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Kendrick T, Dowrick C, Lewis G, Moore M, Leydon GM, Geraghty AW, Griffiths G, Zhu S, Yao GL, May C, Gabbay M, Dewar-Haggart R, Williams S, Bui L, Thompson N, Bridewell L, Trapasso E, Patel T, McCarthy M, Khan N, Page H, Corcoran E, Hahn JS, Bird M, Logan MX, Ching BCF, Tiwari R, Hunt A, Stuart B. Patient-reported outcome measures for monitoring primary care patients with depression: the PROMDEP cluster RCT and economic evaluation. Health Technol Assess 2024; 28:1-95. [PMID: 38551155 PMCID: PMC11017630 DOI: 10.3310/plrq4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Background Guidelines on the management of depression recommend that practitioners use patient-reported outcome measures for the follow-up monitoring of symptoms, but there is a lack of evidence of benefit in terms of patient outcomes. Objective To test using the Patient Health Questionnaire-9 questionnaire as a patient-reported outcome measure for monitoring depression, training practitioners in interpreting scores and giving patients feedback. Design Parallel-group, cluster-randomised superiority trial; 1 : 1 allocation to intervention and control. Setting UK primary care (141 group general practices in England and Wales). Inclusion criteria Patients aged ≥ 18 years with a new episode of depressive disorder or symptoms, recruited mainly through medical record searches, plus opportunistically in consultations. Exclusions Current depression treatment, dementia, psychosis, substance misuse and risk of suicide. Intervention Administration of the Patient Health Questionnaire-9 questionnaire with patient feedback soon after diagnosis, and at follow-up 10-35 days later, compared with usual care. Primary outcome Beck Depression Inventory, 2nd edition, symptom scores at 12 weeks. Secondary outcomes Beck Depression Inventory, 2nd edition, scores at 26 weeks; antidepressant drug treatment and mental health service contacts; social functioning (Work and Social Adjustment Scale) and quality of life (EuroQol 5-Dimension, five-level) at 12 and 26 weeks; service use over 26 weeks to calculate NHS costs; patient satisfaction at 26 weeks (Medical Informant Satisfaction Scale); and adverse events. Sample size The original target sample of 676 patients recruited was reduced to 554 due to finding a significant correlation between baseline and follow-up values for the primary outcome measure. Randomisation Remote computerised randomisation with minimisation by recruiting university, small/large practice and urban/rural location. Blinding Blinding of participants was impossible given the open cluster design, but self-report outcome measures prevented observer bias. Analysis was blind to allocation. Analysis Linear mixed models were used, adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering including practice as random effect. Quality of life and costs were analysed over 26 weeks. Qualitative interviews Practitioner and patient interviews were conducted to reflect on trial processes and use of the Patient Health Questionnaire-9 using the Normalization Process Theory framework. Results Three hundred and two patients were recruited in intervention arm practices and 227 patients were recruited in control practices. Primary outcome data were collected for 252 (83.4%) and 195 (85.9%), respectively. No significant difference in Beck Depression Inventory, 2nd edition, score was found at 12 weeks (adjusted mean difference -0.46, 95% confidence interval -2.16 to 1.26). Nor were significant differences found in Beck Depression Inventory, 2nd Edition, score at 26 weeks, social functioning, patient satisfaction or adverse events. EuroQol-5 Dimensions, five-level version, quality-of-life scores favoured the intervention arm at 26 weeks (adjusted mean difference 0.053, 95% confidence interval 0.013 to 0.093). However, quality-adjusted life-years over 26 weeks were not significantly greater (difference 0.0013, 95% confidence interval -0.0157 to 0.0182). Costs were lower in the intervention arm but, again, not significantly (-£163, 95% confidence interval -£349 to £28). Cost-effectiveness and cost-utility analyses, therefore, suggested that the intervention was dominant over usual care, but with considerable uncertainty around the point estimates. Patients valued using the Patient Health Questionnaire-9 to compare scores at baseline and follow-up, whereas practitioner views were more mixed, with some considering it too time-consuming. Conclusions We found no evidence of improved depression management or outcome at 12 weeks from using the Patient Health Questionnaire-9, but patients' quality of life was better at 26 weeks, perhaps because feedback of Patient Health Questionnaire-9 scores increased their awareness of improvement in their depression and reduced their anxiety. Further research in primary care should evaluate patient-reported outcome measures including anxiety symptoms, administered remotely, with algorithms delivering clear recommendations for changes in treatment. Study registration This study is registered as IRAS250225 and ISRCTN17299295. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 17. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Tony Kendrick
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Michael Moore
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Geraldine M Leydon
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Adam Wa Geraghty
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shihua Zhu
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rachel Dewar-Haggart
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Samantha Williams
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Lien Bui
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Natalie Thompson
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Lauren Bridewell
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Emilia Trapasso
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Tasneem Patel
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Molly McCarthy
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Naila Khan
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Helen Page
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma Corcoran
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Jane Sungmin Hahn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Molly Bird
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Mekeda X Logan
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Brian Chi Fung Ching
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Riya Tiwari
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Anna Hunt
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Yao GL, Tao YJ, Fan YG. Cutaneous metastasis from gastric cancer: Manifestation, diagnosis, treatment and prognosis. Eur J Surg Oncol 2024; 50:107939. [PMID: 38219697 DOI: 10.1016/j.ejso.2023.107939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Cutaneous metastasis from gastric cancer is very rare. The understanding of this disease is incomplete. This situation delays its diagnosis and treatment, followed by poor prognosis. Here, we first report a study based on a network to improve the diagnosis, treatment and prognosis of cutaneous metastasis from gastric cancer. METHODS A comprehensive search of PubMed was performed. All studies on cutaneous metastasis from gastric cancer were collected. The publication date was limited from 2000 to the present, and the language was limited to English. SPSS 26.0 was employed for statistical analysis. RESULTS Seventy-two patients were included. The average patient age was 60.0 ± 16.0 years. In total, 72.2 % of the patients were male. The most common manifestation was nodular skin lesions (45.8 %). The metastases generally presented as multiple lesions (61.1 %). The most common metastasis location was the thoracoabdominal wall (56.9 %). 64.7 % of the patients simultaneously had extracutaneous metastases. Most of the tumors were poorly differentiated carcinomas (87.5 %), and 66.1 % had signet ring cells. 40.8 % of the cutaneous metastases presented as primary manifestations. Only 9.6 % had their diagnosis as soon as the cutaneous metastasis emerged. Systemic chemotherapy (65.6 %) was the most common treatment strategy, followed by radical surgery (12.5 %). The median overall survival was only 6 months. The median overall survival of 5 patients with resected tumors was 48 months. CONCLUSION Cutaneous metastasis from gastric cancer usually manifests as an emerged nodule or erysipelas-like skin lesion. Resection of the cutaneous lesion could be helpful for patients with local metastases.
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Affiliation(s)
- G L Yao
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China
| | - Y J Tao
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China
| | - Y G Fan
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China.
