Competent cardiac auscultation is a declining skill. Digital stethoscopes and hand-held echocardiography (HHE) are modern devices which may improve the accuracy of heart murmur recognition and diagnosis. Their incremental value compared to conventional examination has not been evaluated in depth. OBJECTIVES Our aim was to quantify the utility of digital stethoscopes and HHE as teaching aids to improve medical students' diagnostic accuracy in the evaluation of heart murmurs using a novel clinically weighted scoring system. DESIGN This pilot study involved eight medical students and eight patients with heart murmurs. Four patients were examined at 2 sessions, 1 week apart. Medical students were randomised into two groups: the 'intervention group' examined patients with a standard and digital stethoscope, and then received demonstration of the valvular lesion with HHE to illustrate the diagnosis. The 'control group' used a standard stethoscope only and were taught using traditional methods. Students' scores were compared to a 'gold standard' derived from a consensus of auscultation findings of three cardiologists. RESULTS Overall the mean percent correct of total possible score was 65.4% (SD8.4). Using a mixed models ANOVA approach to repeated measures, the mean [95% CI] increase from training to validation period for the control group was 2.5% [-11.5, 16.5] P(Tukey) = 0.95 and 15.8% [1.7,29.8] P(Tukey) = 0.027 for the intervention group. Between the validation and training sessions for both groups, there was an increase of 9.1% [1.82, 16.4] in scores (p = 0.018). The mean [95% CI] difference in scores of the control and intervention groups was 1.9% [-5.4, 9.2] (p = 0.59). The Cohen's effect size estimate was 0.9. CONCLUSION Digital stethoscopes and hand-held echo may be useful devices for teaching cardiac auscultation. This pilot study provides a novel study design, a heart murmur grading system, and data that will help develop definitive studies to assess new teaching techniques for cardiac auscultation using digital technology.
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Affiliation(s)
- Malcolm E. Legget
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - MeiYen Toh
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Andries Meintjes
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Sarah Fitzsimons
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Robert N. Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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26
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Affiliation(s)
- A. Grey
- University of Auckland; Auckland New Zealand
| | | | - G. Gamble
- University of Auckland; Auckland New Zealand
| | - M. Bolland
- University of Auckland; Auckland New Zealand
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27
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Inkrot S, Chappell D, Gamble G, Jaarsma T, Dungen HD, Gibbons V, Pera V, Davis M, Devlin G. 2405Comparison of patient reported versus clinician estimated self-care in heart failure: results from the MENSCH-NZ study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Inkrot
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - D Chappell
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - G Gamble
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - T Jaarsma
- Linköping University, Department of Social and Wellfare Studies, Linköping, Sweden
| | - H D Dungen
- Charite - Campus Virchow-Klinikum, Department of Internal Medicine-Cardiology, Berlin, Germany
| | - V Gibbons
- Waikato Hospital, Department of Clinical Effectiveness, Quality and Patient Safety, Hamilton, New Zealand
| | - V Pera
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - M Davis
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - G Devlin
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
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28
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Poller L, Pulford J, Stevenson KJ, Cooper P, Gamble G, Thomson JM. Long-Term Stability Studies on the WHO IRP for Thromboplastin (Human Plain BCT/253). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryLong-term stability studies on the WHO second primary International Reference Preparation (IRP) for thromboplastin (human plain BCT/253) stored at ™20° C have been conducted for ten years.Three centres took part in the exercise using frozen normal and coumarinised plasma samples which were tested throughout. There has been no measurable change in the prothrombin time performance of the human plain IRP over the ten-year period. It can therefore be concluded that new IRP may continue to be calibrated against this preparation in accord with WHO recommendations.
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Affiliation(s)
- L Poller
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, Manchester, UK
| | - Jean Pulford
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, Manchester, UK
| | - K J Stevenson
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, Manchester, UK
| | - P Cooper
- The Royal Hallamshire Hospital, Sheffield, UK
| | - G Gamble
- The Coventry and Warwickshire Hospital, Coventry, UK
| | - Jean M Thomson
- The UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, Manchester, UK
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29
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Taylor T, Wang Y, Rogerson W, Bavin L, Sharon C, Beban G, Evennett N, Gamble G, Cundy T. Correction to: Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program. Obes Surg 2018; 28:2508. [PMID: 29560567 DOI: 10.1007/s11695-018-3204-1] [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: 11/29/2022]
Abstract
Unfortunately, the original version of this article contained an error. The Methods section's first sentence and Table 1 both mistakenly contained the letters XXXX in place of the district health board and hospital city names.