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Ibrahim K, Mullee MA, Cox N, Russell C, Baxter M, Tilley S, Yao GL, Zhu S, Roberts HC. The feasibility and acceptability of assessing and managing sarcopenia and frailty among older people with upper limb fracture. Age Ageing 2022; 51:afab252. [PMID: 34977920 PMCID: PMC8753048 DOI: 10.1093/ageing/afab252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND sarcopenia and frailty are associated with increased risk of falls and fractures. This study evaluated the feasibility of assessing sarcopenia and frailty among older people attending fracture clinics. METHODS patients aged 65+ years with an arm fracture attending fracture clinics in one UK city were recruited. Sarcopenia was assessed using gait speed, grip strength, skeletal muscle mass index SMI, SARC-F questionnaire and the European Working Group on Sarcopenia in Older People (EWGSOP) I and II criteria. Frailty was assessed using Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS) and Study of Osteoporotic Fracture. The sensitivity and specificity of each tool was calculated against the EWGSOP II criteria (sarcopenia) and FFP (frailty). Patients identified to have either condition were referred for Comprehensive Geriatric Assessment (CGA). Interviews with 13 patients and nine staff explored the acceptability of this process. RESULTS hundred patients (Mean age 75 years) were recruited. Most sarcopenia and frailty assessments were quick with complete data collection and were acceptable to patients and staff. Sarcopenia was identified among 4-39% participants depending on the tool and frailty among 9-25%. Both conditions were more common among men than women with all tools. The SARC-F and PRISMA-7 had the best sensitivity (100 and 93%, respectively) and specificity (96 and 87%). CGA among 80% of referred participants led to three interventions per participant (e.g. medication changes and investigations). CONCLUSION SARC-F and PRISMA-7 are recommended for use in fracture clinics to screen for sarcopenia and frailty.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine and National Institute for Health Research Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Mark A Mullee
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Natalie Cox
- Academic Geriatric Medicine and the NIHR BRC Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cynthia Russell
- Patient and Public Involvement, National Institute for Health Research Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Mark Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Tilley
- Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Guiqing Lily Yao
- Department of Health Sciences, College of Life Sciences, University of Leicester University, UK
| | - Shihua Zhu
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine and National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton
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Cong W, Chai J, Zhao L, Cabral C, Yardley L, Yao GL, Zhang T, Cheng J, Shen X, Liu R, Little P, Stuart B, Hu X, Sun YH, Oliver I, Zheng B, Lambert H, Wang D. Cluster randomised controlled trial to assess a tailored intervention to reduce antibiotic prescribing in rural China: study protocol. BMJ Open 2022; 12:e048267. [PMID: 34980608 PMCID: PMC8724711 DOI: 10.1136/bmjopen-2020-048267] [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: 12/04/2022] Open
Abstract
INTRODUCTION Up to 80% of patients with respiratory tract infections (RTI) attending healthcare facilities in rural areas of China are prescribed antibiotics, many of which are unnecessary. Since 2009, China has implemented several policies to try to reduce inappropriate antibiotic use; however, antibiotic prescribing remains high in rural health facilities. METHODS AND ANALYSIS A cluster randomised controlled trial will be carried out to estimate the effectiveness and cost effectiveness of a complex intervention in reducing antibiotic prescribing at township health centres in Anhui Province, China. 40 Township health centres will be randomised at a 1:1 ratio to the intervention or usual care arms. In the intervention group, practitioners will receive an intervention comprising: (1) training to support appropriate antibiotic prescribing for RTI, (2) a computer-based treatment decision support system, (3) virtual peer support, (4) a leaflet for patients and (5) a letter of commitment to optimise antibiotic use to display in their clinic. The primary outcome is the percentage of antibiotics (intravenous and oral) prescribed for RTI patients. Secondary outcomes include patient symptom severity and duration, recovery status, satisfaction, antibiotic consumption. A full economic evaluation will be conducted within the trial period. Costs and savings for both clinics and patients will be considered and quality of life will be measured by EuroQoL (EQ-5D-5L). A qualitative process evaluation will explore practitioner and patient views and experiences of trial processes, intervention fidelity and acceptability, and barriers and facilitators to implementation. ETHICS AND DISSEMINATION Ethical approval was obtained from the Biomedical Research Ethics Committee of Anhui Medical University (Ref: 20180259); the study has undergone due diligence checks and is registered at the University of Bristol (Ref: 2020-3137). Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals in China, the UK and internationally. TRIAL REGISTRATION NUMBER ISRCTN30652037.
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Affiliation(s)
- Wenjuan Cong
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jing Chai
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Linhai Zhao
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Yardley
- School of Psychological Sciences, University of Bristol, Bristol, UK
| | - Guiqing Lily Yao
- University of Leicester Department of Health Sciences, Leicester, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jing Cheng
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - XingRong Shen
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Rong Liu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Paul Little
- Primary Care and Population Science, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Science, University of Southampton, Southampton, UK
| | - Xiaowen Hu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Ye-Huan Sun
- Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- National Infection Service, Public Health England South Region, Bristol, UK
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
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5
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Poudel AN, Zhu S, Cooper N, Roderick P, Alwan N, Tarrant C, Ziauddeen N, Yao GL. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS One 2021; 16:e0259164. [PMID: 34710173 PMCID: PMC8553121 DOI: 10.1371/journal.pone.0259164] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Coronavirus disease (Covid-19) has led to a global pandemic since its emergence in December 2019. The majority of research into Covid-19 has focused on transmission, and mortality and morbidity associated with the virus. However, less attention has been given to its impact on health-related quality of life (HRQoL) of patients with Covid-19. Methods We searched for original studies published between December 2019 and Jan 2021 in PubMed, Scopus and Medline databases using a specific search strategy. We also explored literature on websites of distinguished public health organisations and hand-searched reference lists of eligible studies. The studies were screened by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart using pre-determined eligibility criteria. Data were synthesised, analysed descriptively and reported in line with PRISMA guidelines. Results In total, 1276 studies were identified through the search strategy. Of these, 77 studies were selected for full-text reading after screening the studies. After reading full-text, 12 eligible studies were included in this review. The majority of the studies used a generic HRQoL assessment tool; five studies used SF-36, five studies used EQ-5D-5L, and three used pulmonary disease-specific HRQoL tools (two studies used two tools each). The impact of Covid-19 on HRQoL was found to be considerable in both Acute Covid and Long Covid patients. Higher impact on HRQoL was reported in Acute Covid, females, older ages, patients with more severe disease and patients from low-income countries. Conclusion The impact of Covid-19 on HRQoL of Acute and Long Covid patients is substantial. There was disproportional impact on patients by gender, age, severity of illness and study country. The long-term impact of Covid-19 is still in its initial stage. The findings of the review may be useful to researchers, policymakers, and clinicians caring for people following Covid-19 infection.
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Affiliation(s)
- Ak Narayan Poudel
- Department of Health Sciences, University of Leicester, Leicester, England, United Kingdom
- * E-mail:
| | - Shihua Zhu
- Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, England, United Kingdom
| | - Paul Roderick
- Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Nisreen Alwan
- Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, England, United Kingdom
| | - Nida Ziauddeen
- Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom
| | - Guiqing Lily Yao
- Department of Health Sciences, University of Leicester, Leicester, England, United Kingdom
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Ibrahim K, Lim T, Mullee MA, Yao GL, Zhu S, Baxter M, Tilley S, Russel C, Roberts HC. 20 Comparison of Six Frailty Screening Tools in Patients Aged 65+ with An Arm Fragility Fracture. Age Ageing 2021. [DOI: 10.1093/ageing/afab028.20] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Frailty is associated with an increased risk of falling and fracture, but not routinely assessed in fracture clinic. Early identification and management of frailty among older people with arm fragility fracture could help avoid further falls and fractures, especially of the hip. We evaluated the feasibility of assessing frailty in a busy fracture clinic.
Methods
People aged 65+ years with an arm fracture in one acute trust were recruited. Frailty was assessed in fracture clinics using six tools: Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS), and Study of Osteoporotic Fracture (SOF). The sensitivity and specificity of each tool was compared against FFP as a reference. Participants identified as frail by 2+ tools were referred for Comprehensive Geriatric Assessment (CGA).
Results
100 patients (mean age 75 years±7.2; 20 men) were recruited. Frailty prevalence was 9% (FRAIL scale), 13% (SOF), 14% (CFS > 6), 15% (FFP; e-FI > 0.25), and 25% (PRISMA-7). Men were more likely to be frail than women. Data were complete for all assessments and completion time ranged from one minute (PRISMA-7; CFS) to six minutes for the FFP which required most equipment. Comparing with FFP, the most accurate instrument for stratifying frail from non-frail was the PRISMA-7 (sensitivity = 93%, specificity = 87%) while the remaining tools had good specificity (range 93%–100%) but average sensitivity (range 40%–60%). Twenty patients were eligible for CGA. Five had recently had CGA and 11/15 referred were assessed. CGA led to 3–6 interventions per participant including medication changes, life-style advice, investigations, and onward referrals.
Conclusion
It was feasible to assess frailty in fracture clinic and to identify patients who benefitted from CGA. Frailty prevalence was 9%—25% depending on the tool used and was higher among men. PRISMA-7 could be a practical tool for routine use in fracture clinics.