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Affiliation(s)
- Tamasin Taylor
- Faculty of Health and Environmental Sciences, AUT University, 90 Akoranga Drive, Northcote, Auckland, New Zealand.
| | - Yijiao Wang
- University of Auckland (UoA), Auckland, New Zealand
| | | | - Lynda Bavin
- University of Auckland (UoA), Auckland, New Zealand
| | - Cindy Sharon
- Auckland District Health Board (ADHB), Auckland, New Zealand
| | - Grant Beban
- Auckland District Health Board (ADHB), Auckland, New Zealand
| | | | - Greg Gamble
- University of Auckland (UoA), Auckland, New Zealand
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30
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Tottman AC, Alsweiler JM, Bloomfield FH, Gamble G, Jiang Y, Leung M, Poppe T, Thompson B, Wouldes TA, Harding JE. Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control. J Pediatr 2018; 193:68-75.e1. [PMID: 29198539 DOI: 10.1016/j.jpeds.2017.09.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/11/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age. STUDY DESIGN Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently sampled intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD). RESULTS Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35; 40%) and standard (11 of 33; 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm; P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg; P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL-1; P < .05), but no other differences in measures of body composition or insulin-glucose metabolism. CONCLUSION Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age. TRIAL REGISTRATION ACTRN: 12606000270516.
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Affiliation(s)
| | - Jane Marie Alsweiler
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | | | - Greg Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Myra Leung
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Tanya Poppe
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Trecia Ann Wouldes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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31
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Astley CM, Ranasinghe I, Brieger D, Ellis CJ, Redfern J, Briffa T, Aliprandi-Costa B, Howell T, Bloomer SG, Gamble G, Driscoll A, Hyun KK, Hammett CJ, Chew DP. Expertise and infrastructure capacity impacts acute coronary syndrome outcomes. AUST HEALTH REV 2018; 42:277-285. [DOI: 10.1071/ah16244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/24/2017] [Indexed: 11/23/2022]
Abstract
Objective Effective translation of evidence to practice may depend on systems of care characteristics within the health service. The present study evaluated associations between hospital expertise and infrastructure capacity and acute coronary syndrome (ACS) care as part of the SNAPSHOT ACS registry. Methods A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured. Results Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P < 0.001) and the prescription of guideline therapies observed a tendency for an association with (531/1329 (40.0%), 733/1656 (44.3%) and 603/1402 (43.0%) for low, intermediate and high expertise capacity respectively; P = 0.056), but not rehabilitation (474/1329 (35.7%), 603/1656 (36.4%) and 535/1402 (38.2%) for low, intermediate and high expertise capacity respectively; P = 0.377). Higher expertise capacity was associated with a lower incidence of major adverse events (152/1329 (11.4%), 142/1656 (8.6%) and 149/149 (10.6%) for low, intermediate and high expertise capacity respectively; P = 0.026), as well as adjusted mortality within 18 months (low vs intermediate expertise capacity: odds ratio (OR) 0.79, 95% confidence interval (CI) 0.58–1.08, P = 0.153; intermediate vs high expertise capacity: OR 0.64, 95% CI 0.48–0.86, P = 0.003). Conclusions Both higher-level expertise in decision making and infrastructure capacity are associated with improved evidence translation and survival over 18 months of an ACS event and have clear healthcare design and policy implications. What is known about the topic? There are comprehensive guidelines for treating ACS patients, but Australia and New Zealand registry data reveal substantial gaps in delivery of best practice care across metropolitan, regional, rural and remote health services, raising questions of equity of access and outcome. Greater mortality and morbidity gains can be achieved by increasing the application of current evidence-based therapies than by developing new therapy innovations. Health service system characteristics may be barriers or enablers to the delivery of best practice care and need to be identified and evaluated for correlations with performance indicators and outcomes in order to improve health service design. What does this paper add? This study measures two system characteristics, namely expertise and infrastructure, evaluating the relationship with ACS guideline application and clinical outcomes in a large and diverse cohort of Australian and New Zealand hospitals. The study identifies decision-making expertise and infrastructure capacity, to a lesser degree, as enabling characteristics to help improve patient outcomes. What are the implications for practitioners? In the design of health services to improve access and equity, expertise must be preserved. However, it is difficult to have experienced personnel at the bedside no matter where the health service, and engineering innovative systems and processes of care to facilitate delivery of expertise should be considered.
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Springmann V, Schulman S, Martineau J, Stewart JA, Komari N, McLeod A, Strulovitch C, Blostein M, Faucher JP, Gamble G, Gordon W, Kagoma PK, Miron MJ, Laverdière D, Game M, Mills A, Kahn SR. Management and adherence to VTE treatment guidelines in a national prospective cohort study in the Canadian outpatient setting. Thromb Haemost 2017; 108:493-8. [DOI: 10.1160/th12-03-0169] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/16/2012] [Indexed: 01/17/2023]
Abstract
SummaryDocumenting patterns and outcomes of venous thromboembolism (VTE) management and degree of adherence by clinicians to treatment guidelines could help identify remediable gaps in patient care. Prospective, clinical practice-based data from Canadian outpatient settings on management of VTE, degree of adherence with treatment guidelines and frequency of recurrent VTE and bleeding during follow-up was obtained in a multicentre, prospective observational study. From 12 Canadian centres, we assessed 868 outpatients with acute symptomatic VTE who received the low-molecular-weight heparin (LMWH) enoxaparin alone or with vitamin K antagonists (VKA), at baseline and at six months (or at the end of treatment, whichever came first). Index VTE was limb deep venous thrombosis (DVT) in 583 (67.2%) patients, pulmonary embolism (PE) with or without DVT in 262 (30.2%) patients, and unusual site DVT in 23 (2.6%) patients. VTE was unprovoked in 399 (46.0%) patients, associated with cancer in 74 (8.5%) patients, transient risk factors in 327 (37.7%) patients and hormonal factors in 68 (7.8%) patients. With regard to guideline adherence, 58 (7.3%) patients received <5 days LMWH and 114 (14.5%) had overlap <1 day. Among patients with cancer-related VTE, 59.5% were prescribed LMWH monotherapy and 43.2% received such treatment for >3 months. Only 38.1% of patients with transient VTE risk factors had received thromboprophylaxis. Our study provides useful information on clinical presentation, management and related outcomes in Canadian outpatients with VTE. Our results suggest there may be important gaps in use of thromboprophylaxis to prevent VTE and use of LMWH mono-therapy to treat cancer-related VTE.Note: Part of this study was presented as an Oral Abstract Presentation at the American Society of Hematology meeting, Dec. 4–7, 2010, Orlando, FL, USA.
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Young R, Hopkins R, Duan F, Greco E, Chiles C, Aberle D, Gamble G. OA 15.03 Gene-Based Risk Stratification of NLST-ACRIN Screening Participants Identifies The “Sweet Spot” of Screening (N=10,054). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.415] [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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Hopkins R, Young R, Duan F, Greco E, Chiles C, Aberle D, Gamble G. Lung cancer screening and the effects of competing causes of death in the ACRIN-NLST sub-study. Respir Med 2017. [DOI: 10.1016/j.rmed.2017.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Young R, Hopkins R, Duan F, Greco E, Chiles C, Aberle D, Gamble G. Stratification of NLST-ACRIN screening participants identifies the “sweet spot” of screening by identifying early stage lung cancers most amenable to curative surgery (N=10,054). Respir Med 2017. [DOI: 10.1016/j.rmed.2017.