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Affiliation(s)
- K Ibrahim
- Faculty of Medicine, University of Southampton
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) Wessex
| | - T Lim
- Faculty of Medicine, University of Southampton
| | - M A Mullee
- Faculty of Medicine, University of Southampton
| | - G L Yao
- College of Life Sciences, University of Leicester University
| | - S Zhu
- Faculty of Medicine, University of Southampton
| | - M Baxter
- Medicine for Older People Department, University Hospital Southampton NHS Foundation Trust
| | - S Tilley
- Trauma and Orthopaedic department, University Hospital Southampton NHS Foundation Trust
| | - C Russel
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) Wessex
| | - H C Roberts
- Faculty of Medicine, University of Southampton
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) Wessex
- Medicine for Older People Department, University Hospital Southampton NHS Foundation Trust
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7
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Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
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Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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Abstract
Purpose
The purpose of the paper is to review autism identification across different ethnic groups. Diagnosis of autism may be missed or delayed in certain ethnic groups, leading to such groups being underserved relative to their needs. This can result in members of such groups being effectively denied essential avenues of support that can substantially improve the quality of life of autistic persons as well as those whom care for them.
Design/methodology/approach
A literature search for articles reporting autism identification across ethnic groups was undertaken. Data are compared, with a special focus on possible explanations for any inter-group variation.
Findings
Autism identification appears to be generally lower in minority ethnic groups relative to the majority population. Individuals presenting with autism from minority groups appear to have more severe forms of the condition.
Originality/value
There are a multitude of potential explanations for inter-ethnicity variation in autism identification, including health care-related factors, broader environmental influences, cultural factors and possible biological differences. Implications for clinical practice and public health include a need to look at means of ensuring equitable access to relevant autism diagnostic and support services across ethnic groups. Further work is required to better understand the belief systems that operate within specific ethnic groups, how this may potentially impact upon autism identification and measures to address the concerns of such groups.
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Tromans S, Yao GL, Kiani R, Alexander R, Al-Uzri M, Brugha T. Study protocol: an investigation of the prevalence of autism among adults admitted to acute mental health wards: a cross-sectional pilot study. BMJ Open 2019; 9:e033169. [PMID: 31874885 PMCID: PMC7008424 DOI: 10.1136/bmjopen-2019-033169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Autism spectrum disorders (ASDs) are associated with difficulties in social interaction, communication and restricted, repetitive behaviours. Much is known about their community prevalence among adults, data on adult inpatients within an acute mental health setting is lacking.This pilot study aimed to estimate the prevalence of ASDs among adults admitted to acute mental health wards and to examine the association between ASDs and psychiatric and physical comorbidities within this group. METHODS AND ANALYSIS A multiple-phase approach will be used. Phase I will involve testing of 200 patients and corresponding informants, using the autism quotient (AQ), the informant version of the Social Responsiveness Scale, second edition-Adult, the self and informant versions of the Adult Social Behaviour Questionnaire and the EuroQol-5D-5L. Patients with intellectual disability (ID) will bypass Phase I.Phase II will involve diagnostic testing of a subgroup of 40 patients with the Diagnostic Interview for Social and Communication Disorders, the Autism Diagnostic Observation Schedule version 2 and the ASD interview within the Schedules for Clinical Assessment in Neuropsychiatry version 3. 25±5 patients will not have ID and be selected via stratified random sampling according to AQ score; 15±5 patients will have ID. Phase II patients will be interviewed with the Physical Health Conditions and Mental Illness Diagnoses and Treatment sections of the 2014 Adult Psychiatric Morbidity Survey.Prevalence estimates will be based on the proportion of Phase II participants who satisfy the 10th revision of the International Statistical Classification of Diseases and Related Health Problems Diagnostic Criteria for Research (ICD-10-DCR) and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for ASD, adjusting for selection and non-response. Univariate analysis will be conducted for comorbidities to identify the level of their association with an ASD diagnosis. ETHICS AND DISSEMINATION Study oversight is provided by the University of Leicester. The National Health Service Health Research Authority have provided written approval. Study results will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN27739943.
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Affiliation(s)
- Sam Tromans
- Department of Health Sciences, University of Leicester, Leicester, UK
- Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Guiqing Lily Yao
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Reza Kiani
- Department of Health Sciences, University of Leicester, Leicester, UK
- Learning Disability Psychiatry, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Regi Alexander
- Department of Health Sciences, University of Leicester, Leicester, UK
- Learning Disability Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, Norwich, UK
| | - Mohammed Al-Uzri
- Department of Health Sciences, University of Leicester, Leicester, UK
- General Adult Psychiatry, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
- General Adult Psychiatry, Leicestershire Partnership NHS Trust, Leicester, UK
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10
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Ibrahim K, Mullee M, Yao GL, Zhu S, Baxter M, Tilly S, Russell C, Roberts HC. Southampton Arm Fracture Frailty and Sarcopenia Study (SAFFSS): a study protocol for the feasibility of assessing frailty and sarcopenia among older patients with an upper limb fracture. BMJ Open 2019; 9:e031275. [PMID: 31420400 PMCID: PMC6701623 DOI: 10.1136/bmjopen-2019-031275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Falls are a major health problem for older people; 35% of people aged 65+ years fall every year, leading to fractures in 10%-15%. Upper limb fractures are often the first sign of osteoporosis and routine screening for osteoporosis is recommended by the National Institute for Health and Care Excellence to prevent subsequent hip fractures. However, both frailty and sarcopenia (muscle weakness) are associated with increased risk of falling and fracture but are not routinely identified in this group. The aim of this study is to evaluate the feasibility of assessing and managing frailty and sarcopenia among people aged 65+ years with an upper limb fracture. METHODS AND ANALYSIS This study will be conducted in three fracture clinics in one acute trust in England. 100 people aged 65+ years with an upper arm fracture will be recruited and assessed using six validated frailty measures and two sarcopenia tools. The prevalence of the two conditions and the best tools to use will be determined. Those with either condition will be referred to geriatric clinical teams for comprehensive geriatric assessment (CGA). We will document the proportion who are referred for CGA and those who receive CGA. Other outcome measures including falls, fractures and healthcare resource use over 6 months will be collected. In-depth interviews with a purposive sample of patients who undergo the frailty and sarcopenia assessments and healthcare professionals in fracture clinics and geriatric services will be carried out to their acceptability of assessing frailty and sarcopenia in a busy environment. ETHICS AND DISSEMINATION The study was given the relevant ethical approvals from NHS Research Ethics Committee (REC No: 18/NE/0377), the University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Faculty of Medicine Ethics Committee and Research Governance Office. Findings will be published in scientific journals and presented to local, national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN13848445.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, Southampton University, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Mullee
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Shihua Zhu
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Baxter
- Trauma and Orthopaedic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
| | - Simon Tilly
- Trauma and Orthopaedic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cynthia Russell
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, Southampton University, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- Trauma and Orthopaedic Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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11
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Krusche A, Bradbury K, Corbett T, Barnett J, Stuart B, Yao GL, Bacon R, Böhning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Müller A, Neal RD, Osborne R, Rathod S, Richardson A, Sharman G, Summers K, Watson E, Wilde L, Wilkinson C, Yardley L, Little P. Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors. BMJ Open 2019; 9:e024862. [PMID: 30826763 PMCID: PMC6429898 DOI: 10.1136/bmjopen-2018-024862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management. METHODS AND ANALYSIS A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support. ETHICS AND DISSEMINATION The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN96374224; Pre-results.
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Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, Southampton, UK
| | | | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Biostatistics Research Group, University of Leicester, Leicester, UK
| | - Roger Bacon
- Patient and Public Involvement team for the CLASP project
| | - Dankmar Böhning
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Diana Eccles
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Andre Müller
- Saw Swee Hock Public School of Health, National University of Singapore, Singapore
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Kevin Summers
- Patient and Public Involvement team for the CLASP project
| | - Eila Watson
- School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Laura Wilde
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
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12
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Sonuga-Barke EJS, Barton J, Daley D, Hutchings J, Maishman T, Raftery J, Stanton L, Laver-Bradbury C, Chorozoglou M, Coghill D, Little L, Ruddock M, Radford M, Yao GL, Lee L, Gould L, Shipway L, Markomichali P, McGuirk J, Lowe M, Perez E, Lockwood J, Thompson MJJ. A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years. Eur Child Adolesc Psychiatry 2018; 27:797-809. [PMID: 29086103 PMCID: PMC5973956 DOI: 10.1007/s00787-017-1054-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Received: 03/20/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)-12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)-12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome-Parent ratings of child's ADHD symptoms (Swanson, Nolan & Pelham Questionnaire-SNAP-IV). Secondary outcomes-teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference - 0.009 95% CI (- 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [- 0.189 95% CI (- 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [- 0.16 95% CI (- 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK.