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grey A, Bolland MJ, Horne A, Mihov B, Gamble G, Reid IR. Duration of antiresorptive activity of zoledronate in postmenopausal women with osteopenia: a randomized, controlled multidose trial. CMAJ 2017; 189:E1130-E1136. [PMID: 28893875 DOI: 10.1503/cmaj.161207] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Intravenous zoledronate 5 mg annually reduces fracture risk, and 5 mg every 2 years prevents bone loss, but the optimal dosing regimens for these indications are uncertain. METHODS We conducted a 3-year open-label extension of a 2-year randomized, placebo-controlled, double-blind study. Late postmenopausal women with osteopenia were assigned to receive a single baseline dose of 1 mg, 2.5 mg or 5 mg of zoledronate or placebo. The primary outcome was change in spine bone mineral density (BMD). Secondary outcomes were changes in hip BMD and serum markers of bone turnover. RESULTS The study involved 160 women. Zoledronate increased BMD and reduced markers of bone turnover in a dose-dependent manner. After 2 years, the 1-mg, 2.5-mg and 5-mg zoledronate doses increased spine BMD over placebo by 5.0% (95% confidence interval [CI] 3.0% to 7.0%), 5.7% (95% CI 3.7% to 7.7%) and 5.7% (95% CI 3.7% to 7.6%), respectively; after 5 years, the respective increases were 2.0% (95% CI -1.1% to 5.0%), 2.2% (95% CI -1.0% to 5.4%) and 5.1% (95% CI 2.2% to 8.1%). After 2 years, the 1-mg, 2.5-mg and 5-mg zoledronate doses increased total hip BMD over placebo by 2.6% (95% CI 1.3% to 3.9%), 4.1% (95% CI 2.9% to 5.4%) and 4.7% (95% CI 3.4% to 5.9%), respectively; after 5 years, the respective increases were 1.8% (95% CI -0.1% to 3.8%), 2.8% (95% CI 0.8% to 4.8%) and 5.4% (95% CI 3.5% to 7.3%). BMD remained above baseline values for 2-3 years in the 1-mg group, 3-4 years in the 2.5-mg group and at least 5 years in the 5-mg group. INTERPRETATION The antiresorptive activity of single zoledronate doses of 1-5 mg persist for at least 3 years in postmenopausal women with osteopenia. Clinical trials would be justified to evaluate the effects on fracture risk of less frequent or lower doses of zoledronate than are currently recommended. TRIAL REGISTRATION www.anzctr.org.au, no. ACTRN12607000576426.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Borislav Mihov
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Serlachius A, Gamble G, House M, Vincent ZL, Knight J, Horne A, Taylor WJ, Petrie KJ, Dalbeth N. Illness Perceptions and Mortality in Patients With Gout: A Prospective Observational Study. Arthritis Care Res (Hoboken) 2017; 69:1444-1448. [PMID: 27813363 DOI: 10.1002/acr.23147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/27/2016] [Accepted: 11/01/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine whether illness perceptions independently predict mortality in early-onset gout. METHODS Between December 2006 and January 2014, a total of 295 participants with early-onset gout (<10 years) were recruited in Auckland and Wellington, New Zealand. The participants were followed up until February 2015, and mortality information was collected. Participants with complete data were included in the current study (n = 242). Cox proportional hazards models were used to examine the association between illness perceptions and mortality risk, after adjustment for covariates associated with disease severity and mortality in gout. RESULTS In a Cox proportional hazards model adjusted for predictors of disease severity and mortality in gout (number of tophi, serum urate level, and frequency of flares), consequence beliefs, identity beliefs, concern beliefs, and emotional response to gout were associated with all-cause mortality (hazard ratios [HRs] 1.29, 1.15, 1.18, and 1.19, respectively; P < 0.05 for all). In the fully saturated model, the association between consequence beliefs and mortality remained robust after additional adjustment for ethnicity, disease duration, diuretic use, serum creatinine, and pain score (HR 1.18 [95% confidence interval 1.02-1.37]; P = 0.029). CONCLUSION Negative beliefs about the impact of gout and severity of symptoms, as well as concerns about gout and the emotional response to gout, were independently associated with all-cause mortality. Illness perceptions are important and potentially modifiable risk factors to target in future interventions.
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Affiliation(s)
| | - Greg Gamble
- University of Auckland, Auckland, New Zealand
| | | | | | | | - Anne Horne
- University of Auckland, Auckland, New Zealand
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Wang T, Chataline A, Chow K, Lin A, White H, Gamble G, Ellis C. Suspected ACS Patients Admitted and Discharged from Cardiology or Non-Cardiology Management at Auckland City Hospital: Insights from the Comprehensive SNAPSHOT 2012 Audit and Implications for Future National Data Collection. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.125] [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: 11/26/2022]
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Wang TKM, Chataline A, Chow K, Lin A, White H, Gamble G, Ellis C. Suspected ACS Patients Admitted and Discharged to Cardiology or Non-Cardiology Care in Auckland City Hospital: Insight from SNAPSHOT 2012 and Implications for Future National Data Collection. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.05.016] [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: 10/19/2022]
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Vincent ZL, Gamble G, House M, Knight J, Horne A, Taylor WJ, Dalbeth N. Predictors of Mortality in People with Recent-onset Gout: A Prospective Observational Study. J Rheumatol 2016; 44:368-373. [PMID: 27980010 DOI: 10.3899/jrheum.160596] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine mortality rates and predictors of death at baseline in people with a recent onset of gout. METHODS People with gout disease duration < 10 years were recruited from primary and secondary care settings. Comprehensive clinical assessment was completed at baseline. Participants were prospectively followed for at least 1 year. Information about death was systematically collected from primary and secondary health records. Standardized mortality ratios (SMR) were calculated and risk factors for mortality were analyzed using Cox proportional hazard regression models. RESULTS The mean (SD) followup duration was 5.1 (1.6) years (a total 1511 patient-yrs accrued). Of the 295 participants, 43 (14.6%) had died at the time of censorship (SMR 1.96, 95% CI 1.44-2.62). In the reduced Cox proportional hazards model, these factors were independently associated with an increased risk of death from all causes: older age (70-80 yrs: HR 9.96, 95% CI 3.30-30.03; 80-91 yrs: HR 9.39, 95% CI 2.68-32.89), Māori or Pacific ethnicity (HR 2.48, 95% CI 1.17-5.29), loop diuretic use (HR 3.99, 95% CI 2.15-7.40), serum creatinine (per 10 µmol/l change; HR 1.04, 95% CI 1.00-1.07), and the presence of subcutaneous tophi (HR 2.85, 95% CI 1.49-5.44). The presence of subcutaneous tophi was the only baseline variable independently associated with both cardiovascular (CV) cause of death (HR 3.13, 95% CI 1.38-7.10) and non-CV cause of death (HR 3.48, 95% CI 1.25-9.63). CONCLUSION People with gout disease duration < 10 years have an increased risk of death. The presence of subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.
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Affiliation(s)
- Zoë L Vincent
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Greg Gamble
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Meaghan House
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Julie Knight
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Anne Horne
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - William J Taylor
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland
| | - Nicola Dalbeth
- From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand. .,Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland.
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Abstract
OBJECTIVES To assess the amount, relevance, content, and suppressibility of academic electronic spam invitations to attend conferences or submit manuscripts. DESIGN Prospective cohort study. SETTING Email accounts of participating academics. PARTICIPANTS Five intrepid academics and a great many publishers, editors, and conference organisers. INTERVENTION Unsubscribing from sender's distribution lists. MAIN OUTCOME MEASURES Number of spam invitations received before, immediately after, and one year after unsubscribing from senders' distribution lists. The proportion of duplicate invitations was also assessed and the relevance of each invitation graded to the recipient's research interests. A qualitative assessment of the content of spam invitations was conducted. RESULTS At baseline, recipients received an average of 312 spam invitations each month. Unsubscribing reduced the frequency of the invitations by 39% after one month but by only 19% after one year. Overall, 16% of spam invitations were duplicates and 83% had little or no relevance to the recipients' research interests. Spam invitations were characterised by inventive language, flattery, and exuberance, and they were sometimes baffling and amusing. CONCLUSIONS Academic spam is common, repetitive, often irrelevant, and difficult to avoid or prevent.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Greg Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland District Health Board, New Zealand