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK.
| | - Joanne Barton
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, School of Psychology, Bangor University, Bangor, UK
| | - Tom Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Louisa Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Martin Ruddock
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Mike Radford
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Lee
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Gould
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Shipway
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Pavlina Markomichali
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - James McGuirk
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Michelle Lowe
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Elvira Perez
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Joanna Lockwood
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Margaret J J Thompson
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
- CAMHS, Solent NHS Trust, Better Care Centre, Southampton, UK
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13
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Band R, Morton K, Stuart B, Raftery J, Bradbury K, Yao GL, Zhu S, Little P, Yardley L, McManus RJ. Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial. BMJ Open 2016; 6:e012684. [PMID: 27821598 PMCID: PMC5129001 DOI: 10.1136/bmjopen-2016-012684] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/07/2022] Open
Abstract
INTRODUCTION Self-management of hypertension, including self-monitoring and antihypertensive medication titration, lowers blood pressure (BP) at 1 year compared to usual care. The aim of the current trial is to assess the effectiveness of the Home and Online Management and Evaluation of Blood Pressure (HOME BP) intervention for the self-management of hypertension in primary care. METHODS AND ANALYSIS The HOME BP trial will be a randomised controlled trial comparing BP self-management-consisting of the HOME BP online digital intervention with self-monitoring, lifestyle advice and antihypertensive drug titration-with usual care for people with uncontrolled essential hypertension. Eligible patients will be recruited from primary care and randomised to usual care or to self-management using HOME BP. The primary outcome will be the difference in mean systolic BP (mm Hg) at 12-month follow-up between the intervention and control groups adjusting for baseline BP and covariates. Secondary outcomes (also adjusted for baseline and covariates where appropriate) will be differences in mean BP at 6 months and diastolic BP at 12 months; patient enablement; quality of life, and economic analyses including all key resources associated with the intervention and related services, adopting a broad societal perspective to include NHS, social care and patient costs, considered within trial and modelled with a lifetime horizon. Medication beliefs, adherence and changes; self-efficacy; perceived side effects and lifestyle changes will be measured for process analyses. Qualitative analyses will explore patient and healthcare professional experiences of HOME BP to gain insights into the factors affecting acceptability, feasibility and adherence. ETHICS AND DISSEMINATION This study has received NHS ethical approval (REC reference 15/SC/0082). The findings from HOME BP will be disseminated widely through peer-reviewed publications, scientific conferences and workshops. If successful, HOME BP will be directly applicable to UK primary care management of hypertension. TRIAL REGISTRATION NUMBER ISRCTN13790648; pre-results.
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Affiliation(s)
- Rebecca Band
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Katherine Morton
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | | - Shihua Zhu
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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14
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Roderick P, Rayner H, Tonkin-Crine S, Okamoto I, Eyles C, Leydon G, Santer M, Klein J, Yao GL, Murtagh F, Farrington K, Caskey F, Tomson C, Loud F, Murphy E, Elias R, Greenwood R, O’Donoghue D. A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure. Health Services and Delivery Research 2015. [DOI: 10.3310/hsdr03120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundConservative kidney management (CKM) is recognised as an alternative to dialysis for a significant number of older adults with multimorbid stage 5 chronic kidney disease (CKD5). However, little is known about the way CKM is delivered or how it is perceived.AimTo determine the practice patterns for the CKM of older patients with CKD5, to inform service development and future research.Objectives(1) To describe the differences between renal units in the extent and nature of CKM, (2) to explore how decisions are made about treatment options for older patients with CKD5, (3) to explore clinicians’ willingness to randomise patients with CKD5 to CKM versus dialysis, (4) to describe the interface between renal units and primary care in managing CKD5 and (5) to identify the resources involved and potential costs of CKM.MethodsMixed-methods study. Interviews with 42 patients aged > 75 years with CKD5 and 60 renal unit staff in a purposive sample of nine UK renal units. Interviews informed the design of a survey to assess CKM practice, sent to all 71 UK units. Nineteen general practitioners (GPs) were interviewed concerning the referral of CKD patients to secondary care. We sought laboratory data on new CKD5 patients aged > 75 years to link with the nine renal units’ records to assess referral patterns.ResultsSixty-seven of 71 renal units completed the survey. Although terminology varied, there was general acceptance of the role of CKM. Only 52% of units were able to quantify the number of CKM patients. A wide range reflected varied interpretation of the designation ‘CKM’ by both staff and patients. It is used to characterise a future treatment option as well as non-dialysis care for end-stage kidney failure (i.e. a disease state equivalent to being on dialysis). The number of patients in the latter group on CKM was relatively small (median 8, interquartile range 4.5–22). Patients’ expectations of CKM and dialysis were strongly influenced by renal staff. In a minority of units, CKM was not discussed. When discussed, often only limited information about illness progression was provided. Staff wanted more research into the relative benefits of CKM versus dialysis. There was almost universal support for an observational methodology and a quarter would definitely be willing to participate in a randomised clinical trial, indicating that clinicians placed value on high-quality evidence to inform decision-making. Linked data indicated that most CKD5 patients were known to renal units. GPs expressed a need for guidance on when to refer older multimorbid patients with CKD5 to nephrology care. There was large variation in the scale and model of CKM delivery. In most, the CKM service was integrated within the service for all non-renal replacement therapy CKD5 patients. A few units provided dedicated CKM clinics and some had dedicated, modest funding for CKM.ConclusionsConservative kidney management is accepted across UK renal units but there is much variation in the way it is described and delivered. For best practice, and for CKM to be developed and systematised across all renal units in the UK, we recommend (1) a standard definition and terminology for CKM, (2) research to measure the relative benefits of CKM and dialysis and (3) development of evidence-based staff training and patient education interventions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Paul Roderick
- Primary Care and Population Sciences, University of Southampton, UK
| | - Hugh Rayner
- Department of Renal Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Ikumi Okamoto
- Primary Care and Population Sciences, University of Southampton, UK
| | - Caroline Eyles
- Primary Care and Population Sciences, University of Southampton, UK
| | - Geraldine Leydon
- Primary Care and Population Sciences, University of Southampton, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, UK
| | - Jonathan Klein
- Southampton Management School, University of Southampton, UK
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, UK
| | - Fliss Murtagh
- Cicely Saunders Institute, King’s College London, UK
| | | | | | | | | | - Emma Murphy
- Cicely Saunders Institute, King’s College London, UK
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15
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Morgan JM, Dimitrov BD, Gill J, Kitt S, Ng GA, McComb JM, Raftery J, Roderick P, Seed A, Williams SG, Witte KK, Wright DJ, Yao GL, Cowie MR. Rationale and study design of the REM-HF study: remote management of heart failure using implanted devices and formalized follow-up procedures. Eur J Heart Fail 2014; 16:1039-45. [DOI: 10.1002/ejhf.149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- John M. Morgan
- Faculty of Medicine; University of Southampton; Southampton UK
| | | | - Jas Gill
- Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Sue Kitt
- University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - G. Andre Ng
- NIHR Leicester Cardiovascular Biomedical Research Unit; University of Leicester, Glenfield Hospital; Leicester UK
| | - Janet M. McComb
- Newcastle-upon-Tyne Hospitals NHS Foundation Trust; Newcastle-upon-Tyne UK
| | - James Raftery
- Faculty of Medicine; University of Southampton; Southampton UK
| | - Paul Roderick
- Faculty of Medicine; University of Southampton; Southampton UK
| | - Alison Seed
- Blackpool Teaching Hospitals NHS Foundation Trust; Blackpool UK
| | - Simon G. Williams
- University Hospitals of South Manchester NHS Foundation Trust; Manchester UK
| | - Klaus K. Witte
- Multidisciplinary Cardiovascular Research Centre; University of Leeds; Leeds UK
| | - D. Jay Wright
- Institute of Cardiovascular Medicine and Science; Liverpool Heart and Chest Hospital NHS Foundation Trust; Liverpool UK
| | | | - Martin R. Cowie
- Imperial College London; (Royal Brompton Hospital); London UK
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Ghanouni A, Halligan S, Taylor SA, Boone D, Plumb A, Stoffel S, Morris S, Yao GL, Zhu S, Lilford R, Wardle J, von Wagner C. Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment. BMJ Open 2014; 4:e004327. [PMID: 24699460 PMCID: PMC3987721 DOI: 10.1136/bmjopen-2013-004327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 02/06/2023] Open
Abstract
OBJECTIVES CT colonography (CTC) may be an acceptable test for colorectal cancer screening but bowel preparation can be a barrier to uptake. This study tested the hypothesis that prospective screening invitees would prefer full-laxative preparation with higher sensitivity and specificity for polyps, despite greater burden, over less burdensome reduced-laxative or non-laxative alternatives with lower sensitivity and specificity. DESIGN Discrete choice experiment. SETTING Online, web-based survey. PARTICIPANTS 2819 adults (45-54 years) from the UK responded to an online invitation to take part in a cancer screening study. Quota sampling ensured that the sample reflected key demographics of the target population and had no relevant bowel disease or medical qualifications. The analysis comprised 607 participants. INTERVENTIONS After receiving information about screening and CTC, participants completed 3-4 choice scenarios. Scenarios showed two hypothetical forms of CTC with different permutations of three attributes: preparation, sensitivity and specificity for polyps. PRIMARY OUTCOME MEASURES Participants considered the trade-offs in each scenario and stated their preferred test (or chose neither). RESULTS Preparation and sensitivity for polyps were both significant predictors of preferences (coefficients: -3.834 to -6.346 for preparation, 0.207-0.257 for sensitivity; p<0.0005). These attributes predicted preferences to a similar extent. Realistic specificity values were non-significant (-0.002 to 0.025; p=0.953). Contrary to our hypothesis, probabilities of selecting tests were similar for realistic forms of full-laxative, reduced-laxative and non-laxative preparations (0.362-0.421). However, they were substantially higher for hypothetical improved forms of reduced-laxative or non-laxative preparations with better sensitivity for polyps (0.584-0.837). CONCLUSIONS Uptake of CTC following non-laxative or reduced-laxative preparations is unlikely to be greater than following full-laxative preparation as perceived gains from reduced burden may be diminished by reduced sensitivity. However, both attributes are important so a more sensitive form of reduced-laxative or non-laxative preparation might improve uptake substantially.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Darren Boone
- Centre for Medical Imaging, University College London, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Sandro Stoffel
- Institute for Health and Consumer Protection, European Commission, Joint Research Centre, Ispra, Italy
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Guiqing Lily Yao
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Shihua Zhu
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
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Ghanouni A, Smith SG, Halligan S, Plumb A, Boone D, Yao GL, Zhu S, Lilford R, Wardle J, von Wagner C. Public preferences for colorectal cancer screening tests: a review of conjoint analysis studies. Expert Rev Med Devices 2014; 10:489-99. [PMID: 23895076 DOI: 10.1586/17434440.2013.811867] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A wide range of screening technologies is available for colorectal cancer screening. There is demand to discover public preferences for these tests on the rationale that tailoring screening to preferences may improve uptake. This review describes a type of study (conjoint analysis) used to assess people's preferences for colorectal cancer screening tests and critically evaluates research quality using a recently published set of guidelines. Most primary studies assessed preferences for colonoscopy and fecal occult blood testing but newer technologies (e.g., capsule endoscopy) have not yet been evaluated. Although studies often adhered to guidelines, there was limited correspondence between stated preferences and actual screening behavior. Future research should investigate how studies can go beyond the guidelines in order to improve this and also explore how test preferences may differ by important population subgroups.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
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18
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Arora T, Hosseini-Araghi M, Bishop J, Yao GL, Thomas GN, Taheri S. The complexity of obesity in U.K. adolescents: relationships with quantity and type of technology, sleep duration and quality, academic performance and aspiration. Pediatr Obes 2013; 8:358-66. [PMID: 23239604 DOI: 10.1111/j.2047-6310.2012.00119.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/27/2012] [Accepted: 10/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contemporary technology and multiple device use may link to increased body mass index (BMI). The sleep-obesity relationship is inconsistent in adolescents. Sleep duration and quality may have crucial connections to obesity development, particularly in adolescents where sleep alterations are common. Elevated BMI in adolescents may influence academic performance and aspiration, but data are limited. OBJECTIVES The objectives of this study was to assess the linear associations between BMI z-score and (i) quantity/type of technology used; (ii) sleep quantity/quality and (iii) academic performance/aspiration. METHODS Consenting adolescents (n = 624; 64.9% girls, aged 11-18 years) were recruited. The Schools Sleep Habits Survey and Technology Use Questionnaire were administered. Objective measures of height/weight were obtained. RESULTS Quantity of technology was positively associated with BMI z-score β = 0.10, P < 0.01. Those who always engaged in video gaming had significantly higher BMI z-score vs. never-users, β = 1.00, P < 0.001. Weekday sleep duration and sleep onset latency were related to BMI z-score, β = -0.24, P < 0.001 and β = 0.01, P < 0.001, respectively. An inverse linear association was observed between BMI z-score and academic performance, β = -0.68, P < 0.001. CONCLUSIONS If confirmed prospectively, reducing bedtime use of technology and improving sleep hygiene in adolescents could be an achievable intervention for attenuating obesity with potentially positive effects on academic performance.
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Affiliation(s)
- T Arora
- Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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19
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Wu J, Zhu S, Yao GL, Mohammed MA, Marshall T. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study. PLoS One 2013; 8:e67611. [PMID: 23922649 PMCID: PMC3724846 DOI: 10.1371/journal.pone.0067611] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions. METHODS A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008) patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing. RESULTS Of 365,718 patients with complete data, 13.8% (50,558) were prescribed lipid lowering drugs: 28.5% (21,101/74,137) of those eligible and 10.1% (29,457/291,581) of those ineligible. Only 41.7% (21,101/50,558) of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39); diabetes (OR 4.49; 95% CI 4.35-4.64); total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29); and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42). The predictors were similar in eligible and ineligible patients. CONCLUSIONS Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.
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Affiliation(s)
- Jianhua Wu
- Centre for Environmental and Preventive Medicine, Barts and The London School of Medicine and Dentistry, University of London, London, United Kingdom
| | - Shihua Zhu
- School of Public Health and Population Science, University of Birmingham, Birmingham, United Kingdom
| | - Guiqing Lily Yao
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Mohammed A. Mohammed
- School of Public Health and Population Science, University of Birmingham, Birmingham, United Kingdom
| | - Tom Marshall
- School of Public Health and Population Science, University of Birmingham, Birmingham, United Kingdom
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20
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Yao GL, Novielli N, Manaseki-Holland S, Chen YF, van der Klink M, Barach P, Chilton PJ, Lilford RJ. Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers. BMJ Qual Saf 2012; 21 Suppl 1:i29-38. [PMID: 22976505 PMCID: PMC3551195 DOI: 10.1136/bmjqs-2012-001210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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] [Indexed: 11/17/2022]
Abstract
Background We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and ‘road-tested’ the method on an intervention to improve patient handover of care between hospital and community. Method The development of a nine-step evaluation framework: 1. Identification of multiple endpoints and arranging them into manageable groups; 2. Estimation of baseline overall and preventable risk; 3. Bayesian elicitation of expected effectiveness of the planned intervention; 4. Assigning utilities to groups of endpoints; 5. Costing the intervention; 6. Estimating health service costs associated with preventable adverse events; 7. Calculating health benefits; 8. Cost-effectiveness calculation; 9. Sensitivity and headroom analysis. Results Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%. Conclusions We offer a usable framework to assist in ex ante health economic evaluations of health service interventions.