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Ellis C, Gamble G, Edwards C, van Pelt N, Gabriel R, Lowe B, Christiansen J, To A, Winch H, Osborne M, Ormiston J, Legget M. The value of CT cardiac angiography and CT calcium score testing in a modern cardiology service in New Zealand: a report of a single centre eight-year experience from 5,237 outpatient procedures. N Z Med J 2016; 129:22-32. [PMID: 27906915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Computed tomographic (CT) cardiac angiography is of increasing value in several areas of patient management in cardiology. We assessed the ability of CT cardiac angiography to effectively 'rule out' severe coronary stenoses in patients presenting with 'atypical' symptoms and/or an equivocal stress test, which offers a new approach to the management of coronary artery disease. We also examined the use of the CT calcium score test in cardiovascular (CVS) risk assessment. METHODS From a large single centre (Mercy Hospital) in Auckland, using a prospectively acquired, comprehensive database, we audited the entire eight-year experience of 5,169 patients (7/8/06 to 31/1/14) who underwent 5,237 64-slice computed tomographic (CT) cardiac angiogram or CT calcium score tests (GE Lightspeed scanner). RESULTS From 5,169 patients there were 5,237 CT procedures. The mean patient age was 57 (SD 10) years; 42% patients were female. Of the 3,603 (69%) full CT cardiac angiogram scans, 3,509 (67%) included a calcium score test. One thousand four hundred and eighty-three (28%) of scans were a calcium score test only. Of the 3,603 (69%) full CT cardiac angiogram scans, it was possible to 'rule out' significant coronary atheroma (stenosis ≥50%) in 2,947 (82%) of these procedures. Of the 4,903 (94%) patients who had a CT calcium score test, in whom we could calculate the NZ Framingham-based CVS risk, it was possible to reassign 532 (22%) of these patients who were previously thought to be at 'low risk' to be at a higher CVS risk. CONCLUSION CT cardiac angiography has become established in the modern management of cardiology patients. It has particular value as a tool to 'rule out' severe coronary stenoses, and as a tool to give a more accurate assessment of CVS risk. It adds significant value to the care of many patients within an established cardiology practice.
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Affiliation(s)
- Chris Ellis
- Cardiology Department, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland
| | - Greg Gamble
- Department of Medicine, University of Auckland, Auckland
| | - Colin Edwards
- Department of Cardiology, North Shore Hospital, Auckland
| | | | - Ruvin Gabriel
- Department of Cardiology, Middlemore Hospital, Auckland
| | - Boris Lowe
- Department of Cardiology, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland
| | | | - Andrew To
- Department of Cardiology, North Shore Hospital, Auckland
| | | | - Mark Osborne
- Department of Radiology, Mercy Hospital, Auckland
| | - John Ormiston
- Department of Cardiology, Greenlane Cardiovascular Services, Auckland City Hospital and Mercy Angiography, Auckland
| | - Malcolm Legget
- Cardiology Department, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland
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Wang TK, Stewart RA, Ramanathan T, Choi D, Gamble G, Ruygrok PN, White HD. Diagnosis of myocardial infarction and prognostic utility of high-sensitivity troponin T after isolated aortic valve replacement. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brieger DB, Chew DPB, Redfern J, Ellis C, Briffa TG, Howell TE, Aliprandi-Costa B, Astley CM, Gamble G, Carr B, Hammett CJK, Board N, French JK. Survival after an acute coronary syndrome: 18-month outcomes from the Australian and New Zealand SNAPSHOT ACS study. Med J Aust 2016; 203:368. [PMID: 26510808 DOI: 10.5694/mja15.00504] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the impact of the availability of a catheterisation laboratory and evidence-based care on the 18-month mortality rate in patients with suspected acute coronary syndromes (ACS). DESIGN, SETTING AND PARTICIPANTS Management and outcomes are described for patients enrolled in the 2012 Australian and New Zealand SNAPSHOT ACS audit. Patients were stratified according to their presentation to hospitals with or without cardiac catheterisation facilities. Data linkage ascertained patient vital status 18 months after admission. Descriptive and Cox proportional hazards analyses determined predictors of outcomes, and were used to estimate the numbers of deaths that could be averted by improved application of evidence-based care. MAIN OUTCOME MEASURES Mortality for ACS patients from admission to 18 months after admission. RESULTS Definite ACS patients presenting to catheterisation-capable (CC) hospitals (n = 1326) were more likely to undergo coronary angiography than those presenting to non-CC hospitals (n = 1031) (61.5% v 50.8%; P = 0.0001), receive timely reperfusion (for ST elevation myocardial infarction (STEMI) patients: 45.2% v 19.2%; P < 0.001), and be referred for cardiac rehabilitation (57% v 53%; P = 0.05). All-cause mortality over 18 months was highest for STEMI (16.2%) and non-STEMI (16.3%) patients, and lowest for those presenting with unstable angina (6.8%) and non-cardiac chest pain (4.8%; P < 0.0001 for trend). After adjustment for patient propensity to present to a CC hospital and patient risk, presentation to a CC hospital was associated with 21% (95% CI, 2%-37%) lower mortality than presentation to a non-CC hospital. This mortality difference was attenuated after adjusting for delivery of evidence-based care. CONCLUSION In Australia and New Zealand, the availability of a catheterisation laboratory appears to have a significant impact on long-term mortality in ACS patients, which is still substantial. This mortality may be reduced by improvements in evidence-based care in both CC and non-CC hospitals.