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Affiliation(s)
- Guiqing Lily Yao
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
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21
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Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, Bayliss S, Moss P, Stanworth S, Hyde C. A systematic review and economic evaluation of epoetin alpha, epoetin beta and darbepoetin alpha in anaemia associated with cancer, especially that attributable to cancer treatment. Health Technol Assess 2007; 11:1-202, iii-iv. [PMID: 17408534 DOI: 10.3310/hta11130] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and cost-effectiveness of epoetin alpha, epoetin beta and darbepoetin alpha (referred to collectively in this report as epo) in anaemia associated with cancer, especially that attributable to cancer treatment. DATA SOURCES Electronic databases were searched from 2000 (1996 in the case of darbepoetin alpha) to September 2004. REVIEW METHODS Using a recently published Cochrane review as the starting point, a systematic review of recent randomised controlled trials (RCTs) comparing epo with best standard was conducted. Inclusion, quality assessment and data abstraction were undertaken in duplicate. Where possible, meta-analysis was employed. The economic assessment consisted of a systematic review of past economic evaluations, an assessment of economic models submitted by the manufacturers of the three epo agents and development of a new individual sampling model (the Birmingham epo model). RESULTS In total 46 RCTs were included within this systematic review, 27 of which had been included in the Cochrane systematic review. All 46 trials compared epo plus supportive care for anaemia (including transfusions), with supportive care for anaemia (including transfusions), alone. Haematological response (defined as an improvement by 2 g/dl(-1)) had a relative risk of 3.4 [95% confidence interval (CI) 3.0 to 3.8, 22 RCTs] with a response rate for epo of 53%. The trial duration was most commonly 16-20 weeks. There was little statistical heterogeneity in the estimate of haematological response, and there were no important differences between the subgroups examined. Haemoglobin (Hb) change showed a weighted mean difference of 1.63 g/dl(-1) (95% CI 1.46 to 1.80) in favour of epo. Treatment with erythropoietin in patients with cancer-induced anaemia reduces the number of patients who receive a red blood cell transfusion (RBCT) by an estimated 18%. Health-related quality of life (HRQoL) data were analysed using vote counting and qualitative assessment and a positive effect was observed in favour of an improved HRQoL for patients on epo. Published information on side-effects was of poor quality. New trials provided further evidence of side-effects with epo, particularly thrombic events, but it is still unclear whether these could be accounted for by chance alone. The results of the previous Cochrane review had suggested a survival advantage for epo (HR 0.84, 95% CI 0.69 to 1.02), based on 19 RCTs. The update, based on 28 RCTs, suggests no difference (HR 1.03, 95% CI 0.88 to 1.21). Subgroup analysis suggested some explanations for this heterogeneity, but it is difficult to draw firm conclusions without access to the substantial amounts of missing or unpublished data, or more detailed results from some of the trials with heterogeneous patient populations. The conclusions are, however, broadly in line with those of a Food and Drug Administration (FDA) safety briefing, which recommended that patients with a haemoglobin above 12 g/dl(-1) should not be treated; the target rate of rise in Hb should not be too great, and further carefully conducted trials are required to determine which subgroups of patients may be harmed by the use of these products, in particular through the stimulation of tumour activity. Five published economic evaluations identified from the literature had inconsistent results, with estimates ranging from a cost per quality-adjusted life-year (QALY) under pound 10,000 through to epo being less effective and more costly than standard care. The more favourable evaluations assumed a survival advantage for epo. The three company models submitted each relied on assumed survival gains to achieve relatively low cost per QALY, from pound 13,000 to pound 28,000, but generated estimates from pound 84,000 to pound 159,000 per QALY when no survival gain was assumed. Each of these models relied on Hb levels alone driving utility, and each assumed gradual normalisation of Hb in the standard treatment arm after the end of treatment. The Birmingham epo model followed the company models in regard to the relationship between Hb levels and utility, and also assumed normalisation in the base case. With no survival gain, the incremental cost per QALY was pound 150,000, falling to pound 40,000 when the lower, more favourable, confidence interval for survival was used. CONCLUSIONS Epo is effective in improving haematological response and reducing RBCT requirements, and appears to have a positive effect on HRQoL. The incidence of side-effects and effects on survival remains highly uncertain. However, if there is no impact on survival, it seems highly unlikely that epo would be considered a cost-effective use of healthcare resources. The main target for further research should be improving estimates of impact on survival, initially through more detailed secondary research, such as the individual patient data meta-analysis started by the Cochrane group. Further trials may be required, and have been recommended by the FDA, although many trials are in progress, completed but unreported or awaiting mature follow-up. The Birmingham epo model developed as part of this project contains new features that improve its flexibility in exploring different scenarios; further refinement and validation would therefore be of assistance. Finally, further research to resolve uncertainty about other parameters, particularly quality of life, adverse events, and the rate of normalisation, would also be beneficial.
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Affiliation(s)
- J Wilson
- Department of Public Health and Epidemiology, University of Birmingham, UK
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22
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Whitehurst DGT, Lewis M, Yao GL, Bryan S, Raftery JP, Mullis R, Hay EM. A brief pain management program compared with physical therapy for low back pain: Results from an economic analysis alongside a randomized clinical trial. ACTA ACUST UNITED AC 2007; 57:466-73. [PMID: 17394176 DOI: 10.1002/art.22606] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Guidelines for the management of acute low back pain in primary care recommend early intervention to address psychosocial risk factors associated with long-term disability. We assessed the cost utility and cost effectiveness of a brief pain management program (BPM) targeting psychosocial factors compared with physical therapy (PT) for primary care patients with low back pain of <12 weeks' duration. METHODS A total of 402 patients were randomly assigned to BPM or PT. We adopted a health care perspective, examining the direct health care costs of low back pain. Outcome measures were quality-adjusted life years (QALYs) and 12-month change scores on the Roland and Morris disability questionnaire. Resource use data related to back pain were collected at 12-month followup. Cost effectiveness was expressed as incremental ratios, with uncertainty assessed using cost-effectiveness planes and acceptability curves. RESULTS There were no statistically significant differences in mean health care costs or outcomes between treatments. PT had marginally greater effectiveness at 12 months, albeit with greater health care costs (BPM 142 pounds, PT 195 pounds). The incremental cost-per-QALY ratio was 2,362 pounds. If the UK National Health Service were willing to pay 10,000 pound per additional QALY, there is only a 17% chance that BPM provides the best value for money. CONCLUSION PT is a cost-effective primary care management strategy for low back pain. However, the absence of a clinically superior treatment program raises the possibility that BPM could provide an additional primary care approach, administered in fewer sessions, allowing patient and doctor preferences to be considered.
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Affiliation(s)
- D G T Whitehurst
- Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire, UK
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Woodroffe R, Yao GL, Meads C, Bayliss S, Ready A, Raftery J, Taylor RS. Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study. Health Technol Assess 2005; 9:1-179, iii-iv. [PMID: 15899149 DOI: 10.3310/hta9210] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the clinical effectiveness and cost-effectiveness of the newer immunosuppressive drugs for renal transplantation: basiliximab, daclizumab, tacrolimus, mycophenolate (mofetil and sodium) and sirolimus. DATA SOURCES Electronic databases. Industry submissions. Current Clinical Trials register. Cochrane Collaboration Renal Disease Group. REVIEW METHODS The review followed the InterTASC standards. Each of the five company submissions to the National Institute for Clinical Excellence (NICE) contained cost-effectiveness models, which were evaluated by using a critique covering (1) model checking, (2) a detailed model description and (3) model rerunning. RESULTS For induction therapy, three randomised controlled trials (RCTs) found that daclizumab significantly reduced the incidence of biopsy-confirmed acute rejection and patient survival at 6 months/1 year compared with placebo, but not compared with the monoclonal antibody OKT3. There was no significant gain in patient survival or graft loss at 3 years. The incidence of side-effects with daclizumab reduced compared to OKT3. Eight RCTs found that basiliximab significantly improved 6-month/1-year biopsy-confirmed acute rejection compared to placebo, but not compared to either ATG or OKT3. There was no significant gain in either 1-year patient survival or graft loss. The incidence of side-effects with basiliximab was not significantly different compared to OKT3/ATG. For initial/maintenance therapy, 13 RCTs found that tacrolimus reduced the 6-month/1-year incidence of biopsy-proven acute rejection compared to ciclosporin. There was no significant improvement in either 1-year or long-term (up to 5 years) graft loss or patient survival. The acute rejection benefit of tacrolimus over ciclosporin appeared to be equivalent for Sandimmun and Neoral. There were important differences in the side-effect profile of tacrolimus and ciclosporin. Seven RCTs found that mycophenolate mofetil (MMF) reduced the incidence of acute rejection. There was no significant difference in patient survival or graft loss at 1-year or 3-year follow-up. There appeared to be differences in the side-effect profiles of MMF and azathioprine (AZA). No RCTs comparing MMF with AZA were identified. One RCT compared mycophenolate sodium (MPS) to MMF and reported no difference between the two drugs in 1-year acute rejection rate, graft survival, patient survival or side-effect profile. Two RCTs suggest that addition of sirolimus to a ciclosporin-based initial/maintenance therapy reduces 1-year acute rejections in comparison to a ciclosporin (Neoral) dual therapy alone and substituting azathioprine with sirolimus in initial/maintenance therapy reduces the incidence of acute rejection. Graft and patient survival were not significantly different with either sirolimus regimen. Adding sirolimus increases the incidence of side-effects. The side-effect profiles of azathioprine and sirolimus appear to be different. For the treatment of acute rejection, three RCTs suggested that both tacrolimus and MMF reduce the incidence of subsequent acute rejection and the need for additional drug therapy. Only one RCT and one subgroup analysis in children (<18 years) were identified comparing ciclosporin to tacrolimus and sirolimus, respectively. CONCLUSIONS The newer immunosuppressant drugs (basiliximab, daclizumab, tacrolimus and MMF) consistently reduced the incidence of short-term (1-year) acute rejection compared with conventional immunosuppressive therapy. The independent use of basiliximab, daclizumab, tacrolimus and MMF was associated with a similar absolute reduction in 1-year acute rejection rate (approximately 15%). However, the effects of these drugs did not appear to be additive (e.g. benefit of tacrolimus with adjuvant MMF was 5% reduction in acute rejection rate compared with 15% reduction with adjuvant AZA). Thus, the addition of one of these drugs to a baseline immunosuppressant regimen was likely to affect adversely the incremental cost-effectiveness of the addition of another. The trials did not assess how the improvement in short-term outcomes (e.g. acute rejection rate or measures of graft function), together with the side-effect profile associated with each drug, translated into changes in patient-related quality of life. Moreover, given the relatively short duration of trials, the impact of the newer immunosuppressants on long-term graft loss and patient survival remains uncertain. The absence of both long-term outcome and quality of life from trial data makes assessment of the clinical and cost-effectiveness on the newer immunosuppressants contingent on modelling based on extrapolations from short-term trial outcomes. The choice of the most appropriate short-term outcome (e.g. acute rejection rate or measures of graft function) for such modelling remains a matter of clinical and scientific debate. The decision to use acute rejection in the meta-model in this report was based on the findings of a systematic review of the literature of predictors of long-term graft outcome. Only a very small proportion of the RCTs identified in this review assessed patient-focused outcomes such as quality of life. Since immunosuppressive drugs have both clinical benefits and specific side-effects, the balance of these harms and benefits could best be quantified through future trials using quality of life measures. The design of future trials should be considered with a view to the impact of drugs on particular renal transplant groups, particularly higher risk individuals and children. Finally, there is a need for improved reporting of methodological details of future trials, such as the method of randomisation and allocation concealment. A number of issues exist around registry data, for example the use of multiple drug regimens and the need to assess the long-term outcomes. An option is the use of observational registry data including, if possible, prospective data on all consecutive UK renal transplant patients. Data capture for each patient should include immunosuppressant regimens, clinical and patient-related outcomes and patient demographics.
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Affiliation(s)
- R Woodroffe
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Song FJ, Barton P, Sleightholme V, Yao GL, Fry-Smith A. Screening for fragile X syndrome: a literature review and modelling study. Health Technol Assess 2004; 7:1-106. [PMID: 12969542 DOI: 10.3310/hta7160] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the effectiveness, estimate the associated costs, and summarise available evidence about the feasibility and acceptability of different screening strategies in England and Wales. Also to establish a model for estimating effectiveness and costs of these different strategies. DATA SOURCES Literature searches were restricted to MEDLINE and EMBASE, as well as citations in included papers. A broad search strategy was used involving all aspects of fragile X syndrome (FXS) and covered all relevant literature published between 1991 and 2001. REVIEW METHODS An assessment was conducted of published literature and efforts focused on the development of a model that could be used to synthesise data from various sources, estimate cost-effectiveness of different strategies, and conduct sensitivity analyses according to different assumptions. RESULTS The identified screening programmes were effective in detecting carriers, but a comparison of different strategies was not possible. Simulation results by the FXS Model showed that, over the first 10 years, 4% of premutation (PM) females and 70% of full mutation (FM) females could be detected by active cascade screening; it is 10% and 58%, respectively, by prenatal screening. The maximal detection rate for FM carriers by active cascade screening is higher than that by prenatal screening (91% versus 71%). However, the maximal rate of detection of female PM carriers by active cascade screening (6%) is much lower than that by prenatal screening (60%). During the first 10 years of simulation, the estimated direct cost per year to the NHS in England and Wales is 0.7-0.2 million pounds sterling by active cascade screening and 14.5-9.1 million pounds sterling by a programme of prenatal screening. The incremental cost per extra carrier detected (using current practice as the reference standard) is on average only 165 pounds sterling by active cascade screening and 7543 pounds sterling by prenatal screening. The incremental cost per FXS birth avoided is on average 8494 pounds sterling by active cascade screening and 284,779 pounds sterling by prenatal screening. CONCLUSIONS The empirical evidence suggests that both prenatal screening and cascade screening are feasible and acceptable. Population-based prenatal screening is more efficacious, but it will cost more than active cascade screening. The active cascade screening of affected families is more efficient, cheaper, but less effective than a population-based prenatal screening. It is suggested that both strategies be evaluated in large-scale trials, which might also help to determine whether and how the different strategies could be simultaneously or sequentially combined.
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Affiliation(s)
- F J Song
- Department of Public Health and Epidemiology, University of Birmingham, UK
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25
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Madsen JR, MacDonald P, Irwin N, Goldberg DE, Yao GL, Meiri KF, Rimm IJ, Stieg PE, Benowitz LI. Tacrolimus (FK506) increases neuronal expression of GAP-43 and improves functional recovery after spinal cord injury in rats. Exp Neurol 1998; 154:673-83. [PMID: 9878202 DOI: 10.1006/exnr.1998.6974] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tacrolimus (FK506), a widely used immunosuppressant drug, has neurite-promoting activity in cultured PC12 cells and peripheral neurons. The present study investigated whether tacrolimus affects the expression of the neuronal growth-associated protein, GAP-43, as well as functional recovery after photothrombotic spinal cord injury in the rat. In injured animals receiving tacrolimus, the number of neurons expressing GAP-43 mRNA and protein approximately doubled compared to that in injured animals receiving vehicle alone. This increase in GAP-43-positive cells was paralleled by a significant improvement in neurological function evaluated by open-field and inclined plane tests. Another FKBP-12 ligand (V-10,367) had similar effects on GAP-43 expression and functional outcome, indicating that the observed effects of tacrolimus do not involve inhibition of the phosphatase calcineurin. Thus, tacrolimus, a drug which is already approved for use in humans, as well as other FKBP-12 ligands which do not inhibit calcineurin, could potentially enhance functional outcome after CNS injury in humans.
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Affiliation(s)
- J R Madsen
- Department of Neurosurgery, Children's Hospital, Boston, Massachusetts, 02115, USA.
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Yao GL, Kato H, Khalil M, Kiryu S, Kiyama H. Selective upregulation of cytokine receptor subchain and their intracellular signalling molecules after peripheral nerve injury. Eur J Neurosci 1997; 9:1047-54. [PMID: 9182957 DOI: 10.1111/j.1460-9568.1997.tb01455.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous studies have suggested that growth factors and cytokines play an important role in the survival of injured neurons and in neurite elongation. Therefore, intracellular signalling pathways activated by growth factors and cytokine receptors play an important role in neuronal survival or for the re-establishment of connection. Since the JAK (janus kinase)-STAT (signal transducers and activators of transcription) signal transduction pathway is known to play a major role in cytokine receptor signalling, we first examined regulation of JAK gene expression following peripheral nerve injury by in situ hybridization histochemistry. The rat hypoglossal nerve was axotomized unilaterally and the mRNA levels for JAK1, JAK2. JAK3 and TYK2 were examined in the hypoglossal nucleus at postoperative times ranging from 1 to 35 days. Among the JAK family members, JAK2 and JAK3 were substantially increased in injured hypoglossal motoneurons, whereas no significant increases were observed for JAK1 and TYK2. These changes were further confirmed by immunohistochemistry using antibodies specific to JAK2 and JAK3. In addition, we examined the JAK2 and JAK3 associated cytokine receptor components, IL-2R gamma and gp130, which are common to various cytokine receptors. Among these, gp130 immunostaining was upregulated after nerve injury. This was also confirmed by in situ hybridization. These results suggest that the injured neuron prepares the molecular machinery involved in certain cytokine receptor signalling pathways at an early phase of the regenerative process, accelerating for the neuron to respond to cytokines that may regulate survival and/or neurite elongation.