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Affiliation(s)
| | | | - Julie Redfern
- The George Institute for Global Health, University of Sydney, Sydney, NSW
| | - Chris Ellis
- Auckland City Hospital, Auckland, New Zealand
| | | | | | | | | | - Greg Gamble
- University of Auckland, Auckland, New Zealand
| | - Bridie Carr
- Cardiac Network Agency for Clinical Innovation, Sydney, NSW
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Devlin G, Williams M, Elliott J, White HD, French J, Gamble G, Matsis P, Troughton R, Richards M, Ellis C. Management of non ST-elevation acute coronary syndrome patients in New Zealand: a longitudinal analysis. Results from the New Zealand Acute Coronary Syndrome national audits of 2002, 2007 and 2012. N Z Med J 2016; 129:10-16. [PMID: 26914189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS The first New Zealand Acute Coronary Syndrome (ACS) national audit of 2002 was a collaborative effort between clinicians and nurses, and demonstrated important limitations to Non ST-elevation ACS patient (NSTEACS) care. A momentum for change was created. Subsequent audits in 2007 and 2012 allow assessment over time. METHODS Over 14 days in May 2002, 2007 and 2012, patients with suspected ACS admitted to a hospital in New Zealand were audited. 'Definite' ACS was determined at discharge, after in-hospital investigations; we reviewed NSTEACS patients. RESULTS From 2002, more patients underwent assessment of left ventricular function (echocardiogram) and coronary angiography. Evidence-based in-hospital medical treatments and revascularisation have also increased over the decade. CONCLUSIONS Over a ten-year period, evidence-based care for patients presenting with a NSTEACS event in New Zealand has improved. However, considerable room remains to optimise management, particularly with development of systems of care to facilitate prompt referral and delivery of angiography in these high-risk individuals.
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Affiliation(s)
- Gerry Devlin
- Department of Cardiology, Waikato Hospital, Hamilton.
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Bowker B, Gamble G, Zhuang H. Exudate Protein Composition and Meat Tenderness of Broiler Breast Fillets. Poult Sci 2016; 95:133-7. [DOI: 10.3382/ps/pev312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/20/2022] Open
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Faasse K, Martin LR, Grey A, Gamble G, Petrie KJ. Impact of brand or generic labeling on medication effectiveness and side effects. Health Psychol 2015; 35:187-90. [PMID: 26462056 DOI: 10.1037/hea0000282] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Branding medication with a known pharmaceutical company name or product name bestows on the drug an added assurance of authenticity and effectiveness compared to a generic preparation. This study examined the impact of brand name and generic labeling on medication effectiveness and side effects. METHOD 87 undergraduate students with frequent headaches took part in the study. Using a within-subjects counterbalanced design, each participant took tablets labeled either as brand name "Nurofen" or "Generic Ibuprofen" to treat each of 4 headaches. In reality, half of the tablets were placebos, and half were active ibuprofen (400 mg). Participants recorded their headache pain on a verbal descriptor and visual analogue scale prior to taking the tablets, and again 1 hour afterward. Medication side effects were also reported. RESULTS Pain reduction following the use of brand name labeled tablets was similar in active ibuprofen or a placebo. However, if the tablets had a generic label, placebo tablets were significantly less effective compared to active ibuprofen. Fewer side effects were attributed to placebo tablets with brand name labeling compared to the same placebo tablets with a generic label. CONCLUSIONS Branding of a tablet appears to have conferred a treatment benefit in the absence of an active ingredient, while generic labeled tablets were substantially less effective if they contained no active ingredient. Branding is also associated with reduced attribution of side effects to placebo tablets. Future interventions to improve perceptions of generics may have utility in improving treatment outcomes from generic drugs.