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Affiliation(s)
- G L Yao
- Department of Anatomy, Asahikawa Medical College, Nishikagura, Japan
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Kiryu S, Yao GL, Morita N, Kato H, Kiyama H. Nerve injury enhances rat neuronal glutamate transporter expression: identification by differential display PCR. J Neurosci 1995; 15:7872-8. [PMID: 8613726 PMCID: PMC6577944] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
An increase in neuronal glutamate transporter expression after nerve injury was demonstrated by means of differential display PCR (DD-PCR) coupled with in situ hybridization. DD-PCR was carried out to compare differences in expression of mRNAs between axotomized and normal hypoglossal motoneurons in the rat. The expression of several gene fragments were found to be increased following nerve injury; the full length cDNA corresponding to one fragment was cloned by subsequent rat cDNA library screening. The close homology of glutamate transporters with our rat cDNA led us to conclude that this clone corresponds to the rat neuronal glutamate transporter (rat EAAC1). We speculate that the upregulation of this glutamate uptake system may increase the resistance of these cells against neurotoxic glutamate accumulation during the process of nerve regeneration.
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Affiliation(s)
- S Kiryu
- Department of Neuroanatomy, Osaka University Medical School, Japan
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Yao GL, Kiyama H. Dexamethasone enhances level of GAP-43 mRNA after nerve injury and facilitates re-projection of the hypoglossal nerve. Brain Res Mol Brain Res 1995; 32:308-12. [PMID: 7500842 DOI: 10.1016/0169-328x(95)00091-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Application of dexamethasone was found to induce an enhanced expression level of mRNA encoding the growth associated protein (GAP-43) after peripheral nerve injury. Following hypoglossal nerve axotomy, a dexamethasone releasing pellet (1.5 mg released in 3 weeks) was placed near the transected nerve. GAP-43 mRNA was detected in the hypoglossal nucleus by non-radioactive in situ hybridization histochemistry using an alkaline phosphatase-labeled oligonucleotide probe. A significant elevation of GAP-43 mRNA level was observed 2 weeks after the transection in dexamethasone treated animals. This induction was not observed in the dorsal motor nucleus of vagus which expresses moderately high levels of GAP-43 mRNA even without nerve injury. Although dexamethasone did not alter the maximum level of GAP-43 mRNA in the hypoglossal nucleus after nerve injury, it prolonged the period in which the mRNA expression remained elevated. This may be due to post-transcriptional effect by the glucocorticoid. Dexamethasone treatment also caused a slight facilitation of reprojection. This may be due to the enhancement of GAP-43 mRNA level by the glucocorticoid.
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Affiliation(s)
- G L Yao
- Department of Neuroanatomy, Osaka University Medical School, Japan
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Abstract
Injection of colchicine, a mitogen inhibitor, in the dorsal third ventricle induced the expression of the growth associated protein-43 (GAP-43) mRNA in some groups of cells of the adult rat brain. These mRNAs were detected by in situ hybridization histochemistry using an alkaline phosphatase labeled oligonucleotide probe. A substantial up-regulation of GAP-43 mRNA was noticed by the increase of both the number of positive cells and the intensity of the hybridization signal. These changes were observed in the hypothalamic nuclei located near the ventral third ventricle, namely the preoptic area, the supraoptic nucleus, the peri- and the paraventricular nuclei of the hypothalamus, the dorsal subnucleus of the ventromedial nucleus, the arcuate nucleus and the posterior part of the peri-mammillary region. Such abundant GAP-43 mRNA positive cells have not been observed in control adult rat hypothalamus. Since the positive cell number and shape initially suggested that these were neurons or astrocytes, double labeling in situ hybridization using both radioactive (for the detection of GFAP mRNA as a marker of astrocyte) and non-radioactive (for the detection of GAP-43 mRNA) probes was carried out. This demonstrated that these GAP-43 mRNA positive cells were not astrocytes. In addition enhanced GAP-43 mRNA expression was also found in some neuronal component, particularly in neurosecretory magnocells of the pareaventricular and the supraoptic nuclei. This up-regulation was further confirmed by the Northern blot analysis. About five fold increase in GAP-43 mRNA in the colchicine-treated hypothalamic tissue was shown.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G L Yao
- Department of Neuroanatomy, Osaka University Medical School, Japan
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Abstract
Our previous work demonstrated that neurotensin mRNA expression was transiently up-regulated during development in the hypoglossal motoneurone. The present study was carried out to examine how neurotensin mRNA expression changes during nerve regeneration. Following either unilateral resection or crushing of the hypoglossal nerve, mRNA expression was detected by non-radioactive in situ hybridization histochemistry using an alkaline phosphatase-labelled oligonucleotide probe. A reduction in neurotensin mRNA was observed on the operated side after the nerve injury. It took around 2 months for NT mRNA levels to return to normal. Similar down-regulation was observed following crushing, but recovery was more rapid than that observed with sectioning, probably due to the extent of nerve damage. This finding indicates that neurotensin transcription is up-regulated during development but, on the contrary, down-regulated during regeneration.
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Yao GL, Kiyama H, Tohyama M. Distribution of GAP-43 (B50/F1) mRNA in the adult rat brain by in situ hybridization using an alkaline phosphatase labeled probe. Brain Res Mol Brain Res 1993; 18:1-16. [PMID: 8479278 DOI: 10.1016/0169-328x(93)90168-o] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
GAP-43 (B-50,F1, pp46) is a calmodulin binding protein which is specific to the nervous system and also a substrate for the protein kinase C. Furthermore an enrichment of this protein in the growth cone and developmental brain indicate that this protein is related to nerve development, regeneration, and outgrowth. While its level dramatically decreases after the completion of synaptogenesis, the protein is still to some extent continuously expressed in certain regions of the mature brain. In order to clarify GAP-43 localization in mature normal rats, we investigated the distribution of GAP-43 mRNA in the rat central nervous system by using a non-radioisotopic in situ hybridization histochemistry. This method demonstrated GAP-43 mRNA expressing cells with high resolution. GAP-43 mRNA was more abundant in the forebrain than in the lower brainstem. Intense hybridization signal was observed in the mitral cells of olfactory bulb, cerebral cortex, CA3 region of hippocampus, diagonal band, substantia nigra, raphe nuclei, locus coeruleus, and dorsal motor nucleus of vagus. Weak to moderate hybridization signals were also widely expressed in thalamus, hypothalamus, and midbrain. Moreover, most noradrenergic, adrenergic, serotonergic, histaminergic, and caudal part of dopaminergic cells exhibited an intense GAP-43 mRNA signal. Thus, GAP-43 mRNA is abundantly expressed under normal conditions in the brain and may play an important physiological role particularly in the forebrain and in monoaminergic neurons supporting the findings that GAP-43 could be implicated in plasticity and monoamine release.
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Affiliation(s)
- G L Yao
- Department of Anatomy and Neuroscience, Osaka University Medical School, Japan
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Abstract
It is well known that cutaneous pain causes c-fos gene expression in the dorsal horn neurons. The present study examined whether or not an itching sensation had the same effect on these neurons. In order to produce an itching sensation, cotton balls soaked in histamine solutions of different concentrations were applied to the lower limbs of rats and then the treated area was scratched with the tip of a pair of forceps. After 2 h, the number of neurons showing Fos-like immunoreactivity was significantly increased in a dose-dependent manner in the ipsilateral dorsal horn when compared to saline-treated and scratched controls. When scratching with the forceps was omitted, the number of these neurons was reduced to one-third, but was still significantly higher than in controls treated only with saline. Expression of Fos-like immunoreactivity in these animals was markedly reduced by morphine pretreatment (10 mg/kg, i.p.), suggesting that the transmission of both itch and pain is blocked by morphine.
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Affiliation(s)
- G L Yao
- Department of Anatomy, Osaka University Medical School, Japan
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