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Affiliation(s)
- Kate Faasse
- Department of Psychological Medicine, University of Auckland
| | | | - Andrew Grey
- Department of Psychological Medicine, University of Auckland
| | - Greg Gamble
- Department of Psychological Medicine, University of Auckland
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland
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Harding JE, Hegarty JE, Crowther CA, Edlin R, Gamble G, Alsweiler JM. Randomised trial of neonatal hypoglycaemia prevention with oral dextrose gel (hPOD): study protocol. BMC Pediatr 2015; 15:120. [PMID: 26377909 PMCID: PMC4572621 DOI: 10.1186/s12887-015-0440-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 09/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal hypoglycaemia is common, affecting up to 15 % of newborn babies and 50 % of those with risk factors (preterm, infant of a diabetic, high or low birthweight). Hypoglycaemia can cause brain damage and death, and babies born at risk have an increased risk of developmental delay in later life. Treatment of hypoglycaemia usually involves additional feeding, often with infant formula, and admission to Neonatal Intensive Care for intravenous dextrose. This can be costly and inhibit the establishment of breast feeding. Prevention of neonatal hypoglycaemia would be desirable, but there are currently no strategies, beyond early feeding, for prevention of neonatal hypoglycaemia. Buccal dextrose gel is safe and effective in treatment of hypoglycaemia. The aim of this trial is to determine whether 40 % dextrose gel given to babies at risk prevents neonatal hypoglycaemia and hence reduces admission to Neonatal Intensive Care. Methods/design Design: Randomised, multicentre, placebo controlled trial. Inclusion criteria: Babies at risk of hypoglycaemia (preterm, infant of a diabetic, small or large), less than 1 h old, with no apparent indication for Neonatal Intensive Care Unit admission and mother intends to breastfeed. Trial entry & randomisation: Eligible babies of consenting parents will be allocated by online randomisation to the dextrose gel group or placebo group, using a study number and corresponding trial intervention pack. Study groups: Babies will receive a single dose of 0.5 ml/kg study gel at 1 h after birth; either 40 % dextrose gel (200 mg/kg) or 2 % hydroxymethylcellulose placebo. Gel will be massaged into the buccal mucosal and followed by a breast feed. Primary study outcome: Admission to Neonatal Intensive Care. Sample size: 2,129 babies are required to detect a decrease in admission to Neonatal Intensive Care from 10–6 % (two-sided alpha 0.05, 90 % power, 5 % drop-out rate). Discussion This study will investigate whether admission to Neonatal Intensive Care can be prevented by prophylactic oral dextrose gel; a simple, cheap and painless intervention that requires no special expertise or equipment and hence is applicable in almost any birth setting. Trial registration Australian New Zealand Clinical Trials Registry - ACTRN 12614001263684.
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Affiliation(s)
- Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Joanne E Hegarty
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,Newborn Services, Auckland City Hospital, Auckland, New Zealand.
| | | | - Richard Edlin
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Greg Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Jane M Alsweiler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand. .,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Holdaway IM, Hunt P, Manning P, Cutfield W, Gamble G, Ninow N, Staples-Moon D, Moodie P, Metcalfe S. Three-year experience with access to nationally funded growth hormone (GH) replacement for GH-deficient adults. Clin Endocrinol (Oxf) 2015; 83:85-90. [PMID: 25523467 DOI: 10.1111/cen.12691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/23/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Treatment of growth hormone (GH)-deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported. DESIGN Retrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists. PATIENTS Applications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary. RESULTS After an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA(®) instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months of treatment was 0.39 mg/day. After 3 years, 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment. CONCLUSION Carefully designed access to nationally funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.
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Affiliation(s)
- I M Holdaway
- Department of Endocrinology, Auckland Hospital and Greenlane Clinical Centre, Auckland, New Zealand
| | - P Hunt
- Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand
| | - P Manning
- Department of Endocrinology, Dunedin Hospital, Dunedin, New Zealand
| | - W Cutfield
- Liggins Institute, Auckland University School of Medicine, Auckland, New Zealand
| | - G Gamble
- Department of Medicine, University of Auckland School of Medicine, Auckland, New Zealand
| | - N Ninow
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - D Staples-Moon
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - P Moodie
- Pharmaceutical Management Agency, Wellington, New Zealand
| | - S Metcalfe
- Pharmaceutical Management Agency, Wellington, New Zealand